University Hospital merger documents being released

The University of Louisville will hand over records pertaining to the merger involving University Hospital, under a settlement signed Tuesday.

The documents will include "the June 14 agreement to consolidate the three health-care systems into one — though without some supporting documents — and the new system's affiliation agreement with U of L," reports Patrick Howington of The Courier-Journal. The move is a victory for Jefferson County Attorney Mike O'Connell (C-J photo by Pam Spaulding), who sued U of L after merger-related documents were not provided to him upon his open- records request. Though he will not receive all the documents he wished to view, he agreed to settle because of time constraints; the merger is expected to be final by Dec. 31.

The merger involves University Hospital, Jewish Hospital & St. Mary's HealthCare and St. Joseph Health System.The records, which will be handed over by Thursday, will include "the bylaws and articles of incorporation of the still-unnamed new system and a new lease agreement for the state-owned University Hospital property," Howington reports.

A table showing the merger's benefits to U of L was given over Tuesday. It shows U of L will get a larger piece of the hospital's profits than before. "The hospital gave U of L $11 million each of the past four years, but the new company would give the university $11 million each year, adjusted for inflation, plus 24 percent of the 'excess cash' — loosely meaning profit — of the entire system," Howington reports. (Read more)

Child abuse records released, but without names of victims

Though the state on Monday released 85 internal reviews of cases in which children had either been killed or nearly killed from abuse, in many instances it did not release the names of the children who were affected. The reviews also show considerable variability in terms of how thoroughly the investigations were conducted.

The records were handed over by the Cabinet for Health and Family Services after years of litigation and two weeks after Gov. Steve Beshear ordered the release. Twice before, Franklin Circuit Judge Phillip Shepherd ordered the cabinet to turn over the documents to The Courier-Journal and the Lexington Herald-Leader, which had sued the cabinet for failing to provide the records.

But while 353 pages were handed over Monday, the names of at least eight children who died from abuse or neglect had been redacted, along with all the names of children who had been seriously injured, report Bill Estep and Beth Musgrave of the Herald-Leader. "That is totally contrary to the letter and the spirit of the judge's ruling," said Robert Houlihan Jr., a lawyer for the Herald-Leader. "Where there has been a fatality, there can be no justification that I see to redact that name of the dead victim."

The documents show there is a lack of protocol in handling the case reviews. "Some reviews are lengthy and thorough, including an analysis of what social workers could do differently to prevent similar deaths," Estep and Musgrave report. "But some internal reviews consist of one page that doesn't even say whether the child died."

"If children dying does not demand a formalized process, you have to ask yourself, what does?" said Terry Brooks, executive director of Kentucky Youth Advocates. (Read more)

Still, the records do paint some harrowing pictures, with Estep, Musgrave and Valarie Honeycutt Spears reporting Tuesday about one little boy who fell off a deck in Lincoln County while his mother and boyfriend were drunk. "There was no food in the filthy house, but there were pill bottles, beer cans and needles lying around, and blood on the child's bed," they write, noting more than half of the internal reviews show there was either involvement or suspected involvement of substance abuse. (Read more)

Regardless, the redacted documents prompted a scathing editorial in The Courier-Journal, saying "the result produced Monday afternoon is unacceptable and flies in the face of the spirit of Franklin Circuit Judge Phillip Shepherd's court orders."

The editorial also questions Beshear and his "belated" attempt to step in. "Whose cabinet is it, anyway?" it reads. "Is the governor saying one thing in public — 'Our children deserve our protection' and 'Transparency will be the new rule' and 'It's time for the balance to tip toward openness' — and another in private? How else to explain the gulf between what the judge ordered, what the cabinet lawyers said would be released, what the governor said, and what the cabinet produced on Monday? If Gov. Beshear does not approve of the cabinet's latest obfuscations, he must not only say so, he must act on that disapproval." (Read more)

Teens turning to flavored cigars

A study shows teens are dispensing with cigarettes and turning to flavored mini-cigars with fun flavors — strawberry, chocolate, vanilla — enticing to young palates. (National Cigar Museum picture) "Young smokers say these cigarette-size little cigars and cigarillos — slimmer versions of big cigars — look better and can be bought one at a time instead of spending more than $5 for a pack of cigarettes," writes Lena H. Sun of The Washington Post. "Many teens also think that they are less addictive."

After cigarettes, cigar smoking is the second most common tobacco product used by youth nationwide, according to the Centers for Disease Control and Prevention. About 14 percent of high school students smoke them (18.6 percent among boys and 8.8 percent among girls). Though the Food and Drug Administration banned flavored cigarettes in 2009, it did not apply to cigars. They are only available to adults 18 and older, but many stores in Kentucky do not ask for ID.

In many states, mini cigars are taxed less than cigarettes. Federal excise tax is about 39 cents on a pack of 20 cigarettes. The tax on cigars that are the size of cigarettes is 4 cents for a pack of 20. In Kentucky, the tax rate on a pack of 20 cigarettes is 60 cents. Other tobacco products, including cigars, are taxed 15 percent.

While more enticing and less expensive, they are just as dangerous as cigarettes. "You have the same cancer-causing chemicals but wrapped in flavors that don't let you experience the harsh sensation of cigar or tobacco use," said Donald Shell, interim director for Maryland's Center for Health Promotion, Education, Tobacco Use Prevention and Cessation. (Read more For a fact sheet on mini-cigars, on the Kentucky Cabinet for Health and Family Services' website, click here.

Writer weighs in on morning-after pill decision in provocative way, looking at both sides but ultimately saying it protects girls

Freelancer Mariam Williams writes a provocative piece in The Courier-Journal about a federal official's recent rejection of a proposal to allow girls 16 and under to obtain the morning-after pill without a prescription.

Williams speaks to girls who fall in this age group and highlights the advantages and disadvantages of the decision, which was made last week by Health and Human Services Secretary Kathleen Sebelius, despite a recommendation to the contrary by the U.S. Food and Drug Administration.

"Her decision will come at a cost to me and every other adult woman of child-bearing age," Williams writes. "It will set a precedent for every time someone wants to ignore science and embrace an ideology that not everyone else believes. Her actions will tell them that's OK, and when a pharmacist denies a grown woman's request for the morning-after pill, or when people who believe a fertilized egg is a person can't give any scientific reason for the laws they want to pass, they'll point to Kathleen Sebelius.

"But I believe you and girls younger than you are worth the danger her decision put all of us in. She did this to protect you where the adults in your life have failed you, to push you to talk to an adult if you're having sex or if you've been sexually assaulted so that you can get the information you need to be as safe as possible. So I hope you take your behavior seriously. We women do." (Read more)

Make pseudoephedrine available only by prescription and see what effect it has on methamphetamine making, editorial argues

The 2012 General Assembly should make the cold medicine pseudoephedrine available only by prescription  to see if that curbs methamphetamine production, an editorial in the Lexington Herald-Leader argues.

The editorial notes the plan of Democratic Rep. Linda Belcher, D-Shepherdsville, to file another bill to require a prescription for pseudoephedrine, the key ingredient in meth, but with some changes. "Medicines in the form of gel caps would be excluded from the prescription requirement because it's hard to extract the precursors from gel caps," the editorial says. "Also, the requirement would sunset in three years to give everyone a chance to assess its effects and give Kentuckians a chance to adjust to the 130 cold and allergy medicines that cannot be put to use in meth labs."

Rep. Brent Yonts, D-Greenville, said recently that he wants to tackle the problem in another way,  blocking meth-related offenders from being able to buy pseudoephedrine unless they have a prescription. "Unfortunately, there's no reason to think that Yonts' bill would make a dent in methamphetamine production," the editorial reads. "Meth cookers could find plenty of 'smurfers' who have no criminal records to make the buys." (Read more)

Federal cuts, financial instability and competition leave many rural hospitals fearing the future

Many rural hospitals could be forced to close because of cuts to the Critical Access Program and the fact that, according to the National Rural Health Association, , 41 percent of critical-care hospitals are losing money, reports Jenny Gold of Kaiser Health News. This would be devastating to many rural communities, with a great impact felt by low-income and elderly residents. "A small hospital is often one of the biggest employers in a rural town, and closures 'can have an outsized economic impact,'" Eric Zimmerman, a health care lawyer and Washington lobbyist, told Gold.

More than 1,300 U.S. hospitals and nearly one in four acute-care facilities are designated as "critical access," giving them slightly higher Medicare and Medicaid reimbursements in return for limits on care they can provide. Many such hospitals like Hood Memorial, about an hour outside New Orleans, are dealing with uninsured patients, inability to collect payments from patients, and fewer funds from federal and state agencies, Gold reports. Many of these hospitals "tend to provide lower quality care" and are "less financially efficient than other facilities, according to a 2010 study published in the Journal of Health Politics, Policy and Law. Hood, for example, had $700,000 in losses last year despite the higher reimbursements. "It's a lot of variables, and all of them right now are working against us," CEO Hoppie Jones told Gold.

To prevent closures of rural hospitals and ensure "Americans in in isolated areas would still have access to health care," the federal government started the critical access program in 1997. To qualify, hospitals had to have 25 or fewer beds and be at least 35 miles away from another facility. However, states could waive the distance requirement, and many did, leaving hospitals like Hood with at least four other competing hospitals "within a 26 mile radius," Gold reports.

Morning-after pill should not be available to young girls over the counter, HHS secretary says, reversing FDA

Contrary to the recommendation of the U.S. Food and Drug Administration, girls younger than 17 won't be able to get the "morning-after pill" without a prescription. The FDA was overruled by Health and Human Services Secretary Kathleen Sebelius on Wednesday.

"Right now, girls age 17 and older can get the emergency contraceptive without a prescription, but a prescription is required for girls age 16 and younger," reports Darla Carter of The Courier-Journal.

Teva Women's Health requested that the drug, known officially as Plan B One-Step, be available to all girls of child-bearing age. FDA Commissioner Margaret Hamburg was in favor of the request, saying she felt there was "adequate, reasonable, well-supported, and science-based evidence that Plan B One-Step is safe and effective."

But Sebelius disagreed and directed the FDA to write a letter denying Teva's request. "She cited insufficient data to support the company's application, plus cognitive differences between older adolescents and younger girls, such as 11-year-olds," Carter reports. (Read more)