Three anti-abortion bills advance out of legislative committees

Three abortion bills advanced in the legislature last week, one to give the state's attorney general more power to enforce abortion laws, one to require fetal remains to be buried or cremated after the procedure, and one to give the state auditor power to audit reports about abortions.

Abortion-rights supporters dressed as characters from "The
Handmaid's Tale" at the  March 4 House Judiciary committee,
which passed two abortion bills. (Photo by Melissa Patrick) 

House Bill 370, sponsored by Rep. Nancy Tate, R-Brandenburg, would require abortion providers to either cremate or bury aborted fetuses in a licensed funeral facility. Parents could also decide the final disposition of the fetal remains.

“The abortion provider currently has to provide for the disposal. This is merely directing respectful disposal as opposed to being incinerated with other medical waste,” Cathie Humbarger, an abortion opponent with Northeast Indiana Right To Life, told the House Judiciary Committee March 4.

HB 370 is similar to a 2016 Indiana law that was upheld by the U.S. Supreme Court last year.

No one spoke against the bills, though abortion-rights activists sat in the audience wearing white bonnets and red robes like characters from "The Handmaid's Tale," the dystopian novel and award-winning Hulu show in which women are treated as property of the state and forced to bear children. 

The committee also approved House Bill 451, sponsored by Rep. Stan Lee, R-Lexington, would expand the power of Attorney General Daniel Cameron, an anti-abortion Republican, to regulate abortion facilities, including bringing injunction relief as well as civil or criminal penalties for violations.

Current law only allows the attorney general this power if it requested by the Cabinet for Health and Family Services, which licenses and inspects health facilities.

"Several committee members expressed concern about expanding these powers, with Rep. Maria Solaris, D-Louisville, asking about the potential for a "rogue attorney general." Lee said the courts could handle such problems," Deborah Yetter reports for the Louisville Courier Journal. 

Cameron is the first Republican to hold the office since 1947, and "many of his staff members worked in former Republican Gov. Matt Bevin's legal team, defending abortion restrictions in several high-profile legal battles and attempting to close the state's only abortion facility," Ryland Barton reports for Louisville's WFPL.

Since taking office in December, Democratic Gov. Andy Beshear has ended the state's licensure battle with abortion providers and allowed Planned Parenthood of Indiana and Kentucky to offer abortions in Louisville.

Tamarra Wieder of Planned Parenthood told Yetter that the group chose to remain silent after members were cut off from speaking at a recent hearing on another abortion bill, with the chairman saying the committee was out of time.

"Today was a statement about how we've been treated in the past," said Wieder, the organization's public affairs and policy director. "It's a statement on the power grabs that are taking place around Kentucky on reproductive health."

Kate Miller, with the American Civil Liberties Union of Kentucky, told Yetter afterward that her organization also opposes both bills as "a continuing effort to force every Kentuckian to stay pregnant against their will."

State Auditor Mike Harmon and Rep. Stan Lee present Lee's
bill to let the auditor audit abortion reports. (Melissa Patrick photo) 

House Bill 391, also sponsored by Lee, would  expand the state auditor's powers to audit reports about abortions, including audits of whether facilities that perform abortions are following state requirements to report all abortions to the state Office of Vital Statistics.

It was approved March 5 by the House Health and Family Services Committee.

Yetter reports in a separate article that the bill prompted "heated debate, largely along party lines, about it's true purpose."

"Rep. Tom Burch, D-Louisville, questioned whether the measure is a Republican "method of harassing providers" by the party of Ronald Reagan, the president who argued for smaller government.

Lee said it is to ensure abortion statistics are being reported accurately, citing Reagan's famous "'trust but verify' comment about nuclear disarmament with the former Soviet Union," Yetter writes. Lee said, "I would like to think that this piece of legislation is verifying abortion providers who are taking the lives of unborn babies are complying with the law."

Several Democratic women on the committee questioned why abortion clinics, already regulated by the health cabinet, would fall under the purview of the state auditor; one questioned why the auditor, whose main role is to ensure proper use of public funds, was being called to audit facilities that get no state money; another asked Lee and state Auditor Mike Harmon what other private entities his office investigates, and got no direct answer.

Yetter writes, "State law requires any facility where an abortion is performed to report information including the age, race and state of residence of the patient; age in weeks of the fetus; and the type of abortion, such as surgical or by medication. It does not include reporting any identifying information regarding the patient."

An annual report required by law shows that 3,203 abortions were reported in Kentucky in 2018, 18 of them at hospitals and the rest at EMW Women's Surgical Center in Louisville, the state's only abortion clinic.

Jackie McGranahan of ACLU-Kentucky, spoke against the bill, saying she believed it was part of an effort "to make abortions inaccessible to all Kentuckians."

This prompted Rep. Robert Goforth, R-East Bernstadt, to suggest strongly that McGranahan violated the oath she took to tell the truth before testifying. When McGranahan tried to reply, Goforth cut her off more than once before saying "That's your opinion."

Tamarra Wieder of Planned Parenthood, told Yetter that the bill is part of an ongoing effort by the legislature to erode reproductive rights and to expand authority over abortion. "It is a chilling prospect for the future of abortion in Kentucky," she said. At least eight anti-abortion bills are being considered in this legislative session.

First Ky. case of coronavirus disease found; clinicians suspected it, but patient didn't qualify for testing when testing was hard to get

Crystal Miller, head of the health department serving Harrison County, at a press conference Saturday. Others, L to R:  Gov. Andy Beshear; Health Commissioner Steven Stack; Harrison County Judge-Executive Alex Barnett; Cynthiana Mayor James Smith; and Mark Newman, head of UK HealthCare.

This story was updated at 8 p.m. Sunday.

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky found its first case of the new coronavirus, in Harrison County, on Saturday, and Gov. Andy Beshear advised residents of the county to avoid crowds. Sunday, he announced that the county had another case, and that Louisville and Lexington each had one.

Beshear's advice came on the same day that the U.S. Centers for Disease Control and Prevention recommended that all Americans over 60 or those with heart, lung or kidney disease avoid public gatherings. Seniors and people with underlying medical conditions are more vulnerable to the virus.

The governor said the patient had been treated at Harrison Memorial Hospital in Cynthiana, and the University of Kentucky said the patient is now in isolation at UK Chandler Hospital. Beshear said the patient was in serious condition but is improving. "There is no cause for fear at this time," he said.

The hospital said the patient was treated for "flu-like symptoms" and when those didn't subside, the patient was tested further but the state Department for Public Health "determined the patient did not qualify for testing" for the coronavirus. However, "due to the patient's condition," hospital clinicians admitted the patient "into a negative-pressure isolation room," to prevent spread of any viruses. "From there, the patient was transferred to a tertiary care facility," meaning UK.

State Health Commissioner Steven Stack said in an email to the Louisville Courier Journal Saturday night, “Like other states, Kentucky has been following the CDC guidelines for who and when to test. This individual was tested when CDC guidelines and clinician judgment determined testing was medically indicated.”

The Washington Post reports, "Even where test kits are available, many states are following strict criteria for who should be tested to avoid overwhelming their labs."

Stack said earlier Saturday, "The state of Kentucky has all the test kits it needs to test everyone we need to test at this time." With commercial laboratories soon doing tests, "We hope that very soon people will be able to seek routine medical care and get a test . . . just like they would for the flu."

Harrison County (Wikipedia map)

State and local officials said they expect Harrison County to have more cases, and Beshear said the county's schools would close for "at least a portion of a week if not a full week," as health officials had recommended. "We would advise that public gatherings be delayed," and that nursing homes be closed to visitors, he said.

"We are not advising the closing of any business," Beshear said. "What we are suggesting is engaging on social distancing, trying to stay six feet apart, and then practicing good hygiene, practicing really, really good hygiene: washing your hands, washing them well, washing them a whole lot more than you might have a month ago, and making sure that if you are sick, anywhere in Kentucky but especially in Harrison County, do not go to work."

The virus causes a disease that has been named covid-19, for "coronavirus disease 2019." Symptoms may include fever, cough or shortness of breath, and may appear in as few as two days or as long as 14 days after exposure.

Health officials continue to stress that washing hands with soap and warm water for at least 20 seconds is the best way to prevent transmission of the virus because it is mainly transmitted by tiny droplets from sneezes and coughs. Other suggestions include:

• Only use alcohol-based hand sanitizer if soap and water are not available. 
• Avoid touching your eyes, nose and mouth with unwashed hands. 
• Avoid close contact with people who are sick. 
• Stay home if you are sick; especially do not visit with seniors or people with chronic health conditions if you are sick. 
• Cover your cough or sneeze with a tissue and then throw it away. 
• Get a flu shot. There is no vaccine for the new coronavirus, but the flu vaccine can boost resistance to it.
• Clean and disinfect frequently touched objects and surfaces.

The U.S. Environmental Protection Agency has released a list of EPA-registered disinfectant products for use against the coronavirus. The EPA's news release says coronaviruses are one of the easiest types of viruses to kill with the right disinfectant.

Beshear said that the threat posed by the virus is still low, but that he declared a state of emergency Friday to make sure the state has access to all of the resources available to it. He and other officials advised calm.

"We've gotten through this just like this, or even worse, in the past," said Dr. Steven Stack, commissioner of public health. He advised against general use of face masks, or hoarding them, which could leave health care short.

Role players include consumers, employers, Congress

At UK HealthCare, “Supplies of personal protective equipment are exceedingly low, and many items are on back order,” UK Executive Vice President for Medical Affairs Dr. Mark Newman told employees, asking them, "Please be frugal."

Beshear said he has invoked, for preventive and related items, the state law against price gouging, and has asked Attorney General Daniel Cameron to enforce it. Cameron issued a call for residents to report cases of price gouging by calling his office's consumer protection hotline, 1-888-432-9257.

Dr. Crystal Miller, director of the WEDCO District Health Department, based in Cynthiana, said employers should take preventive measures: "I urge you to be flexible in everything that you do; be creative," she said. "If your employees are sick, please be flexible with them."

Beshear has urged employers who don't offer sick leave to grant it, to limit the spread of the virus. He said Saturday that the state will offer its employees more sick leave than they have accumulated.

The state recently started doing its own testing for the virus, with four positive results out of the 21 tests done through midafternoon Sunday. The figures are updated at kycovid19.ky.gov.

U.S. Sen. Mitch McConnell announced Friday that Kentucky would receive at least $7 million to fight the coronavirus. This money is part of a special $8.3 billion appropriations bill President Trump signed that day. McConnell's news release said the funding "will be provided to state officials who will determine how the resources will be distributed."

Asked Thursday if any of the money could be used by  health departments to help fund their efforts in controlling the virus, Beshear said, "I am committed before this legislature ends or through any other powers that I have in making sure that we have sufficient funding to meet the threat. . . . This shows how important our local health departments are, doesn't it? We haven't appreciated those as a state in far too long and I think this serves as a reminder about how absolutely critical they are."

"The number of public health workers in Kentucky fell from 3,449 in 2012 to 2,269 last year," Chris Kenning of the Courier Journal reports, citing the Kentucky Center for Economic Policy. "The strain is particularly acute in small, rural health departments."

Medicaid beneficiaries, take note

Beshear said the state will not require pre-authorization for treatment of Medicaid patients "for anything related to coronavirus." On Friday, he said Kentucky is fortunate to have expanded Medicaid, something it did during the administration of his father, Steve Beshear.

"I do believe that we are in a better place to address this  than many states because of expanded Medicaid," he said. "I don't mention that because of my belief in expanded Medicaid, but it does mean that there is more access out there, that people will have less barriers to get service."

Beshear said Kentuckians should be wary of scammers and con artists claiming to have a cure or a vaccine for the virus, and to be wary of e-mails pretending to be the CDC or other public-health organizations, and people claiming to raise money to develop a coronavirus vaccine or to help victims.

Newman said most patients with covid-19 will be treated in local hospitals or at home. Officials have voiced concern that the disease and the flu will overload hospitals, and that people congregating in clinics could spread the virus.

"If you are sick, try to use the telephone first," Stack said, adding that people with a fever and a cough should "take Tylenol and stay home and rest." He said those who are concerned but not sick should call the state's covid-19 hotline, 1-800-722-5725.

Senate bill to address surprise medical billing now in House

By Jim Hannah
Legislative Research Commission

FRANKFORT, Ky. – Legislation to offer patients some protection from surprise medical bills passed the state Senate Friday.

“There are many factors that contribute to surprise billing,” said Sen. Ralph Alvarado, R-Winchester. “Some will place the blame on insurance companies. Some will place the blame on providers. It all depends on whom you ask. But while we are trying to figure out who to blame, patients are stuck in the middle of the problem – often with large medical bills.”

Alvarado's Senate Bill 150 seeks to stop the practice by requiring insurers to cover surprise billing, sometimes called balanced billing. It happens when a patient receives medical care – often unwittingly – outside of their insurer's network. Subsequently, the doctor or hospital bills the patient for the amount insurance didn't cover.

Alvarado characterized SB 150 as a consumer protection bill. He said surprise billing was a dubious exercise of cost shifting from insurers to patients.

A second provision of SB 150 would require the state insurance commissioner to establish a database of billed health-care service charges. A final provision would provide a dispute resolution program for medical insurers and providers to work out their differences over these out-of-network charges.

Sen. Rick Girdler, R-Somerset, spoke against the bill. He cited a fiscal impact estimate that SB 150 would increase individual premiums for health benefit plans by up to $9 per month.

Sen. Tom Buford, R-Nicholasville, said he voted for the bill because the He noted the self-funded Kentucky Employees’ Health Plan already covers surprise billing for its nearly 265,000 members.

“If we are going to enjoy that benefit, the citizens of Kentucky should share the same,” he said.

Sen. Wil Schroder, R-Wilder, who voted no, said what is needed more is broader reform to empower health-care consumers through such measures as transparent pricing of procedures and drugs.

“Today I filed Senate Bill 265 that I believe offers a better solution in the context mentioned,” Schroder said. The bill has been assigned to the Senate Banking and Insurance committee.

Alvarado said SB 150 wasn’t a hastily drafted bill, but the result of three years of investigation.

“I wish to remind the members of the Senate that a successful bill for surprise billing should only make one group happy – and that is the patients we are trying to protect,” he said. “If other stakeholders are a bit uncomfortable, then we have a good compromise on this issue.”

SB 150 went to the House on a vote of 30-3. Sen. John Schickel, R-Union, cast the only other "no" vote.

Flu slacked a bit in last week of Feb.; season runs through May, vaccine still useful and is best defense; may help with covid-19

In the last week of February, Kentucky reported fewer new cases of influenza and fewer deaths from it than it did the week before.

The latest weekly report from the state Department for Public Health shows that in the week ending Feb. 29, Kentucky counted 1,591 new cases, down from 1,943 new cases the previous week. Five flu deaths were reported in the state, down from 14 the previous week and 16 the week before that. During the flu season, the state has reported 22,591 cases of flu and 85 deaths, four of children.

The actual number of cases is higher, because not all flu cases are counted; flu does not have to be reported, and three counties did not contribute to the last report.

Nationwide, the Centers for Disease Control and Prevention estimates that so far this season, at least 34 million people have had the flu, causing 350,000 hospitalizations and 20,000 deaths. Of those, 136 were children.

Health officials recommend that everyone over 6 months old get an annual flu vaccination. It is not too late, since the season usually runs through May.

Measures to protect yourself from the flu could also provide limited protection from covid-19, the respiratory disease caused by the new coronavirus, for which there is no vaccine. They are:

• Wash hands with soap and water for at least 20 seconds; only use alcohol-based hand sanitizer if soap and water are not available. 
• Avoid touching your eyes, nose and mouth with unwashed hands. 
• Avoid close contact with people who are sick. 
• Stay home if you are sick. 
• Cover your cough or sneeze with a tissue and then throw it away. 
• Clean and disinfect frequently touched objects and surfaces. 
• Get a flu shot.

Flu hotspots continue around the state, including Barren County, with 107 new cases, for a total of 1254; Bullitt with 71 new, for a total of 913; Carter with 41, for a total of 235; Fayette with 78, for a total of 591; Floyd with 59, for a total of 307; Franklin with 91, for a total of 548; Greenup with 42, for a total of 338; Hardin with 49, for a total of 366; Jefferson with 278, for a total of 7,764; Knott with 52, for a total of 426; Knox with 37, for a total of 162; Perry with 79, for a total of 1,135; Pike with 84, for a total of 1,195; and Warren with 55, for a total of 816.

Opioid epidemic keeps shadowing Ky. policy, as Senate removes opioids from list of drugs physician assistants could prescribe

By Melissa Patrick
Kentucky Health News

A House bill to let physician assistants prescribe some highly regulated drugs is moving through the Senate, but without application to some highly addictive drugs like oxycodone and hydrocodone, showing how the opioid epidemic continues to influence state health policy.

Rep. Steve Sheldon presents House Bill 135 at the March 3
meeting of the Senate licensing and occupations committee.
(Photo: Legislative Research Commission Public Information)

As amended by a Senate committee March 3, House Bill 135, sponsored by Rep. Steve Sheldon, R- Bowling Green, would allow physician assistants "modified prescriptive authority" for controlled substances in federal Schedules III, IV, and V after the PAs have practiced for a year.

The Senate Licensing, Occupations and Administrative Regulations Committee removed Schedule II drugs, which include a long list of narcotics used for pain management as well as several psycho-stimulants that are used to treat attention deficit hyperactivity disorder, or ADHD -- a condition for which Kentucky has the highest rate in the nation.

Sen. Chris McDaniel, R-Taylor Mill, told the committee that he would not have voted for the bill if the Schedule II drugs had not been removed. He warned, "Know if we come back for Schedule II next year, I will oppose it as vigorously as possible."

McDaniel acknowledged that only a few PAs would likely abuse their Schedule II prescriptive authority, but said that isn't worth the risk because it was only a small percentage of physicians that not so long ago flooded the state with pain pills.

"The damage that they did was monstrous and we're still working to overcome it," McDaniel said. "The fact is, one step toward where we were, for me, is a step too many."

Majority Floor Leader Damon Thayer said likewise: "I thought the bill that came flying out of the House was a bridge too far, and going to Schedule II is not going to fly in the Senate right now, and I hope you don't come back and try it again next year; it won't be received very well by this body."

Andrew Rutherford, vice-president of the Kentucky Academy of Physician Assistants, told the committee that the PAs would keep seeing Schedule II authority.

"Our ultimate goal is always to provide the best patient care we can to our patients, that includes allowing us to practice to our full scope of practice," he said.

Rutherford told the committee that Kentucky is losing its PAs to other states because it does not allow them to practice at their full scope of care. Kentucky is the only state in the nation that does not allow PAs to prescribe any controlled substances.

The bill passed the House 91-1 on Feb. 6, with Rep. Lynn Bechler, R-Marion, voting against it. This was the fourth time the legislation had been filed, and the first time it's gained any traction.

Sen. Michael Nemes, R-Shepherdsville, noted that the Kentucky Medical Association, which has opposed this bill in the past, isn't necessarily for the bill but is "not fighting it."

Asked about its stance on the bill, the KMA told Kentucky Health News in an e-mail that it "continues to have concerns regarding the expansion of prescriptive authority for controlled substances among non-physician groups. KMA did work, however, with the Kentucky Academy of Physician Assistants on House Bill 135 with two objectives in mind – promoting public safety and preserving the 'physician-led team model.' KMA will monitor the progress of this bill and urge that principles such as these be included as the legislative process continues."

Adam Haley, government-affairs coordinator for KAPA, told Kentucky Health News that PAs were still working with lawmakers to try to carve out the Schedule II drugs that are used to treat ADHD.

"We obviously heard loud and clear from our members of Senate leadership in committee that there are strong reservations about some of the opioids in Schedule II, and while we believe the gold standard of care does include full Schedule II authority, we're sensitive to those concerns and are working with those legislators on addressing the issue of some of the psycho-stimulants in Schedule II and whether or not those can be broken out separately," Haley said.

Sheldon, the bill's prime sponsor, noted that 49 states allow full prescriptive authority for PAs and Kentucky would become the sixth state to place restrictions on Schedule II if this bill were to become law.

The KAPA's Rutherford said, "Changing this legislation will allow Kentucky to be more attractive for PA practice and will hopefully keep many of those PAs from going to practice in neighboring states. This would allow for more providers in Kentucky, which we all know is much needed."

The bill includes several restrictions on how PAs can prescribe drugs, and new continuing-education requirements, including a number of required hours related to controlled substances. It also leads to a more accurate account of who actually prescribes drugs; now, all scheduled drugs prescribed by a PA are attributed to the supervising physician.

Under the regulation, PAs would still have to work under the supervision of a physician who would be allowed to limit which controlled substances they can prescribe.

Sen. Paul Hornback, R-Shelbyville, said he supported the bill as a way to increase access to care in rural Kentucky and that he hoped the House bill to expand the scope of practice for nurse practitioners would also pass.

Nurse practitioners have been able to prescribe Schedule II drugs, the highest level of painkillers, since 2006, under the supervision of a physician. HB 286, a bipartisan bill sponsored by Rep. Russell Webber, R-Shepherdsville, would allow them to do that without a supervising physician after four years, if their license is in good standing. The General Assembly approved similar authority in 2014 for non-scheduled drugs. This bill is posted in the House Licensing, Occupations and Administrative Regulation Committee.

State, local governments have great power to fight coronavirus

"Local and state public health officials wield extraordinary powers in emergency situations such as the current coronavirus outbreak," Michael Ollove and Alex Brown report for Stateline. They can close schools and private businesses. They can restrict or shut down mass transit systems. They can cancel concerts, sporting events and political rallies. They can call up the National Guard. They can suspend medical licensing laws and protect doctors from liability claims. And they can quarantine or isolate people who might infect others."

Laws on emergency powers vary in the details, but such laws still give states and municipalities wide latitude to respond to health threats such as the coronavirus disease dubbed covid-19. That generally includes the right to declare a state of emergency, which serves both practical and psychological functions. Governments can slow the spread of disease by restricting movement or quarantining the sick without having to deal with red tape. And declaring a state of emergency may reassure members of the public who are anxious to know that officials are responding, Ollove and Brown write .

Under emergency-declaration laws, authorities can also redirect health care workers to where they're most needed and help hospitals deal with the onslaught of patients. "For instance, they can decide which hospitals should have isolation wards," Ollove and Brown report. "They can order or request hospitals to release patients with lesser health needs to make room for those infected with the virus. They can take properties to create emergency medical centers if hospital space runs out. And they can transfer equipment and supplies from one hospital to another, based on the needs of the moment."

Local public-health officials also play a critical role in informing the public, either directly or through the news media. Providing clear, factual information to the public can slow the spread of disease, reduce panic, and kill rumors, Ollove and Brown write.

Beshear urges employers who don't offer paid sick leave to do so, to keep sick workers at home and prevent spread of coronavirus

Gov. Andy Beshear (Lexington Herald-Leader photo)

Gov. Andy Beshear wants Kentucky employers who don't allow paid sick leave to change that policy, to prevent spread of the coronavirus.

“We have got to make sure that people stay home when they’re feeling sick until we move past this,” Beshear told journalists, adding that it is only a matter of time before Kentucky sees a case of covid-19, the disease caused by the virus.

“I would encourage all those businesses that are out there that don’t currently offer paid sick leave, absolutely consider it for the next several months,” Beshear said.

The Courier Journal reports, "Kentucky sits in a region with some of the lowest rates of access to paid sick leave in the country, according to Jason Bailey, head of the Kentucky Center for Economic Policy, a left-leaning think tank. Some 62% of private sector workers in Kentucky, Tennessee, Alabama and Mississippi receive paid sick days, compared with 91% of workers in the Pacific Northwest, Bailey said. That's partly because Kentucky has a greater number of low-wage employers — factories and retailers."

But it’s also because the 2017 General Assembly banned local governments from imposing sick leave requirements, Bailey told the Louisville newspaper: “Cities like Louisville are actually barred from doing that. So that creates additional risk because a lot of those workers who do not have paid sick days are also the ones who are in those jobs with regular contact with the public. … We have created a situation through that and other policies that increase our risk.”

Live forum about coronavirus on KET Tuesday night

With the spread of the coronavirus around the world, the United States declared a public health emergency at the end of January, and the number of confirmed cases in the U.S. grew significantly in the first week of March.

To help address this health risk, Dr. Wayne Tuckson of KET's "Kentucky Health" will host a special live forum on the network Tuesday, March 10, at 9 p.m ET. "Trusted health experts will share the latest information about the coronavirus, answer viewers’ questions, and discuss how the state and healthcare providers have been preparing," a KET news release says. The panel will include physicians and other professionals:

• Steven Stack, commissioner of the Kentucky Department for Public Health
• Lori Caloia, medical director of the Louisville Department of Public Health and Wellness
• Derek Forster, medical director for infection and prevention control at UK HealthCare
• Staff from the Lexington-Fayette County Health Department

Have a question you’d like answered? You may submit questions in advance via:
• Email: ketforum@ket.org
• Twitter: @KET
• Facebook: facebook.com/KET

Committee approves doctors' bill to regulate lawyers' ads aimed at soliciting clients who take certain prescription drugs

By Melissa Patrick
Kentucky Health News

A bill to regulate plaintiff-lawyer commercials that solicit clients allegedly injured by prescription drugs or medical devices is headed to the state Senate floor.

Sen. Ralph Alvarado explained SB 178 to the Economic
Development, Tourism and Labor Committee. (LRC photo)  

“I’m sure all of you are aware and have seen legal advertisements on television about prescription drugs,” said Sen. Ralph Alvarado, R-Winchester. “They look like an important health alert about the risks associated with a medication, often using the logo of a national health organization like the Food and Drug Administration meant to imply authenticity. . . .  And their goal is simple: It is to alarm the public and lure the consumer into calling a 1-800 number that promises them financial recovery through legal services."

Alvarado, the bill's sponsor, called Senate Bill 178 a "patient protection bill" and told the  Senate Economic Development, Tourism and Labor Committee members that such ads compromise the doctor-patient relationship and potentially put consumers' health at risk

He said the ads target many common drugs, including blood thinners and treatments for diabetes, heartburn, heart disease and certain cancers.

"Consider a scenario when someone abruptly stops taking a blood thinner, for example. Patients can experience a stroke or a transient ischemic neurological event, residual paralysis and in the worst case, death," said Alvarado, who is a physician. "What we're seeing is people will view these ads and stop taking the medication, despite it being the best course of treatment and despite there not being a medical reason for the person to stop treatment."

He cited studies to support his claim, including one that found 58 percent of physicians reported having patients who stopped taking their medications without consulting their doctors after seeing such ads, and said the American Association of Retired Persons has sent warnings and letters to its members to implore them to not stop taking their medications without talking to their physicians first.

Among other things, SB 178 would require advertisers to warn viewers that it is dangerous to stop taking prescribed medications before consulting with a physician; would prohibit the use of a government agency logo in any way that suggests an affiliation; would prohibit ads that solicit legal business from being labeled a "medical alert" or "health alert"; and would protect personal health information from being sold or transferred to someone for the purpose of  soliciting legal services without the written authorization of the patient.

Sen. Ernie Harris, R-Prospect, asked how enforceable the bill was since most of Kentucky is served by out-of-state TV stations. Cory Meadows, deputy executive vice president and the director of advocacy for the Kentucky Medical Association, said this still has to be worked out, but said Tennessee has a similar law and West Virginia is considering one.

"What this comes down to is protecting patient health and safety as well as preserving that relationship," Meadows said. "There needs to be some regulation and oversight around these ads if we don't want Kentuckians to get hurt or further hurt."

Sen. Wil Schroder, R-Wilder, a lawyer, asked why a violation would be a misdemeanor rather than a civil violation with a financial penalty. Meadows said the original idea was a felony, and was negotiated down. He said some criminal penalty was needed to "put teeth" in the bill.

Jay Vaughn of the Kentucky Justice Association, which represents plaintiffs' lawyers, said the group likes the proposed warning to not stop taking a drug without consulting a physician, but thought the other provisions went too far.

Is the coronavirus causing covid-19 a pandemic? It looks like one, and health officials across the world are treating it like one

By Paige Winfield Cunningham
The Washington Post

Officials have been slow to use the “P” word to refer to the spread of coronavirus.

Yes, that word: “Pandemic.”

. . . The story of covid-19, the disease caused by the virus, isn't the same as a Hollywood thriller. But some health experts are frustrated by the hesitancy of officials to describe it as a pandemic, even though it checks just about every box of criteria.

“Personally, I think we're doing everyone a disservice by continuing this debate,” Lauren Sauer, director of operations for the Johns Hopkins Office of Critical Event Preparedness, told me. “It is creating more panic than just declaring it and moving on.”

A pandemic refers to an infectious disease spreading so rapidly across multiple countries that it can’t be contained. The World Health Organization defines “pandemic” this way: “The worldwide spread of a new disease” that sickens a large number of people because they don’t have immunity to it.

One could argue — and most epidemiologists do — the coronavirus is a pandemic under that definition; cases have been reported in more than 50 countries and on every continent (except Antarctica) and nearly 3,000 people have died from it.

Japan and South Korea have shuttered their schools. China has dramatically scaled back its manufacturing under intensive quarantines. Heck, even the Louvre in Paris is closed.

When officials do use that term, it indicates they’re worried the virus has hit a tipping point where drastic actions such as closing schools, canceling public gatherings and urging people to stay at home are necessary. While containment is the goal under an epidemic — where a disease is spreading only regionally, not globally — mitigation becomes the goal under a pandemic.

There are growing signs that health officials around the world are viewing coronavirus as a pandemic — even if they're not willing to state it yet directly.

• Last Tuesday, the U.S. Defense Department raised its “Risk of Pandemic” warning from “probable crisis” to “imminent crisis,” according to a document obtained by Newsweek. Officials expect the coronavirus will “likely” become a global pandemic within the next 30 days.
• Nancy Messonnier, a top official at the Centers for Disease Control and Prevention, said the following day the coronavirus has met two criteria of a pandemic: causing illness resulting in death and spreading person to person in a sustained way.
  “The world moves closer toward meeting the third criteria — worldwide spread of the new virus,” Messonnier told reporters.
• And yesterday, the WHO director general used the word “pandemic” as he warned “the window of opportunity for containing it is narrowing.”
  “We need to be preparing side by side for a pandemic,” Tedros Adhanom Ghebreyesus told CNBC.

In some regards, it doesn't matter much whether officials say they're dealing with a pandemic or not. Global authorities are already responding to the novel coronavirus as though it’s the highest-level health threat, regardless of the terms used to describe its spread. . . .

WHO no longer uses “pandemic” as a term to classify the threat of infectious diseases. The agency changed its classification system after calling the 2009 swine flu outbreak a “pandemic.” At the time, it was accused of exaggerating the alarm for an illness that turned out milder than initially expected.

But the agency has already given coronavirus its highest threat level — dubbing it a “Public Health Emergency of International Concern” — and its leaders have been wary of using the term pandemic casually.

“Using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralyzing systems,” Ghebreyesus said last week.  But WHO spokesman Tarik Jasarevic told me this morning “we are at a critical juncture in the outbreak.”

“While we must continue efforts to contain Covid-19 — focusing on strengthening surveillance, conducting thorough outbreak investigations to identify contacts and applying appropriate measures to prevent further spread — countries should also use this time to prepare for the possibility of wider transmission,” Jasarevic wrote in an email.

In public, top Trump administration officials are staying away from the term “pandemic” as they try to reassure Americans the threat of getting the virus is still low and do damage control after reports suggested the administration's response has been internally chaotic.

Pence said on CNN's “State of the Union” that the Trump administration is leading an aggressive, coordinated response, keeping the threat of the flulike illness at a low level for the average person.

“The good news is, of the 22 Americans that have contracted the coronavirus, more than half of them are almost fully recovered,” Pence said. “And I think it’s all a reflection of the fact that early on in this crisis, the president took the unprecedented step of suspending all travel from China and establishing a quarantining effect.” 

Risk of Americans getting the new coronavirus remains low, but a top expert cautions that this is an evolving situation

The new coronavirus (Centers for Disease Control)

By Melissa Patrick
Kentucky Health News

Kentucky health officials have been monitoring more than 100 people for the novel coronavirus, all of whom agreed to voluntary isolation after recent travel to mainland China, but as of Sunday there had been no confirmed cases in Kentucky.

The state has tested one person for the virus, and that test came back negative, Gov. Andy Beshear said at a Feb. 27 press conference. State public-health officials have offered a list of several steps you can take to protect yourself and those around you:

• Wash hands with soap and water for at least 20 seconds; only use alcohol-based hand sanitizer if soap and water are not available.
• Avoid touching your eyes, nose and mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Stay home if you are sick.
• Cover your cough or sneeze with a tissue and then throw it away.
• Clean and disinfect frequently touched objects and surfaces.
• Get a flu shot.

Why get a flu shot when it won't work against the coronavirus, which causes a disease that has been named covid-19? The U.S. surgeon general says fewer flu patients equals more resources to combat covid-19; and the Kentucky Medical Association says having the flu weakens the immune system, leaving unvaccinated people more susceptible to contracting other illnesses. In the great majority of covid-19 deaths there has been an underlying medical condition.

At this time there are no recommendations for individuals who are well to wear a face mask, despite there being a rush to buy them. The Centers for Disease Control and Prevention says it "does not recommend that people who are well wear a face mask to protect themselves from respiratory diseases, including covid-19. Facemasks should be used by people who show symptoms of covid-19 to help prevent the spread of the disease to others. The use of face masks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health-care facility)."

On Saturday, the surgeon general concured, saying on Twitter that Americans should stop buying masks because They won't prevent the general public from catching the virus, "but if health-care providers can’t get them to care for sick patients, it puts them and our communities at risk!"

Facts about the virus

Covid-19 is a respiratory illness that can spread from person to person. The CDC says it is transmitted by tiny droplets from sneezes and coughs and can spread to people as much as six feet away. And while it may be spread from contact with infected surfaces or objects, "this is not thought to be the main way the virus is spread," the CDC says.

The virus was first identified in China. The CDC says it is not spreading throughout the United States. Two deaths from the virus were reported Saturday and Sunday in Washington state.

As of Feb. 29, the CDC reported there had been 22 confirmed and presumptive positive cases in the U.S., plus 47 confirmed positive cases among people who have been repatriated to the U.S.: three from Wuhan, China, and 44 from the Diamond Princess cruise ship, which had been docked in Yokohama, Japan.

The World Health Organization reported on Feb. 28 that there are more than 83,000 cases worldwide, with more than 2,800 deaths.

The risk of getting covid-19 in the U.S. is currently low, but Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said at a White House press conference Saturday that it's important to remember that "this is an evolving situation."

Common signs and symptoms of covid-19 include cough, other respiratory symptoms, fever, shortness of breath and breathing difficulty. Symptoms may appear in as few as two days or as long as 14 days after exposure.

Preliminary information shows that older people and people with underlying health conditions may be at increased risk for a severe case of the virus. Most cases of the virus are mild, but that is one thing that makes it harder to deal with.

An insidious disease

Because covid-19 is generally not life-threatening, it is harder to identify and isolate, Dr. James Hamblin writes for The Atlantic: "It is deadly, but not too deadly. It makes people sick, but not in predictable, uniquely identifiable ways. Last week, 14 Americans tested positive on a cruise ship in Japan despite feeling fine. The new virus may be most dangerous because, it seems, it may sometimes cause no symptoms at all."

Marc Lipsitch, a Harvard University epidemiology professor, told Hamblin, “I think the likely outcome is that it will ultimately not be containable.”

Hamblin writes, "Testing people who are already extremely sick is an imperfect strategy if people can spread the virus without even feeling bad enough to stay home from work." 

That's what happened to Carl Goldman, who got the virus while on the quarantined Diamond Princess.

Goldman, who is in his late 60s, tells his story in The Washington Post, writing that his only symptoms are that this chest feels tight and he has coughing spells. He writes that he has no chills, no body aches, breathes easily and has no stuffy nose.

"If I were at home with similar symptoms, I probably would have gone to work as usual," he writes.

His treatment has largely been preventive IV care, "gallons and gallons of Gatorade, and when my fever rose just above 100 degrees, some ibuprofen. . . . It’s surreal to see everyone panic — news conferences, the stock market falling, school closures — about a disease I have. It does seem likely that coronavirus will spread in the United States, but it won’t help anybody if we all panic."

Robert Redfield, the CDC director, said at Feb. 27 press conference, "At this stage, the risk is low we need to go on with our normal lives."

Is our political system properly serving our public-health system?

The president and vice president watched Dr. Anthony Fauci Feb. 29. (Photo: Andrew Harnik, Associated Press)

By F. Douglas Scutchfield and Al Cross

The new viral disease, covid-19, began in China, which continues to report new cases even as the coronavirus spreads to several nations around the world. This suggests that we are likely to have a disease outbreak comparable to the 2009 pandemic of “swine flu” caused by the H1N1 influenza virus. Health experts say the current best way to handle covid-19 is to manage this emerging disease as we managed that emerging disease.

The disease is very much like influenza, which we have managed over the years with varying success. In the absence of a vaccine, we need common-sense steps: wash your hands frequently and thoroughly; keep your hands away from your face; avoid those who have disease; and if you get sick, don’t go to work or school, since you will infect others. Sneeze or cough should be controlled and covered with a tissue which is then discarded.

We are likely to develop a vaccine for this virus, but that will take 12 to 18 months, and given Americans’ poor track record of flu immunization, even if we had a vaccine, would they take it? As for current prevention efforts, we worry that again, our public-health system is not being well served by our political system.

President Trump’s Feb. 26 press conference on this potential pandemic reflected a lack of knowledge and understanding of the subject, and created more misunderstanding. He did better on Feb. 29, giving the lectern to experts such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. The president and his point man on the issue, Vice President Mike Pence, can play a major role in educating people about the development of this epidemic, but they need to stick to the facts and stay on message.

The president did not do those things in a public meeting with an African American group, when he said the virus will eventually disappear “like a miracle,” or earlier, when he said a vaccine is being developed “fairly rapidly,” which to many people means weeks, not months. He also disputed the federal Centers for Disease Control and Prevention’s warning that outbreaks of the disease in the U.S. are inevitable, and then said Democrats and the news media are making too much of the matter, even using the word “hoax.” He seemed to be more concerned with the political impact of the virus than helping people control it. Likewise, Vice President Pence does not inspire high confidence in such matters, given his mismanagement of an outbreak of HIV among intravenous drug users in Southern Indiana. It took him too long to take experts’ advice.

Americans deserve better and should demand better. We need a voice of reason, backed by the best scientific minds in government such as Dr. Fauci, to reassure the nation that the public-health system knows what is happening, is able to predict what is likely to happen, and knows how to deal with the problem – all the while being driven by calm knowledge, concern and commitment, giving the nation a calming voice, not a political rant.

In Kentucky, past policymakers have neglected our local and state health departments. When we don’t provide adequate funding, we shouldn’t be surprised that they need additional resources in a crisis. When the crisis passes, we allow them to slowly lose that funding and are again surprised at their inability to deal with new problems. Several health departments in Kentucky are at the edge of closing their doors, due to the state pension crisis, and we seem little concerned about their ability to protect the public’s health. Perhaps concern about the new coronavirus will change that, if politicians behave properly.

F. Douglas Scutchfield, M.D., is the Peter P. Bosomworth Professor Emeritus in the Department of Health Management and Policy in the University of Kentucky College of Public Health. Al Cross is a journalism professor at UK, director of its Institute for Rural Journalism and Community Issues, and editor and publisher of Kentucky Health News.