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

By Melissa Patrick
Kentucky Health News

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

WFPL photo

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

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

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

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

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

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

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

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

Ky. law to ban the most common method of second-trimester abortion struck down; Bevin administration will appeal decision

A federal judge has struck down a 2018 Kentucky law banning the most common method of second-trimester abortion.

The law would prohibit physicians from providing a procedure called dilation and evacuation, or D & E, which is the standard method for abortion care after 14 weeks of pregnancy. It would make it a felony for a physician to perform such a procedure and make the doctor subject to sanctions against his or her medical license. The law was passed to go into effect immediately, but was delayed by a court-order pending the trial.

District Judge Joseph H. McKinley Jr.

U.S. District Judge Joseph McKinley, who heard the case without a jury, "ruled the law is unconstitutional because it restricts a woman's constitutional right to an abortion before the fetus is considered viable, at around 24 weeks," Deborah Yetter reports for the Louisville Courier Journal.

The American Civil Liberties Union, which filed the challenge to the law on behalf of EMW Women's Surgical Center in Louisville, the state's only abortion clinic, said the ruling was a victory for women's health.

“Today’s ruling affirms that health, not politics, will guide important medical decisions about pregnancy," Alexa Kolbi-Molinas, senior staff attorney with the ACLU Reproductive Freedom Project, said in a prepared statement. "Laws like this are part of an orchestrated national strategy by anti-abortion politicians to push abortion out of reach entirely. Today’s decision holds — in no uncertain terms — that Kentuckians and the care they need come first."

The administration of Republican Gov. Matt Bevin, who has made fighting abortion a central issue, said it will appeal.

"We profoundly disagree with the court’s decision and will take this case all the way to the Supreme Court if necessary, to protect unborn children from being dismembered limb by limb while still alive," Elizabeth Kuhn, Bevin's communications director, said in a statement.

"Opponents of the law say it is part of a broader national ploy by the anti-abortion movement to chip away at access to abortions," Yetter reports. "Supporters claim it is meant to end a brutal practice they liken to fetal dismemberment."

Yetter reports that the procedure is used in about 500 of the approximately 3,200 abortions each year at the EMW Women's Surgical Center.

Since Republicans took complete control of Kentucky lawmaking in 2016, the General Assembly has passed several bills to restrict or eliminate abortion in Kentucky. This year, they passed four such bills. Two have been temporarily blocked by a federal judge, one to ban abortion once a fetal heartbeat is detected, around six weeks of pregnancy; and the other to ban abortion for women seeking to terminate a pregnancy because of an unborn child's sex, race, color, national origin or the diagnosis or potential diagnosis of Down syndrome or any other disability.

Meanwhile, a federal appeals-court recently upheld a 2017 Kentucky law that requires women to have an ultrasound before having an abortion while their doctor displays the image and offers a medical description of the fetus with the heartbeat played loud enough for the woman to hear. The law allows the woman to avert her eyes from the image and to ask for the heartbeat volume to be turned off, but not to refuse the procedure.

Federal judge sets trial date for state's ban on most common type of second-trimester abortion; meanwhile, law remains suspended

A federal judge has ruled that a new law banning a common abortion procedure called dilation and evacuation, or D&E, after roughly 11 weeks will not be enforced in Kentucky until after a trial is held in November.

The order from Chief Judge Joseph H. McKinley set the trial for Nov. 13 after vacating the preliminary injunction hearing that had been scheduled June 5.

The new law banning the procedure, except in cases of medical emergencies, was House Bill 454, sponsored by Rep. Addia Wuchner, R-Florence. It passed the state Senate 31-5, and the House 75-13. The law went into effect immediately after Gov. Matt Bevin signed it on April 10.

McKinley delayed the enforcement of the law through a joint consent order April 12 after the American Civil Liberties Union filed a lawsuit arguing that the law is unconstitutional. A federal court struck down a ban on the procedure in Texas, and similar bans have been temporarily blocked in other states while they await litigation.

A D&E abortion, which is the most common kind of second-trimester abortion, involves dilating the cervix and removing the fetus using suction and surgical tools. If the law is upheld, abortion providers found in violation would be guilty of a felony that carries a prison sentence. Women undergoing the procedure would not be prosecuted.

House committee approves bill to keep doctors' reviews of other doctors from being used in malpractice lawsuits

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to keep doctors' reviews of other doctors from being used in medical-malpractice lawsuits has passed a House committee and moves to the full House, where a similar bill stalled out last year.

Rep. Addia Wuchner, R-Florence, chair of the Health and Family Services Committee, told the panel that Kentucky is one of only two states that don't apply this privilege to medical peer reviews. She said protections in her bill will ultimately improve health care in the state.

"Medical peer review is an industry-wide practice that allows health-care professionals to openly, honestly and candidly discuss their performances with their colleagues and their teammates and learn from their experiences so that we can improve healthcare and outcomes for all patients," she said.

Dr. James Borders, chief medical officer for Baptist Health Lexington, assured the committee that hospital peer reviews are not an attempt to conceal anything.

"When it comes to the routine, day-to -day care of patients, we need to have the openness and flexibility to ask colleagues as to how they would do something better," he said. "I think of what a chilling effect it would have to think that every comment made in those kinds of conversations would be in some way open to legal challenge."

Wes Butler, a health-care lawyer, explained that House Bill 4 was designed to address a state Supreme Court decision in the 1990s that peer-review privilege in Kentucky should not extend to malpractice suits.

Senator Ralph Alvarado, R-Winchester, proposed a similar bill that made it to the House floor last year but didn't get a vote, largely because of a floor amendment by Rep. Chad McCoy, R-Bardstown, to allow statements of fact in peer reviews to be used in court.

McCoy, a member of the health committee, voted for Wuchner's bill, told Kentucky Health News that, "Cheese pizza is better than no pizza." He added that the language in the committee substitute that assures providers who are claiming the privilege are only doing so for safety and quality purposes, in the same way that the federal law requires, allowed him to vote for the bill.

"I am still fearful here," he said, noting that a doctor's testimony and peer review might conflict. "It didn't go where I wanted it to go, but it is an improvement and it's an important bill and like I said, 'cheese pizza'. . . . It's worth it to give up on the privilege if we can get hospitals to participate and try to make themselves better for every body out there."

Rhonda Hatfield-Jeffers, a plaintff's lawyer from Somerset, was the only person who spoke against the bill. She said that while she appreciated the changes, "We want to make sure no factual statements are hidden."

Frankfort judge strikes down law requiring medical review of malpractice lawsuits; Bevin's office says he will appeal

A judge has ruled that a new law aimed at decreasing frivolous lawsuits and lowering malpractice insurance costs was unconstitutional, and he prohibited the state from enforcing it.

The Oct. 30 ruling by Franklin Circuit Judge Phillip Shepherd said the 2017 law is unconstitutional because it restricts the right of people to plead their cases in court by requiring that the cases be reviewed by a medical panel before proceeding, Deborah Yetter reports for The Courier- Journal. 

"The effect of the medical-review panel process is not the reduction of frivolous negligence claims, but rather, the erection of barriers to the court system," Shepherd's order said. "Those that cannot afford the additional delays and costs should not be prevented from pursuing their constitutional right to a 'remedy by due course of law.' "

The law, which took effect June 29, was touted as "the first step toward tort reform" by Gov. Matt Bevin when he signed it into law, Yetter reports. Bevin's office said it will appeal the decision. "We are confident medical review panels are constitutional," spokeswoman Amanda Stamper told Yetter.

Senate Minority Leader Ray Jones, D-Pikeville, a lawyer who has strongly argued against the law, told Yetter he expects the ruling to stand, calling it a "clear barrier to access to the courts."

Support for statewide smoking ban rises to 71%

Seventy-one percent of Kentucky adults favor a statewide smoking ban, up 17 percentage points since the Kentucky Health Issues Poll began asking the question in 2011.

Opposition to such a smoke-free law fell six points in 2016 alone, from 31 percent to 25 percent.

The proposal received bipartisan support, with 76 percent of Democrats, 68 percent of Republicans and 72 percent of independents reporting they favored it. Former smokers also showed support in strong numbers, although nonsmoker support was the highest at 85 percent, according to a news release from the Foundation for a Health Kentucky, which sponsors the poll with Interact for Health of Cincinnati. But two of every five smokers also favored it.

"The fact that 41 percent of current smokers see the value in a statewide smoke-free law may mean that the messages about the dangers of second-hand smoke are getting through," foundation President and CEO Ben Chandler said in the release.

Local anti-smoking ordinances protect about one in three Kentuckians from exposure to second-hand smoke, according to the Kentucky Center for Smoke-free Policy, and about half of Kentucky children are protected by smoke-free policies in school buildings. In 2011, 27 communities had passed smoke-free ordinances. To date, 46 cities and counties have enacted such ordinances, according to a news release. Nationally, 27 states and the District of Columbia have enacted smoke-free laws.

Comprehensive smoke-free laws prohibit smoking in most public places, including workplaces, public buildings, offices, restaurants and bars.

Most adults in every region of Kentucky favor such a law, the poll found. The strongest support, 82 percent, is in the Bluegrass region. Lexington was the first city in the state to enact a smoke-free law.

"The single most effective thing we can do to improve Kentucky's health is to reduce our smoking rates," Chandler said. And the most efficient way to do that is to enact smoke-free laws, which also protect nonsmokers from tobacco smoke."

He noted that Kentucky has the nation's highest smoking rate among adults, 26 percent. "Not coincidentally, we die at a higher rate from cancer than any other state," Chandler said. "We also have some of the highest rates of heart-disease mortality, COPD and asthma."

The state House passed a statewide smoking ban in 2015, but its takeover by Republicans after the election of a Republican governor has dimmed prospects for such a law. Gov. Matt Bevin has said it is a matter for local governments, not the state.

Lexington, Paducah newspapers' editorials take diametrically opposing sides on Bevin's proposed changes to Medicaid

Governor Matt Bevin (Photo from politicususa.com)

By Danielle Ray
Kentucky Health News

Kentucky's most reliably liberal editorial voice and one of its most reliably conservative are, not surprisingly, on opposite sides of Gov. Matt Bevin's plan to change the Medicaid program.

Bevin has proposed changes that would transition 86,000 Medicaid recipients to private insurance within five years, according to estimates from his administration. His proposal would require "able-bodied" recipients to pay a monthly premium of between $1 to $15, depending on income. If a person wanted dental or vision insurance, he or she would have to do such things as enroll in a community-college course, get a job or enroll in a smoking-cessation program.

The Lexington Herald-Leader published an editorial Sunday that calls Bevin's proposed changes a "red-tape tangle of penalties, incentives, premiums and cutbacks in coverage." The newspaper argues that the plan would create new administrative costs while caring for fewer Kentuckians.

The Herald-Leader does not reject the governor's plan wholesale. It applauds certain aspects, such as creating rewards for quitting smoking. It also backs Bevin's pilot program that would expand access to residential treatment for addiction and mental illness in 20 counties in an effort to quell the state's drug abuse epidemic and prevent the spread of hepatitis and HIV.

And the paper likes Bevin's renegotiation of contracts with Medcaid managed-care companies, which administration officials say will save taxpayers $280 million over the next six months. The state's five managed-care firms earned far higher profits than their counterparts in every other state in 2015, the research group Milliman reports.

Jim Paxton, publisher of The Paducah Sun, welcomes the governor's proposed changes. His editorial, which is behind a membership paywall, in Sunday's Sun says change is needed because then-Gov. Steve Beshear added more than 400,000 Kentuckians to the program, something that Bevin, Paxton and many other conservatives see as unsustainable. Paxton says one of every four Kentuckians now qualifies for Medicaid, which he implicitly deems unacceptable.

The federal government is picking up the full tab for the expansion under through this year, under federal health reform. Next year, the state will begin paying 5 percent of the cost, rising in annual steps to the law's limit of 10 percent (expected to be more than $360 million) in 2020. Paxton says Bevin was elected to clean up Beshear's mess and calls his plan "a creative, fair and rational step to do so."

The public may send comments on Bevin's plan to Medicaid Commissioner Stephen Miller or email kyhealth@ky.gov by July 22. A public hearing was held Tuesday in Bowling Green. Hearings will also be held Wednesday in Frankfort and July 6 in Hazard.

Health-care forum examines 'incredible change' in Kentucky's health-care system, looks forward to more access to care

By Molly Burchett and Al Cross
Kentucky Health News

What does health-care reform mean to Kentucky? What impact has Medicaid expansion had? Can we work together to do care differently in Kentucky? Answers to these questions and more were offerd by national, regional, and local health care experts Sept. 16 in Louisville at the Foundation for a Healthy Kentucky's annual Howard L. Bost Health Policy Forum.

This year's topic was "Doing Care Differently," but as foundation chair David Bolt, deputy director of the Kentucky Primary Care Association, told the crowd, "It could have just as easily been named after the Bob Dylan song, 'The Times They Are A-Changin'."

As a health-care provider for 44 years, Bolt said, "I have lived through almost every change since the implementation of Medicare and Medicaid. And I am actually excited about the changes I see on the horizon." He said he thinks the late Dr. Bost would look at what Kentucky is doing and say," It's about time we moved away from a treat-'em-and-street-'em mentality to integrated health care delivery services and systems rooted in accountable outcomes and founded in a value-drive system of improving health."

One of the biggest recent changes in Kentucky health care is Gov. Steve Beshear's expansion Medicaid at the beginning of the year, which offered coverage to Kentuckians under 65 in households up to 138 percent of the federal poverty level. As a result, Medicaid is now the largest health-care payer in the state, serving 1.1 million Kentuckians, one out of every four, Cabinet for Health and Family Services Deputy Secretary Eric Friedlander told the crowd.

"We had incredible enrollment. It's an incredible change." said Friedlander. "We hope it is a change for the better."

Friedlander said enrollment in every county exceede estimates for the state by the accounting firm PriceWaterhouse Coopers, based on estimates from the Congressional Budget Office. Those estimates anticipated 55 percent of eligible persons enrolling in the first year, leveling out at 70 percent in future years. Instead, enrollments through June were almost double the prediction.

Medicaid paid more than $284 million to Kentucky health-care providers in the first half of this year for treating the newly eligible Medicaid beneficiaries, with hospitals receiving 48 percent of those reimbursements, Friedlander said. He said that number will be $1 billion to $2 billion by the end of the year. (Medicaid payments sometimes take months to complete.)

The federal government is paying the entire cost of the newly eligibles through 2016. State officials have said that they won't be able to update cost estimates for 2017 a few more months because additional data must be collected about enrollees after the insured population has stabilized.

"Medicaid expansion is not static," Friedlander said. "It is dynamic, and the individuals that make up that enrollment are constantly changing."

Friedlander said employment in Kentucky health care has increased by 3,800 jobs, but the study estimated that 7,600 jobs would be added in the first year. This means enrollment is almost double what was projected yet job expansion is almost half. That undercuts Beshear's contention, based on the study, that Medicaid expansion will pay for itself by adding heath-care jobs.

As more Kentuckians get insurance, there may be shortages of primary-care doctors, especially in rural areas of states like Kentucky, reports Kaiser Health News. That need could be overstated, Sheila Schuster, a clinical psychologist and executive director of the Advocacy Action Network, said at the forum.

Kentucky has 3,929 advanced practice registered nurses, Schuster said, 54 percent more APRNs than in 2010. A new state law that took effect July 15 "removed a barrier that was keeping them from opening practices," she said. The law allows APRNs to prescribe non-narcotic drugs independently after they have prescribed under physician supervision for four years.

The law was passed after negotiations among the Kentucky Medical Association, the Kentucky Academy of Family Physicians and the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. Schuster suggested that other such compromises are needed to expand access to health care.

"We aren't playing very well with each other in the sandbox," she said, adding that turf battles need to be set aside to keep health-care innovation people-centered.

The forum was co-sponsored by KET, Louisville's Health Enterprises Network, the Kentucky Health Information Exchange, the Kentucky Medical Association and Leadership Kentucky.

Fayette County Board of Health wants to regulate electronic cigarettes, raising some questions

The Lexington-Fayette County Board of Health is discussing ways to restrict the use of electronic cigarettes in public places and strategies to inform people about their potential dangers, Mary Meehan writes for the Lexington Herald-Leader. This continues not only the debate about whether or not e-cigarettes should be regulated the same way as traditional tobacco products but also how much power health boards may have in such matters.

E-cigarettes are battery-powered, and the liquid nicotine turns to vapor that can be inhaled. Though they don't contain tobacco, nicotine is sometimes used as a pesticide and can be harmful to humans as well. The General Assembly recently passed a law regulating e-cigarette sales, making them illegal to minors. The Danville City Commission has already banned the indoor use of e-cigarettes. “The state now classifies them as a tobacco product. What makes them different? By our ordinance, there is no distinction,” City Manager Ron Scott said.

Sometimes advertisements make it seem as though e-cigarettes are a safe alternative to traditional smoking, Meehan writes. Fayette Health Board Chairman Scott White, an attorney, noted that some e-cigarette flavors, such as bubble gum, target children. "If marketing a deadly product to children isn't evil, I don't know what is," he said. "We have enough history with the tobacco industry to know we need to get ahead of this."

Some think e-cigarettes can help people quit smoking, but that hasn't been proven. More research is still needed. Also, even if e-cigarettes help some people quit smoking, they may be a "gateway drug" to others.

The board may change "Lexington's current smoking ban to include e-cigarettes" and create "a public education campaign," Meehan reports. It's unclear how the board would do that, since the ban was passed by the Urban County Council. Also, the state Supreme Court recently ruled that health boards couldn't pass smoking bans, and it's unclear whether that decision would come into play.

Ellen Hahn, director of Kentucky Center for Smoke-Free Policy, told Meehan it would be best to "include electronic cigarettes in smoke-free laws because they are a tobacco product, and they pollute the air," Meehan writes. "E-cigarettes give off tiny particles that can lodge in the lungs and cause disease."

Though public health departments are helping reduce smoking rates in Kentucky, the "rates remain high, with about 29 percent of adults smoking and approximately 18 percent of people younger than 18," Meehan reports. "The state has also reported a leap in nicotine poisonings, and that leap has been tied to e-cigarettes." (Read more)

UK researcher calls for change in state law to allow syringe exchange program to curb hepatitis C epidemic in Eastern Ky.

Despite the benefits associated with syringe- or needle-exchange programs in preventing the spread of hepatitis C, Kentucky law still prohibits them, and a researcher from the University of Kentucky is calling upon policymakers to help curb this public health threat in Eastern Kentucky.

Syringe exchange programs were first created 30 years ago in response to the AIDS epidemic, and they are an important component of a comprehensive disease prevention strategy, says the Center for Disease Control and Prevention. Yet, Kentucky law prohibits them even though federally funded programs have successfully reduced disease transmission.

A recent study of 500 Appalachian drug users found that nearly two-thirds of them were infected with hepatitis C, reports Stu Johnson of WEKU News. Transmission of the disease in rural Appalachian communities is predominantly due to injection drug use, but community opposition and legal restrictions are barriers to establishing exchange programs.

UK epidemiologist Jennifer Havens would like to see a change in the state law to establish syringe exchange programs in Kentucky. She says these programs don't encourage drug use, which has in the past been an incorrect perception that can inhibit exchange adoption, says the CDC. The programs can instead reduce disease transmission.

“I don’t think anyone walking by the program, the syringe service program, is going to say, `I’m going to start doing drugs today because there’s a syringe service program.’ All it does is allow folks who are already injecting a safer way, a safer source of syringes and potentially program that they wouldn’t otherwise be able to access,” Havens told Johnson.

Haven's previous research, which examined individual and network factors among Appalachian drug users, found an association between injection of prescription opioids and hepatitis C. The study concluded that efforts preventing drug users' transition to injection, especially among prescription opioid users, may curb transmission of the disease. 

One public health tool that has successfully reduced disease transmission in other states is the creation of a syringe exchange program, says the CDC. In addition to asking for a policy change, Havens is calling for federal funding to establish syringe exchange programs in an area of Kentucky particularly impacted by the disease: the eastern region.

“In talking to a lot of the leaders in Eastern Kentucky, I haven’t necessarily approached this issue in particular, but they are at their breaking point with regard to what do we do about this epidemic, so I think, actually at the end of the day, a syringe service program would probably be fairly welcome,” Havens told Johnson.

Beyond reducing the spread of hepatitis C, syringe exchanges can also bring abusers into drug treatment programs, says Havens. The programs are reported to effectively link hard to reach drug users with prevention services, such as screening and drug abuse/ recovery programs, says the CDC. 

As heroin use increases in Kentucky, new report shows its strong connections to abusers of prescription pain medicines

Kentucky's law-enforcement agences, policymakers and public-health advocates have taken serious measures to curb the state's rampant prescription drug abuse problem, and recent state and national news stories suggest that the reduced supply of these painkillers, at least the ones in a non-crushable form, has driven pill abusers to heroin. Now there's research to support this theory.

Non-medical use of prescription pain medication may raise the risk of heroin use, says a new report by the Substance Abuse and Mental Health Services Administration. SAMHSA says people aged 12 to 49 who previously used prescription pain relievers non-medically were 19 times more likely than non-abusers to have started using heroin over the past year.

Proving the connection, the converse was true: Almost 80 percent of those who started to use heroin over the past year had abused prescription pain relievers. These findings are part of a larger effort to identify some risk factors of heroin use, and also to understand the "dependence and initiation that have occurred in the past few years," says a SAMHSA news release.

Heroin use, which had already become a problem in Northern and Central Kentucky, has been spreading to the Southern and Eastern Kentucky. The drug is becoming more popular throughout the state and nation because it is cheaper and easier to get than prescription painkillers, specifically opioid medications.

The number of U.S. heroin users has increased by about 60 percent from 2007 to 2011, says the 2011 National Survey on Drug Use and Health.  And while some can argue for the benefits of prescription medication, that same risk-benefit analysis doesn't apply to heroin, which has only risk.

The SAMHSA report offers another risk of prescription drugs: “Prescription pain relievers when used properly for their intended purpose can be of enormous benefit to patients, but their nonmedical use can lead to addiction, serious physical harm and even death,” said Dr. Peter Delany, director of SAMHSA’s Center for Behavioral Health Statistics and Quality. “This report shows that it can also greatly increase an individual’s risk of turning to heroin use – thus adding a new dimension of potential harm.” 

Join high schoolers around the state on Sept. 19 in taking the 'It Can Wait' pledge not to text while driving

In preparation for its national day of action, the "It Can Wait" campaign teamed up with state legislators in four schools across Kentucky to increase awareness about the risks of texting while driving. Become an advocate too by taking the pledge not to text and drive on Sept 19. 

State Rep. Rick Nelson of Middlesboro, Sen. Brandon Smith of Hazard and AT&T partnered to provide a simulation for students at Bell County High School to learn about dangers of texting while driving. The simulator subjected the participants to a variety of real-life traffic conditions, like driving alongside a bus, showcasing the real-life dangers of texting.

“As a father to teenagers with driver’s licenses, I am personally devoted to spreading awareness of the dangers of texting while driving, Smith told the Middlesboro Daily News. “Drivers who send text messages while driving are 23 times more likely to be in a crash, so it is critical to spread the word that when it comes to texting and driving — it can wait.”

The tour, which is also sponsored by Verizon, Sprint and T-Mobile, also stopped in Central Kentucky, where about 200 Scott County High School students participated in the simulation, along with Rep. Ryan Quarles and Sen. Damon Thayer, both of Georgetown. Quarles crashed and Thayer was stopped for driving too slow in the “busy thoroughfare,” reports Dan Adkins of the Kentucky Press News Service. Click here to try the simulator.

The “No Texting While Driving” law has been in place in Kentucky for two years and forbids anyone to send text messages while driving a motor vehicle. The law also forbids any use of a cell phone for driving under 18.

Take the pledge not to text and drive by joining the "It Can Wait" campaign. Click here for more information. You can also download the AT&T DriveMode app that automatically sends a customizable reply to incoming messages to let people know that you'll get back to them at another time.

Eye exams are now required for children ages 3 to 6 when first starting public school or preschool

Add eye exams to your back-to-school checklist, because state law now requires children aged 3 through 6 who are entering a public school or preschool program for the first time to have a vision exam.

“Studies show that vision problems are a major factor in limiting children’s abilities to learn and succeed,” said Dr. Tonia Batts, a Mayfield optometrist, said in a news release from the Kentucky Optometric Association. “Having children’s eyes examined is one of the most important things parents can do to support their children’s education and good health. . . . Many problems may not be obvious to them or their children’s teachers.”

Early diagnosis and treatment can prevent loss of sight from amblyopia, which most people call "lazy eye." Half of amblyopia cases are not diagnosed until after age 5, when it is difficult to correct, Batts said. Amblyopia the leading cause of vision loss in people under age 40, more than injuries or any other disease, but if detected early, is 100 percent treatable.

Batts said an eye examination is particularly important if your child loses place while reading; avoids close work; tends to rub his or her eyes; complains of frequent headaches; squints to use only one eye or consistently performs below academic potential.

Eye exams are covered by many private insurance plans, Medicaid and the Kentucky Children's Health Insurance Plan. Private programs may also help families with eye exam expenses. The Kentucky Vision Project, sponsored by the Kentucky Optometric Association, has donated millions of dollars in vision care, says the group's news release. Sight for Students and the Lions Club have other programs that can help. To find an optometrist in your area, click here.

Judge refuses to stop Kentucky Spirit from leaving the state, saying health cabinet has had plenty of time to prepare

A Kentucky Court of Appeals judge refused on Monday to stop Medicaid managed-care firm Kentucky Spirit from leaving the state on Friday, July 5. Chief Court of Appeals Judge Glenn E. Acree denied the Cabinet for Health and Family Services' emergency motion to require the company to stay through August.

Read more here: http://www.kentucky.com/2013/07/01/2700062/court-refuses-to-block-kentucky.html#storylink=cpy

Last week, a Franklin Circuit Court judge said  the state can't require Kentucky Spirit to keep serving Medicaid beneficiaries two months beyond its July 5 exit date. When filing the emergency motion last week, Cabinet officials said that if Kentucky Spirit leaves the state without a two-month transition plan, it will “jeopardize the health” of 125,000 people.

However, Acree said the cabinet has had plenty of time to prepare for the company's departure, reports Beth Musgrave of the Lexington Herald-Leader. Furthermore, Kentucky Spirit said the state has refused to work with it to ensure an “effective” transition, and Franklin Circuit Judge Thomas Wingate said last week that the state has “been repeatedly cautioned by this Court to prepare for this contingency, and a lack of preparation at this junction does not warrant a grant of the extraordinary remedy of injunctive relief” requested by the state.

The cabinet argues that Kentucky Spirit did not communicate its intentions to leave, despite Wingate's May 31 ruling until the cabinet took Kentucky Spirit back to court earlier this month, reports Musgrave. However, Kentucky Spirit said in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing too much money covering the 125,000 Medicaid enrollees contracted to the company.

So what will happen now? The cabinet has argued that the two other Medicaid managed care companies — Coventry Cares and WellCare — would take on the Kentucky Spirit beneficiaries and letters have been sent to Kentucky Spirit's clients and to health care providers.  A May ruling said Kentucky Spirit could face fines if it terminates its three-year contract before expiration in July 2014; Kentucky Spirit's appeal in that case is still pending. 

Kentucky will soon require simple screening at birth to detect silent killers of newborns

A new state law taking effect in January will require all babies born in Kentucky to be screened for critical congenital heart disease, which is often a silent killer of newborns who appear to be healthy and who are discharged from the hospital with the unrecognizable disease.

Since Indiana became the first state in the nation to get such mandatory screening signed into law in May 2011, more than 20 states have passed legislation requiring a non-invasive, inexpensive screening test called pulse oximetry at birth, reports Laura Ungar of The Courier-Journal. The test can detect this life-threatening disease and allow health care providers to act quickly to save the baby's life.

Don Shieman, Kentucky state director of the March of Dimes, who helped lobby for the law with the state legislature, said about 65 infants are born with CCHD in Kentucky each year. “If we can detect the problem soon enough, we can save lives,” Shieman told Ungar. State Sen. Dennis Parrett, an Elizabethtown Democrat who helped sponsor the state’s new law, said this requirement is a simple solution to a deadly problem he know something about.

“My wife and I have some experience with this,” Parrett told Ungar. “Our younger daughter was born with a severe heart defect” called tricuspid atresia, and underwent surgery at Kosair Childen's Hospital and her heart is doing fine, Parrett told Ungar. “There’s a lot of infants whose heart defects are not caught,” Parrett said. “What we wanted to do is make it a part of normal infant screening.”

Each test costs about $4, so Parrett said there’s no real fiscal impact to adding pulse oximetry to the list or required screenings for newborns, says Ungar. In general, hospitals already have the equipment for the test, many of which are already doing the test.

The legislation could lead to success stories similar to that of Shooter Bratcher of Caneyville, right, who was treated for infection and underwent surgery for CCHD recently at Kosair. Shooter was born full-term and and seemed normal at birth, but about five days after going home, things just didn't seem right, and he kept getting worse. Shooter's parents took him to the ER at their local hospital, Twin Lakes Regional Medical Center in Leitchfield, where doctors didn't pick up on his CCHD, Ungar reports. A day later, he went by ambulance to Kosair, and could have died if his parents didn't notice the little signs of a problem. Unfortunately, such signs sometimes show up at night, when parents are asleep or not paying close attention. Other times, the disease isn't caught quickly enough, leading to serious serious problems such as infections, brain damage, disability or death, Ungar reports.


Pulse oximetry will allow health care providers to detect seven types of CCHD. For more information about the test, the law or to watch a video in which Shooter's parents share their story, click here.

Kentucky Spirit still plans to leave state July 5; judge rules that state can't require company to stay for two-month transition

In the latest development in the saga of the state Cabinet for Health and Family Services and Medicaid managed-care firm Kentucky Spirit, the company appears to be the victor, at least for now, because a Franklin circuit judge this week that the state can't require it to keep serving Medicaid beneficiaries two months beyond its July 5 exit. Cabinet officials have appealed the decision, saying that if the company darts out of the state without a two-month transition plan, it will “jeopardize the health” of 125,000 people.

A May ruling said Kentucky Spirit could face fines if it terminates its three-year contract before expiration in July 2014. The company appealed. On Wednesday, it said it intends to leave Kentucky July 5, just as it made clear last year. The state appealed Thursday, and unless the court's decision is reversed next week in the Kentucky Court of Appeals, Kentucky Spirit will be able to bolt out of Kentucky on July 5, despite the damages it may face, reports Tom Loftus of The Courier-Journal.

The state's appeal aims to keep the company in Kentucky until August to grant the cabinet enough time to switch the 125,000 people covered by Kentucky Spirit to the other two managed-care firms. Cabinet officials say this transition time is vital, especially for a more vulnerable population, because transferring Medicaid recipients to Coventry Cares or WellCare will take time.

“A sudden cessation of services by Kentucky Spirit would jeopardize the health of its approximately 125,000 members, particularly those who require uninterrupted treatment or care which their new MCO would be unable to coordinate without advance notice,” said the emergency motion filed by the cabinet on Thursday, reports Ryan Alessi of cn|2's "Pure Politics."

Kentucky Spirit says the state has refused to work with it to ensure an “effective” transition, and it's now the state's responsibility to do so. Franklin Circuit Judge Thomas Wingate, who no longer has jurisdiction on the matter since Kentucky Spirit appealed, said the state has “been repeatedly cautioned by this Court to prepare for this contingency, and a lack of preparation at this junction does not warrant a grant of the extraordinary remedy of injunctive relief” requested by the state.

Regardless of what happens, Medicaid beneficiaries assigned to Kentucky Spirit shouldn't worry because their coverage will be honored by providers, cabinet spokeswoman Jill Midkiff told Alessi. In an earlier report, Midkiff said providers may feel the blow of this disruption, but Medicaid beneficiaries won't. “There won’t be disruption of services to members,” Midkiff told Loftus, “But there will be a disruption ... confusion with providers and paperwork and who they bill.”

Kentucky Spirit, a subsidiary of St. Louis-based Centene Corp., announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing too much money covering the 125,000 Medicaid enrollees contracted to the company. Kentucky Spirit argues in its lawsuit that the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million. It made the lowest bid, and on average, gets about $100 less per month for each patient than the other two managed-care companies in the state.

The school health services gamble: Ky. health departments could win on the state's bet against Kentucky Spirit's appeal of ruling

By Molly Burchett
Kentucky Health News

Kentucky’s health departments may soon get money for school nurses, based on a court ruling in May that said Medicaid managed-care firm Kentucky Spirit must pay for treatments provided by the nurses. The money wouldn't be coming from Kentucky Spirit, at least immediately, but from funds the state is withholding from the company, betting the payments on a court victory.

Circuit Judge Phillip Shepherd of Frankfort ruled in May that Kentucky Spirit must pay $8 million for services provided by school nurses, and the state has been withholding payment to the managed care company until it complies with the ruling, reports Ronnie Ellis, Frankfort correspondent for Community Newspaper Holdings Inc. On Monday, Shepherd told attorneys for the Cabinet for Health and Family Services and Kentucky Spirit that he is “inclined” to order the state to pay the health departments out of those withholdings.

The cabinet wants Kentucky Spirit to post bonds to cover the disputed payments during the company's appeal process. If the state made payments directly to the health departments, it would be gambling at its own risk, reports Ellis. If Kentucky Spirit wins its appeal of Shepherd’s earlier ruling, the state would have to refund the money, and the health departments would keep the payment.

This lawsuit originally came about when Kentucky Spirit stopped providing coverage for school health services last summer. The company said its state contract didn't require payment for such services, even though the state's Medicaid program has always paid for these services and other managed care companies were providing coverage for them. The court ruled that Kentucky Spirit must pay health departments, and the company appealed the decision.

Regardless of the source of funds, health departments and school districts could find some relief if payments are made because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for school services.

Shepherd will allow attorneys for the state to respond to the motion and hear arguments on July 25, Ellis reports.

Kentucky Spirit appeals court ruling that it can't quit Kentucky early

By Molly Burchett
Kentucky Health News

Centene Corp. announced Monday that it has appealed the Franklin Circuit Court ruling in May that said its managed care subsidiary, Kentucky Spirit, cannot terminate its contract with the state a year early. The company said it plans to be out of the state by September. Click here to view the appeal.

This move represents the continuation of a long, tumultuous relationship between Kentucky's Cabinet for Health and Family Services and Kentucky Spirit, one of three companies hired by the state in November 2011 to manage health care for more than 540,000 Medicaid recipients.

First, Kentucky Spirit announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing money, and the company also filed a formal dispute with the cabinet for damages incurred under the contract. Centene said in its annual report that Medicaid beneficiaries were retroactively assigned to the plan and non-inpatient claims receipts were higher than anticipated, leading to a $38.8 million loss in the second quarter of 2012.

"Since the inception of the contract, we have been in discussions with the cabinet about our concerns with the Medicaid managed care program but have been unable to resolve our differences," Jesse Hunter, Centene’s executive vice president of operations, told St. Louis Business Journal in October of last year. In response CHFS Secretary Audrey Haynes said, “I am deeply frustrated that this publicly traded, Fortune 500 company has chosen to put profits above people and will not honor the terms of its contract."

Next, Franklin Circuit Judge Thomas Wingate ruled that the company could face fines if it terminates its three-year contract before expiration in July 2014, and Centene said it would consider an appeal. Now, as Michael Neirdorff told investors on Monday, Centene is appealing that decision, reports Samantha Liss of St. Louis Business Journal.

“After a few months of operations, it became clear that our financial performance was much different than our projections based upon the data provided by the Commonwealth during the bid process. Our analysis concluded that inaccurate and incomplete data led to actuarially unsound rates for our health plan,” said Nerdorff at Monday's Investor Day event.

All managed-care companies received the same information, and Centene made the lowest bid. Kentucky originally signed a three-year contract with Centene in the summer of 2011, and the company was estimated to service about 180,000 Medicaid beneficiaries, generating an annual revenue of $700 million. Instead, it serves 140,000 recipients and lost $38.8 in one quarter.

However, Centene's $38.8 million quarterly loss in 2012 came alongside $2.2 billion in revenue, and the company's publicly-traded shares surged 11 percent after it announced that it was leaving the state. In April of this year, Centene raised its full-year forecast for premium and service revenue to $10.1 billion to $10.4 billion, Reuters reports.

New oral health coalition expected to spur changes in state

By Tara Kaprowy
Kentucky Health News

For the past 30 years, Dr. Fred Howard of Harlan has been seating patients in his blue dental chair and telling them to open up. When they do, he's seen all kinds of scenarios, from toddlers whose teeth are already rotten from sucking on bottle filled with soft drinks to 20-year-old adults with no teeth at all. On some occasions, children walk in with such a severe abscess in their mouth their eyes are swollen shut.

Though the view can be grim, Howard said he has seen some improvements in his decades of practice, but with new changes in Medicaid managed care, the overwhelming prevalence of children and teens drinking soda pop and an embedded cultural belief in some areas that "teeth are just something to get rid of," Howard concedes that making headway can feel like one step forward and two steps back.

Enter the newly re-established Kentucky Oral Health Coalition, a statewide force whose goal is to ensure Kentuckians have happy, healthy smiles.

Dozens of organizers and stakeholders met in March to discuss the coalition's aims, and a membership drive is underway to build financial momentum. The coalition will promote oral health education, statewide partnerships statewide and advocate oral-health legislation. "I think they will turn into the advocacy group for dental change," said Dr. Julie McKee, dental director for the state Department of Public Health. "They're working hard to come up with a plan. They've got their heads on straight."

One of the major issues facing the dental profession is possible expansion of the scope of practice for mid-level providers, such as dental therapists who can assess, clean teeth, replace sealants, provide fluoride as well as fill cavities and extract teeth. As nurse practitioners do in the medical field, having such providers could help address shortages in rural areas, said Dr. Jim Cecil, former state dental director and coalition steering committee chair. The concept is in practice in 54 other countries, but the only U.S. states with it are Minnesota and Alaska, mainly because of opposition form dentists.

Andrea Plummer, coalition member and senior policy analyst for Kentucky Youth Advocates, acknowledged that scope-of-practice issues "can be a very tense subject" and "there would have to be buy-in" from members of the committee, who include dentists, but discussion is ongoing. Cecil said the issue is "something we'll need to look at and take a stand on eventually."

Howard (pictured with Gov. Steve Beshear at signing of the bill that requires dental exams for students starting school) favors the expansion, but doesn't feel Kentucky's oral-health problems can be solved just by putting more boots on the ground.

"The bottom line is: We can have twice as many dentists, have more dental hygienists, but if we don't change the mindset, if we don't provide the education, I don't think we're going to solve the problem," he said.

To that end, the coalition is also investigating ways to expand school-based health and dental education, either by finding funding, collaborating with groups that are already in place or advocating legislation changes, Plummer said.

A recently enacted state law requires children to get a dental screening before entering kindergarten, but there is little else in the way of legislation that requires schools to offer services to help students with dental problems, Plummer said. "Kentucky law says that students' health does affect their learning and schools should take steps to affect their learning but it's fairly broad," she said.

An analysis by KYA last year showed school districts spend less than 1 percent of their budgets on school health services.

Examining how to get more dentists to accept Medicaid patients is another hot-button issue. Of about 2,200 dentists statewide, only about 600 are enrolled in Medicaid, Cecil said, and "They feel like they're working for free" because of the program's low reimbursements. "In many cases, they're really not meeting overhead."

The administrative burden that comes with these patients has also gotten worse since Medicaid transitioned to managed care, Cecil said. "Everything they do has to be pre-authorized," he said. "That delays approval, delays treatment, delays payment."

Under managed care, Howard said, patients now need to come in twice to get a full complement of X-rays and radiographs done, which can not only make it hard on dental practices, but for patients as well. "The more times they have to come, that gives them more opportunities to miss appointments," Howard said.

The Oral Health Coalition also sees a need for "quality, updated data," Plummer said. Getting data was one of the successes of the first coalition, formed in 1990. Run by volunteers and funded by the dental schools at the University of Kentucky and University of Louisville, it was formed after the General Assembly told the schools that they either needed to work together or one could "risk being shut down," Plummer said. The group had several successes, including working with the state to conduct an oral health survey, lobbying legislators for oral-health measures and holding an annual symposium. But after more than 15 years, "It kind of just fizzled out a little bit," Plummer said. The group went inactive in 2006 but had some assets that the new group will take over.

The group's rebirth began in 2009, when Kentucky Youth Advocates was approached by the DentaQuest Foundation, which is connected to DentaQuest, one of the largest managed-care organizations in the country that administers dental benefits. DentaQuest officials were interested in seeing the coalition resurrected and offered $80,000 to KYA so it could provide the manpower to run it, Plummer said. It was the first time the coalition had funding to back it up. The KYA talked to state stakeholders and discovered "there really did seem to be an interest in putting a coalition back together," Plummer said. Planning began in earnest and in January the steering committee drafted by-laws. In March, 70 people showed up to the first meeting.

That gathering was not just made up of dentists, oral-health advocates and experts, Howard said. Members of the media were present, along with parents, health department officials, school nurses, students and educators. That made all the difference to Howard, who said he is inspired by what changes might occur and what education can take place. "When we have people from all these different venues, we have more of an opportunity to make a difference," he said.

The coalition's next meeting will be July 25. Those interested in attending or becoming members of the coalition can contact Andrea Plummer at aplummer@kyyouth.org or 502-895-8167. Dues for individual members are $25. Government organizations pay $100, nonprofit organizations pay $250 and for-profit organizations pay $500.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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.