Saturday, March 24, 2018

Rural health clinics claim drug makers and distributors 'created and engineered' opioid epidemic, seek national class action

"Two rural Kentucky health clinics are trying to open a new front in the legal battle against drug companies that allegedly used improper tactics to fan an epidemic of addiction to powerful painkillers called opioids," Bill Estep reports for the Lexington Herald-Leader.
Two rural health clinics have filed a federal lawsuit against several drug companies, claiming the firms “created and engineered” the opioid epidemic, causing the clinics to incur past and future costs for treating addicts which they won't otherwise be compensat

“These pharmaceutical companies aggressively advertised to and persuaded practitioners to prescribe highly addictive, dangerous opioids, and turned patients into drug addicts or dependents for their own corporate profit,” charges the complaint by Family Practice Clinic of Booneville Inc., and Family Health Care Clinic PSC of Richmond. It says the firms "created and engineered" the epidemic.

"Their lawsuit lists more than 20 defendant pharmaceutical manufacturers and distributors," Estep reports. "Some of the companies are subsidiaries of others in the complaint. Three attorneys with the Lexington firm of McBrayer, McGinnis, Leslie & Kirkland, along with a firm from Georgia, filed the lawsuit for the clinics."

Estep notes, "Lawsuits seeking damages from drug companies for conduct that allegedly worsened the drug crisis in Kentucky and the nation are not new. There are hundreds of such cases pending around the country." But this one is the first by rural health clinics, according to David J. Guarnieri, one of the Lexington attorneys.

The suit seeks unspecified damages and asks that it be made a class action on behalf of more than 4,100 rural health clinics, including 745 in Appalachian areas of Kentucky (which has 191), Alabama, Mississippi, North Carolina, Ohio and Tennessee. “They’re on the front lines dealing with the opioid crisis,” Guarnieri said.

"The lawsuit argues that drug makers used false and misleading claims to push their products, such as down-playing the risk of addiction; claiming that it is easy to manage opioid dependence and withdrawal; and denying risks from using higher doses of the drugs," Estep reports. "It also alleges the companies targeted vulnerable patient populations, including people served by rural health clinics in Appalachia. There is a high prevalence of “societal risk factors which contribute to an increased and widespread abuse of opioids” in the region, the lawsuit says, including lower income; lower educational attainment; depression; a higher portion of jobs prone to injuries; and poor health status."

The suit claims distributors of the drugs failed "to stop suspiciously large shipments of painkillers and by not reporting red flags about possible diversion of prescription pills to the government as required," Estep reports. It says addiction to opioids "drives up costs for rural health clinics, not just for providing treatment but for added needs such as regulatory compliance and security; lost employee productivity; and having to kick out patients for abusing or diverting prescribed drugs."

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Friday, March 23, 2018

Ban of most common type of 2nd-trimester abortions nears passage; foes say it's part of larger strategy to ban abortion

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A House bill to ban the most common method of second-trimester abortion is near final passage after passing out of the Senate Judiciary Committee and the Senate on the same day, despite warnings that its passage would lead to a legal fight.

Committee Chair Whitney Westerfield, R-Hopkinsville, said concerns about being sued over a bill that protects an unborn child and the potential legal cost to taxpayers shouldn't be a consideration in voting for this bill. "It's worth challenging precedent," he said.

Rep. Addia Wuchner
House Bill 454, sponsored by Rep. Addia Wuchner, R-Florence, would prohibit an abortion procedure known as dilation and evacuation, or D&E, after roughly 11 weeks of pregnancy except in medical emergencies. The procedure involves dilating the cervix and removing the fetus using suction and surgical tools.

If the bill becomes law, abortion providers found in violation of it would be guilty of a felony that carries a prison sentence. The women undergoing the procedure would not be prosecuted.

A federal court has struck down a ban on the procedure in Texas, and similar bans have been temporarily blocked in Alabama, Arkansas, Kansas, Louisiana, and Oklahoma while litigation proceeds. Mississippi and West Virginia have similar bans that haven't been challenged in court, because the bans aren't expected to have an impact on abortion services, according to the American Civil Liberties Union of Kentucky.

Sen. Wil Schroder, R-Wilder, told both the committee and the full Senate that no federal judge from the Sixth Circuit of the U.S. Court of Appeals, which covers Kentucky, has ever ruled on such a law.

Wuchner said at the March 22 committee meeting that the bill did not prohibit all abortion methods after the 11-week mark in Kentucky because Kentucky women would still be able to get a second-trimester abortion through the induction of labor or a procedure called dilation and curettage, or D&C, which involves dilating the cervix and removing the contents of the uterus by scraping and scooping.

In presenting the bill on the floor, Sen. Stephen Meredith, R-Leitchfield, said, “Abortions by dismemberment, crushing or suction are brutal procedures which are and should be considered repulsive, barbaric and inhumane by any society standards. “This bill upholds basic human dignity.”

Opponents of the bill said that without access to legal D&E procedures, Kentucky women will be limited to undergoing more expensive abortions that takes longer and involve a hospital stay.

Marcie Crim, executive director at Kentucky Health Justice Network, told the committee that Kentucky Revised Statute 311.800 will make getting an abortion after 11 weeks near impossible because it says that no publicly owned hospital or publicly owned healthcare facility can perform abortions, except to save the life of the pregnant woman -- and most of Kentucky's hospitals are either publicly owned or owned by a religious organization.

The bill passed the Senate 31-5, with Democrats Julian Carroll of Frankfort, Reginald Thomas of Lexington and Perry Clark, Denise Harper Angel and Morgan McGarvey of Louisville voting against it. Sens. Gerald Neal of Louisville and Robin Webb of Grayson did not vote.

The bill returned to the House for consideration of a change made in the Senate to add a definition for "unborn child." The bill passed the House March 12 on a 71-11 vote.

Tamarra Wieder, director of external affairs for Planned Parenthood Advocates of Indiana and Kentucky, told the committee that experts from the American Congress of Obstetricians and Gynecologists oppose such laws.

"This bill is part of a larger anti-abortion strategy to ban abortion law by law, method by method," she said. "House bill 454, which uses inflammatory, non-medical language to ban abortion, is further proof of this bill's intent."

In 2016, the state's "informed consent" law was amended to require women seeking an abortion to have a face-to-face or live-chat consultation before the procedure.

In 2017, when Republicans took full control of the General Assembly, it passed two abortion bills that were signed into law by Republican Gov. Matt Bevin, who was elected in 2015. One banned abortions after 20 weeks of pregnancy, unless the mother's life is in danger. The other required women to get an ultrasound before an abortion that included an audible heartbeat, and required the doctor to show and describe the image of the fetus to the patient before performing the abortion. This law was struck down in court, but the state has appealed.

The only remaining abortion clinic in Kentucky, EMW Women's Surgical Center in Louisville, is in a legal battle with the state over licensing issues.

Senate bill to create tele-heath payment model, with anti-abortion measure attached, advances to full House

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A Senate tele-health bill aimed at increasing access to care and saving the state money is awaiting a vote in the House, amid an objection from the state's largest health insurer and opposition to an amendment that would keep tele-health form being used in abortions.

Sen. Ralph Alvarado
Senate Bill 112, sponsored by Republican Sen. Ralph Alvarado, passed the Senate without dissent and has been placed in the regular orders of the day in the House. It includes a Senate amendment to prohibit tele-health from being used for abortions.

Alvarado, a Winchester physician, told the House committee that telemedicine has been proven to save money through such measures as "video conference follow-ups and remote patient monitoring that decrease hospitalizations and increase the quality of care."

He added that it allows physicians the ability to remotely monitor chronic diseases more efficiently, increases access to specialty care, increases access to mental-health care, decreases use of emergency rooms, and increases provider access to those with transportation issues.

Alvarado cited a study in the journal Health Affairs which he said found savings of 7.7 percent to 13.3 percent per patient, per quarter, for chronically ill Medicare recipients. In addition, he said the state-employee tele-health program had saved the state $2.5 million.

The bill would require the Cabinet for Health and Family Services to develop telemedicine policies, including a reimbursement model, with similar expectations for the public insurance market. It also requires health-care providers to be licensed in Kentucky in order to receive reimbursements, though they would be able to live anywhere in the world.

Committee Chair Addia Wuchner realized after the panel approved the bill without dissent that there were lobbying interests that wanted to speak against the bill, and she gave them a chance to speak.

Lawrence Ford of Anthem Blue Cross and Blue Shield, said that the insurance firm supports tele-health and its expansion, but has concerns about the bill's requirement that providers be paid the same amount for a tele-health visit as an in-patient visit, unless a lesser rate had been negotiated. He said a tele-health visit through Anthem now costs $49, while an average in-person visit cost $83.

He added that while there was no fiscal note attached to the bill, "There was a statement that was prepared by the Department of Insurance that stated that this legislation could increase health care costs for insurance plans by as much as $7.7 million."

"We have issues and oppose any efforts by the General Assembly to venture into rate-setting services between two parties," Ford said. Later, Rep. Jim Gooch, R-Providence, filed a floor amendment to remove the equal-payment provision.

Tamarra Wieder of Planned Parenthood Advocates of Indiana and Kentucky told the panel that while the organization supports tele-health, it opposes the restrictions that the amended bill placed on abortions, which she referred to as a "constitutionally protected medical service."

"Telehealth delivery of medication abortion has been demonstrated to be just as safe and effective as in-person protocols and to improve patient safety by enabling abortion earlier in the pregnancy when it is the safest," Wieder said.

Kate Miller of the American Civil Liberties Union - Kentucky said the amended bill would decrease rural Kentucky women's access to legal abortions, since the only abortion provider in Kentucky is in Louisville.

After the opponents spoke, Wuchner asked if any committee members wanted to change their vote. None did.

Thursday, March 22, 2018

Denied federal funding, study on the health effects of mountaintop-removal coal mining has been abandoned

"After Trump administration officials ordered a halt to a study on the health effects of mountaintop removal last fall, the study’s committee has been released, effectively terminating the project," Kate Mishkin reports for the Charleston Gazette-Mail.

"The National Academies of Sciences, Engineering and Medicine’s study would have looked at the health effects on residents who live near mountaintop removal coal-mining sites. It was put on hold when the Department of the Interior’s Office of Surface Mining announced that it was reviewing grants and agreements that would cost more than $100,000."

An Interior spokesperson did not answer any questions about why the study was terminated and whether it might be revived in the future. Riya Anandwala, a spokesperson for the National Academies, would not speculate on the reason for the study's termination, but told Mishkin it was "not unprecedented, but it's very rare."

Interactive map shows county data on Appalachian opioid overdoses, correlated with social and economic data

Lexington Herald-Leader map, drawn from Appalachian regional map by NORC, University of Chicago
A new data visualization tool offers in-depth, county-by-county information about the impact of the opioid epidemic in Appalachia and how it relates to factors such as unemployment, poverty, education and disability.

Screen grab of interactive map shows overdose rates with
highest in dark blue. (Click on the image to enlarge it.)

The Appalachian Overdose Mapping Tool, developed by a research organization and the Appalachian Regional Commission, "integrates overdose mortality rates for each Appalachian county with data on unemployment, poverty, and disability, as well as other socioeconomic variables. Users can compare county-level information with regional and national data and see changes in the data between 2006–2010 and 2011–2015. The mapping tool can also generate fact sheets to assist in community planning and response efforts," Wendy Wasserman of ARC reports in a press release.

"Residents across Appalachia are 55 percent more likely to die from a drug overdose than people in the rest of the country, but the disparity is even higher in some Eastern Kentucky counties.
In Leslie County, for instance, the overdose death rate is five times the national average," Bill Estep reports for the Lexington Herald-Leader. Leslie's rate is the highest in Kentucky; four West Virginia counties had higher rates.

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Socioeconomic correlations shown by the interactive map include:
  • In Central Appalachia, counties with the highest rates of overdose are often the same counties with the highest rates of people on disability.
  • In Central Appalachia, the counties with the highest overdose rates are often the same counties with the lowest rates of educational attainment.
  • In Northern and Southern Appalachia, the highest overdose rates are in urban counties.
  • While Central Appalachia remains the most highly affected subregion of Appalachia, other subregions are experiencing increasing rates of overdose.
The map was developed by ARC and the University of Chicago's NORC, which was known as the National Opinion Research Center before its work expanded beyond opinion research.

Wednesday, March 21, 2018

Optometry bill delivered to the governor after Senate changes

By Melissa Patrick
Kentucky Health News

A bill to regulate online eye exams has been delivered to Gov. Matt Bevin after getting final passage from the state House.

On an 88-0 vote, the House agreed with the changes the Senate made to House Bill 191 to remove the original bill's requirement for "simultaneous" consultation between online, Kentucky-licensed eye-care providers and their patients, which critics said would have limited access to eye care and tele-health technologies going forward.

The Senate passed the bill 36-0 March 14 with an amendment that changed the word "simultaneous" to either "synchronous or asynchronous." The bill's sponsor, Rep. Jim Gooch, R-Providence, said the change represented a compromise between all sides of the issue.

The bill requires that a person to be 18 to use the online services, that a medical history be obtained, that the person must have had an in-person eye exam withing two years of the online exam, and that a patient is not allowed to get contacts for the first time during an online exam.

This is the first time regulations have been placed on the online eye-care industry in Kentucky. It was supported by optometrists, who have a strong lobbying and campaign-finance presence in the legislature, and opposed by ophthalmologists, who do not.

Sex-ed bill to require abstinence and monogamy be taught nears final passage; foes want comprehensive curriculum

By Melissa Patrick
Kentucky Health News

A Senate bill to require Kentucky schools to teach abstinence and monogamy in sex-education programs moved out of the House Education Committee March 20, with changes that removed all references to marriage. It was scheduled for a vote in the full House March 22, but was not called up for a vote.

Sen. Stephen Meredith
Senate Bill 71, sponsored by Sen. Stephen Meredith, R-Leitchfield, originally called for teaching that abstinence from sex "outside of marriage" is the expected standard for school-age children, but the House changed it to say that educators must teach that abstinence is the desirable goal for such children.

The amended bill also requires Kentucky's students to be taught that abstinence is the only certain way to avoid unintended pregnancy or getting a sexually transmitted disease. The original language referred to "out-of-wedlock" pregnancy.

It would also require students to be taught that the best way to avoid sexually transmitted diseases is to establish a "permanent, mutually faithful, monogamous relationship." That language replaced the original wording, "in the context of marriage."

The bill says "instruction shall include, but not be limited to" the content it specifies. Kentucky has no specified curriculum for sex education, though the state Department of Education is working on one.

Meredith spent a good deal of time talking about the push-back he has received from opponents of the bill, singling out Planned Parenthood, which he said opposes abstinence education because it has a "hidden agenda" to advance its "business model." He made similar comments on the Senate floor in January.

"They don't want our children just to be sexually aware. They want them to be sexually active, as early as possible," Meredith, a former hospital administrator, told the panel. "Planned Parenthood doesn't make money from abstinence and monogamy. They make their money from treating sexually transmitted disease, selling contraceptives and abortions."

Senate Democratic Leader Ray Jones of Pikeville called out Meredith in the chamber in January for similar comments, saying it was "preposterous" to suggest that any group wanted children to be harmed or abused. Jones voted for the bill.

Tamarra Wieder, director of external affairs at Planned Parenthood Advocates of Indiana and Kentucky, said after the committee meeting, "Planned Parenthood is a health-care provider. We want to make sure that everybody has access to information regarding their body so that they can make healthy choices, and that includes education that goes beyond abstinence only."

Other foes of the bill disputed Meredith's assertion that they don't want abstinence and monogamy to be taught as part of a comprehensive curriculum. "Abstinence is taught in every comprehensive sexuality education curriculum," Rev. Dawn Cooley of Louisville told the panel, and suggested that a comprehensive curriculum is what they should be voting on.

Sen. Denise Harper Angel
The Senate had an opportunity to do just that in a floor amendment filed by Sen. Denise Harper Angel, D-Louisville, in January, but the lawmakers  voted it down with a rousing "no" voice vote. The bill passed 32-5.

Harper Angel's amendment would have required Kentucky's health education standards to line up with national standards that call for "medically accurate, age-appropriate information on a broad set of topics, including and related to human development, relationships, decision making, as well as abstinence, contraception, and disease prevention."

Harper Angel told senators, "If the General Assembly is going to mandate certain standards, these standards need to be comprehensive health standards, not moral standards."

In committee, Rep. Attica Scott, D-Louisville, told Meredith that his bill was driven by a personal belief that he was trying to codify, and asked him why this was a political issue.

"There is a definite benefit to society," Meredith replied. "You see that many of the things that we are struggling with in our country is because those relationships aren't there. You look at the number of children who are raised by single parents today and we know immediately they are placed into a position of financial disadvantage that children who are born in a relationship with two people don't face. So I think this is a definite benefit to society and can't be discounted, shouldn't be discounted."

Scott responded, "As a single parent I disagree with you." That drew applause.

Retiring Rep. Gerald Watkins, D-Paducah, said in support of the bill that because more than half the people below the federal poverty level are single mothers, abstinence education must be part of the curriculum.

Opponents of the bill said its mandate-only approach, instead of mandating a comprehensive curriculum, sends a strong message to schools to teach abstinence-only curriculums -- which they say have been proven ineffective.

Kristen Mark, an associate professor in health education at the University of Kentucky, noted that Kentucky has the  seventh highest unintended-pregnancy rate in the U.S. and 58 percent of Kentucky high-school students report they have had sex by the 12th grade.

"Comprehensive sex education -- where abstinence is absolutely encouraged and is absolutely included, despite what might have been said in the last panel -- has worked in lowering unintended pregnancy, decreasing sexually transmitted infection rates and postponing sexual involvement among young people," Mark said. "These are goals we can all agree on. The data are very clear here."

Mark told the committee that it's important for Kentucky's children to grow up knowing how to navigate sexual experiences in a healthy way, and emphasizing abstinence doesn't do that.

"We really shouldn't be surprised by the MeToo movement," she said, referring to the campaign against sexual harassment. "We shouldn't be surprised that girls and women and boys and men don't know how to navigate consent, even in the best of sexual situations. We should not be surprised that victims of sexual assault are often very reluctant to ask for help. This is a result of shame-based, abstinence-only sex education, the kind that this bill supports."

Two supporters of the bill who spoke were from Lifehouse Maternity Home in Louisville. Its website says it is "designed to help women discover God's love for them and their children."

Michelle Bourke, donor-relations director for the home and a former teacher, said that with "our schools passing out birth control and condoms like candy," it's important for Kentucky's children to also be taught about abstinence, and stressed that the only way to prevent pregnancy and sexually transmitted diseases is through abstinence.

Monica Morgan, a resident of the home, told the panel that her decision to become "secondarily abstinent" allowed her to live a life of not worrying about sexually transmitted infections or becoming pregnant again. She stressed the importance of letting children know there are often unintended consequences of having sex, and that the only way to avoid them is to abstain.

The bill passed the committee 15-3 vote and now heads to the House floor for a vote. Scott and Reps. Mary Lou Marzian and Reginald Meeks, also of Louisville, voted no.

Sunday, March 18, 2018

Original sponsor of $1 cigarette-tax increase says it's not salable right now but hopes House-Senate negotiation keeps 50-cent hike

By Al Cross
Kentucky Health News

FRANKFORT, Ky. -- The state Senate's version of the budget will not include the House's 50-cent-a-pack cigarette-tax increase and 25-cent-per-dose tax on opioid prescriptions, and the original sponsor of a $1-a-pack hike says it is dead for the legislative session.

Stephen Meredith
"I don't think the dollar's sellable right now," Republican Sen. Stephen Meredith of Leitchfield said in an interview Friday. "I think the 50-cent is." He said that would be especially true as part of a comprehensive tax-reform package, more likely in a special session than the current one.

Senate President Pro Tem Robert Stivers, in announcing that the Senate wouldn't adopt the House taxes, suggested that a cigarette tax could be part of a broad tax-reform package. Republicans want to reduce income taxes, arguing that would attract more employers to the state, and a cigarette-tax hike could make up for the initial decline in income-tax revenue.

Referring to the revenues from tax increases in the House budget, Stivers said, "We are not recognizing any of those at this time" in writing the budget. "I can understand the health-care policy argument on that, and that same health-care policy argument is what makes it a tenuous type of predicate to revenues to build a budget on, because you are going to have a shrinking base, and I don't believe that in and of itself, as a stand-along, one-off tax is something that we should do."

Stivers spoke in the context of the opioid tax, which would be the first such tax in the nation, but the shrinking-base argument is also made against the cigarette tax, and the Lexington Herald-Leader reported that Stivers made that argument against it.

Advocates of increasing the current 60-cent tax to $1.60 argue that it would make some smokers quit, reducing the physical and economic toll that smoking takes on Kentucky. They say a $1 hike is needed because tobacco companies can counter a smaller increase with coupons and discounts, then gradually increase prices, to keep smokers hooked.

Senate health panel OKs 4 opioid bills; 3 quickly pass Senate

By Melissa Patrick
Kentucky Health News

Four of the seven bills that passed out of the March 14 Senate Health and Welfare Committee meeting dealt with opioids, and three of them have already passed out of the Senate.

A bill for safe disposal of unused opioids passed quickly out of the committee by a 9-1 vote and passed the full Senate later the same day on a vote of 34-2.  It now goes to the House.

Senate Bill 6 had been pulled off the floor and sent back to committee March 13, prompting sponsor Alice Forgy Kerr, R-Lexington, to say it was delayed in retaliation for her refusal to vote for the controversial public-pension bill. Senate leaders told Deborah Yetter of the Louisville Courier Journal that the bill needed a "technical revision."

The bill would require pharmacists to inform customers about how to safely dispose of unused opioids and other controlled substances, and offer to sell them a product designed to neutralize drugs for disposal. The committee added fines of $25 for a first offense, $100 for a second violation and $200 for each subsequent violation and a provision that Medicaid would not pay for the disposal aid.

Sen. Stephen Meredith, R-Leitchfield, cast the only no vote in committee. He said he supported the idea but had too many concerns about who would bear that cost. He also voted no on the Senate floor, along with Sen. Wil Schroder, R-Wilder.

Explaining his yes vote, Sen. Reginald Thomas, D-Lexington, said, "This is something that we need to move on. Something that we should not play politics with because the people who are affected don't care about Republicans and Democrats." Thomas is running for Congress.

Rep. Addia Wuchner, chair of the House Health and Family Services Committee, saw two of her opioid bills pass out of the Senate committee, and one of them is awaiting posting for House concurrence in a Senate amendment.

House Bill 148 would shift ownership of controlled substances from a deceased hospice patient to the hospice program for disposal. Such drugs now go to estates.

The bill would require hospice and other palliative-care agencies to have written policies and procedures for getting rid of certain painkillers upon the death of the patient. The policy would be reviewed with patients and their families, who would then be asked to agree to the policy in writing. The disposal of the drugs would be completed by the agency or the person pronouncing death and would be witnessed by an adult, who would sign a statement to the fact.

Families who do not agree would be reported to the local health department or local law enforcement.

Wuchner, R-Florence, told the committee that the bill is not meant to threaten families at a time of loss, but to stress the importance of the need to destroy the drugs. It went to the Senate floor without dissent.

House Bill 124 unanimously passed the health committee and the full Senate. It calls for a comprehensive review of all state programs for substance-use disorders, and would require the state to only pay for and license ones that follow nationally recognized, evidence-based protocols.

The Senate added an amendment to allow the Department of Corrections to purchase long-acting, medication-assisted treatment products for substance-use disorders that are resistant to diversion, including unspecified new ones not yet available.

Senate Bill 250 also unanimously passed out of the health committee and the full Senate and will now move to the House. It would require all pregnant women to be tested for hepatitis C, with the results added to the child’s records. It also recommends that the child be tested at 24 months if the mother tests positive. Hepatitis C can be transmitted from mother to baby during childbirth.

Riggs Lewis, system vice president of heath policy at Norton Healthcare, stressed the importance of screening every pregnant woman in order to be able to treat both the mother and baby. He noted that most new cases of hepatitis C are a result of illegal intravenous drug use, so cases are expected to increase. "This is going to be a shadow that follows the opioid epidemic," he said.

Dr. William P. 'Buddy' McElwain, health commissioner for Govs. Louie Nunn, Wendell Ford and Julian Carroll, dies at 84

Dr. W.P. McElwain in 2012
Dr. William P. "Buddy" McElwain, who was Kentucky's health commissioner under three governors in the 1970s, died Tuesday, March 13. He was 84.

McElwain was a graduate of Daviess County High School, Murray State University, the University of Louisville School of Medicine and Johns Hopkins University. After an internship and two-year residency, he served eight years in the U.S. Public Health Service, working at Indian reservations and the Oklahoma health department.

He was associate director of the Fayette County Health Department in 1970 when Gov. Louie B. Nunn, a Republican, named him state health commissioner. He kept the job under Gov. Wendell Ford and returned to it under Gov. Julian Carroll, another Democrat, until 1978, when he returned to medical practice and later worked at the University of Kentucky. He was executive vice president for medical affairs for the Kentucky Health Care Access Foundation, which Democratic Gov. Brereton Jones and the legislature created to provide health care for people who were below the poverty line but did not qualify for Medicaid.

From 1994 to 2012, he practiced at Rockcastle Regional Hospital and Respiratory Care Center in Mount Vernon. After retirement, he remained in the area.

McElwain is survived by a brother, Bob McElwain; sons Paul, David and Brandon McElwain, daughters Nancy Curtis and Ruth Childers, 10 grandchildren and three great-grandchildren. The funeral will be private. Memorial donations may be made to The Miracle Fund, Rockcastle Regional Hospital, 145 Newcomb Avenue, Mt. Vernon KY 40456. For his full obituary, click here.

Saturday, March 17, 2018

No-penalty bill to require kids under 12 to wear bicycle helmets falls 1 vote short in panel; advocates say it will be called up again

By Melissa Patrick
Kentucky Health News

A House bill to require children under 12 to wear bicycle helmets came up one vote short in the Senate Transportation Committee March 14, but advocates say the panel will take up the bill again Wednesday, March 21.

Mary Hass, advocacy director of the Brain Injury Alliance for Kentucky, told Kentucky Health News that two senators who were expected to vote for the bill voted against it, but it would still pass with votes of those who were absent.

House Bill 52, sponsored by Rep. Regina Huff, R-Williamsburg, would require children under 12 to wear a helmet when they ride a bicycle. Violation would result in a courtesy warning, not a fine.

Heather Floyd and her son TJ spoke at the March 14 Senate
Transportation Committee meeting in support of "TJ's bill"
to require children up to age 12 to wear a bicycle helmet.
HB 52 is called "TJ's bill" for TJ Floyd of Oldham County, who sustained a traumatic brain injury in 2010 when he flipped over his handlebars when he was 7 while not wearing a helmet. It passed the House 77-5 on Feb. 2.

"This bill just makes helmets part of bicycle safety," Hass told advocates at a rally after the committee meeting. "There are no fines. It is not meant to be punitive in any way to parents. But BIAK's membership is telling us it gives parents another tool in their toolbox to keep their children safe."

The bill needed seven votes to clear the committee, but only got six. After some off-microphone discussion about what to do next, committee chair Ernie Harris of Oldham County told members that he might call it up again. BIAK said in an email alert the next day that Harris would have the committee hear the bill again Wednesday, March 21 at 9 a.m. in Room 154 of the Capitol Annex. Kentucky Health News has not confirmed that with Harris.

Haas said advocates went into the March 14 meeting thinking they had enough votes, but one supporter, Sen. Jared Carpenter of Berea, was caught in a traffic jam, and another, President Pro Tem Jimmy Higdon of Lebanon, left before the vote was taken. Democratic Sen. Johnny Ray Turner of Prestonburg was also absent.

The "no" votes came from Republican Sens. Joe Bowen of Owensboro, C.B. Embry of Morgantown and Paul Hornback of Shelbyville. A BIAK alert said the group expected Hornback to vote for the bill but he changed his mind before the meeting.

Haas and TJ's mother, Heather Floyd, said Embry had said he would vote for the bill. Embry disputed that, telling Kentucky Health News, "I didn't tell them I was voting for it. I said I would give it consideration." He said the bill probably has enough votes to get out of committee if all members attend.

Embry said he voted no because he didn't think the bill is necessary, especially because it has no penalties. He also voiced concerns about liability if a child was injured while not wearing a helmet on someone else's property or under the care of someone who was not a family member.

"I think they should wear a helmet," Embry said. "I think that parents should require them to wear a helmet. I think they should have enough sense to do that on their own, without the government demanding it."

Sen. Mike Wilson, R-Bowling Green, voiced similar liability concerns during the meeting, but voted for the bill.

At the meeting, Floyd urged the panel to pass the bill to prevent similar injuries to other children. She shared a long list of cognitive and physical struggles that plague TJ and others with brain injuries and that have stripped him of his ability to live an independent life. She said the bill is about bringing awareness to traumatic brain injuries, which affect more than 5 million Americans, and the importance of protecting children's brains.

BIAK says 384 American children die annually from bicycle crashes and 450,000 more are treated in emergency rooms for bicycle related injuries, with about 135,000 of those seen in the ER related to head injuries. Hass said after the rally that bicycle helmets are about 85 percent effective in preventing traumatic brain injuries when used properly.

Mary Hass of the Brain Injury Alliance
for Kentucky spoke at the March 14 rally.
Floyd told the committee, "The biggest and most important point is that this bill can save a child's life."

BIAK Executive Director Eddie Reynolds said after the rally that opposition to the bill often stems from concerns about personal freedoms.

Haas said motorcycle advocates have opposed the bill out of concerns it would lead to restoration of an old law requiring Kentucky adults to wear helmets while riding motorcycles. Current state law requires both operators and passengers on a motorcycle under the age of 21 to wear a helmet.

"There is no will in this legislature to want to put helmets on people who ride motorcycles. We feel that is their choice," Haas said. "This bill is only about protecting children and doing what our membership has asked us to do."

Similar bicycle helmet legislation has been considered in the House for several years. Last year, HB 122 passed the House 90-6 but was not heard in the Senate.

Friday, March 16, 2018

Senate bill to shed light on Medicaid prescription costs and help small druggists moves to House for a vote with price tag removed

By Melissa Patrick and Al Cross
Kentucky Health News

FRANKFORT, Ky. -- A new version of a Senate bill to put the state back in direct charge of its Medicaid drug program, with a big price tag removed, went to the House floor in a specially called committee meeting March 16.

Sen. Max Wise
Senate Bill 5, sponsored by Sen. Max Wise, R-Campbellsville, has evolved into a "transparency bill" that, if passed, will allow the state to find out how pharmacy benefit managers are spending the $1.7 billion a year they get for Kentucky Medicaid prescriptions.

Wise told the House Banking and Insurance Committee that he filed the bill because independent pharmacies are being paid such low fees for dispensing Medicaid prescriptions that many are at risk of closing, despite a 2016 bill aimed at price transparency. The fees are as low as 85 cents per prescription, though the federal Centers for Medicare and Medicaid Services says it should be around $10.64.

Wise's original bill would have mandated that amount, but to get it through the House, he had to overcome objections of the Cabinet for Health and Human Services, which said it would cost $36 million a year. The committee substitute bill would let the Department for Medicaid Services set the fee.

Deputy Medicaid Commissioner Anne-Tyler Morgan told the committee that any rate increase will largely be determined by what the department finds in its investigation and by what the budget allows. Wise, who is on the budget committee, said it is addressing the issue.

The bill would require pharmacy benefit managers (PBMs) to report their average reimbursement and fees paid to their affiliated pharmacies and to those with more than 10 locations and 10 or fewer locations. The state's current contracts with the managed-care organizations (MCOs) that handle Medicaid don't allow access to such information.

The bill would give the Medicaid department and the Department of Insurance authority to penalize the MCOs and PBMs for noncompliance.

Wise said lawmakers in other states are considering similar legislation. He said CVS Caremark, which contracts with four of Kentucky's five MCOs and has a chain of retail pharmacies, has been found in other states to reimburse them at a much higher rate. "We don't know if that's happening in Kentucky or not, but we need to find out," he said.

He said CVS Caremark has been sending letters to independent pharmacies across the state offering to buy them out. CVS did not make an appearance at the committee meeting.

Rep. Jeff Greer, D-Brandenburg, suggested that CVS was able to buy health-insurance company Aetna Inc. by taking advantage of the taxpayers.

Greer, an insurance agent who chaired the committee when Democrats controlled the House, told Morgan, "I hope you guys are able to get answers and get 'em fast."

"So do we," Morgan replied.