Friday, January 31, 2020

Bill to let physician assistants prescribe passes first hurdle; Ky. is only state where they can't, causing health-care access issues

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to allow physician assistants to prescribe highly regulated drugs, a step advocates say is needed to improve health-care access in rural Kentucky, is finally moving through the legislature.

L-R: Andrew Rutherford, Rep. Steve Sheldon, Laurie Garner
"Kentucky is the last state in the U.S. where PAs don't have some form of controlled-substance delegation. The other 49 states have it already," said the bill's main sponsor, Rep. Steve Sheldon, R-Bowling Green. "And no state has ever reduced or rescinded the authority that has been given."

House Bill 135 would allow "modified prescriptive authority" of controlled substances in Schedules II, III, IV, and V after the PA has been licensed and has practiced for one year.

It passed the House Health and Family Services Committee Jan. 30 with a committee substitute. This was the fourth time the legislation had been filed, and the first time it had been brought up in committee for a vote.

Leaders of the Kentucky Academy of Physician Assistants urged passage of the bill, explaining that under the current system a supervising physician has to sign off on any controlled substance prescription written by a PA. They said this results in decreased access to care, delays in care, poor prescribing transparency, and ultimately results in Kentucky PAs moving to other states.

"Our graduating PA students are leaving the state of Kentucky to practice in other states where they have less restrictions and more job opportunities," said Laurie Garner, president of KAPA. "By passing this bill we will keep our best and our brightest in our state rather than seeing them leave for better opportunities elsewhere."

She also offered an example of how the system results in delayed care, noting that because she is often the only provider at her clinic, her patients who need a controlled substance prescription or a refill must wait until the supervising physician is able to co-sign for it, and often end up canceling appointments when she can't immediately help them.

Andrew Rutherford, vice-president of KAPA, said the bill would increase transparency, since drugs would be ordered under the PAs' Drug Enforcement Administration numbers instead of their supervising physicians' numbers.

"It will also allow PAs to be accountable for the controlled medications that they prescribe, based on their treatment plans," he said. "Currently a supervising physician signs off on all these prescriptions and this is falsely inflating many physicians' prescribing numbers."

The bill includes several restrictions, including only allowing PAs to prescribe a three-day supply of Schedule II drugs, with no refills. Schedule II and III non-narcotic substances would be limited to a 30-day supply with no refill; and Schedule IV and V drugs would be limited to the original prescription, with refills to not exceed a six-month supply.

It also carves out several Schedule IV drugs that can only be written as a 30-day supply without any refills, including: diazepam (Valium), lorazepam (Ativan), alprazolam (Xanax) and carisoprodol (Soma).

Administration of the program would fall under the Kentucky Board of Medical Licensure, and a PA's license to prescribe such drugs would need to be renewed every two years. The measure also includes new rules around continuing education requirements, including a number of required hours related to controlled substances.

Under the regulation, PAs would still have to work under the supervision of a medical doctor and that physician would be allowed to limit which controlled substances their PAs can prescribe, or if they want to participate in the program.

U.S. declares public health emergency from coronavirus; misinformation about it is spreading faster than the disease itself

Trying to prevent spread of coronavirus, federal officials said Friday that the government would keep foreign nationals who recently visited China from entering the United States, and would quarantine some Americans returning from that country.

"Declaring a public health emergency over the coronavirus outbreak, Health and Human Services Secretary Alex Azar said the president has imposed a temporary ban on entry for foreign nationals who have been to China in the last 14 days," The Washington Post reports. "American citizens returning from mainland China would be subject to health screening and up to 14 days of quarantine.

Misinformation about the coronavirus is spreading more quickly than the disease itself, "testing Big Tech platforms' ability to police rule-breaking content and China's ability to control domestic criticism," Sara Fischer and Ina Fried report for Axios.

Platforms such as Facebook, Twitter and Google are trying to stop the spread of misinformation, including fake government warnings and false reports about how many Americans are infected. Some misinformation comes from private Facebook groups, The Washington Post reports.

China is also battling misinformation circulating on its social-media platform Weibo, but to complicate matters, the government is spreading misinformation of its own in an effort to allay people's worries. "Chinese state media has tweeted photos purporting to show a new hospital, but which were actually stock images from a company that sells modular containers," Axios reports.

"Health care has long been a target of misinformation, because it plays into existing fears. This is especially true for disease outbreaks, which can spread faster than the news cycle is equipped to handle," Fischer and Fried write for Axios. Such misinformation can make outbreaks worse, because people may mistrust even accurate information about how to stop the spread of diseases.

"This is the latest lesson in why society needs information providers who practice a discipline of verification. In other words, journalists. And news outlets to pay them fairly and enforce standards," says Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News. Here is reliable coronavirus information from the Centers for Disease Control and Prevention.

Thursday, January 30, 2020

Democratic governor wants cigarette-tax hike, new tax on electronic cigarettes, not as much as one Republican's bill

By Melissa Patrick
Kentucky Health News

To pay for such things as a teacher-pay increase and 350 news social workers to fight child abuse and neglect, Gov. Andy Beshear wants to raise the tax on all tobacco products and add a new tax to electronic cigarettes, the only tobacco product in Kentucky that does not have an excise tax.

Gov. Andy Beshear makes his budget speech. (KET image)
The Democratic governor's taxes would have to be approved by the Republican-controlled legislature. Republicans often balk at new taxes, but comments from several leading GOP members suggest that some version of the e-cigarette tax will pass.

They are more skeptical of Beshear's proposed 10-cent tax increase on cigarettes, to $1.20 per pack from $1.10.

In his budget speech to the General Assembly, Beshear proposed a tax on e-cigarettes at 10 cents per fluid milliliter. His office said eight of the 19 states that tax so-called "vaping" products do so with a per-milliliter tax instead of a percentage of of the sales price.

The plan would also raise the tax on snuff and chewing tobacco to 38 cents per unit, from 19 cents,  and would raise the tax on other tobacco products, such as cigars, from 15 percent of the average wholesale price to 30%, which would make the tax rates on other tobacco products effectively the same as the proposed $1.20 cigarette-tax rate.

The higher tobacco taxes would raise $94.2 million for the two-year budget: $50.3 million in the fiscal year that begins July 1, and $43.9 million the following fiscal year, apparently presuming that the higher tax will decrease consumption.

If the cigarette tax were to pass, it would place Kentucky at the same rate as West Virginia, but would be noticeably higher than Indiana, Missouri, Tennessee and Virginia. The bordering states with the highest rates are Ohio, $1.60, and Illinois, $2.98. The national average is $1.81.

In 2018, Kentucky lawmakers increased the cigarette tax by 50 cents, to $1.10 per pack.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, praised the governor's proposals to raise tobacco taxes, noting the health savings that would result from them.

"In addition to raising revenue on one side of the budget, they reduce health-care and business costs and increase employee productivity on the other," Chandler said in a news release. "We know they're effective: the recent cigarette tax hike raised $140 million in new revenue its first year; at the same time, Kentuckians bought 36 million fewer packs of cigarettes."

Rep. Steve Rudy, chair of the House budget committee, said the most likely taxes to pass are those on electronic cigarettes, because “We’re trying to curtail this. . . . I’ve had a lot of school superintendents and teachers tell me it’s becoming an epidemic in the schools.”

Between 2017 and 2019, e-cigarette use more than quadrupled among the state's middle-school students and nearly doubled among its high-school students, with one in four high schoolers and one in five middle schoolers reporting monthly use; and one in 10 high school students reporting daily use.

Sen. Chris McDaniel, chair of the Senate budget committee, more cautiously said he needed to examine all of the components of Beshear's proposal before deciding how to proceed, but said he was open to looking at it.

"Any tax needs to be evaluated in the confines of its total impact," he said. "Since the last [cigarette] tax, we've seen a decline in smoking in the commonwealth. We know we've had a bit of an impact there. And we're going to take a look at it as part of the whole."

Senate Majority Floor Leader Damon Thayer said it's too soon to talk about the cigarette tax, but "I think a tax on vaping is something that needs to be considered. I don't think it should be as high as the tax on cigarettes, but I think it probably should be higher than the current 6 percent sales tax. So I think there is probably some momentum towards getting something done on that."

Thayer said he didn't think e-cigs should be taxed likewise because they are "not the same product" and added that while it's important to work toward decreasing the youth vaping epidemic, it's also important to recognize "there is evidence that vaping helps addicted adult smokers wean themselves off traditional cigarettes."

A 700 page U.S. Department of Health and Human Services report says more research is needed before we can conclude that e-cigs help people stop smoking.

"The evidence is inadequate to infer that e-cigarettes, in general, increase smoking cessation; factors contributing to the uncertainty include the changing characteristics of e-cigarettes, the many different contexts in which they are used, and the limited number of studies conducted to date," says the report, titled, "Smoking Cessation, A Report of the Surgeon General."

Rep. Jerry Miller
A bill to tax e-cigarettes in Kentucky has already been posted in the House Appropriations & Revenue Committee, chaired by Rudy.

House Bill 32, sponsored by Rep. Jerry Miller, R-Louisville, would place a 27.5% excise tax on e-cigarettes. It would apply the same rate to other tobacco products, which are now taxed at 15%, thus raising the levy by the same percentage that the cigarette tax was increased in 2018.

"I believe the tax bill will move out of the House, I feel pretty confident about that," Miller said. "We are working on modifying it to make sure it passes the Senate."

He said it was helpful that Beshear had proposed an e-cig tax, noting that the governor told him after his speech that he liked Miller's bill even better. He said that was likely because his proposal would generate more money than the governor's. "Whereas his is 20 million-ish, mine is in the 30 million range," he said.

Asked if he was willing to compromise the 27.5% rate, he said, "As I tell people, I don't pass perfect bills, I pass the best bills that can pass and I'm going to get the best bill I can pass through the Senate and onto the governor's desk."

Miller has also filed HB 69, which would further regulate e-cigarettes. Heunsuccessfully sponsored an e-cigarette tax bill in the 2019. In 2018, an e-cig tax was included in legislation that raised the tax on traditional cigarettes, but was removed in the Senate just before final passage and after lobbying by Altria Group, the largest tobacco company and 35% owner of Juul Labs, the largest e-cig company.

A recent Kentucky Health Issues Poll found that 75% of Kentucky adults support such a tax.

Wednesday, January 29, 2020

Dr. Steven Stack, Lexington emergency physician and 2016 AMA president, named to lead state Department for Public Health

Dr. Steven Stack
Dr. Steven Stack of Lexington, an emergency physician and the 2016 president of the American Medical Association, will be the new commissioner of the state Department for Public Health. He will start work Feb. 10.

State law requires the health commissioner to be a physican. Acting Health Secretary Eric Friedlander said Stack is a seasoned health-care policy advocate and educator.

"Steven has almost 20 years of years of clinical, operational and management experience to help guide our state Department for Public Health staff and galvanize both its assistance programs and educational efforts. He is an excellent choice to modernize our state’s public health services," Friedlander said in a press release.

Stack takes over the department at a time when it is asking lawmakers to approve a major system overhaul, which also includes changes in how local health departments would be funded. In addition, dozens of local departments are facing pension challenges that could force big cuts in services.

“I am proud to be a part of health programming that is innovative, accountable and focused on making Kentuckians’ lives better,” Stack said in the release. “Our state health officials are here to support and enhance local health department. We can’t forget that health care is local, and we have to balance a practice of targeting the right care with the approach of maximizing our state and federal resources."

Stack is an emergency physician at Saint Joseph Hospital East in Lexington. He is also an adjunct professor at the University of Tennessee's business college. He has served as a councilor (trustee) and advocacy workgroup chair of the World Medical Association. He served 13 years as a member of the Lexington-Fayette Urban County Government’s Emergency Medical Advisory Board.

Stack will replace Dr. Angela Dearinger, who was appointed in August. She was the third physician to hold the position in the previous administration of Republican governor Matt Bevin, whom Democrat Andy Beshear narrowly ousted in the November election. She will return to the University of Kentucky as assistant dean of its College of Medicine, says the release. 

U.S. House passes Senate bill to maintain anti-fentanyl laws

The U.S. House passed a Senate bill Wednesday to keep deadly fentanyl and similar opioids listed as some of the most dangerous drugs, and President Trump is expected to sign it Friday, the day before the listings would expire.

The legislation would keep fentanyl compounds as Schedule I substances under the law governing the Drug Enforcement Administration, "giving law enforcement the tools they need to bring drug dealers to justice," said a press release from Rep. Hal Rogers, R-Somerset.

"Fentanyl, a synthetic opioid that is 50 to 100 times stronger than heroin, continues to be the most lethal drug for Kentucky causing nearly 800 overdose deaths in 2018 alone," said a press release from U.S. Sen. Mitch McConnell, the Senate majority leader. The Senate passed the bill Jan. 16.

The federal Centers for Disease Control and Prevention says the U.S. had more than 28,000 deaths involving synthetic opioids (other than methadone, which is used to treat addiction) in 2017, more deaths than from any other type of opioid.

Tuesday, January 28, 2020

Albany pharmacist who led U.S. in dispensing opioids pleads guilty to federal charges, pays $200K and faces 15-month term

Shearer Drug in July 2019 (Washington Post photo / Michael Williamson)
Albany pharmacist Kent Shearer, whose drug store dispensed more opioids than any other in the United States from 2006 through 2012, has pleaded guilty to three counts of illegal distribution of controlled substances, the U.S. Justice Department announced Jan. 28.

The U.S. attorney for the Western District of Kentucky filed the charges in a criminal information on Jan. 10, but Shearer had been under investigation for a long time, after Clinton County Coroner Steve Talbott called police because of the number of drug overdoses in the county. Michael Cummings, a physician who had his office in the same building as Shearer is serving 30 months in prison on 13 counts of illegal prescribing.

Two charges said that between August 2011 and June 2014, and in 2015, the store dispensed hydrocodone "for patient J.Y., even though Shearer knew that the prescriptions were not written for a legitimate medical purpose. Shearer knew J.Y. was doctor shopping to obtain prescriptions for the same medications from multiple doctors, and because the . . . cough medicine . . . Dr. Michael Cummings prescribed to J.Y. had been prescribed for far longer than recommended in prescription guidelines." One of the charges said "Shearer filled prescriptions early on multiple occasions."

Clinton County (Wikipedia map)
The other charge said that between August 2011 and April 2015, the store dispensed alprazolam, commonly known as Xanax, for the same patient though he "knew that the prescriptions were not written for a legitimate medical purpose. Shearer knew J.Y. was doctor shopping to obtain prescriptions for the same medications from multiple doctors, and because Shearer filled prescriptions early on multiple occasions."

Prosecutors said they would seek a sentence of 15 months in prison followed by three years of supervised release, and Shearer "has agreed to forfeit a $200,000 monetary judgment to the United States" on or before the sentencing date of May 14, 2020. He has sold his business to another local pharmacy, the Clinton County News reports.

Regular marijuana use may enlarge the heart's main blood-pumping chamber, limited study in United Kingdom suggests

Image from Marijuana Direct
Regular use of marijuana could cause changes in the structure of the heart, suggests a study conducted in Britain and reported in a journal of the American College of Cardiology.

"People who regularly use marijuana tend to have a larger left ventricle, which is the main pumping chamber of the heart, according to the findings," reports Dennis Thompson of HealthDay. "Routine stoners also appeared to have early signs of impaired heart function, measured by how the fibers of the heart muscle deform during contraction."

However, when marijuana use stops, "The heart appears to recover in both size and function," Thompson reports. "The researchers warn that the study 'should be interpreted with caution, and more research is required' to understand the potential mechanisms and dose-related effects of cannabis use."

That being said, "The results jibe with concerns people have had about the effects of pot on the heart, said Dr. Martha Gulati, editor-in-chief of the cardiology college's patient-education website.

"There's so much we don't know about cannabis use and its effect on the heart, but one of the things we do know is that when people use marijuana, particularly if they smoke it, the heart rate and the blood pressure go up, and the heart has to work harder," she said.

The study was published in one of the college's peer-reviewed journals, JACC Cardiovascular Imaging. (A review in the same journal said marijuana can interact with common heart medications, including statins and blood thinners, potentially putting patients at risk, NBC News reports.)

The study was observational, not controlled, so other factors may have caused the heart-structure changes, said Dr. Mary Ann McLaughlin, a cardiologist at Mount Sinai Hospital in New York City, who reviewed the findings for HealthDay.

"Alcohol can also cause similar types of changes in the left ventricle with chronic drinking, which can get better when people stop drinking," McLaughlin said. "They said they adjusted for alcohol use in this study, but the question is whether the use was adequately assessed."

Thompson notes, "Europeans also are known to mix their marijuana with tobacco, which has notoriously harmful effects on the heart," citing Paul Armentano, deputy director of the National Organization for the Reform of Marijuana Laws. "Experts also noted that the number of pot users in this study was very small." It observed 47 current, regular users and 105 previously regular users. The rest of the 3,400 sample from the United Kingdom "rarely used pot, if at all."

While more research is needed, Thompson writes, "Until there are more answers, people with heart problems might want to avoid pot, the experts said."

Gulati said, "If you have heart disease, you should really use marijuana with caution. In fact, I, as a cardiologist, would recommend you not to use it because of the physiologic effects of increasing your heart rate and putting more demand and stress on the heart."

Sunday, January 26, 2020

Anti-diabetes activists hope resolution for Ketoacidosis Awareness Day will be only first of many diabetes bills to pass House, Senate

By Melissa Patrick
Kentucky Health News

A resolution to increase awareness of a health condition that can kill diabetics, called diabetes ketoacidosis, has passed the state House. It is one of several diabetes-related bills filed this session, including measures to address the rising cost of insulin.

Rep. Danny Bentley holds an insulin pen at a Jan. 16 press
conference. Rep. Deanna Frazier, R-Richmond, looks on.
(Legislative Research Commission photo)
The sponsor, Rep. Danny Bentley, R-Russell, told the House, "We always talk about diabetes, but we don't talk about how people die from it."

More than one in eight Kentucky adults have been diagnosed with diabetes, and 1.1 million Kentucky adults, or nearly one in three, have pre-diabetes that has been diagnosed or undiagnosed, according to the 2017 Kentucky Behavioral Risk Factor Survey. In that year, diabetes was the seventh fifth leading cause of death in Kentucky, according to the federal Centers for Disease Control and Prevention. 

House Resolution 14, which passed Jan. 23 on a voice vote, proclaims April 26, 2020 as Diabetes Ketoacidosis Awareness Day in Kentucky. DKA happens when a person lacks sufficient insulin to help move glucose, a type of sugar, between the bloodstream and the body's cells, where it is used for energy. When this happens, the body breaks down fat for fuel, which results in a buildup in ketones, which are acid.

If this persists for an extended period, the ketones build up in the blood, causing excessive thirst, frequent urination, nausea and vomiting, abdominal pain, fatigue, confusion and fruit-scented breath.

DKA can result in dangerous levels of dehydration, low levels of potassium, swelling of the brain, fluid in the lungs, and damage to the kidneys and other organs due to fluid loss, diabetic coma and death.

Bentley, a pharmacist who has Type I diabetes, a condition where the body produces no insulin, said people with Type I have the highest risk of DKA, but it can also happen in those with Type II diabetes, where the body produces some, but not enough, insulin.

The resolution says DKA may account for up to 75 percent of all Type I diabetes-related deaths in patients under 30 years of age.

Other diabetes-related bills to watch 

DKA can be prevented with the effective treatment of diabetes, but with the skyrocketing cost of insulin and other supplies needed to manage the disease, many diabetics go untreated or are under-treated because they ration their insulin to make it last. Several bills have been introduced this legislative session to address this.

Bentley and advocates held a press conference to discuss
several diabetes-related bills. (KHN photo by Melissa Patrick)
Bentley held a press conference Jan. 16 to talk about diabetes bills he is sponsoring. He was joined by lawmakers from both sides of the aisle, as well as representatives from Kentucky Insulin4All, the American Diabetes Association and the Kentucky Medical Association. 

"For those who require insulin to live, the cost has spiraled out of control as Representative Bentley has mentioned. And for many it's beyond their reach," said Gary Dougherty, ADA's chief state-government lobbyist. "This has forced one in four insulin users to use less than their doctor has prescribed for them, putting their lives and health at risk." 

Bentley thanked Gov. Andy Beshear for drawing attention to the issue of diabetes and the high cost of insulin at his Jan. 14 State of the Commonwealth address.

Beshear said, "There are a number of bills in the legislature right now to curb the costs of insulin. Representative Danny Bentley, a Republican, and Representative Patti Minter, a Democrat, are sponsoring one such bill. Let’s pass it. The approximately 530,000 diabetics, according to the American Diabetes Association, in this state are counting on it."

Bentley said Beshear "realizes that we have people in this state who are allotting their doses and dying from ketoacidosis."

Minter, a Bowling Green Denocrat whose son has Type 1 diabetes, is a co-sponsor of Bentley's resolution and House Bill 12, which would cap the cost-sharing requirements for prescription insulin at $100 per 30-day supply, no matter the type or amount of insulin a person is prescribed. This bill would only apply to private insurers, not Medicaid or Medicare. Including Bentley, it has 71 sponsors. It has been posted for consideration in the House Health and Family Services Committee.

Similar legislation has passed in Colorado and in Illinois, where it awaits the governors' signature.

Minter has also introduced HB 21 that would require insurance companies in Kentucky to keep covering pre-existing conditions in the event the federal Patient Protection and Affordable Care Act is overturned. Diabetes is considered a pre-existing condition, and prior to the ACA, an insurance company could deny coverage to those who have it.

Bentley said in the last 14 years, the price of insulin has gone up over 550%. He said retail cost for his own insulin requirements would be about $6,000 a year.
"When we adhere to good management, we save dollars on diabetes," he said. "If we can help a person manage their disease, we save money for the state, taxpayer and everyone."

Rep. Charles Booker, D-Louisville, who has Type I diabetes, offered his support of Bentley's bill and told about his experience with ketoacidosis.

"I've had to make decisions on whether to put food on the table for my girls or pay for my insulin," said Booker, a U.S. Senate candidate. "And I'm going to choose my girls every time, and I fell into diabetic ketoacidosis. . . . I couldn't move. I couldn't hug my girls. I thought I was done. A lot of Kentuckians are not as fortunate as I am to be here."   

Bentley has also introduced HB 72, which he called the "Rx Accumulator Bill." It would require insurers to apply any financial assistance used by a patient, like a rebate or coupon, to their deductible. This bill would not only help people with diabetes, but also those with other health conditions. It has been posted in the House Banking and Insurance Committee.

He has also filed  HB 248 and HB 249, which deal with the cost of insulin, including issues related to cost transparency.

"As a Type 1 Diabetic, I know firsthand the struggle diabetics face when they do not have access to insulin," he said in the press release. "These pieces of legislation will help take the burden away for Kentuckians who are diabetic."

Two diabetes-related bills have also been filed in the Senate, both by Sen. Phillip Wheeler, R-Pikeville. Senate Bill 23 would create an insulin assistance program. It has been assigned to the Senate Health and Welfare Committee. SB 69 would also cap the co-payment for prescription insulin at $100 per 30-day supply. It has been assigned to the Senate Banking and Insurance Committee.

Last year, the state passed a Bentley bill to allow pharmacists to dispense insulin and respiratory inhalers in the smallest supply available in an emergency. Kentucky already had a law to allow pharmacists to dispense a 72-hour emergency supply of a prescription medicine, but because insulin and most inhalers are not available in doses that small, they couldn't dispense them.

The law is called "Kevin's Law" for Kevin Houdeshell, an Ohio man with diabetes who died after running out of insulin on New Year's Eve in 2013, despite multiple efforts to reach his doctor to get the refill.

Saturday, January 25, 2020

Flu activity in Kentucky again drops a bit, but remains high, and nine more adults die from it in state; not too late to get a flu shot

Kentucky Health News

Nine more Kentucky adults have died from influenza, bringing the flu season's total to 30, two under the age of 18, according to the state Department for Public Health.

While flu activity remains high in the state, the latest weekly report shows the number of new cases dropped for the third week in a row. In the week ending Jan. 18, Kentucky counted 1,544 new cases. Not all cases are counted, because flu does not have to be reported.

At the same time last year, Kentucky's numbers were less concerning. The state had a total of 4,166 lab-confirmed cases and 13 deaths, one a minor. There have been 11,548 confirmed cases this season.

Health officials urge everyone six months and older to get a flu shot each year, and note that much of flu season remains.

Scattered school districts continue to close for a few days due to flu. For example, Todd County had "non-traditional instruction" Thursday and Friday after more than 10 percent of students were absent Wednesday, reported Adam May of WHOP in Hopkinsville, quoting schools spokeswoman Camille Dillingham.

"Twenty substitute teachers were called to duty and seven positions went uncovered because substitutes weren’t available. She also noted that three of the district’s four principals have the flu. She says custodial staff will thoroughly clean the building while students are not there the remainder of this week. The school system is asking parents and guardians to disinfect items such as backpacks, lunch boxes, gloves and school supplies to help prevent the continued spread of illness."

Through Jan. 18, the Todd County Health Department had not reported any flu cases this season. It was among eight counties that did not contribute to the latest report.

Hotspots continued around the state. Perry and Pike counties continued to be hit hard by the flu in the week ending Jan. 18, with 76 new cases in Perry and 71 new cases in Pike, for respective totals of 715 and 523. Barren added 75 new cases, for a total of 475; Warren 65, for a total of 416; Bullitt 61, for a total of 527; and Allen 57, for a total of 179.

Friday, January 24, 2020

Senate President Stivers, long the key obstacle to medical marijuana in Kentucky, now says he sees 'a narrow path' for it

Senate President Robert Stivers
By Melissa Patrick
Kentucky Health News

The most important legislative opponent of legalizing medical marijuana in Kentucky said Friday that there is a "narrow path forward" for it. Senate President Robert Stivers said that the day after a medical-cannabis bill was filed in his chamber.

Senate Bill 107 has bipartisan sponsorship from 11 of the Senate's 38 members. It is a companion bill to House Bill 136, with 44 co-sponsors, including House Speaker David Osborne.

The House bill's prime sponsor, Rep. Jason Nemes, R-Louisville, told Tom Latek of Kentucky Today that most House Republicans support it and he is optimistic it will pass this year.

Stivers has said he wouldn't support a medical-marijuana bill without medical studies to back it up, but Friday he said it would be a balancing act to weigh the good and the bad of passing such a law.

"I know that Representative Nemes is trying hard and that he is modifying and amending, and I think there is a path, but it is a narrow path," he said.

Stivers said that in the 20-plus studies that have been delivered to him, he has found there are "statistically significant indicators" to use medical marijuana, such as nausea from chemotherapy, or spasticity in people with multiple sclerosis. But he cautioned that the studies were small and of short duration, and he said there are better medicines for glaucoma, an eye condition that many medical-cannabis supporters mention.

He also said that like all medicine, the good must outweigh the bad, noting "statistically significant indicators" in studies showing marijuana exposure to those under 25 hurts brain development; that prolonged exposure increases the likelihood of psychotic experiences; that it has 50 percent more carcinogens in it than tobacco; and can cause heart disease.

"So, it becomes a balancing test," he said. "And nobody has really come, in my opinion, to give us that good path forward."

He added, "Does anybody here in this chamber or the other chamber want to see individuals suffer? No, we don't. But we also don't want to exacerbate a drug problem or a problem with cancers, heart disease, anything like that."

The 160-page medical-marijuana bills offer a list of conditions for which cannabis can be prescribed, such as terminal illness and epilepsy, but don't limit prescribing to those conditions, and would allow physicians to prescribe marijuana to their patients as long as they have a "bona fide" relationship.

The 11 sponsors of SB 107 are Sens. C.B. Embry Jr., R-Morgantown; Perry Clark, D-Louisville; Denise Harper Angel, D-Louisville; Jimmy Higdon, R-Lebanon; Morgan McGarvey, D-Louisville; Gerald Neal, D-Louisville; Michael Nemes, R-Shepherdsville; Dennis Parrett; D-Elizabethtown; Reginald Thomas, D-Lexington; and Robin Webb, D-Grayson.

A medical-marijuana bill passed the House Judiciary Committee 16-1 last year, but with only five days left in the legislative session and opposition in the Senate, it did not get a vote in the full House.

This year's House bill awaits a hearing in the House Judiciary Committee. The Senate bill has not yet been placed in a committee.

Marijuana is legal medicine in 33 states and the District of Columbia. Recreational marijuana is legal in 10 states, most recently Illinois, the first bordering Kentucky.

If approved, the medical marijuana program would start Jan. 1, 2021.

Unanimous Senate sends female genital mutilation ban to House

By Melissa Patrick
Kentucky Health News

A bill to ban female genital mutilation in Kentucky unanimously passed the Senate Jan. 22 and went to the House Judiciary Committee for consideration.

Sen. Julie Raque Adams
The sponsor of Senate Bill 72, Majority Caucus Chair Julie Raque Adams of Louisville, told senators that FGM has no health benefits and  creates life-long physical and physiological harm. It is usually performed on girls between 4 and 14.

“Female genital mutilation is one of the most egregious forms of child abuse," Adams said. "It is internationally recognized as a violation of human rights and a form of discrimination against women."

Kentucky is one of 15 states where FGM is still legal. A federal ban that had been in place for more than two decades was found unconstitutional in 2018, putting the responsibility on states.

The United Nations Population Fund estimates that 200 million women and girls have suffered FGM. The federal Centers for Disease Control and Prevention estimates that 513,000 American females are at risk of FGM or have undergone it. In Kentucky, that number is estimated at 1,845, according to the Population Reference Bureau.

An FGM survivor named Jenny, who asked that her last name remain private, gave several reasons for the bill at the Jan. 15 Senate Health & Welfare Committee meeting.

She said a law banning the practice would offer support to women who are surrounded by people who still believe in it, but want to give their daughters "an out;" prompt women who have had FGM to ask questions, since many think it is done to all females; let people in other states know that Kentucky is not a "safe haven" for it; and promote badly needed education about it.

The bill would make FGM a felony if performed on a female under 18. It would ban trafficking girls across state lines for FGM, and revoke the licenses of medical providers convicted of the practice. It classifies FGM as a form of child abuse and would require mandatory reporting of it.

It would also mandate training for law enforcement and require the state Department for Public Health to produce and disseminate educational materials about it, and allow victims of the practice to file civil lawsuits up to 10 years after turning 18.

The bill had 12 sponsors, representing both parties. Click here for a fact sheet about FGM.

Thursday, January 23, 2020

Bill to raise legal age to purchase tobacco products from 18 to 21 passes state Senate 28-10, goes to House

By Melissa Patrick
Kentucky Health News

A bill to raise the legal age to purchase tobacco products, including electronic cigarettes, from 18 to 21 passed the state Senate 28-10 and went to the House.

Sen. Ralph Alvarado
Senate Bill 56, sponsored by Sen. Ralph Alvarado, R-Winchester, would bring Kentucky's statute in line with the new federal law raising the age to 21, which has already gone into effect.

It also removes status offenses for youth who purchase, use or possess tobacco products, which are often called PUP laws.

“The bottom line is this bill will reduce youth access to tobacco products, slash the number of kids who start using tobacco before age 18, decrease youth tobacco addiction and lead to lower tobacco-use rates overall as these teens grow and mature into adulthood,” said Alvarado, chair of the Senate Health and Welfare Committee.

The bill passed with a committee substitute adding language to make it better fit the federal law and remove penalties for 18- to 20-year-olds.

SB 56 allows the products to be confiscated and shifts the penalty to retailers who fail to adequately check buyers' identifications.

Senate Republican Caucus Chair Julie Raque Adams of Louisville praised the bipartisan bill, which is largely aimed at decreasing the epidemic of electronic-cigarette use among youth.

“We were so close to having nicotine be eliminated from one of the problems we had to add for our youth across the state," she said. "Unfortunately, with the introduction of vaping ... we now have an entire population that is addicted to nicotine once again.”

Between 2017 and 2019, e-cigarette use more than quadrupled among Kentucky's middle-school students and nearly doubled among its high-school students, with one in four high schoolers and one in five middle schoolers reporting monthly use; and one in 10 high school students reporting daily use.

A similar bill was introduced in the last legislative session, but tobacco-friendly senators blocked it. Some tobacco companies lobbied for it, and the federal change, to reduce pressure for regulation of electronic cigarettes.

Voting against Alvarado's bill were Sens. Matt Castlen, R-Owensboro; Perry Clark, D-Louisville; Stan Humphries, R-Cadiz; Robby Mills, R- Henderson; John Schickel, R-Union; Wil Schroder, R-Wilder; Damon Thayer, R-Georgetown; Robin Webb, D-Grayson; Stephen West, R-Paris; and Mike Wilson, R-Bowling Green.

First abortion bill of session clears committee; 2 more in hopper; Beshear administration lets Planned Parenthood apply for clinic

By Melissa Patrick
Kentucky Health News

A bill to require health care providers to do everything possible to save the life of a baby who is born alive has passed out of committee and now heads to the full Senate, where it is expected to pass.

Sen. Whitney Westerfield
The sponsor, Sen. Whitney Westerfield, R-Hopkinsville, paraphrased several Bible passages in his opening remarks, including one in which the prophet Jeremiah quotes God as telling him that "Before I formed you in the womb I knew you; before you were born I set you apart; I appointed you as a prophet to the nations."

Westerfield said, "Before we had a window into the womb through ultrasound, the Lord told us what was happening to that growing life -- for those who believe and follow God's word."

His Senate Bill 9 would require health-care providers give "medically appropriate and reasonable life-saving and life-sustaining medical care and treatment" to any infant born alive, including after a failed abortion, and would make it a felony for not doing so.

The bill, called the "Born Alive Infant Protection Act," passed Jan. 23 out of the Senate Veterans, Military Affairs and Public Protection Committee on a 9-0 vote, with all but one of them, Sen. Dennis Parrett, D-Elizabethtown, Republicans. None of the committee's Democrats were present. The other three Democrats on the committee were not present. 

Westerfield filed a similar bill last year that passed the Senate, but ran out of time in the House. Eighteen of the 38 senators are sponsoring this year's bill; one, Sen. Johnny Ray Turner, R-Prestonsburg, is a Democrat.

Westerfield told reporters after the committee meeting that he was not aware of any instances in which an infant was born alive in Kentucky from a failed abortion and that the measure is needed to "prevent it from ever happening," Bruce Schreiner reports for The Associated Press.

Westerfield added that he's concerned about situations such as late-term abortions that are allowed in some states where an infant might survive, Deoborah Yetter reports for the Louisville Courier Journal. Kentucky law prohibits abortions after 20 weeks, before a fetus is considered viable.

In a letter to members of the committee, Kate Miller, advocacy director of the American Civil Liberties Union Foundation of Kentucky, called the bill an "unnecessary and dangerous piece of legislation" that "has nothing to do with how abortion care actually works and is based on false claims. Bills like these perpetuate myths and lies about abortion care, patients who receive this care, and the doctors who care for them."

Westerfield told the committee that he hopes Democratic Gov. Andy Beshear would sign the bill or let it become law without his signature, but if he vetoes it, "I look forward to overriding that veto." Gubernatorial vetoes can be overridden by majorities in each chamber, and Republicans have supermajorities in both.

Two other anti-abortion bills have been filed in the legislative session that began Jan. 7.

House Bill 67, sponsored by Rep. Joseph Fischer, R-Ft. Thomas, would amend the state constitution to specify that it includes no protection for abortion rights. It has been assigned to the House Elections, Constitutional Amendments & Intergovernmental Affairs Committee.

House Bill 142, sponsored by Rep. Lynn Bechler, R-Marion, would prohibit public money from going to any entity that performs, induces, refers for or counsels in favor of abortions. It has been assigned to the House Appropriations and Revenue Committee.

Last year, the Republican-led General Assembly passed four anti-abortion bills. Two have been delayed by legal challenges, including one that bans abortion once a heartbeat is detected (usually around six weeks of pregnancy) and one banning abortion due to gender, race or disability of a fetus.

A law that bans the most common second-trimester abortion procedure is also being challenged in the courts. This law was struck down by a federal judge, a decision that was appealed by the administration of then-Gov. Matt Bevin, a Republican.

In a Jan. 3 letter, the Beshear administration informed Planned Parenthood of Indiana and Kentucky that it could apply for a license to provide abortions at its clinic in downtown Louisville, Deborah Yetter reports for the Courier Journal.

That would be the second abortion provider in the state, in addition to EMW Women's Surgical Center in Louisville. An abortion clinic in Lexington closed  in 2016 after enforcement action by Bevin's administration -- which also denied Planned Parenthood's application and accused it in court of providing 23 illegal abortions.

“Gov. Beshear’s administration recognized that our license had been wrongfully denied and that the previous administration didn’t follow the proper process," said Hannah Brass Greer, chief legal counsel for Planned Parenthood.

Planned Parenthood has denied that it provided illegal abortions, saying it was acting on instructions of the former administration led by then-Gov. Steve Beshear, Andy Beshear's father, who advised it to offer the procedure in order to be inspected for final action on the license.

The current Beshear administration has dropped the lawsuit, stating there was no failure to comply with the law, Yetter reports.

Mental health first-aid training bill passes state House

By Melissa Patrick
Kentucky Health News

A bill to create a training program for mental-health first aid has unanimously passed the state House and is in the Senate.

Rep. Kim Moser
House Bill 153, sponsored by Rep. Kim Moser, R-Taylor Mill, would train people in how to best address the needs of someone experiencing a mental-health or substance-use crisis.

“The Mental Health First Aid Act will put this evidence-based training program in the hands of educators, law enforcement, first responders, military personnel, our faith leaders—really anyone who interacts with the general public and anyone at risk,” said Moser, who chairs the House Health and Family Services Committee.

Moser noted that mental health is the underlying cause of many issues in society, such as substance-use disorder, suicide and violence.

To that point, she said Kentucky has a high rate of substance misuse and addiction problems, with 1,333 people dying from a drug overdose in 2019. She added that in 2017, 766 Kentuckians died by suicide and noted that suicide is the second leading cause of death for people ages 15 to 34 and the U.S. suicide rate for veterans is 17 per day.

She said the objectives of the program are to build mental health and substance use literacy and to help the public identify, understand and respond to the early signs of mental health issues.

The curriculum is already being used in pockets of the state and this program will take it statewide, she said. She added that the certification does not replace a licensed counselor and is not mandated.

The training would be administered by the Cabinet for Health and Family Services and would be paid for through a trust, funded with state and federal appropriations, grants and private donations.

“Any money in this trust fund would be used specifically for this training program or suicide prevention programs,” she said.

Rep. Mary Lou Marzian, D-Louisville, a nurse, praised the legislation, but voiced concern that there was no funding allocated for it. She called on the lawmakers to find a way to fund it other than "begging for donations and handouts."

"I think that is a very poor way to try to fund one of the most important pieces of legislation [for] the neediest of our citizens with substance abuse issues and mental illness," Marzian said.

Editorial in Frankfort's newspaper says drug addiction should be treated as a health issue, not a crime

The State Journal

With rising inmate populations and crumbling prison infrastructure depleting the state of much-needed funding, it is time to stop treating drug addiction as a crime and start regarding it as the public health issue that it is.

We agree with the Kentucky Chamber of Commerce that reclassifying drug possession charges to misdemeanors and investing in treatment over incarceration will serve a dual purpose — save the state money on prison costs, which grew 15.9 percent between 2016 and 2020, and help to break the cycle of drug addiction through education and treatment.

The cost to incarcerate a state inmate in Kentucky is $18,406 per year. The approximately 4,500 inmates in prison for drug offenses in 2016 cost taxpayers more than $82 million per year.

According to data from the Criminal Justice Policy Assessment Council, a working group established by former Gov. Matt Bevin charged with developing “fiscally-sound, data-driven criminal justice policies,” the number of offenders imprisoned for drug trafficking between 2012 and 2016 jumped 25.6% (1,525 in 2012 to 1,916 in 2016). However, there was a 101.5% increase in the number of offenders (911 in 2012 to 1,836 in 2016) jailed on drug possession charges.

In fact, it was a year ago this week that a Franklin County Regional Jail inmate was discovered dead in his cell after what a lawsuit alleges were days without treatment for withdrawal symptoms related to drug use.

Dylan Stratton, 21, was booked into the jail Jan. 17, 2019, on a drug charge and was placed in the detox holding cell for observation. According to the lawsuit, he refused meals and began vomiting. A day later he had a seizure, reportedly from benzodiazepine withdrawal, and died.

This case is just one of many that illustrate how Kentucky’s jails are ill-equipped to handle drug addicts. Instead of spending money to punish drug users, the state should increase funding for substance abuse treatment.

Database shows the basics of each rural hospital's finances

Want to check the financial history of your local hospital? There's a quick and easy way to get the fundamental figures, thanks to a reporting project last year on rural hospitals by GateHouse Media, which has absorbed Gannett Co. and taken its name. The database built for the project now resides on the USA Today Network site.

At right is a screen grab of the financials of Breckinridge Memorial Hospital in Hardinsburg, Ky., which Kentucky Health News reported last year typically had a week's worth of cash flow on hand after it failed to persuade county officials to impose a property tax to subsidize it. The top part shows the hospital's gross revenues by year; the bottom part shows its net income, revealing years of increasing losses. Another chart, not seen here, shows each year's net profits.

William Heisel of the Center for Health Journalism at the University of Southern California wrote about using the database, and wants to hear results from other users.

Wednesday, January 22, 2020

Ads touting McConnell's record on surprise billing, Medicare for All could be a surprise of their own, since they confuse the issues

This ad promoting Sen. Mitch McConnell conflates the issues of surprise billing and Medicare for All.
Analysis by Al Cross
Kentucky Health News

A conservative group has started television and radio commercials in Kentucky and other states thanking Senate Majority Leader Mitch McConnell and others in Congress for blocking legislation that would offer consumers some protection from surprise medical bills.

While that may not sound politically advantageous to the senator's re-election campaign, the ads conflate and confuse the surprise-billing issue with the much more prominent "Medicare for All" proposal, which is favored by the most liberal Democratic presidential candidates.

The TV ad says, "Some politicians are too scared to stand up to the special interests. But not Mitch McConnell. He fights for us, like on health care and surprise medical billing. Special-interest groups have tried to use the issue to implement a government-run Medicare for All scheme, putting our hospitals and care at risk. But Mitch said NO, because he knows how devastating that would be, for us and our children. So, thank you, Mitch McConnell, for putting patients first."

The Taxpayers Protection Alliance said that in December, McConnell "and legislative allies halted attempts by members of Congress such as Sen. Lamar Alexander (R-Tenn.) and Rep. Frank Pallone (D-N.J.) to have the government impose rate-setting in cases of surprise medical billing. Surprise bills occur when patients receive unwanted and unexpected healthcare bills in the mail days or even weeks after a hospital room visit."

Yes, but the surprise-billing issue has little if anything to do with "Medicare for All," one possible exception being that proponents of the latter cite the former as one problem it would solve. TPA says the two are related this way: "Surprise medical billing is only an issue because of rampant government intervention in the medical sector due to Obamacare and Medicare’s disastrous rural price controls. This is a problem that was specifically caused by misguided government intervention. In fact, three-quarters of Obamacare networks are now considered ‘narrow’ with few choices for patients, leading to many patients receiving ‘surprise bills.’"

TPA says its campaign in Kentucky, Kansas, Texas, and New York is intended to thank McConnell "and like-minded lawmakers for standing up for patients and opposing the federal government dictating health-care prices across the country."

The proposed legislation "doesn’t set actually set rates for out-of-network procedures, but instead sets benchmarks for how much out-of-network providers can collect if a surprise bill shows up," health journalist Trudy Lieberman notes. "But in a TV ad that lasts a few seconds, how would the viewer be able to make that distinction?"

This isn't the first time that a group with undisclosed sources of money has tried to mischaracterize the issue of surprise billing. Last summer, a "dark money" group called Doctor Patient Unity ran an ad campaign in Kentucky and other states saying that Alexander's bill would hurt patients and help insurance companies. The campaign targeted McConnell, Sen. Rand Paul and six other senators.

Tuesday, January 21, 2020

Catholic hospital near Ashland to close, costing 1,000 jobs

Our Lady of Bellefonte Hospital opened in 1953. (Ashland Daily Independent photo)
Our Lady of Bellefonte Hospital in the Ashland suburb of Russell will close by Sept. 30, says the Bon Secours Health System, which operates it. The 214-bed hospital opened in 1953, when Ashland and Russell were booming with steel, railroad and petrochemcial industries.

Now, the hospital cannot "effectively operate in an environment that has multiple acute care facilities competing for the same patients, providers and services," according to a Bon Secours press release paraphrased by Aaron Snyder of The Daily Independent in Ashland. The Ashland hospital market is dominated by 486-bed King's Daughters Medical Center.

"Approximately 1,000 employees are affected," Snyder reports. "There are no immediate job cuts, according to OLBH."

State Rep. Danny Bentley, a Republican from Russell, called it “devastating news for our community. We have so many critical health care needs that are best met by a local facility. I served as a volunteer hospital board member for nine years under its previous ownership and I have seen first-hand the impact this facility makes on Greenup County. My greatest fear is that if we can’t find a way to prevent it from closing, we will never see it reopen.”

Bentley, a pharmacist, said he has asked Democratic Gov. Andy Beshear to work with him and local officials to keep the hospital open.

Bon Secours, whose name is French for "safe harbors," owns Lourdes Hospital in Paducah and Marcum and Wallace Memorial Hospital in Irvine. It acquired those hospitals when it absorbed Mercy Health, another Catholic chain, in a merger less than two years ago.

Jason Asic, OLBH’s interim president, said in the release, “We will work closely with area employers to identify opportunities close to home. In addition, we are establishing partnerships across the Tri-State to help those who may want to explore a different career.”

Kristie Whitlatch, president and CEO of King’s Daughters, said in a statement, “King’s Daughters and Our Lady of Bellefonte hospitals have served eastern Kentucky and southern Ohio for a very long time and we are deeply saddened by today’s news. Their employees, physicians and volunteers are our friends, relatives and neighbors. King’s Daughters will work with Our Lady of Bellefonte, its leadership and team to find any and all opportunities to keep jobs and health care local. We will provide more information related to both very soon. Making sure our community has access to quality healthcare services now and in the future is our No. 1 priority.”

Monday, January 20, 2020

Dentist gives warning signs of oral cancer, 'not always definitive'

By Dr. Shelley Shearer

There are nearly 50,000 new cases of oral cancer in the United States each year, accounting for 3 percent of all cancer diagnoses. Most are discovered in a dental office.

Oral cancer is caused by the uncontrolled growth and reproduction of cells in some regions of the mouth. It can occur inside the cheeks, under the middle and front of the tongue, or on the tissue lining of the mouth or gum. That’s why it is worthwhile to ensure that people know the symptoms, causes and risk factors.

Shelley Shearer
Early detection and treatment of oral cancer can help prevent the cancer from developing further or spreading to other areas. Be sure to tell your dentist is you have experienced any of the following for more than two weeks:
• difficulty chewing or swallowing
• a lump or sore area in the mouth, throat or on the lips
• a white or red patch in the mouth
• difficulty moving the tongue or jaw
• unexpected weight loss
• a sore or ulcer that does not heal or bleeds
• tenderness, pain, or lumps anywhere in the mouth or on the lips.

These are not always definitive signs of oral cancer and may be caused by other conditions, such as an allergy or an infection. But it’s better to check out these occurrences before it’s too late.

Patients often ask what causes oral cancer so they can try to avoid it. Here are some of the main causes and risk factors:
• Tobacco and alcohol use: Any form of tobacco use involves carcinogenic substances entering the mouth, which significantly increases the risk for oral cancer. Excessive alcohol use can also increase the risk.
• Age: The risk of oral cancer increases with age, with the average age of diagnosis at 62 years old.
• Human papillomavirus (HPV): This is a sexually transmitted infection that has strong associations with several forms of oral cancer.
• Sun exposure: The sun emits rays that can burn the lips and trigger the development of oral cancer.
• Gender: Males are more than twice as likely to develop oral cancer than women. Researchers have yet to discover a reason why.

As with most other cancers, it is not always possible to prevent oral cancer. Some risk factors for oral cancer, such as being male or aging, are not preventable. However, consider some lifestyle factors that can reduce the risk of oral cancer such as:
• avoiding tobacco
• consuming alcohol in moderation
• maintaining a healthy diet
• using screen around the mouth and a balm on the lips when exposed to sun
• exercising regularly
• maintaining good oral hygiene by brushing and flossing twice a day
• regularly visiting a dentist for check-ups.

Conduct Your Own Self-Check: Just as women take time for a monthly breast self-exam, those with oral cancer risk factors should conduct their own self-check.

First, look at and feel your head and neck in a mirror. Do the left and right sides of the face have the same shape? Are there any lumps, bumps, or swellings that are only on one side of your face? Also view the skin on your face for changes in color or size, sores, moles or growths. To check the neck, press along the sides and front of the neck for tenderness or lumps.

Lips and cheeks can reveal much as well. Pull your lower lip down and check for sores or color changes. Then use your thumb and forefinger to feel the lip for lumps, bumps, or changes in texture. Repeat this on your upper lip. Examine your inner cheek for red, white, or dark patches. Put your index finger on the inside of your cheek and your thumb on the outside. Gently squeeze and roll your both sides of your cheeks between your fingers to check for any lumps or areas of tenderness.

Often the roof of the mouth is an indicator that something is off. Tilt your head back and open your mouth wide to look for any lumps and see if the color is different than usual. Touch the roof of your mouth to feel for lumps. Extend your tongue and look at the top surface, sides and underneath for lumps, swelling or changes in color and texture.

Tell your dentist if you suspect anything unusual in your mouth. Catching oral cancer early can save time, money and most importantly, your life.

Shelley Shearer is founder of Shearer Family and Cosmetic Dentistry in Florence, and wrote this for the Northern Kentucky Tribune and KyForward.

Saturday, January 18, 2020

Flu cases dip a bit in new year, are still much higher than last season; 21 have died from flu in Kentucky; a shot still protects

By Melissa Patrick
Kentucky Health News

Influenza has killed 21 people in Kentucky this season, two under the age of 18, according to the state Department for Public Health.

The latest weekly report shows that the flu activity in the state has dropped a bit in the first two weeks of the year, compared to the last two weeks of 2019, when the state was reporting more than 2,000 new cases each week.

In the week ending Jan. 11, the last week for which the state has issued a report, Kentucky had 1,898 new cases. During the flu season, which can last through May, 10,004 cases have been confirmed in Kentucky.

At the same time last year, Kentucky's flu statistics were much less concerning; the state had 3,148 lab-confirmed cases and nine deaths, one of a minor.

The number of flu cases in Kentucky is higher than the confirmed number since the surveillance report only shows a sampling of cases throughout the state, and 10 of the state's 120 county health departments did not report.

Because flu is not a disease that has to be reported, the state relies on reporting from "sentinel sites," a network of doctors' offices, hospitals and health departments that voluntarily submit their flu data, so the state does not track every case of flu in Kentucky, said Beth Fisher, a spokeswoman for the state Cabinet for Health and Family Services, said in an email.

A health department fact sheet says, "The sampling represents only a small percentage of influenza cases for the state, but contributes to the ongoing assessment of flu activity in Kentucky and helps determine the level of flu activity in the state each week.

So far, most of Kentucky's cases have been in children between the ages of 1 and 10, likely because a strain of the virus called type B/Victoria has been the predominant virus this season, and children are highly vulnerable to it, according to the Centers for Disease Control and Prevention. The B/Victoria strain normally doesn't show up until March or April.

The CDC says that in recent weeks, approximately equal number of type B/Victoria and type A (H1N1) viruses have been reported.

The health department's Troi Cunningham urged Kentuckians to get a flu vaccine, which is the best defense against it. "It is not too late to get the flu shot," she said in an e-mail. "Get it now. It takes two weeks for it to full take effect."

The CDC says everyone over six months old should get a flu shot each year.

Cunningham particularly urged pregnant women to be diligent in getting their flu shot because the immunity is transmitted to their infant while the baby is still in the womb and can protect them at birth. "CDC research shows a child's risk of dying from the flu can be reduced by 50 percent or more by getting the vaccine," she said.

Four Eastern Kentucky schools canceled classes last week due to widespread illness. Wolfe, Owsley and Lawrence county schools were closed Jan. 15-17. Beth Musgrave reports for the Lexington Herald-Leader. Pike County schools were closed Friday, Jan. 16, Hazard's WYMT-TV reports. Classes were scheduled to resume on Tuesday, Jan. 21, after the Martin Luther King Jr. holiday. The schools did not say what the illness was, but flu is widespread throughout the state.

On Jan. 16, acting in response to the flu, the University of Kentucky restricted visitation at its hospitals, including: no visitors under age 12; none under 18 in the bone-marrow transplant area; only two visitors per patient room at a time; no visitors with flu-like symptoms; and some visitors may be asked to wear a mask or other protective clothing while visiting.

Compassionate exceptions will be made case by casem and additional restrictions may be in place in some units, a UK HealthCare news release said.

The Herald-Leader reports that Eastern State Hospital also implemented visitation restrictions.

Pike County continued to be among the hotspots for flu in the week ending Jan. 11, with 101 new cases, for a total of 452. Perry County, a major hotspot this season, had 44 more cases during the week, for a total of 639. Adjoining and less populous Leslie County added 25 for a total of 208. Warren added 84 and Barren 58, for respective totals of 351 and 400.

MMWR is the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

Friday, January 17, 2020

Medical marijuana advocates more hopeful it will pass, but main foe still cites lack of evidence; bill asks feds to do more research

By Melissa Patrick
Kentucky Health News

A bill to legalize marijuana for medical purposes has been filed in the Kentucky General Assembly, with great hopes by advocates in the House, but the Senate remains a tough sell. image
The bill's prime sponsor, Rep. Jason Nemes, R-Louisville, told Tom Latek of Kentucky Today that support for the measure is growing and he's optimistic it will pass this year.

"We've talked about it in the Republican Caucus and the majority of the caucus supports it," he said.

House Bill 136 offers a list of qualifying medical conditions for which marijuana can be prescribed, such as terminal illness and epilepsy, but doesn't limit prescribing to those conditions and allows physicians to prescribe marijuana to their patients as long as they have a "bona fide" relationship.

So far, the bill has 42 sponsors, including House Speaker David Osborne. It has been assigned to the House Judiciary Committee.

Senate President Robert Stivers, R-Manchester, has said that he wouldn't support a medical marijuana bill without medical studies to back it up. Few such studies have been done, and they don't appear to provide the sort of evidence that Stivers says he is seeking.

The annual Foundation for a Healthy Kentucky policy forum, held in September, focused on what the science says about medical marijuana, and the general consensus from leading researchers is that medical benefits haven't been proven and more research is needed.

Marijuana is legal medicine in 33 states and the District of Columbia. Recreational marijuana is legal in 10 states, most recently Illinois, the first bordering Kentucky.

Rep. Danny Bentley
House Concurrent Resolution 5, which asks the federal government to expedite research on the safety efficacy of medical marijuana, cleared the House Health and Family Services committee Jan. 16. This is the fourth year row Republican Rep. Danny Bentley has filed the resolution.

To conduct research on marijuana's medicinal properties, the federal government would have to move marijuana from a Schedule I, a list of drugs with no medicinal use, to Schedule II.

"I'm asking for safety and efficacy on a chemical where a plant has five to six hundred compounds in it and close to 600 related to THC," said Bentley, a pharmacist from Russell in Greenup County. "Safety and efficacy is my concern." THC stands for tetrahydrocannabinol, the psychoactive ingredient in cannabis.

Bentley expressed concerns about the increasing strength of cannabis products and noted some untoward side-effects that are often overlooked, including the dangers of using it during pregnancy, its affect on the developing IQ of a young person, heart attacks, respiratory issues and the increased risk of schizophrenia, marijuana-use disorder and cannibinoid hyperemisis syndrome.

"It's not your grandma's marijuana," he said.

Bentley assured his colleagues that his resolution would have no effect on Kentucky law in the event a medical marijuana bill was passed. "This is a concurrent resolution asking that they do more research," he said. Later adding, "I'm not against the drug, I'm for the safety of the people of the commonwealth," referring to the state's constitution that also calls for "safety and happiness."

A medical marijuana bill passed the House Judiciary Committee 16-1 last year, but with only five days left in the legislative session and opposition in the Senate, it did not get a vote on the House floor.

Democratic Gov. Andy Beshear has voiced his support of medical marijuana and has indicated it could also be taxed as a way to bring in some much needed revenue to the state -- though this doesn't seem likely to happen, because Republicans who control the legislature say it shouldn't be taxed.

At a Jan. 15 press briefing by House Republican leaders to discuss the bill, Osborne said, "There's truly no interest in taxing medicine."

Sen. Chris McDaniel, chair of the Senate Appropriations and Revenue Committee, said in December that if medical cannabis was deemed to be "a pharmaceutical, we don't tax pharmaceuticals in this state, and we're not going to start." Prescription drugs are exempt from the state sales tax.

The bill's primary sponsor also does not support taxing it as a way to generate revenue for the state.

"At the retail level, we don't want to tax it," Nemes told Spectrum News. "We don't want to make a dollar off of medical marijuana because if you do that, you make it off of the back of sick people and poor people."

The bill would tax marijuana growers and processors at 12 percent, but would not tax dispensaries.

The money from these taxes would go into two medicinal-marijuana trust funds, with 80% going to a state fund and 20% to a local fund. The money could be used for the cost of police enforcement, to help people who need a marijuana prescription but can't afford it, and costs of running the program.

The bill would also allow municipalities to prohibit marijuana businesses from setting up in their jurisdictions.

Rep. Jason Nemes
Nemes explained some of the details of the bill in a Jan. 15 interview with Tom Latek with Kentucky Today.

He told Latek that the bill does not allow smoking marijuana, and is mostly for pills and oils, with an opportunity for inhalers. "This is a no-smoking bill," he said. And the food forms of the products cannot be in any form that is attractive to children, like gummies or suckers, he added.

The bill will require physicians who want to prescribe medical marijuana to be approved by the state Board of Medical Licensure, and be logged into the prescription-drug monitoring program KASPER, which stands for Kentucky All Schedule Prescription Electronic Reporting.

Nemes added that the patient must have a "bona fide physician-patient relationship" to get medical marijuana, but "If the physician says it will help, then the patient can get a medical marijuana card," he told Latek.

The bill also has rules governing those who would test, grow, process and dispense the products, and local law enforcement will have access to everything, he said.

If approved, the medical marijuana program would start Jan. 1, 2021.