Ky. has one of 5 highest death rates in U.S.; UK public-health dean calls it most 'comprehensive, inclusive' measure of health

Kentucky is one of the top five states for the highest death rates, according to a new study that compared mortality patterns between the five states with the highest and lowest death rates.

Donna Arnett, dean of the University of Kentucky College of Public Health, in an e-mail called death rates the most "comprehensive, inclusive" measure of overall health status.

Kentucky was joined by Alabama, Mississippi, Oklahoma and West Virginia for the five states with the highest death rates. California, Connecticut, Hawaii, Minnesota and New York were the five states with the lowest death rates.

It's no secret that Kentucky struggles in just about every area of health, ranking 49th in senior health and 45th in adult health, according to the latest America's Health Ranking Report. And even in areas where the state has made some progress, such as cancer screening, outcomes are still pretty dismal. So it should come as no surprise that the state ranks high in death rates.

Using 2017 data, the Centers for Disease Control and Prevention study compared the average age-adjusted death rates by sex, race and ethnicity, as well as the five leading causes of death between each group of states. Age specific death rates were given as well.

Click on any chart to see a larger version

It found that the average age-adjusted death rate for the five states with the highest rate (926.8 deaths per 100,000 people) was 49 percent higher than the overall rate for the five states with the lowest death rates (624 per 100,000).

Compared to the national average of 731 deaths per 100,000 people, the average death rate for the states with the highest rate was 27% higher, while the average death rate for the states with the lowest rates was 15% lower.

The death rates for ages 25-34 and 35-44 for the states with the highest death rates were more than double compared with the states with the lowest rates. The smallest percentage difference in rates was for persons aged 85 and older.

The average age-adjusted rates were 39% higher for whites and 32% higher for blacks in the five states with the highest death rates compared to the five states with the lowest rates, but they were 27% lower for Hispanics.

Among states with the highest death rates, average age-adjusted death rates were 46% higher for heart disease; 29% higher for cancer; and 39% higher for stroke, compared to the states with the lowest rates. Rates for chronic lower respiratory disease were double and unintentional injuries were nearly double in the highest death rate states compared to the states with the lowest rates.

Lexington man's lawsuit says Juul Labs leads users of its devices to become addicted to nicotine; company says suit 'without merit'

A 25-year-old Lexington man is suing the leading maker of electronic cigarettes, accusing it of deceptive advertising and marketing that leads users become addicted to nicotine. He seeks to expand the suit to a class action including other “similarly situated” Kentucky consumers, including minors, Morgan Eads reports for the Lexington Herald-Leader.

Juul Labs told the newspaper, “This case is without merit and we will defend our mission. Juul Labs is committed to eliminating combustible cigarettes, the No. 1 cause of preventable death in the world.”

The lawsuit was filed by John McFaull, who says he used dip tobacco in 2018, and started using Juul in an effort to “reduce his nicotine intake,” the suit claims. "He had seen advertising for the product, but he did not realize the actual amount of nicotine that the pods contained," Eads writes. "Rather than weaning him off of nicotine, the Juul pods made McFaull more addicted, according to the suit."

Juul said in its statement that their product has never been marketed as a way to stop consuming nicotine. “The Juul system is designed to help adult smokers switch from combustible cigarettes to an alternative nicotine delivery system and is not intended to be used as a nicotine cessation product, or for the treatment of nicotine addiction or dependence,” it said. “Switching is not another word for cessation. They mean two very different things.”

"The lawsuit also names Pax Labs, which developed the Juul e-cigarette, as a defendant," Eads reports. "The lawsuit accuses the company of aiming its marketing at young people with a focus on social media, and advertising that aligns Juul’s products with “social inclusion, sexual attractiveness, thinness, popularity, rebelliousness, and being 'cool'."

State offers new website that links to addiction and recovery resources, including treatment and stories of hope

By Melissa Patrick
Kentucky Health News

Kentucky state government has a new, user-friendly website called "Hope and Help" that brings addiction and recovery supports into one place to help Kentuckians struggling with addiction.

"We want every family in the commonwealth to know hope and help is available through these resources," Justice Secretary John Tilley said in a news release. "Recovery is possible, and it's happening every day across our state."

Tilley was speaking at the Sept. 16 Walk for Recovery event in Frankfort, where Gov. Matt Bevin announced the website to the more than 300 people who walked.

The initiative was created by the governor's office and the Kentucky Justice and Public Safety Cabinet's Office of Drug Control Policy.

One recovery resource linked on HopeAndHelpKY.com is the the FindHelpNow Treatment Locator, a free service that provides near real-time access to Kentucky-based addiction treatment providers that are accepting clients.

It also includes the number for the KY HELP Statewide Call Center, which is available Monday through Friday from 8:30 a.m. to 5:30 p.m. ET. This center allows a person seeking treatment for themselves or others to call 8338-KY-HELP (1-833-859-4357) or text HOPE to 96714 to confidentially speak with a specialist about available treatment services.

The Kentucky State Police Angel Initiative, which allows individuals battling addiction to come to any of the KSP's 16 posts throughout the state to get help, no questions asked, is also included.

In addition, it links to a site that shows where to locate Naloxone, which is a drug that can reverse an opioid overdose, and a site to locate drop boxes for unwanted prescriptions.

Three Kentuckians are also featured on the "Stories of Hope" page in short videos that tell their stories of recovery. Jason Roop of Campbellsville, who is featured in one of the videos, says, "Don't give up! The next chapter is the most beautiful."

The site doesn't yet link to is the Cabinet for Health and Family Service's syringe exchange website, which shows the location, address and operating hours of the state's 63 operating syringe exchange programs that are located in 56 counties, as of Sept. 12. Three more have been approved, but are not yet operational.

Syringe exchange programs, also called harm reduction programs, are meant to slow the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They also provide health screenings and vaccines and connect people who use drugs to treatment. It is often cited that injection drug users who have access to syringe exchanges are five times more likely to get treatment than those who don't.

Elizabeth Kuhn, the governor's communications director, said in an e-mail that they are working with the health cabinet to add to the website information about several of its key initiatives to combat the drug epidemic, including the harm reduction program and the Kentucky Opioid Response Effort.

Kentucky has aggressively worked to crack down on the opioid epidemic that has plagued the state, and the annual ODCP report offered some hope that those efforts are working, finding that Kentucky had a nearly 15 percent drop in overdose deaths between 2017 and 2018, which was almost three times the national decline of 5.1%.

“We must build on our momentum and continue to spread the word,” drug-policy office Director Van Ingram said in the release. “We want to empower every Kentucky citizen with the knowledge and resources to combat this crisis within the home and on the ground. Hope is here and we are ready to help.”

New Children's Health Coalition will advocate 'policies, programs and practices' to improve the health of Kentucky's kids

By Melissa Patrick
Kentucky Health News

Kentucky has a new, statewide coalition to work on improving children's health in school settings.

It was established by the Foundation for a Healthy Kentucky, in partnership with Kentucky Voices for Health and Cairn Guidance, an education and school-health consulting company.

Ben Chandler

The coalition will work to promote policies, programs and practices that are shown to make measurable differences in children's health, Foundation President and CEO Ben Chandler told more than 100 people at the coalition's foundational meeting in Lexington Sept. 10.

 "Children and youth spend a large portion of their lives in schools during the ages when there are critical and rapid changes to their brains and their bodies," Chandler said. "That makes school a key setting in which both health and education outcomes can be achieved."

Chandler added, "Schools also offer a setting to address health and education inequities, and to offer children and youth the opportunity to foster their strengths, their resiliency and certainly their potential.Therefore, policy advocacy focusing on children's health in a school setting can bring about important changes to both health and education."

Kentucky ranks 34th in the overall well-being of its children in the latest Kids Count Data Book, which uses 16 measurements. Nearly one in four Kentuckians are children.

After the keynote speaker, Jamie Sparks,executive director of the Kentucky Association for Health, Physical, Education, Recreation & Dance, gave a synopsis of the history of education, the bulk of the day was spent in break-out sessions where participants worked to develop a vision for the coalition and to identify its strengths, problems, opportunities and threats.

Recurring themes from the break-out sessions were: the importance of communication; the importance of including a youth voice; the need for shared goals; issues of funding and sustainability; the need to create measurable goals; the importance of data collection; and the importance of minimizing duplication by working with other coalitions that focus on children's health.

State Rep. Kim Moser

State Rep. Kimberly Moser, chair of the state House Health and Family Services Committee, wrapped up the day-long meeting, speaking about a number of laws that affect children -- including the recently passed School Safety and Resiliency Act, which among other things calls for more school-based mental health providers, and the tobacco-free schools bill, which she sponsored. Moser said she plans to again file a bill to increase physical education requirements in schools.

"My hope is this diverse coalition will be able to find common policy goals and build the support needed to adopt them," Moser said in the news release.

Emily Beauregard, executive director of KVH, spoke about the power of working together in a coalition, which she said will afford them the ability to make bold policy changes to improve the health of the state's children.

"I also think this is an opportunity for us to reduce disparities," she said. "By having a statewide coalition [and] bringing everyone together around the table, we can really start to look at where the disparities lie and what we can be doing together to reduce those disparities and bring more equity to the lives of kids in Kentucky."

After the meeting, Amalia Mendoza, lead staff from the foundation to the new coalition, said one of the goals of the coalition is to raise awareness about the importance of children's health in Kentucky and the importance of approaching it holistically.

We want to "reinforce local coalitions while at the same time move forward with policies, practices and programs at the state level," Mendoza said. "We have so many chronic disease problems that we forget that if we really want to stop them down the road and stop them from magnifying, we have to start working with kids more. . . . as young as possible and as early as possible."

For more information about the coalition, contact Mendoza at amendoza@healthy-ky.org or call 502-326-2583.

Neva Francis named the latest Healthy Kentucky Policy Champion for her efforts to improve community health

Neva Francis

The Foundation for a Healthy Kentucky has named Neva Francis of Lexington the latest Healthy Kentucky Policy Champion for her career-long commitment to improving community health.

Francis is vice president for healthy communities at CHI Saint Joseph Health, part of KentuckyOne Health.

"Neva understands that there are a multitude of factors that define health and wellness for each unique person and community," Jane Chiles, former board chair of CHI Saint Joseph Health, said in a foundation news release.

One program Francis has led during her more than 40 years as a registered nurse is the "Total Health Roadmap" project, supported by The Robert Wood Johnson Foundation and Catholic Health Initiatives. It has engaged community partners in Laurel, Madison and surrounding counties to serve more than 8,000 residents after they first underwent a screening to assess whether their basic human needs were being met, said Chiles.

In addition, Francis leads various diabetes and nutrition education programs, as well as efforts to reduce hospital re-admissions for chronic diseases throughout the state. She has also worked to prevent violence, substance use and impaired driving, especially among youth and young adults around key milestones in their lives, such as prom and graduation.

Elizabeth Wendeln, a KentuckyOne Health board member, said Francis actively works on the organization's community-needs assessment. "Neva traveled to the counties to get firsthand information on the systemic causes of any particular need," goes to Frankfort as an advocate and also educates and activates board members to "be a voice for the people in influencing policies particularly regarding health in the state of Kentucky," she said.

Francis, along with other winners of the award, is eligible for the Gil Friedell Health Policy Champion award, which comes with a $5,000 grant from the foundation to a Kentucky-based nonprofit of the winner's choice. The winner will be announced at the foundation's annual health policy forum Sept. 23 in Lexington.

Six Kentucky health centers awarded more than $1.7 million in first-of-their-kind grants to be used for oral health infrastructure

Six health centers in Kentucky have received more than $1.7 million in competitive federal grants to be used toward improving oral health.

The Health Resources and Services Administration awarded over $85 million to 298 health centers as part of its Oral Health Infrastructure program.

The six in Kentucky and their headquarters towns are: Cumberland Family Medical Center in Burkesville, Big Sandy Health Care in Prestonsburg, Healthfirst Bluegrass in Lexington, Healthpoint Family Care in Covington, Shawnee Christian Healthcare Center in Louisville and Pennyroyal Healthcare Service in Princeton. All got $300,000 except Pennyroyal, which got $226,345.

A news release from Department of Health and Human Services the says the money can be used for things like "minor alteration and renovation to modernize existing facilities, purchase and installation of dental and radiology equipment, training and consultation to increase oral health integration, and purchase of mobile dental units to increase access to oral health care."

"These are the first awards HRSA has ever made solely for health centers’ oral health-care infrastructure, and they will support better access to oral health services in communities across the country, including under-served urban and rural areas," HHS Secretary Alex Azar said in the release.

Cumberland Family Medical Center plans to use its grant money to purchase portable equipment for its school-based health centers, which provide preventive oral health care to its students, according to a separate news release from Senate Majority Leader Mitch McConnell. The release notes that McConnell contacted HRSA on behalf of the center, which has more than 25 locations.

"We applaud Senator McConnell's efforts to ensure that we and other community health centers can continue to provide high quality care to patients who need it the most," Tracey Roy Antle, the center's chief operating officer, said in the release.

Nominations are sought by Friday, Sept. 20. for award recognizing lifetime contributions to rural health in Kentucky

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

The Dan Martin Award is given to someone who has provided many years of service to rural health, whether in patient care, administration, health-professions education, health promotion or public advocacy.

The rural heath association is seeking nominations for this year's award. To nominate someone, download the nomination form here and e-mail it directly to ashley.gibson@st-claire.org or mail it directly to the attention of Ashley Gibson at 316 W. 2nd St. Suite 202,  Morehead, KY 40351. The deadline is Friday, Sept. 20. Any KRHA member who would like to serve on the awards committee should e-mail Gibson.

The committee ranks the candidates using established criteria and makes a recommendation to the KRHA Executive Committee, which selects the honoree, if someone is deemed appropriate. The award will be presented at the KRHA annual conference Nov. 14-15 in Bowling Green.

"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," Gibson said. "Now is your chance to help us thank someone that you think deserves recognition. We need and appreciate your input."

Ky. River District Health Department director named a Ky. health policy champion for helping pass Perry County's smoke-free law

Scott Lockard

The Foundation for a Healthy Kentucky has named Public Health Director Scott Lockard of the Kentucky River District Health Department its latest Healthy Kentucky Policy Champion for leading the team that helped Perry County enact a smoke-free workplace ordinance.

Perry is the first county in Eastern Kentucky to go smoke-free, and one of only six that have a comprehensive law that includes all workplaces and enclosed public places.

"Scott and his team showed patience, persistence and a determination to do the legwork to get the right policy passed in Perry County," Fran Feltner, director of the Hazard-based University of Kentucky Center for Excellence in Rural Health, said in a foundation news release. "This law will greatly reduce the exposure to secondhand smoke for all residents of the county, and may also reduce the smoking rates."

The Perry County Fiscal Court passed the ordinance June 18 and it went into effect immediately. It bans smoking and use of e-cigarettes in all indoor and outdoor workplaces, and indoor public places.

The health department worked closely with Shannon Smith, state director of government relations for the American Heart Association, to educate the community and Fiscal Court members about the health benefits of the ordinance, the release says.

"With the help, guidance and support of Scott and his team, especially Sherrie Stidham, we were successful in building the powerful partnerships needed to pass this ordinance, which is backed by many health organizations and citizen advocates," Smith said.

Following passage of the ordinance, the county seat of Hazard strengthened its smoke-free policy to mirror the countywide law.

Lockard and the health department, along with other winners of the award, are now eligible for the Gil Friedell Health Policy Champion award, which comes with a $5,000 grant from the foundation to a Kentucky-based nonprofit of the winner's choice. The winner will be announced at the foundation's annual health policy forum Sept. 23 in Lexington.

Adult obesity in Ky. reaches all-time high of 36.6%, fifth in U.S.; doctor says insurance needs to start covering obesity prevention

By Melissa Patrick
Kentucky Health News

Kentucky adults just keep getting larger, reaching an all-time high for the number of obese adults in the state, ranking it fifth in the nation.

"As a society, as a whole, we're not quite convinced yet what a major problem this is," said Dr. Barbara Fleming-Phillips, an internist who helps run the weight management clinic at UK Healthcare's Barnstable Brown Diabetes Center.

Kentucky's adult obesity rate in 2018 was 36.6 percent, according to an annual report by Trust for America's Health and the Robert Wood Johnson Foundation. That's an increase of 6.7% , and 2.3 percentage points, from last year's rate of 34.3%, eighth highest in the nation.

The report says Mississippi and West Virginia have the highest rates of adult obesity, at 39.5%, and Colorado the lowest at 23%.

That said, all the state rates could actually be higher, says the report, since their numbers are based on the Behavioral Risk Factor Surveillance System, a continuous national poll; people self-report, and tend to over-report their height and under-report their weight. Obesity is calculated through body mass index, essentially a ratio of height to weight.

Supporting that theory, the national adult obesity rate is 39.6%, which comes from actual body measurements from the National Health and Nutrition Examination Survey.

The report for Kentucky shows that 68.5% adults in the state are either obese or overweight.

"Clearly things are going in the wrong direction in Kentucky just as they are in the rest of the country," said Fleming-Phillips. "And it's really a systemic, overall-society problem; it's not just a matter of counseling individual people on weight loss, which we do with my job, but it's a matter of looking at the entire system."

Strategies to combat obesity

Fleming-Phillips said it will take a "multi-pronged approach" to tackle excessive weight in Kentucky and the nation. She said that from her clinical experience, the most important contributor to weight loss is the diet, but added that exercise is definitely a component.

Nutritional education is needed in childhood, but adults also need nutrition education that teaches them to choose "real foods" over convenient, processed foods, Fleming-Phillips said.

As for exercise, she said because we are such a sedentary society with sedentary jobs, exercise must become a habit early on in a person's life; otherwise they will have to decide it is important.

Kentuckians don't exercise much. The report says Kentucky ranks No. 1 in the share of adults who say they are physically inactive: 32.3%.

The state also recognizes the need to focus its obesity efforts on children. That's because a child who is overweight when they start kindergarten is three times as likely to become obese by middle school compared to their peers, Christina Dettman, spokeswoman for the Cabinet for Health and Family Services, said in an e-mail.

For example, she said the State Physical Activity and Nutrition Program works to increase breastfeeding in birthing facilities, since studies show children who have been breast-fed are less likely to be obese. The program also works to implement healthy-food guidelines in work and community settings; to integrate nutrition and physical-activity standards into early-care and education systems; and to improve sidewalks, paths and bicycle routes throughout the state.

Dettman added that Kentucky has received a federal grant that can be used for evidence-based strategies at the local level to improve nutrition and physical activity. It will be allocated to 11 community health departments in Eastern and Western Kentucky. They include health departments in the Purchase District, Pennyrile District, Kentucky River District, the Cumberland Valley District, and Muhlenberg, Todd, Calloway, Christian, Pike, Floyd and Whitley counties. According to the Centers for Disease Control and Prevention, the grant is for $856,326.

The report notes that obesity levels are closely tied to social and economic conditions, finding that those with lower incomes are at higher risk of being obese as are people of color.

The obesity rate for blacks in Kentucky is 39.3%; for Latinos it is 30.9%; for whites it is 35.2%. About the same number of men and women are obese.

Baby boomers have the highest obesity rate at 43.8%, followed by those between the ages of 25 and 44 at 40%, seniors at 30.8% and those between 18 and 24 at 18.5%.

The report includes 31 recommendations for policy actions that are largely designed to improve access to nutritious foods, provide safe places for physical activity and to minimize the harmful marketing and advertising tactics that currently exist.

A few examples of its recommendations include the expansion of the Special Supplemental Nutrition Program for Women, Infants and Children to age 6 for children and for two years after birth for mothers, fully funding the WIC Breastfeeding Peer Counseling Program and taxing sugary drinks.

The push to expand WIC services is supported by an obesity decline seen in 31 states among 2- to 4- year-olds enrolled in the program between 2010 and 2014. Kentucky, with a decline of 18.2% to 13.3% respectively, was one of those states.

That said, Kentucky's older children haven't fared so well, with those between the ages of 10 and 17 having the third highest obesity rate in the nation, at 19.3%. And just like the state's adults, obesity rates among Kentucky's high school students continues to creep up and at 20.2% this group also ranks third in the nation for this measure.

Charts from report show figures from earlier years about childhood obesity in Kentucky, by age group

The latest Kentucky Health Issues Poll that asked about childhood obesity found that 56% of Kentucky adults saw childhood obesity as a serious problem for the state; another 35% said it was a problem, but not serious; and 6% saw it as no problem at all.

Obesity treatment and insurance

The American Medical Association recognized obesity as a disease in 2013, with hopes that the designation would change the way the medical community treats obesity, including how insurance companies would pay for the treatment.

But that has not happened, Fleming-Phillips said. Dedication to nutritional education and obesity prevention is still not a priority "anywhere in the medical system," she said.

"It's kind of baffling that obesity has been declared a disease -- and obviously there is a giant problem with obesity -- but insurance companies are not paying for obesity education and prevention or even treatment of the disease, medical treatment of the disease of obesity," she said.

The report also addresses coverage for obesity prevention, saying that while the law requires most insurance plans to cover preventive services, "there is great variability of actual implementation or uptake of these recommendations across insurers."

Chart from report shows the diabetes rate in Kentucky is up.

Being overweight or obese greatly increases the risk of developing other chronic diseases, like type 2 diabetes, high blood pressure, heart disease, stroke, and many types of cancer -- all conditions that plague Kentucky. Obesity is estimated to increase national healthcare spending by $149 billion annually, says the release.

About 14% of Kentucky's adults reported having diabetes, ranking the state seventh highest for this measure, and 39% of them reported having high blood pressure,which put the state at No. 5, the same rank it has for adult obesity.

State investigating 3, probably 5, cases of e-cigarette lung illness

The state Cabinet for Health and Family Services is investigating three cases, and two probable cases, of a lung illness linked to electronic cigarettes "that has rapidly spread across the country, killing six," Bailey Loosemore reports for the Louisville Courier Journal.

Products at Derb E Cigs (Courier Journal photo by Bailey Loosemore)

Cabinet spokeswoman Christina Dettman "said she could not say where the local cases were reported or provide additional information about who got sick," Loosemore reports.

At least 380 confirmed and probable cases of the illness have been reported in 36 states. The Centers for Disease Control and Prevention has not determined its cause but says "most patients have reported a history of using e-cigarette products containing THC," tetrahydrocannabinol, the psychoactive ingredient in marijuana.

"Local health advocates, however, say e-cigarettes still contain nicotine and other toxins that can be harmful to health, and a ban could prevent young users from developing future issues," Loosemore notes. On the other hand, a leading dealer of e-cigs in Louisville, Troy LeBlanc of Derb E Cigs, told the CJ they shouldn't be blamed because "It's all street-level drugs that are causing the illnesses."

LeBlanc told Loosemore that the Trump administration's announcement that it would ban all flavorings in e-cigs except tobacco would "create the largest black market the country's ever seen since Prohibition." She writes, "LeBlanc said the removal could also end up encouraging vaping users to purchase more black-market oils or to return to smoking traditional cigarettes that are proven to be harmful to health."

Reported $12 billion settlement by Purdue Pharma prompts Bevin to try to associate Beshear with state's much smaller settlement

Republican Gov. Matt Bevin spoke to Democratic Attorney General Andy Beshear, as Democratic Secretary of State Alison Grimes seemed to react, before Bevin addressed the state legislature. (Photo by Michael Reaves, Cincinnati Enquirer)

Reports that Oxycontin maker Purdue Pharma will pay $12 billion to settle many other states' claims of damages from the opioid epidemic has brought fresh attention to Kentucky's settlement for 2 percent of that amount in 2015.

The $24 million deal was struck by Democrat Jack Conway, then the state's attorney general, who had just lost the November 2015 governor's election to Republican Matt Bevin. (The suit had been filed in 2007 by Democrat Greg Stumbo, who said it could result in a settlement of $1 billion.)

Meanwhile, Democrat Andy Beshear had been elected attorney general, and after taking office in January 2016 he approved a retroactive $4 million contract for work on the case by a Louisville firm that later made Conway a partner.

While he was a candidate, Beshear was at partner at another law firm, which represented Purdue Pharma in the case. He has said he had no direct involvement in it, but now he is running for governor against Bevin, who went after him in an official statement issued by his office Sept. 11, soon after reports of the possible $12 billion settlement.

"It’s a tragic day for the thousands of Kentucky families who have suffered heart-wrenching pain from the scourge of the opioid epidemic," Bevin said. "I am deeply troubled that Kentucky is forced to stand helplessly by, as more than 20 states and nearly 2,300 local governments across the country receive a historic settlement."

Bevin alleged that Conway and Beshear's law firm "struck a corrupt deal, ensuring that Purdue would be let off the hook by paying only $24 million to Kentucky, even though our state was one of the first and hardest hit by opioids." Noting the retroactive contract, he said, "This crooked deal is one of the biggest frauds ever committed on Kentuckians."

Beshear campaign spokesman Sam Newton replied, "Andy Beshear has been the most aggressive attorney general in the country when it comes to taking on the big drug companies that poisoned our communities and killed our neighbors." He added that it was "shameful" for Bevin to use his office to make "a patently false political smear about something that happened before Andy ever took office."

As attorney general, Beshear has filed nine lawsuits against drug companies for their roles in the epidemic. "Beshear famously walked out of a committee hearing in October 2017 after being grilled by legislators about whether he had anything to do with the $24 million settlement, Phillip Bailey writes for the Louisville Courier Journal.

Earlier that year, Beshear told reporters, "I wasn't a named counsel on that, and I don't recall doing any work on it. I was there a long time; I don't want to suggest that no one asked me a question about what General Conway was like or not like, but I was not an active participant in that case."

Bailey notes, "Kentucky's rate of opioid-involved deaths was 27.9 per 100,000 people, which was almost twice the national average, according to the National Institute of Drug Abuse."

Legislator questions state loan of $50 million to U of L for Jewish Hospital, notes at-risk rural hospitals don't get similar support

U of L Health CEO Tom Miller spoke
at the meeting. (Photo by Melissa Patrick )

By Melissa Patrick
Kentucky Health News

Kentucky lawmakers asked a University of Louisville official why the state should loan U of L $50 million to help it buy financially distressed Jewish Hospital, suggesting the state was picking "winners and losers" since many rural hospitals are in the red and the state isn't helping them out.

At the Sept. 9 Medicaid Oversight and Advisory Committee meeting, Sen. Stephen Meredith, R-Leitchfield, the co-chair, called the state loan "precedent setting." Meredith said he appreciated the desire to maintain the safety-net hospital, but some rural hospitals are experiencing similar plights.

He pointed to Pineville Community Healthcare in Bell County, which recently sold in a bankruptcy auction.

"Are we picking winners and losers when we participate in these kind of efforts?" he asked. "I guess very simply: Why should we spend $50 million for Jewish, but we're not going to do anything for Pineville Community?"

Meredith (WKYT-TV image)

Meredith might have picked any one of several Kentucky rural hospitals as an example.

A report by Navigant Consulting in February found that 16 of Kentucky's rural hospitals, one-fourth of the total, are at high risk of closing unless their financial situations improve. The hospitals are not listed by name. And since 2009, Kentucky has had five rural hospitals close, according to The Cecil G. Sheps Center for Health Services Research at the University of North Carolina.

U of L Health CEO Tom Miller said he couldn't speak to issues related to Pineville hospital, but said U of L wouldn't have moved forward without a partnership with the state and two foundations.

"We believed at the time and we still believe today that there is no one who can take care of these patients" if Jewish closes, he said, stressing that it is not just a Louisville hospital, but a regional facility. He said a third of its in-patient visits are from outside Jefferson County and over 40 percent of its physician visits are by patients from other counties. It also has Jewish Hospital Shelbyville.

Miller said Jewish sees 35,000 emergency patients a year and has between 200 and 250 in-patients a day, and if its heart-transplant program closed, heart patients, many of them very poor, would have to travel either to Lexington, Indianapolis or Nashville for a transplant.

Last month, U of L announced it would buy Jewish and its associated facilities, collectively known as KentuckyOne Health, with help from the state and two foundations. The state's committed portion is $50 million, through a first-of-its-kind loan from the Kentucky Economic Development Finance Authority. The loan must still be approved by the legislature.

Senate Minority Leader Morgan McGarvey, D-Louisville, voiced concerns that the loan far exceeds the existing KEDFA loan limit of $500,000 and doesn't meet the usual requirement to create jobs.

"This loan obliterates every single criteria of being a KEDFA loan," McGarvey said. "What happens if that's challenged and you all are not actually allowed to get the money from KEDFA?"

Miller said U of L is scheduled to close on the deal Nov. 1, even if the state doesn't furnish the $50 million loan. However, he said without the funding it would have to shift resources and cut back on capital improvements at Jewish.

After the meeting, Miller told reporters U of L will have to spend about $40 million a year to maintain the hospital, Morgan Watkins reports for the Louisville Courier Journal.

McGarvey referred to a secretly recorded transcript from a private meeting between Miller and KentuckyOne Health physicians. Chris Otts reported for WDRB that Miller told the doctors that U of L Health could "be successful" with the takeover even without the $50 million loan from the state.

The meeting included a discussion about a plan to expand U of L Hospital. "How are we supposed to think that this isn't just a way of financing a new expansion of U of L Hospital down the road, and you're going to close down Jewish Hospital and sell off the assets?" asked McGarvey.

Miller said the transcript was from an unreliable source. He said there was a discussion about a separate plan to expand the university medical center with the physicians at Jewish "if we didn't go forward with KentuckyOne and those plans have been put on hold."

Meredith cut off McGarvey's pointed questioning, but said the topic would be discussed again. "We've got some serious issues and reservations about this," he said. The leaders of the Republican majorities in the House and Senate have voiced support for the loan, favored by Gov. Matt Bevin.