Call to Order and Roll Call
Thefifth meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, October 15, 2014, at 10:00 a.m., in Room 129 of the Capitol Annex. Representative Tom Burch, Co-Chair, called the meeting to order at 10:00 a.m., and the secretary called the roll.
Members:Senator Julie Denton, Co-Chair; Representative Tom Burch, Co-Chair; Senators Joe Bowen, Perry B. Clark, David P. Givens, Denise Harper Angel, Jimmy Higdon, Alice Forgy Kerr, Katie Stine, and Reginald Thomas; Representatives Julie Raque Adams, Robert Benvenuti III, Bob M. DeWeese, Kelly Flood, Joni L. Jenkins, Mary Lou Marzian, Reginald Meeks, Tim Moore, Darryl T. Owens, Russell Webber, and Susan Westrom.
Guest Legislators: Representative Jeff Greer
Guests: Phillip Wimpee, Deputy Sheriff, Meade County, and Stephanie Wimpee; Dr. Nick Kouns, Chairman, Department of Medicine, Clark Regional Medical Center, Winchester, Past Member of the Kentucky Arts Council’s Board of Directors, and Founding Board Member of the Kentucky Conservatory Theater; Heather Hyden, Member, Community Farm Alliance; Michelle Howell, Barren River Health District; Valerie Horn, Letcher County, Appal-TREE Project and Grow Appalachia; Tamara Sandberg, Executive Director, Kentucky Association of Food Banks; Mark La Palme, Sr., Chief Executive Officer, Kevin Horn, Program Manager, Andy Ayers, Operations Director, Isaiah House Inc.; Phyllis Sosa and Victoria Elridge, Department for Aging and Independent Living, Cabinet for Health and Family Services; Eric Clark and Betsy Johnson, Kentucky Association for Health Care Facilities; Diona G. Mullins, Office of Health Policy, Cabinet for Health and Family Services; Julie Brooks and Paula Goff, Department for Public Health, Cabinet for Health and Family Services; Mark R. Brengelman, Hazelrigg and Cox LLP; Bill Doll, Kentucky Medical Association; and Sarah S. Nicholson, Kentucky Hospital Association.
Approval of the Minutes
A motion to adopt the minutes of the September 17, 2014 meeting was made by Representative Marzian, seconded by Representative Jenkins, and adopted by voice vote.
Consideration of Referred Administrative Regulations
The following administrative regulations were available for consideration and placed on the agenda, having been referred to the Committee on September 3, 2014, pursuant to KRS 13A.290(6): 201 KAR 2:030 – establishes conditions, forms, and examination requirements for licensure by reciprocity for out-of-state pharmacists; 201 KAR 2:040 – establishes the standards for training, qualifications, and registration of pharmacist interns; 900 KAR 6:070 – establishes the requirements necessary for the consideration for formal review of applications for the orderly administration of the CON Program; 900 KAR 7:030 – establishes the required data elements, forms, and timetables for submission of data to the cabinet and fines for non-compliance; 902 KAR 30:001 – establishes the definitions for 902 KAR Chapter 30 pertaining to First Steps, Kentucky’s Early Intervention Program; 902 KAR 30:110 – establishes the point of entry and service coordination provisions pertaining to First Steps, Kentucky’s Early Intervention Program; 902 KAR 30:120 - establishes the redetermination of eligibility requirements for First Steps, Kentucky’s Early Intervention Program; 902 KAR 30:130 – establishes the requirements for assessment, the Individualized Family Service Plans used in First Steps, and assistive technology; 902 KAR 30:150 – establishes the provider qualifications for participation in First Steps, Kentucky’s Early Intervention Program; 902 KAR 30:160 – establishes the provisions of covered services under First Steps, Kentucky’s Early Intervention Program; 902 KAR 30:180 – establishes procedural safeguards for facilities participating in First Steps, Kentucky’s Early Intervention System; 902 KAR 30:200 – establishes the provisions relating to early intervention services for which payment shall be made on behalf of eligible recipients; and 910 KAR 1:180 – establishes the standards of operation for a homecare program for elderly persons in Kentucky. A motion to accept all the administrative regulations excluding 900 KAR 6:070 was made by Representative Marzian, seconded by Representative Jenkins, and approved by voice vote.
In response to questions about 900 KAR 6:070 by Senator Givens and Senator Stine, Diona Mullins, Policy Analyst, Office for Health Policy, stated that the administrative regulation was changed to clarify that, in the determination of whether an application is consistent with the State Health Plan, the cabinet shall apply the latest criteria, inventories, and need analysis figures maintained by the cabinet and the version of the State Health Plan in effect at the time of the public notice of the application. When making a final decision following a reconsideration hearing pursuant to KRS 216B.090 or a reconsideration hearing which is held by virtue of a court ruling, the latest criteria, inventories, and need analysis figures maintained by the cabinet and the version of the State Health Plan in effect at the time of the reconsideration decision or decision following a court ruling shall be applied by the cabinet. The amendment was needed to clarify which documents will be used in making a certificate of need (CON) decision regarding consistency with the State Health Plan. The amendment establishes requirements necessary for consideration of formal review of CON applications. The burden of proof is on the applicant. An application can be denied based if any of the five criteria are not met. The administrative regulation was originally amended to award a CON if state plan criteria were met without hearing objections from other entities, but this amendment was removed after comments from interested parties.
A motion to accept 900 KAR 6:070 was made by Representative Marzian, seconded by Representative Jenkins, and accepted by voice vote.
Child Protection Services (CPS): Unannounced Home Visits
Representative Jeff Greer stated that he has great respect for CPS, but changes are needed in the Kentucky Revised Statutes to provide consistent proper procedures for CPS workers to make random unannounced visits be made to the homes of alleged perpetrators. This would prevent perpetrators from hiding abuse in advance of a visit.
Phillip Wimpee, Deputy Sheriff, Meade County, stated that, in 2005, his three minor children were being abused mentally and physically by his ex-wife’s boyfriend. Out of fear of punishment by the boyfriend, his children would secretly beg him for help. A petition was filed for custody stating the children had been abused and neglected. He was granted temporary custody until CPS could conduct an investigation. The CPS worker called ahead to set up an appointment with all people involved. The investigation was conducted several days from the date of the call giving the boyfriend plenty of time to make changes in the household and time to threaten the children into keeping their secrets. The call-ahead system used undermined Mr. Wimpee’s attempt to gain custody of his children over the years. The children were asking him for help, and he was being met with roadblocks at every turn. His oldest daughter was taking anti-depressants, and a son would come to his house with marks on him and afraid to be in a room with the door closed. In April 2010, CPS found a daughter’s accusations of sexual abuse by the boyfriend unsubstantiated. In August 2010, a daughter was admitted to Wellstone for treatment for severe emotional issues. Wellstone reported to CPS that the boyfriend had sexually abused the daughter. The court finally awarded Mr. Wimpee custody of his daughter. The boyfriend was to have no contact with the daughter, and the ex-wife could only have supervised visits with the children. Even with the findings from Wellstone and recommendations of the court regarding the daughter, the judge ruled that custody would remain the same because nothing had happened to a son yet.
Over the years, Mr. Wimpee taught his children to find a safe place to hide if things got bad with the mother and her boyfriend. The son was more worried that something would happen to his mother, and he wanted to protect her. The son turned 13 years old on November 11, 2013. On November 15, 2013, just before the son was to board a school bus, the boyfriend shot and killed Mr. Wimpee’s ex-wife and the son, and he then called his brother and told him the location of his will. In his last cowardly act, he turned the gun on himself. On April 9, 2014, Mr. Wimpee received a CPS substantiated notification letter that found that the allegations of physical abuse were substantiated.
In response to questions by Senator Denton, Representative Greer stated that there needs to be statewide consistency for CPS workers, and periodic surprise visits are needed so abusers cannot prepare children about what to say. Stephanie Wimpee, the children’s aunt, stated that 2013 House Bill 290 established a child fatality and near fatality review panel that would submit an annual report to the Legislative Research Commission starting on December 1, 2014. The Department for Community Based Services tried to adhere to the CPS Standard Operating Procedures (SOP) manual, but there is nothing in the statutes regarding unannounced visits by CPS workers.
In response to questions by Representative Benvenuti, Mr. Wimpee stated that, in August 2010, Wellstone determined that his daughter’s allegations of sexual abuse by her mother’s boyfriend could be substantiated and that she needed to be removed from her mother’s home. His son was murdered in November 2013. Representative Benvenuti questioned if the daughter had been removed from the home, why the son remained in his mother’s home. Ms. Wimpee stated that is an area that needs to be addressed. Representative Benvenuti stated there needs to be statewide consistency in how cases are substantiated.
In response to a question by Representative Burch, Representative Greer stated that the draft legislation needs to be worded carefully to state that random home visits be conducted for alleged abusers.
Medical Benefits of Cannabis
Dr. Nick Kouns, Chairman, Department of Medicine, Clark Regional Medical Center, Winchester, Past Member of the Kentucky Arts Council’s Board of Directors, and Founding Board Member of the Kentucky Conservatory Theater, stated that he decided to become a doctor when he was eight years old and his parents could not afford to buy his sister’s medicine. It is tough for families who have to live in poverty and unable to afford the essential things of life, like medicine. Approximately 75 percent of physicians nationwide and 70 percent in the United States support the legalization of medical marijuana. New proven scientific evidence makes changes in how a physician practices and provides care for patients. Approximately 30 states have rational marijuana laws. The American Medical Association is advocating that medical marijuana be reclassified from a Schedule I drug to a lower schedule drug. Lifesaving medicines are expensive.
In response to a question by Senator Clark, Dr. Kouns stated that doctors do not testify more often about the benefits of medical marijuana because it is a crime to prescribe it.
In response to questions by Representative Benvenuti, Dr. Kouns stated that there are studies providing evidence that medical marijuana can be useful to help treat patients. Representative Benvenuti stated that additional clinical studies should be conducted by the Food and Drug Administration (FDA) before any drug is approved.
In response to a question by Senator Bowen, Dr. Kouns stated that he had smoked marijuana. Medical marijuana should be compared to other drugs to see how it would impair someone’s functionality. He personally would not smoke it and drive a car. He has not treated a patient with marijuana abuse.
In response to questions by Representative Moore, Dr. Kouns stated that it is inaccurate to compare marijuana to cigarettes, but marijuana has been proven to be beneficial but smoking tobacco has not been. There are always contradictory studies about the benefits of medical marijuana, and anyone can find a study to prove a theory. Doctors are subjected to random drug testing.
Senator Thomas stated that he would like for information to be provided to the committee on the UK and UofL’s progress with following requirements enacted in 2014 Senate Bill 124.
The Intersection of Farming, Food, Health, and Economic Development
Heather Hyden, Member, Community Farm Alliance, Michelle Howell, Barren River Health District, and Valerie Horn, Letcher County, Appal-TREE Project and Grow Appalachia, stated that the connections between poverty, nutrition, and community economics are becoming increasingly apparent and recognized as such on the local state and federal levels. Sustainable agriculture and local food systems can be a gateway for economic vitality, better health, and the creation of community wealth. Despite Kentucky being a top agricultural state, over 750,000 Kentuckians do not always know where to get their next meal. Approximately one in four of Kentucky’s children lack consistent access to enough food for a healthy, active lifestyle. Thirty-five percent of Kentucky’s food bank clients report having to choose between paying for food or medicine or utilities. America’s Health Rankings Report, ranks Kentucky 45th in the United States for overall health with 1.1 million obese adults and 10 percent of the population living with diabetes. Since 1985, the Community Farm Alliance (CFA) has worked with local and regional food system development in rural, urban, and mountain communities. Through direct action and research, CFA members have proven that local food systems can have a substantial long-term impact for creating jobs, improving health through better nutrition, and alleviating poverty. Effective collaboration, coordination, and community-drive decision making are critical components missing from Kentucky’s food system. Kentucky’s 14-federally funded food and nutrition programs have a collective purchasing power of $1.3 billion with the Supplemental Nutrition Assistance Program (SNAP) being the biggest. However, only .0014 percent of SNAP benefits are spent at farmers’ markets largely due to infrastructure and access barriers.
A grant from the USDA National Institute for Food and Agriculture (NIFA) with a match from the Foundation for a Healthy Kentucky provided an opportunity to build on past efforts to further develop a grassroots based collaborative approach to state food policy, and to build capacity for grassroots’ participation in determining local food system needs and sustainable solutions through: 1) increasing collaboration among stakeholders in the food system, specifically low-income residents and farmers; 2) determining the most effective and appropriate structure for cross sector collaboration with the Kentucky Food Policy Network (KFPN); 3) increasing awareness of local food, farm and nutrition issues; and 4) conducting an assets based assessment of existing food policies and programs. Until the USDA-NIFA Grant, Kentucky had no clear democratic channel for collective input from consumers, farmers, public health professionals, anti-hunger advocates, and others to reach the level of decision makers. The steering committee was integral for facilitation, decision making and serving as a hub by which we connected with communities across sectors, geographies, and social groups. The steering committee evolved into a network of over 15 local and regional food system work groups, issue work groups such as Partnership for a Fit Kentucky Food Access-Farmers Markets, and a central leadership team representing farmers, limited income individuals, non-profit organizations, government agents, and philanthropic groups. Kentuckians want increased coordination, increased involvement by the people who are most affect by food policy, and communities and outreach.
An application for a USDA NIFA Community Food Project Planning Grant will be submitted in November 2014 to continue the facilitation of the Kentucky Food Policy Network (KFPN), analyze existing legislation for implementation and policy gaps, provide financial and resource support for regional collaborative, provide distance technology and broader communications, continued education about the intersection of farming, food, health, and economic development, and host a semi-annual Food Policy Summit.
In response to a question by Senator Higdon, Ms. Hyden stated that individuals should receive SNAP benefits more than once a month so a recipient does not use all the money at the beginning of the month and not have any the rest of the month to buy food.
Hunger Free Kentucky
Tamara Sandberg, Executive Director, Kentucky Association of Food Banks (KAFB), stated that KAFB is a statewide network of seven food banks with 915 agencies operating 1,356 food programs that feed approximately 611,111 Kentuckians yearly. Of the 915 agencies, 52 percent rely entirely on volunteers, and 66 percent are faith-based organizations. The goals for the Farms to Food Banks program are to increase access to healthy food among our struggling neighbors, to pay fair prices that help farmers recoup losses, and reduce the amount of wasted food. The KAFB submitted an application to the Kentucky Department of Agriculture for $640,000 to purchase produce and was awarded $641,443.04 in August that included donations from taxpayers. Approximately $528,343 of the $532,000 of the produce purchase budget spent impacted 365 farmers from 60 counties by increasing their cash flow to $1,314, and distributing 2.9 million pounds of produce to 119 counties.
In response to a question by Representative Burch, Ms. Sandberg stated that one in every four children go to bed each night hungry.
Substance Abuse Addiction Treatment: Isaiah House Inc.
Kevin Horn, Program Manager, stated in 2012 he realized it was impossible to maintain his addictions, and he committed to a long-term residential program. He thanks God for the spiritual awakening and for the opportunity at Isaiah House that has allowed him to attain and maintain a health and productive lifestyle. His drug abuse began in 1995 with marijuana, alcohol, and five milligrams of Lortabs found in his father’s medicine cabinet. By 1998, it had progressed to other drugs with Oxycontin being the drug of choice. He spent $100 to $200 a day for opiates and $15 to $20 on Suboxone. He even sent his ex-wife to a Suboxone clinic to get drugs, because she had a Medicaid card. He realized that it is impossible to use a maintenance drug properly without a complete change of mindset, tools to cope with triggers, and placing a spiritual component of recovery as a priority. In his personal and professions experiences, the real life value of maintenance therapy is a decrease in withdrawal issues and that it possibly curbs deviant behavior. But as far as being some type of miracle drug or actually changing the mindset of an addict, it is not even close. Suboxone was the drug that was extremely efficient, but became the biggest deterrent to his long-term sobriety.
Andy Ayers, Operations Director, stated that initially he liked the way that drugs made him feel, but deeper into his use he needed drugs just to feel normal. He hated himself for not having the will power to stop using drugs and for the misery he put his family through. He tried detoxification, rapid detoxification, naltraxone implants, 30 to 60 day programs, joined the military, and went to both methadone and suboxone clinics. The programs either did not teach the tools needed to stay clean or enabled him to maintain his addiction by replacing one drug with another to help go through withdrawal until the next fix. His family gave him the option of checking into the Isaiah House or go to jail for stealing from them; he chose the Isaiah House. After getting over the sickness of opiate withdrawal, he started seeing counselors that would help him dive into and work on all the core problems that creased the addiction. He learned that it was not a lack of willpower that he could not stay clean, but he had a disease that needed treatment. He was put into a 12 step class called Celebrate Recovery that allowed him to make amends for what he had done and forgive himself. Along with work, class, counsel, and love, he learned the tools that were needed to stay clean and sober after he left Isaiah House. It is possible to fight addiction and win if given the right tools.
Mark La Palme, Sr., Chief Executive Officer, stated that he founded Isaiah House, a treatment center for people who suffer from drug abuse, on August 17, 1999 after being sober for only three months. Addiction affects people spiritually, emotionally, relationally, mentally, physically, and educationally. Isaiah House manages 72 beds for men and 14 beds for women at two locations without any state funds and only seven percent federal funds. His faith in Jesus Christ and practical application of the tools learned at 13 short-term treatment centers, he has been able to stay abstinent and sober for the last 15 years. Since August 1999, over 2,200 people have received treatment. An independent self-report survey of all clients from 2001 to 2009 indicated that 65 percent were still clean and sober after five years and 78 percent had not reoffended. Most current models available for treatment fail because an addict has too many choices. Choices in the hands of an addict are rarely good as most will always choose the path of least resistance. Isaiah House is a model that teaches personal responsibility while bearing one another’s burdens. An addict should pay for a portion of the cost of treatment, because the free treatment reinforces that there are no consequences for an addict’s actions and someone else will take care of them.
Isaiah House has a holistic model for treatment where one center manages the care for a person so that the treatment plan is followed in its entirety thereby eliminating the potential for a weak link. Isaiah House oversees detoxification, medical care, step program, education, psychotherapy, family educational classes, marriage and family therapy, legal, financial, and continuum of care case management. Graduation requires that a person has: 1) completed 30 of 30 group and self studies from a curriculum choice of six core and forty electives; 2) passed the GED or taken the ACT for higher education enrollment; 3) received a driver’s license after it had been suspended; 4) adjudicated and paid-up court issues; and 5) found a home church, pastor, accountability group, accountability partner, apartment or home, a car, and a full-time job within an eight-month timeframe. The recovering addict lives in a residential program and receives a 90-day aftercare model.
One of the tools used at Isaiah House, as opposed to medication-based detoxification or addiction management therapy, is called Neuro-Electric Therapy (NET). NET is in FDA clinical trials and Isaiah House is the only place in the United States that offers it. NET is a non-narcotic and non-invasive where electrodes, powered by a nine-volt battery, are attached to the mastoid bone behind the ear. Approximately $1.5 billion has been spent on Suboxone because it was recommended by experts. Support is needed for treatment programs that offer therapy and holistic, faith-based initiatives like those at Isaiah House.
In response to a question by Representative Moore, Mr. La Palme stated that his addiction began with marijuana. Representative Moore stated that it is important that Isaiah House is a Christ-centered program.
In response to questions by Representative Burch, Mr. Horn stated that he was 10 years on when he started taking oxycontin; Mr. La Palme was 13 years old and started with marijuana; and Mr. Ayers was 13 years old and started with marijuana. Some people have a genetic predisposition to take drugs.
In response to a question by Representative Benvenuti, Mr. Ayers stated that marijuana was the drug that started his drug addiction.
Senator Stine stated that Isaiah House is a long-term, therapeutic approach to overcoming addiction that helps people put shattered lives back together.
There being no further business, the meeting was adjourned at 12:01 p.m.