Princess Health and Forrest W. Calico, national leader in rural health care, dies at 75. Princessiccia

Princess Health and Forrest W. Calico, national leader in rural health care, dies at 75. Princessiccia

Appalachia books obituaries public health rural health rural hospitals

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Forrest W. Calico

Dr. Forrest W. Calico, a nationally recognized expert on rural health-care quality, died Monday at his home near Crab Orchard "after striving against multiple myeloma for several years," said his obituary in the Lexington Herald-Leader. He was 75.

A native of Garrard County, Calico received his medical degree from the University of Kentucky in 1966. He also held a master's degree in public health from Harvard University. In the U.S. Air Force, he was a flight surgeon at Area 51 in Nevada, a family physician, residency director and hospital administrator, earning the Bronze Star. He was president and CEO of Appalachian Regional Healthcare from 1993 to 1999, a health-systems adviser to the federal Office of Rural Health Policy and a senior quality adviser to the National Rural Health Association. In 2007 he was named a Rural Hero by the National Rural Assembly and in 2010 entered the UK College of Public Health Hall of Fame.

In retirement, Calico remained active at the state and local levels, serving on the boards of the Foundation for a Healthy Kentucky, the Friedell Committee for Health System Transformation and the Lincoln County Board of Health. In 2012 he published a memoir, Out of the Blue, with the subtitle "How open doors and unexpected paths set the course of my life."

Calico is survived by his wife Patricia Calico, their son Jefferson and wife Cari, daughter Tricia and husband Wes Cohron, his sister Helen Eden, a nephew and six grandchildren. A celebration of his life will be held Saturday, June 18, from 2 to 5 p.m., with a memorial service at 3 p.m., at The Church at Cedar Creek at 5787 US 150, east of Stanford. Memorial donations may go to The Friedell Committee, PO Box 910953, Lexington KY 40591, or the Dr. Patricia A. Calico Endowed Nursing Scholarship at UK, 315 College of Nursing Building, Lexington KY 40536.

Princess Health and Wellness coalition in Perry County, where life expectancy is state's lowest, gets funding from Foundation for a Healthy Ky.. Princessiccia

Princess Health and Wellness coalition in Perry County, where life expectancy is state's lowest, gets funding from Foundation for a Healthy Ky.. Princessiccia

Appalachia children children's health education farm to school farmers' markets food Foundation for a Healthy Kentucky foundations grants hospitals life expectancy nutrition philanthropy schools

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The Foundation for a Healthy Kentucky has funded the Perry County Wellness Coalition's three-year plan to encourage fitness and better nutrition in school-age children, "Kids on the Move!"

The wellness coalition will receive $144,450 from the foundation this year, matched by $124,944 from the community, to increase access to physical activity and provide healthier food options and nutrition education. Perry County has the lowest life expectancy in Kentucky.

"Our children are the most valuable resource we have," said Gerry Roll, executive director of the Foundation for Appalachian Kentucky, which is serving as fiscal agent for the coalition. "It's the best investment we can make as a community partner."

The health coalition will work with local schools to implement physical activity and nutrition-policy changes, collaborate with local farmers' markets for a strong farm-to-school component, and coordinate with other community agencies to create a lasting and collective impact.

The project also will implement best-practices nutrition and exercise programs in schools, support community gardens, summer feeding programs, and a "Farmacy" program to increase the purchase of healthier produce at farmers' markets and local grocery stores, among other changes to be coordinated by the agencies in the coalition.

The Appalachian Regional Healthcare hospital in Hazard will be the administrative hub for the coalition, providing leadership and sharing its expertise in promoting community health. "We have already begun these efforts by providing fitness fairs and health screenings to over 20 schools in our service area and reaching a little more than 2,500 middle school and high school age kids this year alone," said Hazard ARH Community CEO Dan Stone said.

The coalition is among seven Kentucky communities funded by the foundation's "Investing in Kentucky's Future" initiative, which is spending $3 million over five years to fund communities working to improve the health of their school-aged children. The other groups are in Breathitt, Clinton, Grant, Jefferson and McLean counties, and in Boyd and Greenup counties. Perry County was in the original announcement and recently completed its detailed plan. It shares with Breathitt and Wolfe counties the state's lowest life expectancy, 70 years.

Princess Health and Kentucky is the only truly Appalachian state to have put a brake on fatal overdoses from narcotics. Princessiccia

Princess Health and Kentucky is the only truly Appalachian state to have put a brake on fatal overdoses from narcotics. Princessiccia

Appalachia doctors drug abuse drugs General Assembly legislature narcotics pain pain clinics physicians prescription drug abuse prescription drugs state government

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Kentucky is the only truly Appalachian state to have put a brake on fatal drug overdoses, report Rich Lord and Adam Smeltz of the Pittsburgh Post-Gazette as part of a series in the about the deadly epidemic of prescription painkillers in the region.

A chart with the series' story about Kentucky shows that fatal drug overdoses were less numerous in the state in 2013 than in 2012, when the General Assembly cracked down on "pill mills," and that while fatal overdoses rose in 2014, they were still not as numerous as in 2012. Official numbers for 2015 are expected soon, and may rise because of the spread of heroin.

The series also credited a crackdown by the Kentucky Board of Medical Licensure, which "took disciplinary action for prescribing irregularities against 135 of the state�s roughly 10,600 doctors" from 2011 to 2015. "The board also moved against 33 doctors during that time for abusing narcotics themselves."

"Getting tough on doctors works," Lord wrote in the series' main story. The state story reported, "Kentucky�s per-capita opioid consumption -- though still seventh in the nation -- dropped by a steepest-in-Appalachia 12.5 percent from 2012 to 2014, according to IMS Health Inc.," Lord and Smeltz report. "Kentucky is the only state, among the seven studied by the Pittsburgh Post-Gazette, in which fatal overdoses have plateaued. Elsewhere, they have climbed relentlessly."

The story quotes Kerry B. Harvey, U.S. attorney for the eastern half of Kentucky: �In much of Eastern Kentucky, the workforce is engaged in difficult, manual labor,� like mining, farming and logging, �so people would injure themselves and be prescribed these very potent narcotics, because the medical profession changed the way it looked at prescribing these kinds of narcotics for pain.� The drugs dulled the �sense of hopelessness� people had about the area�s economy, �and so for whatever reason, this sort of culture of addiction took hold.�

"Harvey said that as physicians have gone to jail, and others have faced board discipline, the painkiller business model has adapted. . . . Now the doctors take insurance, and bill the insurer or the government not just for the office visit, but for the MRI, urine screen and back brace they use to justify the addictive narcotic." Harvey said, �So instead of a cash business, in many cases now the taxpayers or the insurance companies pay. The result is the same. We end up with our communities flooded with these very potent prescription narcotics.�

Princess Health and At forum on opioid abuse in Corbin, people say they need more treatment services, community education and coalitions. Princessiccia

Princess Health and At forum on opioid abuse in Corbin, people say they need more treatment services, community education and coalitions. Princessiccia

Appalachia drug abuse drug treatment heroin mental health narcotics prescription drugs state government

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Image from Lauren Osborne, WYMT-TV Mountain News

By Melissa Patrick
Kentucky Health News

CORBIN, Ky. � After a day of learning and talking about opioid prevention, treatment and mobilization, people at a forum in Corbin agreed on three things: Access to substance abuse and mental health services remains a huge barrier in southeastern Kentucky; more community education is needed; and drug-prevention programs should form coalitions to better use their limited resources.

Substance abuse affects almost every family in Kentucky, and four Kentuckians die every day from a drug overdose. That was part of the opening message from Dr. Allen Brenzel, medical director of the state Department for Behavioral Health, Development and Intellectual Disabilities.

"This is, in my opinion, one of the most pressing health-care issues facing our commonwealth today," Brenzel said. "If 1,000 people a year were dying from measles in the state of Kentucky, think about the public response that we would have. ... We would be on red-alert, we would have a complete, public-health, massive intervention to solve that problem."

Van Ingram, executive director at the Governor's Office of Drug Control Policy, said that next year's drug overdose report, which will be released in a few weeks, will show the problem is getting worse.

About 125 people, most of them health-care providers, attended the "Cumberland River Forum on Opioid Use Disorders: A Time for Community Action" May 17 at the Corbin Technology Center. It was sponsored by The Kentucky Cabinet for Health and Family Services, the Hazelden Betty Ford Foundation, and Cumberland River Behavioral Health. Similar forums were held in Lexington May 16 and Louisville May 13.

John Tilley

John Tilley, secretary of the Kentucky Cabinet for Justice and Public Safety, said he hoped the forum would "light a fire under this community" to talk to their neighbors and friends, community leaders and legislators about the value of treatment over incarceration for substance abuse and mental health issues.

Tilley, who chaired the House Judiciary Committee when he was a state representative from Hopkinsville, acknowledged that some abusers should be in prison, but said society must distinguish between "who we are mad at and who we are afraid of. ... I promise you the way to get out of this mess is not to over-criminalize addiction and mental illness."

Tilley said "The solution is right before our eyes," using for treatment some of the billions of dollars now used to incarcerate drug users.

Tim Feeley, deputy secretary for the CHFS and a former legislator from Oldham County, agreed: "We are not going to incarcerate our way out of this." He said the state needs more treatment programs and said the cabinet was fully committed to addressing the state's addiction problems to the best of its abilities.

William Hacker

Kentucky has moved away from treating mental health and substance abuse issues criminally, said Dr. William Hacker, chair of Shaping Our Appalachian Region's Health and Wellness Advisory Committee and former state health commissioner. He said other successful anti-drug efforts include grassroots advocacy groups, the online prescription-drug tracking program, needle-exchange programs, a move toward medication assisted treatments for opioid addiction, and the SMARTS initiative, which provides addiction care for pregnant and parenting women for up to two years.

Hacker also mentioned Operation UNITE, a Kentucky non-profit created by U.S. Rep. Hal Rogers that leads education, treatment and law enforcement initiatives in 32 counties in Southern and Eastern Kentucky. UNITE has held a national drug abuse conferences for the past five years, with this year's summit in Atlanta including President Barack Obama. The acronym stands for Unlawful Narcotics Investigations, Treatment and Education.

A former pediatrician in Corbin, Hacker also noted that SOAR recently held a Substance Abuse Roundtable to discuss research and emerging opportunities associated with substance abuse and intravenous drug use in Appalachian Kentucky. He said SOAR works to create a network across the region to share best practices and money opportunities and to create community level empowerment.

"Substance abuse is not a failure of moral character, it is a disease," Hacker said. "Don't give up. Never give up."

At the end of the meeting, the attendees broke into groups that represented schools, community leaders, health-care professionals, parents and the faith community to discuss what actions they could take to address opioid abuse in their communities.

Most groups reported that lack of access to substance abuse and mental health treatment is a barrier in their communities. And while it was noted that some communities offer more services than others, several groups said they did not have enough counselors to support medication-assisted therapies or enough doctors willing to prescribe it. Lack of transportation was also mentioned as a barrier toward getting treatment in several groups.

Also, most groups said community members often aren't aware of the resources, so more community education is needed. They listed schools, churches and county Extension offices as possible sources of education, and noted that a community resource website would be helpful. They also said parents would benefit from a class to learn how to talk to their children about drugs.

The groups agreed that all sectors of the community were needed to combat substance abuse and suggested that drug prevention programs in each community should form coalitions to better use resources and information.

Princess Health and Study says intravenous drug users in almost half of Kentucky's counties are at high risk of getting hepatitis C or HIV. Princessiccia

Princess Health and Study says intravenous drug users in almost half of Kentucky's counties are at high risk of getting hepatitis C or HIV. Princessiccia

Appalachia drug abuse drug use hepatitis c HIV

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By Melissa Patrick
Kentucky Health News

A preliminary report by the federal Centers for Disease Control and Prevention has identified 220 counties in the United States as being most vulnerable to outbreaks of HIV and hepatitis C among those who inject drugs in those communities, and 54 of those counties are in Kentucky.

Most are in Appalachia, but the list includes the non-Appalachian counties of Hickman, Breckinridge, Grayson, Allen, Taylor, Boyle, Mercer, Carroll, Gallatin Grant and Campbell.

Counties deemed most vulnerable to outbreaks are green; top 25 of 220 in U.S. are numbered on map.

Kentucky leads the nation in the rate of acute hepatitis C, with 4.1 cases for every 100,000 residents, more than six times the national average, according to the CDC.

�Both HIV and hepatitis C can be transmitted when people who inject drugs share their needles," Doug Hogan, acting communications director for the Cabinet for Health and Family Services, said in an e-mail to Kentucky Health News. "Many of Kentucky�s HCV cases are among rural youth, ages 12-29, who have been sharing needles."

Clark County Health Director Scott Lockard called the CDC report a "wake-up call."

"We are potentially on the leading edge of one of the biggest public-health crises to hit our state," Lockard said in an e-mail to Kentucky Health News. "It will take a combined effort across sectors to prevent an HIV outbreak in the SOAR region such as the one that occurred in Scott County, Indiana," north of Louisville.

Lockard made these comments in April after attending a Shaping Our Appalachian Region roundtable that focused on substance abuse and intravenous drug use in the region. More than half (56 percent) of the 220 counties identified as most vulnerable for HIV or hepatitis C were located in the Appalachian regions of Kentucky, Tennessee and West Virginia.

"About 25 percent of our state�s population lives in these 54 counties," Hogan said.

The CDC began this study after an unprecedented outbreak of HIV infections occurred in Scott County, Indiana, in 2014 among its intravenous drug users to see what other counties might be vulnerable to such an outbreak.

Researchers looked at all 3,143 U.S. counties and based their rankings on six variables, including: the number of overdose deaths, per-capita-income data, unemployment data, population studies, prescription opioid sales, and prescription sales for opioid treatments such as buprenorphine.

The report points out that this does not mean that HIV or hepatitis C outbreaks are inevitable in these counties, or that there is a current problem with intravenous drug users in these counties, but says that intravenous drug users in these counties are at a higher risk.

One way to slow down the spread of HIV and hepatitis C is through needle exchanges, where intravenous drug users trade dirty needles for clean ones. Needle exchanges were authorized in Kentucky under a 2015 anti-heroin law but also require local approval.

So far, only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Kenton, Knox, Pendleton and Pike are either operating or have approved such programs. Of the 54 high-risk counties, only Boyd, Carter, Clark, Knox and Pike counties have operating needle exchanges.

Hogan said, "The Kentucky Department for Public Health is working closely with (the) CDC and at-risk communities to increase HIV and hepatitis C testing, and is assisting counties in their processes of establishing syringe exchange programs."

Here's a list of Kentucky counties and their national rankings for vulnerability to the rapid spread of HIV and hepatitis C among people who inject drugs: Wolfe, 1st; Breathitt, 3rd; Perry, 4th; Clay, 5th; Bell, 6th; Leslie, 8th; Knox, 9th; Floyd, 10th: Clinton, 11th; Owsley, 12th; Whitley, 14th; Powell, 15th; Knott, 17th; Pike, 21st; Magoffin, 23rd; Estill, 25th; Lee, 30th; Menifee, 31st; Martin, 34th; Boyle, 35th; Lawrence, 39th; Rockcastle, 40th; Harlan, 45th; McCreary, 48th; Letcher, 50th; Johnson, 53rd; Russell, 54th; Elliott, 56th; Laurel, 65th; Carroll, 67th; Taylor, 75th; Grant, 77th; Adair, 93rd; Lincoln, 97th; Wayne, 99th; Cumberland, 101st; Gallatin, 108th; Bath, 125th; Grayson, 126th; Greenup, 129th; Green, 132d; Casey, 153d; Carter, 154th; Monroe, 163d; Garrard, 167th; Robertson, 175th; Lewis, 178th; Edmonson, 179th; Allen, 180th; Boyd, 187th; Hickman, 191st; Breckinridge, 202d; Campbell, 212th; and Mercer, 214th.

Princess Health and More than 100 at SOAR Substance Abuse Roundtable committed to work on prevention and treatment efforts in region. Princessiccia

Princess Health and More than 100 at SOAR Substance Abuse Roundtable committed to work on prevention and treatment efforts in region. Princessiccia

Appalachia drug abuse drug prevention heroin needle exchanges substance abuse

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By Melissa Patrick
Kentucky Health News

More than 100 people attended the Shaping Our Appalachian Region Substance Abuse Roundtable April 7 to learn about current research and emerging opportunities associated with substance abuse and intravenous drug use in region, according to a SOAR news release.

SOAR is a bipartisan effort to revitalize and diversify the economy in Kentucky's 54 Appalachian counties. It has advisory councils for each of its 10 areas of focus, one of which is community health and wellness.

That council's chair, former state health commissioner Dr. William Hacker, facilitated the roundtable at Natural Bridge State Resort Park.

As part of the solutions-driven discussion, Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, told the attendees that it is important to ask the right questions when gathering information about drug abuse to accurately depict what is going on in the region.

�When you ask people if they have a problem with prescription drugs they, of course, say no,� Zepeda said. �When you ask them if they know someone, like a family member or friend, that answer is very different.�

The group also discussed the importance of getting accurate data about substance abuse and overdose into the right hands to make progress on these issues.

�We want to get data into the hands of legislators and those who can do something about prescription-drug overdose,� said Dana Quesinberry, public-health-policy and program evaluator for the Kentucky Injury Prevention and Research Center at the University of Kentucky. �Sitting in a repository, it doesn�t do anything for anyone.�

The roundtable members also discussed needle-exchange programs, authorized under the state's 2015 anti-heroin law. The program is meant to slow the spread of HIV and hepatis C, which are commonly spread by sharing of needles among intravenous drug users.

�We�ve seen a switch from using pills as an opioid to using intravenous methods,� said Greg Lee, the HIV/AIDS continuing-education program director for the state Cabinet for Health and Family Services.

Clark County Health Director Scott Lockard said the federal Centers for Disease Control and Prevention issued a "wake-up call" with its report identifying 54 Kentucky counties as being among the 220 most vulnerable in the nation for the rapid spread of HIV and hepatitis C infection among intravenous drug users. Most of the counties, and eight of the top 10, were Appalachian.

"We are potentially on the leading edge of one of the biggest public health crises to hit our state," Lockard said in an e-mail to Kentucky Health News. "It will take a combined effort across sectors to prevent an HIV outbreak in the SOAR region such as the one that occurred in Scott County, Indiana," just north of Louisville.

Although many Kentucky county officials are talking about needle-exchange programs, so far only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Knox, Pendleton and Pike are either operating or have approved such programs. Of these, Boyd, Carter, Clark, Elliott, Knox and Pike are part of SOAR.

The news release noted that participants left the discussion with a commitment to continue the conversation and to build a strategic plan to address substance abuse issues in the region, with a focus on clinical practices, health systems, drug screenings and other best practices.

Princess Health and Rural drug-overdose rates, high in Kentucky, blamed partly on limits on treatment medication and mental-health services. Princessiccia

Princess Health and Rural drug-overdose rates, high in Kentucky, blamed partly on limits on treatment medication and mental-health services. Princessiccia

Appalachia behavioral health Congress drug abuse drugs health rankings mental health

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"People in rural areas of Appalachia are more likely to die early deaths than in other parts of the country," and a big reason is that they "die from drug overdoses at greater rates than the rest of the country," writes Kery Murakami, the Washington, D.C., reporter for Community Newspaper Holdings Inc.'s CNHI News Service.

Murakami notes that in Leslie County, Kentucky, 7.9 of every 10,000 residents overdosed each year in 2012-14. "That�s six times the national rate," and third in the nation, he writes, citing the annual County Health Rankings done for the Robert Wood Johnson Foundation by the University of Wisconsin Population Health Institute. Several other Appalachian counties in Kentucky and West Virginia rank high.

The rates are high partly because "addicts in some parts of the country get turned away by doctors and are not given a drug called buprenorphine that is used to kick opioid addictions," Murakami reports, citing addiction experts. "Buprenorphine causes less euphoria and physical dependence and can ease withdrawal and cravings."

However, "Federal law caps the number of patients to whom a doctor is allowed to prescribe the drug, out of concern of creating places where large numbers of addicts receive opioid-based medication. Such treatment hubs, much like methadone clinics, bring unwanted community opposition, said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence. That limits treatment choices in rural areas, where one doctor might be the only one licensed to prescribe buprenorphine for hundreds of miles."

The Department of Health and Human Services is moving to ease the limits, and Sens. Ed Markey, D-Mass., and Rand Paul, R-Ky., want to go even further. "But some addiction experts are concerned that raising the caps on buprenorphine will nudge the country toward treating addiction with medication rather than counseling, Murakami reports. The department�s proposed rules would require mental-health care, which is often hard to get in rural areas. The senators� bill would not.

�Turning people away from the most evidence-based treatment we have for a chronic, life-threatening disease is heart wrenching for a doctor,� Dr. Kelly Clark, president-elect of the American Society of Addiction Medicine, told CNHI. �Rural areas have been hit hardest by this round in overdoses, which is the worst round of overdose deaths in our country.� She said medication is especially important in rural areas because opioid use spreads among families. �In rural areas, you�re treating the person, their parents and grandparents,� she said. �Entire families are addicted. It�s not like saying, �Stay away from certain friends,� if they�re shooting up with their sister and their mother.�