Hepatitis outbreak is declining in Ky., but we are still finding more in a week than we once got in a year; 57 have died from it in state

The good news about hepatitis in Kentucky is that the number of hepatitis A cases is dropping. The bad news is that there are still as many cases each week as were once seen in a year's time, and the state is by the far the leader in deaths from the liver disease.

According to the state's weekly report, the number of hepatitis A cases in Kentucky has dropped to around 20 per week for several weeks, a huge improvement from the height of the outbreak in the last months of 2018, when more than 100 new cases were being reported every week. But before the outbreak, which was declared in November 2017, the state averaged about 20 cases a year.

Since August 2017, the report shows that 4,621 Kentuckians have been diagnosed with hepatitis A and 2,233, or 48% of them, have been hospitalized. The primary risk factors for getting this highly contagious disease remains illicit drug use and homelessness.

The 57 deaths reported in Kentucky account for about one-third of the 170 deaths reported to the Centers for Disease Control and Prevention since 2016 in 22 states. "West Virginia and California, by comparison, each has had 21 deaths in their outbreaks. Michigan has had 28, and Indiana 4," Chris Kenning reports for the Louisville Courier Journal.

Four Kentuckians died from the disease in the week ending May 4, says the latest state report. It notes that deaths are identified through periodic reviews of death records and includes anyone who dies with documentation of hepatitis A as a contributing factor to the death -- even if it wasn't the primary cause of death, which is often the case among drug users.

Hepatitis A has been diagnosed in 108 of the state's 120 counties, with 15 reporting new cases in the week ending May 4.

The state's initial response to the outbreak has been criticized for not being aggressive enough.

Kenning notes that a Courier Journal investigation found that the state's former infectious-diseases chief, Dr. Robert Brawley, "recommended $6 million for vaccines and $4 million for temporary workers to help thinly staffed local health departments deliver vaccines to hard-to-reach drug users. He also called for a public health emergency declaration to help pave the way for federal assistance. Instead, Department for Public Health Commissioner Dr. Jeffrey Howard, citing limited funding and the local reserves that some health departments had, sent $2.2 million in state funds to local health departments and declined to seek an emergency declaration."

Howard and other state officials have defended their actions, citing that logistical challenges were greater than a need for more money as the outbreak spread to rural Kentucky.

Brawley, who was allowed to resign in lieu of being fired on June 4, 2018, has maintained his position that the state has not acted aggressively enough. (Since Brawley left, the state has fired Dr. John Bennett, who had been the state's infectious-disease manager since last fall.)

"The Kentucky public should be outraged about the slow-motion public health response that has caused the hepatitis A outbreak to continue into 2019," Brawley told Kenning on May 14. "I am saddened that 57 Kentuckians have died after developing acute hepatitis A and where hepatitis A was a risk factor for their deaths."

In late March, a legislative measure directing the state to review its response to Kentucky's outbreak failed to pass. The Cabinet for Health and Family Services has said it plans to review its response.

Meanwhile, the state has hired a roving team of nurses to administer vaccines in rural county jails and the state is providing more vaccine storage equipment, money and expertise to a handful of currently hard-hit counties, Kenning reports.

Specifically, Kenning reports that the Pulaski County Jail has been vaccinating its jailers, and that the state health department has awarded $46,000 to Jessamine, Bell and Christian counties, which had requested extra support; and that a roving team of nurses will soon be in the Lake Cumberland area.

"The department is continuing to coordinate with local health officials to ensure that resources are available and prevention efforts continue," Howard said in a statement to the Courier Journal on Tuesday. "We want to reiterate that though cases are declining, this is not a time to be complacent. Rather, we must continue to promote prevention including appropriate hygiene practices and vaccination."

Brawley said, "While the number of reported cases has fallen in recent weeks, I expect that the Kentucky hepatitis A outbreak will continue for at least six more months and will have a total of more than 5,000 cases before the outbreak is declared over."

UK College of Public Health researchers start the Journal of Appalachian Health, free to all, free to share

Researchers in the College of Public Health at the University of Kentucky have started the Journal of Appalachian Health, an online, peer-reviewed journal, saying their overall objective "is to improve the health status of the population of Appalachia through the rapid dissemination of knowledge of their health problems and evidence-based solutions to them." The journal is available free to all readers, and all users are free to copy and distribute the material in any medium or format; and can remix, transform, and build on the material for any purpose.

"There is knowledge in the pages of Appalachia’s hills," the editors write in the first issue. "This journal is positioned to find and publish those translations. It grows from a need to provide an outlet for scholarship about Appalachia’s health so that knowledge, and occasionally wisdom, is shared with those who care about and are committed to improving the region’s health."

The journal's first article reports that children 7 to 9 years old in parts of Appalachian Ohio are almost five times as likely to be exposed to secondhand smoke as children in the nation, and that parents likely under-report the prevalence of smoking in their homes, based on blood samples taken from 404 children.

The journal is open to essays and commentaries as well as research reports. Jill Crainshaw of the divinity school at Wake Forest University writes about the experiences of students who have taken "a multicultural contexts course that includes a 10-day sojourn in the mountains of North Carolina. . . . The health and well-being of human communities are connected to the health and well-being of the geographic places where people live, work, and play."

Ky. health policy forum Sept. 23 will focus on medical marijuana, a topic that is sure to come up again in the next legislative session

By Melissa Patrick
Kentucky Health News

The Foundation for a Healthy Kentucky's annual policy forum this fall will be dedicated to the topic of medical marijuana in hopes of separating what is fact and what is myth, and to better understand how legalizing it would affect public health and society as a whole in Kentucky.

"It's our judgment that there is a lot of misinformation out there, a lot of confusion about what the facts really are," said Ben Chandler, president and CEO of the foundation. "And we are going to try to shine a light on those facts as best we can."

National Conference of State Legislatures map

The Howard L. Bost Health Policy Forum is sponsored by the foundation in memory of the physician who helped create Medicare and Medicaid, developed the Appalachian Regional Hospital system, improved mental health services in Kentucky and created the vision for the foundation.

It will be held at the Marriott Griffin Gate Resort in Lexington on Monday, Sept. 23. The full agenda and registration for the event will be available soon, a foundation news release said.

The topic is timely. In the last legislative session, Kentucky legislators were able to get a bill  to legalize medical marijuana out of committee for the first time. And though it wasn't called up for a House floor vote late in the session, and key Senate leaders maintained their opposition to it, its sponsors have vowed to try again next session.

"We're going into the interim with this momentum behind us," bill sponsor Rep. Jason Nemes, R-Louisville, told the Lexington Herald-Leader in March. "And we'll be back again next year."

Chandler noted that 34 states have already legalized medical marijuana and that Canada and 10 states have legalized recreational marijuana.

"That tells me that this thing has gained an enormous amount of momentum and whether the opponents of it like it or not, they are going to have to deal with it," Chandler said. "It's important for policy makers to know the pros and cons of the issue. . . . What is truth and what is myth? I think we can all use a dose of that, including myself."

Andrew Freedman will keynote

Chandler told Kentucky Health News that the foundation has no position on the issue. He said in the release, "This forum is not about changing minds for or against legalizing medical marijuana; it's about making sure that the practical public health implications are understood and considered in the policy-making process. The bottom-line goal in any policy decision on this topic ought to be protecting and improving public health."

The forum's keynote speaker will be the former Colorado "marijuana czar," Andrew Freedman. He served for three years as Colorado's first director of cannabis coordination, creating the state's regulatory framework for implementing legalized adult-use and medical marijuana. He is the co-founder of Freedman & Koski, a cannabis consulting firm, and works with states and Canada as they consider or implement marijuana legalization programs. Freedman will talk about the impact of legalizing marijuana on a variety of public-health aspects.

Other speakers will focus on the impact of loosening marijuana restrictions on several at-risk populations, including children, those with mental-health issues and those in the criminal justice system. Speakers will also address its impact on accidents, poisonings, crime, state revenues and costs.

Speakers will also address what kind of provider and public education is needed if medical marijuana is legalized, how the quality and dosage of medical marijuana products can be controlled, in what form medical marijuana products should be made available, and gaps in research about medical marijuana and its impact, among other topics.

Ky. law to ban the most common method of second-trimester abortion struck down; Bevin administration will appeal decision

A federal judge has struck down a 2018 Kentucky law banning the most common method of second-trimester abortion.

The law would prohibit physicians from providing a procedure called dilation and evacuation, or D & E, which is the standard method for abortion care after 14 weeks of pregnancy. It would make it a felony for a physician to perform such a procedure and make the doctor subject to sanctions against his or her medical license. The law was passed to go into effect immediately, but was delayed by a court-order pending the trial.

District Judge Joseph H. McKinley Jr.

U.S. District Judge Joseph McKinley, who heard the case without a jury, "ruled the law is unconstitutional because it restricts a woman's constitutional right to an abortion before the fetus is considered viable, at around 24 weeks," Deborah Yetter reports for the Louisville Courier Journal.

The American Civil Liberties Union, which filed the challenge to the law on behalf of EMW Women's Surgical Center in Louisville, the state's only abortion clinic, said the ruling was a victory for women's health.

“Today’s ruling affirms that health, not politics, will guide important medical decisions about pregnancy," Alexa Kolbi-Molinas, senior staff attorney with the ACLU Reproductive Freedom Project, said in a prepared statement. "Laws like this are part of an orchestrated national strategy by anti-abortion politicians to push abortion out of reach entirely. Today’s decision holds — in no uncertain terms — that Kentuckians and the care they need come first."

The administration of Republican Gov. Matt Bevin, who has made fighting abortion a central issue, said it will appeal.

"We profoundly disagree with the court’s decision and will take this case all the way to the Supreme Court if necessary, to protect unborn children from being dismembered limb by limb while still alive," Elizabeth Kuhn, Bevin's communications director, said in a statement.

"Opponents of the law say it is part of a broader national ploy by the anti-abortion movement to chip away at access to abortions," Yetter reports. "Supporters claim it is meant to end a brutal practice they liken to fetal dismemberment."

Yetter reports that the procedure is used in about 500 of the approximately 3,200 abortions each year at the EMW Women's Surgical Center.

Since Republicans took complete control of Kentucky lawmaking in 2016, the General Assembly has passed several bills to restrict or eliminate abortion in Kentucky. This year, they passed four such bills. Two have been temporarily blocked by a federal judge, one to ban abortion once a fetal heartbeat is detected, around six weeks of pregnancy; and the other to ban abortion for women seeking to terminate a pregnancy because of an unborn child's sex, race, color, national origin or the diagnosis or potential diagnosis of Down syndrome or any other disability.

Meanwhile, a federal appeals-court recently upheld a 2017 Kentucky law that requires women to have an ultrasound before having an abortion while their doctor displays the image and offers a medical description of the fetus with the heartbeat played loud enough for the woman to hear. The law allows the woman to avert her eyes from the image and to ask for the heartbeat volume to be turned off, but not to refuse the procedure.

Addict who writes a column says addicts are best helped by recovering addicts, with help of families, communities, politicians

Lee's book of columns

By Phillip Lee

As a recovering addict, I know first-hand the devastation and agony families face all across the United States. I know many think it is of our own free will that we use or used drugs. Many feel that it is a stigma on society, and that those right in the middle of the stigma themselves should be cast aside, thrown in prison for all of life or worse. Many feel that the world would be better off if addicts or recovering addicts would simply disappear from the earth, altogether.

While each American citizen is entitled to feel about this disease as they wish, the facts are here in black and white for anyone to read. The facts are in your communities, neighborhoods and towns. They are in almost every walk of life and in every facet of humanity, and no matter how bad you or I wish there weren’t even such things as addictions or drug abuse. I thought it important to point out that we have not disappeared and no, regardless of what some may choose to believe, we do not deserve to die in prisons because we are addicts, recovering or otherwise.

In my mind and soul I know this is as a disease. Those who think otherwise because they were able to quit, limit or control their using in one manner or the other have not truly fallen victim to the manifestation of the disease. I’ve spoken with hundreds if not thousands of addicts and recovering addicts over the years. Not one of them has said, “I’m sure glad things worked out like this.” Or, “I love being an addict.” Not one that I know has ever wished this dreaded disease on anyone. I’m stuck with it and I sure don’t want it, but here I am, trying to make the best of it -- and who knows, maybe persuade the one who has never tried drugs to leave it at that. And if I can help another addict stop using and change his/her life for the better then perhaps my life had greater meaning and purpose after all.

In searching for answers and understanding myself, I’ve acquired a copy of the America’s Health Rankings 2018 Annual Report, compiled by the United Health Foundation. According to the report, Kentucky’s ranking declined from 42nd in 2017 to 45th in 2018, With only Arkansas, Oklahoma, Alabama, Mississippi and Louisiana ranking lower.

Many factors determine the overall score of the report, including obesity, illnesses and death rates associated with cancer and other diseases, as well as immunizations, physicians, counselors, economic health and other determinants. But here I wanted to express what the drug epidemic is doing to the nation and Kentucky.

It’s crazy out of control. That’s why it is an epidemic. Only Ohio, New Hampshire and West Virginia came in with worse numbers in drug deaths, according to the 2018 report. According to provisional data for 2017, there were 72,000 drug overdose deaths in the U.S. in 2017, a sharp increase from 63,000 the year before. Kentucky’s drug fatality rate in 2018 was 28.6 per 100,000 people. The national average was 16.9 per 100,000.

With trends and numbers like this it seems to me that the only answers will come from working on the problem together, without finger pointing and shaming. Who truly gains from finger pointing? Politicians? Communities? Families? Or the individual? Anyone?

How can a politician who has never been addicted come up with a solution based on his own knowledge or experience? How can law enforcement, doctors or counselors or anyone else come up with a solution to a problem they truly know nothing about on a personal level? They know what they know based on experience and academic education. They know nothing of what is truly going on in an addict’s mind, especially in the split seconds just before their addiction leads them to use again. How could they?

I believe that recovering addicts can best help other addicts recover, beyond any other way possible today. That being said, I believe there are solutions that include politicians, communities and families-along with recovering addicts whose been there and lived through the hell of active addiction.

Phillip Lee, a native of Albany, Ky., recently resumed writing his column, "The Journey of an Addict," after relapsing and going into treatment.

Ky., 43 other states sue generic drug makers, alleging price fixing; Beshear sues 3 top insulin manufacturers, making similar claim

Screenshot of CBS illustration of emails among drug makers

Kentucky is among 44 states that filed a lawsuit Friday in federal court in Connecticut, accusing 20 manufacturers of generic drugs of fixing prices and suppressing competition.

Meanwhile, Attorney General Andy Beshear announced that he had also sued the three major makers of insulin for driving up prices. In both cases, he is seeking changes in conduct, recovery of excess profits and civil penalties.

Beshear, a candidate for the Democratic nomination for governor, is one of many politicians who have targeted drug companies over price increases in the last decade. "The criticism has come from across the political spectrum," the international news agency Reuters notes. "Generic drugs can save drug buyers and taxpayers tens of billions of dollars a year because they are a lower-priced alternative to brand-name drugs." Generics account for 90 percent of U.S. prescriptions, one official told CBS News.

The generics suit claims the companies "engaged in illegal conspiracies to divide up the market for drugs to avoid competing and, in some cases, conspired to either prevent prices from dropping or to raise them," Reuters reports. The suit claims Teva Pharmaceuticals USA, the American subsidiary of Israeli-based Teva Pharmaceutical Industries Ltd., orchestrated the scheme.

Teva said in a statement, “The allegations in this new complaint, and in the litigation more generally, are just that – allegations. Teva continues to review the issue internally and has not engaged in any conduct that would lead to civil or criminal liability.”

The 500-page lawsuit "is parallel to an action brought in December 2016 by the attorneys general of 45 states and the District of Columbia," Reuters notes. "That case was later expanded to include more than a dozen drugmakers."

Since 2016, generic-drug prices have declined slightly, but "I don't think that means the conspiracy has ended," Connecticut Attorney General William Tong told CBS's "60 Minutes." He added, "If they stopped colluding, you would expect prices to go down dramatically."

Tong said his investigators found "an industry-wide conspiracy" that answers the question, "Why are prescription drugs so expensive?" He said everyone in America is affected: "It affects health-insurance premiums . . . it impacts Medicare and Medicaid, and it is a chain reaction that drives up the price of American health care to unnatural heights."

The latest suit "accuses the generic drug industry, which mainly sells medicines that are off-patent and should be less expensive, of a long history of discreet agreements to ensure that companies that are supposedly competitors each get a 'fair share'," Reuters reports.

The suit seeks damages, civil penalties and actions by the court to restore competition to the generic drug market.

In the other case, in Franklin Circuit Court, Beshear sued Eli Lilly & Co., Sanofi-Aventis Pharmaceuticals and Novo Nordisk, alleging that they "have increased the price of their analog insulin products at least 10 times, while the costs to make insulin have stayed low, usually less than $7 per vial," a news release from his office said. "The wholesale price has jumped to nearly $300 and the price paid by those Kentuckians hit hardest by the deception can exceed $1,000 a month."

The suit "alleges that Kentuckians without insurance or on high-deductible health plans, Medicare Part D recipients, and those who pay co-insurance are hurt most, as they are forced to pay the full amount or a percentage of the artificially inflated list price of the drug," the release says. "The companies who control the drug market, pharmacy benefit managers, pay a lower, negotiated price. As a result, Kentuckians pay too much for their insulin, while the PBMs profit by paying less. Through this deceptive strategy, drug makers curry favor with PBMs and are able to not only retain profits, but also increase their number of sales."

Beshear noted that Kentucky has the seventh highest rate of diabetes in the nation.

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?"