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As Hospitals Monitor Drugs, Opioid Deaths See Decline

By Katja Timm, Capital News Service

RICHMOND — Virginia hospitals are monitoring painkiller prescriptions more closely and taking other steps to curb the opioid epidemic, and the efforts may be paying off: Drug overdoses in Virginia have dropped for the first time in six years.

In 2016, the opioid epidemic was declared a public health emergency in Virginia. Fatal opioid overdoses increased steadily from 572 in 2012 to 1,230 in 2017. Last year, however, the number of deaths dipped, to 1,213, according to preliminary statistics released this week by the Virginia Department of Health.

The decrease coincided with data from the U.S. Centers for Disease Control and Prevention showing a decline in overall prescriptions of opioids — and with moves by Virginia officials and physicians to apply more scrutiny before issuing such prescriptions.

Dr. Charles Frazier, senior vice president at Riverside Health System in Newport News, said his medical practice and others across Virginia are prescribing narcotics in a more controlled and efficient way.

Frazier was involved in the creation of Virginia’s Emergency Department Care Coordination program.

Established by the General Assembly in 2017, the EDCC’s purpose is to “provide a single, statewide technology solution that connects all hospital emergency departments in the Commonwealth” for the purpose of extending and improving patient care, according to ConnectVirginia, a statewide health information exchange.

“The purpose of the EDCC is to integrate alerts,” Frazier said. “It shows us alerts of whether or not they (patients) have been in other emergency departments, information on how they were treated, with the idea being if a patient came in: Who is their primary care doctor? Who can we connect them to?”

Frazier said that in the program’s first phase, all hospitals in Virginia were required to submit a year or two of historical patient visit data to the EDCC information exchange by June 2017.

“The system is set up to alert emergency department providers and staff if the patient is a frequent emergency department patient, and also if they have been aggressive or abusive to staff,” Frazier said.

Frazier said that most of the time, the system is used to direct patients to proper care.

“I think part of the problem is if people have a hard time with transportation, they go to the ER for basic health care,” Frazier said. “If you go to the emergency room for a sore throat, for example, that can be expensive.”

The second phase of the EDCC, which was implemented last July, involves notifying primary care doctors if their patient is in the emergency department. If the system can identify a patient’s primary care doctor, it will send an alert.

“One thing we are starting to see are health systems collaborate on patients,” Frazier said. “There was a patient at Bon Secours who kept going to various emergency departments around Richmond — VCU, St. Francis, and others. With the EDCC program, they could see where they had been to, and the health systems worked together, along with the insurance company, to help the patient get the primary care they needed.”

Virginia’s Prescription Monitoring Program

Gov. Ralph Northam, a physician himself, helped create the EDCC. He also has been an advocate for the state’s Prescription Monitoring Program.

Under that program, Frazier explained, “Every time a pharmacy prescribes a controlled substance, they need to submit the information to the state — the duration, the dosage — and the system tracks how many times and how many providers have prescribed to the patient.”

Virginia Board of Medicine regulations require seeing chronic pain patients every 90 days and conducting drug screens to make sure patients are taking their medications and not taking illicit substances. Regulations also require prescribing an opioid antidote in certain high-risk situations.

“If you’re treating someone with higher dosages, the regulations outline preventative measures for overdose,” Frazier said.

Opioid overdose fatalities decline

Health officials’ concerns about opioids have grown as fatal overdoses spiked over the past decade. Preliminary numbers show that 1,484 people died from drug overdoses in Virginia in 2018. That is more deaths than from guns (1,036) and traffic accidents (958).

The total number of overdose fatalities was down slightly from 1,536 in 2017.

The vast majority of drug overdose deaths involve opioids. Of the 1,230 opioid-related fatalities last year, about 460 involved prescription medications and the rest involved heroin and/or fentanyl.

The number of prescription opioid deaths dropped from 507 in 2017 to 457 last year. On the other hand, deaths from heroin and/or fentanyl jumped from 940 to 977.

‘These numbers should give us some optimism’

In a press release, Attorney General Mark Herring thanked “advocates, families, doctors, recovery communities, elected officials, public health professionals and others who have helped reduce Virginia’s number of fatal drug overdoses for the first time in six years.”

Herring has been a strong advocate for fighting the opioid epidemic. He has taken a range of actions — from pushing to expand the Prescription Monitoring Program, to producing a documentary titled “Heroin: The Hardest Hit,” to suing Purdue Pharma, the creator of Oxycontin, on grounds that it helped create and prolong the opioid epidemic in Virginia.

“We should be heartened and hopeful to see that overdose deaths seem to have plateaued and may be starting to decline, but nearly 1,500 overdose deaths, mostly from opioids, is still a staggering number that shows this epidemic is far from over,” Herring said.

“But these numbers should give us some optimism that Virginia’s comprehensive approach — emphasizing treatment, education, and prevention, along with smart enforcement — can produce results and save lives.”

New controls on opioid prescriptions

Frazier said the biggest impact on the opioid epidemic might stem from rules imposed last year by the Virginia Board of Medicine.

“Across the state,” Frazier said, “we’ve seen a decrease in the number of opioid prescriptions and the duration of treatment for acute pain — a tremendous difference.”

Frazier said opioids sometimes are appropriate and sometimes aren’t.

“There are people who break their leg and need it for a few days, but for people who have chronic pain, they may require ongoing opioids for a long time,” he said. “While we first try non-opioid therapies, the reality is sometimes opioids are the most effective treatment for chronic pain.”

Patients can self-administer pain relief

When opioids are appropriate for treatment, health care professionals want to ensure that patients can receive their medication safely and easily. Virginia Commonwealth University Medical Center Hospitals have a specific technique allowing patients to self-administer drugs.

Samantha Morris, a care partner at the center’s Emergency Department, said narcotics can be administered directly to a patient, by the patient, with the press of a button. This involves a device called a patient-controlled analgesia pump.

“Fentanyl is usually what I see being prescribed the most, and that one is usually administered through a PCA pump,” Morris said. “It delivers some form of narcotic, usually fentanyl, and the patient presses a button to administer themselves a dose every five to ten minutes, depending on the drug.”

The amount of time a dosage from the PCA pump can be administered is based on the strength of the drug prescribed.

“I see patients mostly in the burn victim unit because they’re in a lot of pain,” Morris said.

Morris said she sees patients come in for opioid-related incidents all the time.

“It’s really difficult, because if a patient is addicted to any kind of substances, whether it’s amphetamines or any kind of narcotic to begin with, we can’t administer pain management, because it’s not going to affect the same pathway.”

Gov. Northam Vetoes Bill Creating ‘School Protection Officers’

By Katja Timm, Capital News Service

 

RICHMOND — Gov. Ralph Northam has vetoed a bill to create a new public-employee category called “school protection officers.”

Supporters of the legislation said the officers would help improve security in Virginia’s public schools. But Northam said the bill failed to clearly define the officers’ duties and credentials.

Introduced by Del. Robert Thomas, R-Stafford, HB 2142 defined a school protection officer as a “retired law-enforcement officer hired on a part-time basis by the local law-enforcement agency to provide limited law-enforcement and security services to Virginia public elementary and secondary schools.”

During the General Assembly’s recent session, the bill was approved 53-45 by the House and 26-13 by the Senate.

Virginia law currently provides for two types of officers in schools — school resource officers and school security officers.

In announcing his veto Tuesday, Northam said school resource officers and school security officers “have well-defined duties and responsibilities set forth in the Code of Virginia and are required to meet stringent training standards” administered as part of the certification process carried out by the Department of Criminal Justice Services.

Thomas’ bill did not specify what security services a school protection officer would provide.

It said only that the Department of Criminal Justice Services would “establish compulsory minimum training standards for all persons employed as school protection officers. Such training may be provided by the employing law-enforcement agency and shall be graduated and based on the type of duties to be performed.”

That raised concerns from Northam, who said duties and training could vary greatly from school to school since each local law enforcement agency has different regulations and standards.

As an alternative to school protection officers, Northam noted that his Student Safety Work Group had recommended increased training for school resource officers. Legislators passed and the governor has signed two bills — HB 2609 and SB 1130 — that mandate that all school resource officers must undergo more training.

By approving those bills, the General Assembly endorsed “the position that more, not less, training will better serve Virginia’s students and schools,” the governor’s veto message said.

“Allowing a new type of officer with undefined duties and indeterminate training will not serve to make Virginia’s students and schools safer. Therefore, there is no compelling reason to create school protection officers when Virginia law already provides for two types of trained officers to provide security in the Commonwealth’s schools.”

HB 2142 is one of 17 bills vetoed by Northam. The General Assembly will reconvene next Wednesday to consider overriding the vetoes. It takes a two-thirds majority in both the House and Senate to override a veto.

Legislators and Victims Plead for Expansions on Distracted Driving Bill

Katja Timm, Capital News Service

RICHMOND -- Teary-eyed parents and supporters of legislation to curb distracted driving filled a small room at the Capitol, some wearing neon yellow traffic vests in solidarity as they offered emotional testimony.

Others held framed pictures of loved ones who died in distracted driving crashes. The press conference was to advocate for HB 1811, introduced by Del. Christopher Collins, R-Frederick. Sen. Richard Stuart, R-Westmoreland, is sponsoring a companion bill, SB 1341, in the Senate.

On Wednesday, the Senate Courts of Justice Committee approved Stuart’s bill on a 13-2 vote with bipartisan support. A co-sponsor of that measure, Sen. Scott Surovell, D-Fairfax, also attended Thursday’s press conference.

Jennifer Smith, whose mother died in a traffic accident caused by a distracted driver, was among the speakers. Smith tearfully read a letter aloud from another mother whose young son was killed when a driver ran over his stroller.

“Every day, I watch drivers too busy on their smartphones to pay attention to their surroundings,” Smith read from Mindy Schulz’s letter. “Each time I see them, I feel the impact of that SUV ripping my son’s stroller out of my hand as I was helpless to stop one from killing my baby.”

Other stories shared were from a father who suffered brain trauma in a crash and a mother who lost her 19-year-old son.

Collins’ bill would expand current state laws regulating the use of a handheld device while driving. The current law prohibits only the reading of any email or text message and manually entering letters or text in the device as a means of communication, according to a summary by the Legislative Information System.

The legislation promotes a “hands-free” approach and would make it illegal for a driver to use any handheld device while operating a vehicle unless the device is specifically designed to allow hands-free and voice operation, such as using the speaker option on a cellphone. The measure would also require driver’s license examinations to include questions on distracted driving.

“As a former police officer, what’s so hard about enforcing the laws we have now is that I don’t know if you’re texting or Facebook-ing,” Collins said. “I can’t write you for Facebook-ing, but I can write you for texting.”

Advocates encouraged members of the House and Senate to pass the legislation in order to “defend and protect” Virginians.

A subcommittee of the House Courts of Justice Committee last week recommended approval of Collins’ bill. The full committee has scheduled the measure for consideration Friday.

Stuart’s bill may go to the Senate floor on Monday.

If neither bill wins approval in the Senate or House by Tuesday, the issue likely will be dead for the legislative session.

Bill Offering Tuition Refunds for Unhealthy Veterans Gets Revised

By Katja Timm, Capital News Service

RICHMOND -- The House Committee on Education recommended an amended bill Wednesday that would refund tuition for veteran students who need to withdraw during a semester due to a medical condition.

Legislators requested an amendment to HB 2113, sponsored by Del. Kathleen Murphy, D-Fairfax, to make its provisions more specific. The bill did not originally state what kind of medical condition and what causes would make a veteran eligible for reimbursement for a leave of absence.

“They can withdraw for the first time due to a service-connected medical condition,” Murphy said. “We wanted to clarify that.”

Qualifying medical conditions include PTSD-related trauma along with physical ailments, according to Murphy.

Additionally, student veterans must have their condition “certified in writing to the institution by a physician licensed to practice medicine,” according to a summary by the Legislative Information System.

The amended bill requires the institution to reimburse the student veteran for the semester tuition, along with any mandatory fees. The student veteran can only qualify for a tuition refund the first time they withdraw due to a medical condition.

The refunded tuition would go back to the student’s GI Bill benefits, Murphy said.

Carrie Ann Alford, the policy director of the Department of Veterans Services in Virginia, said the department supports the bill.

The withdrawal would not affect the student's ability to re-enroll at the institution, according to the bill summary.

The House Education Committee passed the bill with an 20-1 vote, the only nay vote being the Committee Chairman R. Steven Landes, R-Albemarle.

The amended bill was referred to the Committee on Appropriations.

Lawmakers Tout Plan for Casinos in Bristol, Danville and Portsmouth

State Legislators from Bristol, Portsmouth and Danville, during a Monday morning press conference, introduced a plan to build casinos in the hopes of creating new jobs and improving past economic problems.

By Kathleen Shaw, Arianna Coghill and Katja Timm, Capital News Service

RICHMOND — Members of the General Assembly from Bristol, Portsmouth and Danville urged their colleagues Monday to approve legislation to allow casino gambling in those cities. They said the plan would create jobs and boost the economy.

Sen. Charles Carrico, R-Bristol, and Sen. Louise Lucas, D-Portsmouth, joined delegates from each locality at a news conference to push for a state law authorizing casinos. They said that in seven years, such gambling operations could generate a total of nearly $100 million in local revenue and create about 16,000 jobs.

Under the legislation, a referendum would be held in each of the cities, and voters would have to agree whether to allow casinos to be built.

“This is an opportunity for not only us but for southwest and Danville to join forces and give the citizens a choice,” said Del. Matthew James, D-Portsmouth. “A choice to bring a revenue streak, to help pay for schools, give teachers raises and do the things we need to do.”

Republicans and Democrats from Bristol, Portsmouth and Danville have partnered on the legislative initiative, saying their cities face similar financial problems.

“We’re struggling, and our economies are struggling,” Carrico said. “And for me, I want to see Bristol do well. But I also see that Sen. Lucas and Del. Marshall are struggling as well.”

The median annual household income is about $49,000 in Portsmouth, $38,000 in Bristol and $35,000 in Danville — far below the statewide median of $69,000, according to the U.S. Census Bureau. In contrast, the average household income in Fairfax County is more than $117,000.

“The city of Danville had two Fortune 500 companies that at one point had 60,000 jobs. We’ve had to close four schools in the area due to the lack of population,” Marshall said. “But Danville is working hard to rebuild, and we are having some successes.”

Four bills to authorize casino gambling have been introduced for this legislative session. They are SB 1126, sponsored by Lucas; SB 1503, proposed by Carrico; HB 1890, filed by James; and HB 2536, carried by Del. Israel D. O’Quinn, who represents Bristol and surrounding counties.

While casino gambling bills have failed in the past, Lucas and Carrico said requiring community input through a referendum gives this year’s legislation the advantage needed to pass the General Assembly.

In a Q&A session, officials were asked about potential issues that could come from introducing casino gambling, such as crime and addiction. They said authorities would use tax revenues from casinos to address public needs like school facilities, law enforcement and social services.

“We’re going to appoint so much money to addiction abuse and public safety and keep it a safe, industrial way to produce revenue,” Carrico said. “This is a tightly regulated industry.”

At the news conference, legislators also were asked about religious objections some citizens have to casinos. The lawmakers said their proposals would impose regulations on the industry to safeguard the community.

Carrico, a religious man himself, met with pastors and said they were open to the suggestion of casinos. The religious leaders appreciated the ability to vocalize their concerns in the public referendum, the senator said.

Two Bristol businessmen plan to fund construction of the casino in the city.

Jim McGlothlin, CEO of the United Company, and Clyde Stacy, owner of Par Ventures, are long-time partners and coal barons. At the news conference, McGlothlin said the project will not need government funding. McGlothlin said the region’s economic problems are significant and need a ‘big, bold’ project to compete with neighboring states.

As a result, the legislation needs only to pass the General Assembly and garner majority support in a local referendum for the dice to start rolling.

Lucas said casinos are the most efficient way to pull Portsmouth, Danville and Bristol out of an economic rut.

“We just want to create economic development in these three parts of the state,” Lucas said. “It’s plain and simple.”

Amendment to Restore Felon Voting Rights Dies Along Party Lines

By Katja Timm, Capital News Service

RICHMOND, Va. -- For now, Virginia will remain among a trio of states -- joining only Kentucky and Iowa -- with a lifetime ban on voting rights for people convicted of a felony.

On Wednesday, the Senate Committee on Privileges and Elections killed an attempt to allow Virginians who have been convicted of a felony to vote.

Currently, the Virginia Constitution says felons cannot vote unless their civil rights have been restored by the governor or other authorities. Sen. Mamie Locke, D-Hampton, proposed a resolution -- SJ 261 -- to delete that passage from the state Constitution.

On an 8-6 vote at the committee’s meeting on Wednesday, Locke’s proposed constitutional amendment was “passed by indefinitely,” meaning that it likely is dead for this legislative session. The vote was split down party lines on the 14-member committee, with all eight Republicans voting to kill the measure.

Besides SJ 261, the panel on Wednesday considered a similar proposal (SJ 262) by Sen. Louise Lucas, D-Portsmouth. The committee folded Lucas’ measure into Locke’s before killing the proposed amendment.

The resolutions proposed by Locke and Lucas sought to establish just four requirements to vote in Virginia: Voters would have to be U.S. citizens, be at least 18, live in the commonwealth and be registered. The proposed amendment “removes from current constitutional qualifications to vote not having been convicted of a felony and not having been adjudicated to be mentally incompetent,” according to the Legislative Information System.

The amendment had support from representatives of the American Civil Liberties Union and the League of Women Voters of Virginia. Former inmates who had lost the right to vote because of felony convictions also offered emotional testimony.

Claire Guthrie Gastañaga, executive director of the Virginia ACLU, encouraged Virginia legislators to follow in the footsteps of Florida, which recently restored voting rights to more than 1.4 million people. In November, more than 60 percent of Florida supported the ballot initiative.

“That leaves Virginia, Kentucky and Iowa as the only states left -- the only states left in which you have a lifetime ban of voting if you get convicted of a felony,” Gastañaga said.

Gastañaga urged state leaders to look at themselves in the context of history. She said the right to vote should belong to the people instead of those who govern them.

Another supporter of the proposed amendment was ex-convict Wayne Keaton, whose voting rights were restored two years ago.

“I was incarcerated, and I have been fighting since 2010. The governor gave me my rights back in 2016,” Keaton said, referring to an executive order by then-Gov. Terry McAuliffe to restore voting rights to more than 200,000 convicted felons.

Several senators raised questions about the proposed constitutional amendment. Sen. Jill Holtzman Vogel, R-Fauquier, asked if someone who is adjudicated to be mentally incompetent should still be allowed to vote under the proposal.

“It might be appropriate to say that somebody doesn’t have the capacity to participate in the process, but that should be an individualized decision, not an institutional one,” Gastañaga responded.

Although SJ 261 and SJ 262 may be dead for the session, at least one similar proposal is pending before the General Assembly. SJ 283, sponsored by Sen. Emmett Hanger, R-Augusta, seeks to automatically restore the voting rights of felons who have completed their sentences and made restitution. It is awaiting a hearing by the Senate Privileges and Elections Committee.

Supporters of such proposals said they won’t give up.

“This is something we’re committed to for the long haul,” said Bill Farrar, director of public policy and communications for the Virginia ACLU. “We’re going to see it through.”

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