In May 21 Democratic primary for governor, Beshear talks most about health care, but Edelen questions his past contributors

L-R: Former state auditor Adam Edelen, state House Minority Leader Rocky Adkins and Attorney General Andy Beshear answered questions from Matt Jones at a debate in Lexington April 24. (Associated Press photo by Timothy D. Easley)

By Al Cross
Kentucky Health News

If health issues matter when it comes to your vote for governor in the May 21 primary election, the candidates have given you a few things to think about.

In the Democratic primary, Attorney General Andy Beshear has cast himself as the main defender of the 2010 Patient Protection and Affordable Care Act, which his father, then-Gov. Steve Beshear, used to expand Medicaid to many more of the state's working poor.

State House Minority Leader Rocky Adkins and former state auditor Adam Edelen also support the Medicaid expansion, and oppose Gov. Matt Bevin's plan, twice blocked by a federal judge, to require "able bodied" Medicaid beneficiaries to work, volunteer or perform other "community engagement."

Bevin's leading Republican primary foe, state Rep. Robert Goforth of Laurel County, favors the expansion and Bevin's plan to change it, said his campaign manager, T. J. Litafik.

All three Democrats have endorsed the legalization of medical marijuana, but Edelen also calls for decriminalization of possession of a half-ounce or less, to reduce jail costs and fund drug treatment, and he has criticized Beshear's plan to tax medical marijuana as part of a plan to shore up state revenues and pensions.

Edelen is attacking Beshear for the campaign help he got in 2015 from Altria Group, the nation's largest tobacco-products manufacturer, and Purdue Pharma, the maker of Oxycontin, the painkiller that primarily fueled the nation's opioid epidemic. At the time, Beshear was in a law firm that represented Purdue Pharma, but has said he took no part in its cases.

On Oct. 19, 2015, Purdue Pharma gave $100,000 to the Democratic Attorneys General Association, which was supporting Beshear in the nation's only fully competitive race for attorney general. On the same day, the DAGA got its second $25,000 contribution of the year from Altria, the tobacco firm that makes Marlboro cigarettes and now owns 35 percent of Juul Labs, maker of the most popular form of electronic cigarette.

Also on Oct. 19, DAGA sent $250,000 to groups in Kentucky running ads attacking Beshear's opponent, Republican state Sen. Whitney Westerfield of Hopkinsville. All told, it spent $1 million to help Beshear, who beat Westerfield by only 2,201 votes, 0.2 percent of the total. The Republican Attorneys General Association spent more than twice as much to help Westerfield.

Just before Beshear took office, Attorney General Jack Conway settled for $24 million a lawsuit that his predecessor, Greg Stumbo, had filed against Purdue Pharma in Pike County for its role in the opioid epidemic. After Beshear became attorney general, Purdue got Circuit Judge Steven Combs to seal the case file, including the only known deposition from a member of the family that owns the company. Stat, the medical-and-science publication of The Boston Globe, asked the judge to unseal the file, and Beshear's office took no position on the issue.

The judge unsealed the file, and the Court of Appeals upheld him, but Purdue has appealed to the state Supreme Court. The deposition of Richard Sackler, then head of the company, includes emails in which he endorses a lieutenant's recommendation that Purdue not "correct the false impression among doctors that OxyContin was weaker than morphine, because the myth was boosting prescriptions — and sales," Stat reported in February, after the deposition was leaked to ProPublica.

Beshear has responded to Edelen's attack with an ad noting that he has filed nine lawsuits against drug makers over the epidemic, and “won’t take their money.”

Beshear has emphasized health care more than any other candidate, calling for "lowering the cost of prescription drugs and holding pharmaceutical companies accountable" and putting a cap on Medicaid drug spending. He has published a plan on the issue that largely supports the provisions of the federal Patient Protection and Affordable Care Act.

Beshear said in his first ad that he is "helping lead a national effort to protect coverage for pre-existing conditions," the most popular feature of the act. He is among 16 Democratic attorneys general fighting a ruling by a federal judge in Texas that declared the act unconstitutional. On Twitter immediately after the ruling, he said, “I will lead the fight to overturn” it, but at a news conference said he would be "as vocal if not more vocal" than the others.

Ads from Beshear and Edelen both criticize Bevin on health care. Edelen claims the governor "sold out to the insurance companies, let them jack up premiums and kick thousands off their health care."

Asked how Bevin sold out, Edelen spokesman Matt Erwin said in an email, "Matt Bevin supports the elimination of the ACA in its entirety. Nobody would benefit more . .. than the big insurance companies who could return to denying coverage for those with preexisting conditions and offering plans that don't even provide coverage for basic health care services." He said Bevin's Medicaid plan would "cause tens of thousands of Kentuckians, if not more, to lose coverage."

Bevin's plan estimates that after five years, Kentucky's Medicaid rolls would have 95,000 fewer beneficiaries than without the plan, in large measure for failing to comply with its community-engagement and reporting rules. Tens of thousands of Kentuckians go on and off Medicaid each month as their eligibility changes. About 1.4 million Kentuckians are on the program, more than 400,000 through the expansion.

Adkins has stayed out of the Beshear-Edelen fray, hoping to be the alternative, and emphasizes education and economic development. His website notes that he and his running mate for lieutenant governor, Stephanie Horne, "are both cancer survivors and know the pain and cost of unexpected illness, and that's why they want to make sure every Kentuckian has access to health care."

Ky. proposes ban on tattooing over scars, but won't say why; public comment on proposal taken through May; hearing May 28

5/24/19: This story has been updated with information from a Cabinet for Health and Family Services news release. 

 Kentucky health officials are proposing to ban tattooing over scars, without giving a reason for doing so, drawing criticism from doctors and tattoo artists, Lisa Gillespie reports for Louisville's WFPL.

WFPL photo

The proposal doesn't offer a reason for the change and simply reads, "Tattooing of scarred skin is prohibited."

A statement from Doug Hogan, chief spokesman for the Cabinet for Health and Family Services, also didn't give a reason for the change.

“Regulations in this area have not been updated for about 15 years. Public comments are being accepted through the end of May,” Hogan wrote. He said the Department for Public Health “will review and analyze all comments and then determine what changes, if any, need to be made to the regulations.”

UPDATE: On May 24, the Cabinet for Health and Family Services issued a news release that said the cabinet made the change to the regulation to address the potential health issues of tattooing over unhealthy skin.  However, Health Commissioner Dr. Jeffery Howard said, "The specific language in the proposed regulation had some unintended consequences and will be addressed. . . . we believe the final regulation will be improved by the comments we have received." The release notes that the language regarding tattooing over scarred skin will be addressed once the public comment period has ended on May 31st.

David Levine, a researcher and doctor at the Morehouse School of Medicine in Atlanta, told Gillespie that he doesn’t know of any medical research that would warrant such a ban and that he thinks the proposal is written too broadly.

“It probably should have been more specific to the reason that the skin was scarred in the first place,” Levine said. “There are people that are using cosmetic tattooing to actually reduce the appearance of scars.”

Levine did caution that tattoo artists should avoid one type of scarring: a keloid, a raised scar that spreads across the skin, because the process of tattooing would likely lead to more of them. Gillespie reports that this type of scar is most common in African Americans, Asian Americans and Latinos.

Mike Martin, president of the Alliance of Professional Tattooists, told Gillespie that the industry already has rules in place about tattooing over scars, and there is typically no problem as long as the scar isn't fresh. He added that he had never heard of such a ban.

Buddy Wheeler, the owner of Tattoo Charlie’s in Louisville and Lexington, listed several reasons why people cover up scars with tattoos, including cancer survivors who want to cover their mastectomy scars.

Public comments on the proposal are being accepted through the end of May. Comments can be emailed to: CHFSregs@ky.gov. A public hearing on the measure is scheduled for May 28 in Frankfort.

State gets $9 million to address mental health in 3 school districts; survey finds teens statewide having more mental-health issues

By Melissa Patrick
Kentucky Health News

The school districts of Bullitt, Henderson and Warren counties will participate in a five-year, $9 million program to increase awareness of mental-health issues among Kentucky students.

Centers for Disease Control and Prevention illustration

The $9 million grant from the Substance Abuse and Mental Health Services Administration and the Center for Mental Health Services was awarded to the Kentucky Department of Education and the Department for Behavioral Health, Developmental and Intellectual Disabilities, which is is a part of the state's health cabinet.

The money will be used to implement mental-health policies and processes in the districts. Kentucky is one of four states receiving the Advancing Wellness And Resilience in Education (AWARE) grants.

“We know that one in six students experience mental-health challenges that impact their academic achievement. However, less than half of them receive adequate treatment,” Wendy Morris, commissioner of the behavioral health department, said in the news release. “Partnerships between schools and local mental health providers allow identification and referral systems to be built so concerns can be detected and addressed earlier which creates the best opportunity to help the student."

A biennial survey of the state's youth shows that mental-health issues abound in its schools.

The Kentucky Incentives for Prevention survey primarily assesses alcohol, tobacco and other drug use, but it also looks at suicide and other high risk behaviors. It is taken by sixth, eighth, 10th and 12th graders in participating schools every two years. In 2018, more than 159,000 students in 151 of the state's 173 public-school districts took the survey. Its results were released April 25 by the Substance Abuse Prevention Program in the state's behavioral-health department.

One issue that school-aged children across the nation deal with is bullying, and that's no different in Kentucky. The survey found that while bullying is especially prevalent in the lower grades, with 29% of sixth graders and 27% of eighth graders reporting they have been bullied on school property in the past year, it's also high in the upper grades with 20.9% of 10th graders and 15.7% of 12th graders reporting such behavior.

The survey also found that a good number of Kentucky's teens have suffered from serious psychological distress, such as depression or anxiety, in the past 30 days: 10.8% of sixth graders; 17% of eighth graders; 22.3% of 10th graders; and 22.1% of 12th graders. All of these rates were higher in 2018 than in 2016.

The survey also found that many of Kentucky's youth  struggle with thoughts, and actions, of suicide and self-harm.

For example, 10.6% of sixth graders, 16.4% of eighth graders, 19.5% of 10th graders, and 18.5% of 12th graders said they had ever cut or harmed themselves on purpose.

The percentage of sixth, eighth, and 12th graders who said they had seriously considered attempting suicide in the past year increased since 2016, going from 6.4% to 8.5% among sixth graders; from 12.9% to 14.1% among eighth graders; and from 13.1% to 14.1% among 12th graders. The rate for 10th graders, high-school sophomores, stayed at 15.7%.

Many of those students said they had made a plan about how they would attempt suicide: 6.1% of sixth graders said they had, up from 4.7% in 2016. The rates in the other grades stayed stable, with 10.4% of eighth graders, 12.2% of 10th graders and 10.6% of 12th graders reporting they had planned how they would attempt suicide.

The percentage of actual suicide attempts increased in every age group, with 5.7% of sixth graders reporting they had actually attempted suicide at least one time in the past year, up from 4.2% in 2016; 8.2% of eighth graders, up from 7.3%; 8.4% of 10th graders, up from 8.2% and 6.5% of 12th graders, up from 5.7%.

The AWARE grant will be used to enhance school mental health supports, provide "youth mental health first-aid training," implement trauma-informed practices, and generally improve social emotional skills for students in the districts.

The news release touted the grant funding as a way to help implement 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. The bill did not include funding.

Schools will also be able to bill Medicaid for both physical and behavioral health for all students enrolled in Medicaid by the start of the next school year, according to Kristi Putnam, deputy secretary of the Kentucky Cabinet for Health and Family Services. Currently, Kentucky schools can only bill Medicaid for students who are disabled or meet other limited criteria.

The project will serve 37,556 students annually for 5 years and affect 375 school administrators, 3,292 school staff, and over 1,000 parents and community members, the release said.

Boys' suicides increased after release of show '13 Reasons Why;' third season coming; psychiatrist warns all families are at risk

Graphic from KyForward

By Melissa Patrick
Kentucky Health News

The rate of suicide among 10- to 17-year-olds in the U.S. increased 29% in the months after the Netflix show "13 Reasons Why" was first telecast in March 2017, according to a federal study.

Statistically, boys were responsible for the increase. The rate for girls increased, but the rise was not statistically significant, said a news release from the National Institutes of Health. The study was done by the National Institute of Mental Health.

"13 Reasons Why" is based on a book by the same title that depicts the aftermath of a fictional teenage girl's suicide, including 13 audio messages that she left behind for specific people that she blames for her death. The third season is expected to be released this year.

"The results of this study should raise awareness that young people are particularly vulnerable to the media," study author Lisa Horowitz said in the release. "All disciplines, including media, need to take good care to be constructive and thoughtful about topics that intersect with public health crisis."

The researchers used data from the U.S. Centers for Disease Control and Prevention to measure monthly and annual rates of suicide from 2013 through 2017, and then divided that data into three age groups.

The study, published in the Journal of the American Academy of Child and Adolescent Psychiatry,
found that the number of deaths by suicide recorded in April 2017 was greater than the number seen in any single month during the five-year period examined by researchers, mostly among boys.

Overall, the researchers estimated that 195 more suicides occurred in this age group than would have been expected between April and December 2017.

They also found more suicides among teens in March 2017, which they say could have been related to the show's heavy promotion during that month, which included trailers with segments of it.

The researchers warn that their study only shows a correlation between the increases in suicides and the Netflix show and does not prove that the release of the show caused more suicides.

Another recently released study found that students who watched the full second season of the show were less likely to report self-harm or having suicidal ideas than students who didn't watch the show at all; and students who did not watch the whole second season had a greater suicide risk and less optimism about the future than those who watched it to the end. The authors of this study concluded that shows about suicide can have both harmful and helpful effects.

Concern about "suicide contagion" was so great after the show launched in March 2017 that many Kentucky schools sent resource letters home with guidance on how to talk to teens about suicide, with a warning that "vulnerable youth" should not watch the series.

Suicide is the second leading cause of death for youth and young adults in Kentucky.

The 2018 Kentucky Incentives for Prevention survey, which surveyed more than 159,000 students in 151 of the state's 173 public-school districts in 2018, found that 8.5% of sixth graders; 14.1% of eighth graders; 15.7% of 10th graders, and 14.1% of 12th graders said they had seriously considered attempting suicide in the past year.

The survey also found that 6.1% of sixth graders, 10.4% of eighth graders, 12.2% of 10th graders and 10.6% of 12th graders said they had made a plan about how they would attempt suicide in the past year.

The number of students who said they attempted suicide in the past 12 months has also crept up, with 5.7% of sixth graders reporting they had attempted suicide in the past year, up from 4.2% in 2016; 8.2% of eighth graders, up from 7.3%; 8.4% of 10th graders, up from 8.2%; and 6.5% of 12th graders, up from 5.7%.

Dr. Mark Goulston, a psychiatrist who specializes in suicide prevention, recently wrote an article for KyForward about teen suicide and how "suicide can affect any family at any time." He includes a link to his 75 minute YouTube video/podcast called "Stay Alive" as well as a list of insights for parents to consider. They include:

• Accept that anyone can become suicidal.
• Your kids probably won't open up to you if they are in despair.
• Look for changes, even subtle ones. He writes, When moodiness "crosses over into physiological disturbances of sleep, appetite, sexual desire, or just an unshakable dark feeling, and stays stuck there, it has then crossed over into a mood disorder and can be incredibly destructive."
• Know that little things can cause bigger problems. He writes," Something seemingly insignificant could be more impactful than it looks."
• Initiate the conversation; talk to your teens about how they are feeling.

The Kentucky Department of Education offers a page of resources about suicide programs, training and materials that was compiled by the state's behavioral health department, including: Suicide prevention and training resources for Educators; Training for Educators, Staff and Communities; Programs for Middle and High School Students Resources for Schools; Resources for Teens ; Youth Mental Health First Aid.

Kentucky requires all high school and middle school principals, guidance counselors and teachers to fulfill one hour of high-quality professional development training every other year to review suicide prevention. The state also requires students in middle and high schools to receive some type of suicide prevention awareness information at the beginning of each school year.

The education department can provide free "youth mental health first aid" training to school and community groups. This evidence-based, six-hour certification course teaches adults how to identify, understand and respond to the signs of mental illness and substance use disorders and how to connect youth in crisis to the appropriate care.

Webinar about Kentucky's drug overdose and prevention programs to be held May 23; it's free, but registration is required

The Foundation for a Healthy Kentucky is offering a free webinar about Kentucky drug overdose and prevention programs on Thursday, May 23 from 1 p.m. to 2 p.m. Eastern Time. Registration is required.

Two speakers will be featured in the webinar. Terry Bunn, director of the Kentucky Injury Prevention and Research Center, will discuss FindHelpNowKY.org, which provides links to substance use disorder treatment facilities with available openings.

Ty Borders, director of the Rural and Underserved Health Research Center at the University of Kentucky, will share recent research findings on opioid use disorder treatment policies and access in both Kentucky and the nation. Borders is the foundation's endowed chair in rural health policy.

The webinar is part of the foundation's Health for a Change training series. Click here for recordings of previous Health for a Change programs. Click here to register.

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?”