Call to Order and Roll Call
The 6th meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, November 17, 2010, at 1:00 PM, in Room 129 of the Capitol Annex. Representative Tom Burch, Co-Chair, called the meeting to order at 1:09 p.m., and the secretary called the roll.
Present were:
Members: Representative Tom Burch, Co-Chair; Senators Julian M. Carroll, Perry B. Clark, Denise Harper Angel, Joey Pendleton, Katie Kratz Stine, and Jack Westwood; Representatives Bob M. DeWeese, Brent Housman, Ruth Ann Palumbo, Susan Westrom, and Addia Wuchner.
Guests: Ben Keeton, Executive Director, Kentucky BioAlliance; Hugh Haydon, CEO, Kentucky BioProcessing; Steve Gailar, President, MetaCyte Business Lab; Gilda Hill, Executive Director, Thompson Hood Veterans Nursing Home; Therese Sirles, Director, Office of Child Advocacy, Norton Kosair Children's Hospital Foundation; Dr. Erin Frazier, University of Louisville Hospital; Andrew Hysell, Associate Vice President Policy and Advocacy, Save the Children; Lacey McNary, Deputy Director, and Andrea Plummer, Policy Analyst, Kentucky Youth Advocates; Dr. Stephen Church, President, Kentucky Chapter of the American Academy of Pediatrics; Mark J. Royse, Executive Director, AVOL (AIDS Volunteers, Inc.); Mary Bishop, HIV/AIDS Clinical Pharmacist, Wings Clinic, Division of Infectious Diseases, Department of Internal Medicine, University of Louisville; Lou Kurtz, Acting Division Director, and Michelle Blevins, Assistant Division Director, Division of Behavioral Health, Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services; Jodi Mitchell, Kentucky Voices for Health; Kraig Humbaugh, Department for Public Health, Cabinet for Health and Family Services; Eric Clark, Kentucky Association of Health Care Facilities; and Mary York, 124 Chapter of the AAD.
LRC Staff: Miriam Fordham, Ben Payne, Jonathan Scott, Gina Rigsby, and Cindy Smith.
Approval of the Minutes
A motion to approve the minutes of the October 20, 2010, meeting was made by Representative Housman, seconded by Representative DeWeese, and approved by voice vote.
Resolution
A motion to approve a resolution honoring the life of James D. Denton, was made by Representative Wuchner, seconded by Senator Pendleton, and approved by voice vote.
Consideration of Referred Administrative Regulations
The following referred administrative regulations were on the agenda for consideration: 201 KAR 22:020 – establishes the eligibility and application procedures for physical therapists and physical therapist assistants; 201 KAR 22:053 – establishes the code of ethical standards and standards of practice for Physical Therapists and Physical Therapists Assistants; 921 KAR 2:040 & E – establishes the procedures used to determine initial and continuing eligibility for public assistance programs, Kentucky Transitional Assistance Program (K-TAP), and State Supplemental Program for persons who are aged, blind, or have a disability; and 921 KAR 3:030 & E – establishes the application and the voter registration processes used by the Cabinet for Health and Family Services in the administration of the Supplemental Nutrition Assistance Program (SNAP). A motion to accept the administrative regulations was made by Representative DeWeese, seconded by Senator Harper Angel, and accepted by voice vote.
Legislative Hearing on the Community Mental Health Services Block Grant
Lou Kurtz, Acting Division Director, and Michelle Blevins, Assistant Division Director, Division of Behavioral Health, Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services, gave an overview of the block grant. A motion to accept the block grant was made by Representative DeWeese, seconded by Senator Clark, and accepted by voice vote.
Biotech in Kentucky
Ben Keeton, Executive Director, Kentucky BioAlliance, stated that biotechnology is technology based on biology, especially when used in agriculture, food science, medicine, and medical devices, any technological application that uses biological systems, living organisms, or derivatives thereof, to make or modify products or processes for specific use. The industry provides high-tech, high-paying jobs for Kentucky citizens. Hugh Haydon, CEO, Kentucky BioProcessing (KPB), stated that KBP is a service provider to the biotechnology industry specializing in plant made proteins. The company started in April 2006. Biotechnology for his company is the altering of normal gene expression in an organism by using recombinant DNA techniques. Since the company started, it has created 62 new jobs; employed seven doctoral scientists; has four separate new startup companies; received $3 million in Helmsley Charitable funding for an endowed research position; has a broad patent and IP portfolio; has built a $15 million building expansion; and has brought in over $40 million to Kentucky. Steve Gailar, President and CEO, MetaCyte Business Lab, stated that MetaCyte was founded in 2002 by Jewish Hospital HealthCare Services, Inc., Norton Healthcare, Inc., University of Louisville Health Care, and the University of Louisville and is a health and life science incubator. Since 2002, MetaCyte staff has secured more than $20 million in funding for its portfolio companies; created in excess of 40 high paying jobs; and facilitated the return of more than $12 million to the universities for additional research. MetaCyte is now operating as a for-profit subsidiary of the University of Louisville Foundation. In partnership with the inventor and co-founder, MetaCyte creates, launches, and manages portfolio companies, acquiring an equity position in each. By avoiding a fee-for-service model, capital is freed up and directed to company growth. The MetaCyte team provides invaluable knowledge in areas critical to health science industry development, including research and development, business development, venture capital, biomedical engineering, marketing, finance, public relations, pharmaceutical industry management, entrepreneurship, business and intellectual property law, and accounting. Challenges for the biotechnology industry include workforce development, capital, regulatory issues, and infrastructure.
In response to a question by Representative Burch, Mr. Gailar stated that in his opinion, America is ahead of other biotechnology companies worldwide. One concern is to not overburden the regulatory system.
Thomson Hood Veterans Nursing Home
Gilda Hill, Executive Director, Thomson Hood Veterans Nursing Home, stated that the center is a 285 bed facility located in Wilmore with an average of 260 residents. Eastern Kentucky Veterans Center is a 120 bed facility that opened in Hazard in 2002 with an average of 119 residents. The Western Kentucky Veterans Center is a 120 bed facility that opened in 2002 in Hanson with an average of 117 residents. Services provided to veterans in the facilities include 24-hour medical and nursing care, rehabilitation, nutritional, recreational therapy, social, laundry, transportation, spiritual, computers, and wireless internet access. The staff includes physicians, registered nurses, licensed practical nurses, a physical therapist and assistants, a speech therapist, an occupational therapist, nursing assistants, and support staff. The staff considers it an honor to care for the residents who have given so much for them and this country.
In response to questions by Representative Westrom, Ms. Hill stated that there is not a separate unit that specializes in mental illness and staffing ratios depend on the services needed by individuals. In response to questions by Representative Burch, Ms. Hill stated that the facilities have both state and federal inspections. The facilities receive very few deficiencies and each week the Quality Assurance Committee reviews patient charts to make sure patients are receiving all the services they need.
Pediatric Abuse Head Trauma Pilot Project
Therese Sirles, Director, Office of Child Advocacy, Norton Kosair Children's Hospital Foundation, stated that the passage of House Bill 285 was the catalyst for a pilot program implemented at three Norton Healthcare facilities to provide education to parents of newborns prior to discharge from the hospital about the dangers of shaking a baby. After orienting over 300 post partum and neonatal intensive care nurses to the curriculum for parental education, the program began in June of 2010. The curriculum, Portrait of a Promise, is a DVD developed by a physician that emphasizes that it is never alright to shake a baby. Portrait of a Promise is the educational program of choice for healthcare facilities in New York state and has clinically shown to reduce pediatric abusive head trauma by 47 percent. Following the DVD presentation, nurses converse with parents to reiterate the measures to take when caring for a crying baby. An information brochure is provided to mothers at discharge that has a 24 hour, seven day a week number for parents to call to reach out if support is needed. To date, nurses at the Norton Healthcare facilities have educated families in 3,557 households. In September 2010, the nurse managers and staff of the University of Louisville Hospital’s neonatal intensive care unit started using the curriculum to educate new parents. Baptist Hospital Northeast and Baptist Hospital East plan to implement the program in 2011. Norton Healthcare feels very strongly that continued education is key in the reduction and prevention of child abuse, particularly pediatric abusive head trauma.
In response to a question by Representative Burch, the HANDS program is mentioned in House Bill 285. The goal of the Portrait of a Promise is to have an evidence-based, career-specific curriculum.
Kentucky HIV/AIDS Planning and Advisory Council
Mark J. Royse, Executive Director, AVOL (AIDS Volunteers, Inc.), stated that the Kentucky HIV/AIDS Planning and Advisory Council (KHPAC) is a state and federally mandated committee made up of people from around the state who are infected or affected by HIV/AIDS as well as those who serve those living with HIV/AIDS. The committee of stakeholders provides insight that helps guide the state’s response to community needs. While one new person is infected with HIV every day, the good news is it is 100 percent preventable. The council’s recommendations for preventing the spread of HIV in Kentucky include providing comprehensive, science-based sexuality education in public middle and high schools and holding those schools accountable for delivering the information to students; making HIV education a part of all substance abuse counseling programs in Kentucky and expanding the number of those programs wherever possible; and establishing clear procedures for offering voluntary HIV testing to inmates in the Kentucky prison system.
Mary Bishop, HIV/AIDS Clinical Pharmacist, Wings Clinic, Division of Infectious Diseases, Department of Internal Medicine, University of Louisville, stated that the cost of treating HIV is expensive, but it is more expensive if not treated. The clinic has an average of 20 new patients referred each month, and at least two-thirds of these patients already have AIDS, resulting in higher costs for care. All applicants for initial licensure must receive two hours of HIV/AIDS education approved by the Cabinet for Health and Family Services or the licensing board or certifying body and are only required to receive training at least once every ten years thereafter. The guidelines to treat HIV have been updated yearly since 1995 and ten new drugs have been added in the last ten years. KHPAC recommends that all providers of care to patients with HIV/AIDS or at risk of becoming infected with HIV be required to have relevant, timely, and profession specific education on HIV/AIDS every two years, which is to be facilitated through the individual licensing board or certifying entity pursuant to KRS 214.610. KHPAC also recommends that Continuing Medical Education (CME) courses be flexible to allow for targeting the addressed audience and that the ten-year requirement be reduced. The CME requirements also need to reach generalized and emergency room doctors who do not necessarily work with HIV on a daily basis. KHPAC recommends that the Kentucky Aids Drug Assistance Program (KADAP) be appropriated $2.5 million. The KADAP is a program designed to ensure that low-income persons infected with HIV have access to life-prolonging drugs and meet the program’s eligibility requirements. Currently, there are 1,472 clients enrolled in the KADAP with an average cost of $800 per client per month. Not funding the KADAP is a public health risk as it prevents patients from getting needed therapy to lower their viral load, thus decreasing the risk of spreading the virus.
Childhood Obesity
Andrew Hysell, Associate Vice President Policy and Advocacy, Save the Children, Lacey McNary, Deputy Director, and Andrea Plummer, Policy Analyst, Kentucky Youth Advocates, and Dr. Stephen Church, President, Kentucky Chapter of the American Academy of Pediatrics, recommend monitoring children’s body mass index (BMI). Childhood obesity puts many Kentucky children at risk and decreases overall health and wellness. Kentucky obesity rates are also well above the national averages. Self-reported surveys reveal that Kentucky has the seventh highest rate of adult obesity and the third highest rate of childhood obesity in the nation. At least one out of every three children in Kentucky is considered overweight or obese. The growing epidemic has profound health and economic consequences now and for the future. For children, obesity related health issues negatively affect academic achievement and attendance rates. Overweight children are twice as likely to become overweight adults than children of normal weight and 70 percent of obese adolescents remain obese during adulthood. Kentucky pediatric offices are now seeing children with diseases normally attributed to adults, including Type 2 diabetes, hypertension, heart disease, and arthritis. A 2005 study, A Potential Decline in Life Expectancy in the United States in the 21st Century, published in the New England Journal of Medicine, proposed that high obesity rates may for the first time cause children to have shorter life spans than their parents.
The terms overweight and obese are labels for ranges of weight that are greater than what is considered healthy for a given height. The tool most commonly used for measuring this is body mass index which takes into consideration the ratio of one’s weight to height. For children, the BMI formula includes age and gender to present a more accurate measure of health risks. After the BMI number is calculated, it is plotted on the Centers for Disease Control and Prevention (CDC) BMI-for-age growth charts to produce a BMI percentile ranking. BMI percentiles are used by health care professionals to indicate possible weight problems and associated risks. It is not a diagnostic tool. Both the American Academy of Pediatrics and the CDC recommend using BMI to identify possible weight issues beginning at age two.
The BMI monitoring process as proposed in Kentucky represents the most feasible and low-cost option identified to date. It involves a few steps, many of which are already in place. First, the health care provider would calculate the BMI percentile and plot it on the CDC growth charts. Next, the provider would record the BMI percentile on the child’s Preventative Health Examination form that is required for school entry before kindergarten and sixth grade. A BMI percentile field would have to be added to the current form. The school personnel would enter the BMI percentile into the Kentucky Student Information System (KSIS) Infinite Campus. In the current software, there is already a blank field box for BMI percentile to be input. This information would be accessible by the Kentucky Department of Education. Finally, the Kentucky Department of Education would aggregate the BMI percentiles on the state and local levels and make the data publicly available. BMI monitoring would be low cost for Kentucky. Most of the proposed steps in the BMI monitoring process are already in place in Kentucky. The collection of BMI percentiles by health care providers is one additional step in the Preventative Health Examination process. There are no apparent additional costs to Kentucky to aggregate BMI data using the statewide Infinite Campus database.
In response to questions by Representative Wuchner, Dr. Church replied that doctors already use the Preventative Health Examination forms in their offices. The BMI percentile could be added in the blank field box on the Kentucky Student Information System (KSIS) Infinite Campus database.
In response to questions by Representative DeWeese, the BMI monitoring would be done in a physician’s office. It is recommended that BMI percentiles be done every other year, not just when a student enters kindergarten or sixth grade.