Kentucky Children's Hospital at UK opens center to treat children who are harmed by abuse and neglect, in which Ky. ranks 14th

University of Kentucky and Kosair for Kids representatives celebrate opening of the Kosair for Kids Center for Safe & Healthy Children & Families at Kentucky Children's Hospital. (Photo by Adam Padgett)

By Hilary Brown
University of Kentucky

Representatives from Kentucky Children’s Hospital and the nonprofit foundation Kosair for Kids cut the ribbon recently on the Kosair for Kids Center for Safe & Healthy Children and Families, a new clinic space for the treatment of children harmed by abuse and neglect at KCH, part of the University of Kentucky. This center was made possible by a $2 million gift from Kosair for Kids.

“I’ve spent the better part of my career looking at the challenges that Kentucky faces, especially when it comes to the ability of vulnerable Kentuckians to get care they desperately need,” said Mark D. Birdwhistell, vice president for health system administration and chief of staff, UK HealthCare. “I’ve seen how hard it can be to effect change for Kentucky’s vulnerable citizens, and that’s why I’m so proud of this new center and of what we’ve been able to accomplish with the partnership of Kosair for Kids.”

Kentucky ranks 14th in the country for child abuse and neglect; according to the state Cabinet for Health and Family Services, in 2022, 11,002 children experienced neglect, 1,146 suffered physical abuse and 756 were victims of sexual abuse. Those numbers have decreased over the years, due largely to the efforts of Kosair for Kids and their partners across the state.

“Today we celebrate opening a center dedicated to giving the best to children who have experienced the worst, said Barry Dunn, Kosair for Kids president and CEO. “Our goal, our aspiration, is that this center serves as a beacon of hope for children who have experienced unfathomable trauma. We stand with them, united in purpose, on the road to healing. We are proud to call them a Kosair Kid, and we want to show them the love and care they deserve. Kosair for Kids is proud of this place, the skilled and dedicated staff on the front lines of this epidemic, and the growing alliance we have formed to protect all children.”

“I’m an ardent believer that you can’t separate physical health from mental and emotional health,” said Dr. Scottie B. Day, physician-in-chief at Kentucky Children’s Hospital. “Maltreatment and childhood trauma have effects that ripple out into adolescence and adulthood and continue to inform patterns of behavior for generations. Through our partnership with Kosair for Kids, we can disrupt generational cycles of abuse and make Kentucky much safer for kids.”

KCH is home to one of only two pediatric forensic medicine programs in Kentucky. Of the five child-abuse pediatricians practicing in Kentucky, four are at KCH’s Division of Pediatric Forensic Medicine along with specially trained advanced nurse practitioners, social workers and psychologists.

Features of the new clinic include:

• Secure and private space to provide trauma-informed care, including three exam rooms and two therapy services rooms
• Proximity to the Makenna David Pediatric Emergency Center and other services such as radiology and sedation with private entrance and egress to those sites
• Space for therapeutic interventions, evidence storage and consultation with law enforcement and other partners
• Technology to consult virtually with the child’s care team which may include state child protective services, guardian ad litem and law enforcement.

The pediatric forensics staff also provides regular education to medical students, family medicine providers as well as community organizations. They developed a core curriculum for the Department of Community Based Services in the Cabinet for Health and Family Services that includes 16 one-hour lectures. Forensics providers lead a multi-hour training to each new class of Kentucky State Police cadets, as well as continued education to healthcare providers in the community.

Children who are abused and neglected may suffer immediate physical injuries, but also may have emotional and psychological problems, such as anxiety or posttraumatic stress. Over the long term, children who are abused or neglected are also at increased risk for experiencing future violence victimization and perpetration, substance abuse, sexually transmitted infections, delayed brain development, lower educational attainment, and limited employment opportunities. Chronic abuse may result in toxic stress, which can change brain development and increase the risk for problems like posttraumatic stress disorder and learning, attention, and memory difficulties.

All Kentuckians are mandated reporters of child abuse and neglect. If you believe a child is being abused or neglected, call the Child Protection Hotline at 1-877-KYSAFE1 or 1-877-597-2331 or report online.

Attorney general has online form to report Medicaid fraud, abuse

Kentuckians have a new tool for reporting suspected Medicaid fraud and patient abuse to the Office of the Attorney General. They can now electronically report abuse, neglect, and exploitation by completing an online complaint form located at ag.ky.gov/medicaidfraud.

“Providers who fraudulently bill Medicaid for healthcare goods and services steal taxpayers dollars and can endanger the health and welfare of beneficiaries,” Attorney General Daniel Cameron said in a news release. “We want to ensure our seniors are treated with dignity and respect by making it easier for Kentuckians to report suspected fraud and abuse.”

The new form allows Kentuckians to submit complaints from electronic devices, including smart phones, computers, and tablets. It allows users to mark their complaint as related to Medicaid fraud, patient abuse, or both, and prompts them to provide information such as the facility, the health-care provider’s information, the patient’s name, and the suspected abuser’s name.

"While Kentuckians are encouraged to report as many details as possible when completing a complaint, the Medicaid fraud and abuse form allows the reporting party to choose to include their name or to remain anonymous," the release said.

"In addition to the newly developed online form, Kentuckians may also report suspected Medicaid fraud and abuse by calling the Attorney General’s Medicaid Fraud and Abuse Hotline at 1-877-ABUSE TIP (1-877-228-7384). Kentucky law requires any person who knows or has reasonable cause to believe that Medicaid fraud or abuse is being committed to report it to the Medicaid Fraud and Abuse Hotline. Any person who reports the offenses of another in good faith is given immunity from civil or criminal action. Moreover, any person who makes a good-faith report is protected from discharge, discrimination, or retaliation in the workplace."

New AG vows to fight child abuse (Ky. ranks No. 1 in it); child-advocate groups want changes in state laws to protect children

Kentucky's new attorney general called a press conference to declare his office's commitment to partner with child-advocacy organizations and state and federal prosecutors to prevent child abuse, and to prosecute abusers to the fullest extent of the law.

Atty. Gen. Daniel Cameron spoke at a press conference
about child abuse. (Louisville Courier Journal photo) 

"We are No. 1 in child abuse and neglect, and that has to stop, especially as we move into the new decade," Attorney General Daniel Cameron said at a press conference with Kentucky Youth Advocates in Louisville Jan. 7.

Kentucky has ranked first or second for each of the past six years for child maltreatment and has ranked among the 10 worst states for more than a decade, Deborah Yetter reports for the Louisville Courier Journal.

Yetter reported in August, in a story titled "Tortured and Abused: Why Kentucky can't stop hurting -- and killing -- its children," that federal statistics show Kentucky has the nation's highest rate of child abuse or neglect, with some cases so severe an independent panel has classified them as "torture."

In September, Yetter reported that the number of Kentucky children killed or nearly killed from abuse or neglect is likely even higher than what the state reports to the federal organization that compiles the data. "In some cases, Kentucky social service officials decline to classify the deaths as caused by abuse or neglect, therefore keeping the numbers lower," she wrote.

In 2017, Kentucky reported 16 deaths and 56 near-deaths of children from abuse or neglect. In 2018, 24,066 Kentucky children were victims of abuse or neglect, KYA said in a news release.

Substance abuse and addiction occur in as many as 70 percent of the cases investigated by the Cabinet for Health and Family Services, Yetter reports.

Keith Inman, president of Kosair Charities, asked for the public's help in identifying, reporting and helping prevent child abuse. Six years ago, Kosair founded the Face It Movement to end child abuse in Kentucky, which now includes more than 100 groups, Yetter reports.

Cameron said his office will develop a prosecutor's manual to help commonwealth's and county attorneys statewide better prosecute adults for abuse and neglect of children.

KYA Executive Director Terry Brooks said Face It will seek several changes in state law, including removing the clergy-penitent exemption for child abuse so clergy can report it to the authorities; clarifying rules around mandatory reporting of child abuse, to keep an agency from investigating itself; and tightening the rules for home schooling so that parents suspected of abusing or neglecting children can't remove them from school and claim to be home schooling in order to avoid scrutiny.

KYA would also like to reform the county-coroner system, with more training of the elected officals and standardized systems of investigating and reporting child deaths, Yetter reports.

Learn more about Face It’s 2020 policy priorities at faceitabuse.org/policy/. If you suspect child abuse or neglect, make a report at 1-877-KYSAFE1.

Domestic abuse is about as common in male couples as in heterosexual couples, study in three major cities finds

Pride photo

Around half of American men in a three-city survey said they experienced abuse in their same-sex relationships -- about the same percentage reported by women, a new study shows.

The study at the University of Michigan surveyed 160 male couples in Atlanta, Boston and Chicago. It found that 46 percent said they experienced physical, emotional, sexual, or control abuse from a partner. Research on domestic violence usually only surveys the assumed victims (usually women in opposite-sex couples), this researched surveyed both perpetrators and victims.

"We're stuck in this mental representation of domestic violence as a female victim and a male perpetrator, and while that is very important, there are other forms of domestic violence in all types of relationships," said Rob Stephenson, a UM professor. He said about 25 to 30 percent of male-only relationships include violence, around the same as female victims in heterosexual relationships.

The study found that male couples, while facing many of the same challenges that heterosexual couples face such as financial problems or drug abuse, also face homophobia, a challenge unique to same-sex couples. Sometimes, the homophobia comes from within, when one member of the couple is struggling with his identity, Stephenson said. Such a man "might lash out at his partner with physical or emotional abuse as a stress response behavior—similar to heterosexual couples, where an unemployed man lashes out at his female partner because he feels inadequate," a UM press release said.

The research also shows a correlation between HIV prevention and abuse, said Stephenson, because men who are in abusive relationships may not be able to negotiate for condom use, when or how they have sex, or communicate their HIV status.

59 percent of Ky. adults have experienced at least one adverse childhood experience, linked to physical and mental health issues

Robert Wood Johnson Foundation illustration

By Melissa Patrick

Kentucky Health News

Many health-care providers have started looking at adverse childhood experiences when assessing their patients' poor health because ACEs have been linked to risky health behaviors, chronic health conditions, low life potential and early death, and because 59 percent of Kentucky adults were exposed to at least one such experience as a child.

"There are things that happen to us early that make a huge difference in what happens to us as we get older," Dr. Connie White, senior deputy commissioner for the Kentucky Department of Public Health, said at a March 22 meeting in Frankfort to prioritize the state's top health issues.

ACEs are "potentially traumatic events that can have negative, lasting effects on a person's health and well-being, including early death," the department says. They include: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, a mother being treated violently, parental separation or divorce, substance misuse within the household, mental illness in the household, and having an incarcerated household member.

White said it is important for children to live in a secure and nurturing environment during the first two years of their life because this is when brains are "hard-wired" for social-emotional development. But she said it is just as important for children to grow up in an environment that is free of traumatic events.

"It's like building a house," she said. "There is a foundation, and if you don't start out with a very good foundation you are going to have a very unstable house."

White said children who grow up with ACEs often struggle academically and behaviorally.

"These children have impaired memory, they have an inability to concentrate, it's hard for them to stay seated, it's hard for them to follow directions, they are constantly on edge, they are easily provoked and they are impulsive because of the toxic stress they have at home," she said. "So these are children that are hard to deal with and I think the folks in our judicial system see these children all the time."

At least one program in the state is working to inform educators on how to deal with ACEs. The Louisville program, called the "Bounce Coalition," provides training on ACEs and resiliency to school staff and out-of-school activity providers in two Jefferson County public schools and will soon expand to three more and more than 500 YMCA programs this spring. This work, funded by a grant from the Foundation for a Healthy Kentucky, is expected to evolve into a state model for addressing ACEs.

Research shows that the impacts of ACEs don't end in childhood. The original ACE study, conducted by the Centers for Disease Control and Prevention and Kaiser Permanente, found a clear scientific link between many types of childhood adversity and the adult onset of physical disease and mental health disorders.

The report said that as the number of ACEs increases, so does the risk for things like alcohol abuse, chronic disease, poor work performance, financial stress, domestic violence, suicide and poor academic achievement, to name a few. It also found that people with six or more ACEs died nearly 20 years earlier than those without ACEs.

Kentucky just started surveying for ACEs on its 2015 Behavioral Risk Factor Survey. The poll found that 59 percent of Kentucky adults had experienced one or more ACEs, 64 percent had two or more and 17.5 percent had experienced four or more, higher than any other state that surveys for ACEs.

Kentucky's survey found similar results as the original national study, showing that the more ACEs a Kentucky adult had, the more likely he or she was to have smoked cigarettes, use and abuse alcohol use, bear or father children in their teens, attempt suicide during adolescence, have chronic depression as an adult, have impaired work performance, and have many chronic diseases.

"So this is an issue that I think we all need to be cognizant of so that we are not asking people what's wrong with you, but we start to think what happened to you and how did you get where you are right now," White said, noting that it is never too late for a person to learn how to be more resilient.

She added: "We can't go back and fix what's happened, but we can work on trying to figure out where people are coming from and how we can help them be better."

Senate OKs bill for review panels in medical lawsuits after lively debate between doctors, lawyers, others

This story, which was published Thursday morning, has been updated with action in the full Senate.
By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- The Senate has approved a bill that advocates say will help weed out "frivolous" medical malpractice lawsuits and speed up litigation for legitimate suits.

Alvarado

"Right now, Kentucky has one of the nations most litigation-friendly environments, making our commonwealth a prime and profitable target for personal injury lawyers preying upon our health care providers," Sen. Ralph Alvarado, R-Winchester, a physician and sponsor of Senate Bill 6, told the Senate Health and Welfare Committee. Opponents disputed that claim.

The Senate passed the bill Thursday 24-12. It is not expected to pass the House.

The bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court but not legally binding.

The Republican-controlled Senate passed a very similar bill last year but it got nowhere in the Democrat-controlled House, and its prospects are similar this time. However, Wednesday's committee meeting provided a detailed and lively explication of the issue, lasing almost two hours.

Vanessa Cantley, a Louisville personal injury attorney, told the committee that most medical malpractice cases are legitimate. She cited a Harvard University study published in the New England Journal of Medicine that concluded "portraits of a malpractice system that is stricken with frivolous litigation are overblown" and reported that 97 percent of claims for medical injury evaluated over a decade were deemed to be meritorious.

However, Michael Sutton of Louisville, a civil defense attorney, said defendants win 80 per cent of medical malpractice suits.

Cantley said there are 2,700 deaths in Kentucky each year due to purely preventable medical error, but, according to the state Department of Insurance, fewer than 500 lawsuits a year are filed by abuse and neglect victims. She spoke for the Kentucky Justice Association, formerly the Kentucky Academy of Trial Attorneys.

Alvarado and other opponents argued that Kentucky has become a haven for such lawsuits and bills like his have helped deter them. "Medical review panels are a proven solution for limiting baseless claims brought by a personal injury lawyer to ensure a faster, more efficient path for patients with legitimate claims, " he said.

Alvarado said the state is 4,000 doctors short of its need and the legal climate in Kentucky makes it hard to recruit and retain doctors. Sen. Julie Raque Adams, R-Louisville, the committee chair, said the expansion of Medicaid in Kentucky makes it all the more important to make the state attractive to doctors. "Anytime there's a paradigm shift, there are other policies that  need to go along with that paradigm shift," she said.

Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, said review panels "will stabilize our medical malpractice system and make our state more attractive" and "protect the legitimate cases while weeding out the meritless claims," which increase costs to consumers and employers through higher premiums and defensive medicine in the form of extra medical tests.

Kentucky's constitution bans laws that would cap damages

in lawsuits. (Care First Kentucky graphic)

Every state surrounding Kentucky offers some level of protection against medical malpractice, while Kentucky offers no legal protections for healthcare providers, according to Care First Kentucky, a business coalition supporting the bill.

Sen. Reggie Thomas, D-Lexington, a lawyer, argued that Kentucky already has laws to punish attorneys for filing frivolous cases. Alvarado said the rule isn't used much because judges "allow a lot of latitude," and Sutton said it is reserved for "really egregious conduct."

Cantley argued, subtly, that courts are the refuge for patients who suffer from abuse, neglect and malpractice. She said the federal Centers for Medicare and Medicaid Services has ranked Kentucky No. 1 in nursing-home deficiencies, and argued that state boards that discipline doctors do a poor job.

The full Senate's debate on the bill was cut short because the committee adopted a substitute version, preventing Democratic Leader Ray Jones of Pikeville, a plaintiffs' lawyer, from offering any of his amendments, which had been drafted to the original bill. Under traditional procedures, a bill gets its required readings on days between the committee meeting and the floor vote, but in recent years Republicans have given important bills readings before committee action, allowing a vote on them the day after they pass a committee.

First lady speaks out on behalf of domestic-violence victims; Ky. is one of four states without protection for date-violence victims

First Lady Jane Beshear pointed out the accomplishments of the anti-domestic violence movement in Kentucky this week, and spoke the names of 26 women who had died at the hands of their abusers this year. With that, she then announced that October would again be Domestic Violence Awareness Month in Kentucky.

“Nearly one-third of all American women report being abused at some point in their lives. Abuse affects more than just individuals -- families and communities suffer, too,” said Beshear. “Domestic Violence Awareness Month is the opportunity for all Kentuckians to learn how to recognize the signs of domestic abuse and to show support for victims as they work to regain control of their lives.”

Kentucky is one of only four states that do not provide protection for victims of dating violence. “In celebrating the successes of the Violence Against Women Act, we must acknowledge the work still left to do,” said KDVA President Anne Perkins, who also serves as executive director of Safe Harbor, a regional domestic violence program in Ashland.  She called on state legislators to pass a new dating violence bill during the next legislative session. Research shows that young women between the ages of 20 to 24 are at greatest risk of intimate partner violence.

New state web portal eases non-emergency reporting of child and adult abuse and neglect

The state Department for Community Based Services has launched a web-based portal for reporting child and adult abuse and neglect in non-emergency situations. According to DCBS Commissioner Teresa James, the new system should enhance the current intake system, especially for those situations that do not require an immediate response from the department's staff.

Law enforcement and judicial officials, medical professionals, educators, child and senior caregivers and other advocates have been using the program since July, giving feedback to DCBS staff to help refine the system for the general public. According to the Cabinet for Health and Family Services press release, "Users of the portal are required to enter an email contact and will receive an immediate, automated response that their online report has been made. Centralized intake staff will review reports as they are submitted. Users will receive a response message within 48 hours only if their report has not been accepted because it doesn’t meet criteria for investigation. Reports that are accepted do not generate a follow-up email message. The reporting portal has several mandatory input fields so that intake staff can get adequate information about the incident, the alleged victim, the alleged perpetrator and any safety issues in order to screen reports effectively."

The site, https://prd.chfs.ky.gov/ReportAbuse/home.aspx, will be monitored from 8 a.m. to 4:30 p.m. ET Monday through Friday. Reports will not be reviewed during evenings, weekends or state holidays.

If situations arise during these times indicating a child or adult is at risk of immediate harm, these should be reported to 911, local law enforcement or 877-KY SAFE1. Calls are anonymous. If the report meets the criteria for abuse, an investigation is conducted within 24 hours in most cases or, if the child is suspected to be in immediate danger, they are conducted within the hour. Callers should try to know the child's name, approximate age, address, parents' names and location of the child when the call is made. They should also have names and phone numbers of other people who have information about the suspected abuse.

 

Cost is one obstacle for bill that would require coroners to look into nursing home deaths

A bill that would require coroners to be called when someone dies in a nursing home may be in jeopardy. At issue is how to pay for it.

Chief State Medical Examiner Tracey Corey estimates she would need three more doctors, more support staff and more equipment if even 10 percent of deaths needed investigation, the Lexington Herald-Leader's Valarie Honeycutt-Spears reports.

House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, right, would require a nursing home or hospice staff member to alert a coroner about a death on the premises within 24 hours. If they, and they alone, suspect abuse, coroners would be required to inform law enforcement authorities or prosecutors. The aim is to determine if abuse or neglect might have occurred.

"But Burch said if Corey's financial concerns lead to the bill being sent to the committee making decisions about state spending, he think it 'means sudden death' for the legislation," Honeycutt-Spears reports.

Burch also said nursing home officials are balking at the bill's aim to increase the penalties for failing to report abuse or neglect. As of now, such a failure is considered a Class B misdemeanor, which carries a punishment of up to 90 days in jail and a $250 fine. The bill would change it to a Class A misdemeanor, which can result in up to 12 months in jail and a fine up to $500.

The bill would also mean long-term care facilities that fail to designate a staff member to report deaths to the coroner would be fined $200 a week. (Read more)