Health and family cabinet continues to withhold more information in copies of child abuse records than judge allowed

The state Cabinet for Health and Family Services released three more death and near-death cases involving child abuse or neglect Friday under court order, but continued to withhold critical information. It has appealed the order.

The 2009 cases involve two babies who died from suffocation while the parents were impaired. A third case involves a 2-year-old girl from Lawrence County, who was injured after she was reportedly kicked in the head by a horse while unsupervised.

The cabinet "continues to withhold, or redact, far more information" than was allowed under the Jan. 19 order of Franklin Circuit Judge Phillip Shepherd, reports Deborah Yetter of The Courier-Journal. Shepherd said the cabinet could withhold the names of children seriously injured by abuse or neglect, names of private citizens who report suspected abuse, the names of minor siblings in the home and the names of minor perpetrators.

But the cabinet is withholding more information than that. "For example, in the case of the girl injured by the horse, the cabinet deleted the name and relationship of the adult who was watching her, even though the adult is named and identified as her grandfather in a separate internal review of the case," Yetter reports. "The cabinet also withheld juvenile and family court records in that case and the names of all adults involved." The girl recovered from the skull fracture sustained by the horse.

Gavin Villarreal never woke up after he was found with a plastic bag over his head in his crib, possibly placed over the 5-month-old's head by other young children in the home. His parents both tested positive for drugs on the day of his death and were convicted. In the third case, a month-old baby died after his father apparently rolled over him in his sleep. Both parents admitted they had been drinking and used marijuana before they went to bed. (Read more)

Certified personal trainers give tips on how to revive New Year's health resolutions or keep them going

By Tara Kaprowy
Kentucky Health News

As the resolve of New Year's resolutions fades with January passing into February, fitness experts Sheila Kalas and Laura Coombs, right, offered some useful tips for how to stay motivated about getting healthy on KET's "One to One" program with Bill Goodman last week.

The first thing, they said, is to come up with a realistic plan — and trash the one in place if it's set up for failure. "One of the things that I think is a mistake is if you jump into action in January and say, 'I'm going to get up, and I'm going to work out at 6 every morning' and you're really not a morning person. Chances are, that's going to fade," said Kalas, owner and founder of Fitness Plus in Lexington.

The trick is to come up with a plan that works, along with 10 reasons for why it's imperative to stick to it this year. "That way, you're more invested," said Coombs, a certified athletic trainer.

The cornerstones of good health are a nutritious diet and an exercise regime, which, Kalas pointed out, is unavoidable. "It's OK for you not to like exercise," she said. "But it really doesn't get you off the hook from needing to do it." As such, it's important to remove the biggest barrier that stands in the way of a fitness regime: a lack of time, which is often only a perceived barrier, and can be removed if there is a commitment to devote proper time to exercise, Kalas said.

Also important is coming up with activities that are entertaining or even practical. Coombs described a "fit deck," playing cards that each describe a different kind of exercise. The goal is to draw five cards a day and perform the exercise in turn. For those uninterested in formal exercise, Kalas suggested getting a post office box to which a person would have to walk each day to get mail. She added that one of the best tools to use is a pedometer, which allows people to monitor how much they've walked that day and alter their workouts and menus accordingly.

Coombs advises being active seven days a week for 30 minutes each day, whether that involves walking, gardening or playing with the dog. "If I only have to do something three days a week, I'll do it on Monday," she said. "Then on Tuesday, I'll be so proud of myself, I'll put it off." If the exercise doesn't get done by later in the week, the tendency is to just put it off to the following week, Coombs said. Consistency of exercise is more important than the kind of exercise being done, she said.

As for eating, both Kalas and Coombs said it's important to monitor food intake carefully, particularly when it's coupled with a new exercise regime. "Beginner exercisers reward themselves for a single bout of exercise that day," Kalas explained. That person will decide, for example, that, since they've walked on the treadmill that day, they deserve to have dessert. But then they'll decide, "I'm going to walk tomorrow so I'm going to eat more tonight," Kalas said. "A lot of time there's one bout of exercise and two rewards built in."

As for what to eat, choose items that come "from the earth that are not prepackaged," Coombs said. "We have to be sensible and stop looking for shortcuts and stop looking for magic foods and magic numbers," she said. Kalas also suggested counting calories using phone applications or referring to the book, "Eat This, Not That," which suggests swapping one food for another at restaurants in order to avoid excessive calorie intake.

To get children motivated, the best thing to do is to remove sedentary activities by setting limits on TV and computers. And it's important to start introducing the importance of fitness and nutrition while kids are still young. "If the household values healthy eating and exercise, it will trickle down to your children," Kalas said.

Ultimately, when it comes to being successful at making changes, a person needs to accept responsibility for their choices and that they're "the only person that can make it better or worse," Kalas said. "If you're going to have the French fries, the only person that's going to have to burn off the calories is you."

To watch the program online, click here. For the full program archive, go here.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky. 

Facebook app personalizes message to women about getting cervical cancer screening and HPV vaccine

To raise awareness about cervical cancer and ways to avoid getting it, the Cervical Cancer-Free Kentucky Initiative has created a Facebook application that "incorporates pictures of users' Facebook pals into an educational video on cervical cancer," reports Darla Carter of The Courier-Journal.

"We want to get the message [to] where we know people are getting their information, and Facebook, Twitter and websites are 'the things'," said Dr. Baretta R. Casey, director of the University of Kentucky initiative.

The application can be found at www.causethemovement.org. "Their friends' and family's faces will actually come up into the video," Casey said, to make the subject resonate more with the viewer.

The goal is to educate women about cervical cancer, which can be prevented through screening and the HPV vaccine. The disease is more likely to occur in women over the age of 30, according to the Centers for Disease Control and Prevention. There are 12,170 new cases of cervical cancer each year and 4,220 deaths, according to the National Cancer Institute. The American Cancer Society states there will be 180 new cases in Kentucky this year.

The most common cause of the cancer is the human papilloma virus, which is transmitted sexually. Two HPV vaccines, Gardasil and Cervarix, have been approved by the U.S. Food and Drug Administration.

"Right now, this is the only vaccine on the market that can prevent a cancer," Casey said. "I have a daughter and I have a granddaughter, and they have both received the HPV immunization because I don't ever want them to come and look at me and say, 'Mom, why didn't you give me this shot? I wouldn't be going through treatment for cervical cancer now.'"

Women can be screened for the disease with a Pap test, which detects abnormal cells that could lead to cancer. (Read more)

Kids eat more veggies when school lunch trays make suggestions

Kids are more likely to choose vegetables from the school cafeteria line — and eat them — if their tray contains pictures that subtly suggest the dining option.

That was the result of a University of Minnesota study, in which researchers placed pictures of green beans and carrots in the slots of the partitioned cafeteria trays at Richfield Elementary School.

On a typical day, 42 students took green beans and each student who chose them ate about 19 grams of them, reports Jeremy Olson of the Star Tribune. On the day in which the images were placed in the cafeteria trays, 96 students chose green beans and each student that took them ate about 19.1 grams.

When it came to carrots, 77 students took them and ate 31 grams of them on a typical day. On the day of the study, 238 students took carrots and ate about 27.1 grams. "That means that the students who always took carrots probably ate their usual amount, but that the students who took them for the first time ate less," Olson reports.

"Kids . . . don't want to do what they're told," said Traci Mann, a psychologist and one of five faculty members leading the study. "What kids want to do is . . . what their friends are doing or what they think their friends are doing." (Read more)

Stumbo bill aims to attack prescription abuse on all fronts

House Speaker Greg Stumbo filed a comprehensive bill Thursday aimed at attacking the state's prescription drug problem on all sides, namely taking the data already collected from the 11 million prescriptions dispensed in the state and putting them directly in the hands of the attorney general to zero in on pill pushers and dealers. (Illustration by Kentucky Health News)

The 50-page bill, filed by the Prestonsburg Democrat a day after a statewide summit that shed light on the extent of prescription pill abuse, would also require prescribers, including nurse practitioners, to use the state's prescription drug monitoring system known as KASPER and pay an annual fee of $100 to do so.

"This epidemic truly knows no bounds, and it's poised to get much worse if we do nothing," Stumbo said in a press release. "My approach will help us end the deadly flow of these drugs both now and however the battlefield may change in the future." Attorney General Jack Conway agreed something must be done. "I'm sick and tired of people coming up to me saying we've lost a generation to prescription pills," he said.

The main crux of the bill involves shifting the responsibility of KASPER to Conway's office from the Cabinet for Health and Family Services. To proactively track data, the Office of the Attorney General would be responsible for running trend reports from KASPER on a quarterly basis. If a prescriber is not using KASPER, that must be reported to the prescriber's licensing board. When a prescriber is prescribing a suspiciously high amount — thresholds will be developed by the Office of Attorney General and licensing boards — the Office of the Attorney General will report that finding to the prescriber's licensing board, which will deal with the issue promptly in turn.

The bill also aims at improving communication with law enforcement and medical licensing boards; if a complaint about suspect dispensing is received by the Office of the Attorney General or by a medical licensure board, for example, it must be relayed to the Kentucky State Police.

KSP Commissioner Rodney Brewer approves of Stumbo's proposal, particularly because the changes would mean KASPER could be used "as an investigative tool," he said. "It is a real step in the right direction regarding shutting down these fronts that are nothing more than pill mills."

The licensing boards, which would have pain and addiction specialists appointed to them, will be under the strict watch of Conway's office and will be compelled to cooperate "at all times" with its requests. Stumbo, left, has been critical of the state Board of Medical Licensure, which is authorized to analyze KASPER data to find problem prescribers, for failing to police its own profession.

As of now, just 32 percent of prescribers and just 26 percent of pharmacists have KASPER accounts, Dave Hopkins, KASPER program manager in the Office of Inspector General, said in January at a second statewide conference focused on prescription drug abuse. When prescribers have accounts, they are able to pull up reports online on what prescriptions a patient has taken in the past, numbers that can indicate whether patients are "doctor shopping" or abusing drugs.

The bill would require prescribers to use KASPER upon accepting a new patient and every three months with ongoing patients to see if there are suspicious patterns in their prescription history. Before writing a prescription, doctors and other providers must do a complete physical exam of the patient, write up a treatment plan and discuss the risks of the use of controlled substances.

The bill would also allow commonwealth's attorneys and county attorneys to gain access to KASPER. Medicaid would monitor prescribers in their program as well.

Though numbers were slightly lower in rural areas, more than 90 percent of pharmacists and more than 95 percent of prescribers that use KASPER feel it is effective, a study conducted by the Institute of Pharmaceutical Outcomes and Policy indicates. As for mandating its use, doctors seem open. "I would not have a problem with it if there was an easy way to do it, a little bit faster than what we have now," said Dr. Roger Humphries, chairman of the Department of Emergency Medicine at the University of Kentucky's College of Medicine.

The bill would also tackle the operation of pain management clinics themselves. Like a bill filed by Sen. Jimmy Higdon, R-Lebanon, Stumbo's proposal would require that pain management clinics be owned by licensed practitioners. As of now, of the 77 pain clinics in the state, 33 of them are owned by people who have no medical background.

The bill also cracks down on prescribers who have had trouble with the law for drug-related crime. As per the bill, practitioners who have had their license suspended or surrendered for drug violations will no longer be able to practice in Kentucky. Prescribers who have been convicted of a drug-related felony in Kentucky will have their license revoked for 5 years. A second felony will mean permanent revocation.

The bill would also prohibit pharmacies from accepting prescriptions for Schedule II or III controlled substances, like oxycodone and hydrocodone, for more than a 90-day supply. They also would no longer be able to ship more than 30-day supply of the drugs in one shipment. "Part of the problem is there is so much medication out there on the street," said Stumbo's spokesman Brian Wilkerson. "This prevents that."

Stumbo's bill additionally aims at getting a detailed look at how many deaths are occurring due to drugs or drug overdoses in Kentucky. To get accurate numbers, as per the bill's proposal, coroners would be required to report any death caused from the use of drugs or drug overdoes to the Division of Kentucky State Medical Examiners Office. That office will compile an annual report which includes all of the drugs which cause or contributed to the deaths, where they occurred and how the drugs were obtained.

Families with high-deductible health insurance plans are more likely to put off care, study finds

Families who have health plans with high deductibles and who have members with chronic health conditions are far more likely to put off or forgo care entirely due to cost, a study has found. The odds of those families delaying or forgoing care were three to four times more likely than families with traditional plans.

Those were the key findings of a study published in the Journal of General Internal Medicine. Using a mail and phone survey, researchers talked to families with employer-sponsored insurance in Massachusetts between April and December 2008. Respondents included 208 families with high-deductible plans and 370 families with traditional plans.

For adults with high-deductible plans and with incomes less than four times the federal poverty level, the probability they would delay or forgo care was 40 percent. For adults in the same income bracket with traditional plans that probability was only 15.1 percent. (Read more)

Judge continues to block graphic images on cigarette packs

Getting graphic labels on cigarette packages continues to be an uphill battle for the Obama administration, as a skeptical judge sided with cigarette makers who say "they can't be forced to spread the government's anti-smoking advocacy with 'massive shocking, gruesome warnings' on products they legally sell," reports The Associated Press.

U.S. District Judge Richard Leon of Washington, D.C., has already decided that the cigarette makers will probably succeed in their lawsuit, because he has ordered the government to not enforce the requirement that the labels appear on cigarette packages next year.

The labels, approved by the Food and Drug Administration, "included color images of a man exhaling cigarette smoke through a tracheotomy hole in his throat; a plume of cigarette smoke enveloping an infant receiving a mother's kiss; a pair of diseased lungs next to a pair of healthy lungs; a diseased mouth afflicted with what appears to be cancerous lesions; a man breathing into an oxygen mask," among others, AP reports.

Leon has indicated he thinks the labels go overboard in their efforts to convey the dangers of cigarettes. He has ruled they are too large; they were intended to cover the top half of packs. "It sounds like they are headed to a place," he said Wednesday, "where you have to watch a 10-minute video before you can even buy a pack of cigarettes." (Read more)

More complaints lodged about Medicaid managed care; lawmakers demand answers

Complaints continue to pile up about the state's new Medicaid managed care plans, which cover about 560,000 Kentuckians. Lawmakers are hearing gripes from providers who say they are not getting paid, and from patients and clinics who say the three managed-care companies take too long to give permission for certain care.

"It's a drastic change to the system," Neville Wise, the state's acting Medicaid commissioner, told the Senate Health and Welfare Committee yesterday. "We didn't expect the level of issues that we had."

Sen. Julie Denton, a Louisville Republican who chairs the committee, "expressed outrage about a case in which she recently called the president of one company trying to get care authorized for a battered domestic violence victim who sought treatment at a Lexington clinic on a Friday afternoon," reports Deborah Yetter of The Courier-Journal.

Despite Denton's call to Coventry Health Care, the woman was not able to get a scan for a shoulder injury until the following Monday. "This woman had to go in pain all weekend because she couldn't get the services she needed," Denton said. "This is not acceptable, and this is only one instance that I know of."

Denton also asked about late payments to providers. "The payment issues have gone on way too long, and it should have been better," Wise responded.

Kentucky moved to three managed care companies Nov. 1, in an effort to save the state money and balance the Medicaid budget. (Read more)

Journalists invited to apply for free, four-day obesity fellowship

Kentucky journalists wanting to expand their knowledge on obesity, one of the most critical and widespread health issues in the state and nation, should apply for the fellowship "Obesity Issues: The Complete Skinny on Why We're Getting Fatter, What it Means, and What We Can Do About It."

The four-day fellowship, a collaboration between the National Press Foundation and the Colorado Center for Health and Wellness, includes round-trip transportation to Denver, lodging and most food costs. The application deadline is Feb. 13. Sixteen fellows will be chosen.

Fellows will learn about the biology of obesity; environmental factors; the relationship between obesity and chronic diseases, including cardiovascular disease, disease and Alzheimer's; the economics of obesity; how the health-care system responds; why it's difficult to change behavior; and strategies for a healthier workforce.

Speakers include James O. Hill, executive director of the Colorado Center for Health and Wellness; D. John Peters, a leading nutrition and obesity researcher; and other scholars from the  University of Colorado. To apply, click here.

Smile Kentucky! celebrates 10 years and more than 100,000 children helped

Smile Kentucky! celebrates its 10-year anniversary tomorrow, representing $1 million in free dentistry and benefiting more than 100,000 students.

"It's a wonderful program," said Arleta Watkins of Bullitt County Schools. "I've had children who've never had a dental exam before. They get that service for free."

The program serves children in Louisville and nearby counties. Since it began, more than 127,000 students in 143 schools and 11 counties have received classroom dental education, 35,000 kids have gotten free dental screenings at school and nearly 3,000 children have received free treatment.

Smile Kentucky! works with 30 elementary schools in Jefferson and surrounding counties each fall. Students receive dental education, and children in grades 3 to 6 get a free dental screening. Children without dental insurance or medical care get free treatments by going to the University of Louisville's School of Dentistry or private dental offices in February.

"Dental pain and infection is one of the leading causes of missed days at school and affects a child's ability to concentrate," said John Sauk, dean of U of L's School of Dentistry.

U of L is one of 30 agencies on the steering committee. Other founding partners include the Louisville Water Co.,  the Louisville Dental Society, Colgate, Sullivan Schein Dental, Northwest Area Health Education Center and the Bullitt County Health Department.

For more information about Smile Kentucky!, click here.

Shocking realities of prescription pill abuse drive another summit to get everyone in harness to fight it

By Tara Kaprowy
Kentucky Health News

Prescription drug abuse has become so prevalent in parts of Kentucky, people are buying Mason jars of clean urine at flea markets and under the table at tobacco stores so they can pass drug tests.

Kentuckians are pulling out their own teeth so they can go to the dentist to get a three-day prescription for hydrocodone, the most popular painkiller.

When they make arrests, law enforcement officers are finding stacks of food stamps that have been traded for pills.

Almost two-thirds of Kentuckians have used prescription drugs for non-prescription reasons, 30 percentage points higher than the rest of the country.

FBI intelligence analyst Anthony Carter detailed the problem.
(Photo by James Crisp for The Courier-Journal)

Those were just some of the sad, startling facts that surfaced Wednesday in Lexington during the Kentucky Prescription Drug Summit, the second comprehensive, statewide gathering on the subject in two weeks. The summit was sponsored by the two U.S. attorneys for Kentucky hosted by the University of Kentucky and brought together law enforcement, physicians and the pharmaceutical community to learn more about the problem and cooperate in fighting it.

"We're galvanizing our forces, all of our forces, in this fight," Gov. Steve Beshear told the packed crowd. "This is a corrosive evil and we have to stop it." He noted that drug overdoses kill more Kentuckians than traffic accidents, and other speakers said the overdose numbers are under-reported.

"I think a lot of our people have had enough," said Kerry Harvey, the chief federal prosecutor for Eastern Kentucky. That's where the problem is worst, but speakers made clear it is statewide.

The state has electronically tracked prescriptions since 2000, but Attorney General Jack Conway said only about 25 percent of doctors use the Kentucky All-Schedule Prescription Electronic Reporting system, and KASPER's data are "just sitting there and law enforcement are not able to access it" to proactively search for people getting an unusual amount of drugs.

Beshear recently appointed a panel of health-care providers to establish guidelines to identify over-prescribers through KASPER, and his budget proposal would put more money into the system and set up the state's first substance-abuse treatment program for Medicaid recipients.

House Speaker Greg Stumbo, D-Prestonsburg, is expected to file a bill that would require drug prescribers to use KASPER. That bill or another would also require pain clinics to be owned by doctors.

While Kentucky has many suspicious pain clinics, many of the pills have come from out of state, primarily Florida. Wifredo Ferrer, U.S attorney for Southern Florida, said the state is cracking down on pill mills, in which doctors were seeing as many as 500 patients and making between $2,000 and $6,000 in cash each day.

The speeches from officials were leavened with personal stories of drug abuse, death and near-death.

Marine Lance Cpl. Daniel Gross, 26, said he was 21 when his addiction started. He was introduced to pain pills shortly after a roadside bomb exploded beside his Humvee in Iraq in 2006. With his right foot shattered, his other one broken and his brain injured from the blast, he was prescribed Percocet and oxycodone. With prescriptions "overflowing" at Camp Lejeune, N.C., taking pills became commonplace. "If I ran out, I got them from someone else," Gross said.

Quickly he became an addict, a burden he carried with him after he was discharged two years later. "I pawned, stole, lied, cheated," he said. "Nothing else seemed to matter." After two stints in rehab, Gross was able to overcome his addiction. Now clean for 14 months, he won a standing ovation from the crowd.

Police and local prosecutors expressed their frustration over the problem, with State Police Major Anthony Terry likening the situation to "a dog chasing its tail." Floyd County Commonwealth's Attorney Brent Turner said, "We are not treading water. . . . We are drowning in a sea of pills, and if something is not done the whole region is going to be destroyed."

UK President Eli Capilouto told the crowd that the land-grant university needs to be a partner in solving such problems, and the extent of it had become clearer to him the day before, when he met with local extension agents: "This issue came to the forefront."

"This has to be a group effort" among public servants and health-care providers, said Dr. Lon Hays, chair of the UK Psychiatry Department. Too often, he said, providers use "the big gun" of a strong painkiller. "We need to exhaust other methods of pain control before we go to that method of pain control."

For more coverage, from The Courier-Journal or the Lexington Herald-Leader, click here or here.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Home births increase, mostly in rural areas

Home birth is making a resurgence in the U.S., reports Shari Roan of the Los Angeles Times. It used to be commonplace in rural areas where doctors were few and transportation wasn't easy. As those factors faded, mothers chose hospitals over bedrooms, and the rate of home birth fell to less than 1 percent of all births by 1969. It's still not as common, but the rate has risen 29 percent from 2004 to 2009, according to the U.S. Centers for Disease Control and Prevention.

The trend is strongest in northwestern states, including Oregon at 2 percent and Montana at 2.6 percent, probably because of "sheer lack of transportation in rural areas," Roan reports. Cost may also be a factor because home births are about one-third the cost of hospital births. About 62 percent of home births in 2009 were attended by midwives, and the trend is increasing most among white women. (Read more)