By Dave Ranney
KHI News Service

WICHITA — A Kansas Department for Aging and Disability Services decision last week to limit admissions to Osawatomie State Hospital has had an immediate effect on the state’s mental health system.

Marilyn Cook, executive director at COMCARE, the community mental health center in Wichita, said the state’s decision to suspend admission of voluntary patients and more closely screen involuntary admissions at the Osawatomie facility recently prevented the center from transferring several patients thought to be a danger to themselves or others.

“Last Friday, we screened three people who were determined to need involuntary treatment,” Cook said. “We had two more on Saturday, and two more on Sunday for a total of seven over the weekend.”

All seven, she said, were denied admission to the state hospital. They were instead placed in “medical (hospital) beds somewhere in this community.” COMCARE, Cook said, was told the seven would-be patients were denied admission to Osawatomie because they were “already in a safe place,” a reference Cook understood to mean emergency rooms in the city.

After court appearances Wednesday, all seven patients were admitted to Osawatomie State Hospital.

While in Wichita, some of the patients — it’s unclear how many — were hospitalized at Via Christi Health System.

“We were able to meet their needs, although not without considerable effort on the part of physicians we work with,” said Roz Hutchinson, a spokesperson for Via Christi.

Carol Manning, executive director at the Wichita-based Mental Health Association of South Central Kansas, said the delayed Osawatomie admissions underscore persistent gaps in the state’s network of mental health programs.

“Seven in one weekend? That’s a lot,” she said. “What we’re seeing here, I think, is that demand for higher-acuity services is outpacing the resources that are available both locally and at the state level.”

On Wednesday, 61 of the 226 patients at Osawatomie State Hospital were from Sedgwick County, according to a KDADS report.

The numbers cited by Cook match those provided by KDADS Secretary Kari Bruffett, who said Tuesday that 11 “involuntary” patients were admitted to Osawatomie State Hospital over the weekend and seven from COMCARE were denied admission.

KDADS last week announced an immediate suspension of voluntary admissions to Osawatomie after federal surveyors threatened to block a significant portion of its Medicare payments.

The agency also said involuntary admissions would be “aggressively triaged” and that would-be patients were not to be sent to Osawatomie unless their transfer had been pre-approved by an “admissions officer” or an on-duty physician.

The new policy is designed to reduce the number of patients at Osawatomie, which in recent months has often exceeded its licensed capacity.

Bruffett said state officials know the policy creates “challenges” for community mental health centers. But she said conversations in recent days with several center directors have led her to believe that they “understand and appreciate the need for the policy.”

Cook understands the reasons for the policy but predicts that it will have ripple effects throughout eastern Kansas, the hospital’s catchment area.

“It’s looking like people who have a need for involuntary admission to the state hospital may have delays getting that level of care,” she said. “That care is going to have to come from somewhere. I’m not sure where.”

Sandy Horton, executive director at the Kansas Sheriffs’ Association, said he expected to policy to lead to more people ending up in jail.
“I don’t like saying it, but when the resources that we’re talking about here aren’t available in the community, we see more people getting arrested for minor violations and being taken to jail,” Horton said. “It’s probably not the best place for them to be, but it may be the only place.”

He added: “I’ll be surprised if this doesn’t have an adverse effect on law enforcement.”
Prompted in part by the Osawatomie census issues, federal surveyors inspected the hospital in October and cited it for several deficiencies. Among other things, the surveyors uncovered several instances of poor care. One resulted in a diabetic patient having to have a toe amputated. Another led to a patient whose blood clots weren’t properly treated being transferred to another hospital’s intensive care unit.

A survey report obtained from the federal Centers for Medicare and Medicaid Services also documented an instance where a pharmacist discontinued a patient’s heart medication without consulting the patient’s doctor.

State officials said last week that after a second inspection, federal officials had approved a plan for improving conditions at the Osawatomie hospital.

KDADS continues to work with CMS on a “plan of correction” related to census issues at the 206-bed hospital. The agency has 90 days to implement the plan.

Dave Ranney is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas.

SPRINGFIELD, Mo. (AP) — Springfield police are investigating a homicide at a home in the central part of the city.

The Springfield News-Leader  reports that the victim has been identified as Joshua Kelley. The 26-year-old Springfield man was found dead Thursday morning after police responded to a call of gunshots in the area. A neighbor called to report hearing a woman screaming and shots fired around 3:30 a.m.

 Police say investigators are processing the scene for evidence and that an autopsy is planned. Police are urging anyone with information to come forward.

The homicide is the 17th of the year.

WASHINGTON (AP) — President Barack Obama plans to sign a $1.1 trillion government spending bill if it reaches his desk, although he opposes a provision blocking the District of Columbia from legalizing marijuana.

White House spokesman Josh Earnest said Thursday that despite reservations, Obama is set to sign legislation to fund nearly the entire government through the end of the budget year Sept. 30.

District voters approved an initiative Nov. 4 to allow possession of up to 2 ounces of pot or up to three mature plants for personal use. But language inserted by Republicans in the spending bill would bar the city from moving forward with legalization.

Earnest says the president believes Congress shouldn’t interfere with the will of city voters on marijuana and other issues. Obama supports statehood for the District.

WASHINGTON, D.C. – U.S. Senator Roy Blunt (Mo.) spoke on the U.S. Senate floor today about several of the Obama Administration’s costly regulations that hurt Missouri families, farmers, and businesses. Blunt highlighted his support for U.S. Senator Rand Paul’s (Ky.) bill, the “REINS Act,” which would require Congress to approve every new major rule proposed by the executive branch that has an annual economic impact of $100 million or more. Blunt also discussed his introductionof the “ENFORCE the Law Act,” which would help ensure the president upholds his constitutional obligation to “take care that the laws be faithfully executed.”

Click here to watch Senator Blunt’s remarks.

LEAVENWORTH- A Kansas man was injured in an accident just before 1:30 p.m. on Thursday in Leavenworth County.

The Kansas Highway Patrol reported a 2002 Ford Ranger driven by Ernest Bjorgaard Jr., 61, Leavenworth, was westbound on Kansas 32 just east of 222 Street.

The vehicle left roadway to the south, struck a field entrance, became airborne for approximately 35 feet coming to rest in the south ditch.

Bjorgaard Jr., was transported to Lawrence Memorial Hospital.
The KHP reported he was not wearing a seat belt.

By Andy Marso
KHI News Service

TOPEKA — Hundreds of nursing homes and other assisted living facilities in Kansas will be required to participate in a fund meant to spread the risk of malpractice lawsuits starting next month. Advocates for those facilities say the change is a positive, but it has insurance agents scrambling to find liability coverage for their assisted living clients in a limited market.

For more than two decades, health care facilities in Kansas have been required to participate in the Health Care Stabilization Fund, a pot of money derived from a surcharge on their private malpractice insurance that provides additional coverage for malpractice claims. The fund makes it less likely that a few expensive claims could sink a facility financially.
Until this year, nursing homes and other adult care facilities were not considered health care providers under the law. Cindy Luxem, president and CEO of the Kansas Center for Assisted Living, said that wasn’t good for the facilities or consumers who might file a claim.

“We had a lot of providers in Kansas that weren’t really able to provide anything (in compensation),” Luxem said. “And that doesn’t set up a good situation for the consumer.”

Luxem said she and other assisted living advocates wanted to be included in the stabilization fund for years. The opportunity presented itself this year when legislators reopened the statutes governing the fund in response to Kansas Supreme Court concerns over a long-static $250,000 cap on non-economic “pain and suffering” damages in malpractice suits.

Legislators voted to gradually raise the cap and to include nursing homes and other assisted living facilities in the stabilization fund.

Fred Benjamin, president of Coffeyville’s Medicalodges and chairman of the Kansas Health Care Association’s board of directors, called it a “positive change” that was overdue given the evolving ways that health care is delivered.

“People that were in hospital intensive care units 10 years ago are in skilled nursing facilities today,” Benjamin said.

‘Unexpected hurdles’

Hundreds of Kansas adult care facilities are now slated to come under the Health Care Stabilization Fund at the beginning of 2015. But some are still scrambling to find the necessary private liability coverage to do so.

“The changes created some unexpected hurdles in the nursing home market,” said Stephanie Mulholland, a spokeswoman for the Kansas Association of Insurance Agents. “We know that several of them had to find new insurance carriers in a pretty short amount of time.”

All facilities within the stabilization fund must purchase private liability coverage from an “admitted carrier” approved by the Kansas Insurance Department. The insurance department vets the carriers’ financial information to ensure their solvency.

Previously, adult care facilities not in the stabilization fund were allowed to purchase coverage from “foreign surplus lines,” or carriers that the Kansas Insurance Department allows to do business in the state “if such coverages are not readily obtainable in the admitted market.”

Chip Wheelen, executive director of the Health Care Stabilization Fund, said a surprising number of the adult care facilities had obtained their professional liability coverage from the non-admitted carriers.

“I have to admit a lot of them have said, ‘Our insurance agent got our coverage from an excess and surplus lines carrier,'” Wheelen said.

Mulholland said the limited number of admitted carriers for adult care facilities has made it difficult in some cases to find affordable coverage that will satisfy the stabilization fund requirements. There are seven companies admitted in Kansas to provide liability coverage to adult care facilities.

“Insurance agents have quite a bit of experience finding coverage for those harder-to-place markets,” Mulholland said. “They’ve been able to do that in most cases, but in the long term I think we need to look at creating more competition within this particular market to drive rates down.”

Wheelen noted that adult care facilities that have been declined by at least two of the admitted carriers can purchase insurance from the Health Care Provider Insurance Availability Plan that will satisfy the requirements of the stabilization fund.

That public plan is administered on a third-party basis by Topeka-based Kansas Medical Mutual Insurance Company, or KaMMCO, one of the private commercial insurers that is an admitted carrier in Kansas.

Premiums for the availability plan are set at 120 percent of those for the commercial insurance policies, because Wheelen said the availability plan is not intended to be a competitor for the private sector, but rather a backstop for health care providers who are unable to get liability insurance there.
No extra cost expected

The long-term cost to the facilities now joining the Health Care Stabilization Fund is unknown.

Debra Zehr, president of LeadingAge Kansas, a group that represents 160 nonprofit assisted living providers, said she did not expect an increase for her members
“There really isn’t any extra cost necessarily for providers who have carried liability insurance historically, which is 100 percent of our members and a large percent of all providers,” Zehr said.

Zehr noted that when the state switched to managed care Medicaid under KanCare in 2012, the three companies administering the managed care contracts all required facilities to carry liability insurance to be in their networks.

“There may have been in the past some members, some years when rates really went up, they’d drop their coverage,” Zehr said. “But that’s not true anymore.”

The challenge now is making sure those policies come from admitted carriers, to satisfy the requirements of the stabilization fund.

Wheelen said the Kansas Association of Insurance Agents deserves credit for trying to educate agents about that change, including hosting a webinar about it as early as June.

“Unfortunately, I’m afraid a lot of them weren’t watching and they still got caught by surprise,” Wheelen said.

Wheelen said “a lot” of agents have contacted the stabilization fund to find out where to get the needed coverage. Those calls have a greater sense of urgency now.

“Beginning Jan. 1, the rules become more strict,” Wheelen said.

Lisa Ignoto, director of marketing and communications for KaMMCO, said any administrators at adult care facilities who are unsure if they’ve done what they need to do to comply with the Health Care Stabilization Fund requirements can contact advocacy groups like LeadingAge Kansas or the Kansas Health Care Association.

“As the deadline is getting closer, our underwriting department is prepared to step up its game,” Ignoto said. “There’s still time to get it done.”

Andy Marso is a reporter for Heartland Health Monitor, a news collaboration focusing on health issues and their impact in Missouri and Kansas

TOPEKA, Kan. (AP) — An attorney for a Kansas doctor has told the state’s medical board that it should allow her to regain her license despite finding that she kept inadequate records for young patients she referred for late-term abortions.

Attorney Bob Eye said Thursday that the State Board of Healing Arts has no evidence that any of the patients Dr. Ann Kristin Neuhaus of Nortonville saw for mental health exams in 2003 were injured.

Her exams for 11 patients aged 10 to 18 allowed them to obtain abortions from the late Dr. George Tiller of Wichita.

Board attorney Reese Hays argued Neuhaus has shown she can’t be rehabilitated. The board sanctioned her in 1999 and 2001 over record-keeping issues.

The board plans to issue a written ruling by Jan. 9.

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TOPEKA, Kan. (AP) — A Kansas board is considering whether to continue banning a doctor from practicing medicine after scrutinizing her referrals of young patients for late-term abortions and finding that she kept inadequate records.

The State Board of Healing Arts is conducting a hearing Thursday morning in the case of Dr. Ann Kristin Neuhaus of Nortonville.

She successfully challenged a 2012 board ruling that she conducted substandard mental health exams in 2003 for 11 patients aged 10 to 18. Her opinions about patients’ mental problems allowed the late Dr. George Tiller’s clinic in Wichita to terminate their pregnancies.

A Shawnee County District Court judge earlier this year overturned the board’s revocation of Neuhaus’ license but agreed that she kept inadequate records. The judge sent her case back to the board.

JEFFERSON CITY (AP) – Missouri lawmakers are vowing an aggressive investigation into why Gov. Jay Nixon did not use National Guard troops to prevent angry crowds from burning and looting businesses in Ferguson when a grand jury decision was announced in the police shooting of Michael Brown.

A House and Senate investigative committee met for the first time Thursday and pledged to use subpoenas, if necessary, to compel members of Nixon’s administration to testify and turn over documents.

A grand jury decided Nov. 24 not to indict Ferguson police officer Darren Wilson, who is white, for fatally shooting the black 18-year-old in August. After the announcement, some protesters set fire to businesses and vehicles.

Nixon had activated the National Guard before the announcement. But troops were not stationed in front of the Ferguson businesses.

LENEXA – Two people were injured in an accident just before 7 a.m. on Thursday in Johnson County.

The Kansas Highway Patrol reported a 2007 Ford Focus driven by Steven Robert Adams, 20, Kansas City, Mo., was southbound on Interstate 35 at U.S. 69 in Lenexa.

The driver lost control due to the wet roadway, slid into the next lane and was struck by a semi.

The semi driven by Abdi Hersi Karshe, 30, Columbus, OH., also struck a 2013 Ford Econoline van driven by Edward E. Walker, 64, Overland Park.

A private vehicle transported Adams to Overland Park Regional Medical Center for treatment. Walker was also transported to Overland Park Regional. Karshe was not injured.
The KHP reported Adams was not wearing a seat belt.