Tuesday, July 30, 2019

UK HealthCare again named best Ky. hospital in U.S. News & World Report rankings; Baptist Health has three of six on list

By Melissa Patrick
Kentucky Health News

Six Kentucky hospitals have been named among the nation's "Best Regional Hospitals" in the annual rankings by U.S. News & World Report magazine.

They are, in order: the University of Kentucky hospital, St. Elizabeth Healthcare Edgewood-Covington Hospitals, and in a tie for third, Baptist Health LexingtonBaptist Health Louisville, Norton Hospital in Louisville and Baptist Health Paducah.

To make the list, a hospital must offer a full range of services and either be ranked nationally in one of the 12 measured specialties or have three or more high-performance specialty rankings or three or more high performance procedures and conditions rankings.

UK HealthCare, for the fourth consecutive year, claimed the No. 1 ranking with its Albert B. Chandler Hospital. The hospital also ranked in the top 50 hospitals nationally for cancer for the third year in a row, moving to its highest ranking yet in this category, 33rd. The hospital's Markey Cancer Center is the state's only National Cancer Institute center, one of 71 in the nation.

"The criteria for a hospital to be listed in the top 50 for cancer care is rigorous and competitive," Dr. Mark Evers, director of the center, said in a news release. "This ranking, along with our status as an NCI-designated cancer center, is evidence of how we are making an impact in cancer care across Kentucky and beyond."

Among specialties, UK ranked as high performing in geriatrics, nephrology (kidneys) and orthopedics.

The rankings, now in their 30th year, compared more than 4,500 medical centers across the country in 25 specialties, procedures and conditions. Kentucky has more than 120 hospitals.

Baptist Health had three of the state's top six hospitals, with Baptist Health Paducah gaining its first ever rank in the Best Hospitals survey, according to a Baptist Health news release.

“Our physicians, nurses and staff are centered on providing high quality patient care every day,” Gerard Colman, Baptist Health CEO, said in the release. “U.S. News & World Report rankings underscore that excellence, and confirm that we’re living out our mission of leading in clinical excellence, compassionate care and growth to meet the healthcare needs of our communities.”

The report also recognizes hospitals that are "high performing" for nine common adult procedures and conditions, including repair of abdominal aortic aneurysms, aortic valve surgery, chronic obstructive pulmonary disease, colon cancer surgery, heart bypass surgery, heart failure, hip replacement, knee replacement and lung cancer surgery.

UK Healthcare ranked high performing in all of the categories except abdominal aortic aneurysm repair, for which it received an average rating.

St. Elizabeth Healthcare ranked high-performing in one specialty, urology, and all but one of the procedures and conditions; it received an average rating for heart bypass surgery.

Baptist Health Lexington ranked high-performing for all the procedures and conditions except aortic valve surgery and knee replacement, for which it was rated average.

Baptist Health Louisville ranked high-performing for all the procedures and conditions except hip replacement and lung cancer surgery, for which it got an average rating.

Norton Hospital ranked high-performing for five of the procedures and conditions (COPD, colon cancer surgery, heart failure, hip replacement and knee replacement). It got an average rating on the other four.

Baptist Health Paducah ranked high-performing for aortic valve surgery, COPD and heart failure and was rated average rating on the other six.

Louisville's Jewish Hospital, which included evaluations of Sts. Mary and Elizabeth Hospital, dropped off of this year's U.S. News & World Report Best Regional Hospital list, having only ranked high-performing in two of the procedures and conditions categories, including COPD and heart failure. It received average marks for the rest.

Jewish Hospital recently put its heart transplant program on hold, and the future of the hospital remains uncertain since the University of Louisville announced in June that it would not purchase it.

The report offers an overview of 123 Kentucky hospitals with a breakdown of each of the measured categories, as relevant to the services the hospital provides. Click here for more information on how the magazine ranks the hospitals, including details on this year's methodology changes.

Nationally, the Mayo Clinic in Rochester, Minn. claimed the No. 1 spot again on the Best Hospitals Honor Roll. Massachusetts General Hospital ranked No. 2, followed by Johns Hopkins Hospital in Baltimore at No. 3, according to the magazine's news release.

Sunday, July 28, 2019

Health departments and their employees making tough choices now that the General Assembly has passed Bevin's pension bill

Bevin at bill signing (Lexington Herald-Leader photo by Alex Slitz)
Kentucky's health departments and their employees face some difficult decisions in the wake of the pension legislation passed in the recent special session of the General Assembly.

The law written and signed by Gov. Matt Bevin freezes the pension costs of health departments for another year, at 49 percent of payroll, avoiding an increase to 83 percent, which would have forced layoffs and program cuts, and could have put some of them out of business.

But now the health departments must choose whether to stay in the Kentucky Retirement System "at full cost, leave the retirement system by paying a lump sum equal to future projected benefits payments, or buy their way out in installment payments over 30 years," writes David Zoeller of The Paducah Sun.

Marshall County (Wikipedia map)
Zoeller notes that the Marshall County Health Department "has already been making tough decisions," such as ending its school-nurse program and cutting its staff by almost 30 percent.

John Cheves of the Lexington Herald-Leader notes, "Public employers that quit KRS will be encouraged through financial incentives to freeze their employees’ pensions so they accrue no further benefits. Instead of a pension, employees will be transferred into a riskier defined-contribution retirement plan, such as a 401(k), with a balance that rises and falls with the stock market, and that retirees can outlive if their money runs dry. . . . Some could lose hundreds of thousands of dollars in anticipated retirement benefits if their pensions are frozen."

Cheves's object example is the Garrard County Health Department, which has seven employees, some of whom are less than 10 years from retirement. "Under the state pension formula, the final decade on the job is crucial to maximizing their monthly retirement checks," he notes, and gives a specific example:

"Cathy Stapleton, a nurse at the health department, is 55 with plans to retire at 62. She doesn’t want her pension to be frozen and replaced with a 401(k) account that would have seven years — not the usual 30 to 40 — to build wealth through compound interest. One ill-timed market crash could sink her." She told Cheves, "It means a lot when you come into a pension. It means you have a retirement where you can count on having that income every month." Getting a new 401(k) plan at age 55 "would be a lot different."

Garrard County (Wikipedia map)
Department Director J Smith told Cheves he will recommend to the Garrard County Board of Health that it stick with KRS and pay the 83 percent. "Telling middle-aged people who devoted their lives to public service that they’re suddenly going to risk financial insecurity in their senior years is not a viable choice, he said," Cheves reports, quoting him directly: “We’re not going to opt out. If we opt out, to me, we’re screwing our employees here. Some of my people have got just a few years left. We expect to get what we were promised. We were promised a pension.”

The department has already eliminated family-planning services, cut health education, "laid off its emergency-preparedness coordinator and a front-desk clerk, and officially eliminated a third position, Smith’s old job, which he still does in addition to being director," Cheves reports. "That means he splits his time between inspecting schools, businesses, septic tanks and the like for safety and cleanliness, and managing the department."

“I’ll admit, our response time is slower now because of it,” Smith told Cheves. “When people used to call in for a site evaluation, we usually could get out there the same day. Now it might take us a week. It’s just — I’m sorry, we don’t have the people we used to. . . . I told our Board of Health that if we want to keep the services we have left, we’re going to have to have a tax increase.”

Kentucky River District Health Department
service area: Wolfe, Lee, Owsley, Leslie,
Perry, Knott and Letcher counties (KRDHD map)
Using local tax dollars to fund public health would result in huge inequities, said Scott Lockard, director of the Kentucky River District Health Department, which covers some of the state's poorest and unhealthiest counties. "Communities that need public-health services the most, that have the highest poverty rate, that have the poorest health outcomes, also have the least ability to raise local revenue," Lockard told Kentucky Health News in June.

Scores of reported cases of Rocky Mountain spotted fever in Lincoln Trail area; awaiting state health department confirmation

Kentucky Health News

Rocky Mountain spotted fever, the main tick-borne disease in Kentucky, has affected scores of people in the area served by the Elizabethtown-based Lincoln Trail District Health Department.

The six-county department "has investigated a total 79 cases of Rocky Mountain spotted fever for June in the district, which comprises Har­din, Meade, LaRue, Nel­son, Washington and Mar­ion counties," Mary Alford reports for The News-Enterprise in Elizabethtown.

In Grayson County, which is in the Lincoln Trail Area Development District but has a separate health department, 26 cases were reported from July 7 to 17. All the numbers are subject to confirmation by the Kentucky Department for Public Health. In a typical year, the entire state has 10 to 30 cases, Grayson Brown, director of the University of Kentucky Public Health Entomology Laboratory, told Kentucky Health News as the summer tick season began.

Dog ticks (middle) are the usual carriers of Rocky Mountain spotted fever.
"Reports of tick-borne illnesses that make it to the health department stem from people with a known tick bite who go to the doctor, exhibiting symptoms such as fever, rash, headaches, muscle aches and tiredness, and are tested for Rocky Mountain spotted fever, Lyme disease and other ailments,"Alford reports. The district health department has also found a few cases of tick-borne Lyme disease.

How can you protect yourself from these diseases, which can be debilitating and in rare cases fatal? Use insect repellents, shower soon after being outdoors, and check for ticks daily, especially in hard-to-see places, Rebecca Morris writes for The Record in Grayson County, citing material from the federal Centers for Disease Control and Prevention web page about ticks.

CDC recommends "a full body check upon return from potentially tick-infested areas," Alford writes. "Ticks most commonly attach around the ears, inside the belly button, behind the knees, between the legs, around the waist and especially in and around the hair. To remove a tick, people should use tweezers to grab the tick close to the skin and gently pull on the arachnid with steady pressure, and wash hands and the bite site with soap and water after the tick is removed. Also, apply an antiseptic to the bite."

Other tips, from UK's Brown:
  • Check your pets.
  • Keep grass and shrubs trimmed, and clear overgrown vegetation in your yard.
  • Don't walk through uncut fields, brush and overgrown areas.
  • Walk in the center of hiking trails.
  • Wear light-colored clothes, which make it easier to spot ticks.
  • Wear long pants tucked into boots or socks, and tuck your shirt into your pants.
  • Place a band of duct tape, sticky side out, around your lower legs to trap ticks.
  • Use tick repellent that has DEET or picaridin, or use permethrin-based clothing sprays.
Rocky Mountain spotted fever "can take three to 12 days to incubate," Morris notes. "Initial symptoms appear in one to four days, and include a high fever, severe headache, swelling around the eyes and on the backs of the hands, nausea and vomiting." The spotted rash usually appears two to five days after initial symptoms, but 10 percent of victims never develop a rash.

"After five days without medical treatment, patients can have altered mental states, lapse into a coma, develop respiratory problems or even have organ failure," Morris writes, citing the CDC. The disease "can lead to death if patients aren't treated early."

Friday, July 26, 2019

Deepest study yet finds 64% of Kentuckians who'd be affected by Bevin's proposed Medicaid work rules are meeting them already

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin says "hundreds of thousands" of able-bodied adult Kentuckians on Medicaid should be working but choose not to. But when his new Medicaid "community engagement" rules were set to kick in last July, only about 48,000 people on the program would have been short of meeting the requirements, according to a study of Medicaid records and a random-sample survey of people on the program.

Bevin made his assertion at a July 12 Kentucky Chamber of Commerce meeting in Louisville while promoting his new Medicaid plan, which, among other things, requires "able-bodied" adults on Medicaid who are not primary caretakers to work, attend school, take job training, search for a job or volunteer 80 hours a month, if they don't qualify for an exemption or are in drug treatment.

The plan, called Kentucky HEALTH, for Helping to Engage and Achieve Long Term Health, was set to start July 1, 2018. Two days before that, and again on April 1, it was blocked by U.S. District Judge James Boasberg of Washington, D.C. He ruled that federal officials failed to show how the requirements would serve the objective of the 1965 Medicaid Act, to provide people with medical coverage. He also struck down a similar plan in Arkansas. The administration of President Donald Trump has appealed the ruling.

The study was done by health researchers at the University of Pennsylvania, whom the state and the Centers for Medicare & Medicaid Services hired to evaluate Kentucky HEALTH if it takes effect. Kristi Putnam, deputy secretary of the state Cabinet for Health and Family Services, said the study was not commissioned by the cabinet, but was done under an agreement in the contract that allows the university to conduct its own research. The study was published in the Journal of the American Medical Association, meaning it underwent review by other experts before publication.

Putnam said the report does not refute the governor's assertion that there are hundreds of thousands of people on Medicaid that should be going to work, but choose not to.

"I would disagree with that on a universal basis," she said. "I think you have to consider the whole picture of those who are not employed in Kentucky, and not just the ones who are not meeting [the requirements for] benefits programs that are at this point theoretical programs. I think you have to take it as a whole."

She added, "We still believe that there are those hundreds of thousands of people," but the way the study represents those individuals "is a little bit difficult to see."

The study findings

The researchers found that when the program was first set to roll out 13 months ago, 330,075 of the nearly 1.4 million Kentuckians on Medicaid would have been required to participate in Kentucky HEALTH in some way: work or other community engagement; reporting of engagement activities; paying income-based premiums; and earning credits to get free dental and vision care.

Of this group, 132,790, or nearly 40 percent, would have been required to meet the community engagement requirements (the only part of the program that the study evaluated). Most of the 132,790 people were already in compliance; 25,422 were excluded because they were medically frail, 57,981 were already working the required 80 hours a month; 727 were volunteering that much; and 235 were doing a sufficient combination of work and volunteering.

That left 48,427 people who were not meeting the proposed community-engagement requirements. That is 36% of those who would have to meet those requirements, 15% of those who would have to meet any of the other new requirements, and 3.5% of the state's total Medicaid population.

Chart shows how estimates were made. Data with blue backgrounds are population counts from claims data; in tan backgrounds are estimates from a survey of 9,396 Medicaid beneficiaries.
The study excluded 101,502 Medicaid beneficiaries who are on the Supplemental Nutrition Assistance Program (formerly known as food stamps) or the Temporary Assistance for Needy Families program, formerly Aid to Families with Dependent Children, or "welfare."

Putnam, the deputy health secretary, said they should be included in the workforce numbers as not working because many are unemployed, under-employed, are medically frail for only a limited amount of time, or could be participating in the job market "at a higher level" than they are now.

"I recognize that the governor's statement was not [about] underemployment, but that is part of the group that we are trying to help through this," she said.

She said the number the cabinet typically uses to represent how many able-bodied individuals on Medicaid could be working is between 150,000 and 200,000, a number that she said varies because tens of thousands of people move in and out of the program each month.

When Bevin used the phrase "hundreds of thousands," his office told Kentucky Health News that the figure came from the Census Bureau's 2017 American Community Survey, a poll that estimated 443,723 Kentuckians "do not have a disability and are not in the labor force."

Dustin Pugel, a policy analyst at the liberal-leaning Kentucky Center for Economic Policy, pointed out that only 136,400 of the 443,723 people Bevin's office cited were eligible for Medicaid, had insurance, were not disabled and were not in the labor force. ""It becomes pretty clear that we are not talking about 443,000 sitting on their couches," he said.

He said the census poll shows that of the 136,400 Medicaid-eligibles who are not in the workforce, 57,800 had related children in their home; 24,600 were enrolled in school; 6,100 received retirement income; 19,000 received Medicare, which means they did not self-attest to a disability, but had a health condition that qualified them for Medicare coverage as a non-senior. He noted that the numbers are estimates rounded to the nearest hundred and have large error margins.

"The point is that there are far fewer than 443,000 Kentuckians covered by Medicaid who are not working, and of those who are covered by Medicaid but outside the labor force, many have good reason to be," he said. "To assume that all of them could or should turn around and 'go get a job' is wrong headed."

The study surveyed a random sample of 9,936 people who would be subject to the new requirements. That produced estimates of the well-being of the 48,427 who were not meeting the community-engagement requirements: 27% reported fair or poor physical health; 25% reported fair or poor mental health; 33% reported that a health condition limited their activities in the previous 30 days;  60% needed medical care in the last six months; 27% went to a hospital emergency department in the last six months; and 17.5% were working, but less than 80 hours a month.

Pugel and Jason Dunn, policy analyst with Kentucky Voices of Health, said the study confirms what other studies have found, but is stronger because it used the survey and Medicaid claims during 2018.

"These studies all seem to come up with the same results," Dunn said. "People are either already working . . .  and then the rest are providing care-taking for an ill or disabled relative or a child, or they are in school full time. There are just very few that meet that narrow population of not doing something, and we don't know why."

Pugel said, "We don't know what those folks situations are, we only know that they are not currently meeting the requirement as it is written."

Bevin and other advocates of the requirements have argued that free medical care discourages people from seeking work because they might lose their eligibility.

Dunn said the study "shows that the work reporting requirement is simply not necessary. That's the main point that we've been trying to get across, that requiring this level of activity for the sake of eligibility is not necessary. . . . It is ultimately going to harm people in the long run by denying them access to care."

The study also found that between 10% and 20% of those subject to the new rules may need to report hours through other means, like phone or mail, since they did not have access to the internet.

It found that the proportion of Medicaid enrollees that were required to meet the community engagement reporting requirement didn't vary by geographic area, despite large differences in economic opportunities across the Kentucky workforce areas.

The Green River region in Western Kentucky, which includes Owensboro, and Kentuckiana Works, which includes Louisville, stood out in the 10 local workforce areas because about 20% of those who would be required to report community engagement hours did not meet the proposed requirements. The rest of the state ranged from 12.6% to 15.6% for this measure.

UK gets $11 million grant to decrease cervical cancer in Eastern Ky. with focus on risks: smoking, HPV and low rates of screening

The University of Kentucky has been awarded a five year, $11 million grant to work toward reducing the rates of cervical cancer in Eastern Kentucky, a region that has some of the highest rates of incidence and deaths from it in the nation.

The research will address three of the risk factors that contribute to these high rates -- smoking, the human papillomavirus (HPV) and low rates of cervical-cancer screenings among women in the region, according to the news release.

The first project in the program will work to reduce smoking among women in rural communities through various interventions, including strategies to help women who are not quite ready to quit, the lead investigator of this project told Alex Acquisto of the Lexington Herald-Leader.

"Instead of ignoring the smokers who are not ready to quit today, we're going to work with them anyway," said Jessica Burris, an assistant professor of psychology and a member of UK's Markey Cancer Prevention Control Program.

Eastern Kentucky has some of the highest rates of smoking in the nation, which contributes to its likewise high rates of cervical cancer. Smoking not only causes cancer almost anywhere in the body, it can also block your body from fighting it once you have it, says the federal Centers for Disease Control and Prevention. And women who smoke are about twice as likely as non-smokers to get cervical cancer, according to the American Cancer Society.

Mark Dignan, professor in the UK College of Medicine and co-leader of the Markey Cancer Prevention and Control Program, will lead two projects that focus on the human papillomavirus, or HPV, which the CDC attributes to 90 percent of all cervical cancers.

"We really shouldn't have cervical cancer," Dignan told Acquisto. "We know what causes it, we can detect it, and we can treat it." It is the only cancer for which there is a vaccine, but Kentucky's children are among the least vaccinated for HPV, one of the most common sexually transmitted diseases.

The grant will fund a project to improve HPV vaccination rates among people between 11 and 26. The other will mail HPV self-testing kits to women in the region who are not being screened for cervical cancer or are "underscreened."

In addition to cervical cancer, HPV can also cause cancers in the vagina, vulva, penis, anus, rectum and the back of the tongue and throat. Among these cancers caused by HPV, more than 90% could be prevented by the vaccine, according to the CDC.

Burris and Dignan told Acquisto that they expect around 70,000 Kentuckians to be impacted by their project, which is scheduled to start in a couple of months.

The project is funded by the National Cancer Institute and involves a collaboration by the Markey center with Ohio State University, the University of Virginia and West Virginia University. It will involve 10 health systems in Appalachia, including two in Kentucky: Big Sandy Health Care, which operates seven clinics in Eastern Kentucky, and Juniper Health, which has locations in Wolfe, Lee, Breathitt and Morgan counties.

Thursday, July 25, 2019

Skin-cancer rates have spiked 800% among young women; experts advise limiting exposure to sun and tanning beds

New research shows that skin-cancer rates have surged among young women, likely because they use tanning beds, but health experts warn that exposure to the sun's harmful ultraviolet (UV) rays puts us all at risk, so it's important to always take precautions when out in the sun.

The research, presented at the summer meeting of the American Academy of Dermatology, found that between 1970 and 2009, rates of melanoma, the deadliest form of skin cancer, increased 800 percent among women 18 to 39, an AAD news release said.

During a similar time frame, the researchers also found that basal-cell and squamous-cell carcinoma rates also increased, 145% and 263%, respectively.

“Because there’s a delay between UV exposure and when skin cancer appears, most women don’t think it will happen to them,” Dr. M. Laurin Council, a dermatologist and associate professor at Washington University in St. Louis, said in the release. “This data reveals the disproportionate rise in the number of skin cancers in women and the need for further education regarding UV exposure.”

Indoor tanning by Caucasian girls and young women "is of particular focus," says the release, because it is estimated that indoor tanning may cause more than 400,000 cases of skin cancer in the U.S. each year.

"One indoor tanning session can increase a user's lifetime risk of developing melanoma by 20%, squamous cell carcinoma by 67% and basal-cell carcinoma by 29% . . . and this risk increases with each use," says the release.

Council says limiting exposure to UV rays from the sun or other sources like tanning beds is the best way to decrease your risk for skin cancer. She adds that it is especially important to avoid sun exposure between the hours of 10 a.m. and 2 p.m. because that's when the sun's rays are the strongest.

The Centers for Disease Control and Prevention adds that the sun's UV rays can damage your skin in as little as 15 minutes and notes that a tan does not indicate good health, but instead is the skin's response to injury, because skin cells signal that they have been hurt by UV rays by producing more pigment called melanin.

"Every time you tan, you increase your risk of getting skin cancer," says the CDC.

Other suggestions to protect yourself from the sun include wearing protective clothing including lightweight, long-sleeved shirts and pants, a wide-brimmed hat and sunglasses when out in the sun, as well as using a broad-spectrum, water-resistant sunscreen with an SPF of 15 or higher (Council says the SPF should be 30), and apply every two hours, as well as after swimming or sweating

Council also calls on parents to teach their children about the dangers of sun exposure and tanning beds, and their relationship to skin cancer.

In Kentucky , melanoma of the skin, or skin cancer, is one of the top 10 cancers by rates of new cases, at 28.7 cases per 100,000 people.

Tuesday, July 23, 2019

Republican legislators propose taxing electronic cigarettes, as a health measure and a revenue measure; died in Senate in 2018

By Al Cross
Kentucky Health News

Kentucky would tax electronic cigarettes just like other tobacco products for the first time, under a proposal endorsed by three leading Republican legislators and the state health commissioner Tuesday.

Taxing e-cigarettes would discourage their use, especially among children -- whose increased use experts call an epidemic -- and pregnant women, as well as raise needed revenue for the state, advocates of the legislation said.

Foundation for a Healthy Kentucky President Ben Chandler thanks Rep. Jerry
Miller as Rep. Kim Moser and Health Commissioner Dr. Jeff Howard look on.
"This is the classic win-win scenario," Rep. Jerry T. Miller, a Louisville Republican and State Government Committee chair, said at a Frankfort news conference.

An e-cigarette tax was included in a bill that raised the tax on traditional cigarettes last year, but was removed in the Senate, just before final passage and after lobbying by Altria Group, the largest tobacco company and 35 percent owner of Juul Labs, the largest e-cig company.

Senate leaders declined to explain the move then, and Senate President Robert Stivers said Tuesday he couldn't recall what happened. Sen. Chris McDaniel, chair of the Senate Appropriations and Revenue Committee, said he wasn't sure what happened, but thought that a staff member may have raised "a definitional problem" that couldn't be resolved at the last minute.

In this year's 30-day session, Miller unsuccessfully sponsored an e-cigarette tax bill that would have dedicated the estimated revenue of $35 million a year to Kentucky's unfunded pension liability. He said this one does not, on the advice of House Speaker David Osborne, who said the lack of earmarking would get the bill more support.

"We've got a lot of support for this bill," said Ben Chandler, president of the Foundation for a Healthy Kentucky, adding that it would be "one of our priority focuses" in the 60-day session that begins Jan. 7. "It has the potential to go a long way toward cutting youth e-cigarettes use in this state. . . . We will keep a whole lot of young people from getting addicted."

Dr. Jeffrey Howard, the state health commissioner, said the bill "really has the opportunity to make a true impact on health," by discouraging e-cig use by young people, whose brains don't fully develop until they are 25. "It's incumbent on us to make sure they're aware of what these electronic cigarettes can do," he said.

A survey last year showed that 27 percent of Kentucky high-school seniors reported using the devices, up from 12 percent in 2016. Bonnie Hackbarth, the foundation's vice president for communications, quoting Kentucky Youth Advocates, said 18 percent of pregnant women in Kentucky use e-cigarettes.

Chandler said students, teachers and parents "don't know that they're bad for you. . . . "These products are not safe. They are unsafe."

"This is a time when adult habits are developing," said Rep. Kim Moser, R-Taylor Mill, chair of the House Health and Family Services Committee, and Miller's co-sponsor. "This is really a critical time to stop the use."

Miller said the Senate sponsor of the bill will be Louisville Republican Julie Raque Adams of Louisville, chair of the chamber's majority caucus.

The bill would raise the excise tax on tobacco products other than cigarettes to 27.5 percent from the current 15 percent, making the same percentage increase that was applied to the cigarette tax, Miller said.

The resulting price increase would discourage teenagers from using e-cigarettes, said Yulie Spade, 18, a recent graduate of Louisville's Mercy Academy. A classmate, Jenna Ebel, said, "It's causing an epidemic of nicotine-addicted teens."

Miller acknowledged opposition from e-cigarette dealers, who argue that teens can order the products online. He said he thought his bill "will hit most of the youth." 

Howard noted that Kentucky's recent declines in traditional cigarette use have not been as large as those of most other states, and he worries that today's youth e-cig users will become tomorrow's cigarette smokers, reversing recent progress and incurring greater health costs, much of which would be paid by taxpayers through the Medicaid program. "There's certainly a return on investment," he said.

Asked if his presence at the news conference indicated that Gov. Matt Bevin's administration supports the bill, Howard said "I vetted this through our secretary" of the Cabinet for Health and Family Services, Adam Meier, whose previous job was Bevin's deputy chief of staff.

Monday, July 22, 2019

3 children die, 33 are injured per day in accidents on U.S. farms; prevention workshop to be held in Lexington Aug. 6-7

The National Children's Center for Rural and Agricultural Health and Safety will host a workshop will be held in Lexington Aug. 6-7 on preventing injuries of children on farms and ranches.

The workshop website says, "Learn how you can help safeguard children and youth who live, work and play on farms and ranches. This information can be used to develop and enhance childhood agricultural safety strategies for your organization. Interactive sessions will be facilitated by safety experts and leaders in the field of childhood agricultural injury prevention."

Registration is limited to 60 participants. Registration is $249. Click here for more information or to register.  Another workshop will be held in Hershey, Pa., Sept. 17-18.

Joan Mazur of the University of Kentucky, who is helping with the Lexington workshop, attended an earlier one in Iowa, and The Rural Blog asked her to write about it and her work. Here's her report:

By Joan Mazur
     I have been at the University of Kentucky College of Education since 1993 and have been associated with the Southeast Center for Agricultural Health & Injury Prevention with continual federal funding since 1994. The interdisciplinary nature of this center, housed at the UK College of Public Health, as well as its focus on solving real-world issues on family farms, has supported my research interests at the intersection of public education and public health. My husband and I also own a 70-acre farm in Washington County, Kentucky, so my interests in farm safety and health are also personal.
     Over the years I have developed with colleagues many educational programs, most of which involve technology and are targeted at a high at-risk group of teenagers from 14 to 19. Narrative simulations, digital games and other online interventions for preventing injuries and fatalities have been used at schools in farming and rural communities in the Southeast.
     While many of our more horrifying statistics on youth injury and fatality and injury in agriculture are decreasing, one segment of the at-risk younger population has resisted efforts. Every day on farms in the U.S., three children die and 33 are injured. These injuries and fatalities are preventable, and there are guidelines and best practices to assure that children can take advantage of the many benefits of living or working on family farms in safe and healthy ways.
     Recently I attended a Childhood Agricultural Injury Prevention (CAIP) Workshop in Iowa hosted by the National Children’s Center for Agricultural Safety & Health, whose national mission is to prevent agricultural injuries and fatalities to children. Many of us in all fields over the years have attended workshops, even entire conferences that disappointed despite a promise of improved professional learning. However the CAIP Workshop was excellent!
     Every session was highly informative -- delivered to the entire group, with many interactive small-group components to practice and absorb the various techniques and approaches to engaging stakeholders in preventing injuries to children, whether working or non-working, on farms or even in specialized settings such as agritourism sites (orchards, farms, petting zoos etc).
     We have now scheduled a CAIP for Lexington Aug. 5-7. I hope some of you can consider going, as journalists, teachers, counselors and other educators or others such as insurance personnel, FFA, bankers or other community member in positions to influence individual families and policy makers in decision making that can promote the economic, social, educational and personal mental and physical health of rural farm families and children.
     This KY-CAIP workshop is also a partnership between the National Childrens Center for Ag Safety & Health, the North Carolina Agromedicine Institute and the Florida Coastal Center for Agricultural Safety & Health, which will be providing expertise for regional agricultural safety and health issues.

Sunday, July 21, 2019

Health experts say not to 'vape' around children, because the secondhand aerosol (it isn't vapor) from e-cigs isn't safe for them


Evolving research shows that electronic cigarettes' secondhand aerosol (it's not vapor, despite what the industry says) is not without health risk, and experts warn users to not "vape" around children, Michael O. Schroeder reports for U.S. News & World Report.

"People don't, I think, always realize that the secondhand smoke emissions from vaping or e-cigarette use can be harmful," Dr. S. Christy Sadreameli, a pediatric pulmonologist at Johns Hopkins Hospital in Baltimore, and a volunteer spokesperson for the American Lung Association, told Schroeder.

And while she recognized that the debate continues about how the risks of e-cigarettes stack up against traditional cigarettes, Sadreameli added, "We don't think they're harm-free, and we don't think the secondhand emissions are safe for children."

In addition to nicotine, aerosol from e-cigarettes contain ultrafine particles that can be inhaled deep into the lungs; flavorings, like diacetyl, a chemical linked to serious, irreversible lung disease; volatile organic compounds that are known to be carcinogenic; other cancer causing chemicals; and heavy metals, including nickel, tin and lead, according to the Centers for Disease Control and Prevention.

The experts specifically pointed to the dangers of secondhand exposure to nicotine in children, explaining how the drug can harm kids' brain development by altering the reward pathways that navigate positive reinforcement. That makes a child more vulnerable, or at increased risk, for becoming addicted to products that contain nicotine and other drugs.

"Exposure to any nicotine or tobacco product is dangerous for infants and children," Dr. Jonathan Winickoff, the director of pediatric research at the Tobacco Research and Treatment Center at Massachusetts General Hospital, told Schroeder. "The developing brain is exquisitely sensitive to nicotine."

Schroeder also pointed to a study published in the medical journal Chest in January that found teens with asthma who were exposed to secondhand aerosol, and had not used e-cigarettes, were more likely to have an asthma attack.

"While experts emphasize more study is needed to understand the effects of vaping aerosol, they also reiterate there's enough potential for harm that parents should never vape around kids – or in spaces like the home or car, where they'll be," he writes.

A study published in the medical journal Pediatrics in April, found that while some parents continue to smoke traditional cigarettes around their children, many more reported that they vape around them -- "findings [that] seem to underscore an errant perception of e-cigarettes as safe," Schroeder reports.

"We saw three-fold higher rates of parents using electronic cigarettes inside their homes than smoking," Winickoff, the senior author of the study, told Schroeder.

"Of the parents interviewed who were dual users, nearly 64% had a smoke-free home policy, compared with only 26%, who had a vape-free home policy," he writes. "In addition, dual users and e-cigarette-only users together were more likely to have a smoke-free car policy, than a vape-free car policy. Still, only 35% had a smoke-free car policy and just 22% had a vape-free car policy."

Schroeder also reports on the dangers of "thirdhand" exposure to nicotine and all of the aforementioned substances, which settle on surfaces from the aerosol -- just like they do from traditional cigarette smoke.

The experts stressed, "To protect children from secondhand and thirdhand exposure, parents should adopt strictly enforced policies that prohibit e-cigarette use at all times in homes and cars."

Saturday, July 20, 2019

Michael Rust retires as head of Kentucky Hospital Association; Nancy Galvagni was appointed new president and CEO in May

By Melissa Patrick
Kentucky Health News

Michael T. Rust, who led the Kentucky Hospital Association for 24 years, has retired.

Rust said it was a privilege to have worked for the KHA for 24 years, and attributed the bulk of his success to his communication and listening skills.

Michael T. Rust
"You can be the smartest person in the world, but you've got to stay in touch with these guys, the administrators and the hospitals, and you've got to listen to them," he said. "And that I think was the biggest part of my career, that I really listened to these guys. I may not have had the answer all of the time, but at least I listened and got back to them and communicated with them pretty well."

Rust added that one of his greatest accomplishments was that he was able to recruit and maintain 100 percent of the state's 127 hospitals as members of the association, which he said is quite rare among hospital associations.

Rust said he came to Kentucky by way of Florida, where he had been the senior vice president of the Florida Hospital Association. He worked there for 13 years. Prior to that he served as an administrator of a small rural hospital and the vice-president of operations for a 300-bed hospital, both in West Virginia.

He was also a member of the American College of Health Care Executives and became a fellow of that organization in 1998. In 2001, he was elected to the Council of Regents, the legislative body of the American College of Health Executives.

Asked about challenges facing Kentucky hospitals, Rust said the state's shift from a fee-for-service payment system to a "value-based" system in Medicaid remains a big challenge, largely because 70 percent of Kentucky's patients are covered by a government payor whose payments to hospitals don't cover the full cost to treat patients.

He said the state also struggles with healthcare workforce shortages, but “The hospitals of Kentucky are resilient and staffed with outstanding leadership and the highest quality providers. I have the utmost faith that they will face all these challenges head on and continue to succeed at providing outstanding health care for every citizen of the commonwealth.”

Nancy Galvagni
Nancy Galvagni was appointed KHA's new president and chief executive officer in May. “I am pleased to pass the baton to Nancy Galvagni as I know she will serve the association and its members with distinction," Rust said.

Galvagni joined KHA since 1979 and was senior vice president for the past 20 years, She has served as the executive director of the Kentucky Institute for Patient Safety and Quality, a federally certified patient safety organization and a subsidiary of KHA.

Galvagni is a graduate of Pennsylvania State University, is a past president of the Kentucky Society for Health Care Planning and Marketing and is a member of the American Association of Hospital Accounts. Prior to joining KHA, she worked at the New York Hospital Association.

KHA represents hospitals, related health-care organizations and integrated health-care systems. It is celebrating its 90th year. Galvagni is only the fourth chief executive officer in its history.

Friday, July 19, 2019

Opinion: Politicians are playing with fire when they erode support for mandatory childhood vaccinations

OPINION
By F. Douglas Scutchfield and Al Cross


Public health is the nexus of science and politics. Unfortunately, the two frequently do not mix well. A recent example involving childhood immunizations prompts real concern for the erosion of science in the name of politics.

State Sen. Ralph Alvarado, physician and lieutenant governor candidate with Gov. Matt Bevin, recently declared: “I think it’s good health policy to administer vaccines, but if people don’t want them, we shouldn’t force people to take them.” This followed the governor’s ill-advised exposure of his own children to kids with chicken pox, a practice discouraged by both public health and physician organizations.

These politicians are playing with fire. The U.S. is currently experiencing the worst measles epidemic since 1992, and nearly 80 percent of this year’s cases occurred in outbreaks in unvaccinated, close-knit communities, such as the Amish.

Many people oppose vaccination for measles, despite recommendations of the World Health Organization, the Centers for Disease Control and Prevention, and major physician and health organizations. Some of this opposition is the result of a fear of autism associated with vaccination, driven by a British physician whose paper on the topic has been retracted as fraudulent by editors of the leading British medical journal, and who has lost his medical license as the result of his claims.

Some people mistakenly think that vaccines contain mercury, but that has not been true for decades. Studies by the CDC, the National Academy of Medicine and the National Institutes of Health have demonstrated, repeatedly, the lack of any linkage between vaccines and autism.

Measles is not an innocuous disease. It can cause encephalitis, pneumonia and even death.

Immunizations protect us in two ways. They keep you from acquiring the disease, and with enough people immunized, a virus cannot spread, giving a population “herd immunity.”

One of the most effective ways to assure freedom from measles is to assure that all susceptible people are vaccinated. The major way of doing that is to require vaccination for enrollment in school, day care centers, kindergarten and summer camps.

All states have such laws, but in some, pressure from anti-vaccine groups watered them down so that parents can easily refuse immunizations for their children. Kentucky made it easier in 2017, by dropping the requirement that a physician sign the exemption form, and the immunization rate dropped below the 95 percent generally thought to guarantee herd immunity.

There are a few children who, because of some immune disease, should not receive live-virus vaccines, but these are rare cases and should be protected legally from immunization rules. Kentucky and some other states allow non-medical exemptions based on personal preference or belief. It is in such states that we are seeing epidemics in close-knit, unvaccinated populations. That has prompted several states to reexamine the vaccine exemptions and tighten them. Kentucky has moved in the opposite direction, and that trend needs to stop.

It is not in Kentuckians’ best interests to water down our immunization requirements; in fact, we should be tightening personal exemptions for vaccinations. This is the policy recommendation of public health agencies and organizations, and of physician organizations.

Comments that erode support for immunization laws that protect us from vaccine-preventable diseases are detrimental to the public’s health. That is especially true of people in public life, and health professionals who know better. Such comments from such sources erode public support for our protection from illness and death. Our political leaders’ statements and actions should be driven by evidence and science.

F. Douglas Scutchfield, M.D., is the Peter P. Bosomworth Professor Emeritus in the Department of Health Management and Policy in the University of Kentucky College of Public Health. Al Cross is a journalism professor at UK, director of its Institute for Rural Journalism and Community Issues, and editor and publisher of Kentucky Health News.

Jewish Hospital quits heart transplants; U of L says there's less need for them, and can't start a program of its own right now

Jewish Hospital is in downtown Louisville.
Financially ailing Jewish Hospital, which was once a national leader in heart transplants but has done only one this year, says it is putting the program on "long-term inactivation" while maintaining other transplant programs.

Hospital President Ron Waldridge said in an email to employees that the Organ Procurement and Transplant Network, which directs human-tissue transplants in the U.S., "changed how heart donation are allocated" last October, Chris Larson reports for Louisville Business First. "The change resulted in fewer heart transplant cases being sent to Jewish Hospital. . . . Transplant programs must perform at least 10 heart transplant procedures over a rolling 12-month period to stay in compliance with federal standards."

The University of Louisville collaborates on the program. "U of L President Neeli Bendapudi and other U of L leaders who spoke to media downplayed the impact that stopping the program would have on the university's education mission or on U of L Health, the organization that oversees the clinical aspect of the school's medical endeavors," Larson reports.

Toni Ganzel, dean of U of L's School of Medicine, told Larson that many medical schools do not have transplant programs, "but we saw [the program] as a really valuable part of being an academic medical center."

Tom Miller, CEO of U of L Health, told Larson that advances in technology have diminished the need for heart transplants. "And he added that U of L doesn't have the space to add a heart transplant program to U of L Hospital, which is currently operating at capacity." Miller said, "That doesn't mean that we won't some time in the future —we just don't have that today." 

KentuckyOne Health and its new corporate parent CommonSpirit Health have been trying to sell Jewish Hospital and other facilities in Louisville and Shelbyville for more than two years. "U of L announced in June that it was abandoning its plan to buy assets from KentuckyOne, citing an inability to find a partner within the timeline KentuckyOne set for the talks," Larson notes.

Thursday, July 18, 2019

OD deaths in Ky. dropped nearly 15% in 2018; officials credit many policy initiatives, but say 'incredible challenges' remain

By Melissa Patrick
Kentucky Health News

Kentucky saw a nearly 15 percent drop in drug-overdose deaths in 2018, the first decline since 2013, and almost three times the national decline of 5.1%.

Most of the deaths were again caused by fentanyl, a synthetic opioid that can be up to 50 times more potent than heroin, according to the annual Kentucky Office of Drug Control Policy report.

The state recorded 1,333 overdose deaths in 2018. That was 233 fewer than in 2017, when 1,566 were recorded, a decline of 14.9%.

Toxicology reports are available for 1,298 of last year's deaths; fentanyl was found in 786 autopsies, or nearly 61% -- up from 52% in 2017 and 47% in 2016.

Van Ingram, executive director of the Office of Drug Control Policy, said in a news release that the overall decline was likely the result of the state's many policy initiatives, along with a growing awareness about the dangers of opioids and the threat of overdose.

“We’ve pushed hard to develop the most comprehensive approach possible, combining education and treatment with a multitude of other harm-reduction strategies,” Ingram said. “We still have a great deal of work to do, but it’s clear that Kentucky’s efforts are making an impact.”

Reflecting anecdotal law-enforcement reports, there was increase in deaths from methamphetamine, a stimulant that has long plagued Kentucky. It was found in 428 cases, up from 357 in 2017.

The report says overdose deaths from heroin declined in 2018 and did those from alprazolam, an anti-anxiety medicine that is often known by its brand name Xanax; and from gabapentin, which sells under the brand names Neurontin, Gralise and Horizant and is often taken along with other illicit drugs to enhance their effects.

Heroin-related deaths dropped 30% to 188 in 2018, from 270 in 2017. Deaths involving alprazolam dropped 20% to 214 cases, down from 269 in 2017. Deaths from gabapentin dropped 30%, to 255 cases, down from 363 in 2017.

Deaths related to the widely used pain medication oxycodone dropped to 110 from 157 respectively, or 30%.

“The numbers are trending down, but our state still faces incredible challenges,” Justice and Public Safety Cabinet Secretary John Tilley said. “This crisis claimed more than 1,300 lives last year and inflicted untold heartbreak on our families and communities. I only hope the latest numbers serve as evidence that strong interventions and better access to treatment can and do save lives."

Rate is per 100,000 residents; data from
2018 Kentucky Overdose Fatality Report
Of the 1,333 deaths, 1,247 of them, or 93.6 percent, were Kentucky residents. County-by-county figures in the report are based on deaths of residents, and are adjusted for age.

Boyd County (Ashland and Catlettsburg) had the highest rate of fatal overdoses in 2018, followed by Madison (Richmond and Berea), Kenton (Covington, Independence, etc.), Clark (Winchester) and Campbell (Newport etc.).

Counties with fewer than 10 deaths were not included in the rate calculation, so the report have rates for only the 23 counties with 10 or more overdose deaths.

The highest rate of overdose deaths continues to be among people between 35 and 44, followed by 25-34, then 45-54.

State and federal efforts

The state and its partners have launched a number of efforts to battle the state's opioid and substance-abuse epidemic, including the KY Help Call Center (1-833-859-4357), which provides information on treatment options and open slots among treatment providers and an online website that provides a similar service called FindHelpNowKY.org.

The Department of Corrections is overhauling the way it addresses substance abuse. Kentucky State Police have launched the Angel Initiative, which allows anyone with a substance use disorder seeking treatment to visit a KSP post, where they would be directed to treatment.

The General Assembly has passed several laws in recent years, including a crackdown on pain clinics, limiting opioid prescriptions for acute pain to a three-day supply (with exemptions), tougher penalties for heroin dealers and more funding for drug treatment and other response efforts.

A news release from Senate Majority Leader Mitch McConnell's office points out that Kentucky is also benefiting from nearly $200 million in federal money that he has helped to secure.

That includes an $87 million federal grant recently awarded to the University of Kentucky to address the opioid epidemic in 16 high-risk counties, which is the largest grant in the school's history and an indicator of the magnitude of the problem.

"I’ve made the fight to save lives from the horrors of addiction and abuse a top national priority," McConnell said in the release. "The results of our work at the federal and state level with our many local partners on the front lines are evident in today’s announcement."

Data for the report were compiled from the Kentucky Medical Examiner's Office, the Kentucky Injury Prevention & Research Center and the state Office of Vital Statistics.

Wednesday, July 17, 2019

Opioid database shows Ky. ranked 2nd for most pain pills per person in 2006-12; county-level, pharmacy-specific data available

UPDATE: Paintsville Herald Editor Aaron Nelson took a look at the data and found that "Two pharmacies in Paintsville ranked number one and number four across the entire state of Kentucky for opioid shipments between 2006 and 2012." And he named the pharmacies in his story.
Washington Post map; click here to view the interactive version. 
Between 2006 and 2012, drug companies distributed 76 billion doses of prescription pain medicine, "enough pills to supply every adult and child in the country with 36 each year," Scott Higham, Sari Horwitz and Steven Rich report for The Washington Post. And rural counties, especially in Appalachia, received some of the highest shares of pain pills per person.

Washington Post map; click on it to enlarge.
The Post story also includes a link to the raw data, a portal to search for data by county, a map showing opioid deaths from 2006-2012, and more.

That's according to a Drug Enforcement Administration database, made public for the first time by the Post and the daily newspapers in Charleston and Huntington, W.Va. The database tracks the path of every DEA-regulated pain medication in the U.S. It includes local data that shows the counties that received the most pills, fueling the prescription-opioid epidemic, resulting in nearly 100,000 deaths in that time period.

The Post reports that "rural areas were hit particularly hard." The data showed Kentucky ranked second in pills per person per year, at 63.3, topped only by West Virginia at 66.5, which had the highest opioid death rate during the period. South Carolina, mainly due to high rates along its Atlantic coast, was third at 58; Tennessee was fourth at 57.7, and Nevada was fifth at 54.7.

A 2016 report from the Kentucky Injury Prevention and Research Center found that prescription opioids contributed to the overdose deaths of 2,481 Kentuckians between 2006 and 2012.

Section of map shows counties in and near Kentucky.
The Post's interactive map shows that several counties in Eastern Kentucky had the highest distribution rates in the state: Whitley at 187, Perry at 175, Floyd at 168, Bell at 156, Johnson at 152, Pike at 146, Clay at 134 and Lee at 133.

Clinton County, at 147, stands out in the south-central part of the state, as do McCracken, at 107, and Crittenden, at 119, both in Western Kentucky.

Nearly half of the pills were distributed by three companies: McKesson, Walgreens and Cardinal Health. The top manufacturer was Mallinckrodt's SpecGx, with nearly 38 percent of the market.

Because the database is partly comprised of data that drug makers gave the DEA, it shows what they knew about the number of pills they were shipping at the epidemic's peak, the Post points out.

Drug manufacturers, distributors and pharmacies must log and report each narcotic transaction, and are supposed to report suspiciously large or frequent orders to the DEA and withhold such shipments.

Meanwhile, nearly 2,000 communities, counties and Indian tribes have alleged in federal lawsuits that the drug companies filled suspicious orders and did not report them in order to maximize profits.

 The lawsuits were consolidated into one case, which is now larger in scope than the lawsuit against cigarette manufacturers in the 1980s, the Post reports.

Attorney General Andy Beshear, the Democratic nominee for governor, has filed nine lawsuits against opioid manufacturers and distributors, including ones against the top three distributors and top manufacturer. He says that is more than any other attorney general

Beshear is the Democratic nominee for governor. In a debate Wednesday, Republican Gov. Matt Bevin asked him, "How much money have we gotten" from the suits. "We will," Beshear replied. "You blow a lot of smoke," Bevin retorted.

The database was released Monday after the Post and HD Media, which publishes the Charleston Gazette-Mail, won a years-long legal battle to access documents and data from the ongoing litigation.

The West Virginia newspaper won a Pulitzer Prize in 2018 for reporting on drug distribution, using other data. The Post reports that the DEA, the Justice Department and drug companies all fought hard against release of the data. The companies said it would reveal information that could give competitors an unfair advantage, and Justice said the data could compromise DEA investigations.

State health department warns about danger of getting rabies, especially from bats; advises to never touch a bat

By Melissa Patrick
Kentucky Health News

Public health officials are reminding Kentuckians about the dangers of rabies exposure from bats and other wildlife.

Photo from Kentucky Department of Fish & Wildlife
“We want to highlight the importance of rabies prevention and control efforts in our communities, while also reminding Kentuckians of the existing dangers of coming into contact with rabid bats and other wildlife," Kelly Giesbrecht, veterinarian with the state Department of Public Health, said in a news release. "To avoid possible rabies exposure, wildlife should not be fed, handled or treated as pets.”

Rabies is a viral disease that affects the nervous system. It is transmitted from animals to humans by the saliva of a rabid animal, usually from a bite or scratch. The virus cannot infiltrate intact skin.

Because bats are so small, it is sometimes difficult to know if you have been bitten or scratched by one, so the health department warns that any suspected exposure should not be taken lightly. "If untreated, rabies is fatal," says the release.

Rule number one when it comes to protecting yourself from rabies is to never handle a bat.

If you find one in your home, call the local animal control office to remove it and then call a healthcare provider or local health department to determine if preventive treatment is required.

Only a small percentage of bats have rabies, but health officials warn that you can't tell if they have the disease just by looking at them -- though they advise extra precautions around bats that are flying during the day, are in locations where they are normally not found, like your home, or are unable to fly at all.

University of Kentucky Cooperative Extension graphic
It's also important to protect your home by sealing all of the holes that are larger than a quarter-inch. The health department says the best time to do this is in the fall or winter so that any bats that might already be inside are not unintentionally trapped.

The University of Kentucky Cooperative Extension Service offers further tips on how to protect your home from bats, noting that it's important to take the time to to seal all points of entry because bats return each year to their "nursery colony."

The most common ways for bats to enter homes are through chimneys, vents and openings behind shutters or under doors, siding, eaves and shingles.

The release also points out that it is illegal to remove bats from an area between May and August because that is when they raise their young. Instead, health officials say to consult with the Kentucky Department of Fish and Wildlife if you have a bat problem in your home during these months.

In the U.S., rabies is most commonly spread by bats, raccoons, skunks, coyotes and foxes. Once clinical symptoms are present, there is no known medical cure for rabies.

Symptoms of rabies can initially mimic the flu, including general weakness, fever and headache. A person can also have a strange sensations at the site of the bite from a rabid animal. These symptoms can progress within days to symptoms of anxiety, confusion and agitation. Further progression of the disease includes symptoms of hallucinations, insomnia and fear of water, all of which are quickly followed by death, according to the federal Centers for Disease Control and Prevention.

There are usually only one or two human cases of rabies in the U.S. each year, and the most common source is from bats. The health department reports that the last case of human rabies in Kentucky from a bat was in 1996.

"Among the 19 naturally acquired cases of rabies in humans in the U.S. from 1997 to 2006, 17 were associated with bats. Among these, 14 patients had known encounters with bats. In these cases, the bat was inside the home," says the CDC.

Tips to protect yourself from rabies:
  • Do not touch a bat, and teach children to not touch them.
  • Keep your pets vaccinated; it's not only good practice, it's the law in Kentucky.
  • Do not interact with wildlife, or intentionally feed wildlife.
  • If you've been bitten or scratched, wash the wound immediately with soap and water for at least 10 minutes and call your health-care provider.
  • Remember, bats have very small teeth which may leave marks that disappear quickly. If you are unsure, seek medical advice.
  • If a bat is found in a room with an unattended child or near a mentally impaired or intoxicated person, seek medical advice.
  • Report all animal bites to your local health department
  • If possible, confine the animal so it can be quarantined or tested.

Tuesday, July 16, 2019

After receiving 600 public comments, health cabinet removes proposal to ban tattoos on scarred skin in updated regulation

By Melissa Patrick
Kentucky Health News

The state Cabinet for Health and Family Services has updated its requirements for tattoo studios in Kentucky, and they no longer prohibit tattoos on scarred skin, as first proposed.

WFPL photo
The cabinet said in a news release it had received more than 600 public comments on this proposal. In addition, WHAS-TV reported that almost 100 people from all over the state attended a public hearing about the issue May 28 in Frankfort.

"Based on comments received, we elected to remove the language relating to scar tissue," Dr. Jeff Howard, commissioner of the state health department, said in the release.

Opponents of the proposal have said there is no medical reason to ban such tattoos. Others have said such a ban is a violation of their civil rights, and there are already industry rules around this issue. Still others pointed out the many reasons people want to cover their scars, including cancer survivors who want to cover their mastectomy scars.

The state announced the original amendment to the regulation in April, which simply said "tattooing over scarred skin is prohibited." The proposal did not give any reason for adding this language; when asked about it, a cabinet spokesman said only that the proposal was made in an effort to update a regulation that hadn't been updated in 15 years.

In May, the health commissioner issued another release, saying the proposal to ban tattooing on scarred skin in the regulation "had some unintended consequences" and that the language regarding this issue would be addressed once the public comment period ended on May 31.

On Tuesday, July 16, the cabinet announced that the ban had been removed, citing a "a lack of available evidence to support this prohibition." It said the intent of the first revision was to prohibit the tattooing of freshly scarred skin, but "freshly" was left out.

Under the new rule, which next goes before the Administrative Regulation Review subcommittee, a person registering as a tattoo artist will have to complete training about blood-borne pathogens. The rules also outline a registration process for tattoo studios and increased fees to offset inspection cost.

The regulation also updates requirements for disinfecting and sterilizing equipment and adds a new rule to require a notarized statement of parental consent for a minor who is seeking a tattoo without a parent or legal guardian present.

Monday, July 15, 2019

In e-cigarette documentary, on CNBC tonight, CEO of Juul Labs apologizes to parents of teens who are addicted to his devices

Juul Labs CEO Kevin Burns, left, and NBC reporter Carl
Quintanilla tour a Wisconsin Juul facility. (CNBC photo)
A new CNBC documentary exploring the increasing popularity of electronic cigarettes, especially among teens, features a surprising message from one industry CEO: an apology.

Kevin Burns is CEO of Juul Labs, which has about 40 percent of the e-cigarette market. It sells liquid nicotine pods in sweet flavors that are a prime driver in getting teenagers to try vaping. Reporter Carl Quintanilla asked Burns what he would say to a parent whose child was addicted to Juul.

Burns, who joined Juul in late 2017, replied: "First of all, I’d tell them that I’m sorry that their child’s using the product . . . It’s not intended for them. I hope there was nothing that we did that made it appealing to them. As a parent of a 16-year-old, I’m sorry for them, and I have empathy for them, in terms of what the challenges they’re going through."

Angelica LaVito reports for CNBC, "The Food and Drug Administration has declared teen vaping an 'epidemic,' citing federal survey data that showed nearly 21 percent of high school students vaped last year. Former FDA Commissioner Scott Gottlieb and health care advocates blame the surge in teen vaping on Juul."

"Vaporized: America's E-cigarette Addiction" will first air tonight at 10 p.m. ET.

Sunday, July 14, 2019

Bevin touts Medicaid proposal, claims 'hundreds of thousands' in Kentucky 'should be going to work and choose not to go to work'

By Al Cross
Kentucky Health News

Gov. Matt Bevin gave a vigorous defense of his plan to require work or other activities by "able-bodied" adults without dependents who are on Medicaid, in an interview at the Kentucky Chamber of Commerce's Business Summit and Annual Meeting in Louisville on Friday, July 12.

"Is there anyone in this room that thinks it is a good idea for able-bodied, working-age men and women between the ages of 19 and 64 who have no dependents – and they’re able-bodied, they’re healthy – and they choose not to work?" Bevin asked. "How many of you think it’s a good idea for you to subsidize them and allow them not to work? Anybody? That’s what Andy Beshear believes. I don’t. That’s what his father believed. I don’t. We’re not helping people by that."

Attorney General Andy Beshear, the Democratic nominee challenging the Republican incumbent, is the son of Steve Beshear, who as governor in 2014 used the Patient Protection and Affordable Care Act to expand Medicaid to people with household incomes up to 138 percent of the federal poverty level: $16,753 for individuals, $22,715 for a couple and $34,638 for a family of four.

Bevin spoke to reporters after his Chamber interview.
(Photo by Jack Brammer, Lexington Herald-Leader)
As a candidate in 2015, Bevin initially said he would abolish the expansion, then said he would request a waiver of federal Medicaid rules so the program's beneficiaries would have "skin in the game" through premiums, co-payments, deductibles or health savings accounts. After he was elected, he added "community engagement" requirements including work, but those have been blocked in federal court.

"They should do one of five things I have proposed for 20 hours a week, four hours a day, five days a week," Bevin said. "Work, go to school, volunteer, be in training for a specific job, take care of somebody that the state would otherwise be paying for to be taken care of." The fifth option, which Bevin didn't mention, would be enrollment in treatment for substance-use disorder.

"One or more of those things is possible in every community in Kentucky," he said. "And it is, I think, morally irresponsible if we don’t expect people to do what other people are paying to give them something that they themselves may or may not even have." Earlier, he said, "Many of your companies don’t even offer the same benefits Medicaid does."

Bevin said the lack of community-engagement rules "sets a bad precedent. It creates a sense of entitlement and expectation, and it sets a bad example for next generations of children who see their parents not going to work, and working the system. There are hundreds of thousands of people in this state that could be going to work, should be going to work, and choose not to go to work. That is their prerogative; they can choose that, but you should not be expected to subsidize that choice if they could choose otherwise."

Afterward, Bevin refused three times to give a source for his "hundreds of thousands" figure, but later in the day his office cited the Census Bureau's 2017 American Community Survey, a poll that estimated 443,723 Kentuckians "do not have a disability and are not in the labor force."

Those numbers apparently include people who retired before 65, attend college, or work at taking care of others without pay. Mike Randle, publisher of Southern Business & Development Magazine, told the Chamber members the day before Bevin spoke that of the 95 million Americans "outside the workforce," 44 million are retirees, 20.5 million are college students, 13 million are caretakers and “unknown millions” are mentally ill and/or addicted to drugs.

In May, the last month for which figures are available, more than 1.35 million Kentuckians were on Medicaid, including 446,639 covered by the expansion. Estimates vary, but somewhere around half of the expansion members appear likely to be covered by the community-engagement requirements. Nationally, most Medicaid beneficiaries work; no other state has work requirements, though several are trying to implement them.

Bevin said he grew up in poverty, without health care, and his body still shows it. "I’m empathetic to that world, not sympathetic. But I know for a fact that if you give people something when they don’t need it, in the case of these able-bodied people, you don’t have it to provide to the people who do need it." (For a transcript of his remarks, go here.)

The state has estimated that if the waiver is allowed, in five years Kentucky Medicaid would have 95,000 more members than without the waiver, in large measure because they would fail to comply with work or reporting requirements. Bevin repeated his vow that if the U.S. Supreme Court ultimately blocks the waiver and he is still governor, he will abolish the Medicaid expansion.

The chamber's Jacqueline Pitts also asked Bevin about the economic impact of the expansion, more than 90 percent of which is paid for by the federal government, but that question was tacked on to a broader question on the topic and he did not answer it.

Beshear called earlier in the week for "a legitimate, non-political study" of the impact of the expansion on the state's economy and tax revenues.

Beshear declined to appear at the Chamber meeting, saying the group supports Bevin and his agenda. The Chamber said it has a history of working with officials of both parties.