UK researcher calls for change in state law to allow syringe exchange program to curb hepatitis C epidemic in Eastern Ky.

Despite the benefits associated with syringe- or needle-exchange programs in preventing the spread of hepatitis C, Kentucky law still prohibits them, and a researcher from the University of Kentucky is calling upon policymakers to help curb this public health threat in Eastern Kentucky.

Syringe exchange programs were first created 30 years ago in response to the AIDS epidemic, and they are an important component of a comprehensive disease prevention strategy, says the Center for Disease Control and Prevention. Yet, Kentucky law prohibits them even though federally funded programs have successfully reduced disease transmission.

A recent study of 500 Appalachian drug users found that nearly two-thirds of them were infected with hepatitis C, reports Stu Johnson of WEKU News. Transmission of the disease in rural Appalachian communities is predominantly due to injection drug use, but community opposition and legal restrictions are barriers to establishing exchange programs.

UK epidemiologist Jennifer Havens would like to see a change in the state law to establish syringe exchange programs in Kentucky. She says these programs don't encourage drug use, which has in the past been an incorrect perception that can inhibit exchange adoption, says the CDC. The programs can instead reduce disease transmission.

“I don’t think anyone walking by the program, the syringe service program, is going to say, `I’m going to start doing drugs today because there’s a syringe service program.’ All it does is allow folks who are already injecting a safer way, a safer source of syringes and potentially program that they wouldn’t otherwise be able to access,” Havens told Johnson.

Haven's previous research, which examined individual and network factors among Appalachian drug users, found an association between injection of prescription opioids and hepatitis C. The study concluded that efforts preventing drug users' transition to injection, especially among prescription opioid users, may curb transmission of the disease. 

One public health tool that has successfully reduced disease transmission in other states is the creation of a syringe exchange program, says the CDC. In addition to asking for a policy change, Havens is calling for federal funding to establish syringe exchange programs in an area of Kentucky particularly impacted by the disease: the eastern region.

“In talking to a lot of the leaders in Eastern Kentucky, I haven’t necessarily approached this issue in particular, but they are at their breaking point with regard to what do we do about this epidemic, so I think, actually at the end of the day, a syringe service program would probably be fairly welcome,” Havens told Johnson.

Beyond reducing the spread of hepatitis C, syringe exchanges can also bring abusers into drug treatment programs, says Havens. The programs are reported to effectively link hard to reach drug users with prevention services, such as screening and drug abuse/ recovery programs, says the CDC. 

As heroin use increases in Kentucky, new report shows its strong connections to abusers of prescription pain medicines

Kentucky's law-enforcement agences, policymakers and public-health advocates have taken serious measures to curb the state's rampant prescription drug abuse problem, and recent state and national news stories suggest that the reduced supply of these painkillers, at least the ones in a non-crushable form, has driven pill abusers to heroin. Now there's research to support this theory.

Non-medical use of prescription pain medication may raise the risk of heroin use, says a new report by the Substance Abuse and Mental Health Services Administration. SAMHSA says people aged 12 to 49 who previously used prescription pain relievers non-medically were 19 times more likely than non-abusers to have started using heroin over the past year.

Proving the connection, the converse was true: Almost 80 percent of those who started to use heroin over the past year had abused prescription pain relievers. These findings are part of a larger effort to identify some risk factors of heroin use, and also to understand the "dependence and initiation that have occurred in the past few years," says a SAMHSA news release.

Heroin use, which had already become a problem in Northern and Central Kentucky, has been spreading to the Southern and Eastern Kentucky. The drug is becoming more popular throughout the state and nation because it is cheaper and easier to get than prescription painkillers, specifically opioid medications.

The number of U.S. heroin users has increased by about 60 percent from 2007 to 2011, says the 2011 National Survey on Drug Use and Health.  And while some can argue for the benefits of prescription medication, that same risk-benefit analysis doesn't apply to heroin, which has only risk.

The SAMHSA report offers another risk of prescription drugs: “Prescription pain relievers when used properly for their intended purpose can be of enormous benefit to patients, but their nonmedical use can lead to addiction, serious physical harm and even death,” said Dr. Peter Delany, director of SAMHSA’s Center for Behavioral Health Statistics and Quality. “This report shows that it can also greatly increase an individual’s risk of turning to heroin use – thus adding a new dimension of potential harm.” 

Join high schoolers around the state on Sept. 19 in taking the 'It Can Wait' pledge not to text while driving

In preparation for its national day of action, the "It Can Wait" campaign teamed up with state legislators in four schools across Kentucky to increase awareness about the risks of texting while driving. Become an advocate too by taking the pledge not to text and drive on Sept 19. 

State Rep. Rick Nelson of Middlesboro, Sen. Brandon Smith of Hazard and AT&T partnered to provide a simulation for students at Bell County High School to learn about dangers of texting while driving. The simulator subjected the participants to a variety of real-life traffic conditions, like driving alongside a bus, showcasing the real-life dangers of texting.

“As a father to teenagers with driver’s licenses, I am personally devoted to spreading awareness of the dangers of texting while driving, Smith told the Middlesboro Daily News. “Drivers who send text messages while driving are 23 times more likely to be in a crash, so it is critical to spread the word that when it comes to texting and driving — it can wait.”

The tour, which is also sponsored by Verizon, Sprint and T-Mobile, also stopped in Central Kentucky, where about 200 Scott County High School students participated in the simulation, along with Rep. Ryan Quarles and Sen. Damon Thayer, both of Georgetown. Quarles crashed and Thayer was stopped for driving too slow in the “busy thoroughfare,” reports Dan Adkins of the Kentucky Press News Service. Click here to try the simulator.

The “No Texting While Driving” law has been in place in Kentucky for two years and forbids anyone to send text messages while driving a motor vehicle. The law also forbids any use of a cell phone for driving under 18.

Take the pledge not to text and drive by joining the "It Can Wait" campaign. Click here for more information. You can also download the AT&T DriveMode app that automatically sends a customizable reply to incoming messages to let people know that you'll get back to them at another time.

Eye exams are now required for children ages 3 to 6 when first starting public school or preschool

Add eye exams to your back-to-school checklist, because state law now requires children aged 3 through 6 who are entering a public school or preschool program for the first time to have a vision exam.

“Studies show that vision problems are a major factor in limiting children’s abilities to learn and succeed,” said Dr. Tonia Batts, a Mayfield optometrist, said in a news release from the Kentucky Optometric Association. “Having children’s eyes examined is one of the most important things parents can do to support their children’s education and good health. . . . Many problems may not be obvious to them or their children’s teachers.”

Early diagnosis and treatment can prevent loss of sight from amblyopia, which most people call "lazy eye." Half of amblyopia cases are not diagnosed until after age 5, when it is difficult to correct, Batts said. Amblyopia the leading cause of vision loss in people under age 40, more than injuries or any other disease, but if detected early, is 100 percent treatable.

Batts said an eye examination is particularly important if your child loses place while reading; avoids close work; tends to rub his or her eyes; complains of frequent headaches; squints to use only one eye or consistently performs below academic potential.

Eye exams are covered by many private insurance plans, Medicaid and the Kentucky Children's Health Insurance Plan. Private programs may also help families with eye exam expenses. The Kentucky Vision Project, sponsored by the Kentucky Optometric Association, has donated millions of dollars in vision care, says the group's news release. Sight for Students and the Lions Club have other programs that can help. To find an optometrist in your area, click here.

Judge refuses to stop Kentucky Spirit from leaving the state, saying health cabinet has had plenty of time to prepare

A Kentucky Court of Appeals judge refused on Monday to stop Medicaid managed-care firm Kentucky Spirit from leaving the state on Friday, July 5. Chief Court of Appeals Judge Glenn E. Acree denied the Cabinet for Health and Family Services' emergency motion to require the company to stay through August.

Read more here: http://www.kentucky.com/2013/07/01/2700062/court-refuses-to-block-kentucky.html#storylink=cpy

Last week, a Franklin Circuit Court judge said  the state can't require Kentucky Spirit to keep serving Medicaid beneficiaries two months beyond its July 5 exit date. When filing the emergency motion last week, Cabinet officials said that if Kentucky Spirit leaves the state without a two-month transition plan, it will “jeopardize the health” of 125,000 people.

However, Acree said the cabinet has had plenty of time to prepare for the company's departure, reports Beth Musgrave of the Lexington Herald-Leader. Furthermore, Kentucky Spirit said the state has refused to work with it to ensure an “effective” transition, and Franklin Circuit Judge Thomas Wingate said last week that the state has “been repeatedly cautioned by this Court to prepare for this contingency, and a lack of preparation at this junction does not warrant a grant of the extraordinary remedy of injunctive relief” requested by the state.

The cabinet argues that Kentucky Spirit did not communicate its intentions to leave, despite Wingate's May 31 ruling until the cabinet took Kentucky Spirit back to court earlier this month, reports Musgrave. However, Kentucky Spirit said in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing too much money covering the 125,000 Medicaid enrollees contracted to the company.

So what will happen now? The cabinet has argued that the two other Medicaid managed care companies — Coventry Cares and WellCare — would take on the Kentucky Spirit beneficiaries and letters have been sent to Kentucky Spirit's clients and to health care providers.  A May ruling said Kentucky Spirit could face fines if it terminates its three-year contract before expiration in July 2014; Kentucky Spirit's appeal in that case is still pending. 

Kentucky will soon require simple screening at birth to detect silent killers of newborns

A new state law taking effect in January will require all babies born in Kentucky to be screened for critical congenital heart disease, which is often a silent killer of newborns who appear to be healthy and who are discharged from the hospital with the unrecognizable disease.

Since Indiana became the first state in the nation to get such mandatory screening signed into law in May 2011, more than 20 states have passed legislation requiring a non-invasive, inexpensive screening test called pulse oximetry at birth, reports Laura Ungar of The Courier-Journal. The test can detect this life-threatening disease and allow health care providers to act quickly to save the baby's life.

Don Shieman, Kentucky state director of the March of Dimes, who helped lobby for the law with the state legislature, said about 65 infants are born with CCHD in Kentucky each year. “If we can detect the problem soon enough, we can save lives,” Shieman told Ungar. State Sen. Dennis Parrett, an Elizabethtown Democrat who helped sponsor the state’s new law, said this requirement is a simple solution to a deadly problem he know something about.

“My wife and I have some experience with this,” Parrett told Ungar. “Our younger daughter was born with a severe heart defect” called tricuspid atresia, and underwent surgery at Kosair Childen's Hospital and her heart is doing fine, Parrett told Ungar. “There’s a lot of infants whose heart defects are not caught,” Parrett said. “What we wanted to do is make it a part of normal infant screening.”

Each test costs about $4, so Parrett said there’s no real fiscal impact to adding pulse oximetry to the list or required screenings for newborns, says Ungar. In general, hospitals already have the equipment for the test, many of which are already doing the test.

The legislation could lead to success stories similar to that of Shooter Bratcher of Caneyville, right, who was treated for infection and underwent surgery for CCHD recently at Kosair. Shooter was born full-term and and seemed normal at birth, but about five days after going home, things just didn't seem right, and he kept getting worse. Shooter's parents took him to the ER at their local hospital, Twin Lakes Regional Medical Center in Leitchfield, where doctors didn't pick up on his CCHD, Ungar reports. A day later, he went by ambulance to Kosair, and could have died if his parents didn't notice the little signs of a problem. Unfortunately, such signs sometimes show up at night, when parents are asleep or not paying close attention. Other times, the disease isn't caught quickly enough, leading to serious serious problems such as infections, brain damage, disability or death, Ungar reports.


Pulse oximetry will allow health care providers to detect seven types of CCHD. For more information about the test, the law or to watch a video in which Shooter's parents share their story, click here.

Kentucky Spirit still plans to leave state July 5; judge rules that state can't require company to stay for two-month transition

In the latest development in the saga of the state Cabinet for Health and Family Services and Medicaid managed-care firm Kentucky Spirit, the company appears to be the victor, at least for now, because a Franklin circuit judge this week that the state can't require it to keep serving Medicaid beneficiaries two months beyond its July 5 exit. Cabinet officials have appealed the decision, saying that if the company darts out of the state without a two-month transition plan, it will “jeopardize the health” of 125,000 people.

A May ruling said Kentucky Spirit could face fines if it terminates its three-year contract before expiration in July 2014. The company appealed. On Wednesday, it said it intends to leave Kentucky July 5, just as it made clear last year. The state appealed Thursday, and unless the court's decision is reversed next week in the Kentucky Court of Appeals, Kentucky Spirit will be able to bolt out of Kentucky on July 5, despite the damages it may face, reports Tom Loftus of The Courier-Journal.

The state's appeal aims to keep the company in Kentucky until August to grant the cabinet enough time to switch the 125,000 people covered by Kentucky Spirit to the other two managed-care firms. Cabinet officials say this transition time is vital, especially for a more vulnerable population, because transferring Medicaid recipients to Coventry Cares or WellCare will take time.

“A sudden cessation of services by Kentucky Spirit would jeopardize the health of its approximately 125,000 members, particularly those who require uninterrupted treatment or care which their new MCO would be unable to coordinate without advance notice,” said the emergency motion filed by the cabinet on Thursday, reports Ryan Alessi of cn|2's "Pure Politics."

Kentucky Spirit says the state has refused to work with it to ensure an “effective” transition, and it's now the state's responsibility to do so. Franklin Circuit Judge Thomas Wingate, who no longer has jurisdiction on the matter since Kentucky Spirit appealed, said the state has “been repeatedly cautioned by this Court to prepare for this contingency, and a lack of preparation at this junction does not warrant a grant of the extraordinary remedy of injunctive relief” requested by the state.

Regardless of what happens, Medicaid beneficiaries assigned to Kentucky Spirit shouldn't worry because their coverage will be honored by providers, cabinet spokeswoman Jill Midkiff told Alessi. In an earlier report, Midkiff said providers may feel the blow of this disruption, but Medicaid beneficiaries won't. “There won’t be disruption of services to members,” Midkiff told Loftus, “But there will be a disruption ... confusion with providers and paperwork and who they bill.”

Kentucky Spirit, a subsidiary of St. Louis-based Centene Corp., announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing too much money covering the 125,000 Medicaid enrollees contracted to the company. Kentucky Spirit argues in its lawsuit that the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million. It made the lowest bid, and on average, gets about $100 less per month for each patient than the other two managed-care companies in the state.

The school health services gamble: Ky. health departments could win on the state's bet against Kentucky Spirit's appeal of ruling

By Molly Burchett
Kentucky Health News

Kentucky’s health departments may soon get money for school nurses, based on a court ruling in May that said Medicaid managed-care firm Kentucky Spirit must pay for treatments provided by the nurses. The money wouldn't be coming from Kentucky Spirit, at least immediately, but from funds the state is withholding from the company, betting the payments on a court victory.

Circuit Judge Phillip Shepherd of Frankfort ruled in May that Kentucky Spirit must pay $8 million for services provided by school nurses, and the state has been withholding payment to the managed care company until it complies with the ruling, reports Ronnie Ellis, Frankfort correspondent for Community Newspaper Holdings Inc. On Monday, Shepherd told attorneys for the Cabinet for Health and Family Services and Kentucky Spirit that he is “inclined” to order the state to pay the health departments out of those withholdings.

The cabinet wants Kentucky Spirit to post bonds to cover the disputed payments during the company's appeal process. If the state made payments directly to the health departments, it would be gambling at its own risk, reports Ellis. If Kentucky Spirit wins its appeal of Shepherd’s earlier ruling, the state would have to refund the money, and the health departments would keep the payment.

This lawsuit originally came about when Kentucky Spirit stopped providing coverage for school health services last summer. The company said its state contract didn't require payment for such services, even though the state's Medicaid program has always paid for these services and other managed care companies were providing coverage for them. The court ruled that Kentucky Spirit must pay health departments, and the company appealed the decision.

Regardless of the source of funds, health departments and school districts could find some relief if payments are made because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for school services.

Shepherd will allow attorneys for the state to respond to the motion and hear arguments on July 25, Ellis reports.

Kentucky Spirit appeals court ruling that it can't quit Kentucky early

By Molly Burchett
Kentucky Health News

Centene Corp. announced Monday that it has appealed the Franklin Circuit Court ruling in May that said its managed care subsidiary, Kentucky Spirit, cannot terminate its contract with the state a year early. The company said it plans to be out of the state by September. Click here to view the appeal.

This move represents the continuation of a long, tumultuous relationship between Kentucky's Cabinet for Health and Family Services and Kentucky Spirit, one of three companies hired by the state in November 2011 to manage health care for more than 540,000 Medicaid recipients.

First, Kentucky Spirit announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing money, and the company also filed a formal dispute with the cabinet for damages incurred under the contract. Centene said in its annual report that Medicaid beneficiaries were retroactively assigned to the plan and non-inpatient claims receipts were higher than anticipated, leading to a $38.8 million loss in the second quarter of 2012.

"Since the inception of the contract, we have been in discussions with the cabinet about our concerns with the Medicaid managed care program but have been unable to resolve our differences," Jesse Hunter, Centene’s executive vice president of operations, told St. Louis Business Journal in October of last year. In response CHFS Secretary Audrey Haynes said, “I am deeply frustrated that this publicly traded, Fortune 500 company has chosen to put profits above people and will not honor the terms of its contract."

Next, Franklin Circuit Judge Thomas Wingate ruled that the company could face fines if it terminates its three-year contract before expiration in July 2014, and Centene said it would consider an appeal. Now, as Michael Neirdorff told investors on Monday, Centene is appealing that decision, reports Samantha Liss of St. Louis Business Journal.

“After a few months of operations, it became clear that our financial performance was much different than our projections based upon the data provided by the Commonwealth during the bid process. Our analysis concluded that inaccurate and incomplete data led to actuarially unsound rates for our health plan,” said Nerdorff at Monday's Investor Day event.

All managed-care companies received the same information, and Centene made the lowest bid. Kentucky originally signed a three-year contract with Centene in the summer of 2011, and the company was estimated to service about 180,000 Medicaid beneficiaries, generating an annual revenue of $700 million. Instead, it serves 140,000 recipients and lost $38.8 in one quarter.

However, Centene's $38.8 million quarterly loss in 2012 came alongside $2.2 billion in revenue, and the company's publicly-traded shares surged 11 percent after it announced that it was leaving the state. In April of this year, Centene raised its full-year forecast for premium and service revenue to $10.1 billion to $10.4 billion, Reuters reports.

New oral health coalition expected to spur changes in state

By Tara Kaprowy
Kentucky Health News

For the past 30 years, Dr. Fred Howard of Harlan has been seating patients in his blue dental chair and telling them to open up. When they do, he's seen all kinds of scenarios, from toddlers whose teeth are already rotten from sucking on bottle filled with soft drinks to 20-year-old adults with no teeth at all. On some occasions, children walk in with such a severe abscess in their mouth their eyes are swollen shut.

Though the view can be grim, Howard said he has seen some improvements in his decades of practice, but with new changes in Medicaid managed care, the overwhelming prevalence of children and teens drinking soda pop and an embedded cultural belief in some areas that "teeth are just something to get rid of," Howard concedes that making headway can feel like one step forward and two steps back.

Enter the newly re-established Kentucky Oral Health Coalition, a statewide force whose goal is to ensure Kentuckians have happy, healthy smiles.

Dozens of organizers and stakeholders met in March to discuss the coalition's aims, and a membership drive is underway to build financial momentum. The coalition will promote oral health education, statewide partnerships statewide and advocate oral-health legislation. "I think they will turn into the advocacy group for dental change," said Dr. Julie McKee, dental director for the state Department of Public Health. "They're working hard to come up with a plan. They've got their heads on straight."

One of the major issues facing the dental profession is possible expansion of the scope of practice for mid-level providers, such as dental therapists who can assess, clean teeth, replace sealants, provide fluoride as well as fill cavities and extract teeth. As nurse practitioners do in the medical field, having such providers could help address shortages in rural areas, said Dr. Jim Cecil, former state dental director and coalition steering committee chair. The concept is in practice in 54 other countries, but the only U.S. states with it are Minnesota and Alaska, mainly because of opposition form dentists.

Andrea Plummer, coalition member and senior policy analyst for Kentucky Youth Advocates, acknowledged that scope-of-practice issues "can be a very tense subject" and "there would have to be buy-in" from members of the committee, who include dentists, but discussion is ongoing. Cecil said the issue is "something we'll need to look at and take a stand on eventually."

Howard (pictured with Gov. Steve Beshear at signing of the bill that requires dental exams for students starting school) favors the expansion, but doesn't feel Kentucky's oral-health problems can be solved just by putting more boots on the ground.

"The bottom line is: We can have twice as many dentists, have more dental hygienists, but if we don't change the mindset, if we don't provide the education, I don't think we're going to solve the problem," he said.

To that end, the coalition is also investigating ways to expand school-based health and dental education, either by finding funding, collaborating with groups that are already in place or advocating legislation changes, Plummer said.

A recently enacted state law requires children to get a dental screening before entering kindergarten, but there is little else in the way of legislation that requires schools to offer services to help students with dental problems, Plummer said. "Kentucky law says that students' health does affect their learning and schools should take steps to affect their learning but it's fairly broad," she said.

An analysis by KYA last year showed school districts spend less than 1 percent of their budgets on school health services.

Examining how to get more dentists to accept Medicaid patients is another hot-button issue. Of about 2,200 dentists statewide, only about 600 are enrolled in Medicaid, Cecil said, and "They feel like they're working for free" because of the program's low reimbursements. "In many cases, they're really not meeting overhead."

The administrative burden that comes with these patients has also gotten worse since Medicaid transitioned to managed care, Cecil said. "Everything they do has to be pre-authorized," he said. "That delays approval, delays treatment, delays payment."

Under managed care, Howard said, patients now need to come in twice to get a full complement of X-rays and radiographs done, which can not only make it hard on dental practices, but for patients as well. "The more times they have to come, that gives them more opportunities to miss appointments," Howard said.

The Oral Health Coalition also sees a need for "quality, updated data," Plummer said. Getting data was one of the successes of the first coalition, formed in 1990. Run by volunteers and funded by the dental schools at the University of Kentucky and University of Louisville, it was formed after the General Assembly told the schools that they either needed to work together or one could "risk being shut down," Plummer said. The group had several successes, including working with the state to conduct an oral health survey, lobbying legislators for oral-health measures and holding an annual symposium. But after more than 15 years, "It kind of just fizzled out a little bit," Plummer said. The group went inactive in 2006 but had some assets that the new group will take over.

The group's rebirth began in 2009, when Kentucky Youth Advocates was approached by the DentaQuest Foundation, which is connected to DentaQuest, one of the largest managed-care organizations in the country that administers dental benefits. DentaQuest officials were interested in seeing the coalition resurrected and offered $80,000 to KYA so it could provide the manpower to run it, Plummer said. It was the first time the coalition had funding to back it up. The KYA talked to state stakeholders and discovered "there really did seem to be an interest in putting a coalition back together," Plummer said. Planning began in earnest and in January the steering committee drafted by-laws. In March, 70 people showed up to the first meeting.

That gathering was not just made up of dentists, oral-health advocates and experts, Howard said. Members of the media were present, along with parents, health department officials, school nurses, students and educators. That made all the difference to Howard, who said he is inspired by what changes might occur and what education can take place. "When we have people from all these different venues, we have more of an opportunity to make a difference," he said.

The coalition's next meeting will be July 25. Those interested in attending or becoming members of the coalition can contact Andrea Plummer at aplummer@kyyouth.org or 502-895-8167. Dues for individual members are $25. Government organizations pay $100, nonprofit organizations pay $250 and for-profit organizations pay $500.

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.

Abuse must be reported to officials in Ky., unlike scandalized Pa.

State law should prevent the child abuse scandal that has rocked Penn State from happening in Kentucky. (Associated Press photo: Penn State head coach Joe Paterno, assistant coach Mike McQueary and quarterback Mike McGloin.)

Unlike in Pennsylvania, where people are only required to report sexual abuse to a supervisor, in Kentucky suspected abuse must be reported to police, prosecutors or Child Protective Services. If a person fails to report it, that constitutes a crime, reports Andrew Wolfson of The Courier-Journal. "Telling your boss in Kentucky doesn't take you off the hook," said Terry Brooks, executive director of Kentucky Youth Advocates. "We don't let folks in Kentucky wash their hands of abuse."

Interest in the law has surfaced since a graduate assistant Paterno "saw former defensive coordinator Jerry Sandusky raping a boy in a shower in 2002 and told Paterno about it rather than alerting authorities," Wolfson reports. Paterno told his athletic director, but not police or other authorities. He was fired Nov. 9.

Advocates believe the Kentucky law "shows that we are all responsible," said Dan Fox, president of Family and Children's Place, a nonprofit counseling agency. Kentucky is one of 18 states with such a law. Those who fail to report abuse can be charged with a misdemeanor punishable up to 90 days in jail and a $250 fine, though prosecution is relatively rare. There were just 57 cases filed with the Administrative Office of the Courts since 2006. One case involved a Bed Bath & Beyond store, which was charged in 2008 after it didn't help a couple who had found a toddler locked in a hot van in the parking lot. The manager said getting involved was against store policy.

Kentucky had twice as many reported child-abuse cases as Pennsylvania 2009, though it has just one-third the number of children. That difference is believed to stem from the reporting laws of the two states, not because abuse or neglect is less common in Kentucky, Wolfson reports.