Federal agency is pressured to re-post online database of doctors' malpractice and disciplinary cases

U.S. Sen. Charles Grassley has joined journalists, academic researchers and consumer groups in calling on the Health Resources and Services Administration to put back online the National Practitioner Data Bank, a database of malpractice and disciplinary cases against doctors.

"In a strongly worded letter, the Iowa Republican, who has led investigations of fraud and waste in government health programs, said the now-removed file 'serves as the backbone in providing transparency for bad-acting health care professionals'," Duff Wilson of The New York Times reports. Grassley gave HRSA, part of the the Department of Health and Human Services, until Oct. 21 to hand over documents and answer a series of questions, ending with "What is your timeline for getting the database up and running again?"

For a PDF of Grassley's letter, click here. Under pressure, the agency has scheduled a conference call on the issue for Thursday, Oct. 13, from 1 to 2 p.m. Eastern Time.

The database "was created in 1986 for hospitals, medical boards, insurers and others to share information so that bad doctors do not slip through cracks in reporting," Wilson writes. The law makes doctors' names confidential, but the database has a Public Use File for researchers and journalists, in which doctors are identified only by numbers.

Some journalists have been able to identify doctors using information from other sources, such as lawsuits. "After a complaint by one doctor identified by The Kansas City Star, the agency threatened the newspaper reporter with a fine, pulled the doctor’s file from its Web site on Sept. 1 and began a review of how to hide the identities better," Wilson reports. "Its actions provoked protests" from the Association of Health Care Journalists, the Society of Professional Journalists, the Reporters Committee for Freedom of the Press and other groups. In a letter, they told HRSA, "Nothing in the Public Use File can be used to identify individuals if reporters or researchers don’t already know for whom they are searching."

Grassley wrote, "It seems disturbing and bizarre that HRSA would attempt to chill a reporter’s First Amendment activity with threats of fines for merely 'republishing' public information from one source and connecting it with public information from another. A journalist’s shoe-leather reporting is no justification for such threats or for HRSA to shut down public access to information that Congress intended to be public."

The Public Use File can be downloaded from the website of Investigative Reporters and Editors, one of the groups, protesting its removal from the HRSA site, but "that file will be more and more out-of-date as the dispute goes on," Wilson notes. She also reports that Robert E. Oshel, associate director for research and disputes in the Division of Practitioner Data Banks, says the agency is misinterpreting the law. (Read more)

High-dose flu shot, which many doctors recommend for those over 65 due to risk of death, is becoming more available

It's time for flu shots, but the annual reminder has a new angle: Fluzone HighDose, a special vaccine designed for people 65 and older, who make up 90 percent of the 23,000 people who die of the flu and its complications.

"The high-dose vaccine for seniors, introduced last year by drug-maker Sanofi Pasteur, is becoming more widely available in the area, and health workers say it’s in high demand," Laura Ungar reports for The Courier-Journal of Louisville.The Jefferson County Health Department "charges $40 for the high-dose shot and $25 for the regular vaccine that is injected." (C-J photo by Bill Luster: Joe Blincoe of Louisville gets one of the new, high-dose shots)

The high-dose vaccine contains four times as much antibody-creating antigen as a regular shot, and it is recommended by Dr. Nancy Stiles, a geriatrician and associate professor of medicine at the University of Kentucky, but the Centers for Disease Control and Prevention "says problems such as pain and swelling at the injection site and headache or muscle aches were reported more frequently after people got the high-dose vaccine," Ungar writes. "At this point, the CDC is not recommending one type over the other," pending a study. "Whichever type of flu shot seniors get, local doctors are also urging them to make sure they have had a pneumonia shot," which is good for at least five years. (Read more)

Monday, Oct. 10 is World Mental Health Day

Oct. 10 is World Mental Health Day, observed with the aim of raising public awareness about mental health issues. On average, Kentuckians report four mentally unhealthy days per month.

Adults in Pike County reported having the most days a month — seven — that they felt stressed, depressed or emotionally unstable. Those in Daviess, Fayette, Henderson, Mason, McCracken and Webster counties reported the lowest number of mentally unhealthy days. County-by-county data can be found by clicking here.

The theme of this year's day, as decided by the World Health Organization, is "Investing in Mental Health," with the purpose of highlighting the funding shortages that exist to treat people with mental health. In Kentucky, mental health has received the same amount of funding in the state budget each year for the past 15 years.

Americans having to travel farther to get trauma treatment as hospitals close

Millions of Americans are farther away from trauma care than they were 20 years ago, with some having to travel more than 30 minutes to get treatment. Experts say getting help within the first hour is crucial.

A study published in the journal Health Affairs found the distance to a trauma center "increased for 69 million people between 2001 and 2007," reports the Daily Yonder, the national online rural journal. The average amount of travel time was 10 minutes. But for 16 million people, the amount of time it took to travel to a trauma center increased by 30 minutes or more.

"The greatest impact from diminished access has been on people in rural communities," as well areas with a high percentage of African-American residents, low-income people and those without health insurance, The Associated Press reported.

Though U.S. Census numbers show cities growing in population while rural areas decline, Kentucky is still considered a largely rural state (see right), ranking 23rd in the country for population density.

The reason for the increased travel times is due to facilities closing. In 1990, there were 1,125 trauma centers in the country. By 2005, nearly 340 of them had closed, in most cases because of financial hardship; they were treating too high a percentage of people who do not have insurance, Daily Yonder reports.

President Obama's recent call to cut Medicare premiums to critical access hospitals, as well as close CAHs that are within 10 miles of each other, would further burden rural areas, said a panel of experts in Lexington Wednesday.

Medical experts say a trauma patient has the highest change at survival if treated within the first hour. "We're not saying that we should build a trauma center on every street corner," said Dr. Renee Hsia, lead researcher on the study. "But we do have evidence that access for certain populations is already pretty bad, and it's getting worse." (Read more)

State officials step up efforts against prescription drug abuse, targeting doctors

By Tara Kaprowy and Al Cross
Kentucky Health News

LEXINGTON — Targeting what Gov. Steve Beshear called "drug dealers in white coats" is the goal of a new effort against prescription drug abuse in Kentucky, which is killing more Kentuckians than traffic accidents.

State Sen. Robin Webb, D-Grayson, speaks after
Stumbo, Beshear and Conway at press conference.

Announced by Beshear, Attorney General Jack Conway and House Speaker Greg Stumbo at a Lexington press conference, the plan is designed to root out doctors with suspicious prescription practices and pass legislation to better track prescriptions.

Most of the effort is aimed at improving and expanding use of the Kentucky All Schedule Prescription Electronic Reporting system, which relatively few physicians use to see if patients are doctor-shopping for painkillers. An advisory board of physicians, dentists, nurses and pharmacists will work with KASPER officials and law-enforcement agencies to define acceptable prescribing practices in different medical disciplines. Suspicious activity would be reported to the respective licensing boards.

In August, Stumbo grilled the Kentucky Board of Medical Licensure about why it wasn't increasing its oversight on doctors since it had asked for the authority to analyze KASPER data. Lloyd Vest, the licensing board's general counsel, said the data were not specific enough. Stumbo said yesterday, “The problem is how you define what over-prescribing is.” That's what the advisory board will do.

Beshear, asked how soon he would expect an enforcement action to result from the process described, he said he would “push them to move very fast." Other boards handle licensing for dentists, nurses and pharmacists.

Beshear said he wants all physicians to be part of KASPER, especially those who prescribe scheduled narcotics such as oxycodone. Asked about the cost to doctors and patients, he said, "Kentucky will absorb whatever cost." When pressed he said, "We'll handle our part of it and I'm sure the medical profession will hold up their end of it."

Conway said only about 25 percent of physicians use KASPER, but many don't prescribe painkillers. He said the system "takes 10 or 15 seconds" to use but should be made more user-friendly. He said there is a special concern about emergency-room physicians because "a lot of people who are shopping for pills are going to emergency rooms."

Beshear said Operation UNITE, a federally funded anti-drug program in Eastern Kentucky, has received a $600,000 grant from the Appalachian Regional Commission to conduct an education program for about 1,000 physicians and drug dispensers about the dangers of prescription drug abuse and the benefits of KASPER.

Stumbo said Oklahoma recently found 80 percent of its drug overdoses were from prescription drugs and Kentucky would find "exactly the same" if it did the same study. "It's not the drug dealers that are killing our kids, it's the drug-dealing doctors," he said.

Conway said he asked a group of Eastern Kentucky students if they had taken a prescription drug for reasons not listed on the pill bottle and 75 to 80 percent raised their hands. He said the same number said prescription drugs are easy to obtain, and none said their parents lock the medicine cabinets at their homes.

Stumbo, a Prestonsburg lawyer who preceded Conway as attorney general, said the trend reports from KASPER have shown pill abuse leveling off in Eastern Kentucky but rising in places outside the region, and gave Marion County and the Jackson Purchase as examples.

Beshear and Conway are running for second terms in the Nov. 8 election, but Stumbo said the effort is non-partisan and Republican Sens. Jimmy Higdon of Lebanon and Robert Stivers of Manchester are also working on it. They did not attend the press conference, but Higdon said in an interview that he will pre-file a bill require pain clinics to be appropriately licensed and run by physicians who pass background checks.

Also invited but not present was Sen. Tom Jensen, R-London, who is exploring the possibility of again introducing a bill that would make pseudoephedrine, the key ingredient for making methamphetamine, available only by prescription. Beshear, who declined to take a position on that, said he is "committed to finding an answer" to the problem but it does not have the sort of consensus that the prescription drug-abuse issue has.

University Hospital is public, not private, so state has say on merger, Conway says

Louisville's University Hospital is a public institution, not a private one, which means the state gets a say about the proposed merger between the hospital, Jewish Hospital & St. Mary's HealthCare and Lexington-based St. Joseph Health System, Attorney General Jack Conway said Wednesday.

Conway said University Medical Center Inc., which runs the hospital, "was established and created and is controlled by the University of Louisville." U of L has long claimed University Hospital is private and refused to hand over records requested by the ACLU of Kentucky and The Courier-Journal. The ruling means the documents pertaining to the merger itself would have to be made public. Because it deals with an open-government issue, that part of Conway's opinion has the force of law unless overturned in court.

"The finding reinforces the earlier positions by Conway and Gov. Steve Beshear that the deal cannot take place without the approval of state government, which owns the hospital property and granted the contract for University Medical Center to operate it," The C-J's Patrick Howington reports. U of L had said the hospital is private because it is run by a corporation. (Read more)

The ruling could affect the merger because of the religious implications. Saint Joseph is owned by Catholic Health Initiatives, which follows Catholic directives that prohibit abortion, sterilization and euthanasia. For more on the merger, click here.

Natl. Rural Health Assn. president, at UK, says rural health cuts won't save money or help communities but will eliminate jobs

Speaking about President Obama's proposed cuts to rural health care Wednesday, Susan Starling was frank about her feelings: "As a CEO of a critical access hospital, I'm very nervous. What do I need to do as a hospital administrator?" she asked Alan Morgan, chief executive officer of the National Rural Health Association.

"If at all possible, invite your legislator into your facility," Morgan replied. "When they see what you're doing for your community, that's what will turn the tide on this."

The conversation was part of the Healthcare Spotlight Series at University of Kentucky Albert B. Chandler Hospital in Lexington and put on by The Health Enterprises Network in partnership with Hall Render. Morgan was the keynote speaker and Starling, CEO of Marcum & Wallace Memorial Hospital in Irvine, moderated the subsequent discussion. They spoke at length about President's Obama's recent call to reduce reimbursement payments for critical-access hospitals as well as eliminate the CAH designation for those within 10 miles of another hospital.

Morgan, whose association has 21,000 members, said there has been discussion about making cuts to rural health facilities for the past year, starting when the Congressional Budget Office released its proposals for potential savings in March and proposed eliminating CAHs. "Once you put something like that on the table, it stays on the table," Morgan said. The Medicare Payment Advisory Commission followed suit, suggesting the same cuts Obama ultimately called for in September.

Morgan said the proposal runs counter to efforts to create jobs, saying closing CAHs and reducing reimbursement — which he said would force many to close — will eliminate far more jobs than it creates. "We have a hard time communicating to policymakers that if the health care system is not the largest employer in a rural community, it's second only to the school system," he said. "Health care is about the economy."

While cuts may be on the table and the health-reform law is not perfect, Morgan said, it does allocate a "tremendous amount of federal resources" to rural health, most in the form of grants and special programs. But Morgan said much remains to be decided about the law. "If someone tells you it's great, they don't know if it's great. If someone tells you it's bad, they don't know that either," he said. "They just don't know yet. Until the regulations come out on most of this we just don't know."

That being said, Morgan does not feel the act will "fix rural America" since "there is no silver bullet." But he pointed to good things about rural health, such as studies showing that rural facilities outperform their urban counterparts in primary care, safety and preventive services. "As a nation, as rural advocates, we need to be proud of what we do when it comes to quality, when it comes to innovation," he said. "What makes rural great is a strong sense of community, which allows you the ability to network . . . to try innovative approaches."

But doing that takes money, Starling and Morgan agreed. "Just by cutting, we're not changing the system," Starling said. "If we close hospitals in rural America, we're not saving money. We're shifting it to urban. It's actually spending more."

Federal supervision of Oakwood mental-health facility ends

The federal supervision of Oakwood, the long-beleaguered Somerset facility for the mentally disabled, is no longer necessary and will end, officials announced yesterday.

The move means the Kentucky Cabinet for Health and Family Services and the U.S. Department of Justice will lift a 2006 settlement agreement, which stemmed from a Justice Department investigation into civil rights complaints.

"The lifting of the agreement reflects the tremendous amount of progress made at Oakwood in recent years," Gov. Steve Beshear said. "This is a true credit to the combine efforts of cabinet staff and others to improve the care provided to these residents."

Oakwood has 112 residents and is the state's largest home for people with mental disabilities. The Bluegrass Mental Health-Mental Retardation Board has a contract with the state to manage and operate the facility as well as provide community-based mental health, mental retardation/development disabilities and substance abuse services. The group took over in 2006.

"We cleaned up things, we created an infrastructure, we brought sound business management policies and technology, and we appreciated the good staff we inherited while moving out those who were problematic," Bluegrass CEO Shannon Ware told Beth Musgrave of the Lexington Herald-Leader.

The settlement was lifted by the U.S. District Court for the Eastern District of Kentucky Sept. 29. (Read more)

Health exchange could cost up to $34 million in Ohio; Kentucky still biding its time -- until after the election?

As 27 states, including Kentucky, bide their time in setting up a health care exchange — a key component of the federal health-reform law — Ohio officials have said setting one up in their state will cost $19 million to $34 million.

The undertaking could cost $8 million a year just for staff salaries, with 170 employees needed to run the exchange, reports Cliff Peale of the Cincinnati Enquirer. Marketing could cost $5 million a year, said a health-care consultant at Milliman Inc., an actuarial and consulting firm.

"Ideally, we want to see Obamacare repealed," said Susan Verble, deputy chief of staff for Ohio Lt. Gov. Mary Taylor, who also directs the Ohio Department of Insurance. "Whether it's a state or federal-run exchange, it's going to be costly for taxpayers."

Starting in January 2014, "the law will require all Americans to buy health insurance or pay a penalty and require companies with more than 50 workers to offer benefits or pay a penalty," Peale reports. Ohio and Kentucky have each received $1 million from the federal government to research how to start an exchange.

Kentucky has not decided whether it will operate an exchange. Officials with the Cabinet for Health and Family Services said last month Kentucky is still awaiting guidance from the federal government, but didn't respond directly when asked if the impending election for governor was also a factor. (Read more)

Tonight, acting Gov. Earl Ray Tomblin of West Virginia narrowly won a special election for the remainder of an unexpired term, after losing a big lead. The final television commercial from the Republican Governors Association was an attack that Kentucky Gov. Steve Beshear may be trying to avoid: A link between a Democratic governor and the unpopular Democratic president's health-care law, passed with only Democratic votes. --Al Cross, Institute for Rural Journalism and Community Issues

State senator says U of L doctors used Medicaid funds to pay themselves $4.8 million in bonuses, seeks more oversight

State Sen. Tim Shaughnessy has questioned a $30 million transfer of surplus Medicaid funds to Passport Health Plan board members in 2008 and 2009. Shaughnessy, a Louisville Democrat, says doctors at the University of Louisville medical school paid bonuses to themselves using about $4.8 million intended for indigent care and used another $5.2 million to purchase an electronic records system, making them eligible for more bonuses from the federal government, Deborah Yetter of The Courier-Journal reported.

Since Attorney General Jack Conway ruled the transfer illegal, some groups have elected to repay. University Physicians Associates will repay $9 million over five years; U of L, University Medical Center and local hospitals that provided capital to start Passport have agreed to repay, but on different terms. Conway did not indicate whether the $4.8 million in compensation was bonuses or salaries, Conway spokeswoman Shelley Johnson told Yetter.

Shaughnessy said repayment is not sufficient to address the real problem — "that U of L's board wasn't involved in major financial transactions involving groups with which it is affiliated, including Passport, University Physicians Associates and the U of L medical center," Yetter reports. "We need to know how this happened, and we need to make sure it doesn't happen again," Shaughnessy said in an interview.

Shaughnessy is working on legislation for the 2012 General Assembly requiring public university boards to apply more oversight to groups like Passport. He has also written letters to Passport chairman Dr. Gerard Rabalais and U of L President James Ramsey. (Read more) To read Shaughnessy's letter to The Courier-Journal, click here.

$45 million renovation complete at U of L School of Dentistry

The University of Louisville announced the completion of a $45 million renovation to its School of Dentistry last week. The two-year project added 20,000 square feet and renovated another 211,000. Enhancements include "updates to infrastructure, operatory equipment and clinical education support. Other features include new digital radiography, incorporation of an electronic health records system and state-of-the-art classroom technology. Improvements in patient waiting rooms and clinical space include new chairs, lighting, cabinetry and touch screen computer terminals," a press release said.

"These upgrades are critical to competing nationally for high-quality students, recruiting talented faculty and attracting patients who need care and who augment the education experience of our students," said Dr. David Dunn, U of L executive vice president for health affairs. (Read more)

Second death in five years raises questions about placement of mentally ill Kentuckians in personal-care homes

The second death in five years of a mentally ill person who has walked out of a personal care home has "prompted advocates for the brain injured and the mentally ill to question whether personal care homes, which do not provide skilled nursing care, are the appropriate place to house people who have serious, chronic and complex problems," Beth Musgrave and Valarie Honeycutt Spears report for the Lexington Herald-Leader.

Larry Joe Lee, 32, who "had a brain injury, was schizophrenic, bipolar and diabetic," was found dead in after walking away from the Falmouth Nursing Home, the writers note. "In 2007, Larry Bruce Huff, 64, who had schizophrenia and a history of alcoholism, walked away from Golden Years Rest Home in Letcher County and later froze to death." The state closed Golden Years last week, and legislators say they will address the overall problem in the 2012 General Assembly.

"Personal care homes provide long-term care for people who do not need full-time nursing home care but need some assistance," the newspaper explains. "They receive a small state stipend and social security disability — $1,194 a month — to provide services to a complex population that includes the mentally ill, mentally disabled and even those who have recently been released from prison. There are 82 free-standing personal care homes in Kentucky serving more than 3,000 people." (Read more)