Senate passes its version of state budget with many health items; $100 million would 'support a response to the nursing shortage'

By Melissa Patrick
Kentucky Health News

The state Senate passed its version of a two-year state budget by a 30-6 vote Wednesday, the same day it passed out of committee. The bill will soon head to a House-Senate conference committee that will write the final version.

The Senate-revised House Bill 1 has a number of health provisions, with some variations from the House version and Gov. Andy Beshear's proposals.

The Republican-controlled chambers and the Democratic governor have three different approaches to addressing the nursing shortage, which has been exacerbated by the coronavirus pandemic. 

Photo from American Nurses Association

The Senate allocated $100 million of federal relief money in the first year of the budget, starting July 1, "to support a response to the nursing shortage," without giving any details. The House included no money for the retention and recruitment of nurses.

Beshear, who said Thursday that the focus needs to be on retention, called for $6 million each year from the General Fund for nursing scholarships; and from relief funds, $5 million a year for five years to create a new student loan-forgiveness program and $2 million for a marketing and outreach campaign.

The House budget and Beshear's budget both include $17.7 million in the first fiscal year and $19 million in the second fiscal year to cover the costs of local health departments required services, but the Senate's budget only allocated money for the second fiscal year in the amount of $19 million. 

Randy Gooch, executive director of the Jessamine County Health Department, said the Kentucky Health Department Association isn't sure why the Senate would have left out an allocation for fiscal year 2023 and Sen. Chris McDaniel, R-Ryland Heights, who crafted the Senate budget has not yet returned a call for clarification. 

The Senate budget includes Beshear's wish for for 500 new Michelle P. waiver program slots for people with intellectual or developmental disabilities; the House provided for 100. The Senate added 200 slots to the Supports for community Living waiver program for similar beneficiaries, double what Beshear and the House proposed. Both programs have thousands of Kentuckians on their waiting lists.  

The Senate agreed with the House on extra funding for domestic-violence shelters, rape crisis centers and child-advocacy centers, allocating $500,000 more for each in each fiscal year. Beshear proposed a 36% increase each year for each type of organization: $2.5 million, $1.78 million and $1.3 million, respectively.

And while the Senate and House budgets both would fund 200 more social workers, Beshear's budget proposal would have funded an additional 350. 

To implement the new 988 suicide hotline, a three-digit number set to replace the National Suicide Prevention Lifeline in July 2024, the Senate budgeted $3.37 million in the first year and $9.9 million in the second, the amounts Beshear recommended. The House allocated much more: $12.4 million in the first year and $17.6 million in the second, but directed that the money also be used to create more mobile crisis units. 

The Senate allocated $500,000 in each year for the Lung Cancer Screening Program that would be established with the passage of HB 219. The bill passed the House in late January and in the Senate Appropriations and Revenue Committee, which wrote the revised budget. 

The Senate budget also says that each Medicaid managed-care organization that has a participating contract with Kentucky in the next contract renewal will cover lung-cancer screenings.  

Here are some other health-related provisions in the Senate budget. 

From the Tobacco Settlement Fund:

• $500,000 in each fiscal year to support the Kentucky Rural Mental Health, Suicide Prevention and Farm Safety Program, titled the "Raising Hope Initiative."
• $1.4 million each year for substance-abuse prevention and treatment for pregnant women with a history of substance-use disorders;
• $7 million each year for the Health Access Nurturing Development Services Program (HANDS) for poor families with young children;
• $900,000 per year for the Healthy Start initiatives;
• $900,000 a year for early-childhood mental health;
• $900,000 a year for early-childhood oral health;
• $2 million a year for smoking cessation. Advocates have long asked for more smoking cessation funding, asking recently on a Kentucky Educational Television lung-cancer forum that this amount, at minimum, go back to the pre-pandemic level of $3.3 million.
  

From the General Fund:

• $6.25 million in each fiscal year for cancer research and screening to be equally shared by the University of Kentucky and the University of Louisville;
• $500,000 in the first year and $493,500 in the second year for spinal-cord and head-injury research (an amount that was previously taken from the Tobacco Settlement Fund); 
• $93,700 in each year for grants to the Brain Injury Association of America, Kentucky Chapter and the Epilepsy Foundation of Kentuckiana to help veterans who have experienced brain trauma;
• $500,000 each year for the Kentucky Colon Cancer Screening Program;
• $100,000 per year for The Hope Center of Lexington for addiction recovery;
• $900,000 a year for The Healing Place, a Louisville recovery program;
• $1,495,000 a year to support the Lee Specialty Clinic, which provides specialty medical services for individuals with moderate developmental and intellectual disabilities living in residential and community settings. 
• $7.2 million in the first year and $14.48 million in the second fiscal year to expand the senior citizens' meal program. The appropriation will come from federal relief funds. 
• $1 million in the first year to support external performance reviews of substance-use treatment programs administered or funded by the health cabinet. 
• $2.5 million in each year to the Kentucky Pediatric Cancer Research Trust Fund; Beshear's proposal provided $3.75 million in each fiscal year. 
• $750,000 per year for the Kentucky Poison Control Center, unless federal emergency relief funds become available;
• $1 million a year for the Ovarian Cancer Screening Outreach Program at the University of Kentucky; the House budget had $500,000 a year. 
• Federal and state funds are allocated in both years to maintain the pandemic-elevated reimbursement of $29 per day per Medicaid patient in nursing homes.
• Money is provided to support expansion of of a pilot program for Tim's Law to additional locations as a way to ensure statewide access. Tim's Law allows judges to order assisted outpatient treatment for people who have been involuntarily hospitalized, aimed at stopping the revolving door them going in and out of jails and state psychiatric hospitals.

Video to prevent shaken baby syndrome, being seen at birthing centers, wins a state public-health award

A video aimed at preventing shaken baby syndrome, by educating parents about it, has won an award from the Kentucky Public Health Association.

“Many of us remember taking a baby home from the hospital and thinking, ‘Where’s the instruction book?’” said Bill Jones, CEO of WellCare of Kentucky, which so-sponsored the video. “This video doesn’t provide answers for all of parenthood’s challenges, but it will give parents vital information to help keep children safe. As the largest Medicaid provider in Kentucky, we believe strongly in the importance of prevention practices. Often, information is prevention.”

WellCare, a managed-care company, developed the video with Prevent Child Abuse Kentucky and the Kentucky Hospital Association, which shared in the award. They distributed the video to birthing centers throughout Kentucky last year.

The hospital group said the video could be viewed by 50,000 new parents a year, at the state's 46 birthing centers. “Becoming a new parent can be both overwhelming and joyous,” CEO Nancy Galvagni said. “Our birthing hospitals are in a unique position to provide immediate support to new parents, and through this ground-breaking educational video, we can protect thousands of infant lives.”

Shaken baby syndrome is the common name for pediatric abusive head trauma. "Serious traumatic brain injury in young children is largely the result of abuse and results in significant morbidity and mortality," says the Centers for Disease Control and Prevention.

The video focuses on the story of Liz Renner, and her son Colton, Now 4, Colton suffered trauma at the hands of a caregiver as an infant. “My hope is our personal story can be shared with as many new parents as possible so others can prevent this type of trauma from happening to their babies,” Renner said.

Lawmakers pass one-year budget, including pension reprieve for health departments; funding remains similar to last year's budget

By Melissa Patrick
Kentucky Health News

Amid an expected revenue shortfall from the coronavirus pandemic, Kentucky lawmakers passed a conservative one-year budget, instead of the usual two-year one, that offers another reprieve for health departments in a year that they were looking to enact big reforms.

The budget will freeze pension contribution rates for health departments, regional universities and quasi-governmental agencies at 49.47 percent of payroll, allowing them to dodge for another year the looming 93% rate that was set to kick in on July 1.

Many health departments have said that rate would force them to close. The legislature was planning to revamp the contribution system, but the uncertainty about state revenues killed that idea, at least for now.

"While this budget doesn’t provide the language or funds to support our public health transformation and ensure the number of foundational employees to meet our statutory obligations, we understand as well as anyone the uncertainty of our times and recognize the legislatures need to try and maintain current operations for all government another year," Randy Gooch, executive director of the Jessamine County Health Department, said in an e-mail. "However, I have great confidence the legislature will now have more clarity than ever of the need to fund public health at a an appropriate level and will take that action when considering changes to the budget in the future."

The budget provides $23 million for regional mental health boards' pension payments and $25.4 million for health departments' pension payments. The overall budget for public health remains about the same as the previous budget, around $370 million.

Health departments, state health officials and legislators worked for months to help the departments afford their pension obligations, and were nearing success when the coronavirus hit, making likely a huge drop in state revenues. Costs are expected to rise, too, and exactly how much financial help the state will get from federal government remains an unknown.

"We have no way to know how far this recession is going to go, how deep it will truly be and what it will mean to the coffers here in Frankfort," House budget chair Steven Rudy, R-Paducah, said on the House floor while offering the House-Senate compromise budget bill April 1.

All of this has resulted in a one-year budget for the fiscal year that begins July 1 that largely keeps spending at current levels, with plans to pass a budget next year for the 2021-22 fiscal year.

Here are some of the health-related provisions in the budget:

From the Tobacco Settlement Fund:

• $500,000 for a rural mental-health and suicide-prevention pilot program 
• $1.4 million for substance-abuse prevention and treatment for pregnant women with a history of substance abuse 
• $7 million for the Health Access Nurturing Development Services Program (HANDS)
• $942,000 for Healthy Start initiatives
• $942,000 for early childhood mental health 
• $989,100 for early childhood oral health
• $2 million for smoking cessation, much less than advocates want  

From the General Fund:

• $93,700 each for grants to the Brain Injury Alliance of Kentucky and the Epilepsy Foundation of Kentuckiana to help veterans who have experienced brain trauma
• $7.4 million for more school-based mental health services
• $300,000 in the current fiscal year and $1.9 million in the next one for the Kentucky Poison Control Center, which operates the recently created covid-19 hotline
• $500,000 for the Kentucky Colon Cancer Screening Program 
• $2.5 million to the Kentucky Pediatric Cancer Research Trust Fund
• $500,000 for ovarian cancer screening

The budget does not provide any money for additional social workers, or raises for social workers, as had been included in all previous versions of the budget. It also lacks any new waivers for community-based care for individuals with disabilities, as all previous versions had provided.

The General Assembly will reconvene April 13 to reconsider bills Beshear vetoes. House Speaker David Osborne said that more bills are also likely to get passed, including one to help rural hospitals.

No-penalty bill to require bicycle helmets dies, as some senators counted as 'yes' votes fail to show up for final committee meeting

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A no-penalty bill to require children under 12 to wear a helmet when bicycling has died for this legislative session, after falling one vote short in the Senate Transportation Committee March 14, and being passed over due to absences at the next meeting, on March 21.

"Adequate notice was given to members of both parties that this bill was going to be up, and some votes that I thought the sponsor could count on didn't show up," committee Chair Ernie Harris, a Republican from Prospect in Oldham County, said after the meeting. He said the bill is dead.

Democratic Sens. Gerald Neal of Louisville and Johnny Ray Turner of Prestonsburg, as well as Republican Albert Robinson of London, were absent.

Rep. Regina Huff

House Bill 52 would require children under 12 to wear a helmet when they ride a bicycle. Violation would result in a courtesy warning, not a fine.

"We had three votes that were nos, and the rest were yeses," sponsor Regina Huff told Kentucky Health News. "Somehow they all weren't in the meeting on the same day, and I don't know if that's by chance or by design quite frankly." The bill passed the House 77-5 on Feb. 2.

At the March 14 committee meeting, two senators that the Brain Injury Alliance of Kentucky expected to vote for the bill voted against it, and three who were expected to vote yes were absent, according to BIAK.

The lobbying group calls HB 52 "TJ's bill" for TJ Floyd of Oldham County, who suffered a traumatic brain injury (TBI) when he flipped over his handlebars while not wearing a helmet at age 7 in 2010. It says 384 American children die annually from bicycle crashes, and 450,000 more are treated in emergency rooms for bicycle-related injuries, with about 135,000 of those seen in the ER related to head injuries.

"It is a bill for safety, for children at play to be safer when they are riding their. bikes," said Huff, a Republican from Williamsburg in southeastern Kentucky. "Helmets are 84 to 89 percent effective against a TBI, and prevention is the only cure for a TBI." 

But Sen. Paul Hornback, R-Shelbyville, who changed his vote to a no, said it would be "an overreach by government." He told Kentucky Health News that after talking to other policymakers and several lawyers, he became concerned about the implications for owners of private property on which children might ride bicycles and non-relatives who might be caring for them when bicycling.

Sen. Ernie Harris

Kentucky Health News asked Harris why he wouldn't hold a special meeting of the committee in the Senate chamber, when all members would likely be available. He said he had already given the bill two chances, which he had never done for a bill before – then said that it didn't have the support advocates thought.

"People have come up to me to say, 'I really don't want to vote on it, but if I have to, I will,' so the votes are not there," Harris said. "I have no explanation for why some people didn't show up. . . . I did everything I could to get people that would vote for it."

Clearly disappointed, Huff said the advocates would try again next year, and she was pleased it had received a hearing in the Senate for the first time. Similar legislation has been considered in the House for several years; last year's HB 122 passed the House 90-6 but was not heard in the Senate.

No-penalty bill to require kids under 12 to wear bicycle helmets falls 1 vote short in panel; advocates say it will be called up again

By Melissa Patrick
Kentucky Health News

A House bill to require children under 12 to wear bicycle helmets came up one vote short in the Senate Transportation Committee March 14, but advocates say the panel will take up the bill again Wednesday, March 21.

Mary Hass, advocacy director of the Brain Injury Alliance for Kentucky, told Kentucky Health News that two senators who were expected to vote for the bill voted against it, but it would still pass with votes of those who were absent.

House Bill 52, sponsored by Rep. Regina Huff, R-Williamsburg, would require children under 12 to wear a helmet when they ride a bicycle. Violation would result in a courtesy warning, not a fine.

Heather Floyd and her son TJ spoke at the March 14 Senate
Transportation Committee meeting in support of "TJ's bill"
to require children up to age 12 to wear a bicycle helmet.

HB 52 is called "TJ's bill" for TJ Floyd of Oldham County, who sustained a traumatic brain injury in 2010 when he flipped over his handlebars when he was 7 while not wearing a helmet. It passed the House 77-5 on Feb. 2.

"This bill just makes helmets part of bicycle safety," Hass told advocates at a rally after the committee meeting. "There are no fines. It is not meant to be punitive in any way to parents. But BIAK's membership is telling us it gives parents another tool in their toolbox to keep their children safe."

The bill needed seven votes to clear the committee, but only got six. After some off-microphone discussion about what to do next, committee chair Ernie Harris of Oldham County told members that he might call it up again. BIAK said in an email alert the next day that Harris would have the committee hear the bill again Wednesday, March 21 at 9 a.m. in Room 154 of the Capitol Annex. Kentucky Health News has not confirmed that with Harris.

Haas said advocates went into the March 14 meeting thinking they had enough votes, but one supporter, Sen. Jared Carpenter of Berea, was caught in a traffic jam, and another, President Pro Tem Jimmy Higdon of Lebanon, left before the vote was taken. Democratic Sen. Johnny Ray Turner of Prestonburg was also absent.

The "no" votes came from Republican Sens. Joe Bowen of Owensboro, C.B. Embry of Morgantown and Paul Hornback of Shelbyville. A BIAK alert said the group expected Hornback to vote for the bill but he changed his mind before the meeting.

Haas and TJ's mother, Heather Floyd, said Embry had said he would vote for the bill. Embry disputed that, telling Kentucky Health News, "I didn't tell them I was voting for it. I said I would give it consideration." He said the bill probably has enough votes to get out of committee if all members attend.

Embry said he voted no because he didn't think the bill is necessary, especially because it has no penalties. He also voiced concerns about liability if a child was injured while not wearing a helmet on someone else's property or under the care of someone who was not a family member.

"I think they should wear a helmet," Embry said. "I think that parents should require them to wear a helmet. I think they should have enough sense to do that on their own, without the government demanding it."

Sen. Mike Wilson, R-Bowling Green, voiced similar liability concerns during the meeting, but voted for the bill.

At the meeting, Floyd urged the panel to pass the bill to prevent similar injuries to other children. She shared a long list of cognitive and physical struggles that plague TJ and others with brain injuries and that have stripped him of his ability to live an independent life. She said the bill is about bringing awareness to traumatic brain injuries, which affect more than 5 million Americans, and the importance of protecting children's brains.

BIAK says 384 American children die annually from bicycle crashes and 450,000 more are treated in emergency rooms for bicycle related injuries, with about 135,000 of those seen in the ER related to head injuries. Hass said after the rally that bicycle helmets are about 85 percent effective in preventing traumatic brain injuries when used properly.

Mary Hass of the Brain Injury Alliance
for Kentucky spoke at the March 14 rally.

Floyd told the committee, "The biggest and most important point is that this bill can save a child's life."

BIAK Executive Director Eddie Reynolds said after the rally that opposition to the bill often stems from concerns about personal freedoms.

Haas said motorcycle advocates have opposed the bill out of concerns it would lead to restoration of an old law requiring Kentucky adults to wear helmets while riding motorcycles. Current state law requires both operators and passengers on a motorcycle under the age of 21 to wear a helmet.

"There is no will in this legislature to want to put helmets on people who ride motorcycles. We feel that is their choice," Haas said. "This bill is only about protecting children and doing what our membership has asked us to do."

Similar bicycle helmet legislation has been considered in the House for several years. Last year, HB 122 passed the House 90-6 but was not heard in the Senate.

Bill to keep doctors' reviews of peers out of lawsuits is among three health-related bills legislature has sent to the governor

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to keep doctors' reviews of other doctors from being used in medical-malpractice lawsuits is on Gov. Matt Bevin's desk, along with two other health-related bills that have passed both chambers of the legislature.

House Bill 4, sponsored by Rep. Addia Wuchner, R-Florence, chair of the Health and Family Services Committee, was presented on the Senate floor by Sen. Ralph Alvarado, R-Winchester. He sponsored similar bills in previous sessions that got out of the Senate, but gained little to no traction in the House. The bill passed the House 58-27 on Feb. 9.

The bill passed the Senate 25-13 on Feb. 27, with Sens. C.B. Embry, R-Morgantown, and Brandon Smith, R-Hazard, voting against it with all 11 Democrats. There was no floor debate on the bill, but opponents have voiced concerns that keeping doctors' peer reviews out of lawsuits would allow factual statements to be hidden.

Unlike previous Senate bills, the House bill has language aimed at assuring that providers who are claiming the privilege are only doing so for safety and quality purposes, in the same way that the federal law requires.

“Very few health-care initiatives have shown to be more effective in improving health care safety and quality than medical-safety peer review,” Alvarado told the Senate. He said 48 other states already have laws like HB 4. “Confidentiality in peer review encourages integrity in health care. Physicians and nurses are free to speak openly about safety and quality without the threat of punishment that litigation causes.”

The two other health-related bills on the governor's desk passed through the chambers without much fanfare.

HB 5, sponsored by Rep. Daniel Elliott, R-Danville, more clearly defines state guardianship. It adds a provision that would allow jury trials to be waived if the attorney, the family, the judge and a three-member interdisciplinary team agree that this is in the best interest of the person being considered for guardianship. If any of the parties calls for a jury trial, it would be granted.

Kentucky is the only state that still requires a jury trial for guardianship, Tim Feeley, deputy secretary of the Cabinet for Health and Family Services, told the Senate Health and Welfare Committee on Feb. 21. He said the state is overwhelmed, and that many guardians have no resources for care. He said the state is currently the guardian for 4,448 people, and social workers have 65 to 70 cases apiece, about three times more than recommended by national guidelines.

This bill passed the House 79-3 on Feb. 5, with Reps. Jim Wayne, D-Louisville, Jason Petrie, R-Elkton, and James Kay, D-Versailles, voting against it. It passed the Senate unanimously Feb. 28.

Elliott also sponsored House Joint Resolution 33, to create a pilot called Working Interdisciplinary Networks of Guardianship Stakeholders, or WINGS, to examine how the state's guardianship program is working and to identify any needed changes. It passed the House without dissent Feb. 2 and is in the Senate Judiciary Committee.

A bill to allow veterans with traumatic brain injuries to get hyperbaric oxygen treatment is also on its way to the governor's desk. HB 64, co-sponsored by Reps. Stan Lee, R-Lexington, and Tim Moore, R-Elizabethtown, passed both chambers without dissent. It is titled the "Col. Ron Ray Traumatic Brain Injury Treatment Act," for a deputy assistant secretary of defense under President Reagan who suffers from a traumatic brain injury sustained 50 years ago in South Vietnam.

While hyperbaric treatment is regularly prescribed to veterans with traumatic brain injuries, it is often denied because it is considered an "off-label" treatment and not covered by insurance. The bill would allow them access to the treatment, but not require insurance to cover it.

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."

How much do motorcycle helmets reduce the risk of head injuries? A lot, UK study shows

Image from Fox News

It goes without saying that wearing a helmet can reduce the risk of head injuries while riding a motorcycle, but a study at the University of Kentucky backs it up with hard numbers.

Motorcycle helmets "are associated with a 69 percent reduction in skull fractures, 71 percent reduction in cerebral contusion, and 53 percent reduction in intracranial hemorrhage," and "a 20 percent reduction in cerebral concussion," says a release from the UK College of Public Health.

Dr. Michael Singleton, an assistant professor of biostatistics, examined accident data to compare helmet protection against skull fracture, cerebral contusion, intracranial hemorrhage and cerebral concussions of motorcycle operators, and hospital billings from 2008 to 2012, to estimate the relative risks of each type of head injury for helmeted versus unprotected motorcyclists.

Kentucky once had a law requiring motorcyclists to wear helmets, but the legislature repealed it at the behest of state Sen. Dam Seum, a Republican from Louisville.

Though there was little doubt that wearing a helmet increases safety, Singleton said helmeted motorcycle operators may still be at risk. "Current motorcycle helmets do not protect equally against all types of head injury," he said.

Mary Hass of Louisville gets national brain-injury advocacy award

Mary Hass (image
from BIAK Facebook page)

Mary Hass, the volunteer advocacy director at the Brain Injury Association of Kentucky, was one of four medical professionals recognized for their accomplishments in the field of brain injury during the North American Brain Injury Society's 13th annual conference.

Hass, of Louisville, is the first ever recipient of the NABIS Michael Davis Advocacy Award, named in recognition of a board member who passed away last year.

The award was given in honor of her "commitment and dedication to the field of brain injury and her advocacy work to establish programs and service for persons with brain injury in Kentucky, many of which serve as models for similar efforts around the country," says the release.

The conference, recently held in Florida, was attended by almost 400 multidisciplinary brain injury professionals from around North America who gathered to learn and share the latest developments from the field of brain injury. The principal mission of the organization is moving brain-injury science into practice.

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.

Centers for Disease Control working to find ways to prevent traumatic brain injury; affects one in five Kentucky households

The federal Centers for Disease Control and Prevention is using a public-health approach to find strategies to prevent traumatic brain injuries and reduce the physical, psychological, economic and social impacts they cause.

Image: brainline.org

Traumatic brain injuries are those that happen because of a blow or jolt to the head, like a fall or a motor vehicle accident. It contributes to 30 percent of all injury deaths in the U.S., killing 138 people every day, according to the CDC.

Nationwide, the most common cause of brain injury is falls, but in Kentucky, most brain injuries and brain-injury-related deaths are caused by traffic accidents. About 5 percent of Kentucky's population has a brain injury, which is double the nation-wide rate, affecting one if five Kentucky households,  according to the Brain Injury Alliance of Kentucky.

Survivors of serious brain injuries have a range of disabilities, from memory issues, personality changes to debilitating physical disabilities, having a lasting effect on families and communities.

In partnership with the traumatic brain injury and rehabilitation communities, the CDC, using research, is working to meet these goals and results of this research can be found in a special issue of the Journal of Head Trauma Rehabilitation.

One article looks at the problems of unemployment after traumatic brain injury, with data showing that 60 percent of patients who received inpatient rehabilitation for TBI are still unemployed after two years of discharge -- and 35 percent of those who were employed two years after injury were employed only part-time. In Kentucky, 45 percent of those with brain injury reported a loss of employment or educational opportunity because of their injury.

Another article focuses on motorcycle crashes as a cause of TBI and says, "People injured in motorcycle crashes use more health-care resources and are three times more likely to die in the emergency department, compared to those with other causes of TBI." Kentucky had 6,552 hospital visits in 2013 for TBI caused by motor vehicle crash and of these 419 were motorcycle related, according to the Brain Injury Alliance. Kentucky no longer has a law requiring motorcyclists to wear helmets.

Other articles look at the high impact of sports- and recreation-related TBIs, reporting that "About 7 percent of all emergency department visits for sports- and recreation-related injuries are TBIs, with at least 3.4 million sports- and recreation-related TBI emergency department visits occurring over a 12-year study period." Kentucky hospitals had 2,600 TBIs in 2013 related to sports and recreation injury, according to the alliance.

How to keep kids safe from traumatic brain injuries this summer

About 1.7 million people in the U.S. suffer a traumatic brain injury each year, and nearly half a million children under 15 visit an emergency room for TBI. A brain injury is traumatic if it disrupts the normal function of the brain.

Dr. Michael Egnor, vice-chairman of neurology at New York's Stony Brook University Hospital and director of pediatric neurosurgery at Stony Brook Children's Hospital, provides ideas for how parents can help protect their children from brain injuries this summer.

Families are going on more bike rides, but not everyone knows that bicycle accidents are most likely to happen within five blocks of home. "Make sure your child wears a helmet every time he or she rides a bicycle, scooter or skateboard," Egnor said. "We're seeing the most head injuries right now in skateboarding, especially in young teens, who might think it's just not cool to wear a helmet."

Each year more than 200,000 children suffer from injuries on playgrounds in the U.S., according to the U.S. Consumer Product Safety Commission. The main cause is falls. Egnor suggested looking for shredded mulch, pea gravel, crushed stone and other loose surfaces and being extra careful on asphalt and concrete.

Parents with older children and teens should be aware of possible diving accidents. "In about 50 percent of cases of catastrophic injuries, alcohol or drugs is involved," Egnor said. "Ensure that responsible adults supervise pool parties and other events where swimming and diving are involved."

Egnor also warned of concussions during summer sports. He said, "The few serious injuries we treat from organized sports are usually accidents that probably could not have been prevented," he said, while many of the concussions he treats are mild because many sports require helmets.

Dealing with serious injuries quickly is key, Egnor said. "The full extent of the injuries may not appear immediately." (Read more)

Lexington auto mechanic becomes neurosurgeon; now researching traumatic brain injury diagnosis and treatment

In the early 1980s, Geoff Manley was a mechanic, and some of his clients were University of Kentucky faculty. That is how he met microbiology professor Shelly Steiner and started on the road to a new career: neurosurgery and a multi-million-dollar research project.

"Some kids are polite—you know, 'Yes, yes, sir'—but disengaged. Geoff was clearly intelligent and focused," Steiner told Laura Dawahare of UKNow. "You can talk to someone for just a few minutes and know right away how bright they are. Geoff was like that."

Because no one in Manley's family had gone to college, Steiner's suggestion that he finish his GED and attend UK, was a "transformative moment," Manley said. He graduated in 1988 then earned his MD-PhD at Cornell University. Now he is the vice chair of neurosurery at the University of California-San Francisco.

"Manley's earlier work with Steiner and a colleague in the lab influenced his decision to pursue a career in the neurosciences; his particular interest is in traumatic brain injury, or TBI," Dawahare writes.

Though the public often hears about athletes' concussions, TBI results even more often from auto accidents or slips-and-falls. Every year at least 1.7 million people in the U.S. get medical attention for TBI. "I did a lot of bench work earlier in my career, but I was torn between my interest in the basic sciences and my desire to do something directly relevant for TBI patients," Manley said. "So I began to explore a new translational research approach to TBI."

The National Institutes of Health (NIH) gave him $18.8 million over five years to do worldwide research about concussion and traumatic brain injury. TBI is complex, which makes diagnosis and therapy development difficult. Dr. Manley and his colleagues want to change the current TBI measures. "Here we are in the 21st Century, and we classify TBI in one of three ways: mild, moderate or severe," Manley said. "Cancer, by comparison, can be characterized in a very precise way, and treatments are customized to each patient's needs." Therefore, Dr. Manley wants to establish a set of classifications for TBI that are as detailed as the ones used for cancer.

"We expect that our approach will permit researchers to characterize and stratify patients more effectively, will allow meaningful comparisons of treatments and outcomes and will improve the next generation of clinical trials," Manley said. "Advancing our understand of TBI will ultimately lead to successful, patient-specific treatments."

Manley said that Steiner's encouragement helped him not only finish his GED and college but also get where he is today. Steiner said, "Geoff would have made it anyway—he had the intellectual octane and the motivation. He may think others helped him, but it really was his trip." (Read more)

Beshear budget would expand oral health, cancer screening, brain-injury treatment and alternatives to institutionalization

Gov. Steve Beshear's proposed state budget includes money to expand oral health programs, screening for cervical and breast cancer, treatment for Kentuckians with brain injuries and programs to held disabled people stay in their homes or communities.

The largest pot of new money is $3.3 million for oral health, a subject to which Beshear has paid special attention since soon after he became governor in December 2007. His budget would expand preventive oral health programs in the Department of Public Health, and add 10 dental hygiene sites in local health departments over the two-year budget period, July 2014 through June 2016.

Beshear proposes $1 million to expand screenings through the Kentucky Women’s Cancer Screening Program to increase breast and cervical cancer screening.  The funds would also develop systems to help women navigate the health-care system. The governor's office also noted that his budget would continue the $1 million annual funding for colon cancer screening for low-income, uninsured Kentuckians aged 50 to 64.

Beshear would add 303 slots during the budget period for the Acquired Brain Injury Waiver program, which provides intensive services and support to adults who have acquired brain injuries and are working to re-enter community life. He would also add 900 new slots to waiver programs in Medicaid that provide alternatives to institutional care for individuals with intellectual and developmental disabilities.

A news release from Beshear's office said $166.7 million the state is saving because of federal health reform would be reinvested in the the Cabinet for Health and Family Services. "While most state agencies face 5 percent cuts under the governor’s proposal, most public-health and mental health-programs are exempt from cuts," the release said. "Affordable Care Act savings to these agencies mean many services they provide will now be covered with federal funds."

Among cabinet spending not directly for health, Beshear's budget would restore a recent cut in slots for child-care assistance for the poor, fund staff for the Child Fatality Review Commission, and expand the Health Access Nurturing Development Services (HANDS) program for new and expectant parents."This program was expanded to families that already had children in high risk communities in 78 counties with the use of a federal grant," the release said. "Beshear proposes $11.6 million to replace that grant, and an additional $5 million to take this expansion to the rest of the state."

Fort Campbell works to address post-traumatic stress disorder, common ailment of Afghanistan-Iraq veterans

Research shows almost 14 percent of veterans returning home from Iraq and Afganistan suffer from post-traumatic stress disorder (PTSD), and as an estimated 2 million veterans are coming home, Fort Campbell has quickly acted by reaching out to the medical community in Kentucky to help address the challenges of PTSD.

Top behavioral health and brain injury research experts came to Ft. Campbell on Tuesday to teach civilian behavioral health professionals about the military's current PTSD and brain injury research and treatments, reports Kristin Hall of The Associated Press.

PTSD can be one of war's ugly side effect, and it is an anxiety disorder that can develop after exposure to a terrifying event in which ther's potential for grave physical harm, such as "violent personal assaults, natural or human-caused disasters, accidents, and military combat," says the National Institute of Mental Health. Not properly treating PTSD symptoms can lead to alcohol or drug use, spouse or child abuse, depression or suicide

The clinics at Ft. Campbell will focus on PTSD and brain trauma treatment and will each have 13 mental health professionals to offer more personalized, focused care, which is expected to reduce "cases of psychiatric problems, spouse or child abuse, sexually transmitted diseases, suicides and drug use," like the pilot program at Fort Carson in Colorado, reports Adam Ghassemi of News Channel 5.

Some Kentucky veterans, like Mike Jeffrey who spoke about his physical and mental battles after his two tours in Iraq at a Veteran's Recognition Program, are addressing other problems associated with PTSD, which are that many veterans won't talk about it, and they both families and veterans lack awareness about treatment options. Jeffrey talked about the struggles he had when returning home and his "baby steps" toward normalcy.

“I woke up and had kicked down my apartment doors overnight without knowing it,” he said. “It was hell just living with myself,” reported Tracy Harris of The News Democrat. Jeffrey started counseling for his PTSD and is now using a service dog trained specifically for veterans, Seal Team.

“Seal Team is his security blanket,” said Jeffrey's wife, Shelly, who contacted four service dog organizations before finding K-9 trainer Mike Halley, a Vietnam veteran living in Florida, reports Harris. In addition to suggesting use of a service dog, Jeffrey said veterans shouldn't bury their own experience with PTSD, which many are reluctant to talk about.

“We all grew up in the suck-it-up-and-drive Army,” he said. “But you can only suck it up for so long,” said Jeffrey.

Efforts like the ones made by Ft. Campbell and Mike Jeffrey represent progress in treatment of mental health issues. And while these efforts alone won't address the problem, work within local communities can make a world of difference for struggling veterans.

Retired Maj. Gen. Mark Graham said "there is no quick way to eliminate the stigma often attached to seeking out mental health care, but the key is partnerships with the communities," writes Hall.

The story of returning veteran's is a big one that may be hard to cover, so click here for journalism tips. Click here to learn more about PTSD programs in Kentucky, or click the link below to watch news coverage about the behavioral health clinics in Ft. Campbell.

Ft. Campbell Opens Behavioral Health Clinics To Fight PTSD - NewsChannel5.com | Nashville News, Weather & Sports

New, 4-volume veterans' health handbook reflects UK expertise

It is not just about post-traumatic stress and re-entry into the job market anymore, as if it ever was. In topics as diverse as how to best get electronic medical records to how to treat the severely injured who would not have survived earlier wars, The Praeger Handbook of Veterans Health: History, Challenges, Issues and Developments has plumbed the expertise of 65 professionals -- many with ties to the University of Kentucky -- to teach anyone who cares how it's done.

Mary Meehan of the Lexington Herald-Leader reports that the editor of the four-volume set is Dr. Thomas Miller, professor emeritus and senior research scientist in psychiatry at UK, who began working on the handbook in 2006. The book makes wide use of Miller's many decades of work with veterans as well his network of experts from other countries.
 
 Miller told the Herald-Leader that he hopes the book will not only show people the scope of services available and how to get the help they need, but help shape the future of veteran care and by extension health care in the United States. The set is designed as a resource for libraries, health care offices and universities. It is available at online bookstores for $257. (Read more)

Three of four UK's research professorships fund work in health

Three of the four University of Kentucky research professorships awarded for the 2012-13 school year will fund health-related work. Each award is worth $40,000.

Mark Filmore, right, who teaches in UK's Department of Psychology, will research the role that cognitive processes have in promoting risk-taking behavior. It will have an emphasis on recreational drug use, including alcohol abuse and dependence.

Douglas Andres, left, professor and vice chair of the Department of Molecular and Cellular Biochemistry,  "had begun to define the molecular pathways that control adult neurogenesis, and have shown that Rit, a Ras family G-protein, plays a critical role in the survival of newborn adult neurons following traumatic brain injury," a press release reads. If that is the case, strategies that target Rit activation may be effective in helping recover or repair the injury.

In the Department of Internal Medicine, Mark Dignan, right, leads a program that focuses on cancer prevention and control in community settings using community-based participatory methods. Using the funds of his professorship, he plans to expand his training, "allowing him to conduct translational research with teams that include basic and clinical scientists as they continue their work to reduce cancer health disparities," the press release reads.

Christopher Pool, professor in the Department of Anthropology, is the fourth professorship recipient. (Read more)

Caregivers of wounded soldiers find their lives are also changed; getting compensation

The wars in Iraq and Afghanistan disproportionately affect rural areas, which provide more than the average number of recruits. The soldiers who make it home alive come back changed, with traumatic brain damage, post-traumatic stress syndrome or other injuries that require full-time care. Mostly wives and older parents are left bearing the burden.

Catrin Einhorn of The New York Times reports that many caregivers have to quit their jobs and are forced to spend their savings and retirement funds to pay for treatment. A growing number of caregivers suffer from anxiety, depression and exhaustion as a result of their new routines. Rosie Babin, 51-year-old mother of a severely wounded 22-year-old son, was managing an accounting office before her son's injury. Though she's happy to have her son home alive, she now has to take blood-pressure medicine and sleeping pills. "I felt like I went from this high-energy, force-to-be-reckoned-with businesswoman to a casualty of war," Babin told Einhorn. "And I was working furiously at not feeling like a victim of war."

According to research by Joan Griffin, a research investigator with the Minneapolis Veterans Affairs Health Care System, most of the injured are in their 20s and 30s, making this the first time since Vietnam the V.A. has seen such an influx of youth, which extending the length of care to years and sometimes decades. On average, Griffin found that family members spend more than 40 hours a week providing care, making it nearly impossible for them to keep a job.

Organizations like the Wounded Warrior Project have tried to ease the financial burden on these families by lobbying Congress to provide direct compensation and other benefits to caregivers and their families. In 2010, the veteran's agency approved 1,222 applications and awarded monthly stipends of $1,600 to $1,800 to caregivers. Along with the money, they can receive health insurance and counseling, Einhorn reports. This law only applies to caregivers of service members injured after Sept. 11, 2001, and it's uncertain who will qualify and how compensation will be determined.
(Read more)

Fort Campbell using simulated battlefields to assess brain injuries

Doctors at Fort Campbell are using a mock battlefield to assess whether or not soldiers who have suffered a traumatic brain injury are ready to return to combat. The clinic has been recognized by the Department of Defense as a national model.

"Soldiers are making life and death decisions, so doesn't it make sense to use demonstrated competence as the standard for returning someone to duty?" Dr. David Twillie told National Public Radio's Blake Farmer.

In exercises meant to simulate scenarios they face when fighting in Iraq and Afghanistan, soldiers sweep a gravel road for possible roadside bombs, take fire from insurgents and are told to insert chest tubes and tie tourniquets while listening to sound from a scene in Saving Private Ryan. The goal is to assess how well the soldiers handle the stress of the situations. Patients must also take written tests that assess their competence. The combination of both simulated and written assessments is important.

"Very recently we had a soldier that had a desire to stay in, had done well in all our simulations," Twillie said. "But when all the different sights, sounds, smells came back, he just wasn't able to change his focus, and that's very important in combat."

Memory loss, mood swings and difficulties balancing are common symptoms of a traumatic brain injury. About 115,000 soldiers have experienced such an injury, the Defense Department estimates. (Read more)