More health bills pass as legislative session ends; one would require doctor's OK to play student athletes after concussions

By Melissa Patrick
Kentucky Health News

Several more health-related legislation passed in the final two days of the General Assembly's session.

House Bill 524, sponsored by Rep. Addia Wuchner, R-Florence, to prevent and reduce human trafficking, passed without dissent in both chambers and now awaits action from Gov. Matt Bevin.

As often happens in the final hours of a legislative session, some unrelated measures were tacked onto the bill, including non-controversial legislation to more clearly define "serious physical injury" in child-abuse cases involving children under 13.

Several other health-related bills passed in the last days of the session and await action from the governor. Bills passed after the veto period are not eligible to be overridden by the General Assembly, so Bevin's decision on these bills will be final. They include:

HB 333, sponsored by Rep. Kim Moser, R-Taylor Mill, would limit most painkiller prescriptions to a three-day supply for acute pain, and change how synthetic-opioid traffickers are prosecuted.

HB 78, sponsored by Rep. Jim Duplessis, R-Elizabethtown, to require providers of standard mammograms to notify patients if they have "dense breast tissue" when appropriate, because such tissue can hide cancers. The intent of the notice is to allow patients to decide with their provider if they need further screening.

HB 241, sponsored by Rep. John Sims, D-Flemingsburg, would require written clearance from a physician for a coach to play a student-athlete who has been diagnosed with or is suspected of having a concussion.

House Concurrent Resolution 48, sponsored by Walker Thomas, R-Hopkinsville, urges the U.S. Food and Drug Administration to withdraw its proposal to reduce the levels of N-nitrosonornicotine, or NNN, a carcinogen, in all smokeless-tobacco products sold in the U.S. Thomas's district is a home of dark tobacco, used in smokeless products, and Hopkinsville has a plant that makes such products.

Bevin has signed a bill to establish review panels for malpractice cases. SB 4 was controversial, pitting lawyers against doctors such as the sponsor, Sen. Ralph Alvarado, R-Winchester. It passed the House 51-45, with 11 Republicans joining 34 Democrats in voting no, even after substantial changes sought by opponents.

Under the new law, three physicians will say whether a suit against a health-care provider has merit before it could be filed in court. An attorney will chair the panel but not have a vote. The judge in the case would decide whether the panel's opinion could be admitted as evidence.

Also of note, the General Assembly overrode Bevin's veto of SB 91, which will allow judges to order mentally ill adults who meet strict criteria into an "assisted outpatient treatment" program, and confine them if they don't comply.

Legislature passes bills to name caregivers, help smokers quit; could still pass dense-breast notice and student-concussion bills

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Kentucky lawmakers have passed bills this year to make sure someone knows how to care for you when you leave a hospital, expand the role of pharmacists, increase access to smoking cessation, and offer some hope to terminally ill patients, among other health-related measures.

The bills now await Gov. Matt Bevin's signature or veto. Legislators will reconvene March 29 and 30 to reconsider any bills he vetoes; they could also pass additional legislation, but it would be subject to a veto without the opportunity for a override. Now that both houses of the General Assembly are controlled by the governor's party, such eleventh-hour legislation may be more likely.

Health bills that have passed

The "Kentucky Family Caregivers Act," Senate Bill 129, would require hospitals to record the name of a lay caregiver when a patient is admitted, notify that person when the patient is moved or discharged, and instruct the caregiver on the medical tasks he or she will need to perform when the patient goes home. The patient can decline this request. The bill, sponsored by Sen. Paul Hornback, R-Shelbyville. passed unanimously through both chambers and awaits the Governor's signature.

AARP, which supports this legislation, estimates that there are 650,000 family caregivers in Kentucky who save the state around $7 billion a year in health-care costs. AARP said in a statement that the bill will save even more money by improving post-discharge outcomes, reducing hospital readmissions and better allowing Kentuckians to recover at home, where they want to be.

The "Right to Try" bill, SB 21, also awaits the governor's signature. Sponsored by Sen. C.B. Embry Jr., R-Morgantown, it would make it easier for terminally ill patients to use experimental treatments. Terminal patients would be able to try drugs that have successfully completed the first phase of clinical trials but have not yet been approved by the U.S. Food and Drug Administration, with appropriate documentation from their health-care provider and approval of the drug company. The bill passed unanimously through the Senate and cleared the House 87-7.

"Right to Try" legislation has passed in 33 states and has been introduced in Congress, and has the support of Vice President Pence, Bloomberg News reports.

Kentucky lawmakers passed two bills that would expand the role of pharmacists.

SB 101, sponsored by Sen. Julie Raque Adams, R-Louisville, would allow pharmacists to administer all age-appropriate immunizations to minors aged 9 to 17. Current law allows pharmacists to administer flu vaccines starting at age 9, but for all other vaccines, pharmacists can only administer to minors starting at age 14. This bill unanimously passed both chambers and awaits the governor's signature.

SB 205, sponsored by Sen. Stephen Meredith, R-Leitchfield, would allow pharmacists to dispense a 90-day-supply of a non-controlled maintenance drug, such as those for blood pressure or high cholesterol, unless the prescription provides to the contrary. The bill passed unanimously in both Chambers and awaits the governor's signature.

Only one bill aimed at decreasing the state's high smoking rate has passed this session. SB 89, sponsored by Adams, would require all Kentucky health plans, including Medicaid, to provide barrier-free access to any smoking-cessation treatments approved by the U.S. Preventive Service Task Force. Some insurance companies have barriers to treatment, such as co-payments and prior authorizations. Bevin signed the bill March 21.

Health bills unlikely to pass

SB 78, which would have made Kentucky's schools 100 percent tobacco free, passed the Senate but couldn't get enough support among Republicans who control the House to be brought up in committee.

Two other bills aimed at protecting the health of children made no headway: House Bill 252, which would require an automated external defibrillator in every school; and HB 122, which would require children up to the age of 12 to wear a bicycle helmet.

Three bills that would increase the state's access to health-care providers also did not pass this session. SB 158 would repeal the requirement for nurse practitioners to work under a collaborative agreement with a physician to prescribe narcotics and some other controlled substances, and for the first four years of prescribing other drugs. HB 19 and SB 55 would have permitted physician assistants to prescribe and dispense controlled substance. The bills may have been hamstrung by the state's epidemic of opioid abuse.

Another bill that is dead this session is Senate Bill 108, dubbed the "Palliative Care" bill. This bill passed the Senate unanimously, but Rep. Addia Wuchner, chair of the House Health and Family Services Committee, says it needs more work. The bill's aim is to use training and education to increase access to palliative care, which is aimed at providing the best quality of life possible for patients with chronic or terminal diseases.

Health bills that could pass

One health bill likely to pass in the final two days is HB 78, which would require providers of standard mammograms to inform patients if they have "dense breast tissue" when appropriate, because such tissue can hide cancers. The notice would allow patients who have dense tissue the opportunity to determine with their provider if they need further screening.

Almost 40 percent of women have dense breast tissue, and some men do. They are twice as likely to develop breast cancer, Rep. Jim Duplessis, R-Elizabethtown, the bill's sponsor, said at the bill's hearings. The Dense Breast-info website says 27 states require some level of breast density notification after a mammogram. The bill passed unanimously through the House, passed a Senate committee and is before the full Senate.

Another bill that could pass would prohibit a coach from playing a student-athlete who has been diagnosed with or is suspected of having a concussion without written clearance from a physician. House Bill 241, sponsored by Rep. John Sims, D-Flemingsburg, passed unanimously in the House, passed a Senate committee and is before the full Senate.

This story was updated March 22.

Children and teens should see the doctor for any signs of a concussion; sometimes symptoms don't show up for several days

A person doesn't have to be knocked unconscious to have a concussion, so it's important to recognize the symptoms and seek medical attention quickly if warning signs appear.

Children hit their heads fairly often and are usually able to bounce back quickly, but that is less likely the older they get, according to Harris Health System, located in Texas.

“Children’s brains have the ability to regenerate after a concussion (or less serious head injury),” Dr. Shankar Gopinath, chief of neurosurgery at Ben Taub Hospital and associate professor of neurosurgery at Baylor College of Medicine, said in the news release. “Which is advice to be taken with a grain of salt, since parents should still consult their physician after an incident involving a head injury.”

Common Symptoms of a Concussion
graphic: The Children's Hospital of Philadelphia

A concussion is a mild form of a traumatic brain injury that occurs from a mild blow, bump or jolt to the head. Some people lose consciousness, but most do not. The leading causes of concussions are falls, motor-vehicle-related injuries, unintentionally being hit in the head with an object, assault or playing sports, says the Brain Injury Alliance of Kentucky website.

Concussion symptoms are similar in infants, children and adolescents, but there are some differences.

The most obvious symptom in infants is a loss of consciousness, but other signs include crying inconsolably, vomiting and excessive sleepiness. Refusing to eat, prolonged irritability or unusual or prolonged periods of quietness or inactivity are also signs of a concussion or a more serious injury, says the release. All of these symptoms call for an immediate trip to the doctor.

In addition to loss of consciousness, concussion symptoms in older children include severe headache, difficulty with bright lights or loud noises, blurred vision, trouble walking, memory loss, feeling mentally "foggy," confusion and saying things that don't make sense, slurred speech and unresponsiveness, irritability, sadness or nervousness and changes in sleep patterns, says the Brain Injury Alliance of Kentucky.

“Repeated concussions can cause permanent changes neurologically,” Dr. Asim Shah, chief of psychiatry, Ben Taub Hospital and professor at the Menninger Department of Psychiatry Baylor College of Medicine, said in the Harris Health release. “Sometimes even the ability to learn something new [cognition] lowers significantly.”

WebMD notes that symptoms of a concussion don't always show up right away, and can develop within 24 to 72 hours after an injury. And while most children and teens recover quickly from concussion, some symptoms, like memory loss, headaches and problems with concentration, may linger for weeks or months. You should also contact your doctor if symptoms are lingering.

Experts at Harris Health emphasized the importance of children and teens being treated quickly and checked by a physician when warning signs of a concussion appear. WebMD says: "An undiagnosed concussion can put someone at risk for brain damage and even disability."

Pre-season baseline testing helps diagnose concussions in football season; E. Ky. doctor has been offering test for 5 years

Many football players in Eastern Kentucky are getting a baseline test to determine their balance, memory and reaction times before they even compete in the first game of the season, so it can be compared to a similar exam during the season if they have a suspected concussion, Miranda Combs reports for Lexington's WKYT-TV.

Signs and Symptoms of Concussion
(graph from www.kyconcussions.com)

A concussion is a type of traumatic brain injury caused by a bump, blow or jolt to the head, according to the federal Centers for Disease Control and Prevention. All athletes who are involved in impact sports are at risk, Concussions are on the rise among high-school athletes and girls are more prone to them than boys in sports played by both sexes, according to the Brain Injury Alliance of Kentucky.

Dr. Gilliland of KDMC Sports Medicine in Ashland started doing baseline test, also called impact test, five years ago and can often be found on the sidelines of Friday night football games in the region. He does these test for 23 high-schools and three universities in Kentucky, Ohio and West Virginia.

Timothy McCoy, a football player for West Carter High School, is a prime example of how baseline testing works.Timothy was recently hit on the side of the head during a football game, and because he had completed a baseline test with Gilliland, it was determined that his reaction times had changed, verifying that he had a concussion, Combs reports.

Several days later, Gilliland did another evaluation and determined that Timothy no longer had a concussion and gave him the go-ahead to slowly return to the game.

"His reaction time is exactly where it was when he took his baseline test and that's reassuring to me," he told Combs.

Gilliland told Combs that concussions are "different for everybody" and last different lengths of time. He also noted that there had been a shift in public awareness about the seriousness of concussions.

"I think it says that the public is getting educated to this risk and I think it says that we are starting to accept that concussions may have more danger behind them than we had presumed. That doesn't mean that the public wasn't concerned about the issue, it's just the public wasn't educated about the issue" he said.

In 2012, Kentucky passed s sports-concussion law that requires concussion recognition training for coaches and athletic trainers and instigated return to play guidelines for scholastic sport leagues. Visit www.kyconcussions.com for more information.

UK researchers find surprising differences in teens' concussion symptoms and physical and emotional effects

University of Kentucky researchers have discovered surprising differences in symptoms student athletes experience following a concussion, a particular concern as high-school football season nears.

Lisa Koehl, a doctoral candidate in the university's Department of Psychology, and Dan Han, director of the Multidisciplinary Concussion Program at UK HealthCare, drew from a UK database of patients with brain injury and drew a sample of 37 athletes aged 12 to 17.

Koehl said in a press release that 22 of the 37 participants had emotional symptoms after suffering concussions. Among those with such symptoms, 23 percent also had sensitivity to light, while 14 percent had sensitivity to noise. Of the teens who did not have emotional symptoms, 13 percent had light sensitivity, but none of them had noise sensitivity.

Han said said participants who reported anxiety were 55 percent more inclined to have attention difficulties than those who didn't report anxiety. Teens who were irritable or aggressive were 35 percent more likely to report issues with attention those those who were not irritable.

The two groups did not show differences in how many experienced "loss of consciousness, amnesia, nausea and/or headaches, indicating that the groups were likely comparable in the level of the severity of concussion," the press release says.

Koehl said the research helped them understand how physical and emotional symptoms in concussion patients interact, with each causing the other in different cases. "Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school during recovery," Han said. (Read more)

Teens sensitive to light or noise after a concussion are more likely to suffer anxiety or depression, UK study finds

Teens who are sensitive to light or noise after a concussion may also have increased emotional symptoms, such as anxiety or depression, according to a study at the University of Kentucky.

“While most people recover from a concussion within a week, a number of factors affect their recovery, and studies have shown that teenage athletes may take up to seven to 10 days longer to recover than older athletes,” co-author Lisa M. Koehl said in a news release. "Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school.”

The study followed 37 athletes, ages 12 to 17, who had persisting symptoms for an average of 37 days following a concussion. They were checked for post-concussion changes in physical, emotional and cognitive symptoms. The study determined that there were no differences in the severity of concussions in the group, and that a family history of psychiatric problems did not affect post-concussion emotional symptoms.

But it did find that teens who are sensitive to light or noise after a concussion may also be more likely to have emotional symptoms, including irritability, aggression, anxiety, depression, apathy, frequent mood changes or excessive emotional reactions.

Of the 37 athletes studied, 22 had emotional symptoms, and of this group, five (23 percent) were sensitive to light while three (14 percent) were sensitive to noise. Of the 15 athletes with no emotional symptoms, only two (13 percent) were sensitive to light and no teens were sensitive to noise, according to the release.

"Teens who had anxiety were 55 percent more likely to self-report attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability," said co-author Dan Han. "While these findings are preliminary and require a larger sample size to predict outcomes with more confidence, we are intrigued by the potential these data offer in terms of providing teens with a better treatment plan based on their unique cognitive, physical and emotional response to concussion."

The researchers presented their findings at the American Academy of Neurology's Sports Concussion Conference in Chicago in July. Click here for more information about concussions.

Effects of concussions outlast symptoms, UK prof finds; another study says they affect thinking of teenagers more than others

A University of Kentucky assistant professor has found that the effects of a concussion may last longer than the symptoms, a finding that could influence how and when athletes are allowed to get back into a game.

Scott Livingston (UK photo), director of the UK Concussion Assessment Research Lab, used an electrophysiological measurement to arrive at his conclusion. With 18 college athletes, he placed electrodes on a limb while a magnetic-stimulating device was put over their head. They then received a brief pulse of magnetic stimulation to their brain. The amount of time it took for the athlete's limb to receive the response from the brain after the stimulation was then recorded. Nine of tyhe athletes had gotten concussions in the past 24 hours and nine had not.

The athletes were evaluated for 10 days, based on self-reported symptoms such as memory loss, headache and confusion; a computerized neurocognitive test; and the electrophysiological measurement. While symptoms from the concussion were greater within 24 to 72 hours after the injury and lessened over time as measured by self-reporting and neurocognitive testing, electrophysiological measurements show physiological changes increased as symptoms decreased.

Further investigation is needed, "especially to assess how long the disturbances in physiological functioning continue after those initial 10 days post-injury," Livingston said. "But in the meantime, sports medicine personnel caring for concussed athletes should be cautious about relying solely on self-reported symptoms and neurocognitive test performances when making return-to-play decisions." (Read more)

Meanwhile, a study at the University of Montreal has found that "Concussions affect the thinking of teenagers more than they do that of adults or children," reports Nancy Shute of National Public Radio. "But all three age groups show lasting problems with working memory after sports concussions." (Read more)