www.wvgazettemail.com Health http://www.wvgazettemail.com Gazette archive feed en-us Copyright 2017, Charleston Newspapers, Charleston, WV Newspapers ACLU plans bill for school-based mental health centers in WV http://www.wvgazettemail.com/article/20170117/GZ0115/170119617 GZ0115 http://www.wvgazettemail.com/article/20170117/GZ0115/170119617 Tue, 17 Jan 2017 17:17:09 -0500 Natalie Schreyer By Natalie Schreyer A new pilot program to treat children with behavioral or mental health challenges in school-based health centers will be suggested for introduction in the legislative session by the ACLU of West Virginia.

The proposal, which aims to keep children from winding up in the court system, would be developed in conjunction with the state Department of Education and is designed to address behavioral and mental health issues "more constructively," according to Eli Baumwell, policy director at the ACLU of West Virginia.

The program would authorize health care providers, such as social workers, counselors and therapists, to receive referrals for children who had violated the school's disciplinary code, according to the draft legislation of the initiative. Providers would conduct an assessment of the student's mental or behavioral health and would be authorized to treat the student and family members in need.

Parents who object to the policy and prefer to have their children go through the school's traditional disciplinary system, such as detention, suspension, or expulsion, can opt out.

The issue of treating mental and behavioral health challenges among children has been a difficult one in West Virginia. A 2014 report showed that, between 2002 and 2012, court referrals for juveniles who had committed low-level offenses, such as truancy, running away from home or alcohol consumption, increased 124 percent, even as referrals for more serious offenses declined.

The report, completed by a task force of state officials led by former Gov. Earl Ray Tomblin, was released in the wake of the announcement of an investigation by the U.S. Department of Justice into West Virginia's programs for treating children with mental health issues. The Justice Department subsequently found West Virginia in violation of the Americans with Disabilities Act, arguing in a June 2015 letter to Tomblin that the state treated children with mental health conditions too far away from their homes and communities. The Justice Department referred to the state's inability to treat children in their communities as a "systemic failure."

Subsequently, the state's Department of Health and Human Resources launched a program in October 2015, called Safe at Home West Virginia, which attempts to deal with this problem by keeping children in their communities for treatment.

To date, 544 children have been referred to Safe at Home. Of those, 39 have returned to West Virginia from out-of-state residential facilities, 84 have gone back to their home communities from an in-state residential facility, six have returned from a shelter and 260 were prevention cases, according to the DHHR.

Placing youth in facilities run by the DHHR or its Division of Juvenile Services is costly. The task force's report estimated that, on average, the cost of keeping a child in an in-state or out-of-state residential facility, emergency shelter or Department of Juvenile Services facility costs more than $100,000 per year.

Baumwell said the ACLU'S proposed program would save the state money by keeping youth out of those facilities.

One program in the state already serves as an example for the ACLU's proposal. In Morgan County schools, clinical social worker Gary McDaniel has developed a system, based on prevention and early intervention, that is funded by grants. Children in Morgan schools are screened for mental health issues, and those who screen positive for risk of issues like substance abuse, anxiety or depression can then be treated in small groups.

Children who need additional specialized care are referred to local health providers or treated in school, if the family does not have access to transportation.

The program focuses heavily on collaboration and partnerships within the local community, McDaniel said.

Morgan County schools, McDaniel said, do not have the facilities for a built-in school-based health center, which makes its program different from the one proposed by the ACLU, but he said he thinks "it would be a good model to pilot," he said.

In light of the presence of programs like the one in Morgan County, Juvenile Justice Commission Director Cindy Largent-Hill said it's important that any new program coordinate with existing projects.

"We need to be in concert with one another," she said, citing the state's tight budget.

In Connecticut, a similar program has shown positive results. Among schools that participated in that state's initiative since 2010, the average reduction in court referrals was 45 percent in the first year, according to the Child Health and Development Institute of Connecticut.

Like Morgan County, the Connecticut program relies on community-based services as partners. West Virginia, Baumwell said, simply doesn't have the same community resources as Connecticut, so the ACLU's idea is "to make something that fits the needs here in West Virginia."

As the legislative session approaches, on Feb. 8, the ACLU will await feedback from state officials. Kelli Caseman, a supporter of the proposal and director of the West Virginia Kids' Health Partnership, said in an email, "I hope the legislators can see past their preconceived notions about the ACLU and appreciate the value of such a program."

For Baumwell, it comes down to convincing people that it's time to target the problem at its roots.

"If we want to stop the cycle of trauma and of mental and behavioral health problems that are significantly affecting our state's workforce and our state's tax base," he said, "it means working with students, it means working with families, it means catching them at a young age and not just kicking them out of society."

Reach Natalie Schreyer at natalie.schreyer@wvgazettemail.com, 304-348-5189, or follow @NatalieSchreyer on Twitter.

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WVU Cancer Institute gets new director http://www.wvgazettemail.com/article/20170117/GZ0115/170119634 GZ0115 http://www.wvgazettemail.com/article/20170117/GZ0115/170119634 Tue, 17 Jan 2017 09:02:01 -0500 The Associated Press By The Associated Press MORGANTOWN, W.Va. (AP) - Dr. Richard Goldberg, a gastrointestinal cancer expert, has been named the new director of the WVU Cancer Institute.

Goldberg comes from Ohio State University's Wexner Medical Center, where he is the Klotz Family Professor of Cancer Research, physician-in-chief of the James Cancer Hospital and associate director of the Ohio State Comprehensive Cancer Center.

Albert Wright, president of the West Virginia University Health System, says the state's cancer burden is too high, and it's the responsibility of the state's flagship academic medical center to address that, and Goldberg has the leadership and experience to direct those efforts.

According to the institute, Goldberg's research has resulted in more than 300 peer-reviewed publications, and he has held multiple National Cancer Institute-funded grants.

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ACA repeal may affect black lung patients, families http://www.wvgazettemail.com/article/20170115/GZ0115/170119693 GZ0115 http://www.wvgazettemail.com/article/20170115/GZ0115/170119693 Sun, 15 Jan 2017 17:40:50 -0500 Lori Kersey By Lori Kersey BECKLEY - Despite the disease that left him disabled, Gary Hairston looks back fondly on his time as a coal miner.

"If I could be, I would be in there right now," the 62-year-old Beckley resident said.

Hairston had been a coal miner more than 27 years when he left the mines because of coal workers' pneumoconiosis - or black lung disease, an illness caused by inhaling coal dust that has killed 78,000 miners since 1968. He was 48 at the time.

"[It felt] like someone had gotten a knife and run that knife down through my lungs," Hairston said. "That's how bad they was hurting."

Hairston reluctantly left the mines in 2004 after a doctor told him if he didn't, he'd need oxygen for the rest of his life. These days, Hairston uses oxygen, for the most part, only at night and tries to avoid colds and other illnesses that worsen his lung problems.

Black lung keeps him from doing the things he once loved to do, like working and playing basketball. It slows him down when it comes to household chores like mowing the lawn.

"Everything I do I've got to do in moderation," Hairston said. "I've got to know how far to take it ... I know if I get to the point where I can't breathe, I'm going to be struggling."

Like many black lung patients, Hairston's benefits didn't come easy. Hairston said his company fought him in court for two years after he was awarded his.

As a black lung patient, Hairston represents a group of people who may be affected as Republicans continue with plans to dismantle the Affordable Care Act. The health care act added two amendments that make it easier for coal miners to get federal benefits for black lung. The amendments are referred to as the "Byrd amendments," for late Sen. Robert C. Byrd, who wrote them.

One amendment allows the spouses of miners who received federal black lung benefits to continue to get them after the miner's death.

"Without that provision that was reinserted in the law in the Affordable Care Act, the widow has to go and prove that black lung contributed to [her husband's] death," said John Cline, a Piney View-based attorney who deals primarily in black lung cases. "If the cause of death was heart attack, the widow had a hard time establishing that black lung contributed."

That makes for a lot of financial uncertainty for widows at a time when they already have lost their husbands, Cline said.

Another part of the health care reform law allows miners with full disability because of black lung and at least 15 years in the mines a "rebuttable presumption" that mining work contributed to the disability, Cline said.

In other words, "it shifts the burden of proof to the company from the miner or widow, but only if the miner has full disability and 15 years [in the mines]," Cline said.

Cline said he's seen the Affordable Care Act make a difference in the lives of black lung patients and their survivors.

"It has made a huge difference for widows whose husbands had qualified for benefits prior to their deaths," Cline said. "With this provision, the widows just have to submit an application and the benefits continue almost immediately. They're not subject to a loss of black lung benefits as well as the loss of their husbands."

"If we lose that, that's going to be terrible," Hairston, also the vice president of the Fayette County Black Lung Association, said of the 15-year presumption. "On top of that, if I die my wife will keep on getting black lung [benefits], but if [it's repealed] then she's got to keep fighting."

President-elect Donald Trump, who campaigned partly on a promise to put coal miners back to work, easily won West Virginia and Kentucky, which are among five states with the most black lung claims, according to the U.S. Department of Labor. But the billionaire's campaign promise to repeal the Affordable Care Act made no mention of what black lung patients would do without the sections of the health care law.

Hairston said he hopes if lawmakers get rid of the Affordable Care Act, they replace it with something that also protects black lung benefits.

"If they repeal everything, you figure that's gone," he said.

Advocates of the Affordable Care Act say there may be reason to be hopeful. When Republicans previously tried to repeal the law by budget reconciliation in 2015, the Byrd amendments were not part of the repeal.

"The 2015 reconciliation bill that was passed by Congress before being vetoed and would have repealed portions of the Affordable Care Act would not have altered the black lung provisions," Capito spokeswoman Ashley Berrang said Sunday. Sen. [Shelley Moore] Capito believes these black lung provisions should be retained as we move forward with repealing and replacing Obamacare."

Sen. Joe Manchin, D-West Virginia, who advocated for fixing the Affordable Care Act instead of repealing it completely, introduced a black lung amendment and two others to the budget. The amendment would create "a budget point of order against any legislation that would shift the burden of proof of disability due to black lung away from industry and back on miners who worked in the mines for at least 15 years and suffered total disability or their survivors," according to a press release from the senator's office.

"By repealing, but not replacing the Affordable Care Act, our coal miners, rural residents and those struggling with addiction will lose access to the help that they desperately need," Manchin said in the statement. "As I have said many times, I will be first in line to repeal the Affordable Care Act, if we have a better replacement ready, and the only way we will ever achieve that is by putting partisanship aside and working together as Americans first."

In the House of Representatives, Rep. Evan Jenkins also introduced legislation aimed at preserving black lung protections, according to a news release. The legislation is co-sponsored by David McKinley, R-W.Va., and Alex Mooney, R-W.Va. The congressmen have opposed the Affordable Care Act.

"I will fight to make sure any replacement for Obamacare includes the Byrd amendment and this critical black lung benefits program for our miners and their families," Jenkins said in part in the news release.

Bryant said WVAHC has been advocating for the benefits provisions with Capito and Manchin.

"My sense is that both senators are both working very hard to see the Byrd Amendments survive," Bryant said. "[Trump] owes an awful lot to coal miners and their families."

Reach Lori Kersey at

lori.kersey@wvgazettemail.com,

304-348-1240 or follow

@LoriKerseyWV on Twitter.

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CVS unveils discounted generic EpiPen http://www.wvgazettemail.com/article/20170112/GZ0115/170119818 GZ0115 http://www.wvgazettemail.com/article/20170112/GZ0115/170119818 Thu, 12 Jan 2017 20:13:24 -0500 By Tom Murphy The Associated Press By By Tom Murphy The Associated Press CVS is now selling a rival, generic version of Mylan's EpiPen at about a sixth of its price, just months after the maker of the life-saving allergy treatment was eviscerated before Congress because of its soaring cost to consumers.

The drugstore chain says it will charge $109.99 for a two-pack of the authorized generic version of Adrenaclick, a lesser-known treatment compared to EpiPen, which can cost more than $600.

CVS Health Corp., the nation's second-largest drugstore chain, says it cut the price it charges for the generic version of Adrenaclick nearly in half. The lower price is now available at all CVS stores. The chain runs about 9,600 retail pharmacies in the United States, including several locations inside Target stores.

These treatments are stocked by schools and parents of children with severe allergies. They are used in emergencies to stop anaphylaxis, the potentially fatal allergic reactions to insect bites and stings and foods like nuts and eggs.

The syringes are filled with the hormone epinephrine, and they expire after a year. That often forces patients to fill new prescriptions even if they never used the old one.

Mylan NV started taking heat late last summer for its EpiPen pricing, which has climbed more than 500 percent since 2007. A Congressional panel grilled CEO Heather Bresch in September about the soaring cost, which she has blamed in part on insurers, pharmacy benefits managers and other middlemen that stand between the drugmaker and the customer.

Bresch is one of several pharmaceutical executives who have been called to Congress, where both Republicans and Democrats have demanded explanations for spiraling drug prices, which can plunge patients into debt or force them to skip prescriptions.

President-elect Donald Trump said Wednesday during a press conference that he wants to create new bidding procedures on drugs to save money.

Shares of most drugmakers sank almost immediately and are still under pressure today, though the decline in Mylan's stock outpaced most. Shares fell almost 2 percent in early trading after the CVS announcement.

In the aftermath of the unwanted attention, Mylan has expanded the financial aid it offers customers and launched its own authorized generic in December, priced at around $300 per two-pack.

But patients with no health insurance or plans that make them pay a high deductible before covering care are exposed to the full price of the drug if they aren't aware of that assistance or if they don't seek it.

CVS says the new price it is charging for the Adrenaclick generic applies to both insured patients and those who pay cash without coverage. It's what customers will pay at the pharmacy counter.

Prescription drug prices vary widely, due to negotiations between pharmacies, drugmakers and pharmacy benefit managers. The new price that CVS announced Thursday is lower, in some cases by more than $100, than other prices listed on websites like GoodRx that compare retailers.

The maker of Adrenaclick, Impax Laboratories, also offers a coupon program for its generic version that can provide additional price breaks, if a patient qualifies.

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West Virginians appeal to lawmakers: Keep or replace ACA http://www.wvgazettemail.com/article/20170112/GZ0115/170119825 GZ0115 http://www.wvgazettemail.com/article/20170112/GZ0115/170119825 Thu, 12 Jan 2017 18:41:39 -0500 Lori Kersey By Lori Kersey As Congress continues to move forward with plans to repeal the Affordable Care Act, West Virginians who have benefited from the law and their advocates gathered Thursday to ask lawmakers not get rid of it without a plan for replacing it.

West Virginians for Affordable Health Care held the news conference at its office in Charleston.

More than 175,000 West Virginians who signed up for Medicaid under expansion stand to lose coverage if the law is repealed. Another approximately 35,000 state residents could lose the plan they bought on the health insurance marketplace.

Since the enactment of the Affordable Care Act in 2010, West Virginia's uninsured rate has fallen by 57 percent, according to WVAHC.

Renate Pore, interim director of the group, said repealing the law would kill the goal of every West Virginian having access to quality health care coverage.

"Now that goal slipped beyond the horizon and we face not further progress but an unraveling of all that has been achieved," Pore said. "This is unacceptable. We cannot let it happen."

Health insurance and access to care is not just an individual benefit but a social benefit, she said.

Medicaid expansion under the Affordable Care Act has been the state's best tool in treating drug abuse problems in the state, Pore said.

The repeal would also have an economic effect. It would mean 16,000 fewer jobs in West Virginia by 2019, Pore said, citing a January report from the Commonwealth Fund.

"We are now on the slippery slope of repeal," Pore said. "What comes after repeal? Well, who the heck knows? The majority party promises to replace it with something better, but no one really knows what it means."

Besides West Virginians for Affordable Health Care, representatives of the West Virginia Nurses Association, Roane General Hospital, the West Virginia Council of Churches and WV Citizens Action Group as well as a physician with Cabin Creek Health Systems and private citizens who stand to lose coverage spoke in support of keeping the Affordable Care Act.

While Pore applauded the effects of the Affordable Care Act, she admitted the law has its problems. The goal of the law was to drive down the cost of health care spending, but it hasn't done that for many in the private sector, she said.

"That's where the problem that needs to be fixed is," Pore said. "Unless you're poor enough for Medicaid or get financial assistance on the marketplace, if you're a middle-class person that has to buy a policy, it is a very, very high price."

The reason for the high costs are the country's high prescription drug prices, she said.

It's time for Republicans to govern and stop grandstanding, she said.

Pore thanked Sen. Joe Manchin for voting against the repeal. Manchin has argued for fixing the law instead of repealing it completely, saying he would not vote to repeal the law without first seeing what Republicans aimed to replace it with.

Pore also appealed to Sen. Shelley Moore Capito, who voted in favor of the repeal, to reconsider her position. She encouraged those in attendance to contact Capito to do the same.

"We have to keep this pressure on her," Pore said.

Mary Ann Claytor, a St. Albans resident who ran for state auditor last year, also spoke in support of keeping the Affordable Care Act. Claytor's son, Cedric, developed a rare disease at age 20. The disease caused blood clots that damaged his liver, she said.

"I didn't realize that I had this fine print in our [insurance] policy that I had a million dollar maximum lifetime benefits [limit]," Claytor said. "So, once he met the million dollars, he would have been taken off."

As Claytor and her family waited for Cedric to receive a liver transplant, the insurance company continued to send reminders that they were reaching the limit on their benefits.

"How would you imagine that you are worried about whether your child is going to live or your child is going to die and you are getting these letters from the insurance company keeping you on a countdown, just counting down the time," she said.

The Affordable Care Act put an end to lifetime benefit caps and requires companies to offer health insurance to people even if they have pre-existing health conditions that make their care costly.

But Claytor worries that if the law is repealed, her insurance company might reinstate the limits. Her son, who is now paralyzed and requires her help full time, acquired a second rare disease, she said. He's reached more than $1 million in insurance benefits. Would another insurance company cover him with his pre-existing health conditions?

"I urge our representatives to look in their own children's faces and to imagine they're in this situation," Claytor said.

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

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GOP eyes early health care bill, but details vague http://www.wvgazettemail.com/article/20170112/GZ01/170119831 GZ01 http://www.wvgazettemail.com/article/20170112/GZ01/170119831 Thu, 12 Jan 2017 17:52:48 -0500 By Alan Fram The Associated Press By By Alan Fram The Associated Press WASHINGTON - Under mounting pressure from Donald Trump and rank-and-file Republicans, congressional leaders are talking increasingly about chiseling an early bill that dismantles President Barack Obama's health care law and begins to supplant it with their own vision of how the nation's $3-trillion-a-year medical system should work.

Yet, even as Republicans said they will pursue their paramount 2017 goal aggressively, leaders left plenty of wiggle room Thursday about exactly what they will do. Their caution underscores persistent divisions over how to recraft a law they've tried erasing since its 2010 enactment, plus their desire to avoid panicking the 20 million people who've gained coverage under Obama's overhaul or unsettling health insurance markets.

In an interview with conservative radio host Mike Gallagher, House Speaker Paul Ryan, R-Wis., said the initial repeal-and-replace legislation would be "the primary part of our health care policy" and would be followed by other bills. Later, he told reporters at the Capitol that, while Republicans will work quickly, "We're not holding hard deadlines, only because we want to get it right."

Senate Majority Leader Mitch McConnell, R-Ky., said the early repeal bill would "begin to make important progress." He said Republicans "plan to take on the replacement challenge in manageable pieces, with step-by-step reforms." He set no timetable.

"Repealing and replacing Obamacare is a big challenge," McConnell added. "It isn't going to be easy."

The leaders spoke a day before the House planned to give final approval to a budget that would shield the forthcoming repeal-and-replace bill from a Democratic filibuster in the Senate.

Stripping Democrats of their ability to endlessly delay that bill - a tactic that takes 60 votes to thwart - is crucial for Republicans, who have just a 52-48 edge in the Senate. That chamber approved the budget early Thursday by a near party-line 51-48 vote, drawing a Twitter thumbs-up from Trump.

"Congrats to the Senate for taking the first step to #RepealObamacare - now it's onto the House!" the president-elect tweeted.

Trump, who enters the White House next Friday, has pressed Republicans in recent days to act quickly on annulling and reshaping Obama's law. GOP leaders seem to be taking his urgings to heart, although some have suggested his desire for speed doesn't match Congress' vintage lack of agility.

Asked how quickly lawmakers could send Trump a bill, No. 2 Senate Republican leader John Cornyn of Texas said, "The most important thing is, when do you get 218 votes in the House and 51 votes in the Senate," the majorities needed for passage.

"He's not a creature of this place, so there's always a bit of a learning curve," said the No. 3 Senate GOP leader, John Thune of South Dakota.

Obama's law, which he considers a trophy of his soon-to-end presidency, has provided health care subsidies and Medicaid coverage for millions who don't get insurance at work. It has required insurers to cover certain services, like family planning and people who are already ill, and curbed rates that the sick and elderly can be charged.

GOP leaders hope to use their first bill to void and rewrite as much of Obama's law as they can but, so far, they've provided little detail. Cornyn said in a brief interview Wednesday that the early legislation would "push some of the responsibility and resources down to the states and give them more flexibility," such as for Medicaid.

Republicans want to end the fines that enforce the statute's requirements that individuals buy coverage and that larger companies provide it to workers - mandates that experts say were needed to stabilize insurers' rates. They also want to erase the taxes the law imposed on higher-income people and the health care industry, eliminate subsidies that help people buy policies and pare back its Medicaid expansion.

But they face internal disagreements over policy, such as how to pay for their new statute and how to protect consumers and insurers during what might be a two- or three-year phase-out of Obama's overhaul.

They also must heed Senate rules forbidding provisions that don't directly affect taxes and spending from being safeguarded from filibusters. That means repealing important parts of the law - like the requirement that insurers offer coverage to all customers, including the most ill - would have to await later bills that would need Democratic support.

Democrats have so far solidly opposed the GOP effort, but one influential conservative health care authority warned Thursday that it would be best to work with them.

"Bipartisan support for whatever is assembled is the best way - and probably the only way - to ensure that what passes in 2017 is accepted by the public" in a way Obama's law was not, James Capretta, a fellow at the American Enterprise Institute who worked for President George W. Bush, wrote Thursday in National Review Online.

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Republican-led Senate takes first step to repeal 'Obamacare' http://www.wvgazettemail.com/article/20170112/GZ0101/170119855 GZ0101 http://www.wvgazettemail.com/article/20170112/GZ0101/170119855 Thu, 12 Jan 2017 08:55:24 -0500 By ANDREW TAYLOR  The Associated Press By By ANDREW TAYLOR  The Associated Press WASHINGTON (AP) - The Senate has passed a measure to take the first step forward on dismantling President Barack Obama's health care law, responding to pressure to move quickly even as Republicans and President-elect Trump grapple with what to replace it with.

The nearly party-line 51-48 vote early Thursday came on a nonbinding Republican-backed budget measure that eases the way for action on subsequent repeal legislation as soon as next month.

"We must act quickly to bring relief to the American people," said Senate Majority Leader Mitch McConnell, R-Ky.

The House is slated to vote on the measure on Friday, though some Republicans there have misgivings about setting the repeal effort in motion without a better idea of the replacement plan.

Trump oozed confidence at a news conference on Wednesday, promising his incoming administration would soon reveal a plan to both repeal so-called Obamacare and replace it with legislation to "get health care taken care of in this country."

"We're going to do repeal and replace, very complicated stuff," Trump told reporters, adding that both elements would pass virtually at the same time. That promise, however, will be almost impossible to achieve in the complicated web of Congress, where GOP leaders must navigate complex Senate rules, united Democratic opposition and substantive policy disagreements among Republicans.

Passage of Thursday's measure would permit follow-up legislation to escape the threat of a filibuster by Senate Democrats. Republicans are not close to agreement among themselves on what any "Obamacare" replacement would look like, however.

Republicans plan to get legislation voiding Obama's law and replacing parts of it to Trump by the end of February, House Majority Leader Kevin McCarthy, R-Calif., said Wednesday on "The Hugh Hewitt Show," a conservative radio program. Other Republicans have said they expect the process to take longer.

The 2010 law extended health insurance to some 20 million Americans, prevented insurers from denying coverage for pre-existing conditions and steered billions of dollars to states for the Medicaid health program for the poor. Republicans fought the effort tooth and nail and voter opposition to Obamacare helped carry the party to impressive wins in 2010, 2014, and last year.

Thursday's Senate procedural vote will set up special budget rules that will allow the repeal vote to take place with a simple majority in the 100-member Senate, instead of the 60 votes required to move most legislation.

That means Republicans, who control 52 seats, can push through repeal legislation without Democratic cooperation. They're also discussing whether there are some elements of a replacement bill that could get through at the same time with a simple majority. But for many elements of a new health care law, Republicans are likely to need 60 votes and Democratic support, and at this point the two parties aren't even talking.

Most Democrats broke with Senate traditions to offer brief explanations of their votes as they cast them. "My conscious compels me to vote 'no,'" said Sen. Angus King, an Independent from Maine who sides with Democrats. Sen. Rand Paul of Kentucky, unhappy that the measure endorsed huge budget deficits, was the sole Republican to vote against it.

Increasing numbers of Republicans have expressed anxiety over obliterating the law without a replacement to show voters.

Sen. Susan Collins, R-Maine, said she wants to at least see "a detailed framework" of a GOP alternative health care plan before voting on repeal. She said Republicans would risk "people falling through the cracks or causing turmoil in insurance markets" if lawmakers voided Obama's statute without a replacement in hand.

Collins was among a handful of Republicans to occasionally break ranks to support some Democratic messaging amendments aimed at supporting such things as rural hospitals and a mandate to cover patients with pre-existing medical conditions. They were all shot down by majority Republicans anyway.

House leaders planned a Friday vote on the budget, though Republicans in that chamber also had misgivings.

Many members of the conservative House Freedom Caucus were insisting on first learning details about what a GOP substitute would look like - or putting some elements of the replacement measure in the repeal bill.

"We need to be voting for a replacement plan at the same time that we vote for repeal," said Rep. Mark Meadows, R-N.C., an influential conservative.

Some GOP senators have discussed a phase-in of three years or longer to give lawmakers more time to replace Obama's overhaul and make sure people now covered by that law can adjust to a new program.

Some more moderate House Republicans were unhappy, too, including Rep. Tom MacArthur, R-N.J., a leader of GOP centrists in the House Tuesday Group. He said he would oppose the budget because there was too little information about the replacement, including whether people receiving expanded Medicaid coverage or health care subsidies under the existing law would be protected.

"We're loading a gun here," MacArthur said. "I want to know where it's pointed before we start the process."

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WV Board of Medicine reprimands Raleigh Heart Clinic doctor http://www.wvgazettemail.com/article/20170111/GZ0115/170119888 GZ0115 http://www.wvgazettemail.com/article/20170111/GZ0115/170119888 Wed, 11 Jan 2017 17:17:11 -0500 Lori Kersey By Lori Kersey A health care provider at a Beckley heart clinic linked to several cases of hepatitis B and C allowed a person with no medical license to perform parts of patients' stress tests, according to a consent order filed by the West Virginia Board of Medicine.

Dr. Thair Ali Barghouthi, president of the Raleigh Heart Clinic, admitted to the board that he delegated some of the responsibilities of stress tests to his brother, Ahmad Barghouthi, whose Nuclear Medicine Apprenticeship License had lapsed, according to the order.

"Dr. Barghouthi was aware that his brother's Nuclear Medicine Apprenticeship License expired in July 2012," the consent order's findings of fact state. "Dr. Barghouthi admits that, during the performance of nuclear medicine stress test procedures, he has delegated tasks to Mr. Barghouthi, including the positioning of patients, operating nuclear scan equipment, and monitoring the patient and equipment."

A patient of the clinic complained to the medical board that Dr. Barghouthi delegated responsibilities of the patient's nuclear medicine stress tests to his brother in 2012, 2013 and 2014, according to the consent order.

A lawyer representing Dr. Barghouthi in a class-action lawsuit filed by patients said what the doctor's brother did had nothing to do with the lawsuit. The brother positioned patients but didn't inject them, attorney Don Sensabaugh said.

In its filing, the Board of Medicine publicly reprimanded Dr. Barghouthi and prohibited him from delegating professional responsibilities related to the tests to anyone who doesn't have the required certifications or credentials to do the tests, including Mr. Barghouthi.

In March 2016, the West Virginia Department of Health and Human Resources sent letters to 2,300 of the clinic's patients who underwent a stress test with injectable medicine between March 1, 2012, and March 27, 2015. The letters told patients they might have been exposed to HIV and hepatitis A and B, and encouraged them to be tested.

At the time, 12 cases of patients with hepatitis B or hepatitis C were documented. Four more hepatitis cases were detected later, although they couldn't be "conclusively linked to the clinic," a DHHR news release at the time said.

The state recommended that patients at the clinic before March 1, 2012, be tested for hepatitis B, hepatitis C and HIV. No cases of HIV related to the clinic have been reported.

State health officials last year said they were not sure what caused the hepatitis cases. Health Commissioner Dr. Rahul Gupta said an investigation turned up no "smoking gun" as a reason for the viruses being transmitted, but that there are a number of factors that could have caused it.

"It's not just [not reusing] the needle, but there are a host of other precautions that one must take when you're doing the procedure, and that's part of the infection control," Gupta told reporters during a news conference at the time.

At least two patients filed lawsuits against the clinic last year in Raleigh County Circuit Court. A lawsuit filed by Raleigh County resident Pamela Vines was granted class-action status in December, her attorney, Stephen New, said Wednesday. The case has about 100 class members and is moving through the litigation process, New said.

A clerk at Raleigh County Circuit Court said the filing is under seal and cannot be released.

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

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Republican-led Senate to move forward on 'Obamacare' repeal http://www.wvgazettemail.com/article/20170111/GZ0113/170119903 GZ0113 http://www.wvgazettemail.com/article/20170111/GZ0113/170119903 Wed, 11 Jan 2017 15:51:27 -0500 By Andrew Taylor Associated Press By By Andrew Taylor Associated Press WASHINGTON - The Republican-led Senate is poised to take a step forward on dismantling President Barack Obama's health care law despite anxiety among GOP lawmakers over the lack of an alternative.

Senate approval - expected late Wednesday or early Thursday - and then House passage would trigger committee action to write repeal legislation that could come to a vote next month. A full replacement would follow sometime after that, presuming Republicans can come up with one.

"We must act quickly to bring relief to the American people," said Senate Majority Leader Mitch McConnell, R-Ky.

President-elect Donald Trump said Wednesday that repealing and replacing the law should happen "essentially simultaneously," even in the same day, week or hour. That will be almost impossible to achieve due to complex Senate rules, united Democratic opposition and substantive policy disagreements among Republicans.

Republicans plan to get legislation voiding Obama's law and replacing parts of it to Trump by the end of February, House Majority Leader Kevin McCarthy, R-Calif., said Wednesday on "The Hugh Hewitt Show," a conservative radio program. Other Republicans have said they expect the process to take longer.

The 2010 law extended health insurance to some 20 million Americans, prevented insurers from denying coverage for pre-existing conditions and steered billions of dollars to states for the Medicaid health program for the poor.

The Senate procedural vote will set up special budget rules that will allow the repeal vote to take place with a simple majority in the 100-member Senate, instead of the 60 votes required to move most legislation.

That means Republicans, who control 52 seats, can push through repeal legislation without Democratic cooperation. They're also discussing whether there are some elements of a replacement bill that could get through at the same time with a simple majority. But for most elements of a new health care law, Republicans are likely to need 60 votes and Democratic support, and at this point the two parties aren't even talking.

Increasing numbers of Republicans have expressed anxiety over obliterating the law without a replacement to show voters.

Sen. Susan Collins, R-Maine, said she wants to at least see "a detailed framework" of a GOP alternative health care plan before voting on repeal. She said Republicans would risk "people falling through the cracks or causing turmoil in insurance markets" if lawmakers voided Obama's statute without a replacement in hand.

House leaders planned a Friday vote on the budget, though Republicans in that chamber also had misgivings.

Many members of the conservative House Freedom Caucus were insisting on first learning details about what a GOP substitute would look like.

They also were demanding that once a future repeal bill becomes law, it should take no longer than two years to take effect. Some GOP senators have discussed a phase-in of three years or longer to give lawmakers more time to replace Obama's overhaul and make sure people now covered by that law can adjust to a new program.

"There's more elections and more uncertainty," Rep. Dave Brat, R-Va., a Freedom Caucus member, said of his objections to a longer transition period.

Some more moderate Republicans were unhappy, including Rep. Tom MacArthur, R-N.J., a leader of the House Tuesday Group of GOP centrists. He said he would oppose the budget because there was too little information about the replacement, including whether people receiving expanded Medicaid coverage or health care subsidies under the existing law would be protected.

"We're loading a gun here. I want to know where it's pointed before we start the process," MacArthur said.

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$4.8 million for West Virginia health and social service agencies http://www.wvgazettemail.com/article/20170111/GZ0115/170119923 GZ0115 http://www.wvgazettemail.com/article/20170111/GZ0115/170119923 Wed, 11 Jan 2017 08:38:33 -0500 The Associated Press By The Associated Press CHARLESTON, W.Va. (AP) - West Virginia's U.S. senators say social service and health care agencies will share $4.8 million in federal funding to support Head Start programs in Raleigh County and Oceana and medical services in Roane County and other areas.

According to Sens. Joe Manchin and Shelley Moore Capito, funds are going to MountainHeart Community Services, Roane Co. Family Health Care, Raleigh County Community Action Association and West Virginia Department of Health and Human Services.

The $1.8 million going to the state agency is for maternal and child health services for families in West Virginia.

The federal Head Start program provides early childhood nutrition, education and health services.

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New ACA open enrollment numbers in WV show no change from same time last year http://www.wvgazettemail.com/article/20170110/GZ0115/170119948 GZ0115 http://www.wvgazettemail.com/article/20170110/GZ0115/170119948 Tue, 10 Jan 2017 18:19:21 -0500 Natalie Schreyer By Natalie Schreyer The number of West Virginians who enrolled in health insurance plans on the Affordable Care Act's marketplace remained flat in comparison to this time last year, according to new data released by the U.S. Department of Health and Human Services.

Approximately 33,000 West Virginians signed up for a plan on the insurance marketplace as of Dec. 24, 2016, a drop of about 1,500 compared to this time last year, according to the report. The new total represents a slightly lower growth rate than the national average, said Aviva Aron-Dine, a senior official at HHS, on a press call with reporters.

"Fluctuations are normal and the Open Enrollment period is not yet over. With 32,855 having already selected plans for 2017 in West Virginia, this is clearly a product consumers want and need," said Jonathan Gold, press secretary for HHS.

Experts say a variety of factors can affect enrollment in the states, including outreach efforts, trends in population size, and the insurance market outside the ACA marketplace.

One local expert said outreach efforts in the state have been strong, with plenty of individuals known as "navigators" trained to assist citizens on their enrollment options and the signup process. Kat Stoll, health care policy analyst at the West Virginia Center on Budget and Policy, said West Virginia has done a "five-star job" of letting people know about their insurance options on the marketplace, and added that seeing the enrollment numbers stay level "means we're probably doing a good job."

But more West Virginians could be enrolled in health plans on the ACA marketplace. A report released in October 2016 by a division of HHS showed that 15,000 West Virginians who are currently buying insurance on the individual market outside the ACA marketplace could be eligible for subsidies if they chose to buy a plan from the marketplace.

As congressional Republicans debate a swift repeal of the ACA, West Virginia is one of the states that could be most affected. According to a report by the Urban Institute, if the ACA is partially repealed, West Virginia could see a 208 percent increase in the number of uninsured residents by 2019, making it one of four states that could see its uninsured rate triple or nearly triple. West Virginia's Medicaid expansion, which has provided coverage for about 170,000 West Virginians, is also at risk.

Ben Wakana, a spokesman for HHS, said on the call that the expansion has played a role in helping people get substance abuse treatment to combat the opioid epidemic.

"We think that should continue," he said.

Nationally, enrollment has increased by 286,000 over this time last year, bringing the total number of Americans covered by marketplace plans to over 11.5 million as of Dec. 24, 2016.

Reach Natalie Schreyer at natalie.schreyer@wvgazettemail.com, 304-348-5189, or follow @NatalieSchreyer on Twitter.

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Trump pushes GOP leaders for fast action on health care http://www.wvgazettemail.com/article/20170110/GZ0115/170119961 GZ0115 http://www.wvgazettemail.com/article/20170110/GZ0115/170119961 Tue, 10 Jan 2017 15:21:46 -0500 By Erica Werner The Associated Press By By Erica Werner The Associated Press WASHINGTON - President-elect Donald Trump pushed Congress Tuesday to act swiftly to repeal President Barack Obama's health care law, and follow up quickly with a replacement. House Speaker Paul Ryan, after talking with Trump, announced that the House would aim to take both steps "concurrently."

The push for speed and coordination came as growing numbers of Republicans expressed concerns about GOP leadership's plans to repeal the Affordable Care Act without a replacement in hand, even though the party has had more than six years to come up with one.

Trump made his comments in an interview with The New York Times.

"We have to get to business. Obamacare has been a catastrophic event," Trump said.

Under the congressional timetable, procedural budget votes set for later this week in the House and Senate will put the repeal process in motion. But the vote on repealing Obamacare isn't expected until mid-February at earliest; a full replacement hadn't been expected until months or even years later.

Trump seemed confused about that schedule, telling the Times that the repeal should be "probably sometime next week," and "the replace will be very quickly or simultaneously, very shortly thereafter."

Despite his imprecision, Trump was clear that he put an imperative on speed for both repealing and replacing the law. That contradicts the approach sketched out by GOP leaders who've described a transition period of months or years between repealing the law and replacing it with something else.

But even before Trump's comments Tuesday, the notion of a lengthy transition period was running into problems on Capitol Hill from Republicans anxious about waiting too long between repealing the bill and replacing it.

Ryan addressed reporters Tuesday morning and described a new goal.

"It is our goal to bring it all together concurrently," Ryan said. "We're going to use every tool at our disposal, through legislation, through regulation, to bring replace concurrent along with repeal, so that we can save people from this mess."

That may be easier said than done. Under arcane budget rules in the Senate, Republicans will likely be able to use their slim majority to push through repeal legislation without Democratic votes. But they would need Democrats' help to write a replacement bill. Ryan indicated Tuesday Republicans would try to get around that obstacle by passing some elements of the replacement bill using fast-track Senate rules, too.

Ryan announced the new plan to lawmakers Tuesday morning before discussing it with reporters. "He said we're going to be doing it concurrently with the repeal. He said he had a conversation yesterday with Donald Trump, and they're on the same page," said Rep. Dennis Ross, R-Florida.

GOP lawmakers, particularly House members who face voters every two years, are eager to repeal and replace the mammoth health law before the 2018 midterm elections, and some are frustrated that having finally grabbed the reins of power in Washington, the party is unprepared to act.

"We've been at it now for six years and it's time for us to produce a replacement plan and hopefully we'll do that in the very near term," said Sen. Bob Corker, R-Tenn., who's among a group of Republicans pushing for a delay in the repeal bill to allow time to write a replacement.

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With Medicaid expansion in doubt, what's next for free health clinic? http://www.wvgazettemail.com/article/20170109/GZ0115/170109585 GZ0115 http://www.wvgazettemail.com/article/20170109/GZ0115/170109585 Mon, 9 Jan 2017 18:00:00 -0500 Natalie Schreyer By Natalie Schreyer As the fate of the Affordable Care Act and Medicaid expansion remains largely unknown, local health care providers are confronting the potential consequences. One Charleston free clinic that caters to uninsured and underinsured West Virginians, half of whom are on Medicaid, is prepared to face an uncertain future.

With the looming possibility of a repeal of the Medicaid expansion, Angie Settle, the executive director of West Virginia Health Right, fears an influx of patients from across the state who might have no choice but to travel to Health Right if they became uninsured.

And with budget cuts lowering the clinic's state funding in recent years, Settle worries Health Right could be forced to "see even more people with less money."

According to West Virginia's budgets, state funding for Health Right has been declining since 2013, dropping from $4.4 million to $2.75 million this fiscal year amid a budget crisis, a drop of about 37 percent. Those funds are divided among the eight free clinics in the state, leaving the Charleston location with approximately $800,000 from the state, which can vary, according to Settle.

Patricia Rouse Pope, executive director of the West Virginia Association of Free Clinics, said if the Medicaid expansion is rolled back as part of a repeal of the Affordable Care Act, she hopes West Virginia's legislature and governor-elect Jim Justice will recognize the need to keep or even increase the amount of money allocated to free clinics as part of the state's budget.

Senate Finance Chairman Mike Hall, R-Putnam, called Health Right a "significant piece" of the health care picture for local citizens, and added the clinic saves the state money by treating patients who might otherwise end up in an emergency room.

To provide its services, which include health education classes in addition to medical, dental, vision, pharmaceutical and behavioral health treatments, the clinic relies heavily on private grants and donations. But at the core of Health Right are its physician volunteers, nurses and staff.

One of those staff members, nurse and health educator Mary Ann Workman, decided to become a teacher after spending her professional life as a psychiatric nurse. But, she said, the two career paths aren't that different.

"If you're a nurse, you're a teacher," she said.

Workman's popular cooking class sees as many as 25 students per session.

Her healthy living lessons, built around exercise, portion control, and ingredients like lean meats, whole grains and vegetables, hit close to home. Prior to joining Health Right 16 months ago, Workman said she was overweight and a smoker.

Settle thought Workman would be perfect for the teaching position, if she quit smoking. So they struck a deal. Workman became educated on the issues of weight loss and smoking cessation, she said, by living through them herself.

One of her students, Edward Grant, 69, came in more than a year ago as a pre-diabetic patient, but before long, he was a volunteer doing clean-up after Workman's cooking class. Since then, Grant said he has lost 49 pounds and gone from four medications down to one baby aspirin a day. Now, he spends at least four hours a day volunteering at the clinic, but he can often be found hanging around outside those hours.

"It's like home," he said.

Even at this time of uncertainty, Health Right is expanding. The clinic is adding two more chairs to its dental space and building another vision room for eye exams, although it still needs equipment to fill the additional vision space. A mobile dental clinic is also in the works sometime in the next few months that would bring dental services to rural areas.

As a new presidential administration and Congress vow to repeal the Affordable Care Act with no detailed replacement plan yet, Rouse Pope said she is "trying to anticipate what kind of challenges that may create" as more people could become uninsured again.

But Settle said Medicaid reimbursements do not affect the clinic's philosophy.

"We don't ever let that rule our care," she said.

Reach Natalie Schreyer at

natalie.schreyer@wvgazettemail.com,

304-348-5189, or follow

@NatalieSchreyer on Twitter.

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3 years after MCHM spill, concern about WV drinking water remains http://www.wvgazettemail.com/article/20170109/GZ0116/170109586 GZ0116 http://www.wvgazettemail.com/article/20170109/GZ0116/170109586 Mon, 9 Jan 2017 17:26:36 -0500 Ken Ward Jr. By Ken Ward Jr. Three years after the Freedom Industries chemical spill and the Kanawha Valley water crisis that followed, citizen groups and environmental advocates on Monday said the state has made much progress but that continued work to protect West Virginia's drinking water needs to remain a priority.

Representatives of the West Virginia Rivers Coalition, Advocates for a Safe Water System, the Ohio Valley Environmental Coalition and the West Virginia-Citizen Action Group gathered at the Capitol for a brief ceremony to mark the anniversary of the Jan. 9, 2014, spill that contaminated the Elk River drinking water supply that serves hundreds of thousands of people in Charleston and the surrounding region.

"We wanted to be here today to send a message that we still care, we're still paying attention to the protection of our water," said Angie Rosser, executive director of the Rivers Coalition.

Rosser was joined at the event by Evan Hansen, a Rivers Coalition consultant and member of a state government commission studying drinking water safety efforts, and Paul Dalzell, a leader of the group Advocates for a Safe Water System. Also speaking at the event was Kevin Thompson, a lawyer for residents and businesses that sued West Virginia American Water Co. and Eastman Chemical, the maker of the chemical MCHM, over the water crisis.

Hansen discussed legislation passed after the spill to regulate above-ground chemical storage tanks and to force public drinking water systems to plan for how they could prevent or respond to spills like the one at Freedom.

"We've made great strides in protecting our water," Hansen said, "but there's still work to be done."

In particular, Hansen said it is important for public water systems to now work to implement the safety measures outlined in their new source-water protection plans. Also, Hansen highlighted recommendations in the latest annual report from the West Virginia Public Water System Supply Study Commission that call for water systems to be informed whenever the contents of upstream chemical storage tanks change and for improvements in the state Department of Environmental Protection's spill reporting hotline.

Dalzell said Advocates for a Safe Water System continues to work on its top priority: A public takeover of West Virginia American's private water supply system for the Kanwha Valley. Also, he noted, the group is taking part in the state Public Service Commission's ongoing investigation of the spill. Public-comment hearings for that investigation are scheduled for 1:30 p.m. and 6 p.m. Jan. 17 at PSC headquarters, on Brooks Street. The commission's formal evidentiary hearing is scheduled to continue Jan. 24-26.

Thompson said lawyers are still working out the final details of a tentative settlement with West Virginia American and Eastman, which will pay up to $151 million to businesses and residents affected by the "do not use" order issued during the water crisis caused by the Freedom spill.

"This settlement covers everybody, whether they signed up with a lawyer or not," Thompson said.

Details of how to file claims are among the details still being worked out in the case, which is before U.S. District Judge John Copenhaver Jr.

Various lobbyists and some state officials milled around in the Capitol's Upper Rotunda, just above where the water crisis ceremony was taking place in the Lower Rotunda. Two members of the Legislature spoke briefly at the event.

Delegate Mike Pushkin, D-Kanawha, said, "Water is important to economic development. It's not a partisan issue. We should all work together to protect this fundamental thing that we all need."

Delegate Barbara Fleischauer, D-Monongalia, noted that lawmakers did go back and weaken the above-ground storage tank legislation a year after the spill, and said citizens need to continue to pressure lawmakers to ensure the state's water protection remains strong.

"It's not perfect," Fleischauer said of the new law. "We really moved forward, and then we moved back, and we need to make sure we move it forward again."

Reach Ken Ward Jr. at kward@wvgazettemail.com, 304-348-1702 or follow @kenwardjr on Twitter.

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2 drug distributors to pay $36M to settle WV painkiller lawsuits http://www.wvgazettemail.com/article/20170109/GZ0118/170109595 GZ0118 http://www.wvgazettemail.com/article/20170109/GZ0118/170109595 Mon, 9 Jan 2017 14:18:06 -0500 Eric Eyre By Eric Eyre Two of the nation's largest drug wholesalers have agreed to pay a combined $36 million to settle lawsuits that allege the companies benefited from West Virginia's problem with prescription drug abuse.

Cardinal Health, the largest supplier of drugs in West Virginia, will pay the state $20 million. AmerisourceBergen, the third-largest drug distributor in the state, agreed to pay $16 million.

It's believed to be the largest pharmaceutical settlement in state history.

The lawsuits had dragged on for more than four and a half years in Boone County Circuit Court and spanned the terms of two attorneys general.

The settlement money will go to drug treatment programs that help West Virginians addicted to opioid drugs such as heroin and prescription painkillers. The money will be kept in a special account at the State Auditor's office.

"We've taken steps to combat drug abuse in West Virginia with distributors, prescribers and pharmacists, and the money from this settlement will help us expand those efforts with additional treatment and long-term recovery options," Gov. Earl Ray Tomblin said.

Cardinal Health and AmerisourceBergen denied any wrongdoing. The distributors transport drugs from manufacturers to pharmacies.

On Dec. 28, Boone Circuit Judge Will Thompson issued an order, notifying the court that Cardinal Health and AmerisourceBergen had reached settlements with the state. The judge directed the companies and the government to disclose the terms this week.

In addition to the settlement payments, Cardinal Health and AmerisourceBergen agreed to promptly alert state authorities when they see suspicious drug orders from pharmacies.

Cardinal Health has been faxing reports about suspicious orders since June 2012, after then-Attorney General Darrell McGraw sued the company. AmerisourceBergen did not submit any reports. The state Board of Pharmacy has acknowledged that it never enforced the reporting law.

The reports also will go to the Attorney General's Office and the West Virginia State Police.

"We believe that the best possible way to manage this issue is to encourage drug distributor customers, like pharmacists and physicians who work directly with patients, to prescribe and order pain medications responsibly and appropriately," said Gabe Weissman, an AmerisourceBergen spokesman. "Simultaneously, we will continue to do our part to provide the safe and efficient distribution network that ensures product availability for the treatments that preserve or enhance quality of life for patients with legitimate needs, while working with all partners to limit and prevent abuse."

Monday's announcement follows a Gazette-Mail investigative report, which found that drug wholesalers shipped 780 million hydrocodone and oxycodone pills to the state in just six years, a period when 1,728 West Virginians fatally overdosed on those two drugs.

Cardinal Health and AmerisourceBergen combined to ship nearly 40 percent of all hydrocodone and oxycodone pills to West Virginia, according to the newspaper's analysis of U.S. Drug Enforcement Administration data. Several counties saw significant spikes in shipments while drug overdose deaths were climbing.

For instance, Cardinal Health's sales of hydrocodone to Cabell and Logan counties increased six-fold between 2007 and 2010, and doubled in Kanawha County in just one year. AmerisourceBergen's oxycodone sales in Greenbrier County nearly quadrupled over six years, DEA records show.

"Obviously, they had to know, with a state this size, and that many pills coming in, that something wasn't right," Tomblin said Monday.

In 2012, McGraw filed lawsuits against Cardinal Health, AmerisourceBergen and a dozen smaller drug distributors for their role in a drug supply chain that includes doctors who write prescriptions for nonmedical purposes and "pill mill" pharmacies that dispense excessive numbers of painkillers. Attorney General Patrick Morrisey inherited the case upon taking office in January 2013.

The West Virginia Department of Health and Human Resources, along with the Department of Military Affairs and Public Safety, later joined the lawsuit as plaintiffs.

Previous settlements, with nine smaller wholesalers, have netted the state more than $11 million.

Last January, Morrisey's office sued McKesson Corp., the second-leading prescription opioid shipper to West Virginia. That case remains stuck in federal court, with no settlement expected anytime soon.

The state's settlement with Cardinal Health and AmerisourceBergen won't end all litigation the companies face in West Virginia. In late December, the McDowell County Commission filed suit against those firms and McKesson, alleging the wholesalers contributed to the county's opioid epidemic by shipping far too many pain pills there.

And last week, Kanawha County Commission President Kent Carper said the county and the city of Charleston intend to sue the drug wholesalers. Other counties also are expected to file lawsuits aimed at recouping costs associated with prescription drug abuse.

West Virginia has the highest drug overdose death rate in the nation.

"It's been devastating," said Tomblin, whose brother was convicted in federal court in 2014 of selling prescription painkillers. "The amount of money, and the grief and loss of life that these pills have cost the people of West Virginia, it's hard to put a dollar figure on it. The treatment is going to have to go on for years."

The Gazette-Mail's investigation, "Painkiller Profiteers," revealed that a disproportionate number of pain pills was shipped to Southern West Virginia, a region that also shouldered the highest rate of overdose deaths caused by prescription opioids between 2007 and 2012. The largest shipments often went to independent drugstores in small towns.

Cardinal Health has said that its hydrocodone and oxycodone sales make up only a small fraction - about 7 percent - of its total doses of prescription drugs shipped to West Virginia. Hydrocodone is sold under brand names like Lortab and Vicodin. Oxycodone is known better under its OxyContin brand name.

"While the company denies the state's allegations, Cardinal Health recognizes that the epidemic of prescription drug abuse is a multifaceted problem driven by addiction and demand," the drug wholesaler said in a news release.

Outside lawyers representing the state are expected to collect attorney fees equaling a third of the settlement amount.

Tomblin said he talked with Morrisey last week, asking that the attorney general put his portion of the settlement funds into the special account at the Auditor's Office to ensure the money goes to drug treatment and prevention programs. The DHHR and the Department of Military Affairs and Public Safety are putting their settlement money in the account.

"I would hope he would put his share of the settlement into the trust fund, also," Tomblin said. "He said he would check with his people and let us know, but he hasn't let us know yet."

A Morrisey spokesman did not respond to a request for comment.

Morrisey's and Tomblin's offices issued a joint news release Monday. As part of the settlement, the drug distributors had a say in the wording of the release, which notes that the companies shipped drugs only to licensed pharmacies. The wholesalers have defended their actions by using the same language in their own news releases.

Reach Eric Eyre at ericeyre@wvgazettemail.com, 304-348-4869 or follow @ericeyre on Twitter.

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Hurricane nonprofit providing for health care in rural WV counties http://www.wvgazettemail.com/article/20170108/GZ0108/170109621 GZ0108 http://www.wvgazettemail.com/article/20170108/GZ0108/170109621 Sun, 8 Jan 2017 19:24:38 -0500 Ali Schmitz By Ali Schmitz A Hurricane nonprofit is using nearly $1 million in government and private funds to finance a rotating loan fund for health care in 26 rural West Virginia counties.

The Center for Rural Health Development Inc.'s West Virginia Rural Health Infrastructure Loan Fund project is designed to strengthen the health care industry in nearly half of the state's counties.

About a third of the funds come from a grant under President Barack Obama's POWER Initiative. The program is designed to assist communities hit hard by the decline of the coal industry.

The rest of the funds come from foundations and banks.

Sharon Lansdale, the center's president and CEO, said the organization differs from many others throughout the nation because it partners with public and private health care providers.

"What we always say is, 'We don't care how health care is developed in the community, as long as it's sustainable and reliable,'" Lansdale said.

The center's goal is to ensure appropriate health care providers stay in rural areas - whether it is a large hospital or a doctor in private practice.

Lansdale said one of its primary focuses is to make sure primary care services remain in these counties.

"We've provided everything from helping them purchase technology to have health care buildings built," Lansdale said.

The center's loans process has never failed, according to Lansdale. She said she believes the reason why is because they often partner with private loan providers. A bank loan often provides partial funds for projects, and the center covers the rest.

"We provide a lot of technical assistance for borrowers and lenders," Lansdale said.

She said many lenders don't have the time or expertise to properly work for years with providers, so when they step in, it becomes a "win-win-win situation" for the center, the lender and health care providers.

Lansdale said health care is one of the most important factors in rebuilding infrastructure in struggling communities. She believes proper health providers are as integral to communities as water and housing. Without them, she thinks businesses will not relocate or open in the area.

"Our hope is our little part in helping coal-impacted counties in West Virginia will help businesses," Lansdale said.

"We hope it'll help these areas grow infrastructure."

Reach Ali Schmitz at

ali.schmitz@wvgazettemail.com,

304-348-4843 or follow

@SchmitzMedia on Twitter.

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What a difference a year makes: Woman focused on detox after addiction http://www.wvgazettemail.com/article/20170108/GZ05/170109672 GZ05 http://www.wvgazettemail.com/article/20170108/GZ05/170109672 Sun, 8 Jan 2017 02:00:00 -0500 Bill Lynch By Bill Lynch The Scottish author and theologian Ian MacLaren wrote, "Be kind. For everyone you meet is fighting a hard battle."

What that battle is, though, can be hidden, especially if it's an addiction. Recurring stories about the damage to communities caused by prescription pain pills and heroin can be sobering, but the damage itself isn't entirely unexpected.

People have known addiction is bad for decades, but they can forget what addiction looks like.

Police mugshots sometimes show pictures of wild-eyed and disheveled men and women, people who look to be in the middle of a crisis, street people strung out on drugs they used in alleys or abandoned buildings. But an addict can be anybody, even the girl next door.

Nina Zakas is that girl - or she used to be.

Growing up in Rand, the sandy-haired and petite 28-year-old was a cheerleader.

"I cheered in elementary and middle school," she said. "In high school, I was more interested in art and theater."

She laughed. "I thought I was going to be an actress."

That never really panned out. A lot of things didn't pan out.

"I was addicted to heroin," she said, plainly. "I was an IV user. I shot up for eight years."

Nina was cautious about assigning blame. Many 12-step programs, like the one she participates in, insist on participants taking responsibility for past actions. She seemed to believe a propensity toward addiction was part of who she is, but acknowledged her addiction had a starting point.

"I had cancer," she said.

At 15, Nina noticed an odd lump in her breast, but she didn't think a lot about it at the time.

"I just thought it was one of those things that you get that just sort of come and go," she said.

The lump didn't, and when she saw her doctor several weeks later for her annual physical, she mentioned it.

Tests were done, but Nina said the doctor didn't follow up. Nobody said anything about the lump until almost two years later when a doctor told her she had breast cancer.

In the late spring and summer between her junior and senior year at Riverside High School, Nina underwent surgery to remove the cancer, followed by radiation therapy.

The doctor who sat on the test results, Nina said, lost his job, but the treatment was successful.

"I've been cancer-free for 10 years," she said. "I didn't even lose my hair or nothing."

But there was pain. Her new doctor prescribed OxyContin, an opiate, which Nina began to abuse over time.

"It became an excuse to use," she said. "I went through this thing [cancer], so I deserved to do this."

Her teenage OxyContin use was just occasional, and Nina felt like she was in control. Besides, in high school, the drug of choice among her peers was alcohol.

"I drank at parties and stuff," she said.

Shortly after graduation Nina's opioid use quickly increased. Finally, she switched to heroin.

"It was just cheaper," she said.

Addiction to something like heroin, she said, is hard to describe to someone who is not addicted to heroin.

"I guess you think of it as like being addicted to cigarettes - only 10 times worse," she said.

Nina checked herself into her first rehab clinic when she was 21 and tried to quit several times through her 20s, sometimes managing to stay clean for several months.

"But sooner or later I'd go right back to it," she said.

The amount of heroin only grew.

Nina pointedly said she was not a casual or light drug user. She wasn't flirting with drug use.

"I was the girl who'd nod off after shooting up in her mother's bathroom," she said. "Those people you keep hearing about on television who they find passed out in parking lots? That was me."

She overdosed several times.

One of the worst was after she and a friend drove a drug dealer home from West Virginia to Detroit.

"We figured if we helped him out, we'd get some free stuff," Nina said.

They did, and she overdosed.

"Nobody even knew I was in Detroit," she said.

Over the last six years, Nina said she found herself in one bad situation or rough place after another.

"I was involved in a lot of things I'm not proud of," she said.

Nina stole from her family to supply her habit.

"My mother finally cut me off," she said.

They still don't talk.

She took drugs from her boyfriend, who she said dealt drugs but wasn't an addict.

"At least, he wasn't a heroin addict," Nina said. "He had his own trouble with alcohol."

Despite being involved in criminal activity and associating with criminals, Nina said she was never arrested, though the threat of going to jail for anything weighed heavily on her. Just the anxiety of being on the road, driving anywhere, she said, was almost more than she could bear.

She was almost always carrying something that would get her arrested.

"I was terrified and paranoid," she said. "That was my worst fear - getting caught and being 'dope sick' in jail. I heard that was the worst, that they did nothing for you in prison."

She feared being vulnerable and detoxing from heroin without help.

While using, Nina maintained the semblance of a normal life. She held jobs and went to school, but then, almost a year ago, Nina said she'd finally had enough.

"I wasn't homeless or in trouble," she said. "I was just bankrupt inside. I was empty. There wasn't another use left in me. I just could not do it anymore."

So, nine months ago, Nina checked herself into Highland Hospital's detox program. Shortly thereafter, she began going to meetings through the 12 Step Fellowship, an addiction recovery organization.

"I go to meetings every day," she said.

Some meetings are in Charleston. Others are around the county, but Nina said she doesn't miss.

"Each meeting is different," she said. "Some of them are open meetings; you can bring your family. People bring their kids. Others are just for addicts."

Some meetings Nina has been to are attended by a handful, but many are becoming crowded.

"It's not unusual for there to be 70 people at this one meeting I go to," she said. "I don't think people understand how big of a problem drug addiction is here. It's huge."

The meetings are only part of the process of staying sober.

"I had to give up the life I was living," she said.

That included giving up on her boyfriend, whom she said she'd been with for six years. She lost a lot of friends, too.

Nina laughed bitterly. "It's true what they say, you find out who your real friends are."

As a recovering addict, Nina said she hasn't replaced her addiction with something else. She doesn't drink, for example.

"I don't party anymore," she said, with regret. "I don't even smoke."

Nina's life is quieter and tamer now. A night out is to maybe see a movie, but she's not alone. She's made friends and is dating.

"My boyfriend now is in recovery, too," she said.

She has a good job, works with people she likes, who seem to accept her, though she doesn't know how much they know about her past.

"I think most people know what I'm about. They know I'm going to meetings," Nina said. "I'm open about it."

She's hopeful for the future and would like to continue her education someday.

"Maybe I could become a dental hygienist," she said. "That sounds pretty good to me."

One day, she could be mother, too.

Nina said she felt like she dodged a bullet by not having children young. Nothing about that would have ended well.

"But I think that could be a someday kind of thing, too," she said.

Nina hoped to mend some of her lost relationships over time - with her mother, certainly, but not everyone.

Some of her family have their own struggles, and while she loves them, she also said she can't be around them because she must stay focused on her sobriety.

Nina wanted to share her story with other addicts, people who haven't hit bottom yet, but are maybe thinking about getting clean.

There are a lot of services for people who want to try.

"I'm here to tell you, you can do it," she said. "If I can convince one other person like me to quit, it's all worth it."

Reach Bill Lynch at

lynch@wvgazettemail.com,

304-348-5195 or follow

@LostHwys on Twitter.

Follow Bill's One Month at a Time progress on his blog at

blogs.wvgazettemail.com/onemonth/.

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Campaign aims to increase WV's sugary drink tax http://www.wvgazettemail.com/article/20170107/GZ0101/170109670 GZ0101 http://www.wvgazettemail.com/article/20170107/GZ0101/170109670 Sat, 7 Jan 2017 15:26:43 -0500 Lori Kersey By Lori Kersey Several health-related organizations in West Virginia plan to lobby the state Legislature this year for an increase in the state's sugary drink tax.

Local chapters of the American Heart Association, the American Academy of Pediatrics, the West Virginia Center on Budget and Policy, West Virginians for Affordable Health Care and others plan to ask lawmakers for a tax increase of at least 1 cent per ounce on beverages such as soft drinks, energy drinks and fruit juice with added sugar, said Christine Compton, government relations manager for the West Virginia chapter of the American Heart Association.

The legislation hasn't been drafted yet. As of now, the proposal would not include diet drinks, but that could change, she said.

Proponents of the "A Few Cents Makes Sense" campaign say the point is to reduce the consumption of sugary drinks in West Virginia.

"One of the things we've learned over the years, especially from tobacco taxes, we know when prices goes up consumption goes down, as long as it's a significant increase," she said.

A price increase of 10 percent reduces consumption by 12 percent, she said.

West Virginia has long had a history of obesity and poor health outcomes. In 2016, West Virginia tied with Alabama and Mississippi to have the second highest obesity rates in the country, according to The State of Obesity, a project sponsored by the Trust for America's Health and the Robert Wood Johnson Foundation. More than 35 percent (35.6 percent) of state residents were obese in 2016, according to the rankings. Only Louisiana, with 36.2 percent, had a higher obesity rate.

Many of West Virginia's children also have early signs of obesity. According to a study released last month by CDC researcher David Freeman, the number of high weight-to-length infants in West Virginia's WIC program increased two points from 2010 to 2014 while the country's overall rate declined two points. Having a high weight for length is an indicator for potential future obesity.

Dr. Jamie Jeffrey, a pediatrician and director of Keys for Healthy Kids, said sugary drinks make up 46 percent of added sugar calories in peoples' diets.

Nowadays added sugar is found in all kinds of food. That's led to children preferring foods with sugar to those without it. Anything that doesn't have sugar - such as vegetables - tastes bad to them, she said.

Jeffrey said the sugary diets have led children to have diseases that are typically found in adults; pre-diabetes, high cholesterol and high triglycerides, for instance. The answer isn't only to stop kids from drinking sugary drinks, but it's a good place to start.

"We have to start with the low-hanging fruit," Jeffrey said. "The low-hanging fruit is to eat the fruit and not to drink the fruit juice."

While fruit has sugar, it's better for people because it's not processed and it has nutritional value like fiber in addition to sugar.

Jeffrey said she would support a tax of more than 1 cent per ounce. The point is to price it high enough that kids and teenagers can't purchase it, she said. Jeffery compared sugar to tobacco. Studies show the sugar industry has been doing things similar to what the tobacco industry did to promote their products, including targeting young people, paying experts to promote their products as healthy and funding studies that indicate their products are safe, she said.

The portion sizes of these drinks have increased over the years, too. The average size of a soda has more than doubled since the 1950s, up from 6.5 ounces to 16.2 ounces, according to the Center for Science in the Public Interest

West Virginia already has a soft drink tax of 1 penny per 16.9 fluid ounces. The tax benefits the West Virginia University School of Medicine.

Compton said opponents of the proposed tax argue that because the state's current tax hasn't stopped consumption, neither would a new tax. But, she said, the state's current tax is insignificant and most people don't realize it's there.

The proposed sugary drink tax would bring in an estimated $89 million annually at one cent per ounce and $128 million per year at 2 cents per ounce, Compton said.

The American Heart Association doesn't have a vested interest in where the money goes, she said. Some proponents have suggested that it fund West Virginia's Medicaid program or the general fund.

"We really don't care where the money goes," Compton said. "Our main reason in being involved is reducing that consumption."

Kelli Caseman, director of the WV Kids' Health Partnership, a project of West Virginians for Affordable Health Care, said they're not asking for how the revenue from the tax would be used. They just hope the tax would give people pause before they buy a soda or an energy drink, she said. Caseman said at this point in the campaign they're still trying to find backers to join.

"We're going to be spending the next month trying to pull as many people as we can into the vote," she said.

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

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Nearly 5 percent of WV babies born drug dependent in 2016 http://www.wvgazettemail.com/article/20170107/GZ01/170109688 GZ01 http://www.wvgazettemail.com/article/20170107/GZ01/170109688 Sat, 7 Jan 2017 13:37:25 -0500 The Associated Press By The Associated Press BECKLEY - State health statistics show that nearly 5 percent of babies born in West Virginia in 2016 were born drug-dependent.

The Register-Herald reports that out of every 1,000 live births in the state last year, 49.9 babies were born with Neonatal Abstinence Syndrome, a result of the sudden discontinuation of the baby's in-utero exposure to substances used by the mother during pregnancy.

The information is based on the latest data from the West Virginia Health Statistics Center.

In 2014, the rate was 32.1 babies per 1,000, and in 2015, the rate was 34.4.

The West Virginia Department of Health and Human Resources did not begin collecting NAS data from birth certificates until 2014. Public Information Officer Toby Wagoner said the data, therefore, is likely underreported.

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Outgoing health secretary to start new position at WV United Health System http://www.wvgazettemail.com/article/20170106/GZ0101/170109725 GZ0101 http://www.wvgazettemail.com/article/20170106/GZ0101/170109725 Fri, 6 Jan 2017 17:38:53 -0500 Natalie Schreyer By Natalie Schreyer Outgoing Secretary of Health and Human Resources Karen Bowling will join the West Virginia United Health System.

The announcement comes just one week after she said she would leave her post as secretary in January.

Bowling told the Gazette-Mail last week that she would begin a new position starting in February, one that she said would have "significant impact on the people in our state and their health." She spent most of her professional life in the private sector as a nurse, hospital administrator, and board member of several nonprofit organizations, among other roles, before joining Gov. Earl Ray Tomblin's administration in July 2013.

At West Virginia United Health System, Bowling will help transition the hospital to a new way of caring for patients that emphasizes preventive care and improving health by controlling the rates of chronic diseases. The system is designed to reduce costs, keep patients from returning to the hospital with the same problems and reward hospitals that keep people healthy. As vice president of care delivery transformation, Bowling will be part of the team that works on implementing this system.

Under the Affordable Care Act, the federal government has moved toward a model of reimbursing health care providers based on the quality of care they provide rather than the amount of services they perform.

"Not only is Karen a great clinician and administrator, but she's also got a vision of what the government is trying to do for health care that we think is very unique and can help us to be prepared for the future," said Albert Wright, president and CEO of West Virginia University Health System.

Bowling was not immediately available for comment, but in a statement released by WVU Health System she said, "I am honored to join the dynamic team at West Virginia United Health System.

"This position will allow me to serve West Virginians using my healthcare knowledge and my wide array of experience as both a clinician and administrator to improve the health and well-being of our citizens. I truly care about the people of the State of West Virginia and appreciate the opportunity to continue to contribute," Bowling said.

Reach Natalie Schreyer at natalie.schreyer@wvgazettemail.com, 304-348-5189, or follow @NatalieSchreyer on Twitter.

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