Feds allocate $50 million, half of it rural, to expand mental-health programs; similar plan in Virginia follows high-profile incident

Vice President Joe Biden on Tuesday announced $100 million in federal funds will be used to expand community-based mental-health services and treatment centers, with half the money going to rural clinics, Scott Wilson reports for The Washington Post. Biden, a strong supporter of gun control, made the announcement less than a week before the one-year anniversary of the school shootings in Newtown, Conn. that left 26 people dead, including 20 children. The shooter, who killed himself, was suspected to have had mental problems.

At the same time Biden made his announcement, Virginia Republican Gov. Bob McDonnell presented a two-year budget that includes $38.3 million in "reforms and funding boosts for mental health and substance-abuse disorder programs," Olympia Meola reports for the Richmond Times-Dispatch. Last month, state Sen. Creigh Deeds, who lost the 2009 election to McDonnell, survived being stabbed by his son, who then killed himself. The day before the attack the son "underwent a psychiatric evaluation but was not admitted to a hospital, because no bed was available." Part of McDonnell's proposal allows "magistrates to grant a two-hour extension to an emergency custody order – currently a max of six hours -- if needed to find bed space. He would also extend temporary detention orders to 72 hours, and expand crisis intervention team assessment centers." (Read more)

Biden's announcement includes "$50 million in new funding for community health centers looking to expand treatment for people diagnosed with mental health and addiction problems," with the money coming through the Affordable Care Act, Wilson writes. The U.S. Department of Agriculture "will also make $50 million in loans available to rural clinics looking to expand facilities, a way of alleviating a shortage of mental health care outside urban areas." (Read more)

A news release from the USDA states: "The funding will be used for the construction, expansion, or equipping of rural mental health facilities and will be provided through the Community Facilities direct loan program... This year, USDA invested more than $649 million in 130 rural health care facilities – serving nearly 3.2 million rural residents. These investments included critical access hospitals, rural health clinics, psychiatric hospitals, mental health care facilities, group homes for people with disabilities, assisted living facilities, nursing homes, and vocation and medical rehabilitation facilities. USDA is also investing in innovative healthcare technologies such as telemedicine, to further expand access to health care services throughout rural America." (Read more) (NBC News clip)

Program to help non-violent criminals get right in Georgia expands to rural areas

Non-violent criminals in remote areas of Georgia now have an opportunity to avoid jail time and enter a program to help them get their lives back on track. The state Department of Corrections already offered "intensive drug counseling and other services designed to keep probationers from reoffending," at 14 regional day-reporting centers in urban areas, but now rural offenders are getting the same opportunities to get a second chance with the opening of 11 rural centers, Adam Ragusea reports for Georgia Public Broadcasting. The program also saves the state money, with the cost of incarcerating prisoners amounting to more than $50 a day. (Ragusea photo: Probation Officer Christopher Burke talks to probationer Chet Mull, who is working on his GED)

House Bill 349, signed in April, "restores judicial discretion by allowing a departure from mandatory minimum sentences in some very limited circumstances," John Barker reports for Douglasville Patch, about 22 miles west of Atlanta. "As a result, judges now have the option to make more appropriate decisions in drug-related cases where the defendant is not the ringleader of the criminal enterprise, or in other cases where the prosecution, defense attorney and judge agree." Republican Gov. Nathan Deal said of the bill: “Public safety will be improved by giving prosecutors leverage in certain cases and by ensuring that our prison resources are reserved for the ‘kingpins’ while the ‘mules’ are given a chance at reform.”

The program, which costs $750,000 a year, allows participants to spend four days a week in group counseling, and allows officers to give individual extra attention, Ragusea writes. Ruthie Turner, a program counselor, told him, “We teach a class that helps them get ready to make a change in their lives,” by offering substance abuse programs and skills that help probationers re-enter society — “how to do a résumé, how to do a job interview, how to dress for those things." And the program has been a big success, Ragusea writes. "Of the 60 probationers who have graduated the DRC Lite program so far, corrections officials said, only three have gotten into serious trouble with the law again." To read more, or listen to the radio interview, click here.

House eyes Farm Bill extension; ranking Democrat says food-stamp deal closer to Senate cuts

UPDATE, Dec. 13: Congressional Budget Office scoring of the proposed compromise on farm subsidies "puts us in good shape," Senate Agriculture Committee Chair Debbie Stabenow told Rogers, who reports: "Friday’s upbeat tone signaled the focus is already shifting toward preparing other members of the House-Senate conference for votes during the week of Jan. 6." 

UPDATE, Dec. 12: By voice vote, the House passed an extension that would run through January. "Critics contend it is a needless distraction from the task at hand," Rogers reports, "but House Agriculture Committee Chairman Frank Lucas (R-Okla.) saw it as a useful step to sooth frayed nerves while he tries to deliver a final bill in early January."

UPDATE, Dec. 11: Senate Majority Leader Harry Reid said the Senate would not consider another extension of current farm law. That means the law will revert to a 1949 statute that would jack up dairy price supports and double milk prices, but Stabenow said the Agriculture Department had assured her "that the price spikes would not happen before the end of January," writes Mary Clare Jalonick of The Associated Press.

UPDATE: "Farm bill negotiators conceded Tuesday that they will not finish their work before Congress goes home for the year, but insisted that they are close to a final deal and working toward floor action in early January," Rogers reports. But they may forgo an extension to create pressure for a vote in early January.

A House vote to extend the current Farm Bill for a month or so could occur as early as tomorrow, with one negotiator saying lawmakers are near a deal that can be voted on in January, after the holiday recess that begins Friday. David Rogers reports for Politico, "Speaker John Boehner has already signaled he is open to this option and a vote could come as early as Wednesday on the suspension calendar," which would require a two-thirds vote.

This would be the second extension of the Farm Bill since it expired 15 months ago, Rogers writes. "But the circumstances now are very different. Last year at this time, the House had yet to even act on a farm bill and a long-term extension was needed through this past September. The legislative process is much farther along now—albeit still tortured. And there is a genuine hope that a House-Senate conference can report a Farm Bill back for final action in January." (Read more)

Rep. Collin Peterson, D-Minn., "one of four House and Senate negotiators working behind the scenes on a compromise between the two chambers, said the framework of a farm bill deal could be finished before the House adjourns for the year on Friday," Kyle Potter reports for the Fargo Forum. "Peterson said the negotiators have agreed on how much to cut from food stamps – one of the largest sticking points between the House and Senate. Peterson declined to provide a number, but said the deal hews 'substantially closer to the Senate’s' targeted cuts of $4 billion over the next decade rather than the House’s bill, which would slash $40 billion from the Supplemental Nutrition Assistance Program."

Peterson, the ranking Democrat on the House Agriculture Committee, told the Forum, "I think it will pass the Senate, but I cannot guarantee you it will pass the House. They are not going to be happy with the food-stamp cuts.” Peterson said he is confident he can get 'yes' votes from at least half of House Democrats. (Read more)

As wildlife proliferate and increasingly interact with humans, hunting rules are changing

As wildlife pouplations increase and populated areas expand, causing conflicts, hunting is on its way to making a major comeback, with some areas already legalizing hunting within towns and cities, David Von Drehle writes in a cover story for Time magazine's latest edition.

"Faced with an outbreak of lyme disease and rising deer-related car accidents, the city council of Durham, N.C., authorized bow hunting inside city limits in November. Authorities in San Jose, Calif., in the heart of Silicon Valley, voted to allow hunting wild pigs within that city in October. Rock Island, Ill., . . . recently approved bow hunting in town, provided that it occurs in green spaces — golf courses, parks, cemeteries — or on private land."

"We have too many wild animals — from swine to swans," Von Drehle writes. "Whether you're a Walmart employee in Florida wondering what to do with the alligator at your door, a New Yorker with a hawk nesting on your high-rise or an Ohio golfer scattering a flock of Canada geese, you now live, work and play in closer proximity to untamed fauna than any other generation of Americans in more than a century."

"Too many deer, wild pigs, raccoons and beavers can be almost as bad for the animals as too few," Von Drehle writes. "This is why communities across the country find themselves forced to grapple with a conundrum. The same environmental sensitivity that brought Bambi back from the brink over the last century now makes it painfully controversial to do what experts say must be done: a bunch of these critters need to be killed." Time is subscription only, but can be accessed by clicking here.

Okla. 2nd in quakes since 2009; is drilling to blame?

The argument over whether drilling has caused earthquakes in Oklahoma continues, as a state not typically known for seismic activity ranks second in the number of quakes since 2009. The increase in includes a rash of no less than 16 quakes one day in November in the Oklahoma City area.

"Since 2009, nearly one out of every 10 earthquakes in the contiguous United States has been in Oklahoma, according to an EnergyWire analysis of U.S. Geological Survey data," Mike Soraghan reports for the news service. "The analysis looked at onshore quakes of magnitude 3.0 or greater, the strength at which most earthquakes can be felt and reliably recorded." Oklahoma has had 240 quakes since 2009, second to California's 1,486, but well ahead of Nevada, third with 196. (EnergyWire graphic)

"Other states have also seen an increase in earthquakes amid a boom in oil and gas production across the United States," driven by horizontal hydraulic fracrturing of deep, dense shale beds, Soraghan notes. "State officials and researchers have linked injection of drilling waste to quakes in Arkansas, Colorado, Ohio and elsewhere. In Texas, a recent series of quakes northwest of Fort Worth has some local elected officials questioning whether deep injection of drilling waste might be to blame. But for whatever reason, the phenomenon has been particularly acute in Oklahoma."

Residents affected by the quakes aren't holding back when it comes to assessing blame. Jonny Hickman, who lives about 1.5 miles from a well, told Soraghan, "Forty-five years I've lived on this hill. I never felt anything until they started injecting that salt water." Neighbor Tony Bartee, who has a crack in his outside wall, told Soraghan, "You got a lot of big money sitting there,. That fracking is a big deal. If they say for sure that's what's causing it, it's gonna cost those boys a lot of money."

And that, some think, is the problem. Drilling brings in lots of money to the state, and not everyone is quick to point fingers at the practice. Mike Terry, president of the Oklahoma Independent Petroleum Association, told Soraghan, "There are still many unknowns and uncertainties in regards to seismic activity in central Oklahoma. Researchers in Oklahoma, notably Austin Holland with the Oklahoma Geological Survey, have repeatedly said the increase in seismic activity cannot be fully explained by man-made causes." (Read more)

Environmentalists and unions agree: Old, leaky natural-gas pipelines must be fixed

In the midst of the debate about the environemntal impact of the natural-gas boom, unions and environmentalists agree on something: old, leaky pipelines, which put both the environment and public health in jeopardy, need to be repaired. Methane, which is leaking from the pipes, is a powerful greenhouse gas and can be explosive in high concentrations. "The Department of Transportation estimates that more than 30,000 miles of decades-old, decaying cast-iron pipe are still being used to deliver gas nationwide," Kevin Begos writes for The Associated Press.

This agreement between trade unions and environmentalists is notable, especially after a year of struggling to find balance between a need for jobs and the need for fossil fuel pollution reduction. "Some trade unions have supported the drilling boom, while some environmentalists have pushed for bans on the hydraulic fracturing, or fracking, process," Begos writes. "To the extent we have a problem we can identify, it certainly makes sense to fix it," Delaware Riverkeeper Maya K. van Rossum wrote in an email. "I don't think that calling for the fix of existing leaky pipelines is contrary to a call for ending shale gas development or fracking."

In 2011, a cast-iron main installed 83 years before helped cause an explosion, killing five people and demolishing many homes in Allentown, Pa. No one is sure how much gas is leaking now, but old cast-iron pipe definitely poses a risk. Duke University scientist Rob Jackson, who has studied the issue, said fixing leaks "will save money and lives, improve air quality and health and slow climate change. What's not to like?"

"According to the Department of Transportation, New York City still uses about 3,000 miles of decades-old cast-iron pipe, Boston about 2,000 miles, Philadelphia about 1,500 miles and the District of Columbia 400 miles," Begos writes. "Experts say much of the old pipe dates to before World War II, and some of it may even be more than 100 years old." Last month U.S. Sen. Edward Markey, D-Mass., presented two bills about the pipeline repair, and a coalition of groups is backing them, but it's not yet certain how much support they have from Congress. (Read more)

Infant death rates in some rural Kansas counties are more than three times the national average

Infants are dying in Kansas at a rate higher than the national average, with rates even higher among rural families, Kelsey Ryan reports for The Wichita Eagle. The state's infant mortality rate in 2012 was 6.3 deaths for every 1,000 children born, while the national average was 5.9 deaths for every 1,000 children born. In 2012, Kansas had 254 infant deaths, compared to 247 in 2011, an increase of 1.6 percent.

"The infant mortality rates in Kansas are higher for babies born to women who live in rural and densely settled rural areas compared to infants born to women who live in frontier (less than six people per square mile), urban and semi-urban areas, according to state vital statistics data from 2008 to 2012," Ryan writes. Even though more infant deaths occur in urban areas, rural infant deaths really stand out in remote, low-population areas like Rawlins County, the dark green square in the northwest on the map below. The county of 2,500 leads the state in infant deaths, even though there were only three in the study period; its rate was 25 deaths for every 1,000 births. The three counties surrounding Rawlins County also have high rates, with each averaging more than 14 deaths for every 1,000 children born. (Eagle map from Kansas Department of Health and Environment data; for the interactive version click here)

Limited access to quality medical services, and lack of health insurance, are some of the reasons for the higher death rates in rural areas, Ryan writes. "Of the roughly 40,000 live births in Kansas last year, nearly 18 percent of pregnant women received 'inadequate' or 'intermediate' prenatal care, according to state data. Lower levels of care were more likely to occur in rural areas than in urban areas." Most of the counties rated "inadequate" are in the western part of the state, where poverty runs higher. The report also found that in 2012 more than 5,400 women smoked during pregnancy; local data are available on the interactive map.

"Statewide, more than 2,100 women who gave birth in 2012 didn’t seek prenatal care until they were at least six months pregnant, according to the KDHE report. More than 350 women never sought prenatal care before birth," Ryan writes. One reason is the long distances required to travel to see a specialist. Christy Schunn, executive director of the Kansas Infant Deaths and SIDS Network, told Ryan, “Access to health care seems to be a concern. I talk to a lot of families who have had infants die, and they didn’t have medical insurance and by the time they got insurance, they were halfway through their pregnancy. We need early prenatal care.” (Read more)

Read more here: http://www.kansas.com/2013/12/08/3168489/rural-areas-in-kansas-see-higher.html#storylink=cpy

Read more here: http://www.kansas.com/2013/12/08/3168489/rural-areas-in-kansas-see-higher.html#storylink=cpy

E. Ky. leaders consider a severance-tax trust fund, are warned that small-county rivalries must end

Eastern Kentucky leaders trying to get the region's coal-based economy out of a depression seemed interested in ideas from the Iron Range in northeastern Minnesota, presented yesterday to a crowd of 1,500 people at an event in Pikeville convened by Kentucky's Democratic governor and the region's Republican congressman. Coverage from the Lexington Herald-Leader is here.

But as they considered the idea of setting aside part of the state's coal severance tax revenue in a trust fund, and using only the interest for current projects, as the Iron Range does, some wondered if the idea was too late, given the parlous fortunes of the Central Appalachian coal industry. "It probably should have been done 20 or 30 years ago," state Sen. Robin Webb, D-Grayson, told Lexington's WVLK-AM Tuesday.

Democratic Gov. Steve Beshear said at a news conference that the next state budget will be so tight, "we can't be fooling" with the current 50-50 split of severance-tax revenue between the state and the region, but he told Bill Goodman of Kentucky Educational Television that the idea of a regional economic planning fund like the one in Minnesota "ought to be on the table" for the future.

The conference moderator, Rural Policy Research Institute Director Charles Fluharty warned summit attendees were that they needed to get over rivalries among counties in Eastern Kentucky, where many counties are small. "These counties and towns are competitive," U.S. Rep. Hal Rogers, R-Somerset, told Goodman. "It's hard to weld together a regional organization because many of those counties have some animosities from 80 years ago."

Just before the conference began, former Gov. Paul Patton of Pikeville told The Rural Blog that the effort would require a continued commitment by Beshear, who must leave office in 2015, and Rogers, who must give up his House Appropriations Committee chairmanship at the end of 2016. "the congressman and I are committed to the long haul," Beshear said. "We're also committed to some big, broad issues." For coverage from Ronnie Ellis of Community Newspaper Holdings, which has 10 papers in Appalachian Kentucky, click here. For his severance-tax story, go here.

Rural homeless are less visible, writer reminds us

Sid Salter

While the rate of homelessness in rural areas is about the same as in urban areas, urban homeless are often visible on the streets, while many rural homeless people are out of sight, living "in the woods, campgrounds, barns, vehicles or abandoned or substandard housing not truly meant for habitation," writes Sid Salter, a contributing columnist for the Clarion Ledger in Jackson, Miss.

The rural homeless problem is a real one, and hard to define precisely Salter writes: "Counting homeless people, like counting immigrants or others who are distrustful of authority figures, is an incredibly inexact science," and the counts by the U.S. Department of Housing and Urban Development are probably low. "Of the 2,403 Mississippi homeless identified by HUD . . . 501 are in emergency shelters, 582 are in some temporary traditional housing and 1,320 are 'unsheltered.' The worse news about homelessness in Mississippi is that it is exacerbated by poverty, and Mississippi remains the poorest state in the union."

Of Mississippi's 2,403 homeless, HUD classifies 475 "as 'chronically homeless.' Another 230 of our homeless are 'severely mentally ill.' Another 498 of the state’s homeless are listed as engaging in 'chronic substance abuse' while another 230 of them are veterans," Salter writes. "It seems the problem of homelessness is somehow more depressing and hopeless during the holiday season. That’s why many very noble efforts to provide holiday meals and toys for underprivileged children find success at this time of year. But the truth is that poverty, homelessness, mental illness and substance abuse threaten Mississippi families all year long and require not merely the generosity of the holidays but a place at the table of public-policy debate." (Read more)

In the U.S., "There are approximately 14 homeless people on average for every 10,000 people in rural areas, compared with 29 homeless people out of every 10,000 in urban areas," according to the National Alliance to End Homelessness. "The same structural factors that contribute to urban homelessness—lack of affordable housing and inadequate income—also lead to rural homelessness. Perhaps the most distinguishing factor of rural homelessness, however, is access to services. Unlike in urban areas, many rural homeless assistance systems lack the infrastructure to provide quick, comprehensive care to those experiencing homelessness. Reasons for this difference abound, including lack of available affordable housing, limited transportation methods and the tendency for federal programs to focus on urban areas." (Read more) (American Almanac graphic: Rural homeless in shelters)

With enrollment down and funding cut, leader of U.S. community colleges says his bunch is in trouble

During the Great Recession, more students turned to community colleges to save money, and enrollment at those schools zoomed. But since the end of the recession, fewer students are enrolling in community colleges, and state funding has declined, putting the future of some of those institutions in jeopardy, according to J. Noah Brown, president and chief executive officer of the Association of Community College Trustees, Chris Parr reports for Times Higher Education.

Brown told Parr, "Where a college may once have got 40 percent of its support from the state, it may now be receiving 12 percent. About two-thirds of our community colleges are based primarily in rural areas. These are very small colleges with 400 or 500 students. I’m worrying . . . about those institutions’ ability to survive in a student market that may be declining, as well as a market where we’d do well to stabilize public funding.”

Brown's "warning comes after a survey of state community college directors by the University of Alabama at Tuscaloosa’s Education Policy Center found that although many expect 'modest percentage increases in state appropriations' next year, declining enrollment would mean 'less overall tuition income,'” Parr writes. (Read more) For a list of every community college in the U.S. click here.

McConnell: Pass separate bills to reform immigration

Senate Minority Leader Mitch McConnell said in a speech Saturday that looking back is the way to move forward to pass immigration reform, with the Kentucky Republican citing the Compromise of 1850 by Kentucky's Henry Clay and Illinois' Stephen Douglas as a lesson about how politicians can come to a compromise over heated issues, Ryan Alessi reports for cn|2, a service of Time Warner Cable.

Because senators couldn't come to an agreement on the compromise, which dealt with slavery and related issues, it was split into several pieces "in an attempt to seek a compromise and avert a crisis between North and South," according to the Library of Congress. McConnell said Congress needs to do the same thing to pass immigration reform, Alessi reports. "While the U.S. Senate passed a comprehensive measure earlier this year, Republican House Speaker John Boehner said that bill won’t move in the lower chamber in 2013." Others in the House have talked about passing separate bills.

McConnell told the Kentucky Farm Bureau Federation at its annual meeting, "In the House of Representatives, I think the way forward is to pass separate bills dealing with various issues." He said, "Congress needs to make changes to U.S. immigration laws, including to the H-2A guest worker visa program that is important to many farms that hire immigrant workers during planting and harvesting seasons." (Read more)

Interior Department sets 30-year permit to protect wind farms from bird-kill prosecutions

The Department of the Interior has finalized a new 30-year permit to allow wind farms and other projects—if they meet certain requirements—to accidentally kill federally protected eagles. The move "highlights a tension lingering between two key goals of the environmental movement: developing renewable energy sources and protecting wildlife," Alexandra Berzon writes for The Wall Street Journal.

Associated Press photo: A golden eagle avoids wind blades.

 The wind industry will benefit from the new ruling, especially because many felt that the current five-year permit caused uncertainty because companies wanted to launch large-scale project that could take up to 30 years. To receive the longer permit, companies will be required to show they are trying to preserve eagles, according to the Fish and Wildlife Service, Berzon writes. "This isn't a free pass," said Peter Kelley, vice president of public affairs for the American Wind Energy Association, a trade group. "To get a permit you have to persuade the government you're going to do an extensive regime or offset [bird harm] by preserving habitat."

In the past several years, large birds have died from the impact of spinning blades of wind turbines. Fish and Wildlife spokesman Chris Tollefson said, "I think from a legal standpoint it is much easier to make a case against a company if you have a permitting process that hasn't been followed."

Although renewable energy sources like hydroelectric dams, solar arrays and other projects sometimes damage plants and animals, many environmentalists say renewables are still less injurious than fossil fuels. Even so, not everyone is in favor of the change. "This is going to lead to more dead eagles—plain and simple," said Mike Daulton, vice president of government relations for the National Audubon Society.

Executives say the new permit should encourage many companies to apply for permits so they won't be prosecuted. A Duke Energy spokeswoman said of the new ruling, "This provides some certainty and clarification to the industry." (Read more)

Another film, 'Out of the Furnace,' portrays Appalachia as violent, drug-filled world

The Appalachian-based film "Out of the Furnace" debuted over the weekend to less than stellar box-office numbers. But the $22 million film's $5.3 million take wasn't bad, considering everyone involved probably has just one eye on the box office and the other on the upcoming awards season. Just about all the stars—Christian Bale, Forest Whitaker, Sam Shephard, Woody Harrellson, Willem Dafoe and Casey Affleck—has either won or been nominated for an Academy Award. (Rotten Tomatoes photo: Christian Bale in "Out of the Furnace")

The movie, which takes place in Pennsylvania, is another in the long line of films that doesn't paint Appalachia as the greatest place to live, with drugs and violence ruling the day. But the release of the movie got Jay Fernandez of Word and Film thinking about other movies and novels set in Appalachia. He discusses both how Hollywood has displayed Appalachia on the big screen and how novelists have painted the region in words. (Read more)

Roanoke Times looks at Appalachian Virginia's difficulties with federal health reform

The federal health reform law continues to put pressure on rural health care systems. We reported on doctors in rural Vermont who are already at capacity and unable to accommodate new patients. The same problem is occurring in rural Virginia, especially in its Appalachian region, and may increase if tehe state expends the Medicaid program.

As more patients become insured through the law, more people are seeking doctors, but there aren't enough doctors to treat the new patients. In Virginia "there’s a projected shortage of about 600 patient care physicians—a gap that is expected to grow to more than 2,500 full-time equivalent positions by 2030, according a 2010 forecast by the Lewin Group for the Virginia Department of Health Professions," Laurence Hammack reports for The Roanoke Times. 

Places like Highland County (Wikipedia map) have been especially hit hard, Hammack writes. The county of 2,200 people doesn't have a hospital or pharmacy and has been without a practicing physician since last December. The county does have a medical center that has 10,000 patient visits a year; nurse practitioners handle most of them. "In fact, the most frequent call to the Highland County Volunteer Rescue Squad is made from the medical center, where the most seriously ill or injured patients must be transported by ambulance or helicopter more than 50 miles to hospitals in Augusta, Bath and Rockingham counties, according to squad captain Chris Vernovai."

At least Highland County has a facility. In Lee County, at Virginia's western tip, the only hospital closed Oct. 1, Hammack notes. "Wellmont Health System, which ran the hospital, said the closure was partly the result of cuts in Medicare reimbursements under the Affordable Care Act." Beth O’Connor, executive director of the Virginia Rural Health Association, said "the hospital is the first in Virginia to close as a result of Medicare payment reductions, according to O’Connor."

Some local doctors aren't buying that the hospital closed because of the reform law, Hammack reports. Dr. Art Van Zee "said Wellmont’s blaming of the Affordable Care Act is 'an invented, if not spun, reason for the closure.' Van Zee said Wellmont shuttered the hospital with the expectation that patients would go to other hospitals it runs in neighboring counties, protecting its bottom line—if not the residents of Lee County." Van Zee told Hammack, “Many lives are at risk, and some lives without question are going to be lost.” (Read more)

Ky. Appalachian 'summit' Monday draws more than 1,500 registrants; will be telecast, videostreamed

A summit to face the crises of Eastern Kentucky, called for Monday, Dec. 9, by the area's Republican congressman and the state's Democratic governor, has attracted more than 1,500 registrants and will be telecast by the state's television network and the region's TV station. The Lexington Herald-Leader has a scene-setter story, here. UPDATE, Dec. 8: the paper's opinion section today and tomorrow is devoted to the issue, and columnist Tom Eblen writes about it.

Bill Goodman of Kentucky Educational Television writes, "We’ll provide live coverage of the summit starting at 9 a.m. on KETKY and online at KET.org/live. Along the way, I’ll have interviews with various participants to get their perspectives on the day’s events. If you can’t watch our live coverage, you can follow this blog and my Twitter account for an ongoing synopsis of the presentations." Goodman also notes the Facebook page "that Gov. Steve Beshear and U.S. Rep. Harold "Hal" Rogers have established for the "Shaping Our Appalachian Region" project, and a wrap-up show with Beshear and Rogers, to be telecast on KET's main channel at 8 p.m. ET.

WYMT-TV in Hazard, a CBS affiliate, says it will broadcast the summit live from 9 a.m. to noon and 1 to 5 p.m., with continuous coverage on its website.

The summit is being held in Pikeville, seat of Kentucky's easternmost county, which borders Virginia and West Virginia. The impetus for the effort is the recent loss of 6,000 jobs in Eastern Kentucky's coal industry, which has dominated the region for a century but is suffering from depletion of easily mined coal, competition with natural gas, and new environmental regulations. The effort is being helped by the Appalachian Regional Commission and the Rural Development branch of the U.S. Department of Agriculture, and  Rural Policy Research Institute CEO Charles Fluharty is the facilitator.

The effort is aimed at finding long-term solutions to the region's economic problems, but in an editorial this week, The Mountain Eagle of Whitesburg called for a public-works jobs program like the Civilian Conservation Corps that President Franklin D. Roosevelt created soon after he took office during the Great Depression. The weekly suggested that the program and other efforts could be funded with $2.5 billion in the federal fund to reclaim abandoned mines, which is funded by a national severance tax on coal.

The editorial said, in part: "In addition to the problems unemployed coal miners and their families face, thousands of young men and women are living in the region without much hope today — stuck in poverty, nothing to look forward to, no obvious reason to stay in school, not much chance of finding a job, dealing and doing drugs because that’s what their peers are mostly doing. Could a new CCC help? We’ll never know unless we try. Plenty of regional projects that are still being planned or under way could be scaled up. . . . National and state parks have been underfunded for 25 years, and they’re showing the stress from heavy wear and tear. There are thousands of shovel-ready improvements on administrators’ wish lists. Walk the 1,200-mile-long Appalachian Trail: you’ll see that many if not most of the shelters are in disrepair. Explore our hollows: streams need to be restored, back-road bridges rebuilt, trash picked up, the homes of the elderly weatherized — there’s more than enough work to be done."  (Read more; subscription may be required)

Fight among commodity interests makes it more likely that farm law will need short-term extension

The Farm Bill continues to hit snags, as soybean and corn interest groups push congressional negotiators for measures favorable to them. That has the negotiators to test new options "for paying crop subsidies on some variation of a farm’s historic base acres — rather than what’s actually being planted each year," David Rogers reports for Politico. "The reversal dashes early hopes — shared by the House and Senate — to adopt a more transparent system of paying on planted acres. Indeed, a major criticism of the current direct cash payments to farmers is that the money goes out regardless of what is being planted, if anything at all."

"The rough goal now is to pay on 85 percent of base acres for both the new revenue and price loss programs in the proposed commodity title," Rogers writes. "But much depends on what scores come back from the Congressional Budget Office Monday. And at this stage it seems almost certain that the House will not vote before it goes home next Friday, Dec. 13." That has spurred talk of a short-term extension of current farm law to some date in January.

House Speaker John Boehner told reporters the House is ready to give farm-bill negotiators a short-term extension, and House Agriculture Committee Chairman Frank Lucas indicated on Farm Journal's "AgriTalk" this week that negotiations may run into next month, Chris Clayton reports for DTN/The Progressive Farmer. 

Rogers reports, "Midwest Republicans in the Senate, allied with corn and beans, were most adamant that base acres be used for a new target price program advocated by the House. But as corn prices have fallen over the summer, the Senate’s own revenue protection option — paid on planted acres —became vulnerable to the same complaint. Last week the National Corn Growers Association and American Soybean Association, which had supported planted acres themselves, warned they would oppose the bill unless all payments were decoupled from current production."

What this means is that "special accommodations will have to be made for millions of 'orphaned' cotton base acres, no longer qualifying for the commodity programs," Rogers writes. "At the same time, negotiators are testing what it will cost if farmers were to be allowed to reallocate plantings within their base. Such a reallocation seems almost certain for farms with a cotton base [that] have been planting other crops in recent years. But if done on a national scale, the costs could be high given the expansion of corn."

"Corn and soybeans’ victory in this case comes at the expense of those Midwest farmers who had been hoping that aid would be distributed according to average planted acres of recent years. In many cases that would be significantly higher than a farm’s base acres," Rogers writes. "The other side of the coin is that the drop in corn prices means that corn growers will very likely qualify for generous assistance under the new Agriculture Risk Coverage program, which is the mainstay of the Senate’s commodity title. So much so, that if corn were to reach $4 per bushel in 2014, a farmer could double what he now gets in direct cash payments—paid on base acres." (Read more)

Study confirms that placing new doctors' residency in rural areas is key to keeping them around

As many rural communities continue to struggle to attract new family physicians, a study by researchers at the Robert Graham Center says that where doctors practice their residency is the key to bringing more doctors to rural America. The study, which used information from the 2009 American Medical Association Physician Masterfile, found that 19 percent of family-medicine residency program graduates stay within five miles of their residency program site, and 39 percent locate within 25 miles. (Graham Center graphic)

"The distribution of physicians continues to compromise access to primary care, a problem compounded by limited volume of training outside of major metropolitan areas and large academic health centers," the study report says. "More research is needed to explore the influences of practice site other than training location, but these findings seem to support current efforts to decentralize graduate medical education training through models such as teaching health centers and rural training tracks." (Read more)

Rural hospitals do better than last year in ranking based on participation in national survey

Houlton (Me.) Regional Hospital

Nine of the nation's 22 best rural hospitals are in Maine and four are in Tennessee, according to the Leapfrog Group's 2013 list of top hospitals, chosen from 1,324 hospitals that answered a survey.

The number of rural hospitals on the list was a 69 percent increase from last year. The list also included 55 urban hospitals and 13 children's hospitals. Leah Binder, president and CEO of Leapfrog, said in a release: "The larger group of rural hospitals represented, including several critical-access hospitals, shows us that any hospital in America can achieve the highest standards of quality and safety, and any community, no matter how small, can benefit from top-notch health care.”

The Leapfrog news release says those on the list earned an 'A' grade for having "lower infection rates, higher survival rates for high-risk procedures, decreased length of stay, and fewer readmissions." The nine Maine hospitals are Blue Hill Memorial, Calais Regional, Charles A. Dean Memorial, Down East Community, Houlton, Inland, LincolnHealth (Miles Campus), Sebasticook Valley Health and Stephens Memorial. The four in Tennessee are Bolivar General, Camden General, Gibson General Hospital and Humboldt General.

Other rural hospitals on the list are East Morgan County Hospital (Colo.); Florida Hospital Wauchula (Fla.); Mariners Hospital (Fla.); Grinnell Regional Medical Center (Iowa); OSF Saint James - John W. Albrecht Medical Center (Ill.); Wabash General Hospital (Ill.); Fairview Hospital (Mass.); OSF St. Francis Hospital & Medical Group (Mich.) and Spectrum Health Kelsey Hospital (Mich.). To see how participating hospitals scored, click here.

The 49th state struggles to place rural Alaska Native children with Native foster families

There are 400,540 foster children in the U.S., according to the Congressional Coalition on Adoption Institute. Finding families to adopt these children, or merely giving them a safe home where they feel accepted, can be difficult, especially in rural areas like Alaska, where 14.8 percent of the population is Native American. Of the 2,100 foster Alaskan youth placed in foster homes, 1,276 are Alaska Natives, and only 413, or 32 percent, have been placed with Native families, Carey Restino reports for The Arctic Sounder.  

Despite the Indian Child Welfare Act of 1978, "which requires states to do everything in their power to keep Native American children with their families, or at the very least with Native American families that the child’s tribe designates," the problem still exists in Alaska, and other states, Lauren Kawana reports for Oakland North. In 2012 in California, 439 Native American children entered foster care, a rate of 1.2 percent. Native American children "account for nearly 1 of every 10 foster children in Nebraska," up from 1 out of every 14 last year, Martha Stoddard reports for the Omaha World-Herald. Similar problems have occurred in every state with high Native American populations, such as Utah, New Mexico, and South Dakota.

What makes Alaska different are its many small, remote settlements, which makes it hard to attract Natives to become involved in being foster parents, Restino writes. Training and "support is often a plane ride away for rural community foster parents, and the system can be daunting to navigate without an advocate nearby to talk to." Plus, small-town life isn't ideal for fostering. "While in a larger community, foster parents — relative or not — may have some anonymity, in a small town, they are likely to bump into the children’s parents in the grocery store or elsewhere around town."

Christy Lawton, director of the state Office of Children’s Services, told Restino of moving a child from a remote town to a larger community: “It’s like going from Alaska to New York City. That’s what it compares to in terms of the shock.” Aileen McInnis, director of the Alaska Center for Resource Families, a nonprofit organization that the state pays to train and support foster families, told Restino: “When kids are taken out of their community, they lose that really valuable cultural connection. It’s very important to keep kids connected with their culture.” 

The state has 1,300 licensed foster homes. But changes could be coming soon. Democratic Rep. Les Gara, who was a foster child, has begun a campaign to educate and promote fostering throughout the state, Restino writes. "Gara has worked with colleagues to spearhead reforms to reduce Alaska’s foster parent shortage, provide mentors for youth coming out of care, and to increase the accessibility of college and job training to help foster youth succeed. As well, a statewide TV advertisement campaign by the Department of Health and Human Services titled 'One Child' recently won an award for its effort to recruit new foster parents." (Read more)

Commission says Arizona State Forestry Division is at fault in deaths of 19 hotshot firefighters

"The Arizona Industrial Commission Wednesday approved $559,000 worth of fines against the Arizona State Forestry Division in relation to the June 30 deaths of 19 Hotshot firefighters saying the division "placed a higher priority on protection of homes and property than firefighter safety," reports the Daily Courier in Prescott, where the firefighters were based. Only one Hotshot survived the fire. (Courier photo: Hotshots reach the fire June 30)

According to the commission's report, the firefighters died because they weren't removed from harm's way immediately—consistent with policies. "The report says 61 more firefighters in nearby locations to unacceptable and unnecessary risks of 'smoke inhalation, burns and death,'" Dennis Wagner, Yvonne Wingett Sanchez and Sean Holstege report for The Arizona Republic.

The fines amount to $70,000 plus $25,000 for each firefighter who died. This is the full allowed amount for a "willful" violation, which doesn't denote malice but knowing negligence. "Investigators said key safety and planning positions on the Incident Command Team were not filled as required, and other important supervisors arrived late or abandoned their posts, increasing the risk to firefighters in the field," the Republic reports. "It became an emergency because of bad planning," the state's Division of Occupational Safety and Health safety compliance supervisor Marshall Krotenberg said. (Read more)