Kentucky federal judge throws out Bevin's Medicaid suit

A federal judge in Kentucky dismissed Monday a lawsuit that amounted to a counterclaim by Gov. Matt Bevin against 16 Kentucky Medicaid beneficiaries, who have sued a federal agency in Washington, D.C., for its approval of Bevin's plan to change Medicaid in the state.

District Judge Greg Van Tatenhove noted that Bevin chose to participate as a defendant in the District of Columbia case, in which a judge set aside the Department of Health and Human Services' approval of the plan, saying HHS had not adequately considered a key estimate by the state: that its Medicaid rolls would have 95,000 fewer people with the plan in five years than without it, in large measure because of noncompliance with its requirements for work, reporting and so on. HHS is re-reviewing the plan and recently sought public comment on it.

Bevin failed to show what injury Van Tatenhove was supposed to redress for him, the judge wrote: “Not all disputes are capable of federal judicial review. Federal courts are limited in their jurisdiction, and they can only hear cases where the plaintiff can establish jurisdiction. Here, the Commonwealth failed to do so.”

Bevin's suit created "the possibility of two different outcomes before two different judges," notes John Cheves of the Lexington Herald-Leader. "The Washington judge is a Democratic appointee; the Frankfort judge is a Republican appointee."

Bevin spokeswoman Elizabeth Kuhn "released a statement suggesting that he does not plan to appeal," James Romoser of Inside Health Policy reports. Kuhn said, “The complaint was dismissed on procedural grounds and did not address the substance of the case. This case was originally filed because we believe that Kentuckians deserve to have the 1115 waiver considered in Kentucky by a Kentucky judge. In the meantime, the 1115 case before a Washington, D.C. judge was expedited, and [Kentucky’s health agency] is working with CMS to be responsive to that ruling. We respect today’s decision by the court and will continue to pursue the case in Washington, D.C.”

International visitors, potential leaders in their countries, visit Rural and Underserved Health Research Center at UK

Front row, from left: Chanchamnap Sok, Cambodia; Dr. Asma Hamid, Algeria; Dr. Mangu Kendino, Papua New Guinea; Suzette Adel Maher Faragallah, Egypt; Mariana Bezugla, Ukraine. Back row: Dr. Richard Ingram, assistant professor of public health and affiliate of the University of Kentucky's Rural and Underserved Health Research Center; Dr. Tyrone Borders, director of the center; Henry Kohar, Liberia; and Mohamed Abdalla Yosry Mohamed Gamaleldin, Egypt.

The Rural and Underserved Health Research Center at the University of Kentucky hosted eight visitors from Algeria, Ukraine, Egypt, Cambodia, Liberia, Papua New Guinea, and Malaysia as part of a three-program focused on health care among marginalized populations, including rural residents.

The visitors, who were recommended by their embassies to the U.S. Department of State, were part of the department's International Visitor Leadership Program. Several prior participants in the program have gone on to become prime ministers or presidents of their countries.

Because of their interests in rural health and health care, they asked to learn more about the center’s work and how it informs policymakers’ decisions. They met with senior executives at the National Institutes of Health and the Health Resources and Services Administration before traveling to UK. 

By 7-1, public comments in 3rd round on Kentucky Medicaid plan oppose it; suit filed to stop similar work requirements in Arkansas

By Melissa Patrick
Kentucky Health News

When the third round of public comments on Kentucky's proposed Medicaid plan ended at 11 p.m. EDT Saturday, Aug. 18, more than 11,500 people had posted their views online, and, much like twice before, more than 80 percent of the commenters opposed the changes.

Kentucky Health News took a random sample of 200 comments and found that 175 either firmly opposed the changes or made positive comments about Kentucky Medicaid as it exists, and 25 opposed it: 87.5 percent to 12.5 percent, or 7 to 1. The sample's margin of error was plus or minus 6.9 percentage points. Click here to view a summary of all of the responses.

The federal Centers for Medicare and Medicaid Services re-opened the plan for comments after a federal judge vacated it just days before it was set to start on July 1. The judge said the U.S. Department of Health and Human Services had not adequately considered the state's estimate that in five years its Medicaid rolls would have 95,000 fewer people with the plan than without it, in large measure for non-compliance with its requirements. Those include work, school or other "community engagement" rules for able-bodied adults who are not primary caregivers.

A CMS spokesperson told Politico in July that the agency re-opened the comments "to better inform any future decision on the demonstration that was remanded back to the department for further review." Judge James Boasberg's ruling had specifically criticized HHS Secretary Alex Azar "for disregarding public comments that were overwhelmingly against the plan."

Robert Pear of The New York Times reports, "Administration officials said they could sidestep the ruling by providing a better explanation of the rationale for work requirements."

In opposition to the work rules, one commenter cited a Kaiser Family Foundation study and said, "Work requirements would affect a very small percentage of Medicaid recipients, while imposing unnecessary burdens on the rest. Being poor and needing medical care should not require a punitive and demeaning amount of paperwork. I oppose work requirements in the strongest possible terms. Don't waste any more time fighting what the courts have already deemed a lost cause."

Many others told how the 2014 expansion of Medicaid had helped them, and voiced their concerns about the possible changes. "I was working, but as a part-time employee I didn't qualify for the company insurance," said one who became eligible for Medicaid. "I have several health issues and keeping up with the cost of medicine wasn't easy. Having Medicaid has been a blessing. I'm now retired and confused about the new health program."

U.S. Rep. John Yarmuth, D-Louisville, submitted a formal comment opposing the work requirements in the plan, called Kentucky HEALTH for "Helping to Engage and Achieve Long Term Health."

"While there are certainly benefits to employment, work requirements have long been proven ineffective in meeting this goal, and are particularly cruel given the challenges many low-income Kentucky families face in the job market," Yarmuth wrote. "In fact, as was recently reported in The Wall Street Journal, “(taking) medical care away from low-wage workers in unstable jobs is not only ineffective in promoting employment, it may be counterproductive, since losing access to regular treatment can make it harder for people with serious health needs to look for and keep a job.” Taking health care away from 95,000 people, as Kentucky HEALTH would do, would not make them healthier or increase their employment prospects."

The liberal-leaning Kentucky Center for Economic Policy's 13-page letter said it spoke directly to the federal court's ruling, "namely that the proposed changes contradict the purpose of the Medicaid program, which is to provide health coverage to those who cannot afford it. The waiver would result in unacceptable coverage losses, and therefore should be rejected."

Chart by liberal-leaning Kentucky Center for Economic Policy
shows work status of U.S. adults on Medicaid who do not receive
federal Supplemental Security Income for the poor and disabled.

In support of Kentucky HEALTH, one health-care worker wrote, "I think KY should be allowed to institute work requirements and any other requirements for Medicaid recipients they deem necessary. As a provider in Kentucky I see Medicaid recipients every day who are abusing the system by qualifying for benefits when they really should not. Our current system has become a lifestyle instead of a helping hand. I have to work to pay for my extremely expensive health care (and) I can't find a reason that an able bodied person should not have to show some effort for their free health care."

Another in support of the changes more bluntly echoed the "skin in the game" arguments that Gov. Matt Bevin has used: "Hell yes it needs to be approved. Why would someone who is able to work be allowed to sit home and not do anything and collect welfare and be eligible for Medicaid? Yes, Approve this. Kentucky cannot continue to fund the cost of the Medicaid program."

Among the endorsers of the plan was the Kentucky Chamber of Commerce, which said it would help achieve the Chamber's long-stated goal of making the program "sustainable, in order to protect critical state investments in education and other vital programs."

Many of the comments opposing the changes were collected and posted by Kentucky Voices for Health, a coalition of lobbying groups and other advocates supporting the status quo, reports WUKY, the University of Kentucky's radio station. It quotes outreach and education director Angela Koch as saying, "Medicaid waivers are supposed to be innovative. They are supposed to change the way Medicaid works for the better, and this waiver does the opposite. It breaks Medicaid."

Supporters of the mandate counter that finding employment will help people move out of poverty and improve their health in the long run.

Kentucky HEALTH would require able-bodied adults who are not primary caregivers to work, attend school, take job training or volunteer 80 hours a month, or enroll in a drug-treatment program if appropriate. It also includes small, income-based premiums and lock-out periods for non-compliance.

Medicaid covers 1.4 million Kentuckians, almost half of them under the expansion of it to people with incomes up to 138 percent of the federal poverty level, under the 2010 Patient Protection and Affordable Care Act. Most who are on the expansion work.

Whether these thousands of comments will make any difference is yet to be determined. Azar told The New York Times that the Trump administration is "undeterred" by the district court ruling and that they are "proceeding forward."

"We are fully committed to work requirements and community participation requirements in the Medicaid program," Azar said. "We will continue to litigate. We will continue to approve plans."

Jill Hunter, Kentucky's acting Medicaid commissioner, told Darla Carter of Insider Louisville that she didn't know when the state would hear back from CMS, but said, "I know that we’re ready; just let us know when it’s time.”

CMS has also approved work requirements for Medicaid in Arkansas, Indiana and New Hampshire. Seven other states, Arizona, Kansas, Maine, Mississippi, Ohio, Utah and Wisconsin, have applied for permission to implement them.

Two of the same groups that filed the lawsuit for Kentucky Medicaid recipients, the National Health Law Program and the Southern Poverty Law Center, have joined with Legal Aid of Arkansas to file a similar federal lawsuit to block the Medicaid work requirements in that state.

In June, Arkansas was the first state to implement Medicaid work requirements and new state data shows that "thousands of Arkansans may lose Medicaid without even realizing the rules have changed," according to an analysis from the Georgetown University Health Policy Institute.

The institute says that out of about 15,000 people who were expected to record their work activities, 5,426 are in their second month of noncompliance and only 844 had satisfied their reporting requirements, Those who fail to document 80 hours a month for three months can be kicked off the program.

Because of the similarities in the Arkansas and Kentucky cases, the Arkansas suit was assigned to U.S. District Judge James Boasberg of Washington, D.C., who has retained jurisdiction in Kentucky's case, Inside Health Policy reports.

UPDATE, Aug. 29: CMS is asking the court to transfer the case to a different judge, IHP reports.

Most who think they're allergic to penicillin aren't; that can lead to over-use of antibiotics and resistant infections, a big issue in Ky.

About 10 percent of Americans say or think they have a penicillin allergy, but 90 percent of those people are not truly allergic and could tolerate the drug, according to the U.S. Centers for Disease Control and Prevention.

CDC graphic

The CDC says this misconception results in millions of people taking "broad-spectrum antibiotics," which are more expensive and also increase the risk of antibiotic resistance. That's a big deal because it puts a person at risk of being infected by a life-threatening "superbug" that can't be treated.

Superbugs are strains of bacteria that have become resistant to antibiotics and include infections like methicillin-resistant Staphylococcus aureus, which is commonly called MRSA, and Clostridium difficile-related colitis, or C.diff. Both infections can be deadly.

The CDC says every year, at least 2 million people are infected with antibiotic-resistant bacteria and of those, 23,000 die as a direct result of these infections. Kentucky has one of the highest prescribing rates of antibiotics and has led the nation in infection rates for MRSA and CRE (carbapenem-resistant Enterobacteriaceae).

So, it's important to find out if you are truly allergic to penicillin. The CDC encourages everyone who thinks they have an allergy to penicillin to talk to their health care provider in detail about their allergy, and to discuss whether or not they need an allergy test to confirm it.

A new study, published in the British Medical Journal, found that people with a penicillin allergy are nearly 70 percent more likely to get a MRSA infection and 26 percent more likely to acquire C.diff. The study looked at six year's worth of medical records from patients in the United Kingdom who were enrolled in the Health Improvement Network database.

“All of us need to understand that antibiotic use is not a free ride; it carries a lot of risk,” Paul Sax, clinical director of infectious diseases at Brigham and Women’s Hospital in Boston, told Kate Furby of The Washington Post.

Sax, who was not involved in the study, told Furby that the new study adds to the “substantial body of evidence” showing that a penicillin allergy has been linked to longer hospital stays and an increased risk of acquiring resistant infections.

Diagnosing a penicillin allergy can be challenging. Experts told Furby that while symptoms like rash, nausea and diarrhea could be signs of it, these symptoms could also "coincidentally occur" when someone is taking the drug; that children often get rashes that are mistaken for a penicillin allergies; and that even if children are diagnosed correctly, they can grow out of the allergy.

Kim Blumenthal, lead author of the study and assistant professor of medicine at Harvard Medical School, told Furby that people should examine their own medical records, and if it's been more than 10 years since the diagnosis, they should talk to their doctor about getting retested.

Blumental said: “I would want patients to think, ‘Hmm, am I really allergic to penicillin, or did my mom just tell me and it’s not really true, and should I get that evaluated?’”

Study finds non-smoking children of smoking adults 31 percent more likely to die of chronic obstructive pulmonary disease

Photo illustration from Children's Hospital of Orange County

If one or both of your parents smoked and you didn't, you are still more likely to die of chronic obstructive pulmonary disease, says a study published Thursday by the American Cancer Society. This is the first study to find a correlation between secondhand smoke and COPD, Kate Furby of the American Association for the Advancement of Science reports in The Washington Post.

The researchers followed, for more than 22 years, more than 70,000 adults who had never smoked. Those who lived in a household with a smoker while they were children were 31 percent more likely to die of COPD. It's already been established that children exposed to secondhand smoke are more likely to have asthma and other lung problems, and the surgeon general says “No amount of secondhand smoke is safe.”

It may be worse than that. “There is evidence that secondhand smoke is even more detrimental than smoking. A lot of cigarettes have filters. So it [secondhand smoke] can be more detrimental in that regard,” Geetha Raghuveer, a pediatric cardiologist at the University of Missouri at Kansas City School of Medicine, told Furby.

"The study found slight increases in other health risks," Furby reports. "The good news is that the study, while finding increased risk of death from one lung disease, did not find an association with cancer or heart disease, said Michael Eriksen," a former director of the Centers for Disease Control and Prevention's Office on Smoking and Health, who did not participate in the study. “For parents, the implication is, don't smoke at home, and don't smoke around your kids,” he said.

Telling doctors about their patients who die of overdoses makes some reduce their prescribing of opioids

Common painkillers (Photo by Rich Pedroncelli, The Washington Post)

Telling doctors that their patients have died from drug overdoses reduce the physicans' prescribing of opioids, the San Diego County medical examiner's office in California found when it sent such letters to doctors.

The effect was modest, Carolyn Y. Johnson reports for The Washington Post: "Doctors who were informed of their patients' deaths were 7 percent less likely to start new patients on opioids, and issued fewer high-dose prescriptions over the next three months, compared with those who did not receive a letter. In total, there was a 9.7 percent reduction in the total amount of opioids they prescribed," according to results published in the journal Science.

The experiment was aimed at finding a solution to the opioid epidemic that is estimated to have killed almost 72,000 people from overdoses in 2017, 1,565 of them in Kentucky -- a 10 percent increase nationally and an 11.5 percent increase in Kentucky from 2016. The synthetic opioid fentanyl was present in 68 percent of the deaths and in more than half of the Kentucky deaths.

The medical examiner's letters, sent to hundreds of doctors who had prescribed opioids in the past year, also included recommendations for safer prescribing. Johnson described the letter as "supportive, but grim." It read:

“This is a courtesy communication to inform you that your patient (Name, Date of Birth) died on (Date). Prescription drug overdose was either the primary cause of death or contributed to the death. … We hope that you will take this as an opportunity to join us in preventing future deaths from drug overdose.”

Johnson notes that the experiment addresses "the gulf between the care doctors provide and their knowledge about the consequences for patients," noting that many doctors never know when their patients die from an overdose.

“Depending on what field you're in, [the opioid epidemic] can feel a little remote. If you're not a pain doctor or a primary-care doctor, it's not quite as common to know or see your actions having a negative impact, which is what this is showing — it makes it very real," Alexander Chiu, a surgeon at Yale New Haven Hospital who was not involved in the study, told Johnson. "As evidence-based as we are as a profession, sometimes anecdotes can be really powerful."

The researchers write that prescribing may have declined among doctors because they thought they were being monitored, or because it allowed doctors to know what happens to their patients who don't return for appointments, noting that they are disproportionately exposed to patients who return for their opioid prescriptions and are uneventful.

They also note that "people rely upon knowledge that is impactful, recent and easy to retrieve from memory when judging probabilities and making decisions." For example, Johnson writes, "If a doctor learns that a few months after she prescribed 30 pills of OxyContin, a patient died of an overdose, the information may make her reconsider whether the prescription is truly necessary next time."

The researchers urged other communities to adopt this strategy, noting that medical examiners' offices already track overdose deaths and that all states (except Missouri) have a prescription drug monitoring programs. "It is thus feasible to "close the loop" on deaths by encouraging safe prescribing habits through the use of behavioral insights," the report says.

Louisville's ResCare becomes BrightSpring Health Services

Rendering of new company headquarters

ResCare, a Kentucky-born-and-based firm that provides home and community health services to about 60,000 people in 44 states, has changed its name to BrightSpring Health Services, the company announced Aug. 15.

The privately owned firm provides "clinical and nonclinical habilitative care services for people of all ages and health and skill levels, across home and community settings," its news release said. "As care preferences and health-care needs are changing, BrightSpring’s new name reflects the company’s evolution that began nearly two years ago to successfully meet the multifaceted and multidisciplinary requirements of the populations it serves amid this changing health'care landscape."

The firm is "the parent company of several brands that, in some cases, will get renamed, too," Darla Carter reports for Insider Louisville. She notes that the company plans to move into new offices on Whittington Parkway in eastern Louisville this fall.

"BrightSpring will move into its new headquarters in early November, occupying about half of the 140,000-square-foot building and housing about 360 people," Carter reports. "The company, which is owned by Toronto-based private equity firm Onex, is receiving about $550,000 in state tax incentives and grants for the building project. The development cost of the building is about $30 million and BrightSpring is investing about $15 million over the course of a multiyear lease."

BrtightSpring haS about 45,000 employees, including 1,900 in Kentucky. It was founded by Louisville accountant Ron Geary after he served as revenue secretary in the 1979-83 administration of Gov. John Y. Brown Jr. Geary retired in 2011.

UK HealthCare again named best Ky. hospital in U.S. News & World Report rankings; report has overview of most Ky. hospitals

By Melissa Patrick
Kentucky Health News

Six Kentucky hospitals have been named among then nation's "Best Regional Hospitals" in the annual rankings by U.S. News & World Report magazine.

They are, in order: the University of Kentucky hospital, Baptist Health Lexington, Baptist Health Louisville, a tie for fourth between Norton Hospital in Louisville and St. Elizabeth Healthcare Edgewood-Covington Hospitals, and Louisville's Jewish Hospital, which included evaluations of Sts. Mary and Elizabeth Hospital.

To make the list, a hospital must offer a full range of services and either be ranked nationally in one of the 12 measured specialties or have three or more high-performance specialty rankings or three or more high performance procedures and conditions rankings.

UK HealthCare, for the third consecutive year, claimed the No. 1 ranking with its Albert B. Chandler Hospital. It ranked in the top 50 hospitals nationally for diabetes and endocrinology (#33), cancer (#38), ear, nose and throat (#45) and orthopedics (#45). The hospital moved from 50th to 38th in cancer care. The hospital's Markey Cancer Center recently won its second five-year designation as a National Cancer Institute center, one of just 70 in the nation and the only one in Kentucky.

"More than 50 percent of our patients come from Eastern Kentucky and Appalachia where we have the highest cancer rates in the country," said Dr. Mark Evers, director of the center, said in a news release."With this ranking and our NCI-designation, this puts us on par with the top major cancer centers in the country and our patients should feel comfortable that they don't need to go anywhere else to receive the highest quality care."

Among specialties, UK received a "high performing" rank in geriatrics, nephrology (kidneys), neurology and neurosurgery, pulmonology (lungs) and urology.

The rankings, now in their 29th year, compared more than 4,500 medical centers across the country in 25 specialties, procedures and conditions. Kentucky has more than 120 hospitals.

Baptist Health had two of the state's top three, with its main Lexington hospital ranking second and the one in Louisville ranking third. This is the sixth time in seven years that the Louisville hospital has been either No. 1 or tied for No. 1, according to a Baptist Health news release.

“This national recognition confirms what our patients tell us – that Baptist Health hospitals provide the very best of care,” Baptist Health CEO Gerard Colman said. “These rankings also illustrate the daily commitment of our physicians, nurses and staff to live out our mission of leading in clinical excellence, compassionate care and growth to meet the needs of our patients.”

The report also recognizes hospitals that are "high performing" for nine common adult procedures and conditions, including: abdominal aortic aneurysm repair, aortic valve surgery, chronic obstructive pulmonary disease, colon cancer surgery, heart bypass surgery, heart failure, hip replacement, knee replacement and lung cancer surgery.

Baptist Health Lexington was ranked high performing in all of the categories except COPD, for which it received an average rating. Baptist Health Louisville ranked high performing for all except COPD and lung cancer surgery, in which it was ranked average.

UK HealthCare ranked high performing for six specialties: colon-cancer surgery, heart-bypass surgery, heart-failure treatment, hip replacement, knee replacement and lung-cancer surgery. Norton also ranked high for six: abdominal aortic aneurysm repair, COPD, colon-cancer surgery, heart-failure treatment, hip replacement and knee replacement.

St. Elizabeth Healthcare, was listed as high performing for aortic heart-valve surgery, COPD, colon-cancer surgery, heart-failure treatment, hip replacement and knee replacement.

Jewish Hospital was ranked high performing for COPD, heart failure and lung cancer surgery.

Norton Children's Hospital in Louisville was also recognized for being nationally ranked (#49) for its pediatric diabetes and endocronology program.

The report offers an overview of more than 100 Kentucky hospitals with a breakdown of each of the measured categories, as relevant to the services the hospital provides. Click here for more information on how the magazine ranks the hospitals.

Nationally, the Mayo Clinic in Rochester, Minn. claimed the No. 1 spot for the third year in a row on the Best Hospitals Honor Roll. The Cleveland Clinic ranked No. 2, followed by Johns Hopkins Hospital in Baltimore, according to the magazine's news release.

Nominations are sought by Sept. 7 for award recognizing lifetime contributions to rural health in Kentucky

Since 2003, the Kentucky Rural Health Association has awarded an individual with an award for their lifetime contributions to rural health in Kentucky. The award is named for its first recipient, Dr. Dan Martin of the Trover Foundation in Madisonville.

Last year's recipient was Loretta Maldaner, who had served in rural health for over 25 years before retiring in 2016 from her  position as director of the Purchase Area Health Education Center.

The Dan Martin Award is given to an individual who has provided many years of service to rural health, whether that be in the area of patient care, health professions education, health administration, health promotion or public advocacy.

KRHA is seeking nominations for this year's award. To nominate someone, download the nomination form here and e-mail it directly to esnodgrass@lhhs.org or mail it to the attention of Elizabeth Snodgrass at Livingston Hospital, 131 Hospital Dr., Salem, KY 42078. The deadline for nominations is Friday, Sept. 7.

The award committee ranks the candidates using established criteria, makes a recommendation to the KRHA Executive Committee, which then select the 2018 honoree, if someone is deemed appropriate.

The award will be presented at the KRHA Annual Conference Nov. 15-16 in Bowling Green. Any KRHA member who would like to serve on the Dan Martin Award Committee should e-mail
esnodgrass@lhhs.org.

"There are many dedicated, compassionate people at work in rural health in Kentucky and we look forward to being able to give them some well-deserved recognition," Snodgrass says. "Now is your chance to help us thank someone that you think deserves recognition. We need and appreciate your input."

Louisville doctor has possible cure for rare brain disease of Iranian woman, who gets visa after CJ story

UPDATE, Aug. 13: "U.S. officials in Armenia granted Marzieh Taheri, 61, the exemption on Monday, just hours after her son sent them links to the Courier Journal's initial article about her plight and subsequent coverage by other media," the CJ reports.

A Louisville doctor has found what may be the first treatment to repair a rare, debilitating brain condition that can eventually lead to death, and has said he would treat a 61-year-old woman from rural Iran who needs it, but she's from a country that's on the U.S. travel restriction list and her visa application is jumping through hoops, Caitlin McGlade reports for the Louisville Courier Journal.

Marzieh Taheri and son Mehran Jafari
 (Photo provided to Courier Journal)

Marzieh Teheri suffers from a condition called radiation necrosis, which developed after she received treatment for a tumor on her ear about three years ago. McGlade reports that the tumor is gone, but because of a condition that affects 10 percent of patients who get radiation therapy on their heads, brain tissue has died, which has "distorted her brain." Until recently, there has been no hope of a cure.

But that changed after Dr. Shervin Dashti, a neurosurgeon at Norton Healthcare, recently found what may be the first treatment to repair the brain indefinitely without any side effects, McGlade reports.

Dashti told McGlade that it's like half of Taheri's brain is "on fire." He has offered to treat her at the Norton Neuroscience Institute, but won't be able to until the U.S. government approves her visa.

The Trump administration set travel restrictions on people from Iran, North Korea, Venezuela, Libya, Syria, Somalia and Yemen that were upheld in June by the U.S. Supreme Court. The administration says the restrictions are needed to be able to properly vet people from these countries trying to enter the U.S.

McGlade reports that on a case-by-case basis, "People traveling to the U.S. from these countries may get waivers if they can show that denying the visa application would cause them 'undue hardship,' that they are not a threat to the United States, and that their visit would be in the U.S. national interest, according to a September 2017 White House proclamation."

The State Department "asked Taheri to list every country she traveled to in the past 15 years, detailing where she stayed, specific locations visited, how she paid for it and length of visit.The office also asked for previous passport numbers; names and birth dates of all immediate relatives; a list of her addresses for the past 15 years; all phone numbers, email addresses, social media accounts, including messaging apps; and her job history. Her daughters compiled and sent a mountain of documents."

Taheri told McGlade that she is optimistic she'll get a waiver, since the proclamation cites urgent medical care as grounds for eligibility. However, McGlade reports that critics call the restrictions discriminatory because most of the countries on the list are Muslim-majority, and Trump said he wanted to ban Muslims during his campaign.

Dissenting Supreme Court Justice Stephen Breyer has also questioned the waiver program's legitimacy, "citing the small number of waivers granted, lack of transparency and a sworn affidavit from a former consular officer who called the process "window dressing,"" McGlade reports.

A lawsuit has also been filed this year by dozens of people impacted by the ban asserting that the "government is denying or stalling virtually all waiver grants and hasn't given consular officials discretion to grant them," McGlade writes.

McGlade writes that the agencies have yet to file formal responses, but a State Department website disputes that claim. It notes that 1,246 visa applicants have been cleared for waivers as of July 31, 2018.

McGlade reports that the State Department won't say how many of the current visa applicants are from the affected countries, but a June letter to Sen. Chris Van Hollen, D-Maryland, said they had approved waivers for just 2 percent of applicants from Muslim-majority countries in the ban.

"Out of 27,129 applicants who could possibly get a waiver, only 579 had been cleared as of April 30," she reports.

Taheri applied for her visa in June. Dashti told McGlade that everyday Taheri gets weaker, and that she is "circling the drain."

"It is agony to place my faith in a process that I know might be fraudulent, but I have no choice," wrote her son, Mehran Jafari, who now lives in Georgia. "My mother’s life could be saved by 30 minutes of surgery, and I must do everything in my power to get her to Louisville."

He added, "I don't know how my 60-year-old mom who was in the United States three years ago can pose a national security threat. If someone like my mom can pose a threat . . . how safe do Americans feel now? If a 60-year-old kind-of disabled woman can jeopardize your safety . . . this is just not America."

'Drug dealer with a medical license' gets 50 months in prison

A Simpson County doctor has been sentenced to four years and two months in federal prison after being convicted of 15 counts of improper prescribing to patients who died of overdoses. Roy D. Reynolds, 69, was also fined $25,000.

Dr. Roy Reynolds
Grayson County Detention Center photo

Reynolds practiced for more than 30 years in Franklin "before closing his office in 2015 while under investigation," Bill Estep reports for the Lexington Herald-Leader. "Attorneys for Reynolds described him in court documents as a pillar of the community, a family man and Christian who pushed for improvements in local medical care and devoted his career to serving patients. Prosecutors, however, said Reynolds doled out prescriptions for painkillers called opioids, and for anti-anxiety drugs, to patients despite red flags about possible abuse," such as knowledge that his patients were doctor-shopping for drugs. They said one patient overdosed five times but care but Reynolds giving her prescriptions.

Reynolds prescribed 139,667 oxycodone pills in 2012. The second most by a primary-care doctor in the county was 11,794. Reynolds “became a drug dealer with a medical license,” Russell Coleman, U.S. attorney for the western half of Kentucky, said in a news release.

UK Markey Cancer Center named national cancer center for 5 more years; director pledges to halve Ky.'s cancer rate in 10

By Melissa Patrick
Kentucky Health News

Kentucky leads the nation in the percentage of residents who get cancer and those who die from it, and the University of Kentucky Markey Cancer Center is pledging to cut those rates in half in the next five to 10 years.

Dr. Mark Evers speaks Aug. 10 about
the UK Markey Cancer Center's 5-year
renewal of National Cancer Institute
status. (Photo by Melissa Patrick)

"This goal for reducing cancer rates in our state will not be easy, but big, bold goals are what Kentucky needs," Mark Evers, director of the center, said at an Aug. 10 news conference at the UK Chandler Hospital.

The numbers are grim. An estimated 26,000 Kentuckians are newly diagnosed with cancer each year, and about 11,000 of them will die from it, according to the American Cancer Society.

There are bright spots. "In the past five years, Kentucky’s colon cancer rate has gone from first in the country to fifth, and lung cancer rates appear to be going down." Linda Blackford reports for the Lexington Herald-Leader. "There’s still a long way to go, but Evers says he’s optimistic."

“If we can move the needle so we’re no longer number one, that would be huge for Kentucky,” Evers told Blackford. “That would be a sea change for Kentucky. It’s all about changing the culture.”

Kentucky has a strong tobacco heritage, and a new report from the American Cancer Society says the state is doing poorly when it comes to policies to fight cancer, especially those related to tobacco. The report says Kentucky is "falling short" in the areas of smoke-free laws, tobacco-prevention funding, and indoor tanning device restrictions; and offers "no funding" for breast and cervical cancer early detection.

"The fact is most of Kentucky's biggest cancer killers, lung, colon and cervical cancers, are largely preventable," he said.

Asked if it would be possible to meet the goal of cutting cancer rates in half without cutting the state's smoking rates, Evers said that while smoking cessation is a "huge priority," he added that prevention "runs the whole gamut" and must also include efforts to decease colon and cervical cancers.

Smoking causes about one-third of all cancers in Kentucky and Kentucky has the second highest smoking rate in the nation, 24.5 percent.

The news conference was held to announce that the Markey center has won its second five-year designation as a National Cancer Institute center, one of just 70 in the nation and the only one in Kentucky.

The NCI renewal includes a grant of nearly $11 million for research, recruitment, screening, education and clinical trials.

Evers said that since the center's first designation in 2013, the center's affiliate network has grown from eight sites to 20, and that now nearly 60 percent of the state's new cancer cases are either directly or indirectly treated by the center. This increase allows Kentuckians to be treated closer to their homes.

Among a long list of accomplishments, a center fact sheet says NCI research funding has increased 24 percent in the past year and that one-third of Markey's research projects focus on cancer disparities in the Appalachian region of the state, where cancer rates are often the highest.

Evers said that while most of the NCI funding will be used to support "translational clinical research," there is also money allotted to work on significant preventive measures around smoking cessation, colon cancer screenings and human papillomavirus vaccinations, which is known to cause cervical cancer.

"Kentuckians have suffered far too much from the enormous burden of cancer," Evers said. "We at Markey are determined to conquer cancer in the Commonwealth."