ST. LOUIS (AP) — An FBI spokeswoman says two special agents have been shot in St. Louis County and that the incident isn’t directly related to the Ferguson protests.

Rebecca Wu, a spokeswoman with the FBI St. Louis Division, says the agents were assisting the University City Police Department execute an arrest warrant at 2:53 a.m. Wednesday.

One agent was shot in the shoulder and the other agent was shot in the leg. Wu says neither injury is life-threatening.

The flashing lights of police cars, fire trucks and ambulances could be seen near the scene of the shooting, which took place about 5 miles south of Ferguson.

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ST. LOUIS (AP) — A St. Louis County police spokesman says two FBI agents have been shot, but their injuries are not life-threatening.

Officer Shawn McGuire says the shooting took place early Wednesday morning in north St. Louis County. McGuire says the agents were shot while responding to a person barricaded inside a home.

It was not known whether the shooting was related to the Ferguson protests. The shooting took place about 5 miles south of Ferguson.

The FBI did not immediately respond to a request for information.

By Andy Marso
KHI News Service

HIGHLAND — In the last two years Seth Nutt has traveled to nearly every corner of Kansas, introducing rural students to health care professionals.

During trips to Goodland, Hays, Highland, Girard, El Dorado, Harper and Seward County, Nutt and others from the Area Health Education Center at the University of Kansas Medical Center have met with 1,000 high schoolers to tell them about the job opportunities available in health care. Through these meetings, Nutt and others hope the students will seek training health care fields and then return to their communities to provide much-needed services.
“I think the barriers are just not knowing what’s out there,” said Nutt, the center’s service coordinator for health careers and promotion. “Especially if you’re from a rural community, you’re unaware of a lot of the opportunities that are available to you and what careers are really needed.”

While the shortage of dentists in rural Kansas has been documented for years, Nutt said there’s a lack of patient access to other types of health professionals as well.

“In the rural communities, MDs (medical doctors) are needed,” Nutt said. “And nursing. I think when you get into the rural setting, there’s a lot of the careers that are needed.”

Nutt stresses to the high school students that there are more than 150 professions within medicine, and that number is growing as technology expands care options.

Nutt and Lynn Malleck, program manager for the Area Health Education Center’s northeast branch, visited Highland Community College on Monday. A group of about 50 students from five area high schools had gathered there to hear from Kansans working in pharmacy, dentistry, orthopedic research, health information management, nursing, psychology and critical care.

Nutt said it was a relatively small group. The gatherings generally draw between 100 and 150 students.

The Area Health Education Center has instituted other programs since Nutt was hired two years ago, including something called “Night @ the Lab” in which teams of three students are encouraged to do a research project on a specific topic, most recently cancer.

“They have four weeks to research a topic, put together an oral presentation and a visual display, and then they actually present those at regional competitions,” Nutt said.

The top team in each of the six regional competitions advances to a statewide competition at the KU Medical Center in Kansas City, where they are given a “behind-the-scenes look” at the medical center and their work is judged by faculty and staff.

FERGUSON(AP) – Police have dispersed protesters from the streets of Ferguson after second night of demonstrations following a grand jury decision to not indict Officer Darren Wilson in the shooting death of Michael Brown.

Tuesday was far calmer than the previous night, though officers did have to extinguish a police car that was set on fire and vandals managed to damage some additional storefronts.

Several arrests were made, but the protests did not approach the chaos of the previous night, which saw arson, looting and rioting in the streets.

Members of the National Guard – which tripled its numbers in the Ferguson region Tuesday – were far more visible and remained posted throughout the city after the protests ended.

JEFFERSON CITY, Mo. (AP) — A Republican lawmaker said Tuesday he plans to introduce a bill that requires Missouri universities to create standardized tests for school children in the state, a move intended to make sure educators don’t teach contested Common Core standards.

State Rep. David Wood’s legislation would escalate the fight over school benchmarks adopted by Missouri and 42 other states. Common Core aims to create consistent, high achievement goals for students across state lines, but it has become a magnet for conservative critics who say states should have more say over what students learn.

The work groups have until October 2015 to recommend keeping Common Core or adopting new standards. The State Board of Education has a final say.

Wood said his legislation would prevent teachers from continuing to teach Common Core regardless of what the board adopts.

He said he wants the tests in place for online use by 2017 or 2018.

TOPEKA, Kan. (AP) — Dozens of protesters gathered outside the state Capitol in Topeka to voice their anger after a Missouri grand jury refused to indict a St. Louis-area police officer for shooting an unarmed 18-year-old.

About 50 people holding signs turned up at the state Capitol in Topeka on Tuesday evening for a peaceful rally. A half-hour before the scheduled start, two protesters were shooed from the Statehouse steps and told they had to hold their rally on the sidewalk.

A similar number showed up at a Wichita church in response to the grand jury’s decision Monday not to charge Ferguson, Missouri, police officer Darren Wilson for fatally shooting Michael Brown on Aug. 9.

At the University of Kansas in Lawrence, more than 80 students, faculty and community members also protested the decision.

FERGUSON, Mo. (AP) — Ferguson Police Officer Darren Wilson says he couldn’t have done anything differently in his confrontation with Michael Brown to have prevented the 18-year-old’s shooting death.

Wilson made his first public statements Tuesday during an interview with ABC News’ George Stephanopoulos. He offered details of the Aug. 9 shooting like those contained in his grand jury testimony, released a day earlier after it was decided he wouldn’t be indicted in the death.

Wilson says he felt like it was his duty to chase Brown after a confrontation at his police vehicle. When asked about witness accounts that Brown at one point turned toward Wilson and put his hands up, he responded “that would be incorrect.”

He told Stephanopoulos he has a clean conscience because “I know I did my job right.”

By Andy Marso
KHI News Service

TOPEKA — A legislative committee’s recommendation could reignite a debate over whether the state should have the power to regulate Medicaid reimbursements for mental health medications, as it does for other types of drugs.

Kansas law currently bars state officials from using regulatory tools — such as prior authorization and preferred drug lists — to manage the use and cost of mental health medication prescribed to Medicaid recipients. The Legislature’s KanCare Oversight Committee recommended repealing that law last week, saying the state needs to prevent inappropriate use of such drugs. But mental health advocates say there are other ways to do that, and they will oppose any repeal of the law.

“The issue is not new to me,” said Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas. “You want to be really cautious how you proceed with policy changes for this population and people who suffer from mental illness.”

In suggesting the change to state law, Rep. David Crum, a Republican from Augusta, said he aimed to protect Kansans with persistent mental illness while attempting to prevent the inappropriate but common use of antipsychotic drugs for other types of patients.

“Patients with persistent, chronic mental illness should be able to receive antipsychotic drugs with no requirement for prior authorization,” Crum said. “However, for all other patients, Kansas Medicaid needs to be able to perform safety edits to assess whether drugs are being prescribed appropriately.”
What sort of change that would represent from current law is unclear, though, because the statute now on the books does not describe the threshold for “persistent, chronic mental illness.”

“That may be something we’re going to have to define if we’re going to put this into law,” said Sen. Laura Kelly, a Topeka Democrat. “I don’t have a problem with looking at that delineation, but I do think that’s going to be difficult to determine.”

Crum, who did not seek re-election and is serving his final weeks in office, said persistent, chronic mental illness could be defined in legislative hearings on the issue next session. He said he was especially concerned about antipsychotic drugs being inappropriately prescribed to control elderly patients and residents of nursing homes suffering from dementia.

Mitzi McFatrich, executive director of Kansas Advocates for Better Care, said she had warned the oversight committee about that practice’s prevalence in Kansas at previous meetings. However, she never suggested the solution was to repeal the ban on Medicaid regulation of mental health drugs.

“In my mind there’s no clear intersection on those issues,” McFatrich said.

Instead, McFatrich said her suggestions include increasing staff levels at facilities for the elderly and making sure staff members are trained “so they can meet a resident’s needs for attention and redirection in ways that don’t just involve medicating them.”

Elderly patients with dementia are generally covered by Medicare but some also receive Medicaid to help with costs not covered by the primary insurance.

Previous focus on children

Previous attempts to regulate prescription of antipsychotic drugs have focused on different demographic: children.
The Kansas Health Policy Authority, a semi-autonomous state agency disbanded in 2011, cited several statistics about children’s health in a 2009 report that bolstered its recommendation that the Legislature allow more regulation of mental health drugs.
About 17 percent of children on Medicaid were receiving antipsychotics like Risperdal or Abilify, the report said, while the National Institutes of Mental Health estimated that only about 1 percent of children had conditions like bipolar or schizophrenia that those medications are intended to treat.

The report noted that the incidence of those mental illnesses would likely be higher among the Medicaid population than in the population at large because mental illness can be a qualifier for Medicaid coverage.

“However, the greater percentage of children receiving atypical antipsychotics cannot be explained by this population characteristic alone,” the report said.

The health policy authority report said that a significant number of children were being prescribed the antipsychotics off-label — for use other than what the FDA had studied — and suggested that deserved more scrutiny.

The report also said that in a three-month period in 2008, 214 Kansas children on Medicaid were prescribed five or more psychotropic medications, which are used to treat psychiatric conditions, and 201 were prescribed two antipsychotic medications at the same time.

“Scientific evidence supporting the use of multiple psychotropic medications simultaneously is lacking,” the report stated. “Reasons for these potentially inappropriate prescribing patterns have not been isolated.”

The report pointed to a possible link to spotty access to psychiatric care in some areas of the state, noting that 63 percent of mental health drugs in Kansas were prescribed by general practice physicians and other medical professionals not trained in psychiatry.

The Legislature declined to take up the health policy authority’s recommendation to create a preferred drug list for Medicaid, which mental health advocates opposed.

An issue of cost?

Amy Campbell, a lobbyist for the Kansas Mental Health Coalition, said the authority’s report did not provide any solid evidence of prescription misuse.
A child could be prescribed multiple medications during a three-month period, she said, without actually taking those medications simultaneously. For instance, a child could be prescribed a second medication if the first one was ineffective, or could be prescribed one by a general practitioner and then another in a hospital after a mental health crisis.

“The issue there that never was resolved was, were any of these doctors contacted?” Campbell said. “Were any of these drugs actually being prescribed in an unsafe manner, or were these situations where children picked up these drugs in a hospital setting?”

Eric Atwood is director of medical services at Family Services and Guidance Center, a community mental health center in Topeka that serves children of northeast Kansas.
Atwood said research does not suggest Kansas is an outlier in its psychotropic prescription patterns. He said prescription costs, more than safety concerns, motivate state officials to more tightly regulate the use of mental health drugs.

“The studies that have really looked at that have not shown there are dangerous issues of prescribing in Kansas as compared to other states,” Atwood said. “The basic issue is cost and cost containment.”

The health policy report from 2009 did highlight mental health medications as a major cost driver in Medicaid, citing their expense as 40 percent of the overall growth in the program’s prescription drug spending the previous year. The report recommended using tools like prior authorization and a preferred drug list to limit spending.

A preferred drug list allows states to negotiate rebates from pharmaceutical companies, which then have their medication designated as the drug of choice to treat a specific ailment. Prior authorization requires a physician who prescribes a different drug to provide an explanation that is then reviewed by a panel of experts before the prescription is filled.

‘Meaningless hurdles’

The state uses both tools for other prescriptions within Medicaid, but mental health advocates have successfully argued that drugs that treat mental illness should be exempt from them.

Mental illnesses are not uniform, they argue, and sometimes patients must try several drugs before they find one that successfully treats their symptoms. Delaying a prescription for someone with a mental illness by requiring prior authorization, Kessler said, can cause a far more costly trip to an institution, or even prison, if the patient involved has a crisis.

“More and more of the literature is saying prior authorization and (preferred drug lists) on psychotropic medications isn’t good policy,” Kessler said. “You’ll just see cost-shifting to other areas.”

Digital records and communication have the potential to speed the prior authorization procedure, and temporary drug supplies can be made available in the interim.

But Atwood said the system isn’t there yet. He said prior authorization requirements in their current form delay treatment and create “meaningless hurdles and administrative obstacles” for providers.

Campbell said a better alternative would be to renew an abandoned process of post-prescription review in which a panel of experts identified unusual prescribing patterns, contacted the physicians involved and offered consultations.

Campbell said her organization wants to work with the Legislature to determine if any misuse of mental health drugs is happening. If issues are identified, she said, they then can be addressed through education rather than repealing the statute that bars Medicaid management of such drugs.

“We believe there is room for the examination and implementation of policy to help with the safe prescribing of mental health medications,” Campbell said. “But simply wiping out the statute would result in a serious loss of protection for mental health clients.”

ERIC TUCKER, Associated Press

WASHINGTON (AP) — Attorney General Eric Holder says he’s “disappointed” by the violence that followed the Ferguson grand jury decision.

Holder told reporters Tuesday that he is encouraged by some of the peaceful demonstrations, saying that “acts of violence threaten to drown out those who have legitimate voices” and that progress comes from nonviolence.

He says he has instructed his staff to work with leaders of the peaceful protesters to identify and isolate those who are bent on destruction in the community.

He says those who worked to stop others from violence are “heroes.”

Minutes after the decision not to indict Officer Darren Wilson was announced Monday night, protesters poured into the streets of Ferguson. Some commercial buildings were burned and dozens of people were arrested.

OZARK, Mo. (AP) — The American Civil Liberties Union is suing an Ozark fire department for denying spousal benefits to the wife of female fire captain, noting that a local judge recently ordered Missouri to recognize same-sex marriages from other states.

The lawsuit was filed on behalf of Andi Mooneyham, a fire captain at the Ozark Fire Protection District, after she sought benefits for her spouse, whom she legally married in California in July, the Springfield News-Leader reported.

Tony Rothert, legal director of the ACLU of Missouri, said Mooneyham puts “her life on the line at work” and should receive the same benefits as her coworkers. The lawsuit argues there was “no rational, substantial or compelling governmental interest justifying (the fire board’s) discriminatory policy.”

The fire district’s board decided in September that it didn’t have the authority to change the department’s policy to extend spousal benefits to same-sex couples. The board’s attorney, Todd Johnson, had advised the board a month earlier that the Missouri Constitution didn’t allow the action because it defines marriage as between a man and a woman.

Johnson said Tuesday that he stands by the legal opinions he gave to the board.

The ACLU suit references an October decision by a Jackson County circuit judge that said Missouri must recognize same-sex marriages performed in other states.

Fire board member Anthony Appleton said Johnson continued to maintain last month that the ruling didn’t change the fire district’s legal standing.

ST. LOUIS (AP) – An aide to St. Louis County Prosecutor Bob McCulloch is defending the timing of the grand jury announcement in the Ferguson case, even as some question whether the nighttime announcement fed the unrest.

McCulloch held a news conference at 8 p.m. Monday to disclose that the grand jury declined to indict Ferguson police Officer Darren Wilson for killing 18-year-old Michael Brown.

The announcement led to violent protests.

Former two-term Ferguson Mayor Brian Fletcher says it should have been announced early in the day to give police more time to prepare for any nighttime unrest.

McCulloch spokesman Ed Magee says the timing allowed for coordination with law enforcement, gave schools time to get kids home safely, and gave businesses time to decide what was best for them.