Judge rules University of Louisville's hospital is public and subject to Open Records Act; it may appeal

The University of Louisville's hospital is a public entity, a Jefferson Circuit Court judge has ruled in a lawsuit filed to get access to the university's deals with other health providers.

Judge Martin McDonald ruled yesterday in favor of The Courier-Journal, WHAS-TV and the American Civil Liberties Union, noting that the university makes or approves all appointments to University Hospital's board of directors. The university had argued that the board, and thus the hospital, was not a public agency under the state Open Records Act.

The hospital said it might appeal the ruling. McDonald gave it 30 days to give him the records being sought, along with arguments about why they should be exempt" under exceptions to the law, reports The C-J's Andrew Wolfson. "He gave the news organizations at the ACLU 20 days to respond to any claimed exemptions." The hospital has said revealing contracts would put it at a competitive disadvantage.

The suit began after the university refused to let the plaintiffs see records related to its proposed merger with Jewish Hospital & St. Mary's HealthCare and Lexington-based St. Joseph Health Care System. Gov. Steve Beshear vetoed the merger on grounds that a public hospital should not be bound by a religious organization's health-care policies. This month the hospital announced a new deal with KentuckyOne Health, which includes the faith-based entities, but said reproductive services would not be affected despite a policy of "respect" for Catholic health directives. (Read more)

Christian Co. Health Dept. to stop providing cancer screens, contraceptives to residents of other counties

As of Jan. 1, the Christian County Health Department will not provide contraceptives or cancer screening to indigent patients if they do not reside in the county. Nick Tabor of the Kentucky New Era reports the department will provide those services to other counties' residents if the county in which they reside has signed a contract with Christian County before the Jan. 1 deadline agreeing to repay Christian County for those services. Tabor writes that the policy is not applicable to those services that are covered by state or federal government reimbursements.

The health department's move was prompted by a budget deficit that is close to $200,000, some of it traceable to a lack of reimbursement for contraceptive care. Mark Pyle, director of the department, told Tabor that residents of both Todd and Trigg counties often seek services in Christian County and Christian county taxpayers foot that bill. Pyle explained that there’s nothing in state law saying the health departments have to serve anyone who comes in, regardless of residence.

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UK, ARH planning efforts against high rate of heart-disease deaths and limited availability of proper food in Perry County

The death rate from heart disease is nearly twice as high in Perry County (Wikipedia map) as in Kentucky as a whole, so there's no better time than now to announce that the University of Kentucky Medical Center is close to finalizing a three-year agreement with Hazard Appalachian Regional Healthcare Medical Center to provide continuing care, outreach and education to local physicians and county residents, including more and better information about heart-healthy food choices. Bailey Richards of the Hazard Herald reports that this last task is daunting, particularly since availability of good food is an issue in remote parts of the county.

Richards writes that a 2011 study of the heart-healthy food options in Perry County "showed that the area severely lacks low-fat and low-sodium options." Kevin Luley, a registered nurse at the UK Medical Center and winner of the "Heart Health in Rural Kentucky" grant, surveyed all of the restaurants and grocery stores in Perry County and found that most do not have many off-the-shelf options for a healthy diet. Of all of the items available at the restaurants in Perry County, fewer than 6 percent were considered healthy. (Residents can consult their own smartphones for that information. It should also be posted or available upon request.) Of a standard list of produce items, on average only 60 percent were found at the local grocery stores, Luley found. (Read more)

UK music therapy helps manage surgical anxiety, pain, recovery

A University of Kentucky study has found that music therapy can reduce pain before, during and after a surgical procedure, and shorten recovery time. The study report, published in the Southern Medical Journal, showed music was also useful in managing surgical anxiety. According to Lori Gooding, UK director of music therapy and lead author of the report, the music should be selected by trained personnel with a mind toward specific guidelines for music selection in order to maximize its positive effect on patients, though the patient's musical tastes should still be considered. Gooding suggests patients be offered several playlists from which to choose so they can have something to suit their tastes as well as the medical protocol. (UK video)



Gooding writes that the tempo, rhythm and volume of the music should be carefully controlled to maximize its effect. Calm, slow, gentle music was shown to produce the most positive results and facilitate relaxation and pain reduction in patients. UK began providing music therapy for patients in Kentucky Children’s Hospital, UK Chandler Hospital and UK Good Samaritan Behavioral Health in October 2010. The UK Music Therapy program was established as part of the Lucille Caudill Little Performing Arts in HealthCare Program, a unique partnership between the UK School of Music and UK HealthCare. (Read more)

U of L doctors wary of KentuckyOne's promise of autonomy

Doctors at Louisville's University Hospital are expressing concerns that the partnership with KentuckyOne Health and the Catholic health rules that come with that merger might affect patient care. Assurances that their concerns are unfounded have been coming from KentuckyOne's majority owner, Denver-based Catholic Health Initiatives. Anxiety over doctors' medical freedom to treat patients as they feel is necessary is being fueled as staff and physicians are being asked to "respect" Catholic health directives, The Courier-Journal reports.

Sheila Reynertson, advocacy coordinator for the New York-based MergerWatch Project, who tracks secular-religious hospital mergers, told The C-J's Laura Ungar that such language puts doctors in "a difficult position." For instance, she explains, "cancer doctors may wonder about prescribing birth control to prevent pregnancy, she said. Catholic directives include a ban on sterilization, abortions, and euthanasia and say Catholic health institutions can't "promote or condone contraceptive practices." Gary Mans, spokesman for the U of L Health Sciences Center, said he doesn't believe doctors and staff will feel constrained by the directives. (Read more)

Over-the-counter drug makers start campaign to educate potential meth 'smurfers' about consequences of their actions

By Al Cross
Kentucky Health News

The lobby for makers of over-the-counter drugs, which has fought laws to tighten controls on sale of cold medicine that is used to make methamphetamine, is starting a public-education campaign to discourage evasion of the system that tracks purchases of pseudoephedrine. The targeted states are Kentucky and Alabama, which could be key to preventing passage of laws like the one in Mississippi, which requires a prescription for pseudoephedrine. UPDATE, 4/19/13: Missouri has been added.

The Consumer Products Healthcare Association rolled out the campaign in Alabama last month. It joined with the Kentucky Pharmacists Association and the Kentucky Retail Federation yesterday to announce the program in Kentucky, and won the blessing of its primary adversary in the state's legislative battle, Senate Republican Leader Robert Stivers of Manchester. Also on hand at Wheeler's Pharmacy in Lexington was Democratic Gov. Steve Beshear, who had stayed out of the fight until he signed the bill.

Stivers, who is in line to become Senate president, was asked if the drug makers' move signaled a truce in the battle. He indicated that he would wait to see the impact of this year's law, which reduced the amount of pseudoephedrine that can be bought during one a month, before trying to tighten it. "Let's look at the history and see what happens," he said. Earlier, he said: "I appreciate the fact that they're coming here in a very conciliatory way, a very open way, to say we all know there is a problem."

Beshear noted that fewer meth labs have been found in Kentucky this year, but said the success of the law depends on educating the public: "As laws are passed, criminals adapt and find new ways of getting around them."

Preventing that is the goal of CHPA's "Anti-Smurfing Campaign," named for the practice of meth makers using others, "smurfs," to buy pseudoephedrine for them. Beshear noted that the new law makes smurfing a felony, and said the posters are "designed to make smurfers think twice" and "think of the moral and criminal consequences of their actions." He told cn|2 Politics, "I think will be a good deterrent in this situation."

CHPA's director of state government affairs, Carlos Gutiérrez, said the posters were tested in 2011 with focus groups of Kentuckians and strike a balance of educating potential smurfers without alarming law-abiding buyers of pseudoephedrine.

In its efforts to kill Stivers' prescription bill during the 2012 legislative session, CHPA spent more than any other lobbying group has ever reported spending on a legislative session, and that did not include hundreds of thousands of dollars it spent on radio commercials urging listeners to lobby legislators about the bill. Lobbies in Kentucky do not have to report what they spend on such indirect lobbying. Guiterrez was asked if CHPA would do that, and he said he would look into it.

First heart-lung transplant in Ky. in 15 years performed at UK

University of Kentucky surgeons performed Kentucky's first combined heart-lung transplant in 15 years this summer, UK announced today.

Dawn Nelson, 29, of Louisville, received two lungs and a heart from the same donor in one procedure at the Albert B. Chandler Medical Center on July 7. She and her parents discussed it with Courier-Journal reporter Laura Ungar in this video by The C-J's Kylene White:


For Ungar's story, click here. Combined heart-lung transplants are rare; only 27 were performed nationwide in 2011. They are generally performed on younger patients who have a fatal disease and cannot be treated with medication or other interventions.

Nelson was diagnosed with systemic lupus erythematosus at 17 and rheumatoid arthritis at 22. Four years ago, she developed pulmonary hypertension, fatal without timely treatment. The disease destroyed her lungs, and her heart began to fail when it could no longer push blood into them.

Dr. Wesley McConnell, a transplant pulmonologist with Kentuckiana Pulmonary Associates in Louisville, began caring for Dawn two and a half years ago at KPA's Pulmonary Hypertension Center. After she didn't respond to drug therapies, McConnell referred Dawn to UK May 11 for a transplant evaluation. "Dawn was extremely ill and it became clear that her only chance for survival would be a heart-lung transplant," he said. "I knew that UK was her best option because they had the most experienced team in the state."

Dr. Charles Hoopes, director of the UK Transplant Center, performed the surgery, only the seventh such procedure to be performed at UK since it began transplantation in 1964. The last time UK performed this surgery was 1996. "Although the surgery itself is relatively simple, combined heart-lung transplants are rare because they require three donor organs and are reserved for patients who are extremely ill with heart and lung failure," said Dr. Jay Zwischenberger, chair of the UK Department of Surgery. "They also require a great deal of infrastructure and support to perform successfully. At UK, we have that team in place, and moving forward we expect to perform one or two of these combined transplants per year."

More than four months after her surgery, Nelson continues to improve and grow stronger. Dr. Enrique Diaz, medical director for lung transplantation, and Dr. Navin Rajagopalan, medical director of cardiac transplantation, both provide followup care for her at UK, and she continues to see McConnell in Louisville. "Dawn is doing quite well. At the time of transplant, she was so sick she only weighed about 80 pounds," Rajagopalan said. "Now, she feels well, is gaining weight, and is able to do things that she had not been able to do for years.”

Nelson's collaborative treatment is a prime example of the partnership UK is trying to cultivate among Louisville and Lexington doctors, said Dr. Michael Karpf, UK executive vice president for health affairs: “Our goal is to continue to provide highly advanced subspecialty care such as Ms. Nelson’s complex transplant to patients like her who otherwise would either have to leave the commonwealth or, worse, not receive the treatment needed.”

In November 2010, UK in collaboration with Norton HealthCare opened up an outreach Transplant and Specialty Clinic at Norton Audubon Hospital to provide comprehensive pre- and post-transplant care for patients. The partnership ensures that patients like Nelson will not have to leave the state to receive complex acute care or followup treatment, a UK press release said.

Kentucky parents' overall perception of Kentucky children's health doesn't match the statistics, foundation survey finds

Many Kentucky parents' perception of their children's health doesn't match statistics, suggesting that many health problems are going undetected or untreated.

That is the upshot of the Foundation for a Healthy Kentucky's first Kentucky Parent Survey, conducted by the University of Virginia's Center for Survey Research this summer and released today.

Only 4 percent of Kentucky parents said a health professional had told them their child was obese, but the National Survey of Children's Health in 2007 found that almost 37 percent of Kentucky children were obese.

Just 5 percent of Kentucky parents said they had been told that their child had depression or anxiety, but about 25 percent of children 13 to 18 will have struggled with anxiety and 11 percent will have battled depression, according to a 2010 national study. And a recent study found that Kentucky teens were more likely than the national average to have attempted suicide.

About 17 percent of Kentucky parents reported that their child had decayed teeth or cavities, but a national survey of third graders in 2001-02 revealed that 35 percent had untreated dental issues.

Only 3 percent of parents said their child was diagnosed with a hearing problem, but 15 percent of children nationally have measurable hearing loss. And 14 percent reported being told their child had a vision problem, but about one in four preschoolers nationally have vision issues.

Parents also seem not to get enough advice from health care providers about how to treat their children's health issues, even though there are high rates of children suffering from tooth decay, vision problems, asthma, ADHD, depression/anxiety, obesity, hearing impairment and diabetes, the survey found.

While 92 percent of parents said their child had a regular doctor, just 80 percent said their child had a regular dental care provider. And a 74 percent majority of parents surveyed said they were always encouraged by their child's healthcare provider to ask questions during visits. "The exceptions are worth noting," said Susan Zepeda, president and CEO of the foundation. "If three in four parents said their child's provider always encouraged questions, this means that one in four were not always encouraged to ask questions." (Read more)

Lame-duck Congress could cut funding for critical access hospitals; more than two dozen in Kentucky

Critical access hospitals, which in most states are rural facilities with fewer than 25 beds, may be under attack in the lame-duck session of Congress, former national rural-health director Wayne Myers writes for the Daily Yonder. President Obama's "budget proposes to revoke CAH status and special payments for any such hospital within 10 miles of another hospital, and to cut the extra 1 percent payment for all of the critical access hospitals," Myers writes. (Census Bureau map of CAH locations)

This would "have enormous consequences," Myers writes. "Of the hospitals that lose CAH designation probably most will close or merge with another hospital. I've seen no estimates of numbers. There are more than a few congressional budget hawks in both parties who would like to eliminate the special payments to Critical Access Hospitals entirely. If these small hospitals dodge the bullet during the lame duck session, they'll continue to be targets in the next Congress. If they are successful in reducing payments to CAHs, the net effect will be to move health care capacity and jobs from smaller to larger towns."

The issue is complex. Rural areas have less political clout than ever, because of declining population, and many rural people use urban hospitals over CAHs, even for ordinary care. "Those who do use CAHs say their experience there is just as good as that in urban hospitals, even if the quality of care isn't as good as in larger facilities," Myers writes. "Elderly patients stay at CAHs because they know the nurses and doctors and their families live close by."

Issues for CAHs arise out of how Medicare payments are made to them, Myers writes. "A long list of arcane, special funding arrangements has accumulated to try to fit small rural hospitals into a Medicare payment system designed for large city hospitals." The largest program is the "Disproportionate Share Program," or DISH, which gives $15 billion a year to states to hand out to CAHs. The program is being phased out between 2014 and 2020, along with several other programs, as part of the Patient Protection and Affordable Care Act. (Read more)

Canadian study suggests children in day care are more likely to be obese than those cared for by their parents

Children who attend day care regularly are 50 percent more likely to be overweight than those who stay home with parents, according to a new University of Montreal study in Quebec. Lead researcher Marie-Claude Geoffroy said the disparity "cannot be explained by known risk factors such as socioeconomic status of the parents, breastfeeding, body mass index of the mother, or employment status of the mother."

Researchers studied more than 1,600 families with children born in 1997 and 1998 in Quebec, a sample that was representative of the majority of kids in the province. Mothers were interviewed about their children's care at ages 1.5, 2.5, 3.5 and 4. Children were put into groups based on the type of care they received most. Researchers concluded that 65 percent of children spent most of their time in day care. Just 19 percent were cared for mostly by a parent.

Researchers found no clear explanation for the weight disparities, but they argued that day care has the potential to reduce weight problems in children through promotion of physical activity and healthy eating. (Read more)

Share of Kentuckians reporting they had been diagnosed as diabetic nearly tripled from 1995 to 2010

We're not just getting fatter, Kentucky, we're becoming chronically ill because of it. According to the Centers for Disease Control and Prevention, the rate of diagnosed diabetes in Kentucky has increased dramatically in the last decade and a half.

In Kentucky, 9.3 percent of adults reported having been diagnosed with Type 2 diabetes in 2010, up from just 3.6 percent in 1995, according to response to the Behavioral Risk Factor Surveillance System, an ongoing national telephone survey. (Data from 2011 were not compared because the survey methodology changed.)

The figure is undoubtedly less than the actual percentage of Kentuckians with diabetes; nationally, 18 million people say they have been told they have the disorder, and another 7 million are estimated to have it but not be diagnosed. In 1958, the national rate of diagnosed diabetes was 1 percent; now it's 8.2 percent. Not surprisingly, Mississippi, the state with the largest proportion of residents who are obese, has the highest diabetes rate, at nearly 12 percent.

The biggest jump in diagnosed diabetes from 1995 to 2010 was in Oklahoma, where it more than tripled. The South, as a region, had the most frightening numbers, almost one in 10 adults. That was more than double the rate in 1995. Several Northern states saw rates more than double, too, including Washington, Idaho, Montana, Wyoming, South Dakota, Minnesota, Missouri, Ohio and Maine.

"The rise in diabetes has really gone hand in hand with the rise in obesity," CDC report lead author Linda Geiss told The Associated Press. Diabetes is a disease in which the body has trouble processing sugar. Even with medications to help control it, it can cause damage to the kidneys, circulation and nervous system. It is the nation's seventh leading cause of death. (Read more) To read the CDC report, go here. 

Teen smoking in Kentucky declined more than it did in nation from 2002 to 2010, but state remained in top 10

Like most states, Kentucky showed a drop in reported cigarette smoking among 12- to 17-year-olds from 2002 to 2010, according to a report by the Substance Abuse and Mental Health Services Administration.

Nationwide, teenagers' reported "current use" of cigarettes dropped from 12.6 percent to 8.7 percent. In Kentucky, that decline was even more significant, plummeting from 17.6 percent in 2002 to 11 percent in 2010. The 2002 rate was third in the nation; the latest one is sixth. The surveys defined "current use" as smoking in the past month. (Click on map for larger version)

Strangely, the data showed that during the same period, teens' perception of risk from cigarette smoking remained unchanged in Kentucky and most other states. Tobacco use is the leading cause of premature and preventable death in the United States. (Read more) To read the full report, go here.