Chickenpox hits Northern Ky. Catholic-school student who sued after being barred from school and activities for lack of vaccination

The unvaccinated high-school student who recently lost a court battle over health-department enforcement that barred him from his school and all extracurricular activities during a chickenpox outbreak has come down with the disease, Anne Saker reports for the Cincinnati Enquirer.

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

The attorney representing 18-year-old Jerome Kunkel said Kunkel got the pox last week.

Kunkel's symptoms appeared nearly two months after the Northern Kentucky Health Department issued an order barring students in two parochial schools who lacked proof of vaccination or immunity to the chickenpox virus from attending school or any school activities until 21 days after the last case of chickenpox appeared. The health department called for the ban after 32 students, or about 13% of the student body, got the disease.

Kunkel, along with other students who joined Kunkel's lawsuit, object to the chickenpox vaccine because it was developed using human cell cultures from two legal abortions in the 1960s. The cell cultures have been maintained in laboratories, but no additional fetal tissue has been added since they were originally created, according to the federal Centers for Disease Control and Prevention.

The ban included students at Assumption Academy, where Kunkel is a senior, and Our Lady of the Sacred Heart, an elementary school on the same property. The schools and its church are affiliated with the Society of St. Pius X, a conservative branch of Catholicism that rejects Vatican II reforms. The Roman Catholic Church does not oppose the use of the vaccine.

Saker reports that nearly 90% of the schools' students have religious exemptions against vaccinations -- a process that has become easier under the administration of Republican Gov. Matt Bevin.

Judge James R. Schrand ruled against Kunkel, who has appealed; the Kentucky Court of Appeals has yet to rule on the case, and the school-attendance ban remains in effect.

The Kunkel family's attorney, Christopher Wiest of Covington, told Morgan Gstalter of The Hill that they don't regret their decision to not vaccinate. "These are deeply held religious beliefs, they're sincerely held beliefs," she said. "They always recognized they were running the risk of getting it, and they were OK with it."

Chickenpox is a highly contagious disease caused by the varicella-zoster virus that causes itchy, blister-like rash. Most children who get the disease recover completely, but the CDC says it can be "serious, even deadly, especially for babies, adolescents, adults, pregnant women, and people with a weakened immune system." The vaccine for chickenpox was licensed for use in the U.S. in 1995.

At an April 1 hearing, Wiest noted that the Sacred Heart community gathers for Mass and meals on Sundays, suggesting that the school-attendance ban would not keep the disease from spreading, Saker reports. On Tuesday, he said that since then, more than half of his clients had become infected: "I flat-out told the moms and dads the quickest path to resolving this is having them contract chickenpox."

That's a tactic Bevin recently promoted when he said he exposed his nine children to chickenpox instead of vaccinating them, a practice that is strongly opposed by health officials as risky. He volunteered the comment to a radio talk-show host who had been discussing the controversy.

The health department immediately issued a statement that said Wiest advising his clients to actively contract the virus so that they can become naturally immune "is deeply concerning" and is "clearly not appropriate medical advice."

The statement noted that while the tactic may provide individual immunity, the infected person can then easily spread the virus to others, including people who are unable to be vaccinated for various reasons and are counting on those who can be vaccinated to protect them from this disease and others that could potentially kill them, a concept called "herd immunity."

“Encouraging the spread of an acute infectious disease in a community demonstrates a callous disregard for the health and safety of friends, family, neighbors, and unsuspecting members of the general public,” the health department said. A person who has contracted chickenpox can be infectious for up to two days before experiencing the rash that is associated with the virus.

The department added, “Control measures, such as restricted school attendance, participation in extracurricular activities, and instructing those who have symptoms to avoid contact with others, are designed to prevent unvaccinated people who have been exposed to the virus from infecting members of the general public while they are infectious.”

Wiest and Jerome's father, Bill Kunkel, told The Washington Post that the health department is overreacting, and his son is fine: "He had a couple days of misery, but after that he was pretty good. He itched a lot. He didn't die. Isn't that amazing?"

U of L moving to take over Jewish Hospital

"After trying to sell Jewish Hospital and other local operations for about two years, KentuckyOne Health may finally be close to striking a deal, according to an email obtained by the Courier Journal," Morgan Watkins reports for the Louisville newspaper.

Deborah Lee-Eddie, the interim CEO for KentuckyOne's Louisville market, suggested to employees in the email that "they're making headway in their talks with the University of Louisville, which is interested in potentially buying Jewish and other local health-care facilities, such as the Frazier Rehab Institute and Our Lady of Peace psychiatric hospital."

She wrote, "The discussions with U of L Health have been very positive and have progressed to the point that we have now begun preliminary planning for the possible transition," with a team led the university, which has a longstanding affiliation with the hospital. "More than 50 of the school's medical residents and dozens of doctors associated with the university work at Jewish and the Frazier Rehab Institute, and all of the physicians who perform lung, kidney, liver, pancreas, heart and dual organ transplants at Jewish are employed by the university," Watkins notes.

U of L spokesman John Karman told Watkins that the university hopes to reach an agreement by June 30 with the hospital's owner, CommonSpirit Health, formerly Catholic Health Initiatives. U of L operates 400-bed University of Louisville Hospital, a general, safety-net hospital nearby; adding all the facilities in the KentuckyOne group would add 1,300 beds.

Concerns about Jewish Hospital's future "have mounted along with its financial losses over the past few years," Watkins recounts. "Last year, several local doctors and KentuckyOne staff members told the Courier Journal on the condition of anonymity that they were worried Jewish — which has spent over a century caring for patients in Louisville — would close if it couldn't be sold."

Making 21 legal age to buy tobacco products would help fight epidemic of electronic cigarettes among teens, legislator writes

Photo from Getty Images via Courier Journal

By Sen. Julie Raque Adams
Republished from the Courier Journal

If you’re a mom like me, you’re likely alarmed over the recent spike in vaping among teens. Unfortunately, vaping has become a trend for our youth. But as parents, we know it’s really a public health epidemic. Here in Kentucky, almost half of high-school students— with developing brains that are extremely vulnerable to harmful nicotine — have tried vaping.

As the Kentucky Senate Majority Caucus chair, I’ve fought to keep tobacco products away from our kids. That’s why I was proud to stand with U.S. Senate Majority Leader Mitch McConnell as he announced his plan to introduce federal legislation to raise the nationwide age to purchase all tobacco products, including vaping devices, from 18 to 21.

Kentucky leads the nation in cancer mortality and has the highest number of cancer cases linked to smoking. The surge of teenage vaping will only make those statistics worse. If we stop our kids from starting this deadly habit, we can prevent some of the health problems associated with smoking.

Awareness campaigns are important in warning teens about the dangers of cigarettes, but a majority of young people don’t realize their vaping devices contain nicotine. When they vape, our children are inhaling hazardous aerosols and training their brains to depend on the chemicals. Their “trendy” habit can lead to lifelong health problems, hinder physical and mental development, and even make them more likely to become addicted to other substances.

Allowing 18-year-olds to legally purchase vaping devices creates an environment where these addictive products can be shared with younger peers. A startling number of middle schoolers even tried vaping last year. Because 15-year-olds aren’t likely to hang around 21-year-olds, Sen. McConnell’s legislation would help keep dangerous nicotine out of teenage hands.

This year in the General Assembly, my colleagues and I led the charge to ban all tobacco products from Kentucky schools. In the last state budget, we also increased the cigarette tax to make smoking more expensive. These efforts mark a monumental shift toward improving the health of our commonwealth, and the state legislature is using every resource it can to help Kentuckians break the habit. McConnell’s federal legislation is a vital boost to our work to save lives in our state.

Momentum is building for this effort across the country. Twelve states have passed laws to raise their tobacco age limits to 21.

This issue is personal for me, and I’m proud of my long history working on it. While on the Metro Council, I was a leading advocate of Louisville’s smoke-free ordinance. I’m proud to support Sen. McConnell as he takes the next steps to protect our children. With McConnell’s leadership position in the U.S. Senate, I am confident we can deliver results for Kentucky.

No mother should be forced to watch her son or daughter grow up to fight addiction or cancer. Every time we prevent teens from vaping, we increase the likelihood they avoid it throughout their lives. By raising the legal age to purchase tobacco, we’re giving our kids the chance they need to develop without a dependence on harmful chemicals like nicotine.

Sen. Julie Raque Adams (R-Louisville) represents Kentucky’s 36th State Senate District, which includes a portion of Jefferson County. She is the Senate Majority Caucus chair.

Tobacco-free school law, coming in 2020, is none too soon when e-cigarettes are epidemic among teens, Paducah doctor writes

By Dr. Patrick Withrow
Republished from The Paducah Sun

Kentucky statewide student survey biannual evaluation to assess the extent of tobacco (nicotine), alcohol and drug use among 11- to 18-year-old adolescents was recently released. Vaping and electronic cigarette use had doubled or nearly doubled in all four grades surveyed — sixth, eighth, 10th, and 12th in the last two years.

Dr. Patrick Withrow

This unprecedented rise in vaping in Kentucky is much higher than the national average. The peak grades for first trying e-cigarettes and vaping are the sixth and seventh. This is much more popular than the use of alcohol or combustible cigarettes.

The Food and Drug Administration describes use of e-cigarettes as an epidemic among our youth. They clearly state that nicotine is not a benign substance but rather a highly addictive drug that has major detrimental effects on the developing immature adolescent brain. This disturbing and accelerating trajectory of use that is occurring in our youth and the resultant path to multi-drug addiction must end.

The FDA has launched the Youth Tobacco Prevention Plan to stop the use of tobacco products and e-cigarettes such as the devices made by Juul Labs, the most popular nicotine or drug delivery device. The three key strategies are:

• Prevent underage access to tobacco products.
• Curb the marketing of tobacco products aimed at our youth.
• Educate teens about the dangers of tobacco, short- term and long-term.

The FDA is exploring ways to wean teenagers off nicotine as huge numbers of middle and high school students use Juuls and other electronic drug-delivery devices that promote addiction. Doctors treating nicotine-addicted adolescents do not have a wealth of treatment data upon which to draw. Most of the treatment information comes from treating adults that are addicted to nicotine.

According to Dr. John Cecil and Dr. Caitlynn Cecil of The Cecil Clinic in Paducah, who see many adolescent patients, Juul use is extremely common. Dr. John Cecil has treated nicotine-addicted adolescents with some adult treatment protocols. He estimates his success rates to be only 10 percent. He also observes that 80 to 90 percent of the adolescents who use Juuls have a parent or guardian who smoke tobacco products.

Dr. Caitlynn Cecil also performs occasional drug testing as part of her evaluation for mood swings, depression or when she is otherwise suspicious. She states that if a patient is positive for THC, the psychoactive component of marijuana, then they virtually all use Juuls. She states many parents and grandparents are totally unaware about their children using e-cigarettes or Juuls. Most have no idea what the devices are because some resemble USB drives.

Making all Kentucky school campuses completely tobacco and e-cigarette free is critical to changing youth attitudes about tobacco products. This measure will help protect our children from one of the most addictive substances on this planet and allow them to learn and grow in a smoke-free and nicotine aerosol-free environment.

Only 42 percent of Kentucky public school districts have adopted tobacco-free policies. This means 58 percent of school districts do not have a tobacco-free policy. A comprehensive policy that expands across the state will help prevent a real student addiction risk. Faculty, staff and visitors will also avoid exposure to secondhand smoke, nicotine aerosol and residue.

The Senate passed House Bill 11 on the final legislative day of the year, with compromise being necessary for its passage. The law goes into effect the summer of 2020. Local school boards will implement the regulation of the law, or may opt out of the law within three years after it takes effect.

A statewide tobacco-free law takes away the sense that e-cigarettes and smoking are the norm. It also is a proven method to help keep adolescents from starting e-cigarettes or cigarettes, which may quickly progress to addiction.

We should all support this commonsense tobacco-free school law and encourage our school boards to embrace and strengthen the protection it affords our children. Many thanks to state Rep. Kim Moser, House Speaker David Osborne, state Sen. Ralph Alvarado, the Foundation for a Healthy Kentucky and all the partners dedicated to advocating for a healthy Kentucky.

Dr. Pat Withrow is the director of outreach at Baptist Health Paducah. He can be reached at patrick.withrow@bhsi.com.

Retired Ashland cardiologist gets five years in prison for fraud

A retired Ashland cardiologist has been sentenced to five years in prison and ordered to pay $1.1 million in restitution after being convicted two and a half years ago of doing hundreds of unnecessary heart operations.

Dr. Richard E. Paulus, 71, who practiced at King’s Daughters Medical Center, "billed more to Medicare for certain heart procedures than any cardiologist in the country from 2006 through 2011, according to a court record,"reports Bill Estep of the Lexington Herald-Leader. "The hospital paid him a total of $10 million between 2009 and mid-2013, when Paulus retired, according to court records."

Dr. Richard E. Paulus (Ashland Daily Independent file photo)

U.S. District Judge David L. Bunning sentenced Paulus May 2. Bunning could have imposed a 10-year sentence or placed Paulus on probation, which his lawyers requested. "Defense attorneys plan to ask that he be allowed to remain free on bond pending an appeal," Estep reports.

"The sentencing comes after Bunning turned down three separate requests by Paulus for a new trial," following his conviction in October 2016, reports Mike James of the Ashland Daily Independent. "It follows a dizzying succession of legal events — Paulus’s indictment, trial and conviction were followed by Bunning’s reversal of the verdict and then by an appeals court reinstating the conviction and sending the matter back to Bunning. Based on the appeals court ruling, Bunning ruled against a new trial and scheduled the sentencing."

James reports, "Evidence at his trial showed he performed numerous invasive heart procedures on patients who did not need them, and to justify the procedures he falsified medical records to exaggerate their medical condition and to make it appear that the heart procedures were necessary and qualified for payment." Estep reports, "The jury ruled Paulus put false information in patients’ records saying they had more severe blockages than tests showed, in order to justify putting stents in them."

In asking for probation, Paulus's attorneys said "he had provided years of selfless service to patients and the community," Estep writes. "Paulus worked fanatical hours to help patients, never inquired about someone’s ability to pay and often treated people free of charge, his defense attorneys said. One former co-worker said Paulus wore shoes held together with duct tape for a year because he was too busy to get a new pair, his attorneys said."

As e-cigarette epidemic grew among teens, state inspected fewer retailers; among those it did, violations rose; it lacks a full list

By Melissa Patrick
Kentucky Health News

Illegal sales of tobacco to Kentucky children have trended up in the last few years, according to the annual federal report that measures states' progress in reducing youth access to tobacco through random, unannounced inspections.

Meanwhile, the number of inspections in Kentucky has declined, and the state has no comprehensive list of retailers who should be inspected.

From 2014 to 2017, violation rates by Kentucky retailers trended up, going from 5.4% to 10.4%, but dropped to 7% in 2018. The national average in 2018 was 9.6%.

The rate rose to 9.7% in the first seven months of the 2019 fiscal year, which runs through Sept. 30.

These increases came at a time of huge increases in teenagers' use of Juul devices and other electronic cigarettes heavy in nicotine, the U.S. Food and Drug Administration has found.

A state news release about the report said e-cigarettes "had the highest percentage of violations, 14.3 percent, compared to 10.6 percent for smokeless tobacco and 8 percent for cigarettes."

Fiscal Year 2019 data is incomplete; fiscal years are Oct. 1 through Sept. 30.

The report is part of the Synar Program, started under a law sponsored by the late U.S. Rep. Mike Synar of Oklahoma. In Kentucky, it is housed in the Department for Behavioral Health, Developmental and Intellectual Disabilities, which has to keep the violation rate below 20% to maintain a federal block grant for substance-abuse prevention and treatment. However, inspections of tobacco retailers are conducted by the state Department of Alcoholic Beverage Control.

The ABC also does inspections for the FDA. Both programs work toward the same goal of reducing youth access to tobacco, but aren't comparable because they have different inspection requirements.

Retailer violation rates in FDA-funded inspections. Fiscal 2019 data
incomplete; fiscal years are Oct. 1-Sept. 30. (Kentucky Health News charts)

That said, the FDA inspections showed a similar upward trend, based on data from the FDA Compliance Check Inspections of Tobacco Product Retailers website. From 2014 and 2017, retail violations in Kentucky rose from 1.3% of inspections to 7.3%, but dropped to 5.9% in 2018. The national rate in 2018 was 12%.

The FDA website shows that the national rate seven months into the 2019 fiscal year was 5.6%, but it's uncertain if this low rate will hold, since cigarette sales and youth onset of smoking has been shown to be more prevalent in the summer.

ABC conducted fewer inspections in 2018 than it had in recent years, even though youth use of e-cigarettes was booming, among traditional and non-traditional retailers.

"The whole epidemic of e-cigarette use points up this problem even further because now we have vape shops and other places that may or may not be selling traditional tobacco products, but are selling e-cigarettes and we don't know where those are, because they aren't licensed either," said Amy Barkley, regional advocacy director for the Campaign for Tobacco-Free Kids.

Licensing

Kentucky is one of 11 states that doesn't require retailers to be licensed to sell tobacco products, according to the American Lung Association's State Legislated Actions on Tobacco Issues. The requirements vary.

Screenshot of FDA website with inspection data on Kentucky retailers
with violations; site has a detailed list of retailer names and locations.

Anti-tobacco activists acknowledge that tobacco-compliance inspections can be helpful in curbing youth tobacco use, but argue that without a comprehensive list of retailers -- which the state would get by requiring anyone who sells tobacco products to have a license -- they aren't very effective.

Research supports this claim. A study published in the medical journal Pediatrics found that teenagers in areas with strict tobacco retail-licensing laws, and regular retail compliance checks and enforcement, were less likely to use cigarettes and e-cigarettes.

At last month's 2019 Tobacco Conference in Kentucky, a former policy analyst for the state Tobacco Prevention and Cessation Program, argued for tobacco-licensing laws in Kentucky.

“If you look generously, maybe 20 percent of retailers in the state are checked each year to see if they sell products to minors, a one or two time check per year," Elizabeth Anderson Hoagland said. And those inspections are only at known retailers, she said, noting that the Tastee-Freez in Elliott County sells cigarettes, but probably isn't on the inspection list.

“If you're not from there, you're just like, 'Oh, it's an ice-cream parlor'," she said. "You would never think to check to make sure they aren't selling [tobacco] products to 16-year-olds.”

Barkley said licensing retailers would also bring in some much needed revenue to support inspection programs, "even at a small amount."

The Synar report revealed opposition within state government to the idea. It says the state Synar coordinator met with representatives of the ABC, the Department for Public Health and the Department of Revenue last year to discuss the issue, but "The Department of Alcoholic Beverage Control has changed its position on the licensing issue and is not willing, at this time, to support a licensing law."

Susan West, spokeswoman for the Public Protection Cabinet, which includes the ABC, was asked why the agency had changed its position. She said in an email, “Alcohol Beverage Control does not hold a position on tobacco licensing legislation, because ABC is the enforcement arm of the laws created by the legislature. ABC is not aware of who provided this comment in the Synar Report."

Asked who the Synar coordinator is, Beth Fisher of the Cabinet for Health and Family Services said in an email, "The comment you referenced was made in during a meeting between ABC and [the Department of Behavioral Health]. The staff member who made the comment is no longer in the role with ABC."

Retail licensing is sure to be a hot-button topic in the state's next legislative session, since U.S. Senate Majority Leader Mitch McConnell is sponsoring legislation to make 21 the legal age to buy tobacco products in every state, a measure that failed to pass the Kentucky legislature this year.

Barkley argues that retailer licensing in Kentucky will be critical to enforcing a "Tobacco 21" law. She said, "We don't want to just check the box and say we raised the age of sale; we want to actually enforce the law."

Ben Chandler, CEO and president of the Foundation for a Healthy Kentucky, disagrees.

"Simply by moving it up to 21 without doing anything else is a gain, in my view," Chandler said. "We would be in favor of a policy that requires a license, but all I'm saying is I expect a lot of pushback on that one; pushback on Sen. McConnell, from the Chamber."

The Kentucky Chamber of Commerce was the leading spender on legislative lobbying in the first quarter of this year, at $112,740. Third, at $98,762, was Philip Morris and its parent Altria Group, which recently bought 35 percent of Juul Labs and is lobbying states for "Tobacco 21" laws -- to avoid other regulation, such as limits on flavorings that appeal to children, anti-tobacco activists say.

Budget cuts

The Synar report says many of the program's challenges in Kentucky are due to "budget cuts." For example, it says cuts caused ABC to stop state-funded random inspections, which numbered 3,000 a year, in addition to the federally required inspections.The number of Synar inspections has ranged from 300 to 600 per year, West said.

Fisher, of the health cabinet, said in an email that federal officials asked the state to do more Synar inspections in fiscal 2018 "because the accuracy rate was falling below the recommended 80%. Accuracy rate is the number of stores actually inspected, out of the sample. Since Kentucky has no licensing law, it’s hard to keep track of outlets. We clean and renew our lists every year via lists obtained from Kentucky Lottery, SNAP and private companies that construct lists."

The Synar report also said budget cuts make it difficult for ABC to follow up with clerks who are remiss in paying fines for illegal sales; and have curtailed efforts to prevent youth access to tobacco.

These comments prompted Kentucky Health News to ask ABC on March 26 for a breakdown of state and federal spending for both inspection programs since 2014, when the rates started trending up.

After more than a month, West deferred this request to the health cabinet for the Synar expenditures. For the federal funding, she sent a link to the federal Freedom of Information Act website, saying the state couldn't share this the data because it was "non-public information." She was asked why federal funding of state-government activities was not public information, and has not answered the question.

West did say that the total amount spent on FDA compliance inspection program in 2014-17 was $1.4 million and that in 2017, ABC became federally funded with an annual budget of $650,000. She said ABC is working under a three-year contract for 2017-20 and the prior contract with the FDA was for 2014-17.

Fisher, the spokesperson for the health cabinet, where the behavioral-health department is located, said the Synar budget varies each year to accommodate the number of required inspections and has gone from $65,000 annually to $50,000 for fiscal year 2020, which starts Oct. 1.

As for the 3,000 state-funded inspections that are no longer being funded, which the cabinet says cost about $35,000 a year, West said "a portion" of those have been replaced by an extended contract that ABC has with the FDA. The state has not responded to an open-records request from Kentucky Health News for the contract, or said how many is "a portion."

Other issues; ABC leadership changes

The Synar report also suggests that fines for non-compliance should be paid by store owners and not clerks. Under state law, owners are only fined if they do not have clerks sign a compliance statement that says they understand it is illegal for them to sell tobacco products to those under 18.

“The current shortage of staff due to budget cuts makes it difficult for the Department of Alcoholic Beverage Control to follow up with clerks who are remiss in paying their fines," the report says. "Store owners might be more conscientious about seeing that their clerks receive merchant education training if they were fined instead of the clerks."

Hoagland told the conference attendees that the sale of tobacco products is typically around 30 percent of the profit margin for an average convenience store. “There is absolutely no pressure from a state compliance check to make that store owner change their policies, to actually be restrictive of who they are selling to," she said.

On March 12, the Public Protection Cabinet announced several leadership changes at ABC. Carol Beth Martin, who has served as malt beverage administrator since February 2016, was appointed acting commissioner. She replaced Christy Trout-Van Tatenhove, who had been commissioner since October 2016. Karen Sellers was appointed deputy commissioner. The cabinet said Sellers had served for years as a health-care industry executive.

Ky. mom says she doesn't vaccinate her kids due to religious belief; meanwhile, number of U.S. measles cases at 25-year high

Centers for Disease Control and Prevention photo

As the number of measles cases in the U.S. reach their highest count in 25 years, a Lexington mom holds firm to her faith-driven belief to no longer vaccinate her children, Mary Meehan reports for WEKU-FM. 

Toni Wilkinson is one of many parents who cite religious reasons for not vaccinating children. She told Meehan she did that after learning that stem-cell tissue from abortions had been used to produce some vaccines.

“That became a big issue for me because we're very pro-life,” she said.

A few vaccines have been developed using human cell cultures derived from two legal abortions in the 1960s and are maintained in laboratories, but no additional fetal tissue has been added since they were originally created, According to the federal Centers for Disease Control and Prevention,

Wilkinson has seven children, all of them home-schooled. She told Meehan that her two oldest children are fully vaccinated, the next two received the required shots only until middle school, and the three youngest are not vaccinated at all.

From Jan. 1 to April 26, the CDC reports there have been 704 cases of measles confirmed in 22 states, including Kentucky. It is the greatest number of cases reported in the U.S. since 1994, and has been blamed on a decline in vaccinations.

"Kentucky is among 47 states that allow some form of religious exemption from vaccination requirements for children to attend public schools," Meehan notes.

West Virginia has no religious exemption, and has a 98% vaccination rate, well above the national median rate of 94.3%, Meehan notes. Kentucky's rate is 92.6%.

In June 2017, Kentucky's health cabinet made it easier for Kentucky adults to get religious based vaccine exemptions for their children by allowing them to get the exemption form online, have it notarized and then simply submit it to their school upon enrollment -- instead of having to obtain it from their health-care provider along with their signature. And it looks like that's not going to change.

“There has not been any talk about eliminating exemptions to vaccines in Kentucky that I'm aware of at this point,” Kentucky Public Health Commissioner Jeffrey Howard told Meehan.

Meehan reports, "Howard said he supports vaccines and that there are a lot of misunderstandings and myths surrounding them. But, he says, Kentucky is a place where people want to protect personal liberties such as whether or not to vaccinate a child."

Meehan reports  that no major American religion explicitly seeks to forbid vaccines and some within the Catholic church even encourage them -- though a subset of church members, like Wilkinson, reject vaccines on moral grounds related to the past use of fetal cells in some of them.

Dr. Scott Gottlieb was commissioner of the federal Food and Drug Administration from 2017 until earlier this month. He is now a resident fellow at the American Enterprise Institute.

Gottlieb told Meehan that he didn't think the federal government should mandate vaccinations, "because I think these are issues that have long been held left to state supervision for a lot of good reasons."

However, he also said that this surge in measles infections is forcing public health officials to make some tough policy decisions. “We're at the point right now where we're starting to see outbreaks of such a scope that we are going to reach a tipping point and perhaps some point soon," he told Meehan.

Toni Wilkinson told Meehan that she and her friends who have made a similar decision have faced backlash, with both family and on social media, but she still stands by her decision.

“God places children in families for a reason,” she told Meehan.

She also told Meehan that she has brief moments of doubt. “I think there was still a little fear of like, what if my child got what is considered a vaccine-preventable disease, what am I going to feel?”

University of Louisville to hold free event in Oldham County on May 10 to discuss aging, pain management and addiction

Kaiser Health News photo

The University of Louisville Trager Institute will offer a free community event to discuss the dangers of medication misuse and addiction for older adults, alternative solutions to chronic pain management and advocacy for making alternative pain strategies accessible for older adults.

“There is often a stigma around talking about pain and pain management, in addition to lack of understanding of options beyond opioids,” Mona Huff, the institute's community organizer, said in a news release. “Good health starts with self-care and loving yourself. It means asking for help when you need it. Asking for help is not a sign of weakness, but rather a sign of strength.”

The event, "Reconciling Pain and Giving Hope to Seniors,” will be held Monday, May 13 from 10 a.m. to 3 p.m. at the John W. Black Community Center in Oldham County.

Lunch will be provided for those who RSVP to the symposium by May 7. For more information contact Mona Huff at 502-845-6849 or rjhuff01@louisville.edu.

This event is held in partnership with the Kentucky Coalition for Healthy Communities, Tri-County Community Action Partnership, Barren River Area Development District, and the Kentuckiana Regional Planning and Development District.

Health experts warn people with asthma and chronic lung conditions to be careful when spring cleaning; here are their tips

Asthma.net image

Spring has arrived in Kentucky, prompting many to tackle the annual chore of spring-cleaning, but health experts caution people who suffer from asthma or other chronic lung conditions to proceed with caution because some cleaning supplies can be hazardous to your health, according to a Penn State Health news release.

The key to cleaning safely, if you have one of these conditions, is to take proper precautions when using cleaning supplies such as air fresheners, rug cleaners, bleach, oven cleaners and floor polish, because they can produce vapors that may irritate the nose, throat, eyes and lung, the release says.

“For most people, using chemical cleaners occasionally would not create clinically significant reductions in lung function,” Dr. Timothy Craig, an allergist and immunologist at Penn State, says in the release. “But repeated exposure to harmful chemicals over a lifetime could lead to significant disability later in life, especially for people with asthma, chronic obstructive pulmonary disease or Alpha 1 antitrypsin deficiency, a genetic disorder that may cause lung or liver disease.”

About 11.6% of Kentucky adults have asthma, and rates are significantly higher among women than men: 16% and 6.9% respectively. About 11.4% of Kentucky adults have chronic obstructive pulmonary disease, and those rates are also significantly higher in women, 13.3% to 9.4% for men, according to the 2018 Kentucky Behavioral Risk Factor Survey annual report.

Here are six safety tips that the experts say should be on everyone’s spring cleaning checklist:

1. Don’t combine chemical cleaners, especially not ammonia and bleach.
2. Create proper ventilation. Open a window or door, or run a fan, while cleaning.
3. Wear rubber gloves and a mask.
4. Seek old-fashioned cleaners like warm water, baking soda,and vinegar.
5. Read labels. Look for volatile organic compounds and other potential irritants, even in products labeled as “green” or “healthy.”
6. Look for the “Safer Choice” logo. It’s found on 2,000 products, including cleaners, that the Environmental Protection Agency deems as “safer for human health and the environment.”

"People who experience any coughing, wheezing, throat soreness or eye watering while using chemical cleaners should step into another room or walk outside. If the symptoms persist even after leaving the room, call a doctor," says the release.

As pensions threaten school-nurse programs, schools can get new Medicaid money for both physical and behavioral health

By Melissa Patrick
Kentucky Health News

Many of Kentucky's school districts have long struggled to pay for school nurses, let alone professionals in behavioral health care. And now some health departments may no longer be able to provide nurses because they will have to pay more into their employees' pension system.

But schools are about to get some help with their students' health needs, under state officials' plan to allow schools to use Medicaid funding to cover both physical- and behavioral-health services. More than two in five of the state's children are covered by Medicaid.

Deputy Secretary Kristi Putnam

Kristi Putnam, deputy secretary of the Kentucky Cabinet for Health and Family Services, who has spearheaded this effort, said that by the start of the next school year, schools will be able to use Medicaid to serve all students enrolled in the program.

"I'm a former school teacher and I know how valuable it is to have health services and behavioral health services for kids right there at your school," Putnam said. Research shows that children who don't get needed care can suffer academically.

What's it all about?

Until December 2014, schools could only bill Medicaid for students who were disabled or met other limited criteria. That's when the Centers for Medicare and Medicaid Services changed the guidelines to allow states to provide services to any student who is enrolled in Medicaid, and get federal reimbursement for those services.

Only now has Kentucky decided to seek the money, a decision that seems largely driven by an increase of behavioral-health issues in schools.

Gaining access to these funds varies by state. In Kentucky, it requires an amendment to the Medicaid state plan and putting an appropriate billing process in place. Putnam said the amendment and fiscal analysis will be submitted May 1, with a request for an Aug. 1 start date and that they are still working on the billing aspect of the requirements.

She said the administration is working on the assumption that the funding will be approved and will start informing schools about it on May 1, because participation is optional.

States must provide matching money to get federal Medicaid dollars, 30% in Kentucky's case. Putnam said existing school-based Medicaid expenditures can count toward the match.

"The state and local funding that is being used right now for any health and behavioral-health service can be used as the match to draw down additional federal funds," she said. "So there is no increased costs to the state or to the school district."

Putnam said the amendment will be broadly written, so the new money can cover both physical- and mental-health care, along with provisions for telehealth.

"You have to have both," she said. "It's just exciting because there has been limited funding for behavioral-health services . . . but this will allow us to expand both, and we need to expand both."

Kentucky adults are strongly supportive of schools taking a more active role in helping families get health care services for their children, with 84% saying in the latest Kentucky Health Issues Poll that they favor such action.

So far, 14 states, including Kentucky, are either considering, actively pursuing or have already taken advantage of this additional Medicaid funding in their schools, according to a policy brief penned by three non-profits dedicated to health: Community Catalyst, Healthy Schools Campaign and Trust for America's Health.

Why does it matter?

For years, Kentucky schools have struggled to find funding for health care in schools. And while Putnam has pointed to the need for more behavioral health funding, school nurses have been on the chopping block for years as school and health-department budgets have decreased.

Kentucky Department of Education photo

These cuts have forced schools to find creative ways to provide health care to students. Some have moved to school-based health centers, which provide care to students through a public-private partnership; others have used fewer nurses to cover more students. Others have relied on health departments, but cuts in federal and state funding have forced the departments to ask for more money from schools to fulfill this role.

That said, health departments' school-nurse programs could be at further risk because of the state's pension crisis, which on July 1 will require health departments to increase their pension obligation from 49.47% to 83.43% of payroll -- unless a special session of the state legislature changes that.

In the regular session, Gov. Matt Bevin vetoed a bill that would have offered some temporary relief to the health departments and has said he will call a special session to deal with the state's pension system early this summer.

The Marshall County Health Department decided last week to end its school-nurse program, in order to help pay for its possible extra pension obligation of $566,200 a year. In a news release, local health officials called it an "agonizing decision."

"The Marshall County Health Department school health program has been in our schools for over 25 years," they said. "Our school nurses have truly made a positive difference in the lives of our children, their families, the school system, and our community. Discontinuing this program is a tremendous loss for all of us."

Meanwhile, the need for health services in Kentucky schools is greater than ever, with students showing up at school with a long list of chronic physical-health and behavioral-health conditions, an electronic-cigarette epidemic that no one saw coming, as well as schools having to deal with issues around bullying, suicide, the drug epidemic and gun violence.

Mahak Kalra, the health policy director at Kentucky Youth Advocates, who has worked with the cabinet on this project, pointed to research that shows students with health problems, whether they be physical or behavioral, struggle to do well in school.

"So, providing those health services in the school setting can address their immediate health-care needs and can connect them to the services they need and really keep them learning," Kalra said.

She added that it will also reduce many of the barriers parents have to get their children health care, like transportation, non-flexible work schedules or simply finding a provider who will accept Medicaid.

Kalra and Putnam both noted that this additional funding will help support the School Safety and Resiliency Act, or Senate Bill 1, that among other things calls for one trained school resource officer in every school and one guidance counselor for every 250 students by July 1, 2021 or as funds and qualified personnel become available. School-based mental health service providers fall under a subsection of the guidance counselor requirements and are listed as optional.The bill has no funding attached to it.

"This is one way to have those school-based mental health providers provide those services," Kalra said.

Eva Stone, district health coordinator for the Jefferson County Public Schools, pointed out that Medicaid will only pay for licensed mental-health providers, not guidance counselors -- unless they have a special certification, which most of them don't.

Stone, who is also an advanced practice registered nurse, added that amending the state plan to define what this additional Medicaid funding will cover provides a great opportunity for Kentucky to meet all of the needs of the state's children, whether they be physical, mental or social -- like whether a child is homeless or has access to food or is being abused at home.

Stone has long said that school nurses are the best situated to coordinate all of these efforts because "that's what nurses are educated to do." Further, she said, making coordination of care reimbursable in the state health plan would allow for that coordination to happen.

"We have the opportunity to craft this in Kentucky in a way that would make all those players work together," she said.

The state says Kentucky has 1,688 students for each school psychologist; the national standard recommends 500 to 700.

The 2018 School Health Profiles Report shows that 41% of all middle and high schools in Kentucky have a part-time registered nurse and 58% have a full-time registered nurse. The Kentucky Health Issues Poll found that 92% of Kentucky adults would support a law to require a nurse in every school.

Kentucky leads the way on many opioid-related efforts, and was well represented at the four-day drug abuse summit in Atlanta

By Melissa Patrick
Kentucky Health News

Kentucky officials, researchers and clinicians were front and center at the eighth annual national summit on prescription drug abuse and heroin, started by Rep. Hal Rogers of Kentucky, participating in panels covering a range of topics, such as caring for babies who are born addicted to drugs and procedures that help with early detection of substance-use disorders among young people.

U.S. Rep. Hal Rogers spoke at the 2019 National Rx Drug
Abuse and Heroin Summit in Atlanta. (Photo via Twitter) 

“This public-health crisis has damaged our nation and ripped families apart. More than 70,000 people died of drug overdoses in 2017 alone and sometimes it’s hard to find hope in the midst of America’s deadliest drug epidemic,” said Rogers in a news release.

The summit was founded by Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education), a Kentucky non-profit created by Rogers that leads education, treatment and law enforcement initiatives in 32 counties in Southern and Eastern Kentucky.

“Operation UNITE leaders were determined eight years ago to reach across state lines and share best practices with other communities looking for life-saving solutions,” Rogers said. “Each year at this summit, a little more hope shines through as we see shifts in more access to treatment, better policy and legislation, and more prevention programs.”

Attendance at the National Rx Drug Abuse and Heroin Summit in Atlanta April 22-25 was the largest yet, about 4,000. Kentucky was well represented, with a large contingent of researchers and health-care providers from the University of Kentucky on several panels. UK President Eli Capilouto, who introduced Rogers on the first day, pointed out in a video about the event that the summit often sets the national agenda that drives the research around this topic.

One panel covered topics that centered around changes to Kentucky's laws and their potential impacts on patient care and the expansion of prescription data for public health surveillance. Another discussed a multidisciplinary model of care that allows people who come into the emergency room or hospital at UKHealthCare to get immediate treatment for their opioid-use disorder with medication assisted treatments, like buprenorphine, and then get an immediate referral to the First Bridge Clinic for further treatment and recovery care. In its first year of operation, over 300 individuals were referred for treatment with over one-third initiated care, according to a university news release.

Dr. Roger Humphries, the chair of emergency department, talked about how his views on addiction have evolved. He said that years ago he would have never considered treating a person with an opioid-use disorder in the emergency room, but that is no longer the case as evidence by his emergency room's participation in this innovative partnership with First Bridge Clinic.

"I used to think responsibility was fully on patients," he said, " but now I know this is a brain disorder -- one of my kids could fall into a problem like this."

President Donald Trump and First Lady Melania Trump addressed the attendees of the summit on Wednesday. She first highlighted her "Be Best" campaign that among other things raises awareness of neonatal abstinence syndrome and maternal health. The president presented a long list of efforts by his administration, including an investment of $6 billion over two years to combat the crisis. "Everyone here today is united by the same vital goal: to liberate our fellow Americans from the grip of drug addiction and to end the opioid crisis once and for all," he said. "We will never stop until our job is done."

Justice Secretary John Tilley at the summit (Photo via Twitter)

Kentucky Justice Secretary John Tilley was one of four speakers to follow Trump's keynote address. A state news release said Tilley spoke about the state's many innovative reforms and initiatives including "strengthening treatment in prisons, establishing the KY Help Call Center, local-option syringe exchange programs, expanded access to naloxone, a three-day prescription limit for acute pain, the Kentucky State Police Angel Initiative, and the newly-announced $87 million Kentucky CAN HEAL Project," which aims aims to reduce opioid-overdose deaths in 16 counties by 40 percent over the next four years with grants from the National Institutes of Health.

Effort mounted to find and treat hepatitis C, which is spreading; most people who have it probably don't know they have it

"A multimillion-dollar effort to fight hepatitis C was introduced Thursday in Louisville with the help of Gov. Matt Bevin as well as medical professionals and health advocates," Darla Carter reports for Insider Louisville.

The five-year, five-state project in Kentucky and four other states will use screenings, community partnerships and prevention programs, and strengthen the health-care infrastructure to fight the liver disease, Carter reports. The project, called HepConnect, will serve Kentucky, Indiana, North Carolina, Tennessee and West Virginia.

"We can't afford to ignore it," Gov. Bevin said. (Darla Carter photo)

Many people who have hepatitis C don’t know it because it often doesn't present symptoms, said Derek Spencer, a lobbyist for Gilead Sciences, the drug maker funding the project. The state of Kentucky estimates that more than 40,000 Kentuckians have the disease, but “The actual number is likely four to five times that amount,” said the state Cabinet for Health and Family Services.

The opioid epidemic is spreading the hep-C virus, Spencer said: “The majority of new HCV infections in the Appalachian region are attributed to the results of syringe-sharing practices and other equipment associated with injecting drugs.”

Carter notes, "Other ways of acquiring the virus include sharing personal items, such as razors and toothbrushes; getting a tattoo or body piercing in an unregulated setting; or even sometimes through sexual activity." If the illness goes undetected, it “can progress to liver damage, liver failure, liver cancer and death,” Spencer said.

Research by the federal Centers for Disease Control and Prevention in Kentucky, Tennessee, Virginia and West Virginia showed a 364% increase in the number of acute hep C cases "from 2006 to 2012 among young people, mainly whites living in urban and non-urban areas," Carter notes.

Gov. Matt Bevin said at the announcement that hep C was once considered a chronic disease of baby boomers, but we’ve now seen it “leap into younger generations,” he said. “We can’t afford to ignore it.”

Other at the April 25 event "talked about the need to lessen the stigma surrounding hepatitis C and drug use, and a panel of experts from the University of Louisville Hepatitis C Center and elsewhere spoke of the need to address not only the person injecting drugs but also family members who might be infected or impacted," Carter reports..

“Pregnant women can pass hepatitis C on to their babies,” nurse practitioner Barbra Cave said.

The first year of the project will cost $11 million. "The project is being led by the Harm Reduction Coalition, a national organization that promotes the health and dignity of people and communities affected by drug use," Carter reports. It has a Kentucky branch.