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."

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Federal supervision of Oakwood mental-health facility ends

The federal supervision of Oakwood, the long-beleaguered Somerset facility for the mentally disabled, is no longer necessary and will end, officials announced yesterday.

The move means the Kentucky Cabinet for Health and Family Services and the U.S. Department of Justice will lift a 2006 settlement agreement, which stemmed from a Justice Department investigation into civil rights complaints.

"The lifting of the agreement reflects the tremendous amount of progress made at Oakwood in recent years," Gov. Steve Beshear said. "This is a true credit to the combine efforts of cabinet staff and others to improve the care provided to these residents."

Oakwood has 112 residents and is the state's largest home for people with mental disabilities. The Bluegrass Mental Health-Mental Retardation Board has a contract with the state to manage and operate the facility as well as provide community-based mental health, mental retardation/development disabilities and substance abuse services. The group took over in 2006.

"We cleaned up things, we created an infrastructure, we brought sound business management policies and technology, and we appreciated the good staff we inherited while moving out those who were problematic," Bluegrass CEO Shannon Ware told Beth Musgrave of the Lexington Herald-Leader.

The settlement was lifted by the U.S. District Court for the Eastern District of Kentucky Sept. 29. (Read more)