'Fatal Flaws' series on Ky. workplace safety wins national award for Kentucky Center for Investigative Journalism

http://fatalflaws.kycir.org/?utm_source=KyCIR&utm_campaign=13addb68bb-EMAIL_CAMPAIGN_2019_03_28_02_25&utm_medium=email&utm_term=0_3fe1cce7ce-13addb68bb-166990137&mc_cid=13addb68bb&mc_eid=4bc9d6d2c3

Judge again blocks state's Medicaid plan with work requirements for many, says likewise for similar plan already in effect in Ark.

The order vacating federal approval of Kentucky's plan

By Melissa Patrick
Kentucky Health News

A federal judge in Washington has again blocked Gov. Matt Bevin's attempts to require many people on Medicaid to work or do other forms of "community engagement," saying that such rules don't square with Medicaid's objective to give low-income people health care.

U.S. District Judge James Boasberg also ruled March 27 against similar work requirements in Arkansas. Bevin, a Republican running for re-election, has said the U.S. Supreme Court will ultimately decide the issue. His former deputy chief of staff, Health and Family Services Secretary Adam Meier, said in a press release, "We believe that we have an excellent record for appeal and are currently considering next steps.”

The plan is called Kentucky HEALTH, for Helping to Engage and Achieve Long Term Health. It would require "able-bodied" Medicaid members to spend 80 hours a month working, going to school, taking job training, acting as a primary caregiver or getting treatment for drug abuse; make them report monthly; stop their coverage for failure to comply; and pay small premiums, based on income.

Boasberg vacated federal approval of the plan and sent it back to the U.S. Department of Health and Human Services for further review just days before it was set to launch on April 1 -- just like he did in late June, when he vacated it the first time. He said both times that HHS Secretary Alex Azar had not sufficiently considered the state's projection that its Medicaid rolls would have 95,000 fewer people in five years with the rules than without them, in large measure for failing to follow rules.

"Given a second failure to adequately consider one of Medicaid's central objectives, the court has some question about HHS's ability to cure the defects in the approval," Boasberg wrote. In Arkansas, more than 18,000 people have lost Medicaid coverage since a similar plan took effect there.

Kentucky made no real changes to its plan after Boasberg's ruling last June. However, it put more emphasis on its argument that without the new rules, Bevin would end his Democratic predecessor's expansion of Medicaid to about 450,000 people earning up to 138 percent of the federal poverty line -- many more than the forecast drop of 95,000 under his plan. The governor has issued an order ending the expansion six months after any final court decision against the plan.

The Medicaid expansion was authorized by the 2010 Patient Protection and Affordable Care Act, more often called Obamacare. The Supreme Court upheld the law in 2012 with one main exception: "Congress could not require states to adopt that Medicaid expansion by conditioning all their Medicaid funding on a decision to do so," noted Boasberg, an appointee of President Obama.

Judge James Boasberg of the District of Columbia

The high court "explained that the states could not be compelled to engage in a program they had not bargained for with 'a gun to the head.'  Kentucky, it seems, has now picked up that gun by threatening to de-expand Medicaid," Boasberg wrote.

"By definition, so this argument goes, any number of people covered by an experimental Medicaid program would be greater than the number if there were no Medicaid at all; as a result, any demonstration project that leaves any individual on a state’s Medicaid rolls promotes coverage. The court cannot concur that the Medicaid Act leaves the secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose."

Meier replied, “The judge illogically concluded that Medicaid is all about paying for health care for as many people as possible without regard to whether this coverage actually makes people healthier. . . . We want more than to simply give someone a Medicaid card they can put in their wallet. We want a program that focuses on actually improving health outcomes. . . . Kentucky HEALTH is precisely in line with the objectives of the Medicaid program."

Meier said Kentucky HEALTH will no longer begin on April 1 and that beneficiaries will continue to have the same coverage and benefits that they currently have. Beneficiaries should contact their managed care organization or go to www.benefind.ky.gov for the most up-to-date information.

Boasberg's decision brought immediate praise from Obamacare supporters.

“Kentucky Voices for Health and our partners applaud the court’s decision to once again protect Kentuckians on Medicaid by refusing to create additional barriers to care,” said Executive Director Emily Beauregard. “Medicaid works in Kentucky, and Medicaid expansion has saved lives. Judge Boasberg’s decision sends the message that 1115 waivers must uphold the purpose of Medicaid, which is to furnish health coverage to low income people.” Kentucky HEALTH would be an experimental project under Section 1115 of the Social Security Act.

The state's slightly revised plan prompted 16 Kentucky Medicaid recipients to file an amended complaint to the original class-action lawsuit, saying nothing of substance was changed. They are represented by the National Health Law Program, the Kentucky Equal Justice Center and the Southern Poverty Law Center.

HHS's Centers for Medicare and Medicaid Services has approved waivers of the Medicaid rules to include work requirements in eight states, with seven applications pending, according to the Kaiser Family Foundation.  

The Foundation for a Healthy Kentucky struck a deal with the Bevin administration last year to help Medicaid members comply with the plan to keep their coverage. It issued a statement from President and CEO Ben Chandler saying, "The foundation recognizes that adequate health insurance coverage is one of the most cost-effective ways to improve health outcomes. For a state with some of the poorest rankings in health outcomes, coverage is critical to reduce health-care costs, particularly those costs paid by tax dollars, by increasing access to preventive services, improving medication adherence, and providing better treatment for chronic illnesses."

Chandler added, "The foundation is reviewing the court's opinion. Meanwhile, we are aware that some Kentuckians have already voluntarily taken advantage of the job training and placement services expanded under the Kentucky HEALTH framework. If the administration continues to provide the framework on a voluntary basis, the foundation plans to continue working with community organizations and other stakeholders to support Medicaid beneficiaries with accessing resources."

Man who ran drug-treatment facilities in Ironton and Portsmouth, Ohio, is indicted on drug-trafficking charges

Graffiti under the U.S. Grant Bridge in Portsmouth, Ohio
(Cincinnati Enquirer photo by Liz Dufour)

The former operator of Ohio drug-treatment facilities just across the river from northeastern Kentucky was indicted Wednesday on 34 felony counts ranging from drug trafficking to Medicaid fraud.

Paul Vernier, 56, operated Community Counseling and Treatment Services in Ironton and Portsmouth, the Cincinnati Enquirer reports. He is accused of overbilling Medicaid and illegally operating a dispensary for Suboxone, a drug used in medication-assisted treatment for addiction.

“The evidence will show that this guy abused the trust of hurting people who were looking for help and that he played the rest of us – who pay the bills – for fools,” Ohio Attorney General Dave Yost said in a press release. “Time for some accountability.”

Bevin signs bill setting deadlines for insurers to authorize medications prescribed by health-care providers

Gomerpedia.org

Gov. Matt Bevin has signed into law "a bill that’s expected to ease the process for getting some medications and treatments pre-approved by insurers," Darla Carter reports for Insider Louisville.

Senate Bill 54 could speed up the authorization process "to five days or less, along with other enhancements," Carter writes, and quotes Dr. Bruce Scott, a Louisville ear, nose and throat physician who is president of the Kentucky Medical Association.

“Five days is a considerable improvement for our patients,” Scott said. “It’s still five days of stress and five days of waiting, but that’s a whole lot better than what we used to have, which could often stretch on for weeks.”

KMA says the bill, sponsored by Republican Sen. Ralph Alvarado, a Winchester physician, targets "a process that has become onerous to medical providers and patients alike, with doctors’ office staffs sometimes spending hours on hold waiting to hear back from insurers," Carter writes.

Scott told her the process can lead patients “to abandon treatments that are recommended by their doctors, and it adds stress to patients who are waiting for approval of a medication, a treatment, a diagnostic study that their trusted physician has recommended to them.”

An American Medical Association survey "found that nearly 30 percent of physicians report that the prior-authorization process required by health insurers has led to serious or life-threatening events for patients," Carter reports. "The survey of 1,000 practicing physicians also found that more than a third of physicians employ staff strictly to work on pre-authorization tasks."

Insurers say they have an obligation to keep costs down. "Stephanie Stumbo, acting executive director of the Kentucky Association of Health Plans, reminded members of the House Banking and Insurance Committee that insurance companies also have to deal with headaches related to prior authorization," Carter writes.

The bill takes effect Jan. 1. It will require health plans to make decisions about urgent services within 24 hours of getting the necessary information, and on non-urgent services within five days. Scott told Carter the insurers “pushed for seven days, and the bill was originally written at 72 hours [three days], and we compromised with five days.”

Prior authorizations for maintenance drugs, usd to treat chronic conditions, will be good for a year, with some exceptions, including opioid painkillers and benzodiazepines (minor tranquilizers).

Beshear says he's investigating pharmacy benefit managers for possible overcharging, and discrimination against independents

Republican Gov. Matt Bevin and Attorney General Andy Beshear
are the most likely nominees for governor in the Nov. 5 election.

Attorney General Andy Beshear announced March 21 that he is investigating pharmacy benefit managers, the "middlemen" between drug companies and health insurers, including Kentucky's Medicaid program and state-employee health plan.

Beshear is investigating whether PBMs have overcharged the state "and discriminated against independent pharmacies," his office said in a press release, which noted that a state report "indicated two PBMs took in $123.5 million last year from the state Medicaid program by paying pharmacies a lower rate to fill prescriptions, while charging the state more for the same drugs."

The release said, "It is estimated that more than 1.5 million Kentuckians receive pharmacy benefits through Medicaid and the state employee health plan’s PBMs. Thousands of other Kentuckians receive pharmacy benefits through PBMs retained by their private insurance plans. . . . Beshear said PBMs were originally established to help companies and government programs better manage pharmacy costs, but have grown into powerful industry middlemen that go to great lengths to hide and complicate drug pricing information."

The international news agency Reuters reports, "The investigation comes against the backdrop of widespread criticism of rising costs of prescription medicines in the United States, with PBMs, middlemen who negotiate prices for employers and health insurers, coming under intense scrutiny."

The state report, titled "Medicaid Pharmacy Pricing: Opening the Black Box," was done by the state Department of Medicaid Services on orders from the General Assembly, Medicaid Commissioner Carol Steckel said upon its release, "We have additional steps that we will need to take in order to make this program fully transparent."

Beshear is the leading candidate for Democratic nomination for governor. Gov. Matt Bevin is seeking re-election and is heavily favored in the May 21 Republican primary.

Justice secretary touts treatment over incarceration; 'We have to distinguish who we are mad at and who we are actually afraid of'

Justice and Public Safety Secretary
John Tilley (Photos by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

State Justice and Public Safety Secretary John Tilley told foreign scholars visiting Kentucky Friday that treatment, instead of incarceration, is what is needed to help people who suffer from addiction -- a stand that is still a hard sell for some in Kentucky.

"The best place to treat addiction is not a prison cell," Tilley said. "And I still have policy makers in this state who think that is OK, when there is absolutely no evidence, no evidence that that approach enhances public safety."

Tilley and other experts spoke to nearly 90 Fulbright scholars from 49 countries at a University of Kentucky seminar.

Tilley said prosecutors tell him they are "hard-pressed" to find someone in the system who isn't there because of a drug-related offense, that 95 percent of their cases are related to addiction. He noted that since 1970, Kentucky's population rose 38 percent and its prison population rose 700 percent.

"We're beginning to realize that we can't change that behavior with punishment," he said. "We're not going to punish people into sobriety."

But some law-enforcement officials still oppose syringe exchanges that can prevent disease and accidents, and steer people into treatment, said keynote speaker Beth Macy, author of Dopesick: Dealers, Doctors and the Drug Company that Addicted America. "It all seems to collapse in that murky area between healthcare and criminal justice," said Macy, who began covering the opioid epidemic as a newspaper reporter in her hometown of Roanoke, Virginia.

Tilley said he is working on removing drug possession as a felony offense in Kentucky, as more than 15 states have done, "but there are too many who are unwilling to take that leap." He said at least 2,000 Kentuckians are in the prison system only for possession.

Tilley was instrumental in passing Kentucky's 2015 anti-heroin bill, as a state representative from Hopkinsville. Among other things, the bill created a system in which Kentucky counties and cities could authorize syringe exchanges; increased penalties for high-volume traffickers; allocated money for drug treatment; and let the Department of Corrections medicate inmates with opioid-use disorders.

Tilley, a Democrat, was appointed justice secretary in December 2015 by Republican Gov. Matt Bevin. "This is a nonpartisan piece of our government," he told the foreign visitors. "It's about justice and results, and we can all agree on those things."

He said Kentucky is working on many reforms to keep people with addictions out of prison, including, but not limited to: efforts to train police officers on how to recognize mental illness and addiction, and how to use crisis interventions and de-escalation techniques; using social workers in police departments to help find resources for people, instead of locking them up; efforts to help prisoners re-enter the workforce when they are released; pilot programs that offer medication-assisted therapies to inmates; and a program called the Angel Initiative in all 16 state police posts, which lets a person with an addiction to come in and be driven to the nearest treatment bed.

'A failed model' that varies unjustly from court to court

Tilley said the state must stop putting non-violent, low-level, non-sexual offenders in jail, and described how incarcerating worsens social problems.

He said Kentucky has the nation's second highest female incarceration rate, which has put more children into foster care, now numbered at  more than 10,000. "It's all tied together," he said. "We have to distinguish [between] who we are mad at and who we are actually afraid of."

Tilley pointed to research that shows addiction is a disease of relapse and requires many attempts for a person to become sober, and when you add criminal entanglements, it is a "set-up for failure."

He added, "It's a failed model. Why in the world would we try to treat what I think is a public health nightmare with a criminal justice system that was never designed to do this?"

He added that people with addictions who are arrested in Kentucky are treated differently across the state, depending on judges' understanding of addiction and the availability of wrap-around services to help offenders. "It's incredibly disparate, and it's unjust," he said. "It is injustice at its best."

Most who need treatment don't think they do, and most don't get it

Ty Borders, the director of UK's Rural and Underserved Health Research Center, told the scholars Friday that most people who have been diagnosed with substance-use disorders don't think they need treatment, and most who need treatment don't get it.

He said a national study found that only 17 percent of people with a heroin-use disorder in urban areas, and 24 percent in rural areas, thought they needed treatment; and among those with disorder involving prescription drugs, only 8 percent in urban areas and 13 percent in rural areas saw a need.

"The biggest predictor of people actually trying to get treatment for drug use disorder is whether they perceive any need for it," Borders said.

Not many more with a substance-use disorder actually got treatment.

The study found that in 2014-15, about 13 percent of Americans aged 18-64 who had a drug-use disorder got any type of treatment for it. That number was higher among those with an opioid-use disorder, around 24 percent, largely because there is a medication available to treat it, Borders said.

"These are really low rates, especially when you compare these to rates of treatment for hypertension, diabetes, cancer, et cetera," he said.

Ty Borders

On another point, Borders said that while more primary-care providers than ever are able to prescribe buprenorphine, a medication to treat opioid addiction, there are still concerns that their patients aren't getting appropriate counseling and therapy that is supposed to go with it, compared to what they would get from a psychiatrist.

He said Kentucky data show that the proportion of Medicaid patients who were prescribed buprenorphine and also received counseling at the same time increased in 2014-16, but the percentage who actually got the drug went down duruing that period.

"That means fewer people are getting access to this drug, if they had an opioid use disorder and they were covered by Medicaid," he said, adding that one reason for this could be that insurance firms that manage Medicaid  have put in prior-authorization requirements and other mechanisms that make it harder for providers to get approval for payment by the program.

Rep. Kim Moser, R-Taylor Mill, filed House Bill 121 to address this issue, but it got stuck in the Senate and is not far enough along in the process to pass on March 28, the last day of the legislative session. Moser told Kentucky Health News that it's important for patients to be able to get their medication-assisted treatment drugs without any delay because it keeps them from cycling in and out of jail or emergency rooms, and prevents overdose deaths.

Borders said there continues to be a great need for more buprenorphine prescribers in the central and western parts of the U.S., where some people have to drive more than 100 miles to get this medication.

Part of the problem is that the U.S. Drug Enforcement Administration requires health-care providers to either be board-certified to prescribe addiction medications or to take eight hours of training to get certified to prescribe, and then are only allowed to treat 275 patients annually.

Borders said research shows there are more buprenorphine prescriptions in states that expanded Medicaid to people who earn up to 138 percent of the federal poverty level, as Kentucky did. Borders attributed this to more people having access to a health-care provider and therefore the drug, and also being more able to pay for it because they have insurance.

Health departments scramble to fight hepatitis A outbreak

Peyton Manning had hepatitis C but didn't know about hepatitis
A or the outbreak until it hit him. (Michael Clevenger, Courier Journal)

The nation's largest outbreak of hepatitis A has slacked off somewhat in Kentucky, but remains a threat and local health departments are dipping into their reserves and taking unusual steps to get people vaccinated for the liver disease, which has killed 44 Kentuckians during the outbreak.

The medical director of the Lake Cumberland District Health Department doesn't usually give vaccinations, but each of her counties only had one or two nurses to do that, so Dr. Christine Weyman started giving shots, too, Laura Ungar and Chris Kenning report for the Louisville Courier Journal.

"She has gone out to vaccinate drug users who largely were spreading the virus," they report. "She once went so far as to chase two men down a street to persuade them to get the shot. (They weren't interested.) She also went to the crowded Pulaski County Detention Center, realizing the 213-bed jail with more than 400 inmates could be an excellent incubator for the virus. Right outside the jailer's office door, her health department placed a refrigerator for the sole purpose of storing vaccines."

"In many ways," Ungar and Kenning wrote, the Somerset-based department "is a microcosm of rural Kentucky's continuing struggle with hepatitis A. What's happening there reflects how Kentucky's communities with limited resources are quietly battling the nation’s largest and deadliest outbreak — learning as they go and altering their strategies to meet the many challenges they face."

The state has averaged 76 hepatitis A cases per week this year, "sometimes reaching more than 90 a week, compared with 151 a week at its peak in early November," the CJ reports, but "Kathleen Winter, an epidemiologist at the University of Kentucky, said a recent downward curve in the outbreak doesn't necessarily mean it's waning."

"We still need robust intervention," Winter told the newspaper. "It's still too early to say whether it’s really winding down. We still have individuals getting sick, being hospitalized and dying."

The story's first example was Peyton Manning, 27, "who was sleeping behind a Walmart in Lexington and spending his days shooting meth and heroin. Late last year, he admitted himself to The Healing Place in Campbellsville. Then a virus hit him. He couldn’t sleep. He couldn't keep any food down." He went to the UK hospital and recovered at his mother's home.

Manning already had hepatitis C, but said he didn't know about hepatitis A or the outbreak. "didn’t even know it was a thing," he told the CJ. "I started to watch the news. It was like, damn, I didn’t know it was that bad."

Health departments are responding "with a mix of resources," the paper reports. "In addition to using state funding, local health departments can also order federally funded vaccine through the state or buy shots using money from $233 million in county health department reserves," which "vary greatly across counties and area development districts. They're in the negative numbers in some places and reach into the millions of dollars in others."

The Lake Cumberland agency had unrestricted reserves of about $5 million when the outbreak hit in 2017, but was "trying to avoid using this as much as possible to help with the pension crisis," said Ron Cimala, its administrative director. Many health departments have said they will have to close unless the legislature keeps giving them relief from the state's new requirement for funding their employees' pensions.

Ranges of health department reserves that could be used to pay Kentucky Employees Retirement System obligations. About half of the counties are in district departments; others are independent.

Here's a list of health-related bills in the General Assembly as legislators plan to return for their last day on March 28

Kentucky Health News
When the General Assembly returns Thursday, March 28, for the final day of its session, it could pass any number of bills, including several related to health: to make schools tobacco-free, to set up a hotline for students to report "vaping" of electronic cigarettes; to give health departments a reprieve from increased pension payments; to require children under 12 to wear helmets when riding a bicycle; and more. Here's a list of health-related bills and their status as of Friday, March 22, with colors denoting possible action:

Montgomery County reports uptick in cases of syphilis

Health officials in Montgomery County say they're seeing more syphilis cases.

"What had become a relatively rare disease is now seeing a resurgence nationwide," the Montgomery County Health Department said on its Facebook page Friday. The agency "said it has seen an increase in syphilis cases in recent months," the Lexington Herald-Leader reports.

Montgomery County (Wikipedia map)

The department said on Facebook, "The increase has initially been identified among those in the drug community, with injection drug use being a risk factor. However, health officials warn that this disease can be passed along to others outside of this group."

“This disease does not discriminate against anyone or any group,” said Kelly Allen, the department's nurse supervisor. “We want the public to be aware of symptoms in case treatment is needed and to take steps to protect themselves.”

Syphilis, a curable disease, is transmitted by sexual and other forms of contact with a syphilis sore, which is also the most common symptom. That is followed by a rash. "These symptoms may not be painful, but they shouldn’t be ignored," the department said. "Syphilis can cause severe health problems if not treated, including paralysis, blindness and even death. It can also be spread from a mother to her unborn baby."

Bevin says he exposed his nine children to chickenpox, pooh-poohs required vaccinations, misstates who requires them

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin said in a radio interview that he exposed his nine children to chickenpox instead of vaccinating them, a practice that is strongly opposed by health officials as risky.

Bevin also cast doubt on longstanding government policy of requiring vaccinations, and incorrectly attributed the requirement to the federal government rather than the state. His administration recently made it easier for parents to exempt their children from school vaccination requirements.

Bevin raised the topic on Bowling Green's WKCT, where the hosts had been discussing a lawsuit by a Northern Kentucky teenager who had been barred from playing basketball, and then from school entirely, because he had not been vaccinated for chickenpox. Host Chad Young asked Bevin about bills he might veto, but the governor said he first wanted to talk about chickenpox.

Gov. Matt Bevin

“Every single one of my kids had the chickenpox," Bevin said. "They got the chickenpox on purpose because we found a neighbor that had it and I went and made sure every one of my kids was exposed to it, and they got it. . . . They were miserable for a few days, and they all turned out fine.”

Bevin and his wife, Glenna, have nine children, ages 5 to 16, according to his campaign website.

The U.S. Centers for Disease Control and Prevention strongly discourages such "chickenpox parties," saying they are not worth the risk.

"Chickenpox can be serious and can lead to severe complications and death, even in healthy children," the agency warns. "There is no way to tell in advance how severe your child’s symptoms will be. So it is not worth taking the chance of exposing your child to someone with the disease. The best way to protect infants and children against chickenpox is to get them vaccinated."

Dr. Sean McTigue, a pediatric infectious-disease specialist at the University of Kentucky, told Kentucky Health News that the efficacy and safety of vaccines has been proven "time and time again."

McTigue, who teaches pediatrics, said "chickenpox parties" might have made sense before there was a vaccine against the disease, because its risks after infancy increase with age, and some parents wanted to make sure they got it while they were young. But in the post-vaccine era, he called such parties "ludicrous." The vaccine for chickenpox was licensed for use in the U.S. in 1995.

Centers for Disease Control and Prevention graphic
For a larger version, click on it.

Before that, the CDC reports, about 4 million Americans got chickenpox each year, over 10,500 were hospitalized and about 100 to 150 died.

Chickenpox is a highly contagious infection caused by the varicella-zoster virus that causes itchy, blister-like rash. Most children who get chickenpox recover completely, as the governor's children did, but the CDC says it can be "serious, even deadly, especially for babies, adolescents, adults, pregnant women, and people with a weakened immune system."

Shingles a risk

McTigue pointed out that a person who has had a natural chickenpox infection is at a greater risk than a vaccinated person of getting shingles, a painful skin rash that is caused by the same virus that causes chickenpox.

During the radio interview, Bevin said that vaccinating children should be a parent's decision, not the government's.

"If you are worried about your child getting chickenpox or whatever else, vaccinate your child. . . . But for some people, and for some parents, for some reason they choose otherwise," he said. "This is America. The federal government should not be forcing this upon people."

The federal government does not force states to require vaccination, only recommends it, a CDC spokesperson said. The National Conference of State Legislatures says all 50 states have laws requiring specific vaccines for students; 47 grant religious exemptions and 18 allow philosophical exemptions.

Kentucky only allows medical and religious exemptions. Chickenpox is among the diseases for which the state requires proof of vaccination, or medical documentation that the child has had it, in order to enter public kindergarten.

In 2017 the Bevin administration made it easier for parents to invoke the religious exemption to the law that requires vaccination to attend school. The new rules allow parents to download a form, have it notarized and submit it to their school upon enrollment, instead of having to get a signed form from a health-care provider.

Following that, Kentucky's rank among the states in the percentage of children with vaccinations declined, and Spectrum News reported that the number of Kentucky parents claiming the religious exemption increased 59 percent in the 2017-18 school year.

A representative of the state Cabinet for Health and Family Services told a legislative committee in 2017 that the changes had been in the works for several years, in response to complaints that a medical entity should not have authority over a religious exemption; that a co-payment was often required to get a provider's signature; and that parents and guardians were having trouble finding providers to sign the forms.

'Herd immunity' requires mandatory vaccinations

Bevin's assertion that governments shouldn't require vaccinations doesn't take into account the principle of "herd immunity," which occurs when enough people have been immunized against a disease to protect others who are not immunized. Some are not because their immune systems are too weak to allow them to be vaccinated, or because they are too young to be vaccinated.

People with weakened immune systems include those with cancer, especially if they are being treated with an aggressive chemotherapy, people who have had bone-marrow transplants, people who have had an organ transplant, people with auto-immune disorders, like rheumatoid arthritis or Lupus, or people with acquired immunodeficiency syndrome, or AIDS.

"Those people are absolutely reliant upon herd immunity because we can't immunize them," McTigue said. "The only way that we have to protect them is to ensure that everybody around them is immunized so that the chances of them actually coming into contact with somebody who has one of these very infectious viruses or bacteria is very, very low."

He said herd immunity is vitally important to protect babies, because they can't be vaccinated for measles, mumps and rubella or chickenpox until they are a year old because these vaccines are made with very weak, but live viruses.

"So, every single baby less than one year old is unvaccinated and unprotected against those conditions," he said. "And the young babies who cannot yet be immunized against those conditions are exactly the patients that we worry about the most if they get those infections because they are at greatest risk of complications." He added, "A varicella infection to a newborn baby can be fatal."

It should also be noted that parents who chose to not get their children vaccinated also depend on herd immunity to keep their children healthy. But the practice puts others at risk, McTigue said.

"Not only does it put your child at risk of getting severe and potentially life-threatening illnesses, but it also puts other people in the community at risk of getting serious and potentially life-threatening infections," he said.

The case that set the stage

After a chickenpox outbreak at Assumption Academy, a Catholic school in Boone County, the Northern Kentucky Health Department on March 14 told students without proof of vaccination or immunity against chickenpox to not attend school until further notice, and their extracurricular activities were canceled.

Jerome Kunkel, an 18-year-old senior at the high school who has not been been vaccinated, filed suit against the department, claiming "health officials violated his freedom of religion and other rights by ordering students without the vaccine to not attend school or extracurricular activities," Max Londberg reports for the Cincinnati Enquirer. The suit says Kunkel opposes the vaccine on religious grounds "due to its being derived from aborted fetal cells."

The vaccine was developed in the 1960s with cells from a legally aborted fetus, but no aborted fetuses being used today, McTigue said. He said the Catholic Church supports the vaccine.

In response to Bevin's comments, the Kentucky Democratic Party called on the governor to clarify his position on vaccination against the hepatitis A virus, which has killed 44 people in the state.

“Kentucky is currently experiencing the worst outbreak of hepatitis A in the country. It is a major public health risk at this point. The last thing we need is Governor Bevin suggesting that immunization is not important," the party said on its website. "Governor Bevin should reassure the public that he supports the recommendation of the entire medical community with respect to controlling an outbreak of Hepatitis A, which is immunization.”

The governor's office did not return a request for further comment. Bevin, a Republican, is running for re-election this year; his running mate is state Sen. Ralph Alvarado, a Winchester physician who has publicly endorsed vaccinations.

Youth suicide rates are increasing in Ky.; Courier Journal does in-depth stories, in hopes of spurring conversation to find out why

The editor of the Louisville Courier Journal posted this note with the package of stories,

Some readers may find one quotation in this story offensive.

In a package of stories, Allison Ross of the Louisville Courier Journal reports on the rising number of youth suicide deaths over the past five years in Kentucky. She tells the tales of four Kentucky youth who died by suicide, and explores the causes and challenges that youth suicide presents.

One of the stories is about Marcus Pryor, a 12-year-old whose mother, Sandy Metzmeier, said he took a full bottle of antidepressant pills because a friend was being mean to him.

Metzmeier, from Flaherty in Meade County, told Ross that her son called for help from his bedroom and she rushed him to the hospital, where he was treated and sent home, but later he began to have seizures and died the next morning. he was one of 10 Kentucky children under the age of 15 to die of suicide in 2017, Ross reports.

Metzmeier said Marcus told her that he didn't want to die: "He did something drastic and stupid to get attention and thought Mommy would fix it."

Kentucky suicide deaths among those who 18 and younger nearly doubled in 2015, to a total of 34, compared to only 18 in 2014. The numbers kept going up and remained high, Ross notes: "In 2016, 36 killed themselves. In 2017, there were 36 more. At least 10 were not yet old enough to drive. And in 2018, preliminary records show 31 children and teens in Kentucky took their own lives. That same year, more Kentucky children and teens died of suicide than by homicide."

Ross reports that Jefferson County has already seen four youth suicides in the first three months of 2019. "If children were dying of the flu like this, it would be in the paper every day," Sara Oliver of Louisville, who lost her 16-year-old daughter to suicide in 2017, told Ross.

Oliver said she thought her daughter's first iPhone was the start of her anxiety, noting that she was "unable to detach herself from her phone and probably had a warped impression of success," even though she was on her school's homecoming court, sang in Ballard High School's madrigal choir, and played lacrosse.

Experts, advocates and families call for more research and resources to prevent youth suicide.

"Doctors say youth and teens don't have enough access to behavioral health services," Ross writes. "Advocates say there's not enough money going to intervention programs such as suicide hotlines, where desperate people must sometimes be put in a queue until they can talk to a counselor. And researchers say they need more grants to better research how influences such as social media and bullying play a role in why some children kill themselves and others do not."

Patti Clark, who oversees substance abuse and suicide prevention programs for the Cabinet for Health and Family Services, told Ross that some of the increase in youth suicide numbers may be attributed to better reporting, because the state has worked to educate county coroners about properly labeling a suicide. But she added that this doesn't entirely explain the uptick.

Clark told Ross that she was particularly concerned about surveys showing increased suicidal thoughts and actions by younger children, a national trend that include Kentucky.

"In the past decade, the U.S. suicide rate for children and teens 18 and younger has grown by more than 90 percent — with 2017 suicide deaths in this age group hitting the highest count since data collection began in 1999," Ross writes, citing the Centers for Disease Control and Prevention.

Jefferson County Coroner Barbara Weakley-Jones told Ross that her office saw nine youth suicides last year and has already had four in the first quarter of this year, with some of them very young: "You didn't use to see a 6- or 9-year-old commit suicide."

Ross tells the story of a 10-year-old fifth grader named Seven Bridges who died by suicide in January. His story resonated across the country in part because his mother, Tami Charles of Louisville, alleged that school bullying was to blame.

In response to the increase in youth suicides, Jefferson County Public Schools held its first "Bullying and Suicide Prevention Summit" March 21 for school counselors, principals and administrators to talk about prevention and response strategies, Liz Schlemmer reports for WFPL.

Researchers say that youth suicide is rarely caused by a single factor and that they "have noted that some trends, such as bullying and suicide-related behavior, are closely related and that access to firearms has also been linked to a greater chance of suicide," Ross reports.

The CDC and other organizations note that suicide is not solely a mental health concern and that many people who kill themselves had no previous known mental health conditions.

And experts say that, despite efforts, there are still not enough resources for mental-health and crisis help. Ross writes that other issues include stagnant Medicaid reimbursements and an unfunded mandates to provide suicide prevention training in schools, with no oversight over the types of programming presented.

In telling the story of Alechia Click and her ex-husband Ron Click's son, Ronnie, who was 17 when he killed himself in October, Ross reports on the many unanswered questions that Alechia deals with in her loss, like "Was there anything I could have done?" Ron told Ross that there were no warning signs that his son was considering killing himself.

"I told him I loved the shit out of him, and I was proud of him," he said, his voice cracking. "It still didn't help."

Courier Journal Editor Richard Green, in a special note attached to the story, says the paper chose to write about these individual suicides in "hopes a larger community-wide conversation begins about why death by suicide is happening far too frequently among our youth."

Warning signs that may indicate risk of suicide include:

• Talking about wanting to die or interest in killing oneself
• Looking for a way to kill themselves, like searching online or buying a gun
• Talking about feeling hopeless or having no reason to live
• Talking about feeling trapped or feeling unbearable pain
• Talking about being a burden to others
• Increased use of alcohol or drugs
• Acting anxious or agitated; behaving recklessly
• Sleeping too little or too much
• Withdrawing or isolating oneself
• Showing rage or talking about seeking revenge
• Extreme mood swings

If you are having thoughts of suicide, the National Suicide Prevention Lifeline is 800-273-8255.

Albany doctor pleads guilty to illegal prescription of painkillers; federal prosecutors said some resulted in deaths

A doctor in Appalachian Southern Kentucky pleaded guilty March 18 to 13 counts of prescribing controlled substances without any legitimate medical purpose and outside the course of professional medical practice, the U.S. attorney for the Western District of Kentucky announced March 22.

Dr. Michael L. Cummings, 63, a family practitioner in Albany, faces a maximum prison term of 145 years, a combined maximum fine of $7.25 million, and three years of supervised release. Sentencing is scheduled for June 19 before District Court Chief Judge Greg Stivers. 

Cummings' plea agreement with the Justice Department says that in 2012-14, he prescribed the painkillers Oxycodone, OxyContin, Endocet and hydrocodone, the anti-anxiety medicines Valium and alprazolam, the appetite suppressant phentermine, and the sleep aid zolpidem tartrate, all "without any legitimate medical purpose and outside the course of professional medical practice."

Two years ago, Cummings was charged with 18 counts of illegal prescriptions "resulting in the deaths of three patients" in 2014, the U.S. attorney's office said at the time. The news releases used initials to identify the decedents; one of those named in the 2014 release was not named in the latest one. "Cummings was initially charged with prescribing drugs that resulted" in those deaths, "but federal prosecutors dropped those three counts of the indictment," Bill Estep reports for the Lexington Herald-Leader.

"Federal prosecutors said in a motion that Cummings was one of the most prolific prescribers in the state between 2012 and 2014, even though Clinton County has only about 10,000 residents," Estep reports. That "caught the attention of federal authorities, who investigated along with Kentucky State Police. Police watched Cummings’ office in Albany and saw cars from outside the county and state, and also got records showing his patients were filling prescriptions outside the county." That indicated “a medical practice that attracted and/or catered to people who were either abusing or diverting prescription pain medications,” the plea agreement said.

Read more here: https://www.kentucky.com/news/state/kentucky/article228290179.html#storylink=cpy