Chain that robbed Fulton of its hospital continues to abandon small towns, says it's no longer a rural hospital company

In politics, if you want to know where things are coming from and where they are headed, one maxim is to "follow the money." That could apply to the evolution of what used to be a rural hospital chain, Community Health Systems of Franklin, Tenn.

"The company has been selling off or closing poorly performing rural hospitals for the last several years," reports Blake Farmer of Nashville Public Radio. "The selling spree is primarily meant to pay down the company's outsized debt load left over from when Community Health was growing as fast as it could. But the hospital chain was also strategically pulling out of small towns."

Farmer adds, "CEO Wayne Smith told investors gathered at this week's annual J.P. Morgan Healthcare Conference in San Francisco that it's almost entirely left communities with fewer than 50,000 people — once its calling card compared to competing hospital chains." Smith said during a presentation, "We're no longer a non-urban -- or for some of you all, a rural -- hospital company."

Parkway Regional Hospital before it closed in 2015

CHS has 111 hospitals in 20 states. In once owned Parkway Regional Hospital in Fulton, Ky., but closed it in 2015, steering business to a hospital it owned in nearby Martin, Tenn. Kentucky had expanded the Medicaid program, which helped rural hospitals, and Tennessee has not, but much of the now-closed hospital's service area was in Tennessee.

"Public officials from Fulton County wanted to take over the hospital and find other providers who might continue services in the area, but CHS rejected this offer, likely, to pre-empt competition for patients in the county," said a study by the Kaiser Commission on Medicaid and the Uninsured and the Urban Institute. "Further, CHS placed restrictions on the use of the hospital – namely, it permitted no acute-care facility to operate there, an action that one respondent said 'strangled' the community’s access to local health care services."

Bill would make Ky. 34th state to legalize medical marijuana, with lots of rules; lack of research remains obstacle for Senate leader

Lawmakers announced their introduction of a bill to legalize
marijuana for medical purposes on Jan. 9. (WDRB image)

Kentucky lawmakers have introduced a bill to legalize medical marijuana and are more hopeful about its passage than last year, despite opposition from leaders of the state Senate.

The sponsors of House Bill 136, the proposed Medicinal Cannabis Act, said at a news conference announcing the bill on Jan. 9 that it differs from previous versions that have failed "because it establishes a new, highly regulated medical marijuana industry," Lawrence Smith reports for Louisville's WDRB.

The bill would allow health-care providers to prescribe marijuana as medicine and would require licensing by the state for cultivators, dispensaries, processors, practitioners and patients. It would be regulated by the state  Department of Alcoholic Beverage Control, which would have "and Cannabis" added to its name before "Control." (Cannabis is the botanical name of the plant from which hemp and marijuana are produced.)

"Medical marijuana legalization has picked up support from some Republican Kentucky lawmakers, including Sen. Dan Seum of Bullitt County, who said he 'smoked a joint' after cancer treatment a number of years ago instead of taking opioid painkillers," Chris Kenning reports for the Louisville Courier Journal, quoting him: "And guess what? No nausea." Seum said he plans to co-sponsor a bill in the Senate similar to the House measure.
The House bill's primary sponsors are Rep. Diane St. Onge, R-Fort Wright, and Rep. Jason Nemes, R-Louisville. Nemes said he was confident that the bill would easily pass the House, but its chances in the Senateare more in doubt.

John Cheves of the Lexington Herald-Leader reports that on the day the bill was introduced, Senate President Robert Stivers made a floor speech asking for more research on medical uses of marijuana. “Where is the study?” asked Stivers, a Manchester lawyer. “Deliver me the study. An appropriate Tier 3 study with control groups that says it is medicinal or therapeutic.”

Research on the medical uses of marijuana has been largely stymied because federal law makes it a Schedule I drug, one with no recognized medical use.

Republican Rep. Danny Bentley, a pharmacist from Russell in Greenup County, has filed a resolution to ask the federal government to expedite research on medical marijuana. That would require the federal government to move marijuana to Schedule II, a list of dangerous but useful drugs.

"We need more research on the harmful effects. Benefits are modest at best; harms are unknown," Bentley told lawmakers on Dec. 12 at the interim joint health committee.

Legalizing marijuana, whether for medicinal or recreational purposes, is a topic that evokes great controversy.

Malcolm Gladwell reports in an in-depth article for The New Yorker about the research on marijuana, and comes to the conclusion that more research is needed.

He writes that the National Academy of Medicine's report that analyzed the scientific literature on cannabis, released in January 2017, "simply stated, over and over again, that a drug North Americans have become enthusiastic about remains a mystery."

Gladwell notes that whether it's pain, nausea, Tourette's syndrome, Parkinson's or anxiety, there simply isn't enough research to conclusively know if it helps or not, let alone to determine dosing, routes of administration, how it interacts with other drugs and its side effects. He adds that this lack of research is also true about the potential risks associated with its use.

Gladwell also points out that it's hard to study a substance that until recently has been largely illegal. He notes that the available studies were done in the 1980s and '90s, when the product was much less potent than much of the marijuana sold today.

The Herald-Leader editorial board, writing in support of the bill, argues that if Kentucky's lawmakers and Congress can pass a "right to try" bill to give terminally ill patients access to unproven, experimental drugs that lack U.S. Food and Drug Administration approval, "It's hypocritical then that many of the same officials, in Frankfort and Washington, still want to deny a treatment to patients who say it's the most effective relief for their chronic pain, PTSD and other symptoms -- a substance that has been used medicinally for millennia and produces none of the tragic side-effects that FDA-approved prescription opiates have inflicted on Americans."

Thirty-three states and the District of Columbia have legalized marijuana in some form for medicinal use. Another 10 have legalized recreational marijuana.

2 anti-abortion bills are already moving through the Republican-led General Assembly, and several others await action

Sen. Matt Castlen spoke at a Pro-life Caucus event in the
Capitol. (Lexington Herald-Leader photo by John Cheves)

In the first week of the 2019 legislative session, opponents of abortion began moving bills through the General Assembly.

The Senate passed a bill to require mandatory reporting of chemical abortions, and was poised to pass one that would ban abortions if a fetal heartbeat has been detected, usually about six weeks into pregnancy. The measure has received two of its required three readings and has been assigned to a committee.

The bills are part of a package of introduced Thursday by the legislature's Pro-life Caucus. Most are expected to face court challenges if they become law, because of the U.S. Supreme Court's abortion decisions. House Bill 148, sponsored by Rep. Joseph Fisher, R-Fort Thomas, would ban all abortions in Kentucky if the high court overturns the 1973 Roe v. Wade decision.

A federal court struck down two laws passed last year to restrict abortion, and a challenge to a third one is pending, John Cheves reports for the Lexington Herald-Leader. Few abortion bills passed until Republicans took control of the House in the 2016 elections.

This year's Senate Bill 9, sponsored by Sen. Matt Castlen, R-Owensboro, “is simply a bill that says if you have detection of a heartbeat, then that child is a living human being, and you can no longer murder that child in his mother’s womb,” Castlen said at a Capitol news conference Jan. 10.

Rep. Robert Goforth, R-East Bernstadt, (Laurel County) has filed a similar measure, HB 100,  Goforth is running against Gov. Matt Bevin for the Republican nomination for governor. 

Critics of the heartbeat bill say that women don't know they are pregnant until after six weeks of pregnancy, and ultrasounds that might reveal a problem in the pregnancy typically aren't done until 18 to 20 weeks of gestation, Cheves reports.

“Essentially what you’re putting in place is a six-week ban, which from our doctors’ perspective is a complete ban on abortion,” Kate Miller, advocacy director for the Kentucky ACLU, which has sued to block several past abortion laws, told Cheves. “With a six-week ban, we know nothing about the health of the pregnancy.”

Under the bill, doctors convicted of performing an abortion without first checking for a fetal heartbeat would be guilty of a Class D felony and face one to five years in prison, any abortion done because of "medical emergency" after a fetal heartbeat is detected must be documented.

Senate Bill 50, sponsored by Sen. Robby Mills, R-Henderson, would require doctors to report all prescription drugs written for the purpose of abortions, such as RU-486, to the state vital statistics office, which would be required to publish online an easily accessible annual report to show how many such prescriptions are written. The Senate passed it Jan. 11 on a 30-6 vote.

"I believe it is important to accurately report the abortions that happen in our state just as we accurately report other deaths, births and all the other vital statistics," Mills said. Describing himself as a "protector of life," he later added, "When you are taking a medicine that is terminating a life, I think that is something that needs to be reporting."

An opponent of the measure, Sen. Denise Harper Angel, D-Louisville, said "This bill is nothing more than another attempt to overturn Roe V. Wade, which 72 percent of the population doesn't want."

One other abortion bill, HB 5, would ban abortion in Kentucky for women seeking to terminate a pregnancy "because of an unborn child's sex, race, color, national origin or disability, except in the case of a medical emergency." Violation would be a felony punishable by up to five years in prison. A similar bill was filed last year, but did not make it out of committee. This one is sponsored by Rep. Melinda Prunty, R-Greenville.

Deborah Yetter of the Courier Journal reports in some detail about the two state abortion laws that were recently struck down by federal judges: an old one that required abortion clinics to have signed agreements with a hospital and ambulance service, and a recent one to require providers to perform an ultrasound, describe it and show it to the patient prior to an abortion.

A third case involves a 2018 law that would ban the most common type of abortion, known as "dilation and evacuation" at roughly 11 weeks of pregnancy or after. This case was heard in the U.S. District Court in Louisville last year and awaits a decision from the judge.

2/3 of registered voters in Ky. poll on Medicaid oppose Bevin's changes, as simply described; not asked about work requirement

By Melissa Patrick
Kentucky Health News

A poll conducted for a group opposing Gov. Matt Bevin's coming changes to the Medicaid program shows that two-thirds of Kentucky voters oppose the changes generally, and specifically oppose cutting back coverage of dental and vision care and non-emergency transportation services.

InsureKY, which released the poll, is a statewide coalition of nonprofits "formed to promote more affordable health insurance, better care, and stronger consumer protections for all Kentuckians," according to the release. The Kentucky Equal Justice Center, a member of the coalition, paid for the two questions in the Mason-Dixon Polling & Research survey, taken Dec. 12-15.

The first question offered respondents a very simple description of the plan and one of its effects: "Federal officials recently approved Governor Matt Bevin's 'waiver' that will change Kentucky’s Medicaid plan and reduce the number of people who receive benefits." The last statement is based on the state's estimate that after five years the program will have 95,000 fewer beneficaries than it would have without the changes. (Tens of thousands of Kentuckians go on and off Medicaid each month.)

After the simple descriptions, the poll asked, "Do you feel the Medicaid program in Kentucky should be scaled back or do you feel the Medicaid program in Kentucky should be left as it is?" Sixty-six percent said the program should be left as it is, 25 percent said it should be scaled back, and 9 percent said they weren't sure.

Most registered voters in each of the state's five regions said they wanted the program to be left alone, with the highest share in Louisville, 70 percent, and the lowest in Northern Kentucky, 59 percent.

There was a difference among political affiliation, with 77 percent of Democrats, 64 percent of independents and 53 percent of Republicans saying they opposed the changes.

At 33 percent, Republican voters had the highest percentage saying they wanted the program scaled back, followed by independents at 28 percent and 19 percent of Democrats.

The second question asked: "Another change Governor Bevin is making to Medicaid is to remove dental, vision, and non-emergency medical transportation coverage for nearly half a million adults. Instead, these adults would have to earn dental and vision services by completing healthy activities. Do you support or oppose the Governor’s plan to reduce benefits in this way?"

InsureKY graph

The poll found that 65 percent of registered voters opposed these changes, 28 percent supported them and 7 percent were undecided.

The poll did not ask about the plan's work requirements, which may be more popular.

If courts approve, the plan would require most "able-bodied" beneficiaires of the program's 2014 expansion to work, attend school or participate in certain activities 80 hours a month to keep their health insurance.

The plan also includes premiums, small deductibles or co-payments, strict reporting requirements and lock-outs for non-compliance. It is tentatively set to start April 1, with the work and community engagement options to be phased in regionally.

The plan largely applies to the nearly 500,000 Kentuckians who have gained coverage through expansion of the program to those who earn up to 138 percent of the federal poverty line ($16,753 for an individual). Kentucky has about 1.4 million people on Medicaid, but only 165,000 are expected to come under the work and community engagement requirements.

The new plan was set to roll out July 1, but a federal judge vacated federal approval of it June 29 and sent it back to the Department of Health and Human Services for review, ruling that federal officials had not fully considered the projection of 95,000 fewer people on the Medicaid rolls.

Opponents of the plan have said these new rules and strict reporting requirements will result in fewer Kentuckians having access to health care, often noting the 17,000 people in Arkansas who have lost their Medicaid coverage since June because they did not meet their state's new work and community engagement requirements.

The Bevin administration has said the new plan isn't set up to kick people off of the program, but to help them become more engaged in their health care and to help them move to jobs that offer private insurance.

HHS re-approved the plan in November, but more litigation is likely.

Cara Stewart, an attorney with the Kentucky Equal Justice Center, one of the three organizations that filed the original lawsuit on behalf of 16 Kentucky Medicaid recipients, said they will file their amended complaint Monday, Jan. 14, the last day allowed on the judge's briefing schedule. The state will need to file any opposition to the motion and its reply by Feb. 11.

Less vulnerable to the court challenge is the change that will require people who gained coverage through Medicaid expansion to earn dental and vision care by participating in self-improvement activities, such as passing a GED exam or completing a stop-smoking class. These services have been offered for free.

The new plan also completely removes non-emergency medical transportation services and offers no provision for regaining them.

Opposition to these changes also varied among political parties, with 79 percent of Democrats, 62 percent of independents and 49 percent of Republicans opposing them.

“These results are a strong statement. The policy changes being proposed simply do not align with public sentiment or the realities that low-income Kentuckians face,” Sheila Schuster, executive director of the Advocacy Action Network, said in the release.

The poll surveyed a total of 625 registered Kentucky voters via both land-line and cell-phone numbers. The margin of error in any statewide figure is is plus or minus 4 percentage points, and higher for the regional, partisan and demographic groups.

After state cigarette tax rose 50 cents, half of Kentucky's adult smokers cut back, considered quitting or tried to quit, poll finds

By Al Cross
Kentucky Health News

Half of Kentucky's adult smokers say they smoked less, or considered or tried to quit smoking, following the increase in the state's cigarette tax on July 1.

That's according to the latest Kentucky Health Issues Poll, taken Aug. 26 through Oct. 21, in approximately the third and fourth months after the tax rose to $1.10 a pack from 60 cents.

"The cigarette tax increase is changing thinking and behavior about smoking in Kentucky," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll.

The poll found that 39 percent of Kentucky smokers reduced the number of cigarettes they smoked, 33 percent considered quitting, and 26 percent actually tried to quit.

The poll did not ask them if their efforts to quit had succeeded, because “It typically takes several attempts to quit,” said Bonnie Hackbarth, the foundation's vice president for external affairs.

While many tried to reduce their smoking, "Cutting back the number of cigarettes smoked per day . . . is not an effective strategy for quitting," said Ellen Hahn, a University of Kentucky nursing professor and a leading tobacco-treatment advocate. "Even low levels of smoking increase heart disease risk. Reduction in the number of cigarettes does not totally eliminate health risks."

The poll is an annual telephone survey of Kentucky adults, co-funded by Interact for Health, a Cincinnati-area health foundation. It found that Kentucky adults' use of tobacco cigarettes and electronic cigarettes remain much higher in Kentucky than the national average.

Nearly one in four (23 percent) of Kentucky adults smoke, according to the poll. The highest rates are among lower-income adults; 35 percent of those eligible for Medicaid (earning up to 138 percent of the amount the federal government considers poverty) said they currently smoked cigarettes. Among those with higher incomes, the rate was 16 percent. The national rate is 17 percent.

Chandler chairs the Coalition for a Smoke-Free Tomorrow, a group of 180 Kentucky businesses, advocacy groups, health-care companies and other organizations working to improve health by reducing tobacco use and secondhand smoke exposure in Kentucky. The Coalition led the campaign during the 2018 legislative session to increase the cigarette tax by $1 per pack.

"We knew we wouldn't get all the health benefits we sought when the legislature opted for 50 cents instead of a dollar and decided to exempt e-cigarettes completely, but we hoped it would have some positive effect. . . . This poll shows it did," Chandler said.

In lobbying the legislature, the coalition argued that tobacco companies would counter it with consumer coupons and retailer discounts so the effective price would rise more gradually, providing less incentive to quit. The largest tobacco-cigarette manufacturer, Altria Group, seemed willing to accept a 50-cent hike, but successfully opposed a 15 percent tax in electronic cigarettes. Now Altria is buying 35 percent of Juul, by far the leading maker of e-cigarettes,

Chandler said the coalition has "amped up our efforts to encourage Kentuckians to quit, and we'll keep on advocating for policies and funding to help them do just that. Meanwhile, congratulations to those who have taken the opportunity to quit. Quitting smoking is one of the most beneficial steps individuals can take to improve their own health, and reducing tobacco use is the single most impactful thing the Foundation for a Healthy Kentucky can do to improve health in the commonwealth."

For information and assistance in quitting smoking, call 1-800-QUIT-NOW or visit https://quitnowkentucky.org.

UK professor who won whistleblower settlement for loss of post-retirement job returns to run an oral health program for 18 months

Raynor Mullins

When he retired from the University of Kentucky dental school several years ago, Raynor Mullins, now 74, continued working for UK on efforts to improve oral health in the state, especially in rural areas.

When he lost that job, he alleged in a lawsuit that it was retribution for his criticism of Gov. Matt Bevin's removal of dental care as a basic benefit for the working poor in Medicaid. Last month, as the case was about to go to trial, the university agreed to pay him $620,000 and rehire him.

His new job will be director of a new Oral Health Innovation Initiative in the College of Public Health, with the first big goal developing a strategic plan for the initiative. It will receive $100,000 in start-up funding and "Mullins will be paid $52,800 for working 40 percent of a full-time job" for 18 months, and hold the rank of professor, Linda Blackford reports for the Lexington Herald-Leader.

His attorney, Joe Childers, told Blackford, “Dr. Mullins is excited to lead this new Oral Health Innovation Initiative, and believes it will lead to long-term gains for the health of Kentuckians. It is truly a win-win for both Dr. Mullins and the University of Kentucky.”

In settling the lawsuit, "UK did not admit that College of Dentistry Dean Stephanos Kyrkanides had pushed Mullins out for his comments, despite numerous depositions from witnesses who heard Kyrkanides say that Mullins had to go," Blackford notes. "In agreeing to allow the lawsuit to go to trial, U.S. District Judge Robert Weir called the case 'the epic story of academic intrigue and the place of free speech.'" Mullins' post-retirement job did not have traditional tenure protection.

In his lawsuit, Mullins said Kyrkanides had told him that he needed to stay "off radio" on the matter, and "communicated that this direction came from 'up top'." The first named defendant in the suit was Mark Birdwhistell, the UK HealthCare vice president and former state Medicaid director who helped Bevin's staff draft the proposed changes. Mullins claimed Kyrkanides was acting at the direction of Birdwhistell, who was acting at the behest of Bevin or his agents. The other defendant was "John Doe," identified only as a member of the governor's administration. They were dismissed from the case several months ago, after Mullins amended his complaint to exclude them. Bevin's office denied any interference, and Birdwhistell testified in a deposition that he had no discussions with anyone in Frankfort about Mullins' comments and never discussed Mullins with Kyrkanides (who testified likewise).

Quitting smoking is a top New Year's resolution, but can prompt weight gain; dietitian says no big deal, quit anyway; offers tips

By Melissa Patrick
Kentucky Health News

Of the 44 percent of American adults who said they would make a New Year's resolution this year, 12 percent said they plan to quit smoking and 10 percent said they plan to lose weight, according to a Marist College poll.

Since Kentucky has the nation's second-highest smoking rate, 24.6 percent, and the seventh eighth-highest obesity rate, 34.3 percent, both those resolutions are probably common in the state.

It might be best to not set both goals at the same time, since quitting smoking can sometimes lead to a modest weight gain. And many could forgo trying to quit smoking because they don't want to gain weight.

But a registered dietitian from Ohio State's Wexner Medical Center, Liz Weinandy, says the weight gain is usually minimal, and nothing to worry about, because it won't increase your risk of death -- but smoking does -- and the health benefits that come from quitting are almost immediate.

Centers for Disease Control and Prevention graphic

After quitting, a smoker's heart rate drops to normal levels in 20 minutes; carbon monoxide level drops back to normal in 12 hours, allowing a person's blood oxygen to increase; lung function improves in just a couple of weeks; the risk of heart disease drops by half in one year, says the American Lung Association.

Weinary said people tend to gain some weight when they try to quit smoking because nicotine "was suppressing your appetite, reducing your ability to smell and taste, raising your metabolic rate and keeping you up at night if you smoked in the evening. Once it’s out of your system, you may feel hungry more often, your metabolism slows, food tastes and smells more appealing, and you may sleep better. . . . But as your body repairs the damage smoking has done, it also adjusts to life without nicotine."

In a university news release, Weinandy notes that a typical weight gain for those who try to quit smoking is usually 10 pounds or less. She offers three tips on how to minimize it, adding that they are also generally good tips to live a healthier life. In fact, these suggestions would improve the success rate of the top four New Year resolutions in the poll: exercising more, stopping smoking, losing weight, and eating healthier.

First, Weinandy says it's important to be more active after you quit smoking. She suggests that former smokers take a walk during their former smoke-break time or to start taking the stairs instead of the elevator. Increasing activity will help you burn more calories and boost your slowing metabolic rate. "I often suggest focusing on exercise before food," she says, "because most people who smoked weren’t working out, because it was hard to get enough oxygen."

Second, she encourages people who are trying to quit smoking to plan their meals, cook at home and to generally eat better, suggesting that they put money formerly spent on cigarettes towards healthier food. She notes that food may taste differently after quitting, so it's a good time to try new foods.

"Nicotine suppresses appetite, which is one reason people will gain weight when they stop smoking – their hunger increases," Weinandy said. "But I’ve also seen former smokers lose weight since better breathing made their taste buds more attuned and, therefore, they don’t eat as many salty and sugary foods."

Her third suggestion is to make sure you sleep seven to nine hours a night, since this helps to balance hunger hormones, decreasing hunger during the day. "One of the things I talk about with all of my patients – smokers and non-smokers – is the importance of getting enough sleep each night," Weinandy said. "Nicotine is a stimulant and, if you smoked later in the day, it was probably affecting your sleep in the same way as when people take in caffeine."

The poll, sponsored by NPR and PBS NewsHour, surveyed 1,075 adults between Nov. 28 and Dec. 4 via cell phones and landlines. The margin of error for those who were likely to make a New Year's resolution in 2019 was plus or minus 5.7 percentage points.

The poll also found that of those who made a 2018 New Year's resolution, 68 percent said they kept it or kept part of it and 32 percent said they did not.

Flu activity increases in Kentucky; health officials urge all 6 months and older to get vaccinated, and to wash your hands

By Melissa Patrick
Kentucky Health News

Kentucky's influenza level has just been updated to "widespread," prompting health officials and advocates to encourage Kentuckians to get their flu shot -- and to keep their hands washed.

“We strongly encourage anyone who hasn’t received a flu vaccine, particularly children six months and older and those people at high risk for complications related to the flu, to get a flu shot,” Dr. Jeff Howard, commissioner of the state Department of Public Health, said in a news release.

He added, “Also remember to cover your cough and avoid touching your eyes, nose and mouth because germs are spread this way. Be sure to frequently wash your hands with soap and water and stay home if you are sick with flu-like illness.”

A recent Kentucky Health Issues Poll found that about half of Kentucky adults got a flu shot in the last 12 months, more than in previous flu seasons, but the Kentucky Medical Association, the Foundation for a Healthy Kentucky and the Kentucky Foundation for Medical Care, which have led a "Focus on Flu" campaign this year to encourage Kentuckians to get vaccinated, note that this still leaves almost half of the state's adults vulnerable to this potentially deadly virus.

"It's not too late to get a flu shot, which can protect you but also help prevent further spread to others," they wrote in a statement. "We're particularly concerned about infants who are too young to get the vaccine as well as those with compromised immune systems for whom exposure to the flu poses the greatest danger. But even otherwise healthy people are at risk of serious illness, hospitalization and death from the flu."

A "widespread" classification is the highest level of flu activity and is used when at least half of the state's 17 health regions have increased activity.

As of Dec. 29, Kentucky had 1,457 laboratory-confirmed cases of the flu, which is comparable to the number of cases at the same time last year, 1,411, according to the weekly influenza surveillance report.

The report says there have been four adult deaths and one pediatric death linked to the flu this season. Last year, more than 300 Kentuckians, including five children, died from the flu.

Louisville has been one of the hardest hit areas in the state, with 875 cases reported this season and 570 of those reported the week of Dec. 23-29, according to the Louisville Metro Department of Public Health and Wellness's weekly influenza report.

Centers for Disease Control and Prevention map of flu activity by state

Insider Louisville reports that Norton Healthcare's immediate-care centers, which are located in Louisville, Southern Indiana and Shepherdsville, saw an increase of cases in late December, going from 66 cases the week that ended Dec. 15 to 286 cases the week that ended Dec. 22.

Dr. Roger Humphries, chair of UK Healthcare's Department of Emergency Medicine, told Kentucky Health News that they have seen a lot of flu activity this year, especially in kids. He added that the hospitals's pediatric emergency department has seen about 10 to 15 kids a day with the flu since mid-December.

A spokeswoman for Baptist Health Lexington said they had seen 47 patients in their emergency room since Dec. 15, which she described as a "large number" of cases, noting that this number does not include patients from their urgent care centers or express care centers.

Flu is very contagious and is especially dangerous to small children, the elderly and those who have chronic health conditions. It is caused by a virus that spreads from person to person. Symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches.

Persons who develop symptoms should contact their medical provider immediately to determine if they are a good candidate for treatment with an antiviral drug, which could shorten the course of the illness or reduce its severity.

The Centers for Disease Control and Prevention recommends that everyone over six months of age get a flu vaccination, and especially encourages people who may be at higher risk for complications or negative consequences get one, including children 6 months to 5 years old and their caregivers, women who are or might be pregnant during flu season, people 50 and older and their caregivers, obese people, those with chronic health problems, residents of long-term care facilities and health care workers.

Vaccinations can be given any time during the flu season, but take about two weeks following the administration of the vaccine for the recipient to develop protection from the flu. Flu season usually peaks between December and February, but can last as late as May.

If you're looking for a place to get your flu shot, the CDC offers an interactive "flu vaccine finder" that allows you to type in your ZIP code to find nearby locations that offer flu shots. Local health departments also offer the vaccine.

Man who got rich recovering part of plaintiffs' awards for hospitals has given $3 million to Baptist Health La Grange

George Rawlings
(PoloLine photo via Courier Journal)

A man who became wealthy getting money for hospitals from people who won large legal settlements after running up big health-care bills has made his second large gift to his hometown hospital, part of Kentucky's largest hospital chain.

George Rawlings and his wife Beverly, of La Grange, "donated $2 million to Baptist Health La Grange and the Baptist Health Foundation for the renovation of the hospital’s emergency department," Amanda Manning reports for The Oldham Era. "The donation is the largest gift that Baptist Health La Grange has received to date."

Last year, the couple "donated $1 million to the hospital toward the George and Beverly Rawlings Women’s Center," Manning reports.

“It is hard to express our level of gratitude,” Mary Michael Corbett, executive director of the Baptist Health Foundation of Greater Louisville, told the Era. “This is the second year that Mr. and Mrs. Rawlings and The Rawlings Foundation has reached out with a priceless gift around the holiday season.”

Rawlings said when the women's center gift was announced, “We’re blessed to be able to help the community and give. It’s really fun.”

In April 2018, Rawlings was the subject of a story in the Louisville Courier Journal, which said he "may be the richest Kentuckian you've never heard of" and moved from Louisville to La Grange in 2007.

"Rawlings is the father of a multi-billion-dollar industry that hunts down people who get legal settlements related to injuries from car wrecks or from defective products," Andrew Wolfson reported. "He recoups what their health-care provider spent on their medical care, keeps about 20 percent and sends the rest to the insurer. This has made him rich, and spawned a $2.5 billion national industry."

Subrogation is "an insurer's right to recover the amount it has paid for a loss from a third party that caused the loss." Wolfson explains. "Critics say the practice can be cruel because severely injured people can lose most or even all of a settlement – money they counted on to defray lost wages or compensate for pain and suffering. And sometimes they lose that money without being made whole for their damages."

Plaintiffs' lawyers "say Rawlings and others like him make their fortunes on the backs of injured people, often enriching themselves by riding the coattails of lawyers who sometimes fight for years to get settlements and verdicts. Other trial lawyers . . . say the Rawlings Group negotiated fair payments for their clients."

Rawlings "and other practitioners of health-care subrogation say it reduces health-insurance costs, allowing lower premiums for all employees," Wolfson wrote. "Proponents also say it would be unfair if an insurance company covers the medical bills but the injured person keeps money received from a third party to cover those same bills."

Wolfson's story began, "He divides his time between a 180-acre farm in Oldham County and the most expensive waterfront condominium ever sold in Palm Beach, Florida. He and his wife own the biggest private employer in Oldham County, where 1,500 people labor in a sprawling complex the size of four football fields. He has no children and has said he has no close friends. He plans to work until he dies."

Rawlings is a major philanthropist, Wolfson reported: "His foundation’s tax records show he and his company gave away a staggering $75 million in recent years to both sectarian charities and evangelical causes, including youth camps in 13 underdeveloped countries. The late Rev. Jerry Falwell’s Liberty University, where the divinity school is named for the Rawlings family, is a favorite."

Low-income, rural kids may be at higher risk of second- and third-hand cigarette smoke exposure than previously thought

A newly published study in Nicotine & Tobacco Research found that young children from low-income, rural homes could be at a higher risk of exposure to second- and third-hand cigarette smoke than previously reported. Secondhand smoke is smoke in the air that comes from a lit tobacco product; thirdhand smoke is smoke residue that settles into floors, furniture and clothing.

The study, funded by the National Institutes of Health, analyzed data from the Family Life Project, an ongoing longitudinal study of poor families in six rural counties of Pennsylvania and North Carolina who added a child between September 2003 and August 2004. Researchers measured levels of cotinine, which the body makes from nicotine, in the saliva of 1,218 children at ages 6,15, 24, and 48 months; about 63 percent had detectable levels, and about 12 percent had at least as much as one would expect to find in an active adult smoker.

"Greater exposure was associated with lower income, less education, more residential instability, and more instability in adult occupants in the home, whereas time spent in center-based day care was associated with lower exposure," the researchers write.

Greater residential instability correlates with higher smoke exposure because thirdhand smoke lingers, so a nonsmoking family that moves into a home once occupied by a smoker will likely be exposed to thirdhand smoke. Poverty is associated with frequent moves, which the researchers hypothesize could increase such children's risk of thirdhand smoke exposure. More time in a center-based daycare lowers the risks of smoke exposure; day-care centers are generally smoke-free.

Poll: 73% of Ky. voters support state excise tax on e-cigarettes, a proven way to limit use among youth, the devices' biggest users

By Melissa Patrick
Kentucky Health News

A new poll shows that nearly three-fourths of registered voters in Kentucky support a statewide excise tax on electronic cigarettes. Currently, e-cigarettes are subject only to sales tax in Kentucky, while traditional cigarettes carry both a sales tax and excise tax.

Kentucky was about to pass a 15 percent excise tax on e-cigarettes during the last legislative session, but after a visit from Altria Group's chief lobbyist, leaders of the state Senate removed the tax from a bill that ultimately raised the state cigarette tax 50 cents a pack, to $1.10. Altria is reportedly buying 35 percent of Juul, the e-cig maker that has three-fourths of the market.

The Mason-Dixon Polling and Research, Inc. poll, taken Dec. 12-15, found that 73 percent of Kentucky voters supported a state excise tax on e-cigarettes, while 21 percent opposed such a tax, and 6 percent were undecided.

Support for the tax was bipartisan, with 77 percent of Republicans and 72 percent of Democrats and 62 percent of independents for it.

"E-cigarette sales are accelerating globally, nationally, and in Kentucky, and given both our state budget situation and this overwhelming level of bipartisan support from voters, there's every fiscal and political reason to treat them the same way as other tobacco products," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. The foundation paid to put two questions in the poll.

Among the 16 percent of Kentucky adults who said they had tried electronic cigarettes, 53 percent opposed the tax, 37 percent supported it, and 10 percent said they were undecided. Teenagers were not polled, but their use of the vapor products has exploded.

Federal research released in November showed a 78 percent increase in vaping among high-school students between 2017 and 2018, with the number of vapers surpassing 3 million. The same report showed vaping by middle schoolers increased 48 percent from the year before.

The problem is so widespread that the surgeon general has called teen vaping an epidemic, prompting him to release a rare national advisory stressing the importance of protecting children from e-cigs, which are setting them up for a lifetime of nicotine addiction and associated health risk.

"This explosive growth is erasing years of progress in reducing tobacco use among adolescents and teens and creating a whole new generation of Kentuckians who will have to deal with the expensive, debilitating and often deadly diseases tied to tobacco consumption," Chandler said. "The research shows that one of the most effective ways of reducing tobacco use -- especially among youth, pregnant women and those living on low incomes -- is raising the cost of the tobacco products."

According to the federal Centers for Disease Control and Prevention, 100 percent smoke-free policies, hard-hitting media campaigns, access to proven cessation products and tobacco price increases are proven strategies to decrease tobacco use.

The poll found support for an excise tax was strong across the state, with the strongest support in the Bluegrass and Northern Kentucky (79 percent), followed by Western Kentucky (77 percent) and Louisville Metro (70 percent). Eastern Kentucky, the region that reported the highest use of e-cigarettes, 21 percent, had the lowest support for the tax: 64 percent.

Support was slightly higher among men than women, 76 percent and 70 percent, respectively. It was highest among older Kentuckians, with 79 percent of voters between 50 and 64 supporting the tax, followed by 76 percent of those 65 and older, and 75 percent of those between 35 and 49.

Only 56 percent of Kentucky voters between the ages of 18 and 34 supported an e-cigarette tax, no surprise since the poll also found that 41 percent of this group had tried the devices. Vaping was reported by 13 percent of those 35-49, 12 percent of those 50-64; and 7 percent of those 65 and older.

The poll surveyed a total of 625 registered Kentucky voters via both land-line and cell-phone numbers. The margin for error in any statewide figure is plus or minus 4 percentage points, and higher for the regional, partisan and demographic groups.

Nine states and the District of Columbia have imposed an excise tax on e-cigarette sales, according to the news release.

A spokesman for Senate President Robert Stivers said he had no comment on this matter at this time.

In a statement issued Thursday, Altria said: "Altria's tobacco operating companies oppose excise tax increases which fund general government programs that benefit many while placing the economic burden solely on adult tobacco consumers. This is particularly true in Kentucky, where cigarettes were the only consumer good targeted with an excise tax increase in 2018, and increasing taxes on e-cigarettes is just an extension of the same unfair policy."

Williamstown is first city in Northern Kentucky to implement comprehensive workplace and public-place smoking ban

On Jan. 1, the Grant County seat of Williamstown became the first place in Northern Kentucky to implement a comprehensive ban with smoking ban. Kenton County has significant exemptions, meaning it does not have a comprehensive smoke-free policy.

The ordinance, which passed in September, bans smoking, including the use of electronic cigarettes, in all buildings and places of employment, as well as in public outdoor patios. The new law allows for an exception for private clubs, unless it is being used for a function where the general public is invited.

Parks in the city of Williamstown have been tobacco-free since July 2017.

The new law also requires smokers to be 25 feet away from all entrances and windows that open and ventilation systems.

The Northern Kentucky Health Department will be responsible for enforcing the law and investigating any complaints.

"We congratulate the Williamstown City Council in taking this important step to improve the health of the community,” department Health Director Lynne Saddler said in a news release.

Williamstown is the 33rd city in Kentucky to implement a comprehensive smoke-free law, according to the news release.

On Oct. 1, 35 percent of Kentuckians were covered by comprehensive smoking bans for indoor
workplaces and public places. Williamstown's took effect Jan. 1. (Kentucky Center for Smoke-Free Policy)