www.wvgazettemail.com Health http://www.wvgazettemail.com Gazette archive feed en-us Copyright 2016, Charleston Newspapers, Charleston, WV Newspapers Martinsburg officials grant exception for detox facility http://www.wvgazettemail.com/article/20161207/GZ0115/161209633 GZ0115 http://www.wvgazettemail.com/article/20161207/GZ0115/161209633 Wed, 7 Dec 2016 15:20:59 -0500 The Associated Press By The Associated Press MARTINSBURG - Martinsburg officials have voted to allow the establishment of a proposed detox and crisis center after hours of heated debate.

The Journal reports that the Martinsburg Board of Zoning Appeals voted unanimously Tuesday to grant a special zoning exception for the facility.

Peter J. Callahan, of Callahan Counseling Services in Martinsburg, will run the 24-hour facility as a private business with some state funding. He expects the center to open on Aug. 1. After finishing the detox, the center will help individuals find longer-term solutions.

Those in support of the center argued that solutions for the heroin epidemic are needed in the area, even if the clinic is a stepping stone.

Many also spoke in opposition, citing their fears that it would make nearby residential properties less safe.

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PEIA director says big cuts may happen every year http://www.wvgazettemail.com/article/20161206/GZ0101/161209684 GZ0101 http://www.wvgazettemail.com/article/20161206/GZ0101/161209684 Tue, 6 Dec 2016 17:44:17 -0500 Phil Kabler By Phil Kabler A week after the Public Employees Insurance Agency Finance Board approved about $50 million in benefits cuts for next year for those covered by the health insurance plan, PEIA Executive Director Ted Cheatham told legislators Tuesday that could become the norm.

"We're going to need $50 [million] to $60 million a year, every year, of new funding," Cheatham said of avoiding future cuts in benefits.

He said that's simply a factor of operating a health insurance plan that pays out nearly $1 billion a year in health care claims, while medical and prescription drug costs are increasing at a rate of about 6 percent a year.

For active state employees, premiums need to increase 7 percent in 2017-18 and 9 percent a year afterward to avoid additional cuts to benefits, Cheatham said.

For retirees on Medicare, the increases will be steeper, he said.

Under what is called the Pay-Go plan, about $160 million of active employee premiums are used to subsidize Medicare retiree premiums. However, Cheatham said growth in that subsidy is capped at 3 percent a year, meaning that each year, more premium costs will have to shift to retirees.

Currently, retirees pay about 28 percent of their premium costs, but that will jump to 60 percent over the next three to four years, he said.

"That is where the squeeze is going to happen," Cheatham told the Select Committee on PEIA and Long Term Care.

Adding to the squeeze, Cheatham said the number of retirees covered by PEIA is growing by a net amount of about 2,000 a year, while the number of active employees covered by PEIA is declining by about 500 to 600 people each year, primarily because of the ongoing state government hiring freeze.

Beginning in 2019, Medicare retirees can anticipate premium hikes of about 28 percent a year, Cheatham said.

After a lengthy struggle during the 2016 regular and special session, legislators came up with $66.8 million of new funding for PEIA employer premiums for the current plan year.

That was the first time in years that the state provided new funding for PEIA, Cheatham noted, following years in which PEIA spent down its reserve fund to avoid having to seek additional state revenue.

While Sen. Ed Gaunch, R-Kanawha, noted that constituents call on legislators to "fully fund" PEIA, Cheatham said that's not possible with a requirement in law for an 80-20 ratio of employer to employee premiums.

"The only way I see that you could fully fund PEIA is to provide us with the money we need, and say it's not part of the premium calculation," Cheatham said.

Reach Phil Kabler at philk@wvgazettemail.com, 304 348-1220, or follow @PhilKabler on Twitter.

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West Virginia committee advances MMA rules http://www.wvgazettemail.com/article/20161205/GZ0115/161209779 GZ0115 http://www.wvgazettemail.com/article/20161205/GZ0115/161209779 Mon, 5 Dec 2016 08:48:03 -0500 The Associated Press By The Associated Press CHARLESTON, W.Va. (AP) - A committee of West Virginia lawmakers has advanced new regulations governing professional and amateur boxing and mixed martial arts after adding language to ensure doctors screen contestants for concussions.

The committee has also added language stating that pro boxers and both professional and amateur MMA fighters get blood tests for HIV and hepatitis.

State Athletic Commission Chairman Leon Ramsey told the committee that the regulatory commission has adopted those provisions and the doctors and contestants already have to sign forms about past concussions.

The regulations follow state laws in 2011 legalizing professional MMA and in 2015 legalizing amateur MMA.

They specify safety measures like prohibiting anyone under 18 from state-sanctioned fights and specify licensing fees for professionals.

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PEIA board approves more than $50M in cuts http://www.wvgazettemail.com/article/20161201/GZ0115/161209961 GZ0115 http://www.wvgazettemail.com/article/20161201/GZ0115/161209961 Thu, 1 Dec 2016 16:48:43 -0500 Phil Kabler By Phil Kabler Public Employees Insurance Agency Finance Board members approved more than $50 million in 2017-18 plan benefits cuts for state and public school employees, many non-state public employees, and retirees on Thursday.

That includes about $28 million in benefit cuts for state and public school employees, primarily through higher deductibles and out-of-pocket maximums, totaling about $19.4 million, and mandatory 90-day fills for prescriptions for maintenance drugs for chronic conditions.

Board members representing public employees were critical of the cuts, coming less than six months after the Legislature approved a $43.5 million increase in employers' PEIA premiums, resulting in a $14 million increase in employee premiums.

"We're talking about real changes to this plan, and it pains me," said Josh Sword. "It's sad we're in this predicament."

He added, "Here we are, less than a year after the legislative leadership said they fixed PEIA, and we're taking $50 million away from participants. It's disgusting."

Elaine Harris added, "The election's over. Those who said, 'I've signed off not to do any tax increases,' this is people's survival here."

A key change from the plan proposed in October, based on comments at public hearings around the state, was to enact the 90-day mandatory fills of maintenance drugs, in lieu of higher co-pays for specialty drugs and non-preferred list drugs, and raising prescription drug out-of-pocket maximums.

The 90-day mandatory fill will save about $11 million a year, PEIA executive director Ted Cheatham said, since PEIA will reimburse those prescriptions at mail-order rates.

About 220 of the roughly 550 pharmacies in the state have agreed to fill the 90-day prescriptions, he said.

Richard Stevens, executive director of the West Virginia Pharmacists Association, said small, locally owned pharmacies are not participating because they would lose money filling non-generic 90-day prescriptions for chronic medical conditions.

"Your policy-holders are not going to have access to care," he told the board. "They're going to have to drive 30 to 40 miles to get their prescriptions filled, passing pharmacies along the way."

Cheatham said PEIA opted not to require mail order to fill the 90-day prescriptions in order to keep the business in state.

"What we're saying is, let's keep this in West Virginia," he said.

Stevens called on the Finance Board to investigate Pharmacy Benefits Managers (PBMs), which he said are making massive profits at the expense of consumers and small pharmacies.

At board member Mike Smith's request, the Finance Board agreed to have a board retreat this winter to study PBM issues.

Meanwhile, non-state employees will see 6-percent premium increases, and retirees will have 4-percent premium increases. Those PEIA insurees are not subject to the 80/20 employer-employee premium match required by law for state and public school employees.

Reach Phil Kabler at philk@wvgazettemail.com, 304-348-1220, or follow @PhilKabler on Twitter.

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House OKs bill bolstering medical research, drug approvals http://www.wvgazettemail.com/article/20161130/GZ0113/161139954 GZ0113 http://www.wvgazettemail.com/article/20161130/GZ0113/161139954 Wed, 30 Nov 2016 18:52:46 -0500 By Alan Fram The Associated Press By By Alan Fram The Associated Press WASHINGTON - The House easily approved a sweeping biomedical bill Wednesday that would help drug and medical device companies win swifter government approval of their products, boost disease research and drug-abuse spending and revamp federal mental health programs.

The compromise, which envisions spending $6.3 billion over the next decade, was condemned by consumer groups and some Democrats as a present to drugmakers that promised only paltry spending increases for underfunded federal programs.

But their objections were overwhelmed by an alliance among Republicans, many Democrats and the White House for a 996-page measure that bore wins for both parties. The Senate's expected final approval next week would mark an uncommon episode of cooperation between the GOP-run 114th Congress - which plans to adjourn next week - and President Barack Obama in their dwindling days in office.

The vote was 392-26.

"We are on the cusp of something special, a once-in-a-generation opportunity to transform how we treat disease," said Rep. Fred Upton, R-Mich., chairman of the House Energy and Commerce Committee and an author of the legislation.

Not everyone agreed.

Rep. Rose DeLauro, D-Conn., said that while the bill contained "noble goals that I share," its relaxation of some standards for federal drug approvals was dangerous and "neglects the very people clinical trials are meant to help, that is the patients."

No. 2 Senate Democratic leader Richard Durbin of Illinois said he was "totally underwhelmed" by the bill's extra money, and said its cuts in a disease prevention fund created under Obama's health care law to finance new medical research displayed "a warped sense of justice."

But Democratic hopes - and leverage - for winning more money and consumer protections faded with Republican Donald Trump's presidential election triumph. Senate Majority Leader Mitch McConnell, R-Ky., flatly said his chamber will send the measure to Obama, and Durbin said he expected Senate passage.

The bill includes an additional $4.8 billion over the next 10 years for the National Institutes of Health. The medical research agency spends around $32 billion annually, and supporters complain that spending cuts imposed by Congress and rising research costs mean its budget has eroded in value since the early 2000s.

"A couple billion dollars doesn't go very far in cancer research" over 10 years, said Lisa Plymate, a director of the liberal-leaning National Physicians Alliance.

Much of the NIH money would be for Obama's precision medicine initiative, aimed at tailoring drugs for people's genes and lifestyles, and research on cancer, a focus of Vice President Joe Biden, whose son Beau died of the disease in 2015.

The bill would also sharpen the federal focus on mental health efforts, such as creating new posts for government officials who would coordinate such initiatives. But it has little new money for those programs.

"We didn't get everything we needed," said Rep. Tim Murphy, R-Pa., sponsor of those provisions. "We'll keep pushing that."

The measure included funds and an accelerated Food and Drug Administration approval process for techniques aimed at regenerating cells. McConnell has supported those provisions, but critics have condemned the treatments as ineffective.

The Food and Drug Administration would get $500 million to streamline approval processes for drugs and medical devices. States would get $1 billion over the next two years for preventing and treating abuse of addictive drugs like opioids, a problem that is surging in GOP and Democratic represented communities around the country.

The White House used a conference call with reporters Wednesday to drum up support for the measure by emphasizing its drug-abuse treatment funds.

"The No. 1 thing we can do right now is to make sure we're dedicating resources to expand access to treatment all across the country," said Michael Botticelli, director of the White House's Office of National Drug Control Policy.

Democrats and consumer groups were upset with the bill's streamlining of some Food and Drug Administration processes, including making it easier for companies to win approval for some antibiotic drugs, some medical devices considered breakthroughs and for fresh uses of some existing medicines.

Rep. Frank Pallone of New Jersey, top Democrat on the Energy and Commerce panel, acknowledged Democrats' complaints that it would take future legislation to actually provide the money the bill promises. He said he would pressure Republicans to approve the funds and said of the overall measure, "The benefits outweigh my concerns."

The bill was backed by scores of patient groups and industry organizations including PhRMA, representing leading pharmaceutical firms and AdvaMed, the trade association for device makers.

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Connection to people, purpose important to health, official says http://www.wvgazettemail.com/article/20161130/GZ0115/161139957 GZ0115 http://www.wvgazettemail.com/article/20161130/GZ0115/161139957 Wed, 30 Nov 2016 18:28:24 -0500 Lori Kersey By Lori Kersey Connecting people to each other is the most important thing West Virginia can do to improve its health, one of the state's top health officials said Wednesday.

"We know that people that feel isolated or feel abandoned have worse health care problems," said Dr. Clay Marsh, vice president and executive dean for health sciences at West Virginia University.

Historically, isolation has been a problem for the elderly, but the region's drug epidemic is changing that, he said. With parents incarcerated or absent, more children are "fighting for themselves," Marsh said.

Having resources available for after-school programs for children and for home-visiting programs for seniors is important for their health, he said.

"I think we want to help our elderly population that's getting larger and larger feel more connected and not feel isolated," Marsh said. "We really want to focus on our kids so that we can make sure that we try to intervene before they develop the type of lifelong problems that don't only increase health care costs but really reduce the quality and the lengths of their lives."

Besides connecting people to one other, Marsh said finding people work and education are the three most important factors to the state's health.

Marsh was the keynote speaker Wednesday at a meeting of community leaders and health experts and activists from across the state. More than 160 people attended the day-long West Virginia at the Intersection of Health and Community Conference at the Columbia Gas building, in Charleston.

Marsh said grass-roots community efforts like Try This West Virginia, Sustainable Williamson, the Coalfield Development Corporation and others are the answer to the state's poor health outcomes.

"Community-based efforts that can be supported with a relatively small amount of money, really to me are the answer," Marsh said after his talk. "So the communities are teaching themselves to fish versus waiting for someone to come teach them how to fish, versus somebody fishing for them."

Marsh said the states that spend the most on health care typically have the worst health outcomes. West Virginia spends between 24 and 26 percent of its gross domestic product on health care, Marsh said. Despite that, the state often finds itself on the worst-of lists for health problems.

"It says to me that spending more money probably is not the answer," he said.

Marsh defined health as youth.

"I think health is where your biological age is less than your chronological age," Marsh said.

Relationships play an big role in our health, Marsh said. People who have an obese best friend are more likely to be obese than those with an obese first-degree family member, he said. There's a 60 percent chance you're obese if your best friend is, he said. Those with a close family member who is obese have only a 40 percent chance of being obese, he said.

Eating habits, too, play a big part in health. Eating fewer calories is the one thing that all species can do to live longer lives, he said.

The average American eats up to 150 pounds of sugar in a year, he said.

"It's in everything," Marsh said. "Look at your [nutrition] labels."

The conference was sponsored by the Federal Reserve Banks in Richmond, Virginia and Cleveland, West Virginia University, the Claude Worthington Benedum Foundation, the Kanawha Valley Foundation and the West Virginia Primary Care Association.

Reach Lori Kersey at lori.kersey@wvgazettemail.com, 304-348-1240 or follow @LoriKerseyWV on Twitter.

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Report: Charleston adults have second-highest rate of diabetes http://www.wvgazettemail.com/article/20161130/GZ0115/161139958 GZ0115 http://www.wvgazettemail.com/article/20161130/GZ0115/161139958 Wed, 30 Nov 2016 17:47:24 -0500 Jake Jarvis By Jake Jarvis Charleston had the second highest rate of diabetes in 2015 out of almost 200 communities included in a Gallup-Healthways report released Wednesday.

With 17.6 percent of adults in Charleston having diabetes, only Mobile, Alabama, had a marginally higher rate of 17.7 percent, according to the report.

The community rankings were based on telephone interviews with 246,620 adults from all 50 states and the District of Columbia. Charleston's prevalence of diabetes was slightly higher than all of West Virginia's rate, where 16.1 percent of adults said they have been diagnosed with diabetes at some point in their life.

"This is where family doctors can really impact change for our patients," said Dr. Mary Ann Maurer, an attending physician at the Family Medicine Residency Program at Charleston Area Medical Center. "We really love to work together with our patients. A lot of what we do with our patients ... is trying to meet patients where they are."

Maurer said the prevalence of diabetes is largely due to lifestyle trends in the area including a lack of exercising and poor eating habits.

"We have many, many patients who depend on food pantries for at least part of their weekly food, and [a lot] of the food at food pantries are not great for diabetics," Maurer said. She added that food pantries are vitally important to communities, but can't always provide fresh, healthy food.

About 40 percent of Charleston adults included in the report were also considered obese.

"The prevalence of diabetes and obesity continue to increase dramatically. We have an epidemic on our hands," said Dr. Steve Edelman, the founder and director of Taking Control of Your Diabetes, in the report. "Even more alarming is that only half of people with diabetes are adequately controlling their glucose, a statistic that has not changed in 10 years despite a plethora of new and effective drugs and devices."

The Huntington area, which includes adults living in Ashland, Kentucky, also had a high prevalence of diabetes and obesity. There, 13.6 percent of adults said they had diabetes and 31.8 percent said they were obese.

The Wednesday report expands upon an earlier Gallup-Healthways Well-Being Index, which ranked West Virginians as having one of the worst well-beings of any state. The index looked at five categories to define well-being: purpose, social relationships, financial stability, sense of community and physical health.

West Virginia had the worst physical health of any state, and Charleston had the worst overall well-being of any community.

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More white people are dying than being born in 17 states http://www.wvgazettemail.com/article/20161130/GZ0115/161139960 GZ0115 http://www.wvgazettemail.com/article/20161130/GZ0115/161139960 Wed, 30 Nov 2016 17:02:55 -0500 By Tara Bahrampour The Washington Post By By Tara Bahrampour The Washington Post In West Virginia and 16 other states, more white people are now dying than being born - a major shift that is expected to continue and has significant implications for government policy.

The 17 states - home to 121 million people, or roughly 38 percent of the country's population - had more deaths than births among non-Hispanic whites in 2014, up from just four states a decade earlier, according to research released Tuesday by the University of New Hampshire's Carsey School of Public Policy.

The trend, which cuts across blue and red states and can be found in both urban and rural areas, is expected to expand to more states in the near future, including Vermont, South Carolina, Tennessee and Oregon, the report said.

White "natural decrease" - when births fail to keep up with deaths - is due largely to aging of the baby boom generation and declining white fertility rates, particularly since the Great Recession, the report found.

Nationally, the ratio of non-Hispanic white births to deaths is nearly at par, at 1.04 births for every death. The ratio is much higher for minority groups, particularly among Latinos, whose rate is 5.4 births for every death. The ratio for blacks is 1.94 births for every death, and for Asians, it is 1.75 births.

The influx of immigrants from minority groups, who tend to be in their childbearing years, helps fuel the birthrate.

The findings are particularly trenchant in the wake of an election that was often framed in terms of white Americans feeling threatened by the demographic ascendance of minority groups. While the country is still about two-thirds white, the proportions are shifting. 2011 was the first year in which more minority babies than white ones were born, and demographers expect the country to become majority minority in 2044. (While Hispanics are considered a minority group in the United States, the term "Hispanic" refers to ethnic origin regardless of race.)

Its growing young immigrant population puts the U.S. on a different path than European countries, which are facing a looming crisis due to their aging populations. As aging white Americans rely more on Social Security and Medicare, they are expected to be shored up by the influx of young minorities into the workforce.

"What government and politicians need to pay attention to is that it's the younger part of the population that's going to be contributing to the economy," said Bill Frey, demographer and senior fellow at the Brookings Institution. "All of the growth in the labor force is going to be racial minorities. Investing in this next generation in terms of their education and being able to contribute to the labor force and pay into Social Security, Medicare, etc. is going to be to the benefit of that older white population."

Kenneth Johnson, an author of the study, agreed, but noted that not everyone sees it that way.

"It doesn't necessarily have to be competitive, but boy, the rhetoric of recent times tells me that that's the way it certainly has been," he said.

Despite the rapid shift in the number of states with white natural decrease, the absolute size of the non-Hispanic white population continues to be large in many parts of the U.S. The share of the population that is white has decreased from 79.6 percent in 1980 to 61.9 percent in 2014, according to the report. The share of the nation that is Latino rose from 6.4 percent to 17.3 percent during the same period.

"It is going to be a long time before the white people aren't a very powerful political force," Johnson said.

Still, he said he was struck by the speed and scope of the increase, particularly in large states such as California, Pennsylvania and New Jersey.

Among the seventeen states in the study, all but two, Maine and West Virginia, are still seeing more births overall due to growing non-white populations. The Latino population is particularly young, with a median age of 28.4 in 2014, and Latino births exceeded deaths by a large margin in all states and the District of Columbia that year.

Even so, the immigration rate from Mexico has declined since the recession, and so has the Latino birthrate, factors that could slow the decline of whites as a percentage of the total population in some states.

Along with the aging of the baby boomers, the change is driven largely by a decline in the number of white women of childbearing age, combined with an overall decline in the white fertility rate. Overall the number of white women between 15 and 44 decreased by 4.7 million, or 12 percent, between 2000 and 2014.

The Great Recession also changed the trajectory of the birthrate in the U.S., Johnson said, noting that if it had continued as it was going before the downturn, there would have been around 3.5 million more children in the U.S. now.

It is unclear whether the women who didn't have those babies have simply delayed having them or will never have them - if the latter is true, it could accelerate the rate of white natural decrease, whereas an uptick in births could slow it. Either way, nationwide the number of white deaths is expected to overtake the number of white births by the mid-2020s.

The study also cited an uptick in drug-induced deaths among working-class whites. Such deaths outnumbered motor vehicle accident deaths in 41 states in 2014, compared to 10 states in 2004, and could accelerate the transition from natural increase to natural decrease in some states, the study said.

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Nearly 8,000 WV residents sign up on health marketplace http://www.wvgazettemail.com/article/20161130/GZ0115/161139977 GZ0115 http://www.wvgazettemail.com/article/20161130/GZ0115/161139977 Wed, 30 Nov 2016 12:50:00 -0500 Staff reports By Staff reports In the first month of open enrollment, nearly 8,000 West Virginia residents have signed up for health insurance on the state's health insurance marketplace, according to a press release from the Centers for Medicare and Medicaid.

More than 2.1 million across the country, including 7,876 in West Virginia have signed up for a health care plan on healthcare.gov, according to the release. The number includes both new customers and those renewing their plans.

"With plans available for less than $75 per month in premiums, 2.1 million Americans, including 7,876 in West Virginia, have already selected coverage through HealthCare.gov," Sylvia Burwell, Department of Health and Human Services Secretary, said in the release. "I hear from people across the country just how much coverage matters to them, so I continue to encourage all West Virginians who need health insurance for 2017 to visit HealthCare.gov and check out their options."

Burwell's encouragement to sign up comes even as the future of the Affordable Care Act is in question following the election of President-elect Donald Trump, who has promised to repeal and replace President Barack Obama's signature health care reform law. Trump on Tuesday appointed Rep. Tom Price, R-Ga., an opponent to the health care law, to lead the Department of Health and Human Services. In announcing Price's role, Trump called him "exceptionally qualified to shepherd our commitment to repeal and replace Obamacare and bring affordable and accessible health care to every American," according to The Washington Post.

People have until Dec. 15 to sign up in order for their coverage to start Jan. 1.

In West Virginia, 63 percent of Marketplace enrollees can find plans with a premium of less than $75 per month, according to the release. About 8 out of 10 people nationally who enroll in health coverage through HealthCare.gov qualify for financial help.

For help signing up, call 1-800-318-2596, visit HealthCare.gov or visit https://localhelp.healthcare.gov/ for a list of local enrollment centers and events.

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WVU announces dental center with advanced technology http://www.wvgazettemail.com/article/20161129/GZ0115/161129546 GZ0115 http://www.wvgazettemail.com/article/20161129/GZ0115/161129546 Tue, 29 Nov 2016 09:56:26 -0500 The Associated Press By The Associated Press MORGANTOWN, W.Va. - West Virginia University's School of Dentistry says it will partner with the Center for Research and Education in Technology to design, build and equip a facility in Morgantown with advanced dental technology available from manufacturers.

According to school officials, the so-called Innovation Center will be open to students, faculty and the state's private dentists, about 85 percent of them alumni.

It will be available to fourth-year students and simulate a private practice and contain auxiliary equipment for the most recent restorative techniques and digital imaging.

Similar facilities have been opened at Loma Linda University in California and the University of Missouri-Kansas City.

The dental schools' partner is a national nonprofit consortium of more than 20 dental equipment manufacturers and suppliers providing equipment at no cost.

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Under new legislation, advanced practice nurses signing POST forms http://www.wvgazettemail.com/article/20161128/GZ0115/161129575 GZ0115 http://www.wvgazettemail.com/article/20161128/GZ0115/161129575 Mon, 28 Nov 2016 16:20:08 -0500 Lori Kersey By Lori Kersey A law that allows highly trained nurses in West Virginia to treat patients and prescribe limited amounts of some drugs without supervision from physicians is having an effect in at least one area - end-of-life care.

Since June, when West Virginia House Bill 4334 went into effect, advanced practice registered nurses have been able to, among other things, sign Physicians Orders for Scope of Treatment (POST) documents of their patients. The forms are medical orders outlining what seriously ill patients want from end-of-life care.

In the first three months the law has been in effect, APRNs submitted 14 percent of the POST forms sent to the West Virginia e-Directive Registry, according to Dr. Alvin Moss, director of the West Virginia Center for End-of-Life Care.

"It's so amazing that APRNs jumped in there," Moss said. "It says we have a strong backbone of APRNs who are having these conversations with the patients."

In Oregon, where nurse practitioners have had the authority to sign the forms for 15 years, a six-year study published by the Journal of Palliative Medicine concluded that about 11 percent of the POST forms submitted between 2010 and 2015 were completed by an APRN.

"We've started and caught up with a state a decade ahead of us," Moss said.

POST forms are used for patients with serious illnesses and whose medical providers would not be surprised if they died within the next year. The forms allow patients to choose whether they want CPR in the event they have no pulse, or if they should be administered a feeding tube or IV fluids to be kept alive.

Moss said, according to his research, 92 percent of West Virginians polled say they want to die outside of a hospital, but only 58.5 percent actually do. POST forms make patients' wishes more clear, he said.

Before June 10, only physicians could sign the forms. Patients typically complete the forms after talking with a health care professional in their last two months of life.

For Lori Constantine, an assistant professor at the West Virginia University School of Nursing and a nurse practitioner for WVU Medicine, the fact that APRNs are completing many of the POST forms is no surprise. Constantine sees signing the forms as an extension of what nurses have long done for their patients: listening to them and advocating for their needs and wishes.

"Nurses talk to patients about their illnesses," she said. "They advocate for patients - when they may or may not want treatment. ... This is, to me, an extension of advocating for your patients."

The West Virginia e-Directive Registry, an electronic registry where POST forms, advanced directives and do-not-resuscitate cards are available to health care providers around the state, has more than 10,000 POST forms, Moss said. The registry grows by between 250 and 300 POST forms every month, he said.

"We receive a form about every 30 minutes," Moss said. "And about every 50 minutes, someone is going on the registry and finding a form on the patient they're treating. So it's really being used."

Only West Virginia and one other state - Oregon - have this type of registry, Moss said. West Virginia and 15 other states allow APRNs to sign POST forms.

Signing POST forms was just one aspect of the law. Before it passed, HB 4334 was criticized by physicians who said allowing the hundreds of APRNs in the state the ability to prescribe controlled amounts of some drugs would only worsen the West Virginia's opioid epidemic.

"I'm very happy that West Virginia passed this law," Constantine said. "Because it really takes advantage of nurse's expertise and their medical insight and knowledge and combines them with their communication and caring skills to be able to have very difficult conversations with patients to have a shared decision-making process about how to proceed with care in the event they should need more aggressive care or hospitalization."

While West Virginia often is criticized for other health outcomes, like its high obesity and smoking rates, the e-Directive Registry is an example of something the state does well, Moss said.

"It's one thing that the state is doing that's quality and patient-centered," Moss said.

For more information on POST forms and the Center for End-of-Life Care, visit http://wvendoflife.org.

Reach Lori Kersey at

Lori.Kersey@wvgazettemail.com,

304-348-1240 or follow

@LoriKerseyWV on Twitter.

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Judge awards max to woman, 24, after hysterectomy http://www.wvgazettemail.com/article/20161126/GZ01/161129639 GZ01 http://www.wvgazettemail.com/article/20161126/GZ01/161129639 Sat, 26 Nov 2016 19:24:16 -0500 Kate White By Kate White A federal judge awarded a 24-year-old woman the maximum amount permitted under West Virginia's medical malpractice laws after finding that a Beckley doctor who removed the woman's uterus acted in reckless disregard of her safety.

U. S. District Judge Irene Berger ruled Nov. 15 in favor of Sara Lambert Smith and her husband, Scott Smith, in a lawsuit they filed against the United States. The Smiths sued over the actions of Dr. Roy Wolfe, who is considered a U.S. employee through his job with Access Health Associates, a federally funded health clinic in Beckley.

After a two-day bench trial in July, Berger found that the couple "demonstrated by a preponderance of the evidence that Ms. Smith's injuries were the result of the negligence of Dr. Roy Wolfe, who is deemed an employee of the United States."

"Having carefully considered the damages suffered by the Plaintiffs, and in light of both the Court's experience with jury verdicts in state and federal medical malpractice cases and a review of similar cases, the Court finds that Ms. Smith has suffered damages in excess of the statutory cap," the judge wrote.

The cap on non-economic damages in medical malpractice cases in West Virginia is $643,020. Berger awarded $40,000 of that to Scott Smith, for loss of consortium, and the rest to Sara Smith, who was also awarded about $29,600 in economic damages for medical bills.

"The Court finds that Dr. Wolfe's failure to attempt alternative treatments prior to performing a hysterectomy, on a twenty-four-year-old patient with stable vital signs and no evidence of hemodynamic instability, constitutes a reckless disregard to a risk of harm to the patient," Berger wrote. "Therefore, there is no limitation on economic damages."

Sara Smith's damages include, among other things, Berger wrote, the loss of her fertility, the early menopause and hormonal changes after her hysterectomy, and emotional damages related to the loss of fertility, hormonal changes and marital problems.

The couple was represented by lawyers Arden Curry II, Robert Berthold Jr. and Holly DiCocco. Assistant U.S. attorneys Fred Westfall Jr. and Matthew Lindsay argued on behalf of the federal government. Wolfe could not be reached for comment last week.

Medical malpractice lawsuits filed in federal court are decided by a judge rather than a jury.

Though the case was tried in federal court, West Virginia's laws on medical malpractice cases apply.

The state Medical Malpractice Liability Act requires plaintiffs to demonstrate that defendants failed to meet the applicable standard of care - typically by presenting expert witness testimony. Plaintiffs must also demonstrate that a failure caused the alleged injuries and deprived the patient of a chance of recovery or increased the risk of harm, Berger's order states, among other things.

About five days after giving birth to the couple's child via cesarean section, Sara Smith was taken to Raleigh General Hospital in December for heavy vaginal bleeding.

Sara Smith was admitted into the emergency room a little after 5 a.m. Blood tests showed an elevated white blood cell count and an ultrasound showed possible retained products of conception, the judge wrote.

"Her test results were otherwise normal, and indicative of hemodynamic stability despite her ongoing bleeding," the order states, adding Sara Smith's vital signs were also normal.

Wolfe saw Sara Smith at 6:30 a.m. and scheduled her for a dilation and curettage (D&C) and possible hysterectomy, in an effort to stop the bleeding.

"Though Ms. Smith does not recall the conversation, Dr. Wolfe informed her of the risks of the surgery and the possibility that a hysterectomy would be necessary to stop the bleeding, and she indicated her desire to have additional children and retain her uterus if at all possible," Berger wrote in her order.

Sara Smith signed a consent form for the D&C and possible hysterectomy.

Following the D&C, the bleeding continued and Wolfe decided to convert to a hysterectomy, according to the order.

Wolfe did not attempt "uterine massage, additional uteronics (which promote contraction in different ways), balloon tamponade, open uterine massage, bilateral O'Leary stitches, bilateral hypogastric ligation, B-Lynch sutures, hemostatic multiple square suturing, or transfer [to Charleston Area Medical Center hospital] for uterine artery embolization," Berger wrote.

Besides transfer, the judge added, "these procedures would not have taken more than a few minutes each. Some would have taken only seconds to perform."

"Instead, she underwent a hysterectomy at twenty-four years old, following the birth of her first - and now only - biological child," the judge wrote.

Reach Kate White at

kate.white@wvgazettemail.com,

304-348-1723 or follow

@KateLWhite on Twitter.

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Despite setback, Alzheimer's researchers remain committed http://www.wvgazettemail.com/article/20161125/GZ01/161129693 GZ01 http://www.wvgazettemail.com/article/20161125/GZ01/161129693 Fri, 25 Nov 2016 21:41:53 -0500 By Michelle Fay Cortez, Jared S. Hopkins and James Paton Bloomberg By By Michelle Fay Cortez, Jared S. Hopkins and James Paton Bloomberg Alzheimer's is one of the leading causes of death in the U.S. and the only disease among the top 5 for which there is no treatment. Prospects got even bleaker this week when an Eli Lilly & Co. experimental drug failed.

Still, researchers and investors alike are urging the industry not to give up. And pharmaceutical companies, even those that had pulled out of the search for a treatment in the past, are responding with a renewed commitment - for now.

"This is such a devastating disease, and it's so important for scientists to continue to push through this," said Rita Balice-Gordon, the recently arrived head of neuroscience at Sanofi. "I'm committed to beating the drum for doing well-reasoned and well-researched clinical experiments, which will help drive the field collectively forward."

Alzheimer's research has already consumed more than $3 billion in spending over 27 years at Lilly alone, and the failure of its solanezumab treatment sent shares tumbling Wednesday. Lilly's drug, which is targeting the amyloid protein that builds up in patients' brains, didn't slow their inexorable mental decline, adding to growing evidence that finding a way to treat the leading cause of dementia in the world may be even more herculean than experts expected.

Sanofi's Balice-Gordon is under no illusion about the effort to find a treatment, predicting additional failures are coming for a disease that is already littered with setbacks. The Paris-based company is moving gradually, and perhaps seeking a partner, for a compound in early-stage development. Yet her commitment is particularly apt because Sanofi pulled back from Alzheimer's research a few years ago under former Chief Executive Officer Chris Viehbacher.

Lilly, too, plans to stick with its Alzheimer's research. The Indianapolis-based company has one of the broadest pipelines in the industry, with a half a dozen Alzheimer's drugs in development, said incoming CEO David Ricks.

Biogen Inc., Merck & Co. and Roche Holding AG, which all have late-stage - known as phase 3 - trials, offered similar perspectives, saying they remained confident in their clinical programs and stressing that each therapy is designed to attack the condition in different ways.

"We don't think that it - by itself, one therapeutic - negates the amyloid hypothesis," said Samantha Budd Haeberlein, head of Alzheimer's clinical development at Biogen, which has generated promising early results with its drug, aducanumab. "Disappointing, for sure, but for us it doesn't shake our confidence going forward."

The jury is still out for the amyloid theory, which argues that the accumulation of the sticky protein in the brains of patients with Alzheimer's is actually the root cause of the disease.

"It's absolutely unclear," said Tony Butler, an analyst at Guggenheim Securities who recommends buying Lilly shares. Vamil Divan, an analyst at Credit Suisse, also urged caution. Lilly's solanezumab could possibly be used as a combination therapy, or at a different dosage, he said.

"I wouldn't throw the amyloid hypothesis out on this data," said the analyst, who rates the shares outperform. "We're still making incremental progress."

Studies have shown that removing the amyloid plaques that congregate between the synapses in the brain, the ones used to definitively diagnose Alzheimer's during an autopsy, isn't enough to reverse the disease's mental impairment. Lilly's latest trial was done in patients with a mild form of the disease. While there was a suggestion that patients getting solanezumab may have done better than those given a placebo, the difference wasn't meaningful, and Lilly threw in the towel for that patient group.

One hope may be treating patients at an earlier age, before there are any signs or symptoms of disease. Research shows that amyloid plaque begins building decades before there is evidence of mental impairment, and stopping it then may be the best shot at benefit, said Rudy Tanzi, a professor of neurology at Harvard Medical School and director of the genetics and aging research unit at Massachusetts General Hospital.

"It is simply too late to treat amyloid in mild patients," Tanzi said. "We need to treat pre-symptomatic individuals who are showing greater-than-normal amyloid build-up in their brains," detected perhaps by imaging tests, he said.

Such an approach would require decades of treatment, an expensive and potentially risky endeavor if the therapy has even mild side effects that could emerge, or increase, over time, said Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center in New York.

"You may have to begin at 45 or 55, which would mean decades of exposure to a drug that may or may not be totally safe," Gandy said. "My concern is it's so early it will be difficult to target unless you have a drug that's perfectly safe."

Much is still unknown. There's the question of whether the U.S. Food and Drug Administration would ever allow such a study to be conducted in patients without symptoms, who would need treatment for decades before any benefit emerges. And the question remains of how to test patients to find out which are most likely to develop dementia.

"The net is that all of the ongoing phase 3 programs that attempt to slow the progression of Alzheimer's disease still appear to be very high-risk," Tim Anderson, an analyst with Sanford C. Bernstein in New York, said in a note to clients. "This is why we continue to build no revenues in our forecasts."

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Local health department earns national accreditation http://www.wvgazettemail.com/article/20161124/GZ0115/161129748 GZ0115 http://www.wvgazettemail.com/article/20161124/GZ0115/161129748 Thu, 24 Nov 2016 20:56:00 -0500 Lori Kersey By Lori Kersey The Kanawha-Charleston Health Department is the first health department in West Virginia to get accreditation from a national group, officials announced earlier this week.

The department is also among the first 200 of around 2,800 health departments in the country to achieve national accreditation from the Public Health Accreditation Board, a nonprofit, non-governmental organization that administers the national public health accreditation program.

The program is supported by the U.S. Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation.

The announcement capped a four-year process for the health department's staff, said Dr. Michael Brumage, KCHD's health officer and executive director.

"This is a pretty rigorous process," Brumage said.

The staff had to present paperwork to the accreditation board that proved it met 97 measures and standards in 12 different categories, Brumage said.

Two weeks after Brumage took over as health officer and executive director 15 months ago, the health department got word that the accreditation board had put it on an action plan to improve several of the measures, a process that took months, Brumage said.

Brumage said it's not uncommon for health departments to be put on the action plan - about 40 percent of applicants are, he said.

"We had 11 different measures to address and we did so successfully," Brumage said.

One example of the measures the accreditation board looked for was a system for improving customer service, Brumage said. For that measure, the department submitted a customer service survey that clients get.

"That is one of 97 [measures]," Brumage said. "And for that, there were two documents submitted. For another measure standard we submitted three supporting documents and others that we submitted 10. This is not sort of quick stuff. This takes lot of work and dedication from the staff, which is also responsible for the day-to-day work of the department."

Brumage said being nationally accredited will allow the department to be more competitive when it comes to grants. He likened the accreditation process to a physician becoming board-certified.

"When you go to a physician's office and you know the physician is board-certified, that's a mark of proficiency from the profession," he said.

The closest nationally accredited health departments to Kanawha Charleston are in Columbus, Ohio and Garrett County, Maryland, he said.

"We know there are other health departments in the state that are working on this and we're hopeful we're just the first of many," Brumage said.

Brumage said the accreditation is not an endpoint but a milestone on the journey of continuous quality improvement.

"We do a lot of work every day that may be not as visible as a hospital's work and this kind of accreditation process verifies the work we're doing behind the scenes is valuable and meets accreditation standards," Brumage said.

The health department is planning a formal celebration for its accreditation at the Charleston Civic Center on Dec. 8.

Reach Lori Kersey at

lori.kersey@wvgazettemail.com,

304-348-1240 or follow

@LoriKerseyWV on Twitter.

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Major Alzheimer's drug study fails, but many others still in testing http://www.wvgazettemail.com/article/20161123/GZ01/161129810 GZ01 http://www.wvgazettemail.com/article/20161123/GZ01/161129810 Wed, 23 Nov 2016 14:49:54 -0500 By MARILYNN MARCHIONE The Associated Press By By MARILYNN MARCHIONE The Associated Press Another major Alzheimer's drug study has failed, leaving patients and families wondering if there ever will be a treatment to slow or reverse the most common form of dementia, which afflicts more than 5 million in the United States alone.

Eli Lilly & Co. said Wednesday that solanezumab failed to slow mental decline in people with mild Alzheimer's. The drug is still being tried in two other studies, and at least 18 other drugs are in late-stage testing, including several similar to solanezumab. Dietary therapies, supplements and even a medical device also are being tried.

"There are other approaches that we need to pursue. We need to redouble our efforts," said Maria Carrillo, chief science officer of the Alzheimer's Association.

Some things being tried:

STARTING EARLIER

Solanezumab was tested in people with mild dementia after two previous trials showed it did not help those further along, with moderate Alzheimer's. Many doctors think even the mild stage is too late to try to reverse neurological damage.

Today's news "strengthens my belief that we should be trying this before people have symptoms," said Dr. Reisa Sperling, a neurologist at Brigham and Women's Hospital in Boston.

She is testing whether solanezumab can prevent development of dementia in people with no symptoms but sticky deposits of a substance called amyloid, which forms plaques in the brains of Alzheimer's patients. More than 800 out of the intended 1,150 participants have been enrolled, and she's rethinking whether that's enough. The National Institutes of Health and Lilly are funding the research.

OTHER DRUGS

Solanezumab binds to amyloid, helping the body to get rid of it.

Three other experimental drugs aim earlier in the process. They target BACE, an enzyme involved in producing amyloid. Lilly and AstraZeneca have partnered on one BACE inhibitor; others are being developed by Merck & Co. and by Eisai Inc. with Biogen.

Another late-stage study tests a drug aimed at tau, the other protein thought to play a key role in Alzheimer's besides amyloid. Results are expected at a medical conference next month.

BEYOND TRADITIONAL ALZHEIMER'S DRUGS

A large study is testing the blood pressure drug nilvadipine. Yet another is trying a nose spray version of insulin, which some earlier work suggested shows promise.

Several studies test various diet and nutrition studies, including one late-stage experiment with vitamin E and selenium supplements.

Finally, doctors are testing a device, sort of a pacemaker for the brain. It delivers transcranial magnetic stimulation to stimulate specific regions that appear affected by dementia.

Online:

Other drug trials: http://www.alzforum.org/therapeutics

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US abortion rate falls to lowest level in decades http://www.wvgazettemail.com/article/20161123/GZ01/161129812 GZ01 http://www.wvgazettemail.com/article/20161123/GZ01/161129812 Wed, 23 Nov 2016 14:39:26 -0500 By DAVID CRARY The Associated Press By By DAVID CRARY The Associated Press NEW YORK (AP) - The number and rate of abortions tallied by federal authorities have fallen to their lowest level in decades, according to new data released Wednesday.

The latest annual report by the Centers for Disease Control and Prevention, incorporating data from 47 states, said the abortion rate for 2013 was 12.5 abortions per 1,000 women aged 15-44 years. That is down 5 percent from 2012, and is half the rate of 25 recorded in 1980.

The last time the CDC recorded a lower abortion rate was in 1971, two years before the U.S. Supreme Court's Roe v. Wade decision that established a nationwide right for women to have abortions. Abortion was legal in some states at that time.

The CDC tallied 664,435 abortions in 2013 from the 47 states, down 5 percent from 2012 and down 20 percent from 2004. The CDC does not receive abortion data from California, Maryland and New Hampshire - and thus its total is less than the widely accepted current estimate of more than 900,000 abortions per year in all 50 states.

Back in 1990, when California was supplying data, the CDC recorded a peak of more than 1.4 million abortions.

The CDC's latest findings meshed with an Associated Press state-by-state survey conducted last year - with extensive data from 2014 - showing that abortions had been declining in virtually every state since 2010. There were big declines in conservative states passing laws to restrict abortions and also in more liberal states that protected abortion rights.

The CDC report suggests there are several factors behind the abortion decline, including a sharp drop in adolescent pregnancies, expanded coverage of contraception costs by health care plans, and increased use of effective, long-lasting contraceptive methods such as intrauterine devices and hormonal implants.

Among the CDC's detailed findings:

-Women in their 20s accounted for more than 58 percent of abortions and had the highest abortion rates. Young women and girls aged 19 and under accounted for 11.7 percent of abortions.

-Two-thirds of abortions were performed within the first eight weeks of gestation, and nearly 92 percent by 13 weeks. Only 1.3 percent were performed after 20 weeks - a point at which many anti-abortion activists want a federal abortion ban to be imposed. President-elect Donald Trump has promised to support such a ban if legislation reaches his desk.

-State abortion rates varied widely, from 3.6 per 1,000 women age 15-44 in Mississippi to 24.3 in New York. Mississippi is among a handful of states with only one functioning abortion clinic.

-Medical abortions - generally using the drugs mifepristone and misoprostol - accounted for about 22 percent of abortions; surgical procedures accounted for nearly all the others.

-About 15 percent of women who obtained an abortion were married. About 60 percent had previously given birth to at least one child.

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Burwell makes pitch for keeping Affordable Care Act http://www.wvgazettemail.com/article/20161122/GZ0115/161129868 GZ0115 http://www.wvgazettemail.com/article/20161122/GZ0115/161129868 Tue, 22 Nov 2016 17:02:36 -0500 Andrew Brown By Andrew Brown As Republican congressional leaders and president-elect Donald Trump are considering the repeal of the Affordable Care Act, Sylvia Burwell is trying to show people the benefits of President Barack Obama's signature health care law.

The U.S. Secretary of Health and Human Services and West Virginia native was in Charleston Tuesday to kick off a public relations campaign to show why the federal law is important and highlight the number of people benefiting from it.

"This isn't a conversation about a word - Obamacare. It's actually about real people's lives," Burwell said. "We need to have those stories told, and that's what we are starting here today - no better place than West Virginia."

The effort to defend the law comes at a time when insurance premiums in public marketplaces are expected to increase and some of the nation's top insurers are dropping out of the state and federal exchanges that were set up after the law was passed in 2010.

The comprehensive health care law has been a primary target of Republicans for years and played heavily in the presidential election, as Trump called for its repeal and Hillary Clinton suggested it could be reformed.

Burwell laid out some of the successes of the health care law, including reduced Medicare prescription costs, a ban on insurance companies turning down people with pre-existing conditions and ending limits on the amount of treatment someone can have over the course of their lifetime.

She also highlighted portions of the law that have blocked additional costs for contraception, capped out-of-pocket spending under insurance plans and decreased the number of uninsured adults nationwide from 18 percent to 11 percent.

In West Virginia, hundreds of thousands of people in the state have health insurance for the first time, including more than 178,000 people who have qualified for coverage under the expanded Medicaid program.

Since Trump won the election, he has softened his campaign rhetoric and suggested he will keep parts of the law, including the mandate on pre-existing conditions.

Burwell is taking Trump and other opponents of the law at their word when they say they will keep many of the most popular portions of the law, but she questions whether those pieces can work if the rest of the law is dismantled.

"This is like Jenga," Burwell said. "That is a lot of what the Affordable Care Act is. It's like Jenga, where you can maybe move a piece, but when you pull out a key piece, the whole thing is going to tumble."

One of the reasons insurance companies relented to covering people with pre-existing conditions was because lawmakers also put in the requirement that everyone had to purchase either public, private or employer-based coverage. That compromise is likely to fall apart if the insurance mandate is removed.

To show how the health care changes under Obamacare have helped, Burwell was joined on a panel Tuesday by individuals who have benefited for various portions of the law.

Allen Kennedy, who is self employed, didn't have insurance for years, but decided he needed it now that he was getting older.

He is now one of the thousands of West Virginians who found out they were covered under West Virginia's Medicaid expansion. It has allowed him to have surgery on his eyes to remove cataracts that would have stopped him from working, he said.

Kelly Allen, a Morgantown resident and health care employee with West Virginia University, currently can't be denied insurance because of her immunodeficiency disorder, but she fears that could change.

When she was still on her mother's insurance, they often got calls threatening to drop her coverage because of her health condition. Her mother kept an attorney on speed dial, she said.

"I knew if I ever had a lapse in my coverage or if I ever hit a lifetime limit, I would essentially be uninsurable for the rest of my life," Allen said. "So the Affordable Care Act affects me very much."

"I don't want to go back to the way life was before the Affordable Care Act," she said.

Members of the Obama administration, including Burwell, have recognized the failings of some aspects of the law, including the lack of competition that is a result of major insurers dropping out of the marketplaces.

In the past year, major national insurance providers, like Aetna, have pulled out of numerous states, and in late October, the Department of Health and Human Services released a report that showed that the average premium for a mid-level plan in the market was expected to increase by 25 percent next year.

That number immediately caught fire on the campaign trail as Trump and congressional Republicans held it up as evidence of the law's failure.

That report, however, did also show that 77 percent of the people enrolled in the individual insurance plans were paying less than $100 per month due to subsidies offered through federal tax credits.

Still, other people with higher incomes shopping on exchanges don't always qualify for those subsidies.

Obama authored a policy paper in The Journal of the American Medical Association in July that laid out some changes that he believes could improve the system.

The outgoing president called for the remaining 19 states to expand their Medicaid programs, for additional insurance subsidies in the state and federal marketplaces, for policies to rein in prescription drug costs that have increased dramatically in recent years and a Medicaid-like public insurance option for states that have limited competition among private insurers.

That last part was considered in 2010, but was dropped out of the final law.

Obama laid some of the blame for problems with the system at the feet of health care lobbying groups that have sought to stymie change.

"Special interests pose a continued obstacle to change," Obama wrote in the policy paper. "We worked successfully with some health care organizations and groups, such as major hospital associations, to redirect excessive Medicare payments to federal subsidies for the uninsured. Yet others, like the pharmaceutical industry, oppose any change to drug pricing, no matter how justifiable and modest, because they believe it threatens their profits."

Burwell was also joined Tuesday by health professionals that have seen a dramatic drop in uncompensated care at hospitals, which ultimately saves those health care organizations money.

Rocco Massey, another panelist, works as the Community CEO at Appalachian Regional Hospital in Beckley, which, like other hospitals throughout the state, has seen millions of dollars in cost savings due to more people being insured.

"At our organization, 100 percent of that money is plowed back into our community," Massey said. "It all comes back. It comes back in the form of new services. It comes back in the form of new equipment, new buildings. It helps us recruit new physicians back to West Virginia, and it helps us retain nurses."

Fewer people are using the emergency room as their only form of care, he said. Instead, they are visiting the hospital's community clinic more regularly for routine and preventative care.

Margaret Grassie, a Charleston resident, was one of those people using the emergency room as her doctor's office.

As an employee of a small business, she didn't have insurance before she qualified under the Medicaid expansion. Now, she has been able to afford her daily medication, treatment on her ankle and a monitor for her diabetes.

"Basically, I fell through the cracks," Grassie said. "And the elevator that brought me up was the Affordable Care Act."

Reach Andrew Brown at andrew.brown@wvgazettemail.com, 304-348-4814 or follow @Andy_Ed_Brown on Twitter.

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Supreme Court overturns $1 mil verdict against hospital http://www.wvgazettemail.com/article/20161120/GZ0115/161129948 GZ0115 http://www.wvgazettemail.com/article/20161120/GZ0115/161129948 Sun, 20 Nov 2016 17:07:11 -0500 Kate White By Kate White The West Virginia Supreme Court last week overturned a $1 million verdict a jury awarded to a nurse who claims she was wrongly fired by Thomas Memorial Hospital.

The opinion filed Thursday states that jurors in Kanawha County in 2014 didn't have enough evidence to rule against the hospital in the case of Susan Nutter.

Actually, Chief Justice Menis Ketchum wrote for the majority that Kanawha Circuit Judge Tod Kaufman should have thrown out the case before it went to trial.

"We find no evidence to support the jury's conclusion that the hospital wrongfully discharged the nurse in order to jeopardize or undermine a specific public policy. We also find insufficient evidence to say the discharge was intended to inflict emotional distress upon the nurse. Further, we find that the nurse's claim for defamation was barred by a one-year statute of limitation," the opinion states.

Justices also criticized Kaufman for asking more than 300 questions of witnesses about whether the hospital owed Nutter unpaid wages. The questioning, the majority wrote, "undermined the reliability of the jury's verdict." The case was sent back to the lower court for a new trial on that single issue.

Ketchum was joined by Justice Allen Loughry and Raleigh Circuit Judge John Hutchison, who was appointed when Justice Brent Benjamin recused himself from the case.

Loughry wrote in a separate opinion that he agrees with the majority's conclusion but not with how they got there. He doesn't place the blame with jurors but instead writes that much of the evidence should have never been presented to the jury.

In their dissent, Justices Margaret Workman and Robin Davis write that the majority "arrogantly assumes" they know better than the judge presiding over the trial and the jurors who watched the evidence unfold.

"Instead, the majority ignores decades of precedence, shows no deference whatsoever to the trial court's judgment, and presents a complete 'gloss job' of the facts," Workman and Davis wrote. "What is beyond troubling, however, is the majority's blatant disregard for the jury's reasoned verdict and patent refusal to apply well-settled law in a neutral way. "

Nutter worked for about a year in the hospital's Med Psych Unit. In November 2009, hospital officials determined she had documented for care she did not give and terminated her employment.

Reach Kate White at

kate.white@wvgazettemail.com,

304-348-1723 or follow

@KateLWhite on Twitter.

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Wards of the state: WV's drug epidemic strains foster care system http://www.wvgazettemail.com/article/20161120/GZ01/161129960 GZ01 http://www.wvgazettemail.com/article/20161120/GZ01/161129960 Sun, 20 Nov 2016 00:01:00 -0500 By M.K. McFarland For the West Virginia Press Association By By M.K. McFarland For the West Virginia Press Association

Editor's note: This ongoing series explores West Virginia's challenges in caring for its foster children as their numbers rise during the drug crisis. Names have been changed to protect the privacy of the children. Click here to read Part 2: "Foster care can strain the family."

FAIRMONT - At the beginning of June, Josiah and Ana Gray had three daughters ages 9 to 16; a 1,704-square-foot, four-bedroom home with a room for each girl; and a budget with little wiggle room.

Before the month was out, much of that had changed.

On June 23 the couple's brood grew by four foster children ages 2 to 9.

Now every bedroom but one has two occupants, including a fifth bedroom created in their basement.

The family's budget would be completely in the red if not for the generosity of their church community, family and friends.

On a hot evening in August, the first day of school in Marion County, Josiah stood in the kitchen watching the three youngest children in the living room. The older boy, 7, watched television, while the younger boy and girl, 3 and 2, played with toys. The four older girls were in their rooms or out getting last-minute school supplies.

Dinner was at least an hour away and the official snack time had come and gone. Before the Grays began fostering, a walk through the kitchen at any time of day might have yielded a handful of chips or a piece of fruit between meals. But when the family grew from five to nine, the grocery budget did not grow correspondingly.

"I'm hungry," said the 7-year-old boy as he wandered into the kitchen.

"You'll have to wait until dinner," Josiah responded gently.

Now there was a shelf in the kitchen corner cabinet that held food only for school lunches. Another shelf held snack foods. The kids could have a snack between lunch and dinner, but it was measured and specific. Sometimes it was half a banana, four strawberries or a Go-Gurt. Dinner for nine might be five pork chops, grilled and cut into strips, with a side vegetable and granola bars.

Strategic food planning was one way Josiah and Ana had been able to open their home to four sibling foster children while they waited for state financial assistance that still had not arrived two months later.

nnn

The children taken in by the Grays were among 5,169 West Virginia kids in foster care in June. That was 608 more than at the same time last year and almost 1,000 more than in June 2013, according to the state's monthly legislative foster care reports.

In September of this year, there were 5,182 children in the state's system.

The numbers are also rising nationally, by 18,000 from fiscal year 2012 to 2014, after declining steadily for the previous six years. Many states are struggling to keep up.

In West Virginia, drug abuse is a driving factor in the growing number of children in foster care.

The state Supreme Court reviews all cases of child abuse and neglect that come before the courts.

Carla Harper, a program manager with the state Department of Health and Human Resources, said substance abuse was a factor in 80 percent of 9,116 cases in which petitions were filed to remove children from their homes between 2011 and 2015. This number does not include cases excluded from the count because risk factors were unreported.

The growing number of children in foster care strains a system that had too few homes two years ago.

In its report on the 2014 fiscal year, the Bureau for Children and Families noted a lack of foster homes (in every region), particularly those homes willing to accept older children, kids with severe behavioral issues and large sibling groups.

The report also noted long waiting lists in every region for substance abuse treatment, and especially a lack of substance abuse treatment programs for youth.

The state has 174 emergency shelter beds for youth who are being assessed to determine if they will be removed from their homes or returned. In September, 177 kids were listed in emergency shelter placement.

nnn

Josiah Gray is the executive pastor for a church in Morgantown, and his wife does part-time clerical work.

They watch their finances carefully. When they were a family of five, Ana managed to hold their grocery budget to about $400 a month by collecting coupons, watching for sales and buying in bulk.

There wasn't enough money for new cars or extravagant vacations, but the family was making ends meet.

Everything changed when Ana opened Facebook late on the night of June 10.

A friend's message asked if she and Josiah would consider taking a sibling group of two brothers and two sisters into their home. The children's parents had lost custody, and their grandmother could no longer care for them.

No certified foster family in the state had room for a sibling group of that size, so the brothers and sisters were to be split unless relatives could find a place for them.

The plea came from the children's cousin in a family for which Ana and Josiah had been praying and trying to offer support for almost two years. For the couple, this turn of events was heart-wrenching.

Josiah had presided at the funeral of the children's maternal grandmother a year earlier. He had promised the family that if they needed anything, he and his family would be there.

As they read the Facebook message together, Josiah asked Ana what she thought.

She told him, "We have been through so much with this family ... and I feel like if we have the resources, we need to at least try it."

The couple called a family meeting and presented the situation to their daughters. Their oldest immediately rose to begin assessing the house and collaborating with her sisters on a floor plan to accommodate everyone. The vote was unanimous.

Realizing their kids were willing to sacrifice their personal space made the decision much less difficult. Within two days of the Facebook message, the couple responded.

They would take the four kids while the parents tried to get back on their feet.

Josiah announced their plan to his church and asked for volunteers to help ready their home.

On Wednesday, June 22, volunteers from the Grays' church came out for the second time in a week and a half to install drywall and rewire the unfinished basement. At the end of the day, the two oldest girls moved their belongings downstairs.

The next day, less than two weeks after the Facebook plea, the Grays drove to a neighboring county and picked up the children, officially becoming kinship/relative caregivers in West Virginia's system of foster care.

Kinship/relative care accounted for 976 children in the foster care system in June. It is the primary model for placement when the state has to remove a child from a home. It is considered less traumatic and disruptive for the children, who get to stay close to their community of support.

To quickly place children in kinship homes, the state offers emergency financial assistance while it fast-tracks families through the certification process to become "agency foster care" homes. Until they are certified, kinship families aren't entitled to state boarding care payments for foster children.

In June, about 1,500 children were in "agency foster care" with relative/kinship families that had gained certification at some point after taking the children.

When the Grays brought the children home, some of the kids' extended family members came to welcome them.

Josiah said it felt like a big sleepover that first night. The kids were excited as car seats were transferred to the Grays' Explorer. Later that night the weight of the situation hit him.

He realized, "They're not going back home today; they're staying."

In the following weeks, the weight of the decision seemed even heavier as their bank account began to shrink.

School was approaching and the foster kids had only summer clothes. The Grays' grocery bill doubled, and the muffler on one of their vehicles went bad.

The Grays knew the addition of four children was going to stretch their budget, but they thought they could make it work with state aid.

They were entitled to a State Paid Kinship Care Placement Payment while they worked toward certification. Typically, kinship/relative caregivers apply for Temporary Assistance for Needy Families, or TANF benefits, while they work toward certification. The process is more complicated for those with no blood relationship.

In order to get the State Paid Kinship Care Placement Payment, the paperwork process required the Grays to apply for TANF benefits, get rejected, then take the rejection notice to DHHR, who then could push payment through.

Once certified, the Grays would receive boarding care payments of $600 per child per month to help with food and clothes.

However, the certification process could take months and there would be no back pay.

So Josiah and Ana realized for the time being they would have to count on kinship benefits of about $350 per month.

By the middle of August that check had still not arrived. They had been expecting it since the middle of July. It turned out a computer error had occurred.

Then they were turned down for clothing vouchers. Kids in kinship care can get vouchers for about $300 but only once a year. After a foster family is certified, the boarding care payments are to cover clothes. Ana and Josiah's foster children had stayed with another relative first, and she had used the vouchers for needed summer clothes.

In August, the state was able to release around $341 in emergency vouchers to the Grays to use at Wal-Mart.

The Grays applied for SNAP benefits, or food stamps, to help subsidize groceries. They exceeded the income cutoff for a nine-person family by $6.

In the middle of August, Josiah met Ana at the door as she was heading out with the two older girls to buy school supplies. She cringed when he handed her cash and told her not to use their bankcard. There wasn't enough money in their account.

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Coming in Part II: The Grays had always planned to foster or adopt but were waiting until they were more comfortable financially. Circumstances dictated otherwise, and their community has rallied around them. Josiah says, "Do we really love people? If we do, then we're willing to sacrifice things for the sake of others, and so if it means that we don't get to eat what we used to eat, then that's OK. The love we're showing these kids is worth it."

Writer M.K. McFarland worked for more than a decade in state media and now teaches at the Reed College of Media at West Virginia University. She volunteers as a cuddler in the newborn intensive care unit at Ruby Memorial Hospital in Morgantown. She began working on this series after seeing the effects of the opioid epidemic on newborn children.

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Blenko creates special piece to benefit diabetes research http://www.wvgazettemail.com/article/20161120/GZ05/161129982 GZ05 http://www.wvgazettemail.com/article/20161120/GZ05/161129982 Sun, 20 Nov 2016 04:00:00 -0500 Douglas Imbrogno By Douglas Imbrogno Blenko Glass, in Milton, one of the oldest handmade glass factories in America, has joined with the Juvenile Diabetes Research Foundation to produce a special edition piece.

The release of the piece is timed to coordinate with National Diabetes Month, which is taking place this month. The piece features a blue circle on its neck, which is the universal symbol for diabetes. The handcrafted glass is 101/2 inches tall of azure blue with a single, darker cobalt blue circle on the neck and the signature of Blenko Glass and "2016" on its base.

It is on sale now for $50, and $5 of all sales will go toward the JDRF, a charitable organization dedicated to funding type 1 diabetes research.

Blenko had previously been approached about making a special- edition glass piece for breast cancer awareness, and it went over well. It was then approached about doing a piece for National Diabetes Month, said Blenko's Dean Six, vice president of marketing and sales.

"They explained their symbol was a blue circle," he said. "We played around with a couple things and showed them some things that had a blue circle in the design, and they picked one."

Registered dietitian Malissa Sarver is a type 1 diabetes coordinator at the hospital KDMC-Ohio in Portsmouth, Ohio.

Juvenile diabetes is today most often called type 1 diabetes and is an autoimmune disease that strikes both children and adults suddenly, Starver said.

It has nothing to do with age, diet or lifestyle. There is nothing you can do to prevent it. And, at present, there is no cure and must be controlled with insulin shots or an insulin pump, Starver said.

She has a 3-year-old who was diagnosed with type 1 diabetes at age 1, but the disease can strike adults at any time. Actress Mary Tyler Moore was diagnosed later in life, Starver said.

In type 1 diabetes, the pancreas stops producing insulin - a hormone the body needs to get energy from food. This means a process the body does naturally and automatically becomes something that requires daily attention and manual intervention.

Those with type 1 diabetes must constantly monitor their blood-sugar level, inject or infuse insulin through a pump, and carefully balance insulin doses with eating and activity throughout the day and night.

"There's a lot of misunderstanding about diabetes and type 1 diabetes. Will these kids ever grow out of it? No, they won't. Was it from eating too much sugar? No, it's an autoimmune disease."

The vases are available only through the end of 2016 in the Visitors Center shop at Blenko in Milton; via phone order by calling 304-743-9081 or online at shop.blenko.com/Special -Edition-Items_c46.htm.

Reach Douglas Imbrongo at

douglas@wvgazettemail.com,

304-348-3017 or follow

@douglaseye on Twitter.

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