The 3rd meeting of the Interim Joint Committee on Health and Welfare was held on Friday, September 5, 2008, at 1:00 PM, at the Marriott’s Griffin Gate Resort, 1800 Newtown Pike, Lexington, Kentucky. Senator Julie Denton, Co-Chair, called the meeting to order 1:05 PM, and the secretary called the roll.
Present were:
Members: Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Charlie Borders, Perry B. Clark, Denise Harper Angel, Alice Forgy Kerr, Joey Pendleton, Dick Roeding, and Johnny Ray Turner; Representatives James R. Comer Jr., Joni L. Jenkins, Mary Lou Marzian, Reginald Meeks, Darryl T. Owens, Ruth Ann Palumbo, Kathy W. Stein, and Addia Wuchner.
Guests: Mike Robinson, Jill Seyfried, Rashmi Adi-Brown, Prevent Child Abuse Kentucky; Shane Salter, CEO, CASA DC; Janie Miller, Secretary, Steve Nunn, Deputy Secretary, Betsy Dunnigan, Acting Deputy Commissioner of the Department for Mental Health, Developmental Disabilities, and Addiction Services, and DaVida Gyr, Director, Division of Facilities Management, Office of Administrative and Technology Services, Cabinet for Health and Family Services; Jim Abbott, Commissioner of Facilities, Finance and Administration Cabinet; Susan G. Zepeda, Ph.D., Executive Director, Foundation for a Healthy Kentucky; Eric Rademacher, Ph.D., Interim Co-Director, Institute for Policy Research, University of Cincinnati; Mary Goodman and Christi Morgan, CPPC; Bill Cooper and Shirley Eldridge, Department for Aging and Independent Living, Cabinet for Health and Family Services; Charlene Greer, Owensboro Medical Health System; June Bell, St. Joseph’s Peace Mission; Michelle Sanborn, Children’s Alliance; Kirk Patton Woosley, Kelly Skerchock, and Stephanie Brammer-Barnes, Elizabeth Caywood, Cabinet for Health and Family Services; Jennifer Larson and Barb Bright, Boyd County Health Department; Kathy Recktenwald, Pediatric Forensic Medicine, University of Louisville; Melanie Tyner, Dr. Susan Pollack and Jessica Fletcher, University of Kentucky; Marelee Underwood, Kentucky Association of Sexual Assault Programs; Joanie Moore, Denise Weider, Debbie Dile, Katie Jessee, Joann Lianekhammy, Audrey Brock, Chris Cordell, and LeeAnn Williams, Department for Community Based Services, Cabinet for Health and Family Services; Lilly Jo Cockrell, Parent Consultant, Green River Area Development District; Anne Joseph, Covering Kentucky Kids and Families; Pam Jenkins, Baptist Healthcare; Mike Weinrauch, Becky Cecil, Gincy Fowler, Diane Glenn, and Gayle F. Bourne, Commission for Children with Special Health Care Needs; Eric T. Clark, Kentucky Association for Health Care Facilities; Vickie Arrowood; Peggy Williams, Majority Floor Leader’s Office; Marsha Hockensmith, Protection and Advocacy; Nathan Goldman, Board of Nursing; Zina Harris and Eder Crenshaw, and Deborah L. Arthur Stone, Jefferson Community Network for Child Safety; Quinetella Weathers; and Sheilia Gowdy.
LRC Staff: DeeAnn Mansfield, CSA; Mike Bossick, Miriam Fordham, Ben Payne, Gina Rigsby, Jonathan Scott, and Cindy Smith.
A motion to approve the minutes of the June 18, 2008 and August 20, 2008 meetings was made by Senator Roeding, seconded by Senator Harper Angel, and approved by voice vote.
The following administrative regulations referred to the committee for consideration: 201 KAR 20:070 & E – establishes the requirements for the licensure of nurses by examination prescribed by the Kentucky Board of Nursing; 902 KAR 55:110 – establishes criteria for reporting prescription data, providing reports to authorized persons, and a waiver for a dispenser who does not have an automated recordkeeping system; 908 KAR 3:050 – establishes the patient cost per day for board, maintenance and treatment at facilities operated by the cabinet; 910 KAR 1:160 – establishes the adult day and Alzheimer’s respite program; 921 KAR 3:030 – establishes the application and the voter registration processes used by the cabinet in the administration of the Food Stamp Program; 922 KAR 1:310 – establishes basic standards for child-placing agencies. After Stephanie Brammer-Barnes, Cabinet for Health and Family Services, explained the agency amendment, a motion to adopt the amendment to 902 KAR 55:110 was made by Senator Roeding, seconded by Representative Owens, and adopted by voice vote. A motion to approve 902 KAR 55:110 as amended was made by Senator Roeding, seconded by Representative Owens, and adopted by voice vote. After Elizabeth Caywood, Cabinet for Health and Family Services, explained the agency amendment, a motion to adopt the amendment to 922 KAR 1:310 was made by Senator Roeding, seconded by Representative Owens, and adopted by voice vote. A motion to approve 922 KAR 1:130 as amended was made by Senator Roeding, seconded by Representative Owens, and adopted by voice vote. A motion to approve 201 KAR 20:070 & E, 908 KAR 3:050, 910 KAR 1:160, and 921 KAR 3:030 was made by Senator Roeding, seconded by Representative Owens, and approved by voice vote.
The Community Mental Health Services Block Grant, Title V Maternal and Child Health Block Grant, Substance Abuse Prevention and Treatment Block Grant, and the Temporary Assistance for Needy Families (TANF) Block Grant were approved.
Representative Burch, Co-Chair, Families and Children Subcommittee, reported that the subcommittee met that morning and heard a presentation by Sandra Brock, the Executive Director of the CHFS Office of the Ombudsman, concerning the findings of the Child Protective Services Complaint Report that was mandated in HJR 137 from the 2007 Regular Session of the General. Patricia Wilson, Commissioner of Department for Community Based Services, discussed the cabinet’s response to the Child Protective Services Complaint Report.
Dr. Ruth Ann Shepherd, Division Director for Maternal and Child Health for the Department for Public Health, discussed the origins, purpose, and function of the Child Fatality Review System. The subcommittee received an update of the First Steps program. Dr. Ruth Ann Shepherd also presented an update of the First Steps program.
Representative Marzian, Co-Chair, Health Issues Subcommittee, reported that the subcommittee met that morning was given an update on the activities of the Department for Public Health by Dr. Steve Davis, Deputy Commissioner. Dr. Davis also discussed the results of the 2007 Kentucky Behavioral Risk Factor Surveillance System Survey which is a phone call survey conducted in conjunction with the Center for Disease Control and Prevention. Betsy Dunnigan, Acting Commissioner, Department for Mental Health, Developmental Disabilities, and Addiction Services, gave a presentation on the new public awareness campaign on suicide prevention called “Let’s Talk”.
Shane Salter, CEO, CASA DC, testified about his and his brother’s experiences through the foster care system. He testified that he and his brother were in several foster homes, and eventually had up to be split up and placed in separate home. This caused him and his brother to become rebellious, even running away at times. His brother felt that he had abandoned him and that he was alone in the world. Mr. Salter said that he finally realized he wanted better for himself and started to turn his life around, but his brother did not. Mr. Salter eventually founded CASA for Children of DC where he spearheads a grass-roots movement comprised of nearly 150 diverse community volunteers advocating for children that have been abused or neglected. The volunteers enhance the decision making ability of judges regarding siblings, youth placed in the child welfare and juvenile justice systems, families engaged in residential drug treatment, youth preparing for adulthood, and others confronting challenges with sexual identity.
Senator Denton asked about his brother. Mr. Salter stated that because he did not feel like he had a stable home life, he is very angry. It has caused him to not be able to establish a home life of his own.
Senator Clark asked if there is any data that tracks children through the foster care system. Mr. Salter said there has been a study conducted that shows an overwhelming number of children lack continuity, and approximately 70 percent of the children leave the system with post traumatic stress syndrome. Senator Clark asked about the percentage of children who end up in jails. Mr. Salter said that 70 percent of the homeless population has been in foster care, and 60 percent in the penal system have been touched by foster care. Children who do not have a support system end up in trouble. Unfortunately, most communities do not know how to handle the problems and help turn things around. Senator Clark stated that it would be better to put assets on the front end instead of the penal system. Mr. Salter said that the child welfare system is territorial or ego-driven. The needs of career professionals are put ahead of children. Social workers and/or nurses cannot do it alone, everyone has to be involved.
Representative Wuchner asked if resources for CASA differ from state to state. Mr. Salter said that the national CASA association would be a good resource to obtain this information.
Representative Meeks asked looking at Kentucky, what is helping or hurting. Mr. Salter stated that even having a Department for Community Based Services and Commission on Children with Special Health Care Needs is incredible. Nationally, states need to ensure stability of placement. Assessments should be conducted to make sure children receive the correct placements. Families need to be helped with problems before it gets so bad that a child has to be placed in foster care. There needs to be sibling group homes to keep siblings together whenever possible. The most important thing is that we treat foster children like we would treat our own children. Representative Meeks stated that efforts have been addressed in past administrations, but have not borne fruit yet. He asked for a status report of these efforts.
Representative Burch asked Mr. Salter what helped him overcome the odds. Mr. Salter stated that he encountered the right people at the right time. He confronted the reality of what happens in foster care, and then realized he wanted better for himself.
Senator Denton asked what needs to be done to assure stability in placements. Mr. Salter stated that we need to match children with the strengths of families, ensure young people’s outcomes by screening providers, meet the mental needs of children, and make sure families have needed resources.
Senator Borders stated that while one goal is to place children as soon as possible, we need to determine if early adoption is the better alternative. Mr. Salter said that there needs to be support, whether financial or whatever, for people who want to adopt American children. Senator Borders asked if faith-based institutions could help spread the word about the need of children to be adopted. Mr. Salter stated that, again, the strengths of families need to be matched with each child.
Representative Owens asked about the difference between kinship care and foster care. He also asked if the agency was aware of children having post traumatic stress syndrome because they were separated from siblings. Mr. Salter said that kinship care builds on strengths of family and helps the child feel like they were not totally abandoned. Technology could be used to help find family members who would be willing to take the children into their homes who would otherwise not know about the child’s needs. Mr. Salter stated that states need to be very careful making cuts in children’s programs. He also stated that the government does not have the same accountability for outcomes as parents. High standards need to be met whenever it is necessary to separate children.
Representative Stein said that no new taxes pledges are hurting Kentucky and asked if he has seen this in other states. Mr. Salter said that he has seen it in other states. He said that most citizens do not make the connection of taxes with outcomes for children, and do not realize that raising taxes would result in a better quality of life for the children.
Senator Roeding stated that the adoption laws in America need to be revamped to make it easier for people who want to adopt. Mr. Salter stated that bureaucracy needs to be removed from the system to make changes.
Senator Borders stated that Kentucky has limited revenue, but funds need to be prioritized better.
An update on the Glasgow Nursing Home was given by Betsy Dunnigan, Acting Deputy Commissioner, Department for Mental Health, Developmental Disabilities, and Addiction Services, DaVida Gyr, Director, Division of Facilities Management, Office of Administrative and Technology Services, Cabinet for Health and Family Services, and Jim Abbott, Commissioner of Facilities, Finance and Administration Cabinet. Ms. Dunnigan stated that the 2008-2010 biennial budget included language that the cabinet shall develop and submit a plan by December 1, 2008, to the Legislative Research Commission, for referral to the appropriate committee, to replace Glasgow State Nursing Facility. If the plan called for the facility to be located elsewhere, before any action to relocate the associated beds and patients could occur, the justification of cost and economic effects on the Glasgow community shall be addressed. The nursing facility is licensed for 100 beds and designated as an Institution for Mental Disease (IMD). An IMD is a hospital, nursing facility, or other institution of more than 16 beds, primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care, and related services.
Currently there are 78 residents at the Glasgow nursing facility. Due to building issues, the cabinet has compressed the number of admissions. The facility is recognized as having expertise in the management of Huntington’s disease by the Huntington’s Disease Society of America. This facility is the only long-term care facility in the state that has received this recognition. The patients at Glasgow Nursing Facility cannot be placed in a regular nursing home environment due to extensive psychiatric medical and behavioral daily needs of the patients. The Finance and Administration Cabinet determined that extensive work to the facility would be required to keep the current facility functioning efficiently, while ensuring applicable building codes are met. The cabinet has spent approximately $1.1 million since the structural discovery to create a temporary habitable and safe place for residents. Permanent repairs to the existing structure would cost $2,250,000, electric upgrades, $1.3 million, and $8,820,000 for HVAC and lighting upgrades. The facility has additional code deficiencies that eventually need to be addressed that would cost several million dollars. The cost to replace the existing structure would be $20,000,000. While the cabinet gave the new construction project prioritization, unfortunately, the project was not approved in the 2008-2010 biennial budget. The cabinet has been advised that the existing structure should be routinely monitored by a structural engineer to verify the continued structural integrity until a new structure can be built and patients transferred.
Representative Comer stated that the facility provides excellent care, and if moved from Glasgow, will have a detrimental impact on the community. He asked who determined the estimated costs of the upgrades to the structure. Mr. Abbott stated consultants were hired to determine the costs. In 25 years, more funds would be needed for upgrades on the facility, but a new facility would not require more funds for 50 years. Representative Comer asked if there is a demand for more beds, and Ms. Dunnigan stated there is a waiting list.
Representative Palumbo asked the current number Huntington’s patients and how many could be at the facility at any given time. Ms. Dunnigan stated that currently there are three patients, but there is no set limit because priority is given to these patients. Representative Palumbo stated that Huntington’s is not a mental illness, but Ms. Dunnigan explained that it goes along with the disease.
Senator Borders asked how many of the 100 beds were filled and how many of those patients were from Glasgow. Ms. Dunnigan stated there are currently 78 patients and the majority lived with 50 miles before being admitted to the facility.
Representative Burch asked if a new facility would have more beds, and Ms. Dunnigan stated it would have 100 beds like the current facility. He asked how prevalent Huntington’s was statewide, and Ms. Dunnigan said she would have to get back to the committee with that information.
Senator Denton asked about the average of patients over the last five years. Ms. Dunnigan stated there was an average of 76 patients over the past four years. Senator Denton asked if there was a need for all 100 beds, and Ms. Dunnigan stated yes.
Susan G. Zepeda, Ph.D., Executive Director, Foundation for a Healthy Kentucky; Eric Rademacher, Ph.D., Interim Co-Director, Institute for Policy Research, University of Cincinnati, gave an overview of the 2008 Kentucky Health Issues Poll. Dr. Zepeda stated that the survey was conducted between January 16, 2008 to February 11, 2008 by the University of Cincinnati Institute for Policy Research and targeted 1,632 adults over 18 years of age within five regions of Kentucky. She gave the following statistics from the survey: 1) 20 percent of adults 18-64 years are uninsured; 2) 28 percent have been without insurance at sometime in the past year; 3) 60 percent are insured through an employer ; 4) 20 percent have public insurance; 5) 97-98 percent believe it is important that Medicaid covers children in low-income families, disabled adults who cannot work, elderly who cannot afford nursing homes, and low-income working parents who cannot get employer-sponsored insurance; 5) 50 percent want an increase in cigarette taxes, 16 percent cut other programs, 11% said increase the state sales tax, 10% increase state income tax in order to cover everyone eligible for Medicaid; 6) 80 percent agree that quality, affordable care is a fundamental human right; 7) 93 percent said want the legislature should work on reducing the number of Kentucky children without health insurance. She said the 2008 Kentucky Health Issues Poll results can be found at www.healthyky.org.
There being no further business, the meeting was adjourned at 2:59 p.m.