Nursing homes push for lawsuit protection with fast-moving bill and broadcast ads; newspaper editorials excoriate sponsor, industry

A state Senate committee has approved a bill that would require lawsuits against nursing homes to clear a review panel before going to court, a move that has drawn very sharp criticism from the editorial pages of the state's two largest newspapers. Meanwhile, the nursing-home industry is running television and radio ads urging calls to legislators in favor of the measure, which the Senate Health and Welfare Committee approved 7-4 last Wednesday without hearing from its opponents.

"Slimy action on questionable bill" read the headline over Tuesday's Lexington Herald-Leader's editorial, which began, "Good ideas can withstand criticism. So, when lawmakers move a piece of legislation without hearing from any of its opponents, you have to wonder whether they're sneaking through a stinker."

The chairman of the committee and the bill's sponsor, Sen. Julie Denton, R-Louisville, said some members had to leave for other meetings. "But somehow they had time to listen to industry spokesmen before voting," the Herald-Leader noted. "The nursing home industry claims that it is under siege from frivolous lawsuits drummed up by attorneys advertising for clients and that this legal threat pushes up nursing homes' insurance and legal costs, taking money that otherwise could go into patient care." (Read more)

The Courier-Journal editorial, which first reported the committee's action, accused Denton of "a brazen abuse of her power as committee chairman" and said sarcastically that she was "humane" to spare members of he committee "the ugly details of nursing home neglect and abuse. . . . Why should members, before lunch, have to consider graphic testimony about bedsores, near-starvation, dehydration and bowel obstructions suffered by elderly, helpless people? But for members of the General Assembly who are interested in the facts, here are some:

• Kentucky currently has about 23,000, mostly frail, elderly people who are residents in about 280 nursing homes. About half the homes have been cited by federal inspectors for a serious deficiency since 2009.
• 40 percent of the homes are rated at below average by the U.S. Center for Medicare and Medicaid Services when it comes to basic health and safety.
• In 2012, Kentucky ranked first in overall federal fines for violations and one Kentucky nursing home racked up the nation’s highest fines for the year.
• Kentucky ranks first in serious nursing home deficiencies that threaten the safety of residents. (Read more)

Sen. Ray Jones, D-Pikeville, who called Denton's move "blatantly wrong." has filed several floor amendments to the bill, which remained in the Senate Rules Committee Monday.

The Kentucky Association of Health Care Facilities is pushing the bill with TV and radio commercials urging calls to legislators. It placed $9,464 worth of ads on Lexington TV stations through Feb. 14.

First major study of diet and strokes links fried, sugary Southern diet, low on fruits and vegetables, to increased risk

Genuine Kentucky fried platter:
Cornbread, fried catfish, fried green
tomatoes, fried apples and fried okra
(Photo from Ramsey's, Lexington)

By Molly Burchett
Kentucky Health News

People with a Southern diet, or one heavy on fried food and sugary drinks like sweet tea and soft drinks, are more likely to suffer a stroke, a new study finds.

It's the first big look at diet and strokes, and researchers say it might help explain people in the nation's "stroke belt" or southern states suffer more of them, reports Marilynn Marchione of The Associated Press.

These findings have important implications for Kentuckians because stroke accounts for 5.5 percent of Kentucky deaths each year and more than 81 percent of Kentucky adults eat fruit and vegetables fewer than 5 times a day, which is a indicator of risk for stroke:

Heart Disease and Stroke Risk Factors from federal Behavioral Risk Factor Surveillance System national survey	Ky.	U.S.
Eat fruits and vegetables less than 5 times/day	81.6	75.6
Overweight or obese	69.1	62.9
No moderate or vigorous physical activity	55.8	50.5
High total blood cholesterol	38.5	37.6
High blood pressure	30.0	27.8
Cigarette smoking	28.2	19.8
Diabetes	9.9	8.0

"We're talking about fried foods, french fries, hamburgers, processed meats, hot dogs," bacon, ham, liver, gizzards and sugary drinks, said the study's leader, Suzanne Judd of the University of Alabama in Birmingham.  For the study, a southern diet also included jerky, red meat, eggs, and whole milk.


Fried foods tend to be eaten with lots of salt, which raises blood pressure and sweet drinks increases risk for diabetes- both are known stroke risk factors, Judd said.

People who ate about six meals a week featuring these sorts of "Southern" foods had a 41 percent higher stroke risk than people who ate that way about once a month, researchers found.

In contrast, people whose diets were high in fruits, vegetables, whole grains and fish had a 29 percent lower stroke risk, reports Marchione.

"It's a very big difference," Judd said. "The message for people in the middle is there's a graded risk" — the likelihood of suffering a stroke rises in proportion to each Southern meal in a week. 

These findings were reported last week at the American Stroke Association conference. The study was launched in 2002 to explore regional variations in stroke risks and reasons for them.

Stroke death rates in Kentucky vary widely among counties. Here's a county map of the rates, from KentuckyHealthFacts.org, which has a county-by county list:

The map shows stroke rates in ranges per 100,000 population from 2003 through 2007. Purple counties had rates above 69; blue counties ranged from 52 to 69; turquoise were 44 to 52; light blue were 31 to 44 (the number that is about the national average), and tan were 18 to 31.

Some Christian Co. health board members balk at director's idea of using $100,000 of $2.4 million reserve for recreational trail

The director of the Christian County Health Department urged its board to give $100,000 from reserves to fund a rail-to-trail project to provide residents with new opportunities for exercise.

Coverting old railroad beds to recreation trails could help improve Christian County's infrastructure to promote healthy living, which is needed because a study last year ranked Christian County 116th out of Kentucky's 120 counties in this area, said Health Department Director Mark Pyle.

The department has $2.4 million in reserve, but several board members opposed the idea, citing a budget shortfall this fiscal year, financial troubles with the school-nurse program and delays in Medicaid reimbursements, reports Nick Tabor of the Kentucky New Era.

The City of Hopkinsville hopes to raise $400,000 for the first phase of the trail project. A recreational trail would initiate a culture change and residents should have public resources equal to those of other regions, Mayor Dan Kemp told Taylor.

Pyle told Tabor the trail would help the health department accomplish its goal of advancing public health, and the reserve money isn't there for sitting on. He said he believes the board will agree to using the money for the project at its next meeting, April 22, after considering funding priorities.

The New Era endorsed the health department's contribution as a good investment in local health, which by law is the health board's responsibility. For a PDF of the editorial and the news story, click here.

Ky. Rural Health Association seeks entries in reporting contest

The Kentucky Rural Health Association invites nominations for its annual rural health reporting awards, which aim to encourage more and better coverage of Kentucky’s rural health-related issues by the state’s newspapers.

The contest has daily and non-daily divisions, each with two categories: series and single story. Each of the four winners gets a plaque and a $100 prize at KRHA's summer conference. Articles must originally have been published during the preceding fiscal year. Entries will be accepted from staff writers, editors, freelance writers and others affiliated with a Kentucky-based newspaper, and from KRHA members and community members at large on the writers’ or newspapers’ behalf. Each entry should include three copies of the article as it originally appeared in the newspaper. The awards will be based on relevance to rural health, quality of reporting, impact on health care policy and new insights generated by the reporting.

For entry information, contact Ernie L. Scott of the Kentucky Office of Rural Health at 750 Morton Blvd., Hazard KY 41701, or 606.439.3557 ext. 83689, or ernie.scott@uky.edu.

Statewide smoking ban close to House vote, Stumbo says

For the second straight year, the state House Health and Welfare Committee has approved a bill that would ban smoking in enclosed public places or workplaces. It is still unlikely to become law, but might get farther in the legislative process.

"The proposal has never been voted on by the full House, and it would probably have a rough road in the Republican-controlled Senate," Beth Musgrave reports for the Lexington Herald-Leader. "Senate President Robert Stivers, R-Manchester, said that the government shouldn't tell businesses they cannot regulate smoking on their own property." (Stivers' hometown does just that; it is one of 22 Kentucky jurisdictions with smoking bans.)

House Speaker Greg Stumbo told Musgrave that he supports the measure, House Bill 190, and that sponsors are close to getting the votes it needs to pass the full House. The House has 100 members, but a bill can pass with as few as 40 votes as long as enough members abstain and it has a plurality.

The bill passed the committee Wednesday by a vote of 11-0, with four Republicans abstaining: Reps. Tim Moore of Elizabethtown, Robert Benvenuti of Lexington, Ben Waide of Madisonville and Addia Wuchner of Burlington.

Rep. Julie Adams of Louisville, the bill's Republican sponsor, told Musgrave that 29 states have statewide smoking bans, 24 with bans like the bill would impose. "This is a mainstream issue," she said. "The Kentucky General Assembly is way behind the general public." (Read more)

Basketball star Derek Anderson will join Smoke-Free Kentucky for its annual lobbying day in Frankfort Thursday, Feb. 14. He said in a press release, “Kentucky has so much to be proud of.   We are known for our hoops and horses.  Unfortunately, we are also number 1 in the number of deaths from lung cancer.  This is unacceptable to me. I want to be a part of the movement to change that.”  He added, “I am a businessman.  Smoke-free workplaces make good economic sense.” (Read more)

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/02/07/2507141/statewide-smoking-ban-clears-kentucky.html#storylink=cpy

Beshear calls for action to improve state's health, but says only that 'It's time for us to begin looking seriously' at a smoking ban

By Al Cross
Kentucky Health News

His priorities were education and tax reform, but Gov. Steve Beshear mentioned several health issues in his State of the Commonwealth speech tonight to a joint session of the General Assembly.

Beshear called for action to correct the state's "fundamental weaknesses," including "a population whose health ranks among the worst in the nation." Near the end of his speech, he said, "We need to continue improving the health of our people," but after about a minute of discussing tobacco and smoking he stopped short of endorsing a statewide ban on smoking in the workplace. (KET photo)

"It's time for us to begin looking seriously at doing this on a statewide level," he said to some applause, after noting that nearly half of Kentuckians live in jurisdictions where smoking is legally restricted, that the state has the highest or next-to-highest smoking rate overall and among teens and pregnant women, and that "Our smoking-related mortality rate is the worst in the nation. . . . Our addiction hurts productivity, jacks up health care costs and kills our people."

Beshear called for improving prenatal care and newborn screening, and for minor improvements in last year's bill to fight prescription drug abuse. He said the bill has caused a precipitous drop in abuse of prescription painkillers. "Kentucky at one time had the sixth highest rate in the nation, but . . . we improved 24 spots," he said. "Nearly half of the state's known pain management clinics have closed rather than submit to new rules that protect patients." He said use of the Kentucky All Schedule Prescription Electronic Reporting system "has increased nearly seven-fold . . . and prescriptions for some of the most abused drugs have dropped up to 14 percent from a year ago."

However, the problem of babies becoming addicted to drugs in their addicted mothers' wombs has skyrocketed in the last decade or so, Beshear said: "In 2000, reports showed 29 babies in Kentucky born addicted to drugs. But in 2011, there were 730 babies – more than 25 times as many. And that figure is thought to be under-reported." He did not say how he wants to improve screening.

Beshear did not mention perhaps the biggest health policy question facing the commonwealth, whether to use federal subsidies to expand the Medicaid program to people in households earning up to 138 percent of the federal poverty threshold. Now the program covers people in households earning up to 70 percent of the poverty line. The federal government would pay all the cost of the additional enrollees through 2016, when the state would start picking up part of the tab, up to 20 percent in 2020.

Some Republicans say the state can't afford the expansion, while some Democrats say it would be a good long-term investment in the state's health and economy. Beshear has said he wants to do it if the commonwealth can afford it, and expects to get cost estimates around the end of March -- about the time the legislature must adjourn.

For a PDF of the speech text, click here. For an audio recording, go here. For video from KET, here.

Physician assistants and some doctors urge lawmakers to pass bill that could ease provider shortage in rural Kentucky

Doctors and more than 150 physician-assistant students urged lawmakers Tuesday to pass a bill they stated involves dropping only one requirement in the law and could ease a physician shortage in Kentucky, reports Ryan Nick of cn|2's "Pure Politics."

Passage of Senate Bill 43 would repeal a law that allows physician assistants to treat patients only when a supervising physician is on site for the first 18 months after their certification. If passed, PAs would still be supervised but would be permitted to perform services in a location separate from the supervising physician, as long as that physician can be reached by phone at all times.

No other state requires PAs to have 18 months of on-site supervision. Colorado, the state with the next-longest mandate, requires supervision only for the first 1,000 hours after certification.

The bill's supporters say the burdensome supervision requirement has led to 55 out of Kentucky's 120 counties being medically underserved and has encouraged many PAs to practice in other states, reports Storm. They also say this rule needlessly complicates patient care, especially in rural areas where doctors are stretched thin, reports Melinda Beck of The Wall Street Journal.

The bill's sponsor, Sen. Tom Buford, R-Nicholasville, told Kentucky Health News that he expects the Kentucky Medical Association to seek some changes in the bill, but also expects it to pass because Senate Republican leaders, hospitals and universities support it. "We're educating these PAs at a lot of state expense just to work in other states," he said. House Speaker Greg Stumbo, D-Prestonsburg, told Storm he sees no reason why the bill shouldn't pass. Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee, told KHN that she supports the bill.

PAs are expected to be in even greater demand when the health-care reform law brings hundreds of thousands of Kentuckians into the health-insurance system. Beck notes the state is expected to face a greater shortage of physicians, particularly in primary care and rural areas. Buford said, "We're going to provide all this health care for everybody, and there's nobody to go see." For more from cn|2, including video interviews, click here.

Kasich of Ohio is fifth Republican governor to accept Medicaid expansion; he and others cite need to protect rural hospitals, poor

Several Republican governors have decided to expand Medicaid under federal health-care reform, saying their conservative principles were outweighed by a need to protect their state's rural hospitals and low-income people. Yesterday, the governor of one of the biggest states got on the bandwagon.

John Kasich of Ohio joined Jan Brewer of Arizona, Brian Sandoval of Nevada, Susana Martinez of New Mexico and Jack Dalrymple of North Dakota in saying they will take heavy federal subsidies to expand the program to households with incomes up to 138 percent of the federal poverty threshold.

Democratic Gov. Steve Beshear of Kentucky has said he wants to expand Medicaid if Kentucky can afford it, and he expects to get cost estimates around the end of March.

While Kasich is not an "Obamacare" supporter, he said expanding Medicaid “makes great sense for Ohio” because it would save $235 million over the next two years and free about $100 million in local funds for mental-health and addiction services, reports The Columbus Dispatch.

Kasich said the decision could extend health coverage to as many as 578,000 uninsured Ohio residents, and could keep everyone else’s health insurance premiums down because there won’t be so many uninsured people going to emergency rooms for their medical care, reports David Nather of Politico.

Kasich emphasized that he would like to see the 2010 law repealed, but the federal money it would pump into the state — about $13 billion over the next seven years — was too much to pass up, reports Stateline. The federal government will pay the full cost of expansion through 2016; then  states will have to pitch in, rising to a limit of 10 percent by 2020.

Brewer likewise said it doesn't make sense for Arizona to pass up federal dollars, reports Howard Fischer of the Arizona Daily Sun. "We will protect rural and safety-net hospitals from being pushed to the brink by growing their cost in caring for the uninsured," Brewer said. She also said the expansion will create enormous economic benefit, inject $2 billion into the Arizona economy, save and create thousands of jobs and provide health care to hundreds of thousands of low-income individuals, reports Fischer.

Brewer said going along with expansion will save Arizona money because the costs of providing care to the uninsured are not simply absorbed by hospitals but passed along through increased insurance premiums. Supporters of the expansion hope the five Republicans' decisions will prompt more GOP governors to follow suit. Twenty governors from both political parties are still undecided. (Read more)

Report says veteran suicide rate is up from 2007

Almost every hour in this country, on average, a veteran commits suicide. The Department of Veterans Affairs reported that 22 veterans per day took their own lives in 2010, up four a day from the 2007 rate. Perhaps contrary to public perception, the report said most suicides occurred among veterans over 50. It recognized Vietnam-era veterans as a risk group, as well as female veterans.

Military service members come disproportionately from rural areas. Kentucky has two army posts, Fort Knox and Fort Campbell.

(Among active service members in 2012, more died from suicide than in combat, we reported here. The Army said Friday that 325 soldiers committed suicides last year; if the tentative number is confirmed, it would be a historical high. "If that bleak total remains at 325, the toll in 2012 would have risen by 15 percent over 2011 when the Army sustained 283 suicides," NBC News reported.)

Reactions to the VA report ranged from encouragement to outrage. The VA pointed out that the daily veteran suicide rate has "remained relatively stable over the past 12 years," but the percentage of the overall national suicide rate accounted for by veteran suicide has actually decreased.  Veteran suicides accounted for about one-fifth of American suicides in 2010, down from one-fourth of suicides in 1999.

The VA said that showed its programs are working, but promised to take "immediate actions." NBC reported that "the top strategy" on the VA's agenda was an already-established task force that could help suicide screening identify warning signs earlier.

Some groups were dismayed by the VA report and demanded more action. Iraq and Afghanistan Veterans of America called for more research and collaboration. "The country should be outraged that we are allowing this tragedy to continue," IAVA found and CEO Paul Rieckhoff told NBC.

On Feb. 13, the U.S. House Committee on Veterans' Affairs will hold a hearing on veterans and mental health care. The Veterans Crisis Line -- 800-273-TALK -- is available for veterans who are concerned about their mental health. (Read more)

Big papers' Page 1 stories spotlight recovery center for pill addicts, lack of state program for problem gamblers

Gripping stories from recovering addicts, on the front pages of Kentucky's two largest newspapers this morning, highlight Kentuckians' fights against all types of addiction, from gambling to drugs.

Hope of recovery emerges from Laura Ungar's story in The Courier-Journal that focuses on the Isaiah House recovery center in Willisburg. A gymnasium at the site has been transformed into a factory of sorts, where a pill addict who has been clean three weeks polishes car parts, while a morphine addict with 103 days’ sobriety hammers nails into wood to make pallets, Ungar reports.

Work is an essential part of recovery at the Isaiah House, giving structure to chaotic lives, teaching job skills and building confidence. “It gives them a sense of purpose, of accomplishment,” Executive Director Mark LaPalme told Ungar. “They get their dignity back — that’s what work does.”

LaPalme, a Connecticut native and recovering cocaine addict, said he started Isaiah House in his basement in 1999, after a spiritual experience moved him to set aside seven bedrooms for other addicts. Today, the house helps to rebuild the lives of drug and alcohol addicts, while promoting worth ethic and responsibility throughout the recovery process (Read more).

Jack Brammer of the Lexington Herald-Leader writes about Kentucky's lack of a state program to treat problem gamblers. It is one of 13 states without such a program.

Billy Stephens, 66, Hawesville Mayor Rita Stephens' husband, said he lived a "a life of lies" with his gambling addiction, but with professional treatment, has not gambled since 2010. When he finally sought treatment, he could find no affordable treatment in Kentucky. The family had to borrow money to pay for his $6,000 treatment in a 36-day program in Louisiana, which is free to residents of the Bayou State.

"My addiction almost destroyed me," he told Brammer. "My insurance in Kentucky would have helped with my treatment if it were alcohol. But it was gambling." (Read more)

Invisible health panel could help Ky., if it had money and met

A panel charged with helping devise solutions to the nation’s health-care workforce crisis, which includes ensuring rural areas have enough health-care providers, is having a workforce crisis of its own: It hasn’t been funded, and it’s never met, writes Kyle Cheney of Politico. 

The National Health Care Workforce Commission was created by Congress nearly three years ago under the Affordable Care Act, the panelists were appointed, but that’s about it. The lack of action was noted at a hearing Tuesday of a subcommittee of the Senate Special Committee on Aging, convened by Sen. Bernie Sanders (I-Vt.), chairman of the Subcommittee on Primary Health and Aging.

Sanders issued a report estimating that 57 million Americans lack ready access to primary care. Since  millions are expected to gain coverage when the reform law goes into full effect next year, there is a looming concern over whether there are enough doctors, physicians' assistants, nurse practitioners, nurses and so on. Most of the worry relates to the lack of primary-care providers in underserved areas, which could be a huge problem for Kentucky.

In addition to exploring the health workforce needs in rural and “medically underserved” settings, the commission was supposed to address the capacity of the nursing workforce, graduate medical education policies, education and loan programs for health-care professionals and the “mental and behavioral health care workforce capacity,” writes Cheney.

Since the 15-member panel was appointed in September 2010 by the U.S. comptroller general, 10 members’ terms have expired, and they’ve been reappointed for another three years each, Cheney reports. No funding has been approved, although both Senate Democrats and President Barack Obama have proposed $3 million funding packages.

“In order for the promise of expanded coverage passed into law by ACA to become a reality, the provisions designed to reach those goals must be fully funded and implemented,” Sanders said. “We need to make sure that our health care system has the infrastructure in place to provide the care necessary to prevent diseases and improve the health of all Americans.” (Read more)

Small steps can prevent Kentucky's No. 1 killer, heart disease

It is now February, which is American Heart Month and a perfect time to remind people that small steps can reduce their risk of heart disease, Kentucky's No. 1 killer.

You may be surprised to hear that almost 80 percent of heart disease is preventable and there are daily things that can be done to keep hearts healthy, according Dr. Martha Grogan, medical editor-in-chief of Mayo Clinic Healthy Heart for Life.

For example, try to move 10 extra minutes each day, Recent research shows a sedentary lifestyle may increase your risk of heart attack almost as much as smoking, said Grogan.

Each day, make an effort to get up from your desk to go talk to a colleague instead of sending an email, or walk around the house as you are talking on the phone, she recommends: “Moving even 10 minutes a day for someone who’s been sedentary may reduce the risk for heart disease by 50 percent.”

Hearts are also hurt when you deprive yourself of sleep, which is a necessity like food and water, said Virend Somers, a Mayo cardiologist and sleep expert. Chronic sleep deprivation can increase the risk of obesity, high blood pressure, heart attack, diabetes and depression.

Healthy habits can reduce a majority of risks for heart attack. "A 53-year-old male smoker with high blood pressure has a 20 percent chance of having a heart attack over the next 10 years. If he stops smoking, his risk drops to 10 percent; if he takes high blood pressure medicine, it falls to 5 percent," says preventive cardiologist Randal Thomas, M.D.

These healthy habits and changes like quitting smoking and taking blood pressure medicine can make a difference in life and death. For more from the Mayo Clinic, click here; for a American Heart Month information from the federal Centers for Disease Control and Prevention, go here.