Northern Kentucky judge rules in favor of health department, denies unvaccinated student's request to return to school

A judge has ruled against a Catholic high school student in his lawsuit against the Northern Kentucky Health Department, which barred him from school and all extracurricular activities during a chickenpox outbreak because he hadn't been vaccinated against the disease, Anne Saker and Max Londberg report for the Cincinnati Enquirer.

Jerome Kunkel, 18, testified in Boone Circuit Court April 1.
 (Photo by Liz Dufour, The Cincinnati Enquirer)

WLWT-5 reports that Boone County Circuit Judge J.R. Schrand denied the student's request to return to school, writing that Kentucky law requires the health department to "enforce such rules and regulations as it deems efficient in preventing the introduction or spread of the varicella and to accomplish this, it is required to establish and strictly maintain quarantine and isolation at such places as it deems proper."

Assumption Academy senior Jerome Kunkel, 18, sued the department after he wasn't allowed to play basketball during the statewide league playoffs because he hadn't been vaccinated and didn't show immunity from the disease.

The case prompted Gov. Matt Bevin to say in a radio interview that the government "should not be forcing this upon people," after explaining that he had exposed his nine children to chickenpox instead of vaccinating them, a practice that is strongly opposed by health officials as risky.

Kunkel told the Enquirer earlier that he is not against all vaccines, but only the ones that used aborted fetal cells in their making, including the chickenpox vaccine, Saker and Londberg report.

The chickenpox vaccine was first developed using tissue from a pair of aborted fetuses in the 1960s, but the modern vaccine contains no fetal cells. It became available in the U.S. in 1995. The National Catholic Bioethics Center approves the use of the vaccine, and even encourages it.

The health department's ban called for all students without proof of immunity from chickenpox to not come to school or participate in any extracurricular activities until 21 days after the last case of chickenpox appeared. The health department called for the ban after 32 students, or about 13 percent of the student body, got the disease.

Kunkel's lawyer, Christopher Wiest of Covington, said about 30 other students were out of school under the ban and had joined Kunkel in his lawsuit, the Enquirer reports. The students either attend Assumption or Our Lady of the Sacred Heart, an elementary school on the same property.

Parents were sent a warning in mid-February, after the number of suspected chickenpox cases jumped from six to 18.

Evidence at the court hearing showed that only about 18 percent of the students at the two schools had been vaccinated against childhood illnesses, like the chickenpox. The state's vaccination rate for chickenpox is about 90 percent, the Enquirer reports.

Kunkel asked the judge to let him go back to school, saying the ban was imposed on him because of religious retaliation, which the health department denied.

“This is not a case of religious discrimination,” Jeff Mando of Covington, who represented the health department, said. “Instead, it presents this question: Do unvaccinated students at Assumption have the right to attend school, play basketball and attend other extracurricular activities in the face of an outbreak of a very serious and infectious disease at the school?”

Mando pointed out that the state-issued religious exemption form that the Kunkels signed to get Jerome exempted from vaccines contains this warning: "This person may be subject to exclusion from school, group facilities or other programs if the local and/or state public-health authority advises exclusion as a disease-control measure."

Mando said the ruling "upheld the health department's mission to protect public health and the welfare of folks in Northern Kentucky."

The department said in a statement that the ruling "follows on the heels of the Northern Kentucky Health Department receiving national recognition through re-accreditation by the Public Health Accreditation Board, underscores the critical need for public health departments to preserve the safety of the entire community, and in particular the safety of those members of our community who are most susceptible to the dire consequences when a serious, infectious disease such as varicella, is left unabated and uncontrolled."

St. Joseph only Kentucky hospital in Healthgrades' Top 250

Saint Joseph Hospital of Lexington is the only Kentucky facility to get the America’s 250 Best Hospitals Award from Healthgrades, an online source for information about physicians and hospitals, owner Catholic Health Initiatives announced in a press release.

The hospital and Saint Joseph East, also in Lexington, earned several awards for patient care in the latest ratings. “These awards are made possible by the outstanding ministry and service of our dedicated physicians and hospital employees,” said Bruce Tassin, CEO of CHI Saint Joseph Health and president of Saint Joseph Hospital.

Saint Joseph was also judged to be one of the 100 best hospitals recognition for stroke care, critical care and pulmonary care. It and Saint Joseph East achieved high ratings in several other service areas. For information on how Healthgrades determines awards, visit www.healthgrades.com/quality.

CHI Saint Joseph Health says it is a system with 135 locations in 20 Kentucky counties, including hospitals, physician groups, clinics, primary care centers, specialty institutes and home-health agencies, serving Kentuckians in 35 counties. Its flagship hospital was established in 1877 by the Sisters of Charity of Nazareth. "The hospital’s original mission was to provide compassionate care to the poor and underserved – a tradition still carried out today," the news release said.

Andy Beshear's first TV ad in primary casts him as friend of Medicaid expansion, coverage of pre-existing conditions

In the opening television commercial of his campaign for governor, Attorney General Andy Beshear "highlights his efforts to defend the Affordable Care Act and Kentucky’s Medicaid expansion," which his father, Steve Beshear, instituted as governor, Bruce Schreiner reports for The Associated Press.

The ad contrasts the Democrat's health-care stands with those of Republican Gov. Matt Bevin, who first wanted to end the expansion of Medicaid under the 2010 law to people earning up to 138 percent of the federal poverty level. Now Bevin wants "able bodied" Medicaid recipients to work, go to school or perform other "community engagement" 80 hours a month, but a federal judge has twice blocked that plan. Meanwhile, "The Trump administration told a federal appeals court it wants former President Barack Obama’s health care law struck down in its entirety," Schreiner notes.

"Beshear’s 30-second ad starts out by showcasing Lukas Stevens, a young boy with diabetes, as Beshear touts his efforts as attorney general to protect health coverage for pre-existing conditions," a key part of Obamacare, Schreiner writes. Beshear says in the ad that the end of such coverage “would hurt Lukas and nearly half of all Kentuckians. I’m not going to let that happen. As attorney general, I’m helping lead a national effort to protect coverage for pre-existing conditions.”

Beshear is one of several Democratic attorneys general opposing a lawsuit by Texas and other Republican-led states to overturn the law, which Bevin has long argued is unconstitutional. As a candidate, he first said he would repeal the expansion, but backed off to the community-engagement plan. But he has issued an executive order saying that if the plan is finally rejected by the courts, the expansion would end six months from that point, because it is too expensive.

Beshear says in the TV spot, “I’ll protect expanded Medicaid to provide access to affordable health care. Governor Bevin won’t.” 

Beshear is opposed in the May 21 Democratic primary by state House Minority Leader Rocky Adkins and former state auditor Adam Edelen, who has been running ads for a few weeks and is also featured in ads run by a political committee that says it is independent of his campaign.

Foundation for a Healthy Kentucky is updating its directory of health coalitions; deadline to submit information is April 15

The Foundation for a Healthy Kentucky is updating its directory of local health coalitions and is asking groups that work to improve health in their communities to provide their contact information online by April 15 if they want to be included.

The Kentucky Health Coalitions Directory provides a way to "grow and strengthen health coalitions in the Commonwealth" and includes any group of individuals or organizations that have joined forces to improve health and health care in Kentucky.

"We can get a lot more done when we get out of our silos and come together to work on common goals, and that's a key part of the foundation's philosophy and mission," Ben Chandler, president and CEO of the foundation, said in a news release. "The directory helps enable community advocates, health care providers, educators, public officials, business leaders and others to connect and collaborate with one another."

The efforts of the coalitions in the directory vary: some increase access to healthy food and physical activity; others plan needed health screenings and provide health education for people at risk for serious health problems such as cancer, diabetes and other chronic diseases; and others advocate for smoke-free or complete-streets ordinances.

Chandler also noted that the foundation offers a series of webinars and workshops for coalitions, nonprofits and other health organizations to enhance their skills and otherwise grow their capacity to improve health in Kentucky. Click here for a list of upcoming "Health for a Change" events as well as recordings of previous ones. Click here to enter your coalition's information for the directory, which will be published online this summer.

Louisville health department offers fentanyl strips to safeguard drug users; fentanyl responsible for more than half of 2017 ODs

Buzz Feed News image

As a way to protect drug users from deadly fentanyl, Louisville's health department has started passing out test strips, Beth Warren reports for the Louisville Courier Journal.

Fentanyl was initially added to heroin, but has increasingly been hidden in many other drugs, including methamphetamine and pills that are made to look like legal ones, Warren reports.

Fentanyl is a synthetic opioid that can be up to 50 times more potent than heroin. It was responsible for more than half of the 1,565 overdose deaths in 2017, according to the annual Kentucky Office of Drug Control Policy report.

That number could be even higher in this year's report, preliminary numbers in Louisville suggest. An analysis by the Courier Journal found that fentanyl and its derivatives were responsible for 210, or two-thirds, of the 313 overdose deaths last year in Jefferson County. The analysis found that 46 of the deaths were from heroin and 103 were from methamphetamine.

The test strips are controversial, Warren reports, but a growing number of states are using them, including California, Rhode Island, Massachusetts, Delaware and Maryland. She describes how they work, noting that they are much like a home-pregnancy test and show results in 30 seconds.

"It's just enough time where someone wouldn't be impatient and go ahead and use," Takeisha Nunez, supervisor of the Louisville Metro Department of Public Health and Wellness syringe exchange program, which hands out the test strips, told Warren.

Opponents of the strips include including three veteran police officers who told Warren that the strips endorse illegal drug use but asked to not be named. Another critic, Dr. Elinore McCance-Katz, assistant secretary for mental health and substance use at the U.S. Department of Health and Human Services, has cautioned that "It is not inconceivable to think that people who are severely addicted will actually use the test strips to seek fentanyl," as a way to get a stronger high.

indeed, Warren reports that people with addictions have told her that they have used the strips to seek a stronger high, while others have told her they use them to avoid fentanyl, "not wanting to die like some of their friends."

Dr. Sarah Moyer, Louisville's health director, told Warren that she researched the use of the test strips before deciding to offer them, telling Warren that "surveys of participants who used test strips showed that more than 70 percent of them decided to change their behavior with the knowledge gained from the test," Warren writes.

Moyer said the health department is first targeting "high-risk" participants, including those just leaving jail or rehab, who are vulnerable to relapse. The department recently ordered 2,000 strips, paying 80 cents a piece for them, Warren reports.

"Fentanyl test strips and naloxone don't increase drug use," Moyer told Warren. "They reduce the harms and deaths from substance-use disorder." Naloxone is a drug that reverses opioid overdoses.

Warren reports that many illicit drug users don't know that fentanyl is being added to drugs other than heroin, and that the health department is working to educate them that they need to use the strips on all illicit drugs.

Further, harm reduction efforts like providing fentanyl strips, Naloxone and access to syringe exchange services provides a touch point for people who have addictions so that when they are ready to seek recovery, they will know where to go for help, Moyer told Warren.

For more information about treatment programs in Louisville and beyond, go to findhelpnowky.org.

Resolution to require study of response to hepatitis A outbreak, and recommendations to avoid a repeat, failed in the legislature

Hepatitis A vaccine (USA Today photo by Nikki Boliaux)

The state Cabinet for Health and Family Services won't have to conduct a study of its response to the hepatitis A outbreak that has killed at least 52 in the state and is the nation's worst outbreak of the liver disease. It also won't have to make recommendations to the General Assembly "to ensure that future responses to outbreaks are more effective," as a legislative resolution would have directed.

The Senate-passed resolution directing the study and recommendations wasn't brought up for a vote in the House on the last day of the session, "despite broad bipartisan support," reports Deborah Yetter of the Louisville Courier Journal.

The sponsor of the resolution, Senate Democratic Leader Morgan McGarvey of Louisville, told Yetter that he didn't think it failed because of any opposition to the measure. "Rather, he said, he thinks it got caught in the crush of last-minute legislation that kept members of the House wrangling over other, more controversial bills almost till midnight," he said.

McGarvey said he will "demand answers" about how state officials responded to the outbreak, and Rep. Joni Jenkins, D-Shively, "said she expects lawmakers will pursue the matter with the cabinet," Yetter reports. Jenkins said, "It is a national embarrassment that we've handled it so poorly."

"The Courier Journal reported in February that a slow response over the past year by state public health officials to an outbreak of the contagious liver disease appeared to contribute to what became the the nation's largest and deadliest outbreak," Yetter notes.

Drug makers' payments to doctors may influence their choice of what drugs to prescribe, and that can cost patients real money

By Trudy Lieberman
Rural Health News Service
      Peggy, an Indiana woman and reader of this column, recently sent me a lengthy email about her 94-year-old mother who is rapidly spending down her minimal savings to pay for prescription drugs.
      Peggy didn’t hold out much hope that prices would come down before it was too late for her mom.  But she succeeded in lowering her mom’s drug costs, and what she learned along the way can be helpful to others strapped by high pharmaceutical bills.

      Her mother is typical of many women in old age who have only a tiny financial cushion to absorb the continual price hikes imposed by the drug makers.  She was raised during the Depression, didn’t work much outside the home, lived in a condo her son bought, and then moved to an assisted-living facility almost two years ago.

      The facility’s $3,100 monthly fee, plus drug copays, bit into her savings, which totaled about $30,000 when she moved to assisted living.  Government benefits earned by Peggy’s father who served in the Korean War, a very small pension from a former employer, and Social Security benefits cover all but about $600 of the assisted-living fee. The rest comes from her savings, which now are about half what they were in 2017.

      While most of her mother’s drug copays and other out-of-pocket pharmaceutical expenses have been manageable, Peggy explained that it was the $313 copay for a three-month supply of a well-known, heavily advertised blood thinner, which a cardiologist had ordered, that was the biggest culprit depleting her mother’s savings.

      That was the price her mom was paying when she hit Medicare’s infamous “donut hole” last year.

      Peggy said that every time her mom visited the physician, the doctor told her she was lucky to take the expensive blood thinner instead of the other “stuff” which he called “rat poison,” implying a cheaper drug was inferior, even dangerous. Peggy said that at every visit, he said she was fortunate to be taking something better.

      Then a family member discovered openpaymentsdata.cms.gov, a database maintained by the Medicare program that reveals the money pharmaceutical companies pay doctors in speaking, research and consulting fees, and for food and drink expenses. Her mom’s cardiologist had received nearly $80,000.

      Peggy had a bad feeling about the doctor, and switched her mom to another physician who kept her on the high-priced drug for two months. Then she was diagnosed with anemia, taken off blood thinners and prescribed low-dose aspirin.

      In the meantime, Peggy’s husband had a heart attack and developed a blood clot.  His doctor prescribed a low-cost blood thinner that’s been on the market for years.  She said he’s doing just fine on the “rat poison” disparaged by her mother’s first doctor. His cost: a $6 copay every 30 days.

      For a long time, impartial medical experts have thought that the choice of drugs and devices may be related to payments doctors receive from drug and device companies.

      Since 2014 the Physician Payments Sunshine Act requires drug and device makers to report to the government the payments they make to doctors. The Medicare database is a treasure trove of some 11 million payments to physicians.

      The online publication ProPublica found that drug and device makers gave more than $1 billion to doctors and hospitals from August 2013 through 2016.  Some individuals have received payments in the millions.

      Still, the drug and device database may be one of health care’s best-kept secrets. 

      A study published in the British Medical Journal found that only about 3 percent of respondents said they knew their doctor had received payments from the medical industry. Unlike Peggy’s family, they had no idea that Medicare’s Open Payments database existed.

      Most Americans don’t readily switch doctors, even in the face of overwhelming evidence that the doctors performed badly. The Lown Institute, a Boston medical think tank, reporting on the British study, concluded, “Maybe we should be more open to switching doctors based on their relationship with industry.”              

      Peggy had some advice of her own: “Do the research. Did the doctor receive money to push the drug? Ask questions?  How much does the drug cost? Is it really a better alternative?”

      Do you have an experience about health insurance you’d like to share or a question you’d like to ask? Write to Trudy at trudy.lieberman@gmail.com.

State health department funds mobile syringe exchange for Laurel, Whitley, Knox, Clay and Jackson counties

A mobile syringe exchange will go to five Eastern Kentucky
 counties: Knox, Laurel, Whitley, Clay and Jackson. (WYMT-TV) 

Five Eastern Kentucky counties will soon have a mobile syringe exchange to minimize the spread of infectious diseases and to help get people who are addicted to drugs into treatment, Justin Kase reports for WYMT-TV in Hazard. It is expected to be running in two months.

A specially outfitted van, called a Mobile Harm Reduction Unit, is funded by a grant from the state Department for Public Health and will serve adjoining Knox, Laurel, Whitley, Clay and Jackson counties. All but Jackson are among the top 54 counties in the nation with an increased risk of outbreaks of hepatitis C and HIV due to intravenous drug use.

Mark Hensley, the executive director of the Laurel County Health Department, told Kase that the mobile exchange will offer many of the same services as stationary ones, including HIV and hepatitis C testing, hepatitis A vaccines, information about addiction treatment, and a peer counselor aboard.

Each of the counties in the program has an established syringe exchange in place. Hensley said Laurel County opened its syringe exchange about two months ago, and participation has been a bit slow. He told Kase that he expected better participation with the mobile van because it might help to break down some of the barriers associated with syringe exchange programs, such as "reliable transportation or just fear of the program itself."

The plan is for the unit to spend one day in each county before moving on to the next. Locations have not been determined. "We might establish four different locations within the county, you know, maybe try to hit the four corners of those rural areas," Hensley told Kase.

20 test positive for E.coli and six of them are hospitalized, mostly in Central Kentucky; state health department searching for source

E. coli symptoms (Graphic by JR Bee, Verywell Health)

Twenty Kentuckians have tested positive for an infection caused by a strain of E. coli bacteria, and public health officials say they have not yet identified the source of the outbreak, the state Department for Public Health said.

Investigators said some element of food distribution is the likely cause of the outbreak, which has struck both children and adults, mostly in Central Kentucky.

The health department reports that no deaths have been linked to the outbreak, but six people have been hospitalized.

Health-care providers across the state have been alerted to watch for patients with quick-onset diarrhea, which can be associated with E. coli. The release says this is a particular strain of E. coli that produces a type of toxin, called Shiga toxin, that can be dangerous for those infected.

“Exposure to E. coli bacteria can be debilitating and potentially life-threatening, especially for small children and individuals with weakened immune systems," said Public Health Commissioner Dr. Jeff Howard. "With this in mind, the Department for Public Health has taken swift action to identify patients, ensure appropriate testing, and follow-up care as we work to determine the source."

Howard encouraged everyone to be aware of the signs and symptoms of E.coli infections and to seek care if they exhibit any of them.

Symptoms typically include stomach cramps and diarrhea, including bloody diarrhea. Symptoms usually start two to five days after consuming contaminated food. The state news release notes that the infection can sometimes lead to hemolytic-uremic syndrome, a serious complication that can cause kidney failure a week or more after the onset of diarrhea.

"State health officials are working with staff at local health departments in the counties with suspected or confirmed cases to determine the source of the infections," says the release.

To prevent E. coli infections:

• Wash hands frequently for at least 20 seconds with soap and warm water, especially before eating,after going to the bathroom, when handling raw meat and eggs, and after handling or petting animals 
• Thoroughly wash produce before eating
• Thoroughly cook meat
• Clean and sanitize food preparation areas
• Avoid swallowing lake or pool water
• Drink only pasteurized milk
• Frequently clean and sanitize restrooms, including door knobs and faucet

If you believe you have an E.coli infection, call your health-care provider, write down what you ate in the week before you got sick, report your illness to the health department, and be prepared to answer questions about your illness, the health department advises.

Bill to require 'reasonable accommodations' to pregnant women at work passes on last day of legislative session

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill that allows pregnant women "reasonable accommodations" while at work, and supports breastfeeding, passed on the last day of the legislative session. It awaits action by Gov. Matt Bevin, whose decision will be final because it passed on the last day

Sen. Alice Forgy Kerr

Senate Bill 18, sponsored by Republican Sen. Alice Forgy Kerr of Lexington, gained final passage in the House on an 87-5 vote.

In presenting the bill to the House, Rep. Nancy Tate, R-Brandenburg, said it had the support of many business and pro-life groups, adding that 24 other states have passed similar laws. She stressed that the bill does not require mandatory paid parental leave.

The bill passed the Senate on 25-7 on Feb. 22, with an amendment that allows employers to choose from a list of accommodations rather than a mandatory list. It also removed a 10-day notice period for employers to alert pregnant employees of their rights, according to a state news release.

The "reasonable accommodations," which include things like more frequent breaks or being moved to a less strenuous or less hazardous position, are limited to employers with 15 or more employees. Normal anti-discrimination law applies to those with eight or more employees. The bill also requires applicable employers to provide a private space that is not a bathroom for expressing breast milk.

“Providing clarity on this issue is badly needed in Kentucky,” Kerr said in presenting the bill to the Senate. “As things stand right now, the employer and employees are forced to navigate a complex web of federal law and case law which leads to confusion and frustration. It discourages workforce participation among our women.”

The American Civil Liberties Union called the bill's passage a great victory for Kentucky families. "Senate Bill 18 provides much-needed clarity for employers and reasonable protections for pregnant workers to prevent problems before they start," ACLU-KY Advocacy Director Kate Miller said in a news release. "After working with a broad array of partners for a number of years to pass these critical protections, we are thrilled the General Assembly brought this law to final passage.”

Statewide tobacco-free-schools bill finally passes, and the governor is expected to sign it into law, effective July 1, 2020

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to ban the use of tobacco products in all Kentucky public schools and events finally passed on the last day of the legislative session and is on the way to Gov. Matt Bevin's desk for his signature or veto.

Sen. Ralph Alvarado

Because it was the last legislative day, Bevin's decision will be final. Sen. Ralph Alvarado, Bevin's running mate for lieutenant governor, reiterated that Bevin had told him he would sign the bill if it comes to his desk, and said he would be shocked if he didn't.

When presenting the bill to the Senate, Alvarado, a Winchester physician, said that 8,900 Kentuckians die every year from smoking; and that tobacco-related illnesses cost Kentucky nearly $2 billion each year, including nearly $600 million in Medicaid expenses.

"It's time for Kentucky to step up to the plate and protect its children," said Alvarado. "Let's get our children healthier. Let's save taxpayer money. Let's save Kentucky lives." The bill would take effect Jan. July 1, 2020.

Rep. Kim Moser

The Senate passed House Bill 11, sponsored by Rep. Kim Moser, R-Taylor Mill, by a 28-10 vote. It had passed the House 85-11, but not until two amendments were added to appease concerns about state-government overreach. One would give school boards three years to opt out of the ban; the other would allow adults to smoke on field trips or events off school property events if students are not present. 

Even with the amendments, Sen. John Schickel, R-Union, called the bill "the very definition of government overreach" and said it was "what some people would call a nanny state." He argued that the bill wasn't necessary because school boards already have the authority to pass such policies.

"We as conservative Republicans have no business dictating to local communities on matters such as this," he said. The bill leaves enforcement up to school boards.

Only 42 percent of Kentucky school districts have 100 percent tobacco-free policies, covering 57 percent of the state's students, and many of them have not updated their policy to meet new standards for electronic cigarettes, which have become a real problem in Kentucky schools.

Federal research showed a 78 percent increase in "vaping" among high school students and a 48 percent among middle schoolers in the last year alone. And though state-level data hasn't been released, focus groups led by Kentucky Youth Advocates showed a similar uptick in the state.

Alvarado also pointed to the rise in e-cigarette use among teens as a reason to pass the bill. He said that teens have no idea that one Juul pod has the same amount of nicotine as a pack of cigarettes, and that some kids are going through eight pods a day. The Juul products are the most popular among teens because they look like oversized flash drives, come in flavors and are easy to hide. 

"We're creating an entire new generation of addicts when it comes to nicotine," Alvarado said.

Speaking in favor of the bill, Sen. Reginald Thomas, D-Lexington, called it a "good start" toward improving smoking rates in the state, which he said were among the worst in the nation. This is true for both adults and teens in the state.

In Kentucky, 14.3 percent of high-school students smoke, compared to 8.8 percent nationally.  Almost as many, 14.1 percent,  use e-cigarettes, a bit above the 13.2 percent nationally, according to the 2017 Youth Risk Behavior Survey. That said, health experts have warned that e-cigarette figures are probably higher now because Juul sales have surged since the survey.

Thomas also pushed back against the government overreach argument, pointing to two school-related bills that passed this session, one to mandate the last Wednesday in September of each year as a day of prayer for Kentucky's students and another to require schools to display "In God We Trust." He said to applause from the gallery, "We are always for local control until we are against it."

Speaking in favor of the bill, Sen. Danny Carroll, R-Paducah, said that even though it had some flaws, "Anything that we can do to decrease smoking in our state to save lives is a vote worth taking."

Sen. Paul Hornback, R-Shelbyville, who voted no, said he thought passing a bill to raise the age to purchase tobacco to 21, like the one that had failed to get out of his committee this session, would have been a better way to deal with this issue.

Moser, who was in the Senate chamber when the bill passed, said, "This is just a great step in the right direction for Kentucky students."

Bonnie Hackbarth, vice-president for external affairs with the Foundation for a Healthy Kentucky, said that the bill's passage means that about 275,000 more Kentucky students will be covered by tobacco-free school policies.

"That's a huge win for the health of Kentucky and the health of Kentucky kids," she said. "It is going to reduce youth initiation and ultimately smoking rates in Kentucky"

"Tobacco conversations in Kentucky are complex and bring lots of pressures on our elected leaders, and that is why House Bill 11 is such a profound win for Kentucky's kids," Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release.

He added, "Prohibiting tobacco use on school campuses creates an environment where smoking cigarettes and e-cigs is not the norm, provides positive adult role modeling, and protects students, staff, and visitors from the harms of secondhand exposure."

Alvarado called the passage of the bill "the beginning of a gradual culture change that needs to happen."

Health departments, regional mental-health centers, other entities get a pension fix, but at a cost to some employees' pensions

Teachers filled the Senate gallery. (Herald-Leader photo by Matt Goins)

As it closed up shop, the legislature gave local health departments, regional mental-health centers and other government-related agencies another reprieve from pension costs that threaten their future, but at a cost to some employees' pensions.

"Under the plan, the organizations can remain in the Kentucky Retirement Systems and begin paying a staggering 84 percent of their payroll as their share of pension contributions, which is what the rest of state government paid this year," John Cheves reports for the Lexington Herald-Leader. "Or they can leave KRS by July 2020 and pay off their pension liabilities, either with one lump sum or starting at their current rate of 49 percent of payroll and gradually increasing by 1.5 percent a year" until the liability is funded.

In organizations quitting KRS, employees hired since 2014, and all new hires, "will be enrolled in defined-contribution plans" like 401(k)s, Cheves writes. "Longer-term employees can choose whether to remain in KRS with their defined-benefits pensions or switch to a defined-contribution plan. But if they remain in KRS, their employer’s liabilities will increase.

The revised House Bill 358 "would allow most employees of the affected groups to continue accruing future retirement benefits in the current pension plan," unlike the Senate's earlier version of the bill, which would have moved most employees to "a new 401(k)-like plan," Tom Loftus reports for the Louisville Courier Journal. "Any group that leaves the pension plan or is more than 30 days late in making payments" would be moved into a 401(k)-like plan, "and pension checks to retirees from such groups could be suspended until the group gets current on its payments."

Gov. Matt Bevin had told lawmakers that he would sign the Senate's earlier version into law, but would reject any approach he thought would unnecessarily harm the badly underfunded pension plan. "Sen. Chris McDaniel, the Taylor Mill Republican who co-chaired the committee that worked out the compromise, said he hoped that Bevin would sign the bill into law, but did not know whether he would," Loftus reports. Because Thursday night was the last one of the session, "Bevin could veto it and the legislature would have no ability to override the veto."

The bill passed largely along party lines, 26-11 in the Senate shortly before 8:30 p.m. and 58-39 in the House at 11:11 p.m.

Health departments, regional mental health agencies, domestic violence shelters, rape crisis centers and other groups warmed that an increase in their pension contributions to 84 percent of payroll, from the current 49 percent, "would force dramatic cuts in services," Lofts writes. "Health departments serving 64 counties would become insolvent and likely close their doors within two years."

But the Senate did not want to merely grant relief because that would have robbed the pension plan "of money it anticipates and desperately needs. The plan is considered the worst-funded public pension plan in America with only 13 percent of the assets on hand needed to cover future benefits," Loftus notes. "The compromise bill is projected to cost that plan $799 million — forcing what is sure to be a big hike in future contributions from the remaining employer in that plan: state government."

"There's nothing but bad choices involved in this," McDaniel told reporters Thursday night. "And this (the compromise bill) is the best of all of those."

Cheves writes, "Critics of the bill complained that it was a complex measure being foisted on them in the final hours of the legislature, and that given the huge costs involved, some quasi-public agencies might not be able to afford either option available. “This doesn’t help the quasis,” said Sen. Robin Webb, D-Grayson. “It doesn’t help them. It’s a path to insolvency. It’s a path to bankruptcy.”