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

Gusty 05:35 Add Comment

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 Suicide rates are rising in the U.S.; experts attribute high rate in rural Ky. to poor mental health access, stigma and 'gun culture'. Princessiccia

Princess Health and Suicide rates are rising in the U.S.; experts attribute high rate in rural Ky. to poor mental health access, stigma and 'gun culture'. Princessiccia

behavioral health Centers for Disease Control and Prevention guns health care access mental health research rural health suicide

Gusty 09:11 Add Comment

By Melissa Patrick
Kentucky Health News

After a decade of decline, suicide is becoming more common in the United States, increasing by 24 percent from 1999 through 2014, according to the federal Centers for Disease Control and Prevention.

The CDC report looked at cause-of-death data between 1999 and 2014 and found that suicide rates increased for both males and females in all age groups from 10 to 74.

Graph: CDC Age-adjusted suicide rates by sex

Overall, the suicide rate increased from 10.5 per 100,000 people in 1999 to 13 per 100,000 in 2014, showing a steady 1 percent annual increase through 2006 and a 2 percent annual increase after that.

And while the suicide rates for males continues to be higher than those for females, the report notes that the gender gap is narrowing. Among females, the rate of increase was 45 percent, compared to 16 percent for males.

Suicide rates for middle-aged women aged 45-64 were the highest, in both 1999 (6 per 100,000) and 2014 (9.8 per 100,000), showing a 63 percent increase. In females, the largest increase occurred among girls 10-14 (200 percent), though the actual number of suicides in this group was relatively small, tripling from 0.5 per 100,000 in 1999 to 1.5 in 2014.

For men, suicide rates were highest for those 75 and over, with approximately 39 for every 100,000 men in 2014. However, men 45-64 had the greatest increase among males, increasing from 20.9 per 100,000 in 1999 to 29.7 in 2014, a rise of 43 percent.

In 2014, poisoning (34.1 percent) was the most common method of suicide in females and firearms (55.4 percent) was the most common in males.

The CDC report didn't address why suicides are up, but several studies offer clues about possible reasons among the middle-aged, including a study published in 2015 in the American Journal of Preventive Medicine that found that "job, financial, and legal problems" are most common in adults aged 40-64 who had committed suicide, and a 2011 CDC study which found that suicide rates increased during periods of economic recession and declined during economic growth among people aged 25-64 years.

Rural areas have highest suicide rates

Suicide is the 10th leading cause of death in the nation and the state, and with nearly 700 Kentuckians dying by suicide annually, Kentucky is one of the top 20 states for it.

Suicide is more prevalent in rural areas, where the rate is almost twice as high as in urban areas (17.6 suicides per 100,000 vs. 10.3 per 100,000), according to a separate CDC study.

"The myth is that suicide is an inner-city, urban problem, but the reality is that it is not," Melinda Moore, a licensed psychologist and assistant professor at Eastern Kentucky University, said in a telephone interview.

Moore, also the chair of the Kentucky Suicide Prevention Group, attributed some of the increase in suicide rates in rural Kentucky to its "gun culture."

"We have a culture that is very familiar with guns and that familiarity, unfortunately, can really lead to people using very lethal means when they are suicidal," she said.

And when you add gun culture to economic distress, which is common in much of rural Kentucky, it can be a "cocktail for disaster" for those who are suicidal, she said.

Another challenge is the lack of access to mental-health care in rural Kentucky, Moore said, noting that even if people have access to mental-health providers, many providers aren't trained to work with suicidal people. She said this should be improving, since the state now requires all behavioral health providers get suicide training when they renew their licenses.

Julie Cerel, psychologist and associate professor in the University of Kentucky College of Social Work, attributed the increase in rural suicides to several things, including the Gun culture, lack of access to mental-health care and the stigma that surrounds mental-health issues that deters people from seeking help.

Cerel, also president-elect of the American Association of Suicidology, said one reason for the national increase in suicides could be that coroners have become better trained on how to report them. She said that is very important, because people who were close to a person who died by suicide need to know so that they can seek their own mental-health support.

Cerel said 47 percent of Kentuckians knew someone who died by suicide, "and people who are exposed to suicide, especially if it is someone close to them, are more likely to have their own depression and anxiety and thoughts of suicide."

What should you do if you have suicidal thoughts or are concerned about someone?

Moore and Cerel said the first line of defense, especially in areas that don't have great mental-health resources, is to call the national suicide-prevention lifeline, 800-273-TALK (8255). This is a free, 24/7 service that can provide suicidal persons or those around them with support, information and local resources. It also offers a website at www.suicidepreventionlifeline.org .

Moore said community mental health centers are also great resources for those who are suicidal in rural Kentucky, and Cerel stressed the importance of telling someone if you are having suicidal thoughts, including your primary health-care provider.

Princess Health and Struggling Tenn. hospital takes care of Kentuckians, who get better care than Tennesseans thanks to expanded Medicaid. Princessiccia

Princess Health and Struggling Tenn. hospital takes care of Kentuckians, who get better care than Tennesseans thanks to expanded Medicaid. Princessiccia

accountability drug abuse economy health care access Medicaid obesity Patient Protection and Affordable Care Act rural health rural hospitals

Gusty 18:04 Add Comment

Jellico Community Hospital, just across the Kentucky border in Tennessee along Interstate 75, was taken over by Community Hospital Corp. last May, but that's not a guarantee it will survive, especially since Tennessee refuses to expand Medicaid to its poorest citizens, as Kentucky has, Harris Meyer reports for Modern Healthcare.

Meyer notes that one of the contributing factors to the hospital's struggle is the Tennessee Legislature's refusal to expand Medicaid under health reform to those who make up to 138 percent of the federal poverty level. That would decrease the hospital's level of uncompensated care.

About half the hospital's patients come from Kentucky, and its administrators, doctors and nurses all told Meyer that it is easier to get testing and specialty care for Kentucky Medicaid patients than for uninsured Tennessee patients who would qualify for expanded Medicaid.

�We're able to do more for Kentucky patients,� Christy Elliott, the hospital's case management supervisor, told Meyer. �For Tennessee patients, it's a struggle. If you don't have insurance, you don't get services.�

One such patient was Rebecca Jarboe, a mother of three from Kentucky. She told Meyer that she went into a "difficult" labor during a snowstorm on Valentine's Day. Because of the weather and her condition, she said she and her husband decided to travel 14 miles from their home to Jellico to have the baby, instead of making the 70-mile-journey down I-75 to the University of Tennessee Medical Center in Knoxville, 20 miles of which would have been over snow-covered Pine Mountain (known locally as Jellico Mountain).

�The care here is excellent,� a tired-looking Jarboe told Meyer while lying in her hospital bed cradling 2-day-old Silas and surrounded by her family. �Whatever you need, they are right at the door, and everyone is really friendly.�

The 31 states that have expanded Medicaid have been able to "shore up finances" in many of their rural hospitals, Meyer writes, but others have not fared so well. Nationwide, more than 50 rural hospitals have closed in the past six years, and nearly 300 more are in deep financial trouble, according to the National Rural Health Association.

A state report by then-Auditor Adam Edelen last year found that one in three of Kentucky's rural hospitals were in poor financial condition. Since the release of the report, several Kentucky rural hospitals have merged with larger hospital groups to make ends meet and rural hospitals in Nicholas and Fulton counties have closed.

Meyer also notes that Jellico hospital's problems go deeper than just not expanding Medicaid. In its service area good-paying jobs with health benefits have dwindled, only 10 percent of the population has private health insurance, residents have higher-than-average rates of disease, and there is rampant obesity and drug abuse. A similar story could be told about many rural Kentucky communities.

In addition to providing health care, the 54-bed hospital with its staff of 232 is the community's largest employer, as is often the case. The mayor of nearby Williamsburg, where the hospital has a clinic, noted that new businesses will often not consider moving to a community without a hospital.

�A lot depends on economic development in these communities,� Alison Davis, a professor of agricultural economics who studies rural healthcare at the University of Kentucky, told Meyer. �What are they going to do to create jobs? It's the No. 1 issue besides substance abuse they are facing. It's a struggle, and not every community will make it through.�

Adventist Health System, out of Florida, announced in May 2014 that it wanted to get rid of the hospital because it was losing "millions a year." A year later, CHC, a Texas-based not-for-profit with a mission to preserve access to healthcare in rural communities, took over the hospital and its clinic. CHC owns, manages and provides support to 21 community hospitals nationwide, according to a news release.

CHC told Meyer that it is optimistic the hospital will survive because of the medical staff's commitment to keeping quality healthcare in their community. It has also implemented cost-saving measures, like decreasing staff and installing a less costly electronic health record system, and is exploring ways to further save money, while increasing its client base.

But several local business leaders told Meyer they weren't so sure the hospital will survive.

�There have been so many layoffs that they don't have enough people to do lab work or X-rays, and you have to wait and wait,� Elsie Crawford, business manager of the Wilkens Medical Group in Jellico and a member of the City Council, told Meyer. �You can't draw more patients if you don't have enough people to take care of them.�

Dr. Charles Wilkens, who helped establish and maintain the hospital, told Meyer, �People would die for lack of health care if we didn't have a hospital in this community.�

Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

Princess Health and Officials hope reduction in Ky. colon cancer deaths via screening can be replicated with lung cancer, in which state is No. 1. Princessiccia

cancer colorectal cancer health reform lung cancer Medicaid obamacare Patient Protection and Affordable Care Act rural health rural-urban disparities smoking smoking bans

Gusty 09:11 Add Comment

Health officials in Kentucky, especially in the eastern part of the state, hope to increase lung-cancer screenings by following a successful colon-cancer screening initiative, Jackie Judd reports for PBS NewsHour. (Centers for Disease Control and Prevention graphic: Colon-cancer screenings are up)

In rural Eastern Kentucky, smoking and lung cancer rates are double the national average, while the state is second in adult smoking rates and leads the nation in lung cancer and rates of death from it. That is "fueled by a toxic combination of poverty, medical illiteracy, limited access to care, lifestyle choices like smoking, and a fatalism that says knowing you have cancer won�t save you."

Another challenge is that local bans of smoking in public places have left two-thirds of residents living in areas with no such bans, and a statewide ban seems unlikely because it failed to pass the state House this year after narrowly passing last year. New Republican Gov. Matt Bevin opposes a statewide ban.

Fifteen years ago Kentucky led the nation in "both the highest incidence and mortality rates for colorectal cancer," Allison Perry reports for University of Kentucky News. Rural residents didn't seek care, partly because of a lack of facilities and partly because of a refusal to schedule an appointment. If local residents wouldn't seek care, health officials decided to bring care to local residents.

"In the seven years following this new focus on colorectal cancer, the screenings rates nearly doubled, from 34.7 percent of the age-eligible population receiving screenings to 63.7 percent," Perry writes. "This raised Kentucky�s rank from 49th in the country to 23rd compared to other states. No other state has had such a dramatic increase in colorectal screenings in such a short period of time. As a result, the lives of many Kentuckians have been saved: the incidence rate for colorectal cancer is down nearly 25 percent, and the mortality rate has dropped 30 percent. Through colorectal screenings, doctors can find precancerous lesions and remove them before they become cancer. Screenings also allow physicians to find these cancers at an earlier stages, when they are more likely to respond to treatment."

The number of cancer screenings jumped in 2014 and 2015, as the state expanded eligibility for the Medicaid program under federal health reform, making many more people eligible for free screenings. Bevin is seeking change the state's program in ways that could require co-payments, premiums and deductibles.

In Kentucky "the challenge is to not only encourage certain lifelong smokers to get screened, but to get them to quit, and for others to never start," especially because of the addictive nature of smoking, Judd reports. "It will be even more difficult than changing the profile of colon cancer, because smoking involves addiction. The hope of public health officials is that the model used to bring down colon cancer deaths can be used to the same effect, not only for lung cancer, but for other diseases plaguing this depressed swath of America."

Princess Health and More Kentucky patients are recuperating in their local, rural hospitals after surgery in an urban hospital. Princessiccia

Princess Health and More Kentucky patients are recuperating in their local, rural hospitals after surgery in an urban hospital. Princessiccia

rural health rural hospitals urban health

Gusty 18:53 Add Comment

By Melissa Patrick
Kentucky Health News

Rural residents are increasingly being transferred out of big urban hospitals to recuperate in rural hospitals, many of which are struggling financially and can use the business.

"We have seen trends of this around the state," said Elizabeth Cobb, vice president of health policy for the Kentucky Hospital Association, said in an interview.

Oregon's legislature voted recently to encourage the trend in that state, by appropriating $10 million for rural health-care improvements, with the largest part encouraging such transfers.

In Kentucky, Cobb said the transfers would have to make sense from procedural, convenience and financial perspectives, but when it works out it is great for both the urban and rural hospitals, and also for the families.

"Certainly when there is a treatment or procedure that will take a significant amount of recovery, it is a wonderful thing for rural Kentuckians to be able to transfer back to their community facility to finish off their recuperation," she said.

Oregon's program aims to create a more consistent patient population in its rural hospitals, which will help stabilize their funding. At the same time, the program will relieve pressure on strained urban hospitals, Chris Gray reports for The Lund Report.

Rural hospitals are struggling financially all over the country and often have inconsistent patient volumes, while urban hospitals struggle with reaching capacity, and often worry they might have to expand, Gray notes.

A state report by then-Auditor Adam Edelen last year found that one in three of Kentucky's rural hospitals were in poor financial condition and suggested that to survive, they might have to adapt to new business models, such as merging with larger hospitals or hiring them as managers, forming coalitions with other hospitals, or finding a health-care niche that hasn't been served, such as creating a partnership with urban hospitals to allow rural patients the ability to recuperate closer to home.

While it sounds like a "common-sense system," Gray reports that the program is costly to set up, between $4 and $7 million, but once it is up and running, and the hospitals learn how to coordinate, "it should be self-sustaining, since money from insurers, Medicaid and Medicare will follow the patient," according to an interim workgroup of rural health officials from Oregon.

A rural health physician told Gray that "local hospitals and healthcare access, along with good public schools, provide the backbone for a viable community when employers are looking to invest in a community," he writes.

Princess Health and University of Kentucky rural health expert, Ty Borders, appointed to national advisory committee on rural health.Princessiccia

Princess Health and University of Kentucky rural health expert, Ty Borders, appointed to national advisory committee on rural health.Princessiccia

Foundation for a Healthy Kentucky health policy rural health University of Kentucky

Gusty 07:29 Add Comment

University of Kentucky College of Public Health Professor Ty Borders was recently appointed to the National Advisory Committee on Rural Health and Human Services.

Ty Borders

This committee is part of the Health Resources and Services Administration and includes a 21-member panel of nationally recognized rural health experts that is responsible for making recommendations to the Department of Health and Human Services on issues related to rural health. Borders's appointment will continue until April 2019.

�This appointment is an honor not only for Dr. Borders and his family, but also for Kentucky,� Rep. Andy Barr, R-Ky., said in a UK news release. �Dr. Borders possesses a broad and deep understanding of the health care challenges facing rural Kentucky and America. His unique insight about evidence-based strategies that could improve rural health and health care delivery will greatly benefit the committee.�

Borders is the chair of the Department of Health Services Management and the Foundation for a Healthy Kentucky endowed chair in Rural Health Policy. He also serves as a founding co-director of the UK Institute for Rural Health Policy and is the editor of the Journal of Rural Health, an academic publication devoted to rural health research.

Princess Health andKentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011.Princessiccia

Princess Health andKentucky led the nation in hepatitis C cases in 2013; state's rate rose 357 percent from 2007 to 2011.Princessiccia

Appalachia diseases drug abuse drug use drugs health hepatitis c prescription drug abuse rural health rural-urban disparities

Gusty 08:18 Add Comment

By Tim Mandell
Kentucky Health News

Kentucky had the nation's highest rate of hepatitis C in 2013, with 5.1 cases per every 100,000 people, says a report by the federal Centers for Disease Control and Prevention. As many as 3.5 million people in the U.S. have hepatitis C and more than 56,000 Kentucky resident may have chronic hepatitis C infection, according to the state Cabinet for Health and Family Services. The main cause of hepatitis C is shared needles among intravenous drug users.

Hepatitis C cases rose 364 percent in Kentucky, Tennessee, Virginia and West Virginia from 2006 to 2012. The big increase was in 2007-11, when the rate rose 357 percent, a CDC state health profile says.

"Of the cases that have been reported and researchers gathered data about potential risk factors, 73.1 percent reported injecting drugs," Brian Wu reports for Science Times. Among new cases, 44.8 percent were people under 30.

While officials said HIV rates are low in the four Appalachian states, they said they fear that the increase in hepatitis C cases could lead to a rise in HIV cases, Wu writes. Officials said needle-exchange programs are key to reduce the number of potential HIV cases. Kentucky recently authorized such programs if local officials agree to them.

"About 4.5 million Americans older than 12 abused prescription painkillers in 2013 and 289,000 used heroin, according to the Substance Abuse and Mental Health Services Administration," Liz Szabo reports for USA Today. "About 75 percent of new heroin users previously abused opioid painkillers. The number of first-time heroin users grew from 90,000 people in 2006 to 156,000 in 2012, according to the CDC."

Kentucky has the third highest drug overdose mortality rate in the U.S., with 23.6 deaths per 100,000 people, says the 2013 report "Prescription Drug Abuse: Strategies to Stop the Epidemic," reports Trust for America's Health. "The number of drug overdose deaths�a majority of which are from prescription drugs�in Kentucky quadrupled since 1999 when the rate was 4.9 per 100,000."