Call to Order and Roll Call
The seventh meeting of the Interim Joint Committee on Health and Welfare was held on Wednesday, December 16, 2015, at 1:00 p.m., in Room 129 of the Capitol Annex. Senator Julie Raque Adams, Co-Chair, called the meeting to order at 1:05 p.m., and the secretary called the roll.
Present were:
Members: Senator Julie Raque Adams, Co-Chair; Representative Tom Burch, Co-Chair; Senators Ralph Alvarado, Danny Carroll, Julian M. Carroll, Denise Harper Angel, and Jimmy Higdon; Representatives Robert Benvenuti III, George Brown, Jr., Bob M. DeWeese, Joni L. Jenkins, Mary Lou Marzian, Reginald Meeks, Phil Moffett, Tim Moore, Darryl T. Owens, Ruth Ann Palumbo, David Watkins, Russell Webber, and Addia Wuchner.
Guests: Vickie Yates Brown Glisson, Secretary, Cabinet for Health and Family Services; Kevin T. Kavanagh, MD, MS, Board Chairman, Health Watch USA; Ramona Johnson, Bridgehaven Mental Health Services; Whitney Jones, M.D. and Founder, Kentucky Cancer Foundation and Colon Cancer Prevention Project; Kendra Lyman; Nick Mulnar; Dee Robinson, Activist; William Myers, JD, MBA, Executive Director of CASA of the River Region; Patti Mayhew, CASA volunteer, CASA of the Heartland; The Honorable Retired Judge Todd Walton; Louis Kelly, Kentucky Board of Physical Therapy; Diona Mullins, Office of Health Policy, Cabinet for Health and Family Services; Cheryl Lalonde, Kentucky Board of Pharmacy; and Donna Brown, Kentucky Association of Chiropractors.
LRC Staff: DeeAnn Wenk, Ben Payne, Jonathan Scott, Sarah Kidder, Becky Lancaster, Gina Rigsby, and Miranda Deaton.
Minutes
A motion to approve the November 18, 2015 minutes was made by Senator Alvarado, seconded by Representative Jenkins, and approved by voice vote.
Introduction and Welcome
Vickie Yates Brown Glisson, Secretary, Cabinet for Health and Family Services, stated that she is looking forward to working with the General Assembly.
Consideration of Referred Administrative Regulations
The following referred administrative regulations were up for consideration: 201 KAR 2:220 - establishes minimum requirements for the development and maintenance of collaborative care agreements between pharmacist and practitioner; 201 KAR 21:015 - establishes the minimum standards of professional and ethical conduct and practice that a chiropractic licensee shall maintain; 201 KAR 22:020 - regulation establishes the criteria for eligibility, methods, and procedures of qualifying for a credential to practice physical therapy in Kentucky; 201 KAR 22:040 - establishes the requirements and procedures for the renewal and reinstatement of credentials by the Board of Physical Therapy; 201 KAR 22:070 - establishes the requirements a foreign-educated physical therapist shall satisfy to become credentialed in the state of Kentucky; 201 KAR 25:011 - establishes the procedures to be followed in obtaining an application, the fees to be charged, and the procedures relating to the examination and issuance of a license to practice podiatry in this state; 201 KAR 25:021 - establishes an annual license renewal fee and a delinquent penalty fee for all licensed podiatrists; 201 KAR 25:031 - establishes continuing education related to the use of the Kentucky All-Schedule Prescription Electronic Reporting System (KASPER); 201 KAR 26:121 - establishes the required scope of practice for licensed psychologists who hold the health service provider designation, licensed psychologists, certified psychologists, certified psychologists with autonomous functioning, licensed psychological associates, and licensed psychological practitioners and provides guidance about scope of practice for license holders of the board who also hold mental health credentials from another regulatory board; 201 KAR 26:175 - establishes the continuing education requirements for renewal of a license by the Kentucky Board of Examiners of Psychology; 201 KAR 26:200 - defines terms as they relate to licensed psychologists; 201 KAR 32:025 - establishes the requirements for marriage and family therapist associates; 201 KAR 32:035 - establishes the supervision requirements for marriage and family therapy associates and their board-approved supervisors; 201 KAR 32:045 - establishes the process for taking the written examination by the Board of Licensure for Marriage and Family Therapists; 201 KAR 32:060 - delineates the requirements for continuing education and prescribes methods and standards for the accreditation of continuing education courses for a marriage and family therapist and associate; 900 KAR 6:055 - establishes the forms necessary for the orderly administration of the Certificate of Need Program; 900 KAR 6:075 - establishes the requirements necessary for consideration for nonsubstantive review of applications for the orderly administration of the Certificate of Need Program; 900 KAR 6:090 - establishes the requirements for filing, hearing, and show cause hearings necessary for the orderly administration of the Certificate of Need Program; and 910 KAR 1:240 - establishes the certification process for assisted-living communities. A motion to approve all the administrative regulations was made by Senator Carroll, seconded by Representative Jenkins, and approved by voice vote.
Hospital Acquired Infections
Kevin Kavanagh, M.D. stated that antibiotic resistant bacteria is reaching epidemic level. The warnings were made as early as 1992, but were largely ignored. MRSA has reached epidemic proportions in the United States. Approximately 44 percent of staph cultures are MRSA. Kentucky resides in a region where 62 percent of staph cultures are resistant to methicillin and has the second highest rate of MRSA bacteremia in the United States. Kentucky’s rate is twice as high as 14 other states in the nation. In England, the MRSA epidemic was on a larger scale but was still able to be reversed using interventions that included screening and isolation. Other organisms like the virtually untreatable bacteria CRE are also emerging. Europe knew about the CRE epidemic two years before the United States. The United States does not have an adequate reporting system. Approximately 4,500 cases of CRE were reported in the United States. Overutilization of antibiotics has caused Kentucky to have the highest rate of CRE in the United States. No single facility can solve this problem or even prevent infections within a facility. The state health department and public health authorities are key in coordinating education and ensuring accurate reporting. All facilities are at risk of an outbreak. There have between 1.6 million to 3.8 million healthcare associated infections in nursing homes. Kentucky was one of the first states to enact a coordinated healthcare system approach to the problem and require reporting of a wide range of multi-resistant drug organisms.
Mental Health
Ramona Johnson, Bridgehaven Mental Health Services, stated that Bridgehaven has served adults with severe mental illness since 1958. The facility offers rehabilitation, recovery, and community integration for adults with severe and persistent mental illness in a community-based, non-residential program. Services include individualized, person-centered planning, group and individual therapy, dual diagnosis programs, art therapy, pet therapy, integrated health clinic, computer skills, independent living skills, illness management and recovery, peer support, Peer Empowerment Path, cognitive enhancement therapy, a welcoming support system encouraging growth and independence, and a mental health home where people who receive services call themselves members. Bridgehaven has achieved an 85 percent reduction in psychiatric hospitalization saving almost $2 million a year in treatment costs, 93 percent in recovery goals, 71 percent improvement in quality of life, 75 percent of members that live independently after leaving the facility, 100 percent reduction in incarceration, and 71 percent of formerly homeless members remain in housing for at least six months.
Senator Adams stated that there is no stigma for patients at Bridgehaven.
In response to a question by Representation Marzian, Ms. Johnson stated that approximately 60 to 75 people have been referred to the facility because of Medicaid expansion benefits.
In response to questions by Representative Jenkins, Ms. Johnson stated that there has been a reduction in mental and behavioral health issues because patients are being closely monitored.
Representative Burch stated that there is a need to properly deal with mental health issues.
Colon Cancer Advisory Committee Update
Whitney Jones, M.D. and Founder, Kentucky Cancer Foundation and Colon Cancer Prevention Project, stated that in 2001, Kentucky had the highest colorectal cancer (CRC) incidence rate and the second to the lowest CRC screening rate in the United States. The General Assembly provides funding for the Kentucky Cancer Program and the Kentucky Cancer Registry and the Kentucky Colon Cancer Advisory Committee. Preventative screenings lowered the CRC incidences. In 2022, Kentucky initiated a statewide effort to reduce the burden of CRC in the Commonwealth that included more than 60 separate public and private agencies and organizations working together in a truly coordinated and collaborative way. Since 2002, the CRC screening rate in Kentucky increased from just over 34.7 percent of the eligible population to 65.7 percent. There was been a 25 percent reduction in CRC incidence and 30 percent decrease in CRC mortality. No other state in the United States has experienced such a dramatic change in CRC screening in such a short period of time. This could not have happened without the support of the Kentucky General Assembly. The downside is that one-third of eligible Kentuckians have never been screened for CRC because of fewer resources and less education. To reach this vulnerable population, new innovative and culturally sensitive approaches will need to be implemented. No other state has private partnerships that help cover screenings for underinsured individuals. A couple of barriers for someone being able to get a screening are deductibles and transportation.
Kendra Lyman and Nick Mulnar stressed that both of them received early screening and were able to prevent colon cancer.
Animal and Human Rights
Dee Robinson, Activist, stated that Animal/Human Abuse Syndrome or The Link is a powerful connection between interpersonal violence and domestic pet cruelty. In 2016, the FBI announced that animal abusers in federal cases will be considered Class A felons that include arsonists and murders. It is time for Kentucky to enact tougher animal abuse legislation. Animal crime is often the most visible sign that children, the elderly, or partners may also be in danger of unmitigated violence or extreme neglect. Batterers who commit pet abuse have higher rates of sexual violence, marital rape, emotional violence, and stalking than non-abusers. In addition, pet abusing batterers use more controlling behaviors like male privilege, isolation, blaming, intimidation, threats, and economic abuse. Until now, the focus of proposed animal abuse legislation in Kentucky has been for the sole purpose of protecting animals, however people should be a priority in our society. Previously filed domestic pet protection bills failed because there was not a strong enough case linking the welfare of people to the welfare of pets.
One out of every three women in Kentucky will be victims of domestic violence, and 85 percent of all women who escape physical abuse in their homes and seek shelter report that there was ongoing animal abuse before they left. Recent studies find nearly 70 percent of victims either stay to protect pets from an abuser or witness their pet being hurt before the abuse turns on them. Seventy percent of pet abusers have criminal records in all areas, not just domestic abuse. Animal abusers are five times more likely to commit violent crimes against people.
KRS 525.135, the torture bill, should be changed to make four first time offenses Class D felonies: (1) Gross and deliberate neglect including deprivation of food and water, lack of shelter that protects the animal from extreme temperatures and deprivation of needed medical attention that causes trauma associated with death or near death to a cat or dog; (2) Extreme torture or deliberate physical abuse that results in the death or near death of a cat or dog; (3) Sexual assault of an animal; and (4) Dog fighting which includes owning, possessing, keeping, breeding, training, selling, or stealing or otherwise transferring a dog for the purpose of that animal or its offspring being used for bait or fighting for please or profit and attending and watching or participating in a dog fight. Also needed is cross-training and cross-reporting among law enforcement officers, humane investigators, veterinarians, health professionals, domestic violence advocates and child protection workers; training and continuing education about The Link for judges and prosecutors; inclusion of animal-focused violence in standard assessments and intake forms for child protective services, mental health and domestic violence workers; community partnerships to respond to family violence and educate the public about taking all acts of violence seriously; and an animal abusers registry for convicted felons of domestic pet abuse. Animal abusers put everyone at risk, and the law needs to be changed to protect all Kentuckians.
CASA – Court Appointed Special Advocates
William Myers, JD, MBA, Executive Director of CASA of the River Region, stated that currently CASA is active in 43 Kentucky counties. In 2014, 932 CASA volunteers worked on active cases. To date, 3,577 children have been served. According to total substantiated abuse and neglect number per the Department for Community Based Services (DCBS) and the Administrative Office of the Courts 2014 data, over 17,000 children went unserved by CASA. Over 21,000 child victims of substantiated abuse and neglect are involved in the Family Court System. Children are served by 19 independent 501c(3) programs funded by private donors, federal, state, and private foundation grants. PCAK reported that between 2010 and 2014, there was an increase of 22.9 percent in the number of reports that met criteria for investigation.
CASA volunteers are dedicated community members that are required to take 30 hours of initial training plus 12 hours of continuing education. A CASA volunteer has one case to focus completely on the children involved. The CASA volunteer visits the child, ensure proper care, and provide a report to the judge. Programs and CASA volunteers adhere to Quality Assurance Standards by the National CASA Association and supported by the Kentucky CASA network. CASA is regulated by the Kentucky Revised Statutes.
The Honorable Todd Walton, retired Family Court Judge, stated that CASA programs have been available to courts presiding over child dependency, neglect, and abuse cases since July 1990. In November 1995, a CASA program was established for Bracken, Fleming, and Mason Counties that provides a district court judge trained community volunteers to advocate on behalf of dependent, neglected, and abused children. The CASA volunteer speaks on behalf of the child who is too young, too afraid, too injured, too sick, or too helpless to speak for themselves. The CASA volunteer is not a child’s lawyer or social worker but a direct link to the judge. The law empowers and requires CASA volunteers to gain access to all information pertaining to the child and make recommendations to the judge that are in the best interest of the child. Child dependency, neglect, and abuse cases are complicated, difficult, numerous, time-consuming, resource consuming, and perhaps the very most important cases a district judge or family court judge will decide. The efforts of the CASA volunteer on behalf of the child enables the judge to make a decision based upon all the available facts. A CASA program assists the court in an orderly and positive way in making timely decisions. Consequently, the child is protected, family preservation or family reunification efforts can proceed, or alternatively, the termination of parental rights and adoption. The value of a CASA program is immeasurable.
Patti Mayhew, CASA volunteer, CASA of the Heartland, stated that in 2014, CASA of the Heartland in Hardin County worked with only 119 of the 481 dependency, abused, and neglected children in Hardin County’s court system. With the number and complexity of cases, the Cabinet for Health and Family Services (CHFS) and the social workers are often overwhelmed by the need in communities. In addition to being working with Family Court judges, CASA volunteers complement and collaborate with the CHFS and social workers to help provide an additional layer of support for children and families. CASA volunteers share knowledge of and connect children and families with targeted services and opportunities that can help change generational cycles of child abuse and neglect. A CASA volunteer can make a huge impact on the future of our most at-risk children. There is a need to increase capacity in current programs and build more programs in Kentucky to serve more children at an earlier age. The children are crying for love, care, and support, and it is our obligation to listen.
Representative Wuchner stated that CASA is not funded in the state budget. Consistency in a child’s life is important, because no child should not have hope.
Representative Moore stated that CASA provides children support and advocate while in the custody of the cabinet and beyond.
In response to questions by Representative Burch, Judge Walton stated that the qualifications for becoming a CASA volunteer are 21 years of age or older, be willing to complete necessary background checks, provide references and participate in an interview. complete a minimum of 30 hours of pre-service training, be available for court appearances, with advance notice, and be willing to commit to the CASA program until your first case is closed. It is not always in the best interest of the child to open hearings to the public, especially sexual and physical abuse cases.
In response to questions by Representative Meeks, Mr. Meyers stated that in addition to the requirements already stated, a CASA volunteer is sworn in by a judge. The number to call about specific CASA information in Jefferson County is 502-595-4911.
In response to a question by Senator Danny Carroll, Mr. Meyers stated that regional child advocate centers are located across the Commonwealth. Judge Walton stated that child advocate centers are different from CASA and causes some confusion between the two.
Adjournment
There being no further business, the meeting was adjourned at 2:45 p.m.