3 Possible Factors Behind Sell-Off Of KentuckyOne Facilities Tuesday, May 16 2017 

It’s been five years since Catholic Health Initiatives tried to bring together high-performing hospitals in Lexington and less successful hospitals in Louisville. And now, the Louisville hospitals are being sold: Jewish Shelbyville, Jewish, Sts. Mary’s and Elizabeth and the Frazier Rehab Institute.

The move was announced Friday and KentuckyOne CEO Ruth Brinkley said in a news release that the decision to sell the facilities was “made with great care and consideration.”

“New owners and operators of the facilities outside of our central and eastern community focus will have the resources and ability to continue to deliver care, support employees and physicians and engage the community.”

Here are 3 likely reasons behind the sale:

  1. The patients. While the University of Louisville hospital has the biggest portion of Louisville’s Medicaid recipients and uninsured, Jewish and St. Mary’s are close behind. A big part of that is because of location. West and South Louisville are home to more low-income people, and there are big health care disparities that run down the middle of Louisville.

Ann Hagan-Grigsby from the Park DuValle Community Health Center said 30 percent of their patients are uninsured. And most patients go to one of these hospitals when they’re sick.  And it’s often only when they are very sick that they go.

“Until then, I’m not going to worry about it because I’m worried about food, shelter, clothing and other societal issues,” Hagan-Grigsby said. “Health care is not the top one on your list. It’s just not.”

And patients who have all those other stressors might forgo preventive care and go straight to the ER when problems arise.

  1. Compared to other hospitals in Louisville and the others KentuckyOne are not selling, these facilities rank low with Medicare, meaning that they’re not paid as much as the higher-ranking hospitals.

Medicare gives hospital star ratings based on a lot of factors. And bad ratings mean that facilities are not paid as much as the higher-ranking hospitals. For example, one such ranking is the percentage of patients who receive an appropriate recommendation for follow-up colonoscopy. The higher the number of people, the better. Colonoscopies can detect cancer, ulcers and other diseases.

A third of patients at Jewish Hospital Shelbyville got a recommendation. Three quarters did at Jewish and St. Mary’s Hospital. That compares to one of KentuckyOne’s successful hospitals in Bardstown, where almost 90 percent of people got that recommendation.

In some cases, a low quality score could mean the patient population is just harder to manage. Hagan-Grigsby with Park DuValle Community Health Center says she doesn’t think this kind of sale would have happened East of that health care divide down Louisville.

“If you have a patient population that’s primarily insured, and tends to be very compliant in terms of accessing care, then your challenges are different,” she said.

  1. KentuckyOne is likely trying to make itself a better buy. Catholic Health Initiatives started KentuckyOne back in 2012 to form a regional health care powerhouse, and did so as well in many other states. In 2015, there were 108 hospitals in 18 states. But last year, they went down to 102 hospitals and also reported $500 million in operating losses. Part of those losses came from decreasing payment rates and the Medicare penalties.

Now CHI is in talks with California-based Dignity Health to merge the companies.

What’s next? KentuckyOne is looking for a buyer of these hospitals. Michael Imburgia runs a specialty heart clinic downtown. Many of his patients use Jewish and the Frazier Rehab Center for care. His main concern is that they stay open.

“My bigger fear, they do take care of a lot of indigent patients, and they don’t just take care of people in Louisville, it’s throughout the state,” Imburgia said.

Medicare Isn’t The Safest Of Safety Nets In Kentucky Monday, May 15 2017 

If you’ve got Medicare insurance, you probably already know this. But if you don’t, you need to know this: It won’t be a relief from high health care costs.

That’s according to a new study out from the Commonwealth Fund.

The out-of-pocket cost for an average Medicare recipient is $3,024 a year, according to the study. That doesn’t include monthly premiums. And Medicare recipients pay on average $1,300 every time they’re hospitalized.

The report out Friday shows that although the program for those over 65 or disabled has a basic set of benefits, the real protection from medical bankruptcy comes with a pricey supplemental policy.

Their research found two-fifths of people with Medicare earn below $24,000 but spend 20 percent or more of their income on premiums with medical care. That includes costs covered by some insurance plans. Recipients’ payments don’t usually go far either, as Medicare excludes dental, vision and hearing coverage.

“Those that can are spending a lot on premiums for their insurance and are still at risk for out of pocket costs, particularly if they have middle or low incomes — meaning incomes in the $20,000 range, $30,000 range or lower — and that’s the majority of Medicare beneficiaries,” said Cathy Schoen, study author and Senior Scholar in Residence at the New York Academy of Medicine.

There is no cap on how much people can spend — a protection people on the individual market gained through the Affordable Care Act. With no limit to what they must pay out-of-pocket, some recipients can’t afford the supplemental plans that offer benefits that basic Medicare does not. Of people living below the poverty limit, 74 percent had no dental insurance during the year and less than half had an eye exam.

The numbers are a reminder that funding even basic level Medicare is important, according to Schoen. That’s done through a tax on employee earnings. By 2024, one in four U.S. residents will be over the age of 65. But there won’t be enough young people in the workforce to pay for those people’s Medicare coverage. The federal pot of money that pays for Medicare is due to run out in 2028.

That year was even sooner when the Affordable Care Act passed. But the ACA — also known as Obamacare — put more money in the Medicare fund. One of those things was a 0.9 percent income tax on people earning more than $200,000 a year.

In the House GOP’s American Health Care Act, that tax would be repealed. The Senate is now working on its own repeal and replace legislation, and it’s unclear if that tax repeal will be in it.

Many Medicare recipients in Kentucky area are also in the Medicaid program because they earn less than 138 percent of the poverty limit. In addition to the lack of dental and vision benefits in Medicare, the program also does not pay for nursing homes and long-term care. Medicaid picks up that tab.

Schoen with the Commonwealth Fund said that’s also why an awareness of Medicare’s flaws is important. That shines a spotlight on the repeal and replace legislation, because GOP legislators might change the way Medicaid is paid for, limiting the amount of money a state would get.

“If the state has less federal money to support those services, it could mean either cutting back on the number of people who are eligible, paying providers less or cutting back on benefits,” Schoen said.

Kyeland Jackson contributed to this report.

This story has been updated.

KentuckyOne Selling Off Louisville Hospitals, Group Practices Friday, May 12 2017 

One of the biggest health care operators in Louisville is offloading four major hospitals and six physician group practices.

KentuckyOne Health announced Friday that Jewish Hospital, Frazier Rehab Institute, Sts. Mary & Elizabeth Hospital and Jewish Hospital Shelbyville will all be sold.

“This decision has been made with great care and consideration. New owners and operators of the facilities outside of our central and eastern community focus will have the resources and ability to continue to deliver care, support employees and physicians and engage the community,” said Ruth W. Brinkley, president and CEO of KentuckyOne Health via news release. “We understand this will bring change and questions to our employees and community partners. We have an extensive transition program underway to ease the change and ensure focus on our priories to our patients and our partners.”

Physician group practices in the KentuckyOne Health and Saint Joseph Martin’s Medical Group, Medical Centers Jewish East, South, Southwest and Northeast will also be sold off.

KentuckyOne was formed five years ago with the merger of Jewish Hospital and St. Mary’s HealthCare in Louisville. It quickly started buying up other hospitals and physician practices as the Affordable Care Act was implemented.

In December, KentuckyOne and University of Louisville Hospital announced the end of their joint operating agreement. Officials said the University Medical Center would take over operations of U of L hospital this year.

Heart Of The Matter: Needle Drug Use Brings Spike In Heart Infections Monday, May 8 2017 

The Ohio Valley’s addiction crisis has brought another health problem, as rising numbers of needle drug users are contracting a serious form of heart infection called endocarditis.

The rate of endocarditis doubled in the region over a decade, and many patients require repeated, expensive treatment and surgery as they return to drug use and once again become infected.

According to the Centers for Disease Control and Prevention, annual Medicaid spending on endocarditis is more than $700 million, a number likely to rise if treatment does not change to also address the growing health impact of substance abuse.

Doctors at the University of Kentucky are creating a team approach to address endocarditis and the addiction contributing to it. It’s a challenge that has forced them to change traditional practices, break down walls between different medical practices, and get to the heart of the problem.

Mary Meehan | Ohio Valley ReSource

Sharing or even reusing syringes can build up the bacteria causing endocarditis.

An Emerging Problem

Endocarditis is a result of bacteria accumulating around and infecting a heart valve. It can appear initially as mild, flu-like symptoms or chest pains and extreme discomfort. Emergency surgery to replace heart valves is required in the most extreme cases, but standard treatment involves weeks of sustained doses of antibiotics to make sure the infection is completely cleared.

Mary Meehan | Ohio Valley ReSource

University of Kentucky researcher Jennifer Havens documented a spike in endocarditis cases.

Since 2008, University of Kentucky researcher Jennifer Havens has tracked the health of hundreds of addicts in Hazard, Kentucky. She said that in the last few years she’s seen a spike in endocarditis cases.

“They may or may not be sharing needles but they’re reusing the same syringes, which accumulates bacteria, which they’re basically shooting into their bodies,” she said.

Havens said traditional cardiac units aren’t designed to treat addiction so the patients frequently return to previous, dangerous habits.

“If you’re not treating their substance abuse issue in the hospital they can potentially go right back out and infect themselves,” Havens said.

According to the CDC, addicts with endocarditis are 10 times more likely than other patients to die or require a second surgery months after initially leaving the hospital. Research has also shown that addicts tend to leave the hospital more often before the weeks-long series of antibiotics that is necessary to complete treatment.

Alexandra Kanik | Ohio Valley ReSource

In many cases, the patients are in withdrawal from opiate addiction during treatment. The intense atmosphere of post-surgery care only amplifies the anxiety and pain of withdrawal from opiates, said UK infectious disease specialist Dr. Saritha Gomadam.

“It definitely affects us,” she said. “Our heart just goes out when we see a really young patient in their 20s crying that they want to quit.”

Overall, the median age of endocarditis patients is rising slightly. But at UK and other hospitals treating a large population with substance abuse disorders, it is younger patients who are more often returning in need of multiple surgeries. Gomadam said the question of how to treat them most effectively “is something we talk about almost every time we are on service.”

“There is sort of a moment where you both sit there and you know you have to do something,” she said.

There are also physical limitations to how much the body can take.

“Any kind of surgery has its risks,” she said. “There comes a point where there’s only so many times that their body can be opened up.”

The scar tissue from repeated surgeries can make valve replacement difficult and dangerous.

Teachable Moment

When the patient comes into the hospital with endocarditis it offers an opportunity for the team to have a discussion about substance abuse treatment, said Dr. Laura Fanucchi, who specializes in internal medicine and addiction. She is working with Gomadam to create the new treatment method.

“I believe — and our data support this — that coming to the hospital being very sick from a complication from untreated substance abuse disorder or untreated opioid addiction can be a moment where we can really reach that patient and help them start positive changes,” said Fanucchi.

UK Hospital

Dr. Laura Fanucchi said addiction treatment “has been siloed from general medical care.”

But addressing the social challenges around addiction requires skills outside of traditional endocarditis treatment.

“If we don’t work together we are not going to be successful because the patient has problems that my antibiotics will not cure,” said Gomadam.

Gomadam and Fanucchi are in the early stages of creating a unique team approach for endocarditis after seeing the same young, addicted patients again and again.

“We are working closely with internal medicine, cardiology, cardiothoracic surgery,” Gomadam said, with each group bringing in a particular expertise.

Breaking Silos

Such an approach requires education for both patients and providers.

“A lot of patients with untreated addiction feel very stigmatized by the health care community,” Fanucchi said.

That distrust can result in patients being even reluctant to say they have a problem abusing drugs.

On the other hand, health providers often see the ravages of addiction but very few people in recovery. That takes its own toll, especially on health care providers.

“I think seeing for a long time the complications of untreated substance use disorder some health care professionals start to feel hopeless, and that will engender a culture of frustration,” Fanucchi said.

Alexandra Kanik | Ohio Valley ReSource

She said the answer lies in creating communication across medical and addiction services that have traditionally operated independently of each other.

“I think it’s longstanding in treatment of addiction that it has been siloed from general medical care,” said Fanucchi. “It’s not historically been part of general medical education and residency. So we’re going to address that.”

The approach has been well received, she said, but it is a big shift that will take time.

Fanucchi said another key in finding the right treatment focus is recognizing the need for sustained medical intervention and recognizing relapse as a part of the disease process.

“Trying to be successful, particularly with opioids, with detox only or abstinence only is part of the reason that we are in this problem that we are in, unfortunately,” she said.

That means bridging the hospital stay with drugs that help with withdrawal, such as naloxone and buprenorphine, plus counseling or treatment.

“The analogy is that someone comes into the ER sick from diabetes and you send them home and tell them not to eat sweets but don’t give them any insulin,” she said. “And we wonder when they come back why their diabetes is a problem again.”

At Derby, Job Corps Students Practice Their Trades Saturday, May 6 2017 

Alexander Francis is wearing the bright yellow and gray jacket of a Churchill Downs security guard, helping a lost Derby-goer. Francis is here because of a job training program for low-income youth that he hopes will help him launch a career.

His path to the Derby started in Greeley, Colorado. He lived there with his parents and six younger siblings before he applied for Job Corps, a federal program that offers students a GED, if needed, and job training. After high school graduation, his parents couldn’t pay for college.

After 15 job applications, he still didn’t have a job. His parents said he had to move out. So he found his way to Kentucky, where he’s in training to potentially work at a prison or even be a police officer.

“I don’t know what I would be doing right now” if it weren’t for Job Corps, said Francis, 20.

Lisa Gillespie | wfpl.org

Alexander Francis

Today, he’s one of 30 Job Corps students being paid to work security at the Derby, and he hopes this will lead to a full-time job after graduation in June.

While unemployment has fallen, those with less education continue to lag behind. Last year, 7.4 percent of people without a high school diploma were unemployed. That compares to 2.7 percent unemployment for college graduates.

“The job market for basic high school graduate jobs, it’s not very good, but from what I’ve heard they’re always looking for police officers, security guards,” Francis said.

Maybe, Francis hopes, he will even save up enough from his Job Corps pay to get a degree in criminal justice and psychology.

Job Corps has been around for more than 50 years, and one of the most successful programs is in Prestonsburg, Kentucky. It ranks No. 9 in success in placing students in jobs out of the 125 centers across the country, according to Job Corps.

Around 500 students graduate from the Prestonsburg center’s six-month to year-long program each year, according to Jimmie Wilson, business community liaison with the Carl D. Perkins Job Corps Center. Students must be between 16 and 24, and either have a disability, come from a foster care system or live below the poverty line.

The program first came to Prestonsburg when coal was still the main employer in that region. Those jobs are disappearing. But there’s still a need for security guards.

Beverly Compton is the security instructor with Job Corps. She said actual work experience — like what Francis and his classmates are getting at Derby this weekend — make all the difference for students. And this year, several supervisors have made requests for specific students to stay on through Sunday because their work has been strong, Compton said.

“It makes the kids feel good, their confidence level is high,” Compton said.

Advocates: Kentucky Schools Would Feel The Pinch If GOP Revives Health Plan Wednesday, Apr 26 2017 

Public schools would be in a financial pinch if Congressional Republicans are successful in changing the way Medicaid is funded.

The federal Individuals with Disabilities Act requires public schools pay for health care services for students with disabilities — including services like school nurses, speech and mental health therapists. Kentucky schools received $34 million in 2015 toward those costs. Over half of the funds came from Medicaid — the rest came from the state.

That money could be in jeopardy if the American Health Care Act – also referred to as Trumpcare – is revived. The GOP plan proposes cutting $839 billion in Medicaid spending to states over 10 years.

Other changes include funding Medicaid through block grants, which would give states a chunk of money each year to pay for the program. Critics say block grants wouldn’t take into account unexpected public health crises — like a hepatitis C breakout, for example — and it would be up to states to fill in gaps or not.

Brad Hughes with the Kentucky School Boards Association said if federal funding goes away, schools would still be required to pay for health care services for students. He said that could be done by raising taxes or tapping into school general funds that provide other services.

“It could be a devastating unfunded mandate on public schools,” Hughes said. “Then they have to figure out how to pay for it.”

Public schools receive money from the federal government to help pay for health care for children with disabilities but the money also benefits children without disabilities. That’s because if a school nurse is hired, all students at that school likely have access to that nurse.

Having school nurses and other health care professionals in schools also saves money. That’s because when children seek health care at school, parents don’t have to pay co-pays for a doctor’s visit. For parents of children in Massachusetts schools in 2009, those medical costs were valued at $20 million. That’s according to a 2014 study in the Journal of the American Medical Association.

Terry Brooks with Kentucky Youth Advocates said the potential cuts would come to a state that already doesn’t allocate many resources to children’s health care in schools, even though there is a link between education success and health.

“In Kentucky, a real focus on school-based health is very rare,” Brooks said. “It usually boils down to a superintendent who’s thoughtful about the intersection of health and education, and they go to work on making it happen. If we know it’s an idea that’s delivering good services for kids and it’s a win-win, to threaten that is bad economics and bad for kids.”

The cuts could also come as Gov. Matt Bevin makes changes to Kentucky’s Medicaid program. Bevin has proposed monthly payments for all Medicaid recipients, no matter their income, excluding pregnant women and people with disabilities.

That’s concerning to Brooks. He said when parents are insured, they are more likely to also have their children insured. Over 400,000 people gained access to Medicaid through the state’s expansion in 2014.

Kentucky could make up the difference for schools and help them pay for health care for students but Brooks said advocates won’t know what Bevin’s budget priorities are until he unveils his next budget in 2018.

Lawmakers May Override Bevin’s Veto Of Mental Health Bill Wednesday, Mar 29 2017 

Kentucky senators are considering overriding a veto by Gov. Matt Bevin of a bill – known as “Tim’s Law” — that would allow a court to order involuntary outpatient mental health treatment.

The bill is named after Tim Morton, a Lexington man who had a serious mental illness. He also had a neurological condition called anosognosia that left him unable to recognize he had an illness.

The bill would affect people specifically with that condition, and who had been involuntary committed to a hospital for treatment. Anosognosia commonly occurs among people with bipolor disorder and schizophrenia.

Bevin vetoed the bill Monday night, writing in his veto position statement that no one should be involuntarily ordered to treatment if they haven’t committed a crime or aren’t a danger to themselves or others.

The veto was a shock to mental health advocates — the bill passed the Senate with three dissenting votes and with no dissent in the House. Advocates gathered in the Capitol on Wednesday to ask lawmakers to override the governor’s veto.

Sheila Schuster is executive director of the Kentucky Mental Health Coalition.

“[Morton] died at 46 of self neglect and neglect by the system because the involuntary commitment didn’t keep him in treatment long enough that he could begin a road to recovery,” Schuster said. “We’re trying to avoid that revolving door by catching people before they’re a danger to themselves or others.”

The Senate needs 20 votes to override, and the House 51.

Republican Sen. Julie Raque Adams of Louisville is pushing for an override of the veto.

“It’s not as if we’re randomly selecting people who may or may not have a mental illness,” Adams said. “This is a very specified population that is spelled out.”

Legislators have until Thursday to override the veto.

Bill To Remove Barriers To Smoking Cessation Benefits Awaits Governor’s Signature Thursday, Mar 16 2017 

Smokers could have an easier time kicking the habit thanks to a measure passed by the Kentucky General Assembly this week.

Though insurance companies already offer aids including nicotine patches, the bill would prevent insurers from charging co-pays, requiring prior authorization or step therapy — a program that encourages the use of the least expensive drug before moving onto more costly drugs — to gain access.

The legislation now awaits Gov. Bevin’s signature.

Kentucky has one of the highest rates of smoking in the country, a cost of $1.9 billion a year to the health care system. That includes $590 million in Medicaid according to Tonya Chang, advocacy director with the American Heart Association.

Chang said the requirements insurers were using are not backed by research.

“I’m not aware of any science that supports step therapy in smoking cessation,” Chang said. “Those treatment decisions are best left in the hands of doctors.”

The legislation, sponsored by Republican Senator Julie Raque Adams of Louisville, would remove those requirements that are recommended by the United States Preventative Services Task Force.

Smoking cessation benefits became a requirement of coverage for exchange plans when the Affordable Care Act, also known as Obamacare was passed. Most employers and Medicaid plans also offer them.

However, if current legislation in Congress passes, the bill may not benefit as many people.

The GOP-led American Health Care Act, also being touted as Ryancare and TrumpCare, would eventually stop paying Kentucky and other states money for Medicaid expansion beneficiaries. That would mean while Kentucky could keep coverage for people up to 138 percent of the poverty limit, it would be up to the state to foot the bill.

The Congressional Budget Office this week said that compared with current law, under the Republican replacement plan 14 million more people would be uninsured by 2018, and 24 million more would be uninsured by 2026. So, the fewer the people with coverage, the fewer who have access to smoking cessation aids.

Chang with the American Heart Association said their focus is now on increasing the cigarette tax. It is currently 60 cents. In order to see a decline in smoking rates, the tax would have to be raised to $1.60, according to an October report from the journal Health Affairs.

The AHA and other public health groups also targeted a smoke-free schools bill that would have banned smoking on public school property. That bill did not pass the General Assembly.

In Other News…McConnell’s not-so-happy homecoming, Cardinals woes and Lawrence’s ‘biggest Oscar moment’ Friday, Feb 24 2017 

Homecoming: USA Today, The Seattle Times, New York Magazine and NPR say this week, on his trips through his home state of Kentucky, Senate Majority Leader Mitch McConnell has received somewhat of a mixed reception. At a Chamber of Commerce luncheon in Lawrenceburg, Rose Mudd Perkins, had some thoughts for the senator, says U.S. News […]

Troubled Waters: A Coalfield County Loses Trust In Water And Government Monday, Jan 30 2017 

On any given day in Martin County, Kentucky, the water system loses more water to leaks than it delivers to paying customers through their faucets. The system is under a state investigation for the third time since 2002. Customers complain of frequent service interruptions and discolored water, and their bills come with a notice that drinking the water could increase the risk of cancer.

This is the state of infrastructure in a county that’s mined many millions of dollars worth of coal since the early 1900s, providing the power required for America’s industries and modern comforts. As with many coalfield communities, all the profit and advances the area’s laborers and natural resources made possible haven’t left much evidence of improvement in the local economy and infrastructure.

Opening a tap is an exercise in trust which most of us take for granted. But in Martin County it’s just one more reason for residents to feel let down by the powers that be — one more chapter in the long story of how the people have lost faith in their government.

Alexandra Kanik | Ohio Valley ReSource

Dirty Water and Distrust

Josie Delong lives in Warfield, Kentucky, which is one of Martin County’s bigger towns with a population of 269. Because it’s across a ridge line from Martin County’s water intake near Inez, the county seat, Warfield has had some of the worst recent water struggles in Martin County.

“We drink nothing but bottled water,” Delong said. “I even put bottled water in my kids’ bathroom when they brush their teeth.”

A lot of people in Martin County won’t drink the tap water. Peggy Newsome, a clerk at the local Save-A-Lot supermarket, estimated that at least 75 percent of the people she checks out buy bottled water.

Delong said the water has long had a chemical smell and she worries that it might be contributing to her health problems, including bleeding ulcers.

“So I go to my doctor and the first thing he says is, ‘Contaminated water. How’s your drinking water?’” she said. “Is it caused by the water? I can’t say that 100 percent, but my belief —  it is.”

Courtesy Josie Delong

Josie Delong with a sign used as part of her advocacy for cleaner water.

Delong is among many residents who say they have seen water service cut off at times with little or no notice.

The service interruptions relate to the system’s inability to meet peak demands for water. For example, when the temperature drops below freezing, many people leave their taps open to make sure pipes don’t freeze. That creates peak demand on the water system, and last winter in Warfield, it was enough to drain the water tanks.

That left Joe Hammond with a dilemma. Hammond is the public face of the Martin County Water District. He said the lack of water would force the local school to close.

Courtesy Mountain Citizen

A still image from a video of foul water in a Martin County home.

“At night they would shut it down so that they’d have water for schools,” Hammond said.

Before you use water after a loss of service, it’s best to flush the pipes to get out any dirt that’s seeped inside in the meantime. But you can only do that if you know your water’s been cut off.

Hammond said it was a quick decision late at night to shut down water to the Warfield area and that explains why a notice, known as a boil water advisory, didn’t go out until until the next morning.

Delong and others say they never heard anything about a notice, not for that night or for any of the following nights when the water was again cut off.

The problem with stopping water flow to a section of pipes is that there’s no longer any water pressure to keep out contaminants. That’s especially true in Martin County, where the pipes are so leaky that the water-loss rate has consistently been over 50 percent.

Benny Becker | Ohio Valley ReSource

Joe Hammond of the Martin County Water District took questions at a hearing on water problems.

Last June, Martin County State Sen. Ray Jones called in several top state officials for a public meeting to address the county’s drinking water issues. The water district’s Hammond tried to explain the county’s system for calling customers affected by a cutoff or boil water advisory. But he was cut off by angry audience members. One man said he’d never heard of anyone getting such a warning. “I’m done with it, it was a lie!” the man shouted and stormed out of the room.

Sewage Stressing System

The other top issue at the public meeting was concern over two disinfection byproducts, Trihalomethanes and Haloacetic acids. Since 2002, these have been showing up on notices sent to customers of the Martin County Water District. The notices inform customers that their water has exceeded maximum contaminant levels, and that long-term exposure can increase the risk of cancer, especially for the elderly, infants and anyone with a compromised immune system.

According to Joe Burns of the Kentucky Rural Water Association, disinfection byproducts aren’t an issue for most U.S. water systems that draw from groundwater. In Kentucky and the Ohio Valley region, however, many systems draw water from rivers and streams, which opens up more possibility for contamination that needs to be treated with chlorine.

The disinfection byproducts are the result of chlorine interacting with organic molecules. Much of the organic molecules come from what are commonly known as “straight-pipes”. In Martin County, like much of the coalfields, there’s a serious shortage of wastewater infrastructure, which means sewage often gets piped straight into the nearest stream.

Benny Becker | Ohio Valley ReSource

Martin County’s water intake on the Tug Fork River.

Gail Brion directs the University of Kentucky’s Environmental Research and Training Laboratories and has worked on water treatment issues for decades. She calls the amount of sewage in this region’s watershed “as close as I could come to Third World conditions without a passport.”

More sewage in the water source means more chlorine is needed. Nina McCoy, a retired biology teacher, has been testing water around Martin County for nearly 25 years. She said the frequent violations for high levels of disinfection byproducts is an indication of the poor quality of the water  coming out of the county’s water treatment plant.

“We’re constantly being told, this is basically your own crap,” McCoy said.

Officials have tried to reassure the public that disinfection byproducts shouldn’t make them afraid to drink their water.

Peter Goodman, the Director of the Kentucky Division of Water, was at the June meeting in Martin County. He tried to reassure the crowd that they’re not at any great risk. He said the levels are just a little over the standard, that the standard is very conservative, and that since it was recently strengthened many water districts are dealing with the issue.

At the Martin County Water District Office, Hammond shared a handout that emphasizes that the risk of cancer from disinfection byproducts is small and a worthwhile trade-off if the alternative is water that could potentially make you sick right away.

Coal’s Contamination

Martin County’s major industry has also caused massive contamination of surface waters.

Courtesy Ohio Valley Environmental Council

The Martin County Coal slurry spill in 2000.

Leaks and spills from coal mines and gas drilling operations are common. Many are minor, blackening a stretch of stream or producing mysterious, short-lived slicks. Other spills are disastrous.

That was the case on Oct. 11, 2000, when a massive coal slurry impoundment, or sludge pond, broke through an old mine shaft underneath. Wolf Creek and Coldwater Creek ran black with sludge, overflowing their banks by up to seven feet, and the millions of gallons of sludge forced the closure of drinking water intakes along miles of downstream rivers.

A decade later, residents could still find residue of the sludge along streams just a few inches below the surface.

The spill and the way it was handled by authorities has further eroded people’s trust in both the county’s water and its leaders.

Some residents complained that there was little warning for residents at the time of the disastrous spill, and a mine safety investigation of the incident was mired in scandal and accusations of a cover up to protect the coal company.

A War on Poverty Battlefield

Now, Martin County is in a really tough situation. Forty percent of the county’s residents live in poverty. Only 30 percent are in the workforce. The coal industry has been laying off workers as it competes with cheaper natural gas, depletes the best coal seams, and relies more on machines.

Hard times here are nothing new. Martin County has been facing many of the same economic and infrastructure challenges for decades and was a highly visible part of one of the country’s most famous efforts to address poverty.

In 1964, President Lyndon Johnson visited Martin County as he launched the War on Poverty. A government film described it as “a trip to the root of Appalachian poverty” and noted that the area’s economic hardship was “attributable primarily to a general lack of industrialization and losses in the coal mining industry.”

LBJ Library/public domain

President Lyndon Johnson on the porch of a Martin County home in 1964, as he launched his “War on Poverty.”

The  War on Poverty did lead to significant investment that had measurable benefits,  but many have lamented that Johnson’s program did not have the impact it aspired to.

“Here’s the thing, in 1964 LBJ kicked off the War on Poverty,” said Gary Ball, editor of Martin County’s weekly newspaper, The Mountain Citizen. “Here we are, over 50 years later and we can’t even get decent drinking water.”

Tight Budgets

Coal’s decline has had an enormous impact on county budgets across Central Appalachia.

Judge Kelly Callaham, the top elected official In Martin County, said the the local government has been forced to make a lot of cutbacks. He said the county is now getting less than a quarter of the tax revenue from coal that it got as recently as three years ago.

“If somebody’d looked at me when we was getting $800,000 a quarter and said, ‘Judge, you’re not gonna get but $150,000 three years down the road,’ I’d say you’re crazy man,” Callaham said. “But that’s what happened.”

That drastic loss of income makes it harder to pay for water system improvements.

The judge said the quick change in coal tax revenue surprised him, but some in the community were unhappy with how the county has handled its funds. Newspaper editor Gary Ball said county leadership should have been better prepared and made better decisions. He pointed to the county’s recent investment in a $10 million government center as money that could have been better spent improving the county’s water system.

Judge Callaham said he wouldn’t have supported building the courthouse if he’d known how much tax revenue the county would soon lose. He also argued that the old courthouse needed to be replaced because it had issues with lead and asbestos that he suspects caused his health problems.

Benny Becker | Ohio Valley ReSource

The new $10 million government center (right) beside the old courthouse (left).

The dispute over spending priorities is just one more example of the strained relationship between residents and officials. “People just aren’t trustful of their political leaders,” Ball said. “And when you think about it, the leaders haven’t given them a whole lot to win that trust.”

Some Improvements

Martin County’s water district is getting help from the Kentucky Rural Water Association, thanks to the state’s Division of Water. The association has sent in technicians to train and assist the county on detecting and repairing leaks.

Joe Hammond said he’s hopeful that this will help the county’s water loss rate continue to drop — it’s approaching 50 percent after previously topping 60 percent. But Hammond said there isn’t enough money to make the kinds of fixes that are really needed and the patches being made are short-term at best.

“If you have a hole already, it’s just going to get bigger,” he said.

Benny Becker | Ohio Valley ReSource

Martin County relies on a water treatment plant that was built in 1968.

Hammond has a list of prospects for funding. Two options come from the state government — the Kentucky Infrastructure Authority and the Department for Local Government. Those are unlikely to provide the large amounts needed to renovate the treatment plant and start replacing pipes that have been in the ground for as long as 50 years. But they are becoming more plausible now that the water district has submitted the required financial audits.

Hammond and others in the community seem to have their hopes most firmly set on money from the federal Abandoned Mine Land fund. A proposal pending in Congress, the RECLAIM Act, would allow spending from that trust fund for projects in the region that improve economic possibilities.

Gail Brion has experience with federal funding for water systems from her time working at the Environmental Protection Agency. She says the EPA used to provide a lot more federal money for water systems in places like Martin County, but there was a fundamental shift in how the agency approached funding during the Reagan administration, when she describes the EPA as having gone through a “great dismantling.”

Brion said she’s bothered by how America’s priorities have changed when it comes to water systems and other infrastructure.

“These water systems were established with federal money,” Brion said. “That money has now become a revolving fund that has to be paid back. And when you can’t pay for your services to begin with, how are you going to pay back a loan to make those services better?”

Brion said she hopes there’s a growing consensus about the importance of investment in the country’s infrastructure. But she’s not sure that will include things such as water systems.

Benny Becker | Ohio Valley ReSource

Gail Brion directs the Environmental Research and Training Laboratories at the University of Kentucky.

Fighting for Change

Sadly, the issues in Martin County aren’t that exceptional. Counties across the coalfields and in other rural areas face similar challenges of poor infrastructure, lack of investment, declines in the industrial job base and polluted watersheds.

Despite the many problems with its drinking water, Martin County doesn’t stand out as a worst case. In 2016, the Martin County Water District reported 10 water quality violations and 19 boil water advisories. That puts the county below average compared with other Kentucky water systems and the number of reported advisories.

Where Martin County does stand out is in its community of hell-raisers: The Mountain Citizen highlights water issues week after week; Josie Delong formed a Martin County Water Warriors Facebook community; and many other outspoken local activists are making noise.

So while there’s still a lot that needs to be done for the people of Martin County to regain trust in their leaders and their water, one thing is certain: The county has an active community fighting for change, and for clean water.

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