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.

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.

 

Under scrutiny and criticism, cabinet changes way it handles reviews of children who die or nearly die from abuse or neglect

The Cabinet for Health and Family Services is now using a standard form when conducting internal reviews involving children who died or nearly died from abuse or neglect. Staff are now also being instructed to focus on specific topics in the reports. These are some of the ways the cabinet has changed how it handles the reviews since it came under "intense scrutiny from the state's largest newspapers," reports Beth Musgrave for the Lexington Herald-Leader.

A recent Herald-Leader analysis of 84 reviews from 2009 and 2010 showed there were vast disparities between how they were conducted in different parts of the state, with some of them lengthy and detailed and others just one-page reports that sometimes didn't even include the facts of a child's death.

Teresa James, acting commissioner of the Department for Community Based Services, said the standard form allows for "a greater amount of consistency." Recommendations that stem from the reviews, which are meant to zero in on ways the cabinet could have helped avoid the outcome, will also now require action plans.

Terry Brooks, executive director of Kentucky Youth Advocates, praised the effort. "This is a critical and significant step forward in terms of accountability, transparency and quality assurance," he said. (Read more)

Six of 41 child-abuse fatalities show improper follow-up by Cabinet for Health and Family Services, Herald-Leader analysis finds

The way child-abuse deaths are reviewed in Kentucky continues to be problematic. Looking at the 41 child fatalities in 2009 and 2010, Lexington Herald-Leader reporters Beth Musgrave and Bill Estep found at least six cases in which the Cabinet for Health and Family Services "did not do an internal review even though there were previous reports involving the family before the child died."

State law requires the cabinet to conduct such a review when a child dies or nearly dies because of abuse or neglect and the cabinet had prior involvement with the family.

That didn't happen in the case of 2-year-old Derek Cooper, whose father placed his hands over the crying boy's mouth "until the child was silent," a state report said. Cooper's father, Brandon Fraley, had had contact with the cabinet when he was a child himself, and in 2006 there was an allegation of domestic violence against him, Musgrave and Estep report. Cabinet spokeswoman Jill Midkiff said the cabinet doesn't do internal reviews when the contact with the cabinet occurred when the alleged abuser was a child, but Midkiff "provided no explanation about why the 2006 domestic violence investigation of Fraley didn't trigger an internal review," the newspaper reports.

The analysis also showed vast differences in the way internal reviews are conducted in different parts of the state. "Some of the reviews appeared to be thorough, but in others, child-protection workers produced only one-page reports with little detail on what happened to the children and no assessment of potential improvements," Musgrave and Estep report.

"The cabinet for so long has hidden everything it could," said state Rep. Susan Westrom, D-Lexington, who tried earlier this year to pass a bill that would create an external child-fatality review panel. Gov. Steve Beshear has issued an order to create such a panel, whose members will review cases and make recommendations. The panel will not have cabinet staff as members.

Westrom's bill got hung up partly over the cabinet's attempt to impose further restrictions on the sort of information it is required to make public. The newspaper's analysis the result of a long fight the Herald-Leader and The Courier-Journal have waged to make the child-abuse documentation available to the public. C-J lawyer Jon Fleischaker said on KET yesterday that the cabinet continues to redact more information that it should, in an effort to protect its own interests. The fight continues in the appellate courts. (Read more)

House committee approves panel to investigate child-abuse deaths; findings would be closed to public

An independent panel of experts would look into the deaths of abused and neglected children and then give recommendations to state officials for how to improve its child-protection system. That was the proposal that was approved unanimously Thursday by the House Health and Welfare Committee.

In House Bill 200, "the group's meetings would be closed to the public, and its documents would remain secret," reports Beth Musgrave for the Lexington Herald-Leader. Jon Fleishchaker, a lawyer for the Kentucky Press Association, said there was no reason why the business of the panel should be secret. "We are all for a statewide panel," he said, "but the public needs to be able to see what the recommendations are."

The bill would also outline what information the Cabinet for Health and Family Services would be responsible for releasing to the public when "abused children who have had previous contact with the cabinet die or are severely injured," Musgrave reports. The legislation would allow the cabinet to "keep the names of children who suffered serious, non-fatal injuries and information that would identify siblings in the home," Musgrave reports.

The Cabinet for Health and Family Services has been embroiled in a lawsuit with The Courier-Journal and the Lexington Herald-Leader, which sued the cabinet in order to seek documents pertaining to child abuse deaths or near-deaths. A Franklin Circuit Court judge has twice ruled that the cabinet turn over its files, but it has appealed. (Read more)

18 Kentucky children died from child abuse or neglect last year, down from 33 in 2009, but report is incomplete, critics say

A report by the the Cabinet for Health and Family Services shows 18 Kentucky children died from abuse or neglect in the past fiscal year, down from 33 the year before. Ten were part of families that had been involved with state social service officers, reports Deborah Yetter of The Courier-Journal.

The report is required by state law, but was a much shorter version than it has been in years past. This year's document was 15 pages long, compared to the 29-page report from last year and "provides limited information and omits much of the detail of past annual reports," Yetter writes.

Terry Brooks, executive director of Kentucky Youth Advocates, said the drop in deaths is good news, but called the scaled-down version of the report "a failure," saying it made it difficult to compare findings from past years. It was also three months late in being released.

"They are scrambling to get it out three months late," he said. "At a time when this issue needs some transparency and more visibility, they have given us the Reader's Digest version."

Lawmakers have scheduled a meeting Dec. 19 to talk to cabinet officials about the issue of child abuse deaths and to review the report, the latest sign the issue is starting to attract more attention. Earlier this week, Gov. Steve Beshear ordered the release of records of abuse in which children died, but the cabinet immediately filed a motion saying it needed more time.

In 2009, a federal government report found Kentucky had the highest rate of child abuse deaths with 41 deaths based on 2007 data — the most recent at the time — from the U.S. Department of Health and Human Services. In 2010, Kentucky dropped to 19th place with 22 deaths based on the 2008 data. The 2009 numbers showed Kentucky ranked fourth. (Read more)

Abuse must be reported to officials in Ky., unlike scandalized Pa.

State law should prevent the child abuse scandal that has rocked Penn State from happening in Kentucky. (Associated Press photo: Penn State head coach Joe Paterno, assistant coach Mike McQueary and quarterback Mike McGloin.)

Unlike in Pennsylvania, where people are only required to report sexual abuse to a supervisor, in Kentucky suspected abuse must be reported to police, prosecutors or Child Protective Services. If a person fails to report it, that constitutes a crime, reports Andrew Wolfson of The Courier-Journal. "Telling your boss in Kentucky doesn't take you off the hook," said Terry Brooks, executive director of Kentucky Youth Advocates. "We don't let folks in Kentucky wash their hands of abuse."

Interest in the law has surfaced since a graduate assistant Paterno "saw former defensive coordinator Jerry Sandusky raping a boy in a shower in 2002 and told Paterno about it rather than alerting authorities," Wolfson reports. Paterno told his athletic director, but not police or other authorities. He was fired Nov. 9.

Advocates believe the Kentucky law "shows that we are all responsible," said Dan Fox, president of Family and Children's Place, a nonprofit counseling agency. Kentucky is one of 18 states with such a law. Those who fail to report abuse can be charged with a misdemeanor punishable up to 90 days in jail and a $250 fine, though prosecution is relatively rare. There were just 57 cases filed with the Administrative Office of the Courts since 2006. One case involved a Bed Bath & Beyond store, which was charged in 2008 after it didn't help a couple who had found a toddler locked in a hot van in the parking lot. The manager said getting involved was against store policy.

Kentucky had twice as many reported child-abuse cases as Pennsylvania 2009, though it has just one-third the number of children. That difference is believed to stem from the reporting laws of the two states, not because abuse or neglect is less common in Kentucky, Wolfson reports.