Couple shares 'horrible journey' of prescription drug abuse

Recovering pill addict Stacy Pennington
of Ashland is due to give birth next month.
(Courier-Journal photo by Matt Stone)

Stacy and James Pennington had to lose everything, including their children and home, before they were able to face their prescription drug abuse problem. Now in recovery at The Healing Place in Louisville, they spoke to The Courier-Journal's Laura Ungar of their downward spiral.

"It had gotten to the point where my prescription drugs were my everything. As long as I had them, I was OK," said James, 40, of Ashland. "Before, we had everything we could want. In the end, we were just feeding an addiction. We had lost everything."

Stacy Pennington said she took her first painkillers in 2002 after she cut her finger on a glass candle jar and needed two surgeries. "A year later, she was diagnosed with cervical cancer, then severe endometriosis, and she required several more surgeries," Ungar reports. "Each of her 14 operations brought another prescription for pain pills."

James Pennington took prescription drugs for the first time at age 14 after he dislocated his shoulder. After he broke his shoulder in a motorcycle accident when he was 25, he got a 30-day supply for Percocet and, later, was prescribed more of the drug after a knee injury. "Pain medications became my drug of choice from there on out," he said.

Soon, he was traveling to "pill mills" in Florida to fuel his addiction, pills he sold and shared with his wife. When Stacy gave birth to their daughter, she was heavily addicted and eventually lost custody of her. James' older daughter was also taken from the home. 

Before Stacy Pennington checked in to The Healing Place, she had sold her engagement ring, the Penningtons sold their home before they lost it, and they were spending $100 to $500 a day to feed their addiction. Now, Stacy is expecting another child and the couple is fighting for their sobriety. "It's a horrible journey. I had to absolutely lose everything. But I see that as a blessing," said James Pennington. "I'm so glad I'm on the other side today." (Read more)

Louisville has highest concentration of nursing-home and extended-care companies in U.S.

Louisville has the largest concentration of nursing-home and extended-care companies in the country. Of the 570,000 people who call Louisville home, 4,000 work in the industry and produce $28 billion in revenue, reports Frank Browning for Kaiser Health News. (Kaiser photo illustration)

Though the city didn't intend to become the leader in the long-term care industry, companies opted to cluster around each other, with Humana the nucleus of the movement. "As its influence grew, the health insurance giant created spinoffs and attracted like-minded businesses, including a growing number of companies dealing with long-term care," Browning writes, without noting that Humana itself began as a nursing-home company, Extendicare, then evolved into a hospital firm and an insurance company.

There are seven key players in theindustry who have headquarters in the city: Kindred Healthcare, Trilogy Health Services, Atria Senior Living Group, Elmcroft Senior Living, ResCare, and Signature Health Care. Those companies then attracted firms such as RecoverCare and PharMerica. "It's been an evolution," Christian Furman, a gerontologist at the University of Louisville medical school, told Browning.

One of the key moves was attracting Signature, which has 73 long-term care facilities in seven states, from Florida to Kentucky. A promise of up to $4 million of corporate income tax credits in 10 years helped, but "access to talent was most important. There's an incredible amount of expertise here," said CEO Joe Steier.

The clincher was "the whole alignment of public and private support, including the University of Louisville, that has made the city into a national and international center for aging care companies," Steier said. (Read more)

Coventry, ARH at impasse over Medicaid; state says service will not be interrupted for 25,000 affected

Though negotiations between Appalachian Regional Healthcare and Coventry Cares appear to be futile, the state is taking steps to make sure there won't be an interruption in care for the Medicaid recipients who will be affected by the impasse.

"The cabinet will assure the judge that, in the event that a notice is received from Coventry that ARH will not be in their network as of July 1, members will be able to call the Department for Medicaid Services to switch" to another managed-care organization, said Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services.

Coventry Cares is one of four companies chosen by the state to provide care to Medicaid recipients. The move to managed care — intended to save money — has been rocky, with providers complaining about delayed payments from the companies and cumbersome pre-approval processes for treatments. ARH sued Coventry, and another managed-care company, saying they owed the hospital chain more than $18 million for services. But Coventry says the state allowed another managed care company not to include ARH in its network, which means a lot of higher-risk, higher-cost patients covered by Coventry.

ARH operates eight hospitals and health clinics in Eastern Kentucky and serves 25,000 Medicaid patients, reports Valarie Honeycutt Spears for the Lexington Herald-Leader. Coventry agreed to extend its contract with ARH until June 30, but will likely not extend it again. A Coventry document filed in court last week says "it appears unlikely that these differences can be bridged." (Read more)

Improvements to Rx monitoring systems worth the expense, study finds; using systems influence doctors' prescribing decisions

A plan for an ideal prescription drug monitoring system was published today in the New England Journal of Medicine, with its authors concluding spending more money to improve systems is worth the expense.

To improve databases, the paper's authors recommended "standardization of the type of information submitted to the databases, and a move toward the use of bar-coded prescription paper to more quickly log entries, or a robust e-prescribing system that would eliminate paper and the resulting prescription fraud and 'doctor shopping' that contributes to illicit use of these controlled substances," reports research-reporting service Newswise. (Read more)

Forty-three states, including Kentucky, now have databases to monitor prescriptions for pain relievers and another five states have passed laws to create them, reports Mary Wisniewski for Reuters. Part of the reason for the push is prescription drug abuse is an increasingly big problem, with more people dying from prescription drug overdoses each year than cocaine and heroin combined. Kentucky is a hot spot, with nearly 1,000 people dying from prescription drug overdoses in 2010.

On July 12, a new law will take effect in Kentucky that will make it mandatory for a physician to consult the state drug-monitoring system before writing a prescription for certain drugs for a new patient. Doing so can influence how a doctor chooses to prescribe. A study by the emergency department of the University of Toledo's College of Medicine found "doctors or pharmacists who reviewed state prescription data changed how they managed cases 41 percent of the time," Wisniewski reports

The study found 61 percent of prescribed either no opioid medicine, or less than originally planned, while 39 percent decided to prescribe more. (Read more)

Significant management improvements at Passport Health Plan, audit finds

Passport Health Plan has improved significantly since a 2010 audit uncovered wasteful spending and other problems, a new audit has concluded.

The managed care organization that cares for Medicaid recipients in Jefferson and 15 surrounding counties "has made significant improvements in accountability and financial record-keeping," a press release from Audrey Tayse Haynes, the new secretary of the Cabinet for Health and Family Services. "Patient satisfaction with the health care provider remains high," she states.

"The audit is a follow-up to former State Auditor Crit Luallen's scathing report of November 2010 in which Luallen found lavish spending by Passport's former executives on travel, meals and other expenses," reports Tom Loftus for The Courier-Journal. "It also questioned transfers of about $30 million of reserve funds to the major health-care organizations represented on Passport's board of directors."

Gov. Steve Beshear ordered a plan to correct the problem, which involved replacing Passport's executives, among other changes. Though there has been improvement, "after having exclusive rights to the region for about 14 years, Passport will have to bid against other managed care organizations if it wants to be among those that will serve it in 2013," Loftus reports.

Still, since the state has switched to managed care for the rest of the state and severe problems have surfaced with the three companies that have been hired to serve those recipients, Passport's reputation has improved substantially. State Auditor Adam Edelen said in February the state was unprepared for the quick transition to managed care in the rest of the state. (Read more)

Task force to consider middle-school sports regulation

A task force made up of legislators, educators and athletic officials will examine what guidelines should be in place for sports at the middle school level, which are not regulated in Kentucky.

The task force was created by the 2012 General Assembly to "discuss 'best practice' guidelines for middle school sports and to take into consideration non-profit organizations that oversee some individual teams," reports Valarie Honeycutt Spears for the Lexington Herald-Leader.

"It remains to be seen" what the task force could recommend, Rep. Bob Damron, D-Nicholasville, told Spears. But Damron, who sponsored the resolution creating the task force, said "in the long run that's probably a good direction to have one entity standing for middle school athletics."

The Legislative Research Commission will name task force members by Aug. 1. Recommendations to legislative committees are expected by Dec. 7. (Read more)

New treatment first offered in Louisville is helping asthma sufferers

Shannon Denson, who has severe asthma, gets bronchial
thermoplasty. Courier-Journal photo.

Asthma sufferers can now benefit from an innovative treatment that was first offered at University Hospital in Louisville.

Patients like Shannon Denson are seeing improvement thanks to bronchial thermoplasty, "a minimally invasive, three-step procedure using heat to open airways in adults with severe asthma so they can breathe more easily," reports Laura Ungar of The Courier-Journal.

"Over the years, airways become very narrow. This opens them up," said Dr. Tanya Wiese, an interventional pulmonologist with University of Louisville Physicians, which partnered with UH to offer the treatment.

The treatment is not a cure but it does improve the condition of the lungs, which is good news since asthma rates are high in Kentucky. In the Ohio Valley, almost 15 percent of Kentucky adults said they had asthma, making it the seventh-highest rate in 2010, a survey by the U.S. Centers for Disease Control and Prevention found. (Read more)

U of L profs get $6.3 million to continue spinal cord research

Susan Harkema, a University of Louisville professor, talks
about epidural spinal stimulation. Courier-Journal photo.

Two University of Louisville professors have received a $6.3 million grant to continue their work helping paralyzed patients restore movement by using electrical stimulation.

The grant was awarded to Susan Harkema and Dr. Jonathan Hodes from the Leona M. and Harry B. Helmsley Charitable Trust.

Last year, they received much acclaim when they published a study in the journal The Lancet "showing that the use of continual, direct, electrical stimulation of a patient's lower spinal cord using technology designed for pain relief can allow a person using a wheelchair to stand and bear weight," reports Laura Ungar for The Courier-Journal.

With these new grant funds, Harkema said they will "be able to built a stimulator that will allow the individual to take advantage of these advances in their homes and communities."

One of the initial case studies involved Rob Summers, a former baseball player from Oregon who was paralyzed below the chest after a car accident. After the therapy, he was able to get to a standing position and stand as long as four minutes. "He was also able to take steps with help and move his toes, ankles, knees and hips." Harkema said he continues to improve.

Nationwide, more than 5 million Americans live with some type of paralysis, and more than 1.3 million have spinal-cord injuries. (Read more)

Federal panel says PSA screening for prostate cancer does more harm than good, but no better test is available

Prostate cancer cells. Getty Images photo by Abbey Michael.

An influential federal panel says testing healthy men's prostate-specific antigen levels to detect prostate cancer does more harm than good.

The PSA test can lead to unnecessary biopsies for men who turn out to be cancer-free. Those biopsies can also lead to men being treated for cancers that are so slow-growing (a characteristic of most prostate cancers) that they didn't need to be detected.

An estimated 1,000 to 1,300 men die annually from complications associated with treatments that are initiated because of PSA screening, reports Alice Park for Time magazine. Moreover, treating harmless prostate tumors increases the chances of making men impotent or incontinent.

The U.S. Preventive Services Task Force published the recommendation in the Annals of Internal Medicine. In 2009, the panel also recommended that women delay routine mammograms until the age of 50. That was controversial, and "The task force's recommendation goes against two decades of widespread use of the PSA test, a $35 blood test," Park reports.

"The recommendation is not just counter to what the lay public has been taught about cancer prevention but what physicians have been taught as well," said Dr. Michael LeFevre, co-vice chair of the USPSTF and a professor of family and community medicine at University of Missouri. "We've been told for decades to be afraid of cancer and that the only hope is early detection and treatment. So it's hard for physicians and patients alike to accept that not all cancers need to be detected or need to be treated and that there are harms associated with screening, not just benefits."

Through PSA testing, physicians "were finding the cancer earlier, so the time from diagnosis to death was longer, but the patient wasn't actually living longer," explained Dr. Otis Brawley, chief medical officer of the American Cancer Society.

But there isn't a better test to replace the PSA, and Ian Thompson, chairman of urology at the University of Texas Health Science Center, said to reject it completely is unwise. He said U.S. death rates from prostate cancer dropped between 30 and 50 percent since the screening became commonplace in the early 1990s, though those numbers could also have been influenced by more effective treatments. Thompson said he didn't want to go back to the "bad old days" when doctors only found prostate cancer when it was already unable to be cured, reports Liz Szabo for USA Today.  (Read more)

Louisville comes in third to last in fitness and health ranking of 50 largest cities

Rowing under California's Bay Bridge (Photo by City Kayak)

In a fitness ranking of the country's 50 largest cities, Louisville ranked an abysmal 48th, sitting just above Detroit and Oklahoma City.

These were some of the results of the American College of Sports Medicine's 2012 Fitness Index. Cities were assessed on preventive health behaviors; levels of chronic disease; health care access; and community resources and policies that support physical activity such as bike lanes and parks.

Minneapolis-St. Paul was ranked first for the second year in a row, scoring 77.2 out of a possible 100 points. Louisville got just 32.1 points, but it did climb up one ranking slot over 2011's assessment.

The index is gaining notoriety and "might well become the scorecard for cities looking to attract health-conscious companies and people to settle in for a spell," reports Melissa Healy for the Los Angeles Times. "It draws on parks and recreation data from the Trust for Public Land, on nutrition and health behavior collected by the Centers for Disease Control and Prevention, and on federally tallied school report cards to learn about school policies that promote fitness." (Read more)

Nursing home chain says it will lease its Kentucky facilities because legislature didn't pass bill to filter lawsuits

A major nursing-home chain says it will lease all of its Kentucky properties to a Texas company because a bill to insulate nursing homes from lawsuits did not pass the General Assembly this year,

Extendicare Health Services owns Pembroke Nursing and Rehabilitation Center, Shady Lawn Nursing Home in Cadiz and 19 other facilities in Kentucky, reports Nick Tabor of the Kentucky New Era in Hopkinsville. The company has been riddled with problems. A 2009 study ranked three of its Kentucky facilities among the country's worst nursing homes.

"The combination of a worsening litigation environment and the lack of any likelihood of tort reform in the state of Kentucky has made this the prudent decision for our company and its unitholders," said Tim Lukenda, president and CEO of Extendicare.

In this year's legislative session, nursing homes lobbied for a law that would have created medical review panels to evaluate potential lawsuits against nursing homes, personal-care homes and some facilities for the intellectually and developmentally disabled. The goal of the panel was to help eliminate frivolous lawsuits against the long-term care industry.

The Pembroke facility has been sued 20 times in Christian Circuit Court since 2002, and seven of the suits are still pending, Tabor reports. The others were dismissed, most with confidential settlements. (Read more)

Care in rural hospitals is just as good as that in urban hospitals, study concludes

While rural Americans have less access to primary care and have worse health outcomes, the care at rural hospitals is equal to, if not better, than that at urban hospitals, a National Rural Health Association report says.

The study also found rural health care is not more expensive than urban care. "However, urban residents rarely out-migrate to rural settings for either routine or advanced treatments or care yet many rural patients are referred to or voluntarily travel to urban providers based on the myth of better care," a summary of the study says.

The study was compiled by iVantage Health Analysis, a private health-care research company. It collected data on Medicare costs and health outcomes for doctors and hospitals for 12 months and divided the results into rural and urban groups based on zip codes, to give a picture of the state-by-state importance of rural hospitals.

In Kentucky, nearly half of its Medicare beneficiaries lived in rural counties in 2010. Nationwide, just 21 percent of them do, though there were western states with much higher percentages. In Wyoming, for example, 69 percent of Medicare beneficiaries live in rural places. Spending per Medicare beneficiary in Kentucky was nearly $8,000 in both urban ($7,851) and rural ($7,879) settings in 2010. That spending is high compared to the rest of the country, however; only nine other states had higher spending.
The study could have wider wider ramifications given changes in the federal health-care reform law and the move toward accountable care organizations, in which doctors and other providers are encouraged to team up to give coordinated care for a population of people and be paid financial incentives to do so.

"Value in health care is created by doing a few things well and not by trying to do everything," the summary reads. "The rural findings may just suggest that by national selection, rural has figured out what it does well and has optimized those services for the patient's benefit." (Read more)