More residency placements will be needed as medical school enrollments rise, perhaps by 30 percent through 2016

Aimed at addressing expected physician shortages, enrollment at U.S. medical schools is on target to increase by 30 percent by 2016, the Medical School Enrollment Survey has found.

But even if enrollment rises through expansion of medical schools and construction of new ones, "This won't amount to a single new doctor in practice without an expansion of residency positions," said Dr. Darrell G. Kirch, president and CEO of the Association of American Medical Colleges.

First-year medical school enrollment is expected to reach 21,376 in 2016-17, a 29.6 percent increase over enrollment in 2002-03. Nearly 60 percent of the growth will happen in the 125 medical schools that were accredited in 2002; 25 percent will happen in schools accredited since then, and 17 percent will come from schools that are applicant or candidate schools.

The United States is facing a shortfall of more than 90,000 primary care and specialty doctors by 2020, the AAMC estimates. With medical schools stepping up, what's key is "an increase in federal funding to expand the number of residency training positions — which prepare new doctors for independent practice," research-reporting service Newswise reports.

"Otherwise it may become more difficult for medical students to complete their training and for patients to get the care they need — as our population continues to grow and age, more doctors retire, and 32 million Americans enter the health care system as a result of the Affordable Care Act," Kirch said. (Read more)

Nurse anesthetists no longer need to be supervised in Ky.

Kentucky will be the 17th state to opt out of a federal requirement that requires nurse anesthetists to be supervised by a physician, a move that Gov. Steve Beshear said will increase flexibility and efficiency in operating rooms.

The Kentucky Hospital Association applauded the effort. "Certified registered nurse anesthetists are an extremely important part of health-care delivery in Kentucky, particularly in the rural areas of the state," said Mike Rust, KHA president. "This opt-out will ensure patient access to quality anesthesia care."

"We've consulted with the Cabinet for Health and Family Services and health care providers, and this is clearly a change we need to make to improve access to critical medical care," Beshear said. "In cases like this, where the federal requirement is an obstacle to some of the best options for delivery of high-quality health care, we're pleased to take this step to opt out."

A 2010 report that analyzed Medicare data for 1999 to 2005 and published in the journal Health Affairs found no evidence opting out of the oversight requirement resulted in more patient deaths or complications. (Read more)

State prescription drug databases like KASPER cut back doctor shopping and drug abuse, new study shows

Photo by iStockphoto

Research from the University of North Carolina indicates drug databases like the Kentucky All Schedule Prescription Electronic Reporting system do reduce doctor shopping and change prescribing behavior.

Another article showed state drug databases "facilitate a relative decrease over time in prescription drug misuse, despite state differences in program administration," reports Maggie Clark for Stateline, the freshly revised news service of The Pew Center on the States.

A 2010 evaluation of KASPER showed 90 percent of doctors who used the system found it effective in preventing drug abuse and doctor shopping. A new Kentucky law "mandates that all physicians and pharmacists who prescribe schedule II and III drugs, such as oxycodone and hydrocodone, check the patient's prescription records before writing or filling a prescription," Clark reports. Dispensers must also register prescriptions in the state database without 24 hours of writing or filling the prescription.

Clark points out the legislation change sparked a debate about "how to balance patient privacy and law enforcements needs in fighting a serious criminal and public health problem." Attorney General Jack Conway, who wanted KASPER put into his office's hands, lost that fight as part of the legislative compromise. It will remain the responsibility of the Cabinet for Health and Family Services and, by extension, the doctor-run Kentucky Board of Medical Licensure.

Privacy issues have likewise surfaced in Vermont. "The discussion really is about what kind of access the police will have to electronic personal health information," said Allen Gilbert, executive director of the Vermont Civil Liberties Union. (Read more)

Major newspapers publish reflections, reactions and details (including videos) on new law that will fight 'pill mills'

Reflections on the new law to fight "pill mills" are in both of Kentucky's major metropolitan newspapers today.

The Courier-Journal, which rightly takes partial credit for focusing attention on the issue, has a story by Laura Ungar that summarizes what the bill will do and not do. In the Lexington Herald-Leader, Kentucky Medical Association President Shawn Jones has an opinion piece defending his organization's lobbying against key parts of the bill.

"Unfortunately, in a desire to pass something, many did not consider the details of proposed legislation, and many of the details were extremely troublesome," writes Jones, right. "Most troubling were the proposed infringements on patient privacy through access to the state's Kentucky All Scheduled Prescription Electronic Reporting, or KASPER, system, which contains what is essentially a log of all of the controlled substances an individual has bought. A controlled substance is not just what many people have characterized as 'pain medicine.' It also includes prescriptions for medicines for anxiety, depression or attention deficit disorder." (Read more)

Jones is among the people featured in videos posted with The Courier-Journal's story. Others include Dr. Greg Cooper of Cynthiana; attorney Fox DeMoisey, who represents physicians accused of malpractice; and Dr. Patrick Murphy, a pain-management physician, talking about the various responsibilities of doctors in his field.

Tonsillectomies not necessary much of the time; among $158 billion spent each year on unnecessary health care

Photo by Matthew Staver, Bloomberg

Tonsillectomies are the most common procedure for children requiring anesthesia. "The only problem is there's no evidence they work for most" kids, reports Sarah Cliff of The Washington Post.

"The procedure does show some benefits for those with really serious symptoms — very sore throats, fevers and other symptoms at least seven times in the past year — but no improvement for those whose indications are milder," Cliff reports.

Yet, more and more of the procedures are being performed. Between 1996 and 2006, the number of tonsillectomies increased by 74 percent.

"It's a silent epidemic of unnecessary care," said David Goodman of the Dartmouth Atlas of Health Care. "In most instances, it's done for patients with much less recurrent symptoms than should be indicated. I think a lot of this is unbeknownst to providers."

Unnecessary health care costs about $158 billion every year, Cliff reports, and the sum is partly to blame on demanding patients, to whom doctors acquiesce. Because doctors are paid based on volume, there is also an incentive to provide more care, even if it's not necessary.

Goodman said the medical education system is one main culprit. "Medical schools and graduate schools are failing us deeply," he said. "We need to move some of these ideas about the evidence being uncertain into the beginning of education. There's been such little work on that." (Read more)

Beshear OKs prescription bill, telling pill mills, 'Get out of this state'

Saying it couldn't get to his desk quickly enough, Gov. Steve Beshear signed a bill aimed at curbing prescription drug abuse in celebration today, warning so-called pill mills to "Get out of this state, because we're coming after you."

House Bill 1 requires doctors and pharmacists who prescribe or dispense Schedule II and III drugs, such as oxycodone and morphine, to use the Kentucky All Schedule Prescription Electronic Reporting system and requires pain clinics to be owned by at least one physician. Clinics already in operation that have not had trouble with the law but are not owned by doctors will be grandfathered in under the law.

Though there was a strong push for it by law enforcement, the bill will not move KASPER over to the attorney general's office but will stay under the control of the Cabinet for Health and Family Services and the doctor-controlled Kentucky Board of Medical Licensure.

House Speaker Greg Stumbo, who sponsored the bill, called the legislation "a major step forward in the ongoing battle to put the brakes on prescription drug abuse."

Though KASPER will not move to  Attorney General Jack Conway's office, as Conway wanted, he endorsed the effort. "It helps keep entrepreneurs out of the pill mill business and requires doctors, with reasonable exceptions, to use the KASPER system," he said. "I encourage those who are fearful of increased oversight to end the hyperbole and begin a constructive process with the legislature and executive branch to implement this bill." (Read more)

Pill-mill bill passes; attorney general won't get drug-monitoring system but narcotic-prescribing doctors will have to use it

House Speaker Greg Stumbo, center, walks
with House budget committee chair Rick
Rand and House Majority Floor Leader
Rocky Adkins. (Courier-Journal photo).

Legislators have sent Gov. Steve Beshear a bill to curb prescription drug abuse and crack down on rogue pain clinics, ending the special session of the General Assembly.

The final version left the state's prescription drug-monitoring system under the control of the Cabinet for Health and Family Services and the doctor-controlled Kentucky Board of Medical Licensure rather than move it to the attorney general's office, as the last version in the regular session would have. But in another significant change, it will require doctors and pharmacists who prescribe or dispense Schedule II and III drugs, such as oxycodone and morphine, to use the Kentucky All Schedule Prescription Electronic Reporting system. Only about 25 percent of Kentucky physicians now use KASPER.

Putting the drug-monitoring system in the hands of the attorney general was considered a linchpin of efforts to help law enforcement to proactively identify suspicious prescribers; law enforcement officers can access the database only if they have a case opened, and say they need the data to open cases. But the Kentucky Medical Association called giving law enforcement oversight of information with prescription-drug information a violation of personal privacy. "You are essentially legislating medical care," said Shawn Jones, president of the KMA.

Beshear, who repeatedly pressured legislators to pass a bill pertaining to the issue, issued a statement this evening expressing his delight. "Even though the prescription drug bill doesn't include every element we had hoped, it is an enormous bipartisan accomplishment, and it restores Kentucky as a leading state in innovative tactics in battling prescription drug abuse," he said. "The elements of the bill also help prevent Kentucky from becoming a source state for prescription pills.

House Speaker Greg Stumbo, who sponsored the bill, called its passage "a step forward" though he "would have preferred a stronger version." He told reporters that he did not feel this would be the last time lawmakers would be changing laws to fight the problem, and noted that Beshear could use his gubernatorial reorganization powers to change the administration of the system: "I think the governor, in the days ahead, will continue to take aggressive action on addressing this problem."

The measure will require pharmacists to submit information to KASPER within 24 hours of dispensing a narcotic and doctors must check the system before prescribing one to a new patient. They then would be required to check a KASPER report every three months during a patient's treatment.

As before, the measure will require most pain clinics be owned by at least one doctor; 33 of Kentucky's 77 pain clinics are owned by people with no medical background. Those who already own clinics and haven't had run-ins with the law will be "grandfathered" and be allowed to continue operating. "That really waters it down. A lot!!" Operation UNITE Director Karen Kelly said on Facebook.

Lawmakers also passed the transportation budget bill, which was the main reason why they were called in for a special session by Beshear. They reached an impasse last week when the Senate would not approve the budget, a move Beshear and Senate President David Williams blamed on each other.

There were suggestions that the road and drug issues, the only items that the legislature could consider under Beshear's call of the session, were related. "As the Senate receded on the amendment to put back $50 million of [road] money into Senate President David Williams' district, word went out that the House would compromise on the pill bill and let the Senate keep KASPER [where it is] as long as a funding change took place," Ryan Alessi reports for cn|2. "The Senate sprang into action amended the pill bill and leaders from the two chambers worked together to pass legislation before supper time."

Doctors' lobby still working for changes in 'pill mill' legislation

By Al Cross
Kentucky Health News

The Kentucky Medical Association, historically one of the most powerful lobbying interests at the General Assembly, has mounted a last-ditch attempt to change or perhaps kill the bill that would crack down on "pill mills" that contribute to prescription drug abuse.

The bill would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney general's office from the Kentucky Board of Medical Licensure, which is made up almost entirely of doctors and has done little to curb the growing problem.

The tracking system remains the central concern for the KMA, which issued a "call to action" for physicians to contact legislators and argue that it "could infringe on privacy and lead to excessive oversight of legitimate medical practices," reports Mike Wynn of The Courier-Journal. "Other critics have said the bill could make doctors reluctant to provide pain medication for legitimate patients."

KMA President Shawn Jones told Wynn, “We would like to see something come out of this session. We would just like to make sure that it is something that addresses both the needs of law enforcement and at the same time is not overreaching in its imposition on our ability to practice medicine in a professional way.”

The KMA’s call notes that the system "tracks medications such as Xanax, Valium and Klonopin and was placed under the cabinet’s responsibility partly for patient privacy and protection," Wynn notes. Jones told him, “The access to that data really should be limited to government agencies that are charged with public health, and not law enforcement.”

Moving the tracking system to the attorney general's office is "pretty much a cornerstone of this legislation," Senate Majority Floor Leader Robert Stivers, R-Manchester, left, told Ryan Alessi Friday night on cn|2's "Pure Politics" program. He said the medical licensure board "hasn't done a whole lot" about prescription drug abuse, and indicated that part of the bill would stand.

However, Stivers said he and other supporters of the bill might drop the bill's 30-day limit on the length of painkiller prescriptions because of concerns that it would raise costs to patients. Those concerns helped delay the bill on the 59th day of the legislature's 60-day session. House Speaker Greg Stumbo "has said the issue could be resolved with a simple fix in the bill’s language," Wynn notes.

Stivers and Stumbo were among a group of bipartisan political leaders, led by Gov. Steve Beshear, who issued a statement Friday calling on the General Assembly to pass the bill Thursday, when it is scheduled to reconvene. The legislature is in recess, pending possible vetoes of other legislation by Beshear.

KMA "also takes issue with a $50 fee that the attorney general would be able to charge doctors to fund the program," Wynn reports. "Jones said the amount will only continue to climb in coming years to address a societal problem that doctors did not create. Proponents contend that the fee is nominal and is capped by statute except for inflation adjustments." (Read more)

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

In bipartisan way, political leaders push passage of 'pill mill' bill

A bipartisan group of political leaders issued a call today "to pass a bill that will help the state battle one of its most significant threats – prescription drug abuse," a press release from Gov. Steve Beshear's office said. Beshear, Attorney General Jack Conway, House Speaker Greg Stumbo, Senate Republican Floor Leader Robert Stivers, Sen. Jimmy Higdon, R-Lebanon, and House Judiciary Committee Chairman John Tilley, D-Hopkinsville, said the legislature should pass House Bill 4 when it returns to Frankfort for its final day April 12.

"Since the beginning of 2012, more than 400 Kentuckians have been hospitalized because of prescription drug overdoses – a statistic that the leaders say underscores the crucial need to pass this bill in this legislative session," the release said. "Kentucky has the nation’s sixth-highest rate of prescription drug overdose deaths, at nearly 18 deaths per 100,000."

Conway said in the release, “I'm hopeful everyone, including the medical community, can get on board with House Bill 4 to ensure that we don't lose another generation in Kentucky to prescription drug abuse.” The bill would move the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system to Conway's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has done little to rein in "pill mills" that churn out prescriptions for painkillers.

"Law enforcement members warn that Ohio, Tennessee, West Virginia and Florida have passed legislation similar to HB 4 to address pill mills, and failing to pass similar legislation could create a diversion effect in which Kentucky could become a source state for prescription painkillers," the release said.

Stumbo, who preceded Conway as attorney general, said in the release, “Given the true epidemic we are seeing, we cannot afford to wait another year to try to pass this again.” In October, Stumbo, Beshear and Conway "announced creation of an advisory board of physicians, dentists, nurses, and pharmacists to work with KASPER officials and law enforcement professionals to create guidelines for generally accepted prescribing practices among different medical disciplines," the release said. "These criteria will be used as a guide for when a prescriber or dispenser’s KASPER reports may be flagged for unusual prescribing activity."

The bill would require all prescription providers to register and use KASPER, require pain management clinics to be owned by a licensed medical practitioner, make medical licensure boards investigate prescribing complaints within four months. 

Legislature passes bill on personal-care homes but stalls on one to regulate pill mills as doctors lobby hard

By Al Cross
Kentucky Health News

The effort to quash "pill mills" that feed one of Kentucky's worst problems, prescription drug abuse, stalled on the next-to-last day of the General Assembly's session and faces cloudy prospects on April 12, when the legislature returns to conclude its business. But the legislature gave final passage to a bill aimed at limiting the admission of mental patients to personal-care homes.

The snag in the pill-mill bill stems from the Kentucky Medical Association's opposition to moving the state's electronic prescription-tracking system to the attorney general's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has been found to go easy on them, compared to other states. The bill includes several other measures, including a requirement that pain clinics must be owned by doctors.

After Sen. Carroll Gibson, R-Leitchfield, failed in a parliamentary maneuver to make the bill more difficult to pass, and Senate President Pro Tem Katie Stine, R-Southgate, ruled that his motion had lost on a voice vote, Majority Floor Leader Robert Stivers, R-Manchester, "said it might be better to consider the bill April 12, but Sen. Ray Jones, D-Pikeville, said delaying a vote on it would give its opponents more time to try to kill it," report John Cheves and Jack Brammer of the Lexington Herald-Leader. "Stivers called for party caucuses to meet to discuss the issue. After the caucus meetings, the Senate adjourned and Stivers said lawmakers would work on the bill for possible consideration April 12."

The session's final day is scheduled to give the legislature a chance to override any vetoes by Gov. Steve Beshear, so a bill passed then could be killed by a veto. That might seem unlikely, since Beshear has been among those pushing for stronger action against pill mills. However, if he were unhappy with a bill the legislature sent him, he could veto it and call a special legislative session to pass one more to his liking. That possibility, and his power to set the agenda of a special session, could make him a player in the negotiations between now and April 12.

The bill’s sponsor, House Speaker Greg Stumbo, D-Prestonsburg, downplayed the problem. He blamed it on "confusion over a provision that limits the amount of drugs that may be supplied to a patient at any one time," Mike Wynn of The Courier-Journal reports. "Some lawmakers feared that limits on prescriptions would cause more patient co-pays, but a simple fix to the bill’s language could allay those concerns, Stumbo said."

Also on Friday, the legislature sent Beshear a bill that would "require potential residents at personal-care homes to be screened for brain injuries by medical professionals," the Herald-Leader reports. "Personal care homes provide long-term care for people who do not need full-time nursing care but need some assistance."

Senate Bill 115 "stems from the death last year of Larry Lee, a brain-injured resident who disappeared from a personal care home and was found dead four weeks later on the banks of the Licking River, not far from the Falmouth Nursing Home in Pendleton County," the Herald-Leader notes. "There are about 2,500 to 3,000 people in 82 free-standing personal care homes across Kentucky," and many are mentally disabled or mentally ill. Kentucky Protection and Advocacy, a watchdog state agency, released a report last week saying that said placement of the mentally ill in personal-care homes violates federal disability laws. (Read more)

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

Meds-for-meth, pain-pill bills each clear a second chamber; both probably headed to conference committee(s)

"State lawmakers gave new life Wednesday to two bills designed to tackle Kentucky's problems with methamphetamine labs and prescription drug abuse," John Cheves and Jack Brammer report for the Lexington Herald-Leader.

"On a 60-36 vote, the House approved Senate Bill 3, which would further limit the amount of cold medicines containing pseudoephedrine that consumers could buy without a prescription. Pseudoephedrine is a key ingredient used in making meth. Meanwhile, the Senate approved House Bill 4, which transfers from the state Cabinet for Health and Family Services to the attorney general's office an electronic monitoring system that keeps track of prescriptions for pain pills. The vote was 26-9. Both bills are likely to go to conference committees made up of representatives from both chambers, who will try to negotiate a compromise on differences in the House and Senate versions of the bills." (Read more)

Senate panel OKs pill-mill bill with provision moving prescription-monitoring system to attorney general's office

Over the objections of the Kentucky Medical Association, a Senate committee today approved a bill that would "transfer oversight of the state’s prescription-monitoring system from the Cabinet for Health and Family Services to the attorney general’s office," Jack Brammer reports for the Lexington Herald-Leader.

House Bill 4, an effort to fight so-called "pill mills," passed the Senate Judiciary Committee 7-2 after Chairman Tom Jensen, R-London, said last week that he trusted the attorney general's office to handle the job, now in the hands of the Kentucky Board of Medical Licensure. The bill now goes to the Senate Rules Committee, which could send it to the floor or to another committee, a move that would probably kill it since this is the last week of the legislative session.

The bill would allow no more than 20 attorney-general employees to access the monitoring system. It would also require doctors to report pain-pill prescriptions within 24 hours starting July 1, 2013, and would "not charge health care providers a fee for using the system," Brammer reports. The committee also changed the bill to allows only physicians to own pain-management clinics. (Read more)

More foreign-born doctors practice in rural areas, come from poor nations; Kentucky is about average, West Virginia is high

More than 15 percent of physicians in the U.S. received training in lower-income countries, including India, Pakistan and the Phillippines, a new study has found, reports Lori Kersey of The Charleston Gazette. The study was a joint effort by the National Research Council and the Stanley Medical Research Institute, and was published online on PLoS ONE.

Most doctors from low-income countries practice in low-income areas of the U.S., where most U.S.-trained doctors don't usually want to go. West Virginia has the most such doctors, at 29 percent all of physicians in the state. Kentucky has 16 percent, just above the national average of 15.4 percent. Montana, Idaho and Alaska all have less than 2 percent.

The authors of the study said low-income countries that send most of their doctors to the U.S. lost more money training them than they receive in U.S. foreign aid. In 2010, the Phillippines spent $1.7 billion training more than 20,000 doctors who then came to the U.S., but was only given $33 million in U.S. foreign aid. The authors suggest the U.S. should pay those countries back in some way. (Read more)

Board suspends license of doctor at raided Lexington pain clinic

DEA agent enters building housing clinic
(Herald-Leader photo by Charles Bertram)

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storylink=cpy

The Kentucky Board of Medical Licensure imposed an emergency suspension yesterday on the license of the doctor at a Lexington pain clinic that was raided by the Drug Enforcement Administration on Wednesday.

Dr. Najam Azmat "had little formal training in pain management or primary care, yet he was paid $7,500 a week to write prescriptions for powerful narcotic painkillers" at Lexington Algiatry, a pain clinic on Alexandria Drive, the Lexington Herald-Leader reports, drawing on board documents. The board's order said, "Azmat organized his practice at the Lexington Algiatry Clinic to maximize fraud and abuse, and it appears to be intentional."

The board "acted on an investigation that's been going on for some time," President Preston Nunnelley told the Herald-Leader. Azmat referred the newspaper to his lawyer, Fox DeMoisey of Louisville, who said he could not respond because he had not seen the board's allegations or the DEA's search warrant. "He intends to defend the matter vigorously," DeMoisey told the paper.

Azmat told a board investigator that he was employed by Warren Gold of Tampa, Fla., who owns Lexington Algiatry, for $7,500 a week. Valarie Honeycutt Spears and Josh Kegley of the Herald-Leader report, "Gold provided him with an apartment in Lexington, and Azmat traveled between Lexington and Georgia, where his family lives, organizing his work schedule around his flight schedule, the documents said." (Read more)

UPDATE, Feb. 18: A representative of the clinic "filed to do business under a new name," Kegley reports.

His latest story has more background on Gold, left, who pleaded no contest in Tampa to operating a pain clinic without a license, which at the time (2010) was required only by a local ordinance. His probation ended Dec. 23. He does not have a medical license in Florida or Kentucky, Kegley reports.

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/02/16/2071374/board-suspends-medical-license.html#storyli

Ky. Citizen Doctor of the Year nominations being accepted

The Kentucky Academy of Family Physicians is accepting nominations for Kentucky's Citizen Doctor of the Year award. Patients are encouraged to send in their recommendations by Feb. 1.

The award honors an outstanding, community-minded family physician who provides compassionate, comprehensive care. Candidates should be role models of their profession and of their communities. They must also be members of the academy.

Kentuckians wishing to nominate should send a letter (two-page maximum) that includes the nominee's name, office address and phone number and reasons why the nominee has earned the award to: Kentucky Citizen Doctor of the Year, c/o KAFP, PO Box 1444, Ashland KY 41105-1444. They should also include their own contact information, including email. For more information about the academy, click here.

Johnson County focus of C-J series on docs, prescription abuse

The second day of The Courier-Journal's investigation into prescription drug abuse and the role of doctors looks at Johnson County, ranked 11th in the state for drug overdose deaths despite its small population of 24,000. It ranks second in such deaths per capita, right behind adjoining Floyd County, as shown on this C-J map of death rates by county. (Click on map for larger version.)

In Paintsville, Johnson's county seat, three doctors have been convicted in the past 10 years of prescribing narcotics illegally. The epidemic prompted the county Fiscal Court to try to pass an ordinance that would have outlawed clinics that were "dealing largely in cash; drawing significant numbers of patients from other counties; generating at least half of their revenue from prescribing narcotics; dispensing disproportionate amount of prescriptions, compared with other medical services; and not being affiliated with a nearby hospital," R.G. Dunlop reports. Attorney General Jack Conway's office ruled the county did not have the authority to pass such a ban.

Dunlop relays the stories of the Paintsville doctors with shocking prescribing practices and also speaks to the mayor, who called the problem "an epidemic." "What we end up doing is arresting all these 'victims' ... and the doctors who create the problem continue to practice." The C-J site also includes this video of Dunlop and photographer Scott Utterback's encounter with Aaron Cantrell, a co-owner of a clinic that is pictured today and will be the focus of more coverage tomorrow. (Read more)

State medical board is soft on physicians, compared to other states and professions, and seems to be getting more lax

Though the state has a serious problem with abuse of prescription drugs, the Kentucky Board of Medical Licensure has a history of being soft on physicians with problematic prescription pill-writing practices, reinstating licenses after doctors have been convicted of felonies within Kentucky and granting licenses to doctors who have had them taken away in other states. So reports R.G. Dunlop of The Courier-Journal, whose three-day package that began yesterday highlights many instances of doctors whose medical privileges have been restored after serious run-ins with the law.

He starts with Tufan Senler, who ran a weight-loss clinic in Jefferson County and pleaded guilty to felony drug trafficking and money-laundering charges. "But in March 2010, after Senlar had been sentenced to two years' probation, the Kentucky Board of Medical Licensure restored his medical privileges — even though he still had more than six months of court-imposed home incarceration to serve," Dunlop reports.

In October, the C-J submitted questions to the board, asking it to provide information about 30 disciplinary cases, as well as its policies. "The board's written responses, received a month later, did not address most of the questions about specific cases, and ignored cases entirely," Dunlop reports.

Legislators have expressed their disapproval, with House Speaker Greg Stumbo and Attorney General Jack Conway both asking the board to make use of the state's prescription drug-monitoring system known as KASPER. Until last week, the board was against requiring doctors to use KASPER, though on Thursday agreed to support mandatory registration.

Not only has the board has been lax in tracking doctors, it has allowed physicians to practice in Kentucky when they've ran into trouble in other states. Again, Dunlop lists several examples, one of which involves Ali Sawaf. His medical privileges had been taken away at a Michigan hospital and he was convicted of tax evasion and domestic violence. In 1998, the Kentucky board granted him a license, and three years later, he was "facing a multitude of federal and state criminal charges, including the illegal prescribing of controlled substances," Dunlop reports. He was given a 20-year prison term.

Frank Rapier, who recently retired as the head of Appalachian High Intensity Drug Trafficking Areas program, said it was "ridiculous" that the board would allow doctors who were convicted or disciplined in other states to practice in Kentucky. "Why would we allow that?" he said. "An arsonist gets kicked out of one state, and you're gonna let him in yours?" In Florida, the state medical board often tells doctors who have been asked to surrender their licenses to "never" reapply. In Virginia and Ohio, a doctor can have his or her license permanently revoked. In Kentucky, they can reapply after two years in most cases.

And though Kentucky's board is lax compared to other states, it seems to be getting more lenient. "According to data compiled by a federation of licensure boards nationwide, the Kentucky board's total 'prejudicial actions,' which include the most serious sanctions it imposed, dropped from 95 in 2009 to 52 last year," Dunlop reports. "That was the fewest such actions by the board since at least 1999."

For more than 10 years, Kentucky's board has consistently been ranked by Public Citizen, a national nonprofit consumer-advocacy organization, as one of the country's best. But in 2010, it dropped to 12 place, down from third the year before. Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, called the drop "very worrisome."

Kentucky's licensing board is also more lax than other professional boards in the state. After a felony conviction, Kentucky lawyers and pharmacists can lose their licenses permanently. The pharmacy board "can also revoke a license for five years and a day, which requires the pharmacist to seek reinstatement and, at least in some instances, to retake required tests," Dunlop reports. Attorney Kent Westberry, a former federal prosecutor and president of the Kentucky Bar Association in 2004-05, said he could only remember one instance of an attorney who had been disbarred for a felony conviction getting his license reinstated.

Gov. Steve Beshear said the board has pledged "to take swifter, more decisive action against these drug-dealing doctors who are no longer practicing medicines but who are instead enabling devastating additions." Conway said he is "hopeful" the board will become part of a solution in combatting prescription drug abuse. Stumbo said he plans to propose legislation that will improve the use of KASPER and make the board take "prompt action to curtail the prescribing privileges of anyone convicted of inappropriate prescribing."

Board attorney Lloyd Vest said changes must come from the legislative level, saying that the options of permanent license revocation and longer periods before reinstatement is considered would have to be made law and "the board would certainly respond to those legislative statements." (Read more)

Federal agency is pressured to re-post online database of doctors' malpractice and disciplinary cases

U.S. Sen. Charles Grassley has joined journalists, academic researchers and consumer groups in calling on the Health Resources and Services Administration to put back online the National Practitioner Data Bank, a database of malpractice and disciplinary cases against doctors.

"In a strongly worded letter, the Iowa Republican, who has led investigations of fraud and waste in government health programs, said the now-removed file 'serves as the backbone in providing transparency for bad-acting health care professionals'," Duff Wilson of The New York Times reports. Grassley gave HRSA, part of the the Department of Health and Human Services, until Oct. 21 to hand over documents and answer a series of questions, ending with "What is your timeline for getting the database up and running again?"

For a PDF of Grassley's letter, click here. Under pressure, the agency has scheduled a conference call on the issue for Thursday, Oct. 13, from 1 to 2 p.m. Eastern Time.

The database "was created in 1986 for hospitals, medical boards, insurers and others to share information so that bad doctors do not slip through cracks in reporting," Wilson writes. The law makes doctors' names confidential, but the database has a Public Use File for researchers and journalists, in which doctors are identified only by numbers.

Some journalists have been able to identify doctors using information from other sources, such as lawsuits. "After a complaint by one doctor identified by The Kansas City Star, the agency threatened the newspaper reporter with a fine, pulled the doctor’s file from its Web site on Sept. 1 and began a review of how to hide the identities better," Wilson reports. "Its actions provoked protests" from the Association of Health Care Journalists, the Society of Professional Journalists, the Reporters Committee for Freedom of the Press and other groups. In a letter, they told HRSA, "Nothing in the Public Use File can be used to identify individuals if reporters or researchers don’t already know for whom they are searching."

Grassley wrote, "It seems disturbing and bizarre that HRSA would attempt to chill a reporter’s First Amendment activity with threats of fines for merely 'republishing' public information from one source and connecting it with public information from another. A journalist’s shoe-leather reporting is no justification for such threats or for HRSA to shut down public access to information that Congress intended to be public."

The Public Use File can be downloaded from the website of Investigative Reporters and Editors, one of the groups, protesting its removal from the HRSA site, but "that file will be more and more out-of-date as the dispute goes on," Wilson notes. She also reports that Robert E. Oshel, associate director for research and disputes in the Division of Practitioner Data Banks, says the agency is misinterpreting the law. (Read more)

Work locally for health care solutions, experts say at annual policy forum; contrasting Medicaid approaches seen

By Tara Kaprowy
Kentucky Health News

After hearing experts say communities should take the lead in improving the quality of health care and lowering its cost — especially because there are so many unknowns about the new federal health care law — McCreary County mother and health activist Susan Taylor stepped up to the microphone Tuesday in Somerset.

"I hear what you're saying, but how do you go about getting our leaders motivated?" she asked a panel at the 2011 Howard L. Bost Memorial Health Policy Forum.

"That has sort of been my challenge," replied William Hazel, health and human resources secretary in Virginia. "It's an education process."

There were no simple answers, but experts, medical professionals and community members were willing to ask the tough questions and offer their views at the forum, sponsored by the Foundation for a Healthy Kentucky and named for a Kentuckian who played a major role in writing the Medicare law.

Again and again, experts said solutions can be found by going local, rather than focusing on goings-on in Washington or Frankfort. "My whole point is this: Make it work where you live and work and the whole country will want to be like that," said Len Nichols, left, professor of health policy and director of the Center for Health Policy Research and Ethics at George Mason University.

Nichols, the forum's keynoter, advised state legislators and rural Americans to stay calm about health care, focus on what can be measured and change accordingly. "Forget politics," he said. "Forget Obama. Don't watch TV at all. Focus on where you live."

He acknowledged that is easier said than done, because politicians can't talk about health reform "without making half the population mad and half the population scared." "People are scared, and why wouldn't they be scared?" he asked. "It looked and felt and still feels like the Great Depression."

But federal health reform is necessary, Nichols said, because the current system is unsustainable: 7 percent of the average family's income went toward paying health insurance premiums in 1987. By 2006, it had risen to 17 percent and by 2016, withough reform, it is projected to be 34 to 45 percent. Medicare is likewise unsustainable, Nichols said, with a projected 7.3 percent of the gross domestic product being spent on paying for Medicare alone by 2035.

While the majority of the new health law won't be implemented until 2014, and with repeal still a possibility if Obama loses the 2012 presidential election, community-based changes can contain health care costs.

In West Tennessee, businesses have banded together and formed the Memphis Business Group on Health, which represents 350,000 employers, employees and their families. The group chooses its providers based on value and performance and, because its numbers are significant, providers are willing to comply with the group's requirements. CEO Cristie Upshaw Travis said the private sector can "transform the market" by banding together in this way. "They've had absolutely no choice but to change how they do their benefits," she said.

Hospitals, physicians and health plans are all assessed using survey reporting instruments, whether that means an administrator answering questions about the number of pressure ulcers in a hospital or an insurance agent evaluating a plan on consumer engagement or chronic disease management. "Having this public report in our community has had an impact on the improvement, quality and efficiency of care," Travis said. "In one way, it gave them something to focus on."

In North Carolina, the state has turned to patient-centered medical homes for Medicaid patients. In this model, a family doctor's office becomes the hub of a patient's care. With the help of physician assistants and nurse practitioners, doctors use electronic health records to track patients between visits, communicate with specialists, monitor blood sugar and blood pressure and are actively involved in whether patients are getting enough exercise or taking their medicine.

There are 1,400 medical homes in North Carolina, the first of which was developed in a rural county in the late 1980s. "There was a huge access problem, the emergency room was overrun," said Tork Wade, executive director of Community Care of North Carolina. But by increasing access points, linking patients with a primary care physician and engaging community leaders — "That was another key thing," Wade said — the effort worked. "We got money to go to another 12 counties," Wade said. "(The model) responded to a real need, it wasn't just top down."

The state's embrace of Wade's non-profit program, which is effectively a managed-care plan for Medicaid, struck a contrast with Kentucky's current shift to a managed-care system run by competing, for-profit companies. "My problem with a competing system is that it doesn't lift all boats," Wade said at a breakout session, where advocates said the Kentucky plan seems more concerned with saving money than ensuring quality.

Kentucky Health and Human Services Secretary Janie Miller, left, a McCreary County native who gave openign remarks, said Medicaid should provide what patients need, "but there hasn't really been a strong, deliberate, structured method . . . to really assure we're getting the best bang for the buck."

Though the North Carolina program is now statewide, the key was that the answers came from the communities, Wade said: "It has to be local. If it doesn't work in the community, it's not going to work. So you might as well start there." Getting buy-in from rural communities was easier than in urban centers because "in urban areas there are competing health systems," Wade said. "In rural areas, there is a single system of care and a history of people working together."

Susan Taylor is going the local route by focusing on prevention with Get Healthy McCreary County, which the health department there formed in 2007. The mission is to create awareness about healthy living in the community and promote any events that relate to it.

Though the group has hosted a few events, including a cooking class for kids and an educational session on the health reform law, Taylor says she is having trouble generating interest. "I just think they haven't really realized how important our health is," she said. "Once we get sick, then we'll go to the doctor and worry about it. They don't understand prevention."

Taylor went to Tuesday's forum to find answers, but came away with more questions. As for the federal health care law fixing community problems, Taylor — whose personal interest even prompted her to get a copy of the 1,200-page health care law from her congressman — admitted she doesn't know if that will happen. "I think we saw that" at the forum, she said. "Even amongst the people who seem aware, still no one really know how it's going to play out."

UK prof receives Kentucky Academy of Family Physicians award

Dr. Samuel Matheny has received the 2011 Distinguished Service Award from the Kentucky Academy of Family Physicians. "It is his peers recognizing him for some of his unselfish activities, particularly things focused on the overall good for patients in the commonwealth, improving quality of life for patients and for the family physicians that take care of patients," said Gerry Stover, executive vice president of KAFP.

Matheny practices in Lexington, and for the past 17 years, has been a professor and chair of Family and Community Medicine in the University of Kentucky College of Medicine, of which he is graduate. He is double board certified in family and preventive medicine.

In service to the KAFP, he has invited renowned speakers to speak to the membership. He has also created new awards that honor physician volunteers and opened up nominations to community members for the citizen doctor award. He has also addressed the needs of the physician workforce Kentucky.