Statewide farm editor identifies self-employed workers' problems with Obamacare, and hers with Congress

Farmers and other self-employed people may have special trouble maneuvering through the process of obtaining health insurance on the state exchange, writes Sharon Burton, editor and publisher of The Farmer's Pride, Kentucky's statewide agricultural newspaper.

Sharon Burton

"The first thing I realized is the system doesn’t know how to deal with people who are self-employed," Burton writes. "I figure that’s just about every farmer in the commonwealth" of Kentucky, which is operating its own exchange, Kynect.

"My husband is a owner/operator commercial truck driver, so his income can fluctuate from year to year. When I adjusted our income based on that fluctuation, the system was not happy with me because I estimated our 2014 income to be different than our 2012," Burton writes, adding that her kynector, a state-paid adviser who helps people use the exchange about it, "She said she too had problems signing up anyone who was self-employed. She also warned me that we should notify Kynect if our income varied even within $1,000 or could face serious ramifications at the end of the year."

Kynect spokeswoman Gwenda Bond told Kentucky Health News, "If self-employed individuals have variable incomes there might be an extra step for them to accurately verify income. They would have to submit additional information, in some cases, because the income verification system accepts the amount reported only if it is within 10 percent of what the IRS has on file for the most recent year."

Burton adds, "There are a lot of bugs in the system. For one, if your spouse’s employer offers family coverage – even if they don’t pay any portion of it – you are not eligible for any subsidies. We all know insurance offered through companies often provides family coverage but it isn’t affordable.
Now you will be disqualified from Obamacare because that unaffordable plan is out there."

Burton has also lost patience with Congress. "The ones who voted for it spend all their time defending it, and the ones who voted against it spend their time trying to make sure it fails," she writes. "Just fix it people. Get on with it. It’s like starting a business. You have a plan, but where you end up often looks a lot different than where you start because you make changes as needed. This is a starting point; let’s move on to the next stage and stop bellyaching." (Read more)

Appalachian Ky. newspapers emphasized political voices in coverage of Obamacare in 2 months before exchange opened

Newspaper readers in Appalachian Kentucky rarely had the opportunity to read factual, impartial information about health-care reform in the two months before the new health-insurance system opened for enrollment.

That is among the preliminary findings of an ongoing study by the Institute for Rural Journalism and Community Issues, part of the School of Journalism and Telecommunications at the University of Kentucky and publisher of Kentucky Health News. The research found that coverage was dominated by opinions of public officials, largely those opposed to the law.

The research examined most newspapers in one of the unhealthiest and poorest regions of the country to see how well they were preparing their communities for a huge change in the health-insurance system. For the story by UK student Justin Richter, click here.

Weekly newspaper's editorial advises readers to ignore 'irresponsible rhetoric' about Obamacare and find out the facts

The Sentinel-News, a twice-weekly newspaper in Shelbyville, reminded Kentuckians to pay close attention to the "irresponsible rhetoric" surrounding the launch of the Patient Protection and Affordable Care Act.

Since registration opened Oct. 1, "misinformation and carefully constructed lies" abound, the paper said in an editorial. It reflects on how many people have "fallen victim" to exaggerated individual experiences posted on social media and "even worse, the acceptance and delivery of similar items by otherwise responsible broadcast news outlets."

The editorial says there is great disagreement about the viability of the law and both sides of the political aisle are producing statistic and "experience"-based arguments to sway you to their way of thinking.  It goes on to say that the Better Business Bureau has issued an alert about scammers trying to capitalize on the process, and it is easy for consumers to be "had" in this environment. Fact-checking organizations have called some of the information propaganda. Tragically, the editorial says, "the 'information' being distributed to validate their arguments appears to be flimsy and desperate and without sound base."

The message of this editorial is: Consumers, do your homework and check your facts. It recommends a visit to the website of KIPDA, a Louisville-region planning agency that is helping people navigate the new system; checking the website of the state health-insurance marketplace, Kynect, to see what insurance will cost you and your family; calling an information hot line; analyzing all of your options ; and doing the math: Are the new health care options more or less expensive, more or less restrictive than another option you may have?

And finally, the editorial reminds us to be patient: "All parties (need to) let it roll out, evaluate how it works and then adjust the law to ensure that it meets the needs of most Americans and provides the intended health care." (Read more)

Weekly newspaper in Jessamine County localizes the changes coming to health insurance and health care

The Jessamine Journal did a story this week that every Kentucky newspaper can do, spotlighting the local impacts of Medicaid expansion under federal health reform and federal tax credits for private insurance through the state health benefits exchange that opens Oct. 1, and comparing the local percentages to the rest of the state.

This graphic by Jonathan Kleppinger illustrated the story.

"A larger percentage of low-income people in Jessamine County than in most Kentucky counties have been uninsured and will be able to receive free health coverage through the Affordable Care Act," Kelly McKinney began her story. She noted that only 21 counties in the state have a higher
percentage of people who have no health insurance and will be eligible for Medicaid when it expands Jan. 1.

McKinney went to a local expert for an analysis and wrote, "Having health insurance will mean better health care for the estimated 3,535 low-income Jessamine Countians who haven’t had insurance, said Randy Gooch, public health director for the Jessamine County Health Department." Gooch also mentioned some potential problems: the lack of enough health-care providers to handle the influx of people entering the regular health-care system, and a reduction in services by health departments because they can't bill insurance companies for services.

McKinney's story is an example of how to put these topics into local terms and give readers information they need about changes coming to health insurance and health care. For a while, it was the most-read story on the weekly paper's website. To read it, click here.

Adair County Hospital District files Chapter 9 bankruptcy

In a move perhaps unprecedented in Kentucky, the Adair County Hospital District has voted to file for protection under Chapter 9 of the federal bankruptcy code, the same chapter used by bankrupt cities such as Detroit.

The district has a $20 million debt, creditors demanding payment, and no clear way to pay them. "The Chapter 9 filing will allow the hospital district to reorganize by extending the timeline to repay debt, refinance debt, or reduce debt by different means. It does not liquidate the taxing district nor does it close down operations" of Westlake Regional Hospital in Columbia, reports Sharon Burton of the Adair County Community Voice.

David Cantor, an attorney with Seiller Waterman LLC in Louisville, told Burton the filing is “incredibly rare” and perhaps the first in the state. “We cannot find any published cases of a Chapter 9 in the Commonwealth of Kentucky,” he said.

Farmers National Bank of Danville has sued in state court, seeking to force the  district board to levy a local property tax to pay its debt. "The federal court will, however, now likely decide the local taxation issue," Burton reports. "The hospital board voted to establish a tax but it is stalled until at least the 2014 general election after a group of citizens successfully filed a recall petition."

Only part of the Community Voice story is online, but a 7 MB PDF of its three pages with hospital news can be downloaded here.

Newspapers large and small inform readers (and even non-subscribers) about the complexities of health-care reform

By Al Cross
Kentucky Health News, Institute for Rural Journalism and Community Issues

In about two months, states and the federal government will open online marketplaces for health insurance, which will also offer subsidies based on income and the opportunity for the poor to enroll in the Medicaid program in states that have expanded it above the poverty level. By March 31, almost all Americans will be required to have health insurance or pay a penalty.

These steps will implement the health-reform law that Congress passed in 2010 and that even the White House calls Obamacare. It will be one of the most complex and challenging changes in American society since World War II, and newspapers are starting to help their readers get ready for it. Sunday's Lexington Herald-Leader had a story by Mary Meehan titled "What you need to know about Kentucky's health-reform plan."

But such reporting is not, and should not be, solely the province of metropolitan newspapers. Last week the Adair County Community Voice in Columbia published a 10-page special section on health-care reform. The front page had an overall story on the Patient Protection and Affordable Care Act, based on information gathered at a Kentucky Chamber of Commerce informational meeting, and a sidebar on the penalties and subsidies, with a box on each. Inside were several other stories, mainly from Kentucky Health News, and lots of ads from health-care providers.

The really special thing about the special section was that Editor and Publisher Sharon Burton sent the edition containing it to every household in Adair County, using the postal regulation that allows newspapers to send 10 percent of their annual circulation to non-subscribers at subscriber rates. At the Institute for Rural Journalism and Community Issues, we have long urged local newspapers to do this with their health sections, because we think there is a big overlap among people who most need such information and people who do not subscribe to their local newspaper. Newspapers can sell enough ads to cover the extra printing and postage costs, or even sell a sponsorship for the additional circulation.

"Information about health care reform has come in bits and pieces and most of us probably really don't understand it with any depth," Burton told us in an email. "I jumped at the opportunity to attend the Kentucky Chamber of Commerce Health Care Reform Summit because the agenda looked excellent and it has been difficult to get a good overview of how health care reform will impact our local businesses and individuals. We originally planned a total-market issue in June but had to delay it until July. We decided to delay the health care reform section as well so that it could go to everyone. We've had numerous compliments from readers who had said it was the best compilation of information they have seen in one place."

To download the Community Voice's health-care reform section, as a PDF of approximately 10 MB, click here.

Minorities need to ignore myths and sign up for organ donation, writes African American columnist for Herald-Leader

http://www.kentucky.com/2013/07/27/2736229/merlene-davis-minorities-need.html

Weekly paper in Hazard says Beshear should expand Medicaid

Gov. Steve Beshear should expand the Medicaid program for the poor under federal health reform to improve the health and welfare of Kentuckians, The Hazard Herald said in its editorial this week.

"We’re tired of reading report after report listing the health of Kentucky’s people at the bottom nationally," the weekly newspaper said. "That is especially the case in Eastern Kentucky, where here in Perry County we ranked as the 119th unhealthiest county out of 120, according to a recent study. In fact, the vast majority of the bottom 20 counties are here in Eastern Kentucky. There are many dire needs in our region of the state, from jobs to education to better access to health care. Here is one instance where our government, which the people fund, can opt to very possibly improve the lives of its citizens."

The federal government would pay the costs of expanding Medicaid to people in households with incomes up to 138 percent of the poverty level from 2014 through 2016. The state would pay 3 percent in 2017, rising to 10 percent in 2020. The editorial noted critics' warnings about costs, and a study predicting that expansion would increase the state's total Medicaid costs only 6.3 percent. "But, in truth, this is simply a monetary argument from interests on both sides of the debate," the paper said. "We feel the greatest interest belongs to the people of Kentucky. We feel the greatest priority should be placed on improving the health and welfare of our people." (Read more)

Bill to shield nursing homes from lawsuits clears Senate along party lines; not looking healthy in House despite TV, radio ads

Last week the state Senate approved on party lines a bill that would make lawsuits against nursing homes go through a review panel first. Republicans supported the bill and Democrats voted against it in a 23-12 vote that marked the clearest partisan split in the Senate in this year's legislative session.

Senate Bill 9 would create medical review panels of three physicians and an attorney moderator to hear complaints against long-term care facilities and vote on whether the suit had enough merit to go to court.  The bill's sponsor, Senate Health and Welfare Chairwoman Julie Denton, R-Louisville, declind to answer an opposign senator's questions about the bill. She said in introducing it that the panel would be advisory but its opinion would be admissible in court and would curb such lawsuits, reports Jack Brammer of the Lexington Herald-Leader.

Bills like this have failed in years past and could have diverse implications for Kentucky communities and nursing homes. At least one Kentucky newspaper looked around and found that lawsuits are one reason Extendicare Health Services Inc. shed management responsibilities last year for all 21 of its facilities in Kentucky, reports Nick Tabor of the Kentucky New Era in Hopkinsville.

Without Extendicare management in Western Kentucky, the volume of nursing-home lawsuits in the region appears to be shrinking, Tabor reports. In recent years, nearly all the Christian County cases that have been closed were dismissed through settlements, not by judges declaring them unfounded. This suggests the bill would minimally affect the county, writes Tabor. Other Kentucky communities may be affected differently; judges differ from circuit to circuit.

Although the bill passed the Senate, it appears to be on its deathbed in the House. Rep. Tom Burch, D-Louisville, who chairs the House Health and Welfare Committee, joked about its prospects to Tabor: “I can’t make any predictions about the bill this time, but I’ve called in three priests to have the last rites ready.” If nursing homes received this new layer of protection, he said, hospitals and day-care centers would want it too.

A similar bill died in Burch's committee last year; this version is being supported by television and radio commercials urging viewers and listeners to call their legislators in support. When Extendicare announced last spring it was transferring management of all its Kentucky facilities to a Texas company, it cited Kentucky’s “worsening litigation environment” and said tort reform seemed unlikely here.

Bernie Vonderheide, director of Kentuckians for Nursing Home Reform, said most so-called “frivolous” lawsuits would cease if the state imposed minimum staffing requirements on nursing homes, his group's main legislative goal. (Read more)

Herald-Leader says state running out of time to fix Medicaid managed care, with decision on expansion looming

A recent editorial in the Lexington Herald-Leader called for swift legislative action to fix the problems of Medicaid managed care. Timely action is even more necessary since the state is considering expanding the program, some critics have said.

Fifteen months ago the administration of Gov. Steve Beshear made a quick transition to managed care that privatized Medicaid for 550,000 poor, elderly and disabled people and was projected to save Kentucky $375 million in three years.  If the state expands Medicaid, that number of covered individuals could grow to more than 1 million — or roughly a quarter of all Kentuckians.

Although Medicaid is encouraging preventive care, such as more well-child visits and diabetes testing, providers haven't been paid for some of their services. The state recently granted the managed care companies a seven percent rate increase, and the companies have said they're losing money here and one is pulling out in July. But at the end of the first eight months of managed care Medicaid, the state had paid $500 million more to the companies than the companies had paid to providers.

"The delay and denial of payments are creating financial crises for providers and pharmacies and forcing small hospitals to lay off employees, deplete reserves and default on bonds," the editorial said. "This is creating a massive transfer of wealth from Kentucky medical practices and hospitals to for-profit companies based in other states. . . . For patients, the companies are putting up barriers to care that would be illegal in the private sector. The new burdens that have been placed on vulnerable Kentuckians and their medical providers threaten to unravel not just the safety net but, in some places, the whole health care system."

The editorial called on the General Assembly to pass legislation to curb abuses such as "the stiffing of hospitals that provide emergency care as required by federal law. . . . House Bill 299 and Senate Bill 178 would also curb the false economy of severely limiting in-patient mental-health care for children while referring them to nonexistent out-patient care."

The legislation would also require Medicaid managed care companies to:

• Meet the same provider network standards, including distance to hospitals and obstetrical care, as other insurers operating under Kentucky law.
• Decide claims based on nationally recognized clinical standards and provide specific reasons for denials so providers would know what's allowable.
• Participate in an appeals process for denied claims.

Appalachian Regional Healthcare wants to sue the U.S. Department of Health and Human Services and others, alleging that the new system is out of compliance with federal law.

"The feds shouldn't have to be dragged in," the editorial says. "The federal government covers roughly 70 percent of Kentucky’s $6 billion Medicaid program. Expanding Medicaid to include more low-income people is a linchpin of federal health care reform," and Beshear has said that he wants to expand Medicaid if the state can afford it. "Kentucky can't wait much longer to get Medicaid right." (Read more)

Ky. Rural Health Association seeks entries in reporting contest

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

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

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

Coalition of health groups launches two-week ad campaign to drum up support for a statewide smoking ban

A geographically targeted newspaper and online advertising campaign calling for "a comprehensive, statewide smoke-free law" is hitting Kentucky media outlets this week, as the legislature convenes, and next week. The campaign was launched by Smoke-Free Kentucky Coalition, the Campaign for Tobacco-Free Kids and the Robert Wood Johnson Foundation. The newspaper ad can viewed here.

Twenty-nine percent of Kentucky adults are smokers, giving the state the highest smoking rate in the U.S., and ranks very high in youth smoking, according to the Centers for Disease Control. Kentucky also has the nation's highest lung cancer death rates, 87 percent of which are caused by smoking, according to the National Cancer Institute. The state also "lags behind other states in enacting a comprehensive, statewide smoke-free law that covers all indoor workplaces, including bars and restaurants," a press release about the ad campaign says. Twenty-four states have smoking bans. A fall poll for the Foundation for a Healthy Kentucky showed that 59 percent of Kentucky adults support a smoking ban in workplaces, restaurants and bars. For a story on the poll, click here.

Tobacco-Free Kids communications manager Catherine Butsch said the ad is running in the Lexington Herald-Leader, the Messenger-Inquirer of Owensboro, the Daily Independent of Ashland, the Commonwealth Journal of Somerset, the Kentucky New Era of Hopkinsville, the Glasgow Daily Times, the Paducah Sun, the Paducah-based West Kentucky News, the Sentinel-Echo of London, the Lebanon Enterprise, the Jessamine Journal, the Tompkinsville News, the Carlisle Weekly of Bardwell, the Fulton Leader, the Marshall County Tribune Courier, and the Kentucky Gazette, a government-oriented twice-monthly in Frankfort. The online ad will run on websites of the Herald-Leader, Business Lexington, The Lane Report and CN2, a cable news service. The campaign will cost $93,000, Butsch said.

Painkiller epidemic was driven in part by drug makers' financial relationships with researchers who discounted the risks

For almost a decade, medical officials and experts claimed OxyContin rarely posed problems of addiction for patients. The drug's label, which was approved by the Food and Drug Administration, said addiction risks were small. Research published in the New England Journal of Medicine also said OxyContin wasn't addictive; so did a study in another journal, which OxyContin manufacturer Purdue Pharma reprinted 10,000 times. Since the drug first hit the market, it has fueled a large-scale swath of prescription pain killer addiction, beginning in Central Appalachia, that has grown into a national epidemic, especially in rural areas.

The epidemic was driven in no small part by doctors' lack of knowledge about OxyContin, which was perpetuated by the drug's manufacturer through false claims that became scientific consensus. But now, "Many in the medical profession have rediscovered the destructive power of opiates," and are calling that consensus into question, Peter Whoriskey of The Washington Post reports. "A closer look at the opioid painkiller binge, in which retail prescriptions have roughly tripled in the past 20 years, shows that the rising sales and addictions were catalyzed by a massive effort by pharmaceutical companies to shape medical opinion and practice."

Doctors were wary of prescribing painkillers to any patient except those with cancer for years. But manufacturers and some pain specialists "helped create a body of scientific research assuaging the long-standing worries about opioids and pushed to expand the use of the drugs in people with chronic pain: bad backs, arthritis, sore knees," Whoriskey reports.

Through an examination of key scientific papers, court documents and FDA records, the Post found that many of the studies claiming OxyContin wasn't addictive were supported by Purdue Pharma. The conclusions those studies reached were sometimes not supported by data, and when the FDA needed to develop an opioid policy, it turned to a panel of doctors who had financial relationships with Purdue Pharma and other drug makers. (Read more)

In starting its sixth package in series on prescription drug abuse, The Courier-Journal shows treatment programs fall short of need

Brittany Crouch suffers through withdrawal in Frenchburg
before leaving for treatment in Lexington, as daughter
Kaylee Adams, 3, cries. (C-J photo by Alton Strupp)

"In a state plagued by one of the worst prescription-drug abuse problems in the nation . . . treatment options are woefully limited, especially for hard-core addicts in need of the most intense care, Laura Ungar reports for The Courier-Journal in the opening story of its sixth package in the series called "Prescription for Tragedy."

"Only 40 of Kentucky’s 301 treatment and recovery sites offer 24-hour residential care, which experts say may be the only hope for the most severely addicted. And those 40 centers are concentrated in just 19 of the state’s 120 counties, mostly in urban areas, meaning addicts in rural counties often must travel hours for help, Ungar writes, noting that almost 80 percent of the sites "are for outpatients only, typically offering one hour of care a week."

That is the type of care received by two-thirds of Kentuckians admitted for treatment, but by 46 percent nationwide in 2009, the last year for which comparative figures are available. Fewer than 5 percent "entered residential care, compared with 17 percent nationally," Ungar writes. "Treatment shortages are most severe in Appalachian counties with the state’s highest overdose rates. Six Kentucky counties that rank among the 10 highest for overdose deaths have just one outpatient center or no center at all." (Read more)

Today's package includes a map of treatment centers in the state; in the print version, it is overlaid on a county map showing rates of death from prescription drugs, with the highest in Appalachian Kentucky. The dots in green, yellow and red on the Google-based map below indicate centers that provide care more intensive than outpatient.

Do Kentucky families care about obesity? Louisville newspaper blog says yes; now comes the hard part

In The Prime, The Courier-Journal's collection of news, features, videos and blogs "that help you thrive as you age" has taken on a new crusade: obesity. It's a brave initiative in the blog's ongoing effort to get families on board with better health, better eating and longer lives. The blog started with a simple question: Do Kentucky families care about this issue? The answer is a resounding yes. Sharon Cecil, writing for the nutritional, medical, spiritual and fitness advisers on the blog board, explains that the group has done a year's worth of work and has now scheduled focus groups for more specifics. Stay tuned here.

Louisville cardiologist John Mandrola, meanwhile, takes on sugary drinks in the Sept. 22 blog installment of In the Prime. He astonishes with the simple fact that the average male teen drinks 357 calories daily from sugar-sweetened beverages. Not a useful nutrient in sight. And, he adds, if that male is pre-determined genetically to be obese, a Harvard study just found that could be even more susceptible to the harmful effects of sugar-sweetened beverages. The bad news only gets worse. (Associated Press photo)

Lastly, Cecil, a nurse, has high marks for the HBO series, "The Weight of the Nation: Confronting America's Obesity Epidemic." Go here to see all parts of that series.

Pikeville newspaper spotlights local doctors and pharmacists charged in prescription pain-pill epidemic, forecasts more action

The Appalachian News-Express, the thrice-weekly newspaper in Pikeville, has turned the spotlight on Pike County physicians and pharmacists who are aiding and abetting the abuse of prescription painkillers. We have to wonder if more reporting like this from local news media wouldn't help fight the problem, which has become epidemic in Kentucky, especially in the east.

"Prescription drug abuse has dominated news headlines across the state over the last several weeks and new cases are leading officials to believe that more and more cases will be filed against physicians in and around Eastern Kentucky," the 2,200-word story begins. "Officials on both the state and federal level have been busy over the last year in taking action against a number of medical professionals, both in and around Pike County."

The full story by Chris Anderson is available only to subscribers, but is available to members of the Kentucky Press Association who subscribe to its Kentucky Press News Service.

Doctors' letter to the editor about the importance of physical activity is worthy of consideration from all Kentucky newspapers

Given its timeliness and message, Kentucky Health News encourages editors of Kentucky newspapers to consider publishing this compelling letter.

Physical activity — a daily staple

To the editor:

The 2012 London Olympics were a feast. Nobody with a hunger for sports, national rivalries or stories of individual struggles and accomplishment should have left the table unsatisfied. The Games served up a bounty of the very best.

After the feast, though, we need good, daily nutrition. Seeing the world's best athletes break records and vie for top honors, we can take their example and weave physical activity, exercise and sport into our daily lives. There's only one Usain Bolt, but millions of us run full-tilt through our careers and family life. The gymnastic magic of Gabby Douglas can inspire our headlong tumble through competing obligations and the flexibility to get it all done.

Translating Olympic activities into everyday life is more than a metaphor. With sedentary lifestyles linked to one in four deaths from non-communicable diseases, and with preventable conditions consuming unsustainable portions of health care costs, we must act individually and as a society to keep ourselves fit and healthy.

Food for thought

The facts are undeniable, and the evidence continues to mount. As the Games were poised to begin, no less an authority than The Lancet published a series of articles that underscore the extraordinary peril of physical inactivity for global health and national economies. Experts from Harvard, the Centers for Disease Control and Prevention, and around the world made the case for urgent action: "In view of the prevalence, global reach, and health effect of physical inactivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences."

The reality is that the United States will not be able to grow it economy fast enough or large enough to pay for the treatment of rising levels of highly avoidable diseases and conditions, many of which are related to low levels of physical activity. This calls for collective action to encourage and enable all people to become and remain more active, whether through activities of daily living, exercise or sports.

On an individual level, we will each benefit from meeting at least minimum guidelines for physical activity. The payoff is improved health and quality of life for the individual, greater productivity in the workplace, and lower health costs for all of us. The alternative is unthinkable.

That's food for thought, indeed. As we push back from the table, still savoring a 17-day feast of athletics and achievement, let's make a menu of physical activity part of our daily lives. Anything less is too hard to swallow.

Janet Walberg Rankin, president, American College of Sports Medicine
Dr. Robert Sallis, chair, "Exercise is Medicine" Global Initiative

Six of 41 child-abuse fatalities show improper follow-up by Cabinet for Health and Family Services, Herald-Leader analysis finds

The way child-abuse deaths are reviewed in Kentucky continues to be problematic. Looking at the 41 child fatalities in 2009 and 2010, Lexington Herald-Leader reporters Beth Musgrave and Bill Estep found at least six cases in which the Cabinet for Health and Family Services "did not do an internal review even though there were previous reports involving the family before the child died."

State law requires the cabinet to conduct such a review when a child dies or nearly dies because of abuse or neglect and the cabinet had prior involvement with the family.

That didn't happen in the case of 2-year-old Derek Cooper, whose father placed his hands over the crying boy's mouth "until the child was silent," a state report said. Cooper's father, Brandon Fraley, had had contact with the cabinet when he was a child himself, and in 2006 there was an allegation of domestic violence against him, Musgrave and Estep report. Cabinet spokeswoman Jill Midkiff said the cabinet doesn't do internal reviews when the contact with the cabinet occurred when the alleged abuser was a child, but Midkiff "provided no explanation about why the 2006 domestic violence investigation of Fraley didn't trigger an internal review," the newspaper reports.

The analysis also showed vast differences in the way internal reviews are conducted in different parts of the state. "Some of the reviews appeared to be thorough, but in others, child-protection workers produced only one-page reports with little detail on what happened to the children and no assessment of potential improvements," Musgrave and Estep report.

"The cabinet for so long has hidden everything it could," said state Rep. Susan Westrom, D-Lexington, who tried earlier this year to pass a bill that would create an external child-fatality review panel. Gov. Steve Beshear has issued an order to create such a panel, whose members will review cases and make recommendations. The panel will not have cabinet staff as members.

Westrom's bill got hung up partly over the cabinet's attempt to impose further restrictions on the sort of information it is required to make public. The newspaper's analysis the result of a long fight the Herald-Leader and The Courier-Journal have waged to make the child-abuse documentation available to the public. C-J lawyer Jon Fleischaker said on KET yesterday that the cabinet continues to redact more information that it should, in an effort to protect its own interests. The fight continues in the appellate courts. (Read more)

Herald-Leader dislikes mental health agency's 'clubby glow'

In an editorial today, the Lexington Herald-Leader criticized the "clubby glow emanating from the inner circle" of the Bluegrass Regional Mental Health-Mental Retardation Board, whose financial status was featured in Sunday's issue of the newspaper.

Though the paper didn't take issue with top executives earning large salaries, it did have a problem with the makeup of the board and its staff. First, the current CEO, Shannon Ware, is married to the former CEO, Joseph Troy. Troy's son-in-law is director of information technology. And at least eight of the 25 members of the board have served since the 1980s. Another three have served since the 1990s.

"Collectively, these offer the potential for an organization where the status quo is rarely challenged," the editorial reads. The editorial board took particular issue with the nepotism in place: "While it is theoretically possible that a supervisor might treat a family member exactly the same as an unrelated employee, in reality it is hard to imagine. Regardless, the very appearance of favoritism can be damaging to an organization." (Read more)

Couple shares 'horrible journey' of prescription drug abuse

Recovering pill addict Stacy Pennington
of Ashland is due to give birth next month.
(Courier-Journal photo by Matt Stone)

Stacy and James Pennington had to lose everything, including their children and home, before they were able to face their prescription drug abuse problem. Now in recovery at The Healing Place in Louisville, they spoke to The Courier-Journal's Laura Ungar of their downward spiral.

"It had gotten to the point where my prescription drugs were my everything. As long as I had them, I was OK," said James, 40, of Ashland. "Before, we had everything we could want. In the end, we were just feeding an addiction. We had lost everything."

Stacy Pennington said she took her first painkillers in 2002 after she cut her finger on a glass candle jar and needed two surgeries. "A year later, she was diagnosed with cervical cancer, then severe endometriosis, and she required several more surgeries," Ungar reports. "Each of her 14 operations brought another prescription for pain pills."

James Pennington took prescription drugs for the first time at age 14 after he dislocated his shoulder. After he broke his shoulder in a motorcycle accident when he was 25, he got a 30-day supply for Percocet and, later, was prescribed more of the drug after a knee injury. "Pain medications became my drug of choice from there on out," he said.

Soon, he was traveling to "pill mills" in Florida to fuel his addiction, pills he sold and shared with his wife. When Stacy gave birth to their daughter, she was heavily addicted and eventually lost custody of her. James' older daughter was also taken from the home. 

Before Stacy Pennington checked in to The Healing Place, she had sold her engagement ring, the Penningtons sold their home before they lost it, and they were spending $100 to $500 a day to feed their addiction. Now, Stacy is expecting another child and the couple is fighting for their sobriety. "It's a horrible journey. I had to absolutely lose everything. But I see that as a blessing," said James Pennington. "I'm so glad I'm on the other side today." (Read more)