Here's latest quarterly report of Ky. nursing homes' deficiencies

In the second quarter of 2011, inspectors found 291 deficiencies in 49 Kentucky nursing homes, nine of which had 10 or more. Rosewood Health Care Center in Bowling Green had 19 deficiencies, followed by Mountain View Health Care Center in Elkhorn City with 18 and Christian Health Center in Louisville with 16.

Kentuckians for Nursing Home Reform, a non-profit organization that advocates for nursing home residents, obtains such data regularly through open-records requests to the Kentucky Cabinet for Health and Family Services and distributes it statewide.

On average, inspectors find six deficiencies in Kentucky's nursing homes, according to Medicare's nursing-home comparison data. Inspections assess a facility on the care of residents and how that care is administered; on how staff and residents interact; and on its environment. Certified nursing homes must meet more than 180 regulatory standards. The state Office of Inspector General website has more data, such as the results of inspections and the ownership of each facility.

The other nursing homes with 10 or more deficiencies in the second quarter were: Wurtland Nursing and Rehabilitation Center (15); Christian Health Center, Corbin (14); Royal Manor, Nicholasville (12); Glasgow State Nursing Facility (12); Regis Woods Care and Rehabilitation Center, Louisville (12); and Owsley County Health Care Center, Booneville (12).

Planned merger of Louisville hospitals grows more controversial; C-J devotes considerable space to it and Beshear steps in

UPDATE, July 27, 3:43 p.m.: Gov. Steve Beshear issued a statement saying "It is clear there are growing concerns within the community about issues related to the hospital’s future level of access to medical services, and those concerns need to be fully vetted before the Commonwealth takes the legal steps required to approve this merger," such as changes in leases of public property and agreements on operation of the hospital. Just as important as the legal issues, Beshear said, is "the public policy of how the University of Louisville Hospital will continue to honor its mission as a public teaching hospital that provides access and care to citizens, especially those who are indigent." The governor said his administration "will hold a series of conversations with the principals in the proposed merger and other interested parties," starting with a meeting among four of his cabinet secretaries, Mayor Greg Fischer, state Auditor Crit Luallen and Attorney General Jack Conway.

The merger that would put a Catholic health group in charge of the University of Louisville's hospital is growing ever more controversial, as demonstrated by today's edition of The Courier-Journal. The top story was about U of L President Jim Ramsey's uncertain response to a request by state legislators to answer questions of a legislative committee, accompanied online by a photograph of a somewhat sheepish-looking Ramsey, left. UPDATE, July 28: Ramsey says he will appear before the panel Aug. 17.

The paper's editorial page was mainly about the issue. The top editorial was headlined "Ramsey's silence," and it referred to the second 'editorial' on the page, actually a recitation of email correspondence between Ramsey and one of his Fern Creek High School classmates and her husband, who oppose the merger and questioned Ramsey's charcterization of an earlier C-J editorial as "not based on complete and factual information."

Next to that piece was a letter from the lawmakers: Rep. Tom Burch, chairman of the House Health and Welfare Committee and a Catholic who opposes the merger because of its implications for reproductive and end-of-life procedures; and Reps. Mary Lou Marzian and Joni Jenkins of Louisville. It was illustrated by a photo of Ramsey looking thoughtful. Above it was a letter, illustrated by a photo of Pope Benedict XVI, from Eugenia K. Potter, former executive director of the Kentucky Commission on Women, headined "Is it dogma or discrimination?" Conservative commentator Martin Cothran has a contrary view on his blog.

UPDATE, July 27, 8 a.m.: The C-J editorial page is again mainly about the issue, with an editorial urging the state auditor, governor and attorney general "to thoroughly scour and bring transparency to the negotiations with Catholic Health Initiatives;" an article by former University Hospital nurse Beverly Glasscock saying that the hospital wouldn't be able to perform emergcy abortions needed to save a woman's life; and a letter from former university trustee Bill Stone defending Ramsey from what he calls an "over the top" attack by the paper's editorial board.

Workshop Aug. 4-5 will help health groups with policy, programs

A two-day workshop intended to help health coalitions and organizations make progress at the policy level and implement evidence-based programs will begin Aug. 4.

On the first day, speaker Monte Roulier of Community Initiatives will speak about the art and science of building health and whole communities. On the second day, speakers from the Centers for Disease Control and Prevention will demonstrate how to use The Community Guide, a free resource that offers guidance on what programs and policies are evidence-based for obesity, mental health, asthma, tobacco, substance abuse, violence and other health issues.

The workshop is part of the "Health for a Change: Ignite — Unite — Act" series, a program of the Foundation for a Healthy Kentucky. It starts at 10 a.m. Aug. 4 and ends at 4 p.m. Aug. 5. at the Hurstbourne Place Office Building in Louisville. To register, click here.

Majority of Americans now support comprehensive smoking bans

For the first time since it started asking the question in 2001, a majority of Americans polled by the Gallup Organization say they support a ban on smoking in all public places. The poll showed 59 percent of Americans support such a ban. In 2001, only 39 percent of people did, The Huffington Post reports. Only 20 percent said they would support making smoking illegal, as alcohol was during Prohibition from 1920 to 1933.

According to the American Lung Association, 27 states and the District of Columbia have passed comprehensive smoke-free laws. Kentucky is not among them, but 31 Kentucky communities have passed such laws. A poll conducted by the Foundation for a Healthy Kentucky released earlier this year showed 44 percent of respondents said they were strongly in favor of a statewide smoking ban. Another 15 percent said they were somewhat in favor of it. (Read more)

Program serving young, blind children hit hard by state budget cuts

A program that helps educate blind preschoolers throughout Kentucky has had its state funding drastically cut. Louisville-based Visually Impaired Preschool Services, also known as VIPS, will only receive $10,000 from the state this year, compared to $80,000 three years ago, The Courier-Journal's Deborah Yetter reports. (C-J photo by Michael Hayman)

The program provides free, at-home education for children who are considered legally blind until they turn 4. "The impact is that we won't be able to serve them as often," said Diane Nelson, the program's executive director. "It's so sad."

While the cut will not affect VIPS' preschool in Louisville, it will affect parents and children in more rural parts of the state because fewer specially trained teachers will be sent from Louisville and Lexington to help them. The program serves about 300 children in Kentucky and southern Indiana. Last year, about 50 of those children were outside Louisville and Lexington. This year, only 22 rural children are being helped. "We don't have the money to go out and find these kids," Nelson said.

The funding reduction is the latest in a series of cutbacks that have affected Kentucky public health in the past several years. All told, public health funding has been cut $12 million in recent years. (Read more)

State health commissioner retiring after seven years in the job, fighting for public health and expanding its role

By Tara Kaprowy
Kentucky Health News

After dealing with the aftermath of 9/11, an anthrax scare, H1N1 flu, the worst ice storm in Kentucky's history and a series of budget cuts, it's been a busy decade for Dr. William Hacker at the state health department. But after 10 years at the agency, seven as its boss, Hacker will retire at the end of the month.

He is getting great reviews for his work as commissioner, which has included expanding the role of public health beyond its traditional roles, including disaster response and prevention.

"Dr. Hacker has always provided quality leadership," said Scott Lockard, president of the Kentucky Public Health Association. "He has been a great advocate for public health. He has been well respected both in state and on the national level and he will be deeply missed."

"Dr. William Hacker has been an exemplary leader for public health and has led by example with his professional and genteel leadership style," said Linda Sims, director of the Lincoln Trail District Health Department and president of the Kentucky Health Department Association. "Dr. Hacker has been instrumental in helping local health departments during budgetary challenges with guidance and support. The development of new services and screenings for children have increased under his efforts that will make a difference for many years to come."

Hacker, a native of Manchester, joined the department in February 2001 to work in the maternal and child health division. He'd practiced as a pediatrician in Corbin for 18 years and subsequently spent six years with Appalachian Regional Health Care.

Just eight months after he came on board at the health department, his role expanded drastically. "On 9/11, we were asked how many burn beds we had available in Kentucky because they felt they would be flying burn victims to us," he said. "We had never had funding to establish the ability to actually track the beds available. Public health did not have a role to play in critical health care. But they called on public health that day."

Three weeks later, suspicious white powder started appearing in the mail, and public health offices nationwide were called again. Though anthrax spores were not found in Kentucky, envelopes containing white powder were, and they needed to be tested by public-health officials.

Dr. Rice Leach, then the commissioner, asked Hacker to establish the Public Health Preparedness Branch of the Division of Epidemiology and Health Planning, marking a major shift for the department. Traditionally, public health had not been involved in incident management, which occurs when first responders are sent in to handle a crisis. "We were the backup to deal with consequence management," Hacker said. "But when you're dealing with bioterrorism, public health needs to step in. There was a lot of learning that went on between law enforcement, emergency medical services and public health. That was a cultural shift. We were forced through the natural evolution of events to step up to the plate."

In 2004, following Leach's retirement, Republican Gov. Ernie Fletcher named Hacker commissioner. He established the Kentucky Outreach and Information Network, which expanded the department's ability to reach vulnerable populations like senior citizens and people with language, hearing or motor difficulties. Partnerships are still in place with other state agencies, Family Resource Youth Service Centers, literacy programs and faith-based organizations such as the Christian Appalachian Project. "We'd say, 'Here's the message we need to get out, whether we were talking about a hot weather advisory or how long is it safe to eat food out of your refrigerator if your electricity is out," he said.

In 2005, Hurricane Katrina struck New Orleans, prompting several thousand people to come to Kentucky. "We had to figure out how to take care of these people without any resources and many times without any family connections," Hacker said. Hurricanes Gustav and Ike followed, presenting similar challenges.

The next major disaster was the 2009 ice storm. The role of public health was to provide shelter, which Hacker called "a major challenge." But emergency stockpiles obtained by the Public Health Preparedness Branch proved useful. "We use cots, satellite radios and generators that were supposed to be used for an inflatable hospital," he said. "That provided power in Elizabethtown."

Emergency stockpiles were also tapped for items like face masks in 2009-10, when people started getting sick with H1N1. "We responded efficiently because of the training we had been planning for," Hacker said. In 2006, department officials prepared extensively for a bird flu "that is still smoldering," Hacker said, but has never reached the ability to spread quickly from person to person.

In the middle of all this, the state changed governors, but not health commissioners. Democratic Gov. Steve Beshear, who took office in December 2007, appointed a new secretary of the Cabinet for Health and Family Services, but showed confidence in Hacker by keeping him as commissioner of the cabinet's Department of Public Health. "I was prepared for Gov. Beshear to select someone else, but I was very pleased when he gave me the opportunity to continue to serve," Hacker said. Apart from Leach and Dr. Carlos Hernandez, Hacker has served one of the longest terms of any commissioner in the past 40 years.

Beshear told Kentucky Health News in July 2011, "Dr. Hacker’s commitment to public health and education is unassailable, and he provided great leadership and vision for our Department of Public Health. Dr. Hacker built teams, mentored, encouraged and connected organizations and people to achieve better outcomes for Kentuckians’ health. His success is largely driven by his belief in inclusion -- that bringing together many organizations can improve health in Kentucky. Kentucky will miss him."

Beshear's retention of Hacker greatly pleased Al Smith, who had just concluded 33 years as producer and founding host of "Comment on Kentucky" on KET. A former newspaper publisher in London and Western Kentucky, Smith helped Hacker campaign for a comprehensive hospital to serve Corbin and London. "He was ahead of his time, as usual, and we lost the political game," Smith recalled. "Fortunately, his great gifts have been appreciated by the state and other health providers who have kept him in leadership for many years. I hope there will be other opportunities for his influence and service at another time. . . . In or out of public service, Dr. Bill Hacker is a leader who always seeks the best for Kentucky."

Asked his biggest accomplishment, Hacker named two: leaving behind a capable team and establishing the Preparedness Branch, which he said is now deeply embedded. "I have a personal relationship with senior FBI agents that did not exist before," he said. "We have a very close partnership with emergency management officials. And we're close with the Department of Agriculture because of the correlation between animal diseases and human diseases. All those partnerships have positioned Kentucky's government entities to be more responsive."

That responsiveness, however, has a lot to do with funding, which Hacker said is his biggest worry, because public health tends to be invisible. "If you ask, most people think public health just takes care of poor people. We, in fact, take care of all forms of people. It's just we do our jobs well and so it's invisible to those folks unless they need a public health service."

Already, Hacker has dealt with several rounds of budget cuts and is worried that "political leaders and the public don't really understand the impact of what the future may look like" with a less well funded public health system. "It could mean slower response to diseases, slower response to disasters, less cervical cancer screening, less prenatal care. There's a whole host of services being provided but they cost money," he said.

Still, though it's not without concern for the future of the department, Hacker, 64, said it's time to head home. He will continue to live in Lexington. "My wife has some health problems and for 44 years she's made sacrifices to support my career. I think the time has come to reverse the equation," he said. "My decision to leave was a difficult one because I love the mission of public health. But it became clear to me that this was the right time to transition from employment to retirement. I will continue to support the mission of public health in any way I can contribute."

Dr. Steve Davis, longtime deputy commissioner of the department, will take over as interim commissioner Aug. 1. He called Hacker "a good doc and a good man. Simply put, we have been blessed to have him for many years."

Louisville hospital merger could thwart some patients' final wishes

More concerns are being raised about the merger that would put a Catholic hospital group in charge of the University of Louisville's hospital. First, it was the prospect that women getting Caesarean sections would not be able to get their tubes tied at the same time. Now, "A growing chorus of protest from local residents, doctors and others has erupted over the fact that Catholic doctrine could override patients' end-of-life wishes," Laura Ungar and Patrick Howington report for The Courier-Journal.

"While many wealthier patients could simply choose a different hospital, indigent patients have little choice but University Hospital for treatment, including end-of-life care," the reporters note. "That has left some worried about how end-of-life decisions will be affected if living wills and decisions to remove a feeding tube, for example, will not be honored if they are 'contrary to Catholic teaching'."

Denver-based Catholic Health Initiatives told the newspaper that advance directives such as living wills would be honored “in the vast majority of cases” but “There may be the rare situation, such as a patient in a persistent vegetative state who is not in the dying process, when what the patient is requesting through his or her advance directive is not consistent with the moral teaching of the Church. In those few cases, a Catholic health care facility would not be able to comply, and with the family's guidance, the patient would be transferred to another facility, or to their home under hospice and family care.” (Read more)