Federal agency is pressured to re-post online database of doctors' malpractice and disciplinary cases

U.S. Sen. Charles Grassley has joined journalists, academic researchers and consumer groups in calling on the Health Resources and Services Administration to put back online the National Practitioner Data Bank, a database of malpractice and disciplinary cases against doctors.

"In a strongly worded letter, the Iowa Republican, who has led investigations of fraud and waste in government health programs, said the now-removed file 'serves as the backbone in providing transparency for bad-acting health care professionals'," Duff Wilson of The New York Times reports. Grassley gave HRSA, part of the the Department of Health and Human Services, until Oct. 21 to hand over documents and answer a series of questions, ending with "What is your timeline for getting the database up and running again?"

For a PDF of Grassley's letter, click here. Under pressure, the agency has scheduled a conference call on the issue for Thursday, Oct. 13, from 1 to 2 p.m. Eastern Time.

The database "was created in 1986 for hospitals, medical boards, insurers and others to share information so that bad doctors do not slip through cracks in reporting," Wilson writes. The law makes doctors' names confidential, but the database has a Public Use File for researchers and journalists, in which doctors are identified only by numbers.

Some journalists have been able to identify doctors using information from other sources, such as lawsuits. "After a complaint by one doctor identified by The Kansas City Star, the agency threatened the newspaper reporter with a fine, pulled the doctor’s file from its Web site on Sept. 1 and began a review of how to hide the identities better," Wilson reports. "Its actions provoked protests" from the Association of Health Care Journalists, the Society of Professional Journalists, the Reporters Committee for Freedom of the Press and other groups. In a letter, they told HRSA, "Nothing in the Public Use File can be used to identify individuals if reporters or researchers don’t already know for whom they are searching."

Grassley wrote, "It seems disturbing and bizarre that HRSA would attempt to chill a reporter’s First Amendment activity with threats of fines for merely 'republishing' public information from one source and connecting it with public information from another. A journalist’s shoe-leather reporting is no justification for such threats or for HRSA to shut down public access to information that Congress intended to be public."

The Public Use File can be downloaded from the website of Investigative Reporters and Editors, one of the groups, protesting its removal from the HRSA site, but "that file will be more and more out-of-date as the dispute goes on," Wilson notes. She also reports that Robert E. Oshel, associate director for research and disputes in the Division of Practitioner Data Banks, says the agency is misinterpreting the law. (Read more)

High-dose flu shot, which many doctors recommend for those over 65 due to risk of death, is becoming more available

It's time for flu shots, but the annual reminder has a new angle: Fluzone HighDose, a special vaccine designed for people 65 and older, who make up 90 percent of the 23,000 people who die of the flu and its complications.

"The high-dose vaccine for seniors, introduced last year by drug-maker Sanofi Pasteur, is becoming more widely available in the area, and health workers say it’s in high demand," Laura Ungar reports for The Courier-Journal of Louisville.The Jefferson County Health Department "charges $40 for the high-dose shot and $25 for the regular vaccine that is injected." (C-J photo by Bill Luster: Joe Blincoe of Louisville gets one of the new, high-dose shots)

The high-dose vaccine contains four times as much antibody-creating antigen as a regular shot, and it is recommended by Dr. Nancy Stiles, a geriatrician and associate professor of medicine at the University of Kentucky, but the Centers for Disease Control and Prevention "says problems such as pain and swelling at the injection site and headache or muscle aches were reported more frequently after people got the high-dose vaccine," Ungar writes. "At this point, the CDC is not recommending one type over the other," pending a study. "Whichever type of flu shot seniors get, local doctors are also urging them to make sure they have had a pneumonia shot," which is good for at least five years. (Read more)

Monday, Oct. 10 is World Mental Health Day

Oct. 10 is World Mental Health Day, observed with the aim of raising public awareness about mental health issues. On average, Kentuckians report four mentally unhealthy days per month.

Adults in Pike County reported having the most days a month — seven — that they felt stressed, depressed or emotionally unstable. Those in Daviess, Fayette, Henderson, Mason, McCracken and Webster counties reported the lowest number of mentally unhealthy days. County-by-county data can be found by clicking here.

The theme of this year's day, as decided by the World Health Organization, is "Investing in Mental Health," with the purpose of highlighting the funding shortages that exist to treat people with mental health. In Kentucky, mental health has received the same amount of funding in the state budget each year for the past 15 years.

Americans having to travel farther to get trauma treatment as hospitals close

Millions of Americans are farther away from trauma care than they were 20 years ago, with some having to travel more than 30 minutes to get treatment. Experts say getting help within the first hour is crucial.

A study published in the journal Health Affairs found the distance to a trauma center "increased for 69 million people between 2001 and 2007," reports the Daily Yonder, the national online rural journal. The average amount of travel time was 10 minutes. But for 16 million people, the amount of time it took to travel to a trauma center increased by 30 minutes or more.

"The greatest impact from diminished access has been on people in rural communities," as well areas with a high percentage of African-American residents, low-income people and those without health insurance, The Associated Press reported.

Though U.S. Census numbers show cities growing in population while rural areas decline, Kentucky is still considered a largely rural state (see right), ranking 23rd in the country for population density.

The reason for the increased travel times is due to facilities closing. In 1990, there were 1,125 trauma centers in the country. By 2005, nearly 340 of them had closed, in most cases because of financial hardship; they were treating too high a percentage of people who do not have insurance, Daily Yonder reports.

President Obama's recent call to cut Medicare premiums to critical access hospitals, as well as close CAHs that are within 10 miles of each other, would further burden rural areas, said a panel of experts in Lexington Wednesday.

Medical experts say a trauma patient has the highest change at survival if treated within the first hour. "We're not saying that we should build a trauma center on every street corner," said Dr. Renee Hsia, lead researcher on the study. "But we do have evidence that access for certain populations is already pretty bad, and it's getting worse." (Read more)

State officials step up efforts against prescription drug abuse, targeting doctors

By Tara Kaprowy and Al Cross
Kentucky Health News

LEXINGTON — Targeting what Gov. Steve Beshear called "drug dealers in white coats" is the goal of a new effort against prescription drug abuse in Kentucky, which is killing more Kentuckians than traffic accidents.

State Sen. Robin Webb, D-Grayson, speaks after
Stumbo, Beshear and Conway at press conference.

Announced by Beshear, Attorney General Jack Conway and House Speaker Greg Stumbo at a Lexington press conference, the plan is designed to root out doctors with suspicious prescription practices and pass legislation to better track prescriptions.

Most of the effort is aimed at improving and expanding use of the Kentucky All Schedule Prescription Electronic Reporting system, which relatively few physicians use to see if patients are doctor-shopping for painkillers. An advisory board of physicians, dentists, nurses and pharmacists will work with KASPER officials and law-enforcement agencies to define acceptable prescribing practices in different medical disciplines. Suspicious activity would be reported to the respective licensing boards.

In August, Stumbo grilled the Kentucky Board of Medical Licensure about why it wasn't increasing its oversight on doctors since it had asked for the authority to analyze KASPER data. Lloyd Vest, the licensing board's general counsel, said the data were not specific enough. Stumbo said yesterday, “The problem is how you define what over-prescribing is.” That's what the advisory board will do.

Beshear, asked how soon he would expect an enforcement action to result from the process described, he said he would “push them to move very fast." Other boards handle licensing for dentists, nurses and pharmacists.

Beshear said he wants all physicians to be part of KASPER, especially those who prescribe scheduled narcotics such as oxycodone. Asked about the cost to doctors and patients, he said, "Kentucky will absorb whatever cost." When pressed he said, "We'll handle our part of it and I'm sure the medical profession will hold up their end of it."

Conway said only about 25 percent of physicians use KASPER, but many don't prescribe painkillers. He said the system "takes 10 or 15 seconds" to use but should be made more user-friendly. He said there is a special concern about emergency-room physicians because "a lot of people who are shopping for pills are going to emergency rooms."

Beshear said Operation UNITE, a federally funded anti-drug program in Eastern Kentucky, has received a $600,000 grant from the Appalachian Regional Commission to conduct an education program for about 1,000 physicians and drug dispensers about the dangers of prescription drug abuse and the benefits of KASPER.

Stumbo said Oklahoma recently found 80 percent of its drug overdoses were from prescription drugs and Kentucky would find "exactly the same" if it did the same study. "It's not the drug dealers that are killing our kids, it's the drug-dealing doctors," he said.

Conway said he asked a group of Eastern Kentucky students if they had taken a prescription drug for reasons not listed on the pill bottle and 75 to 80 percent raised their hands. He said the same number said prescription drugs are easy to obtain, and none said their parents lock the medicine cabinets at their homes.

Stumbo, a Prestonsburg lawyer who preceded Conway as attorney general, said the trend reports from KASPER have shown pill abuse leveling off in Eastern Kentucky but rising in places outside the region, and gave Marion County and the Jackson Purchase as examples.

Beshear and Conway are running for second terms in the Nov. 8 election, but Stumbo said the effort is non-partisan and Republican Sens. Jimmy Higdon of Lebanon and Robert Stivers of Manchester are also working on it. They did not attend the press conference, but Higdon said in an interview that he will pre-file a bill require pain clinics to be appropriately licensed and run by physicians who pass background checks.

Also invited but not present was Sen. Tom Jensen, R-London, who is exploring the possibility of again introducing a bill that would make pseudoephedrine, the key ingredient for making methamphetamine, available only by prescription. Beshear, who declined to take a position on that, said he is "committed to finding an answer" to the problem but it does not have the sort of consensus that the prescription drug-abuse issue has.

University Hospital is public, not private, so state has say on merger, Conway says

Louisville's University Hospital is a public institution, not a private one, which means the state gets a say about the proposed merger between the hospital, Jewish Hospital & St. Mary's HealthCare and Lexington-based St. Joseph Health System, Attorney General Jack Conway said Wednesday.

Conway said University Medical Center Inc., which runs the hospital, "was established and created and is controlled by the University of Louisville." U of L has long claimed University Hospital is private and refused to hand over records requested by the ACLU of Kentucky and The Courier-Journal. The ruling means the documents pertaining to the merger itself would have to be made public. Because it deals with an open-government issue, that part of Conway's opinion has the force of law unless overturned in court.

"The finding reinforces the earlier positions by Conway and Gov. Steve Beshear that the deal cannot take place without the approval of state government, which owns the hospital property and granted the contract for University Medical Center to operate it," The C-J's Patrick Howington reports. U of L had said the hospital is private because it is run by a corporation. (Read more)

The ruling could affect the merger because of the religious implications. Saint Joseph is owned by Catholic Health Initiatives, which follows Catholic directives that prohibit abortion, sterilization and euthanasia. For more on the merger, click here.

Natl. Rural Health Assn. president, at UK, says rural health cuts won't save money or help communities but will eliminate jobs

Speaking about President Obama's proposed cuts to rural health care Wednesday, Susan Starling was frank about her feelings: "As a CEO of a critical access hospital, I'm very nervous. What do I need to do as a hospital administrator?" she asked Alan Morgan, chief executive officer of the National Rural Health Association.

"If at all possible, invite your legislator into your facility," Morgan replied. "When they see what you're doing for your community, that's what will turn the tide on this."

The conversation was part of the Healthcare Spotlight Series at University of Kentucky Albert B. Chandler Hospital in Lexington and put on by The Health Enterprises Network in partnership with Hall Render. Morgan was the keynote speaker and Starling, CEO of Marcum & Wallace Memorial Hospital in Irvine, moderated the subsequent discussion. They spoke at length about President's Obama's recent call to reduce reimbursement payments for critical-access hospitals as well as eliminate the CAH designation for those within 10 miles of another hospital.

Morgan, whose association has 21,000 members, said there has been discussion about making cuts to rural health facilities for the past year, starting when the Congressional Budget Office released its proposals for potential savings in March and proposed eliminating CAHs. "Once you put something like that on the table, it stays on the table," Morgan said. The Medicare Payment Advisory Commission followed suit, suggesting the same cuts Obama ultimately called for in September.

Morgan said the proposal runs counter to efforts to create jobs, saying closing CAHs and reducing reimbursement — which he said would force many to close — will eliminate far more jobs than it creates. "We have a hard time communicating to policymakers that if the health care system is not the largest employer in a rural community, it's second only to the school system," he said. "Health care is about the economy."

While cuts may be on the table and the health-reform law is not perfect, Morgan said, it does allocate a "tremendous amount of federal resources" to rural health, most in the form of grants and special programs. But Morgan said much remains to be decided about the law. "If someone tells you it's great, they don't know if it's great. If someone tells you it's bad, they don't know that either," he said. "They just don't know yet. Until the regulations come out on most of this we just don't know."

That being said, Morgan does not feel the act will "fix rural America" since "there is no silver bullet." But he pointed to good things about rural health, such as studies showing that rural facilities outperform their urban counterparts in primary care, safety and preventive services. "As a nation, as rural advocates, we need to be proud of what we do when it comes to quality, when it comes to innovation," he said. "What makes rural great is a strong sense of community, which allows you the ability to network . . . to try innovative approaches."

But doing that takes money, Starling and Morgan agreed. "Just by cutting, we're not changing the system," Starling said. "If we close hospitals in rural America, we're not saving money. We're shifting it to urban. It's actually spending more."