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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.”

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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.

 

 

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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

MORGANTOWN, W.Va. – A study about the correlation between discrimination and drug abuse by Haslyn E. R. Hunte, Ph.D., assistant professor in the West Virginia University School of Public Health Department of Social and Behavioral Sciences, and San Diego School of Public Health professor Tracy L. Finlayson has been published online in the Journal of Urban Health.

In the study titled, “The Relationship between Perceived Discrimination and Psychotherapeutic and Illicit Drug Misuse in Chicago, IL, USA,” Dr. Hunte and Finlayson found that more experiences of discrimination by a person are related to higher levels of drug use.

“One of the interesting findings of this study is that discrimination is harmful to all groups of individuals, not only racial or ethnic minorities,” Hunte said.

For full release: http://wvuhealthcare.com/wvuh/Content/Media/News-Releases/2013/SEPT/WVU-public-health-researcher-examines-link-between

MORGANTOWN, W.Va. – The Seventh Annual Froggy 99 Hop for Hope and Z106 Cares for Kids Radiothon benefiting West Virginia University Children’s Hospital at Ruby Memorial will hit the airwaves live on Tuesday, Sept. 17.

WVU Children’s Hospital, Children’s Miracle Network and Froggy will host the radiothon at the Kroger store on Washington Boulevard in Belpre, Ohio, broadcasting live from 6 a.m. to 6 p.m. on Sept. 17 and 18.

Radio personalities will tell stories about children who have benefited from services provided by WVU Children’s Hospital. Patients are also scheduled to visit the radiothon to share their stories on air. In 2012, families from the mid-Ohio Valley turned to WVU Children’s Hospital more than 2,800 times and found hope and healing.

To date, the radiothon has raised more than $321,000 in support of WVU Children’s Hospital.

For full release: http://wvuhealthcare.com/wvuh/Content/Media/News-Releases/2013/SEPT/Parkersburg-radiothon-to-benefit-WVU-Children%E2%80%99s-Ho

MORGANTOWN, W.Va. – A half million dollar endowment providing scholarships for female students enrolled at the West Virginia University School of Medicine has been made possible by the late Ruth St. John in memory of her daughter.

The Dr. Judith Buff Memorial Scholarship Fund will benefit female students who are West Virginia residents and are either the first in their families to attend an institution of higher education, descendants of West Virginia coal miners or interested in coal miners’ health.

St. John, a native of Charleston, never set foot herself on the WVU campus, but the recent resurgence of coal workers’ pneumoconiosis – black lung disease – as well as her late daughter’s perseverance in the medical field inspired her generosity. St. John passed away in 2011.

Judith Buff, M.D., graduated from the WVU School of Medicine in 1972. She was one of only two female students in her class, falling on the wrong side of the gender disparity in the medical profession at the time. Undeterred, after residency training at the University of Cincinnati, she began a career as a dermatologist. Dr. Buff passed away from cancer in 1999.

For full release: http://wvuhealthcare.com/wvuh/Content/Media/News-Releases/2013/SEPT/Dr-Judith-Buff-Memorial-Scholarship-Fund-created-f

MORGANTOWN, W.Va. – Alejandra Meza, a first-year student in the West Virginia University School of Medicine Pathologists’ Assistant (PA) Program, spent 10 days last month in Gaborone, Botswana, assisting with a six-day training for histopathology laboratory staff at the National Health Laboratory (NHL).

Meza, originally from Los Angeles, was one-fourth of a team of pathology professionals sent by the American Society of Clinical Pathology (ASCP) to southern Africa on a global health trip August 1-13. Their mission was to instruct 17 participants in the theory behind the histotechnology practices outlined in their instruction manuals.

Histotechnology is the process of grossing, or cutting, fixing and staining a tissue sample on a slide to be examined and diagnosed by a pathologist.

Cherie Germain, P.A., director of WVU’s PA Program, recommended Meza for the team because of her prior histology experience and her experience working with limited resources in an Army combat support hospital.

For full release: http://wvuhealthcare.com/wvuh/Content/Media/News-Releases/2013/SEPT/WVU-pathology-student-trains-laboratory-staff-in-B