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.

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.

This is Child Abuse Awareness Month; tips for prevention

April is child abuse awareness month, and the state Cabinet for Health and Family Services is reminding Kentuckians that it's the law to report suspected child abuse or neglect.

"Protecting our children should be everyone's number one priority, and during the month of April, we are raising awareness about the warning signs of child abuse and how to report it," Gov. Steve Beshear said. "The cabinet works year round to educate our families and investigate every aspect of abuse. Together, we can make Kentucky a safer place for all our children."

To report child abuse, Kentuckians should call 800-KYSAFE1. Calls are anonymous. If the report meets the criteria for abuse, an investigation is conducted within 24 hours in most cases or, if the child is suspected to be in immediate danger, they are conducted within the hour.

Callers should try to know the child's name, approximate age, address, parents' names and location of the child when the call is made. They should also have names and phone numbers of other people who have information about the suspected abuse.

The ultimate goal is to reunite families when circumstances improve. "We want children to return home to a stronger, safer family," said Jim Grace, assistant director of the Department for Community Based Services' Division of Protection and Permanency.

The cabinet's handling of child abuse investigations and its reluctance to release records pertaining to child abuse deaths and near deaths has been a hot-button issue in the past year. The Courier-Journal and Lexington Herald-Leader both sued the cabinet for refusing to turn over records and a judge twice ruled the cabinet was wrong not to do so. Since, it has released hundreds of pages of records, but has chosen to redact, or omit, some of the information therein. In January, Beshear acknowledged the cabinet had been accused of "operating under a veil of secrecy in a supposed attempt to protect inept workers and a poorly designed system."  Legislators have since heard hours of arguments about the issue, and a bill that would create an external panel to review child abuse cases involving fatalities and near-fatalities, while imposing more secrecy, is one of the few measures that could pass the General Assembly when it re-convenes for one day next Thursday to end its legislative session.

In its effort to increase awareness about child abuse, the cabinet offered strategies for parents to prevent abuse, including:

• never discipling a child when a parent's anger is out of control

• never leaving a child unattended, especially in a car

• learning the signs of physical abuse, nothing bruises, cuts, burns or other injuries a child can't explain

• teaching children the difference between "good touches," "bad touches" and "confusing touches"

• listening to a child when he or she doesn't want to go with something

• noting a change in a child's behavior or attitude

• teaching children what if he or she gets lost

• teaching children the correct name for private body parts

• being alert for talk that indicates premature sexual understanding

• paying attention when someone shows an unusual interest in a child

• making sure a child's school or daycare will only release him or her to a designated person
(Read more)

Health and family cabinet continues to withhold more information in copies of child abuse records than judge allowed

The state Cabinet for Health and Family Services released three more death and near-death cases involving child abuse or neglect Friday under court order, but continued to withhold critical information. It has appealed the order.

The 2009 cases involve two babies who died from suffocation while the parents were impaired. A third case involves a 2-year-old girl from Lawrence County, who was injured after she was reportedly kicked in the head by a horse while unsupervised.

The cabinet "continues to withhold, or redact, far more information" than was allowed under the Jan. 19 order of Franklin Circuit Judge Phillip Shepherd, reports Deborah Yetter of The Courier-Journal. Shepherd said the cabinet could withhold the names of children seriously injured by abuse or neglect, names of private citizens who report suspected abuse, the names of minor siblings in the home and the names of minor perpetrators.

But the cabinet is withholding more information than that. "For example, in the case of the girl injured by the horse, the cabinet deleted the name and relationship of the adult who was watching her, even though the adult is named and identified as her grandfather in a separate internal review of the case," Yetter reports. "The cabinet also withheld juvenile and family court records in that case and the names of all adults involved." The girl recovered from the skull fracture sustained by the horse.

Gavin Villarreal never woke up after he was found with a plastic bag over his head in his crib, possibly placed over the 5-month-old's head by other young children in the home. His parents both tested positive for drugs on the day of his death and were convicted. In the third case, a month-old baby died after his father apparently rolled over him in his sleep. Both parents admitted they had been drinking and used marijuana before they went to bed. (Read more)

U of L physicians' group drops open-records appeal, but C-J may still not get records

An organization representing University of Louisville doctors who were trying to keep their financial records private dropped its lawsuit appealing an adverse open-records decision Tuesday. In April, Attorney General Jack Conway ruled that University of Louisville Physicians Inc. is a public agency and, as such, is subject to the Kentucky Open Records Act. Conway's opinion was requested by The Courier-Journal.



Last November, state auditor Crit Luallen released a scathing audit against Passport, which provides managed care for 165,000 Medicaid patients in Jefferson and 15 surrounding counties. The audit accused the organization of "wasteful spending, conflicts of interest and the questionable transfer of $30 million in Medicaid funds to organizations represented on Passport's board, including University Physician Associates," The Courier-Journal's Tom Loftus reports. Because of the audit, the newspaper asked for financial records from University Physicians Associates and University of Louisville Physicians Inc., which is the successor to University Physicians Associates. They refused to hand over the records, and Conway's decision followed.



Though the attorney general determined the organization should be subject to the open-records law, and the doctors' lawsuit has been dismissed, giving Conway's opinion the force of law, The Courier-Journal may not receive the records it has asked for. In its notice of dismissal, University of Louisville Physicians stated it could change "its structure and function in the future which it believes may alter its status as a public agency."



"We are still forming our final structure and function," Diane Patridge, ULP's vice president for marketing and communications, told Loftus. "Once we're up and fully established we may appeal this current determination." Curiously, "Partridge also said that ULP has no records to release to the newspaper as a result of the dismissal of the case," because it has no employees -- even though it was incorporated in March 2010. "She said University Physicians Associates . . . has handled all financial matters and paperwork for ULP to date," Loftus reports.



“This case is another piece of a puzzle,” Courier-Journal attorney Jon Fleischaker said. “It’s another step to try to make sure there’s more transparency at the University of Louisville School of Medicine and University Medical Center.” (Read more) "Sounds like a shell game with shell corporations," said Al Cross, director of the Institute for Rural Journalism and Community Issues and associate extension professor of journalism at the University of Kentucky.

Data leaks are a risk with electronic health records; state says it has safeguards to protect privacy

As hospitals and other health-care providers in Kentucky and across the country are adopting electronic health records to save money and improve care, they do so at some risk. The medical files containing insurance forms, Social Security numbers and doctors' notes of about 300,000 Californians were posted recently on the Internet, available to anyone who might stumble across them or know how to search for them. "At a time of mounting computer hacking threats, the incident offers an alarming glimpse at privacy risks as the nation moves steadily into an era in which every American's sensitive medical information will be digitized," The Associated Press reports.

"When things go wrong, they can really go wrong," said Beth Givens, director of Privacy Rights Clearinghouse, a nonprofit that tracks data breaches. "Even the most well-designed systems are not safe ... This case is a good example of how the human element is the weakest link."

Generally, data breaches are the result of hackers who break into computers or thieves who steal the actual equipment. Sometimes they can just be be caused by human error. Leaks can also happen as data passes through health industry networks. "Dozens of companies can be authorized to handle a single person's medical records," the AP reports. "The further away from the health care provider the records get, the flimsier the enforcement mechanisms for ensuring the data are protected."

One of the biggest breaches was in 2006 when a laptop containing data for 26.5 million veterans was stolen from the home of a government employee. The computer was recovered. This year, hard drives containing personal information of 1.9 million Health Net insurance customers were taken. They contained health histories, financial information and Social Security numbers. The matter is still under investigation.

In the wrong hands, "health records can be used for blackmail and public humiliation," AP notes. "The information can also be used by insurance companies to inflate rates, or by employers to deny job applicants."

Preventing data leaks is on the minds of Kentucky officials setting up the Kentucky Health Information Exchange, the state clearinghouse for EHRs. Participating providers have to sign several agreements in which they attest the information they obtain will be used responsibly. "The golden rule is this data will only be viewed by a provider who is providing care to a patient," said Jeff Brady, executive director of the Governor's Office of Electronic Health Information. To make sure that is happening, Brady said the software has an audit function, in which administrators are able to see who looks at a patient's data, when they did, from what computer and what piece of data was examined. (Read more)