On Wellness in WV

I wrote a story for today’s paper about a mindfulness training to be held in the fall for first responders from Kanawha, Putnam and Cabell counties. We have limited space in the paper, but I wanted to share more about the research being conducted on the training, and what agencies that don’t operate in Kanawha, Putnam or Cabell counties can do.

Richard Goerling, a police lieutenant in Oregon who developed a training on first responder resiliency and performance, will be leading the two-and-a-half day training. He says it’s about noticing emotions as they arise, and not spending unnecessary energy trying to control or ignore the emotion. He also says it’s about learning to pay attention to stress-related changes in the body. Goerling said participants will learn “how do we be present and create space for performance with the emotion that arises.”

“Ignoring emotion actually makes us more weak,” he said. “Typically today we wait until first responders are broken and then we try to fix them.”

Organizers have not announced where in the region the event will be held, but it is planned for late fall.

Dr. Michael Brumage, executive director and health officer for the Kanawha-Charleston Health Department, and Brittany Canady, a health psychologist at Marshall University, applied for a $49,000 grant to get the training. West Virginia Clinical and Translational Science Institute will conduct research on it, based on standardized self-assessments, and will test the presence of stress hormones in a person’s saliva before the training and then again weeks after it’s over. Researchers will measure participants’ baseline emotional physical and mental well-being through questionnaires and also measure salivary cortisol level (an indicator of stress). They predict changes in mindfulness, physical health, mental health and stress, and that those changes will be reflected in salivary cortisol levels at 4 weeks and 90 days after the intervention.

The grant application says that results “will be shared with the first responder community.” But only about 70 people will be trained.

“Our hope is that we can test out this intervention, hopefully find out that it’s helping people, and then be able to relay those results to others so the word can get out,” Canady said. “There’s really nothing that we know of that’s been done with first responders in Appalachia.”

Here’s what organizers told me about what other counties with fewer resources could do:

Goerling suggested that West Virginia agencies that lack funds to hold similar trainings could look for local yoga trainers. He also noted that in early 2018, Pacific University Graduate School of Psychology in Oregon and the University of California San Diego Center for Mindfulness will launch a peer coach training. West Virginia agencies could send representatives, who could then come back and train staff. He also recommended pooling resources with other local and regional agencies.

Brumage also noted that there are meditation and tai chi groups in the region.

“I think our best advocates for this kind of training will come from the first responder community themselves,” he said.

first-responders

 

Sometimes you can can learn a lot about someone by what they don’t say.

On July 15, we published a story I wrote about how a plan the U.S. Senate was considering to repeal and replace the Affordable Care Act would cause West Virginians to lose access to addiction treatment.

The story noted that the bill would end Medicaid expansion in West Virginia and make deep cuts to traditional Medicaid. It noted that in 2016, about 50,000 of those covered by Medicaid expansion in West Virginia had substance-use disorders, according to the Department of Health and Human Resources.

From the story:

The Congressional Budget Office hasn’t released an estimate for the newest version of the bill. But it estimated the similar previous version would cut Medicaid by $772 billion over 10 years, based mainly on ending the extra funding for states that expanded Medicaid under the Affordable Care Act and setting per-capita-based caps on traditional Medicaid payments to states. It estimated 15 million fewer people would have Medicaid in 10 years.

Medicaid is the single largest payer of substance abuse and mental health treatment in the country. Nationwide, Medicaid covered three in 10 people with opioid addiction in 2015, according to the Kaiser Family Foundation. West Virginia has the highest overdose death rate in the nation, mainly due to opioids.

The newest version of the bill could also make obtaining coverage harder for people who have been addicted to opioids to find coverage on the private market because it would allow insurers to sell plans that discriminate against people with pre-existing conditions by charging higher rates.

Dr. James Berry, addiction psychiatrist and medical director at West Virginia University’s Chestnut Ridge Center, said the bill would be “devastating to the people who don’t have the financial resources in order to take advantage of programs such as ours.”

Lois Vance, addiction care coordinator at Kanawha City Health Center, said “If they lose their insurance, the whole world is going to be looking down on them again.”

And from a previous story:

Medicaid expansion money spent on substance abuse treatment, including services and prescriptions, increased from about $25 million in 2014 to $111,767,057 in 2016.

In 2013, 5,827 people with opioid abuse diagnoses were covered by Medicaid, according to the DHHR. Medicaid paid for $6.8 million in opioid abuse-related claims that year. By 2016, the number had increased to 14,808 patients. Medicaid paid for more than $17 million in opioid abuse-related claims that year.

All three members of the U.S. House of Representatives — Reps. David McKinley, Alex Mooney, and Evan Jenkins, all Republicans — voted for a bill that would have similarly resulted in a loss of coverage among the opioid-addicted population in West Virginia. It would have cut Medicaid by an estimated $834 billion over 10 years, resulting in 14 million fewer Medicaid enrollees by 2026, the Congressional Budget Office found. States would also have been allowed not to require insurers to cover certain conditions, including mental health and substance abuse problems.

Spokesmen for Mooney and McKinley have not responded to requests for comment on how their votes could have affected the opioid-addicted population in West Virginia. Those requests were sent July 17, following the release of the latest story.

A spokeswoman for Jenkins responded to the initial request, but never sent a statement or set up an interview as requested.

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AP file photo

National news outlets are reporting that President Trump invited a group of senators to the White House tonight, to convince them to support the GOP plan to repeal the Affordable Care Act.

But at about 8:30 p.m. Monday, two additional senators, Jerry Moran of Kansas and Mike Lee of Utah, said they would not even vote to begin debate on the legislation. Two other senators, Rand Paul of Kentucky and Susan Collins of Maine, had already said they could not support the bill, and without Democratic support, GOP leaders could only lose two votes and still pass the bill.

Sen. Shelley Moore Capito, R-W.Va., who would have cast a key vote, “didn’t receive an invite” to the meeting with Trump, according to spokeswoman Ashley Berrang.

Berrang said, via email, that Capito’s absence at the meeting doesn’t indicate a position and referred to last week’s statement.

Berrang said Capito “intends to review the CBO score when it is released, and that has not happened.”

Compared to the previous version, the bill makes similarly deep cuts to Medicaid. Capito has said the previous version cut that program “too deeply.”

It adds $45 billion to combat the opioid crisis. Capito has said she advocated for that funding, but health policy experts have said it won’t be enough to make up for other detrimental provisions of the bill.

Politico reports: “Aides to key swing-vote Republicans including Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Jeff Flake of Arizona, Cory Gardner of Colorado and Ron Johnson of Wisconsin said they were not attending.”

From the Hill: “a White House official said the following GOP senators were attending: No. 2 Senate Republican John Cornyn (Texas), Lamar Alexander (Tenn.), Roy Blunt (Mo.), Steve Daines (Mont.), James Lankford (Okla.), Richard Shelby (Ala.), and John Thune (S.D.).”

 

 

 

Before Tom Price came to town to “listen”

Remember when U.S. Health and Human Services Secretary Tom Price visited Charleston in May for a “listening tour” on opioid addiction? Of course you do. West Virginia made national news when journalist Dan Heyman was arrested after attempting to ask Price a question, about whether domestic violence would count as a pre-existing condition under the GOP plan to replace Obamacare.

I found the description of the event as a “listening tour” a bit strange, because I knew from a previous open records request that state officials had already told GOP leaders supporting the bill, in letters, that it would “negatively affect the ability of West Virginians with mental, behavioral health and substance use disorders to access needed services,” and that the president’s budget would have a “dramatic impact on substance abuse and mental health services.” “Federal funding must be maintained or West Virginia’s health care infrastructure will collapse,” both Governors Jim Justice and Earl Ray Tomblin have said.

So I wanted to know more about who, exactly, thought the tour was a good idea, what the Trump administration had to say when they contacted state officials, and the planning that went into it.

If you’re interested, here are the 155 pages of emails DHHR was required to send me under state law. Some of the highlights include:

Laura Trueman, of HHS, emails the governor’s office, saying Price wants to come on Tuesday, May 9 to “highlight work being done on opioids by the states.” The email also says he wants to perhaps “meet with the Governor and his Advisory Council, and then go see something in the community – perhaps first responders, hospital visit, or a rehab place or drug court.” The governor did not attend.

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HHS officials also insisted that press not be able to attend the roundtable discussion (although we were able to attend a four-question “press conference.” Most of my time at that event was spent listening to prepared statements by various officials, not on questions.) According to emails, Butch Antolini, a spokesman for the governor, asked about making the event open to press. Trueman gives reasons why not:

no-press

HHS was apparently concerned about “losing control of the message,” which conflicts with its stated goal of a “listening tour.”

They also stated that “Candor might be compromised.” This is confusing to me, because we at the Gazette-Mail regularly speak to most of the roundtable participants about the opioid crisis.

More concerns about press:

press

Trueman sends suggested language for the invitation to the event. It begins:

suggested-language

Butch Antolini, the governor’s communications director, responds:

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And on May 9, the day of the event:

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There’s more here, if you’re interested. Seems like there was a lot of confusion leading up to the event, and that Congressman Evan Jenkins, who is running for Senate, was not originally supposed to be standing alongside Conway and Price at the press conference. I’m going to get back to a story I’m working on about how the GOP bill would affect the opioid epidemic killing my friends and neighbors.

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In late March, I wrote about how an adolescent abortion bill had been amended into a “compromise” in the House of Delegates.

Under current law, a physician can decide that a girl is mature enough to make the decision on her own, or that telling her parents would not be in her best interest, before a second physician performs the abortion.

The bill, House Bill 2002,  made it so physicians could no longer do so, requiring them to go to court instead for a judicial bypass – a process the American Academy of Pediatrics, among numerous other opposed medical organizations, has said “poses risks of medical and psychological harm.”

After sexual abuse survivors testified during a public hearing, three lawmakers, including Delegate Kayla Kessinger, Barbara Fleischauer, and Amy Summers, worked in a House of Delegates judiciary subcommittee to amend the bill so that most physicians could no longer waive parental notification, but that licensed psychologists and psychiatrists would be able to do so.

But as the compromise bill continued to make its way through the Legislature, leading supporters of policies restricting abortion, including Karen Cross, of the National Right to Life Committee, said they couldn’t speak to the bill because they didn’t know what was in it, and that it was moving so quickly.

So, I wondered what they were telling lawmakers, and supporters.

When the Senate reverted the bill back to its original version during a evening meeting that was not announced and was not added to the video archives that night, dispensed with another committee reference, and sent the bill to the floor for another vote, it certainly seemed like there was never a compromise.

But a few emails, obtained through an open records request, can tell us a little more about how it happened.

On March 30, Karen Cross and Mary Anne Buchanan, of West Virginians for Life, emailed lawmakers, saying there were “changes that need to be made to the bill. Please support the strike and insert.”

wvians-for-life-email-1

In a previous email to Delegate Tom Fast, R- Fayette, Cross had said she believed working with the Senate on the bill would be “easier.”

When asking senators to vote for the final bill, they said it had “undergone a number of compromises.”

The sentence wording is vague, and I don’t know if any senators took the language to mean the final bill was approved by the medical community or women’s health advocates.

It wasn’t.

I’m reminded that when the Senate passed the original version of the bill, Margaret Chapman Pomponio, executive director of WV Free, told me they had supported the amended version because compromise on abortion legislation was “almost unheard of.”

I’ve emailed both Cross and Kessinger, the lead sponsor, for comments and will update this post if/when they respond.

 

 

 

 

 

When I was 13, I developed acute appendicitis on the second day of my first band camp. I can still remember standing in the late-July sun, clenching my side and fighting the urge to pass out in the middle of practice. I remember later that afternoon, recoiling as my pediatrician palpated my abdomen, and I remember the rush of anxiety when, after asking me to stand up straight and noting that I couldn’t, he sent me next door to the hospital to confirm his suspicions.

Most of all, I remember what came after: I was sent home with a neatly stitched, two-inch incision and a 10-day prescription for hydrocodone for any lingering pain. I hadn’t actually felt any pain since before my surgery — I felt fantastic, and I made sure to tell my parents that excitedly not long after waking up — but the hydrocodone was to “keep me ahead” of any pain I might feel. It worked, of course; after a week, my mom unceremoniously trashed my remaining pills and pushed me back to camp.

It’s been more than a decade, and I can still remember what a week on opioids felt like. I recall telling my mom that I felt “taller,” and I did, but I felt other things, too — blissfully unconcerned, foggy and warmly relaxed.

It may not sound like much, but seven days may be all it takes to change the brain and foster an opioid addiction, according to Dr. Carl “Rolly” Sullivan, director of the addiction program at WVU Medicine and one of a growing number of doctors railing against an “opioid first” mentality that has come to dominate pain management in the last couple of decades. It doesn’t take long to get hooked, but leaving opioids behind can be nearly impossible for the well and truly addicted — more than half of recovering addicts will relapse at least once. That’s why news that the Centers for Disease Control and Prevention had issued guidelines  expressly discouraging prescribing the powerful narcotics in the first place was so welcome in West Virginia, where at one point, pain pills outnumbered people 100 to 1.

The CDC guidelines are a start, but they’re just one step on the road to a recovery that has as much to do with prescribers as it does with addicts. Doctors practicing today, and especially those trained in the last 20 years, were often taught about pain as “the fifth vital sign” and offered opioids as the solution for their patients’ woes. Attitudes have started to shift — the CDC’s guidelines are a good indication of that — and a number of initiatives at the federal level could coalesce into a backbone for the nation’s effort to combat opioid abuse.

Last week, the White House asked the Association of American Medical Colleges to urge medical schools to include a requirement that students be taught in line with the CDC’s new prescriber guidelines. This week, Marshall University and West Virginia University announced in turn that the schools hope to help lead the initiative, which now has the backing of roughly 60 medical schools, and would ultimately mean a new generation of doctors taught to avoid opioids as a first choice for treating non-palliative pain.

The CDC itself is not a regulatory agency, and its recommendations are meant to offer doctors a guidepost when navigating their own practice. As Dr. Tom Friedan, CDC director, said of the guidelines: “(W)e are not a regulatory agency. So these are guidelines. They are recommendations. States, the national governors’ association, health care systems, insurers may look to these guidelines, when they implement policies within their own jurisdictions or institutions but what our role is to provide the best available science to try to improve the care of patients who are suffering from chronic pain which is a very challenging situation for patients to have to live with and a very challenging condition for physicians to treat.”

That’s probably what’s most important to note with the WVU/Marshall announcement: the schools have put their support behind actual regulation that would change the way the universities, and other medical schools, approach teaching prescribing practices.

President Barack Obama discussed the proposal today, along with several others, during the National Rx Drug Abuse Summit. Highlights from the president’s announcements include a proposed rule to increase the current patient limit for qualified physicians who prescribe buprenorphine (Suboxone) from 100 to 200 patients, as well as a rule that would require Medicaid and Medicare to offer substance abuse treatment at the same level of insurance reimbursement as medical and surgical care.

Bill Nye and the science of choice

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I thought it might be interesting and appropriate, in view of the fact that celebrated science speaker Bill Nye is set to visit Charleston in November, to point  to his explanation of everything that is wrong with trying to attack women’s health services.

Nye is well-known for his no-nonsense approach to a variety of hot button topics, ranging from global warming to evolution, but since this blog is about health, and since the support for some women’s health organizations has been called into question in recent weeks, I thought this video was particularly interesting.

“Nobody likes abortion,” Nye says in the video. “But you can’t tell somebody what to do.”

I don’t know whether there will be any sort of question-and-answer period following Nye’s talk, but I’d love to hear more from him on the topic ( maybe I can sneak in, since I missed out on getting a ticket.)

Speaking of women’s health — the Planned Parenthood Clinic that West Virginia Speaker of the House Tim Armstead hopes to divert funding for serves roughly 1,000 a year who, because of the level of access in Wood County and because of the types of patients PP normally sees, would likely end up at the Mid-Ohio Valley Health Department. Dr. Drema Mace, the health officer for the health department, said the agency would likely be able to absorb those patients “with a little lead time.” She didn’t elaborate on whether expanding family planning services would cut into the time or resources for other services offered at the department, but it looks like the PP clinic in Vienna may have to survive on its own merit.

 

Just one month (and one day) ago, the Cabell-Huntington Health Department held its first syringe exchange/harm reduction session at the department, meant to steer addicts toward services and screenings they would likely never have felt welcome to seek out in another setting. It was the result of months of planning and several state and local partnerships, and that first Wednesday saw a good showing — in its designated two-hour, once-a-week window, the health department saw 15 patients.

Response to the program has only grown, according to Dr. Michael Kilkenny, the health officer for the Cabell-Huntington Health Department — yesterday the clinic saw 54 patients, and was forced to extend its visits an extra hour to accommodate them all. In all, the health department has provided 143 services to 111 individual patients since its start just one month ago, and the interest in services beyond the syringe exchange is slowly growing — more than one patient is now on a waiting list to enter rehabilitation, Kilkenny said.

“We’re seeing more engagement with our other services,” he said. “I think there’s a lot of potential to grow, and we’re really hopeful — the recovery coaches always seem like they’re talking to someone, and conversation is where it starts.”

The health department’s harm reduction visits so far:

Sept. 2: 15 patients

Sept. 9: 32 patients

Sept. 16: 42 patients

Sept. 23: 54 patients

Note for Sept. 23: of the 54 patients seen yesterday, 34 of them were new, and 20 returning patients, according to Kilkenny.

Of course, the program is just getting started, and Kilkenny expects more expansion in the coming weeks, so stay tuned.

 

 

planned

After weeks of accusations, rebuttals and, most recently, a vote by the U.S. House of Representatives to defund the women’s health organization, Planned Parenthood is still in the hot seat, thanks to a series of heavily redacted hidden-camera videos from anti-abortion the Center for Medical Progress that show Planned Parenthood executives and affiliates candidly discussing harvesting fetal tissue from abortion procedures. More specifically, the practice of selling aborted fetal tissue in the service of medical research — something that was declared legal in 1975 and has persisted with Planned Parenthood clinics and other organizations that provide abortions in the U.S. ever since, according to the American Society for Cell Biology.

The 10 videos the Center for Medical Progress has released since July are striking, but as of today, none of Planned Parenthood’s abortion practices have been declared illegal, despite an ongoing federal investigation and a handful of state investigations into its practices.  

Arguments have been made against the legitimacy of the videos, the morality of fetal tissue donation and research, and  the role of Planned Parenthood itself in our nation’s healthcare system. I’m going to skip all of those discussions, as they’re better served by other sources, and get to what I think is most important to recognize in this issue in terms of its effects in West Virginia. While abortion is perfectly legal, only 3 percent of what PP does involves abortive services, and of course, almost none of the money used for abortions comes from the federal government.

(Note: it’s important to note that while PP does provide few abortions when compared to its other services, many of those services are far less expensive than an abortion, which skews the organization’s budget quite a bit. Look here for a more extensive explanation of that.)

The national issue of PP funding became a state one this week, when Speaker of the House of Delegates Tim Armstead penned a letter to Karen Bowling, essentially asking her if it would be feasible to “divert funding” from West Virginia’s only PP clinic, located in Vienna.

Tim Armstead’s letter, in its entirety, to DHHR Secretary Karen Bowling, dated Sept. 21:

Letter to DHHR regarding Planned Parenthood

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Bowling has not yet responded to Armstead, although she is working to compile the information Armstead requested, according to the DHHR.

In an article in today’s Gazette-Mail, capitol reporter Phil Kabler writes that, somewhat obviously, the clinic in question does not receive $800,000 per year. Kabler writes that “records with the state Auditor’s Office show that, since Aug. 1, 2014, the DHHR’s Division of Health has made 111 payments to the Planned Parenthood facility totaling $78,648. That does not appear to include any payments by Medicaid for individuals’ office visits to the clinic.” House of Delegates spokesman Jared Hunt told Kabler the $800,000 figure “came from a legislative staff analysis of the budget documents for the DHHR’s Family Planning Program, which showed $803,000 in state funds and $2.4 million in federal funds provided for Planned Parenthood of West Virginia.” Bowling later issued a statement correcting that, explaining that the $803,000 was used “to purchase bulk supplies for approximately 150 providers across the state who participate in family planning services.”

As noted in the Speaker’s letter, the Vienna clinic does not perform any abortions. STD testing? Yes. Breast exams? Of course. Armstead is asking the DHHR to take funding away from a small clinic and give the money it receives for services — services that do not include the service he protests — and give it to another clinic that would perform all of those services and consequently absorb the nearly 1,000 unduplicated patients the clinic sees each year. Nevermind whether it’s necessary or kosher to do something like that in the case of this particular clinic — I’m still waiting to hear if it’s possible without an interruption in services. Tisha Reed, deputy director of WV FREE, the state’s largest women’s health advocacy group, thinks not:

“Removing Title X funding from the Planned Parenthood site does nothing to address (Armstead’s) concern regarding the practice of fetal tissue donation, but would definitely affect access to women’s healthcare, which he states he does not wish to do,” she says. “The only certain outcome would be to remove a vital provider of reproductive healthcare services for men and women.  If this clinic were to be defunded, only one site would remain in Wood County for Title X Family Planning services such as contraception and cervical and breast cancer screening-the Mid-Ohio Valley Health Department.  This location is only staffed with an advanced practice nurse or specialized women’s health care physician one day per week — Tuesday — and is unable to absorb the demand that exists. This means that visits are by appointment only and problem situations either have to wait for an appointment or visit an emergency-care facility.  Removing funding would cause a disparity of care for many men and women in Wood County who are not able to confine their need to 8 a.m. to 4 p.m. on Tuesdays only.”

MORGANTOWN, W.Va. – For the second time in three years, Bingyun Li, Ph.D., associate professor in the West Virginia University School of Medicine Department of Orthopaedics and director of the WVU Biomaterials, Bioengineering and Nanotechnology Laboratory, has been recognized internationally for his research.

Most recently, Dr. Li received the Asia Pacific Orthopaedic Association (APOA)-Pfizer Best Scientific Paper Award. The award was presented at the 2013 Combined Conference of the Fifth APOA Infection Section Scientific Meeting, Ninth Asia Pacific Spine Society Congress and Ninth APOA Paediatric Section Congress. It was held at the end of August in Kuching, Malaysia. More than 650 orthopaedic surgeons and residents from around the world, including about 12 orthopaedic surgeons and scientists from the United States, attended the conference.

In 2011, Li was awarded the Berton Rahn Research Fund Prize from the AO Foundation, a Switzerland-based medically guided nonprofit organization led by an international group of surgeons specialized in the treatment of trauma and disorders of the musculoskeletal system.

For full release: http://wvuhealthcare.com/wvuh/Content/Media/News-Releases/2013/SEPT/WVU-School-of-Medicine%E2%80%99s-Li-receives-prestigious-a