NEW HAVEN — Despite persistent federal and state government efforts to tax tobacco use out of existence, the number of smokers in the U.S. has remained stable in recent years, rather than declining. The reason? Genetics.

So says the Yale School of Public Health, where recent research suggests that individuals’ genetics play an important role in whether they respond to tobacco-control policies. The study appears online in the journal PLOS ONE.

Smoking dropped sharply after the Surgeon General’s landmark report on the dangers of tobacco was published in 1964, but rates have plateaued during the past two decades despite increasingly strong-armed government tactics to pressure citizens to quit. The study found biological evidence that may help explain why some people respond to anti-smoking inducements, such as higher taxes and the expansion of clean-air laws, and why others do not.

“We found that for people who are genetically predisposed to tobacco addiction, higher cigarette taxes were not enough to dissuade them from smoking,” said lead researcher Jason M. Fletcher, associate professor in the Department of Health Policy & Management at the Yale School of Public Health.

Tobacco use remains a leading cause of preventable death in the U.S., responsible for more than 400,000 deaths each year, according to the study. Tobacco taxation, meanwhile, has been credited with helping to reduce use by more than 50 percent since the Surgeon General’s report.

 HAMDEN — William Kohlhepp of North Haven, associate dean of the School of Health Sciences at Quinnipiac University, has been re-elected to a three-year term as secretary-treasurer of the Physician Assistant Education Association (PAEA), the only national organization representing physician assistant educational programs in the United States. Currently, 168 of the 170 accredited programs in the U.S. are association members. The PAEA provides services for faculty at its member programs, as well as to applicants, students and other stakeholders. Kohlhepp, who also is a professor in the physician assistant program at Quinnipiac, earned his doctorate of health science at Nova Southeastern University. He holds a master of health administration from Quinnipiac and a physician assistant certificate from the University of Medicine and Dentistry of New Jersey.

 HARTFORD — Hartford Healthcare has adopted a "universal flu prevention program" that require its employees to get flu shots.

All Hartford Healthcare employees, licensed independent practitioners, volunteers and students were required to get a flu shot by December 1. In addition, Hartford Healthcare vendors/contractors who perform work at any Hartford Healthcare facility for a month or more during flu season also must receive a flu shot.

Medical and religious exemptions are allowed, but staff members with approved exemptions are required to wear surgical masks during flu season when they are within six feet of an area in which they may encounter patients.

 2012 state legislation impacting the private sector

 

As 2102 draws to a close, Connecticut lawmakers are gearing up for a new legislative session.

Here’s a look at the consequences of some of their recent decisions, and the ups and down of the political process.

 

Paid Sick Leave

On January 1, 2012, Connecticut became the only state requiring some employers with 50 or more employees to provide paid sick leave to service workers.

 

Among other provisions, employees can earn one hour of paid sick leave for every 40 hours, with a maximum of 40 hours per year. They must work at least 680 hours before becoming eligible.

“People seem to be figuring it out,” says Jonathan B. Orleans, an attorney with Pullman & Comley. “There are a bunch of aspects we anticipated would cause some problems. It is difficult to know which employees are covered and which are not. There are issues about the rights of employees under the statute to carry over unused leave from one year to the next.”

As of late November 2012, however, only three complaints had been filed, according to state Department of Labor attorney Heidi Lane. One concerned an employee who wasn’t covered because he was a temporary worker. Another dealt with an employer who didn’t give a worker sick leave but, when informed about the law, immediately complied.

Lane attributes the lack of complaints to “lots and lots of training, in seminars and on the phone.”

“There are many questions from businesses still,” she acknowledges. “It seems to be they’re in compliance but they need to talk a little bit about how to handle certain things.

“A common one is an employee has already used 38 hours of paid sick leave. They have two hours left, but they take eight for a sick day. Our position is those two hours are protected and they could use the remaining six toward whatever attendance policy the employer has. Some have more generous policies, and employees can they take it in half-day increments.”

Many questions concern eligibility.

“The legislature only included 68 categories of service workers,” Lane says. A librarian is covered, for example, but a library aide or technician is not. Neither are truck drivers and mechanics.

For union members, if a collective bargaining agreement was in effect on January 1, the law doesn’t apply until their contract expires.

Another quandary is that the law works on a calendar year.

“A lot of employers use their own fiscal year,” Lane says. “That’s very hard for some employers because they sort of have to rewrite their policies for the paid sick employee.”

 

New Energy Plan

On October 5, Gov. Dannel P. Malloy unveiled a major initiative emphasizing energy efficiency and greater access to cleaner sources of energy.

 

The Connecticut Comprehensive Energy Strategy aims to “make our state’s businesses more competitive, and it can ensure that we preserve and protect our environment for generations to come,” Malloy said in announcing his plan at a business energy conference co-sponsored by the Connecticut Business & Industry Association [CBIA].

 

A central part of the strategy is to increase the use of natural gas to 75 percent of businesses and more than 250,000 homes in the state over a seven-year span.

The proposal also recommends raising the charges on consumer electric bills paying for residential and commercial energy conservation programs, and retooling those programs to offer more incentives for higher-cost efficiency upgrades.

Connecticut lags behind other states in residential heating with natural gas, which has been cheaper than oil in recent years. Only 31 percent of Connecticut homes use it, compared with 48 percent in Rhode Island, 47 percent in Massachusetts and 70 percent in New Jersey.

 

A stumbling block is the price — it costs around $7,500 to convert to natural gas. The state already helps low-income families make the conversion, and the plan outlines ways to help others, through loans payable on utility bills.

“We’re very supportive of the overall theme of the strategy bringing cheaper, cleaner more reliable energy to Connecticut,” says Eric Brown, associate counsel at the CBIA. “There’s many good things in there that we think will make Connecticut more competitive in coming years and decades. Some details have to be worked out, such as how to fund it, but we are supportive of the initiatives to maximize energy efficiency and to expand access to natural gas in the state.”

Calling the initiative, “overall a solid and positive piece of work,” Brown adds that CBIA is eager “to work with stakeholders” on implementation.

“It’s all become possible with the creation of the agency [the Connecticut Department of Energy & Environmental Protection] and the governor, who is very adamant about addressing our dubious position as one of the most expensive states to do business,” Brown says. “We’re excited about the prospects.   

The Independent Connecticut Petroleum Association is less enthusiastic. The organization has criticized the strategy, citing concerns about too much emphasis on natural gas.

 

A series of public meetings and technical reviews ended in early December.

 

Malloy spokesman Andrew Doba says the draft plan will be finalized during the first week of January. The General Assembly will consider the proposed legislation when it convenes on January 9.

 

Budget Deficit

The state deficit looms larger than the $284 million estimate made back in May, when the legislature approved a $20.5 billion budget plan for fiscal 2013.

Deficit projections swelled to $365 million by November 28, when Gov. Malloy announced $170 million in cuts to more than 275 programs ranging from social services [$82 million] to magnet schools [$2 million] and UConn [$10.2 million].

Nearly a week later, on December 3, state comptroller Kevin P. Lembo hiked the deficit projection to $491 million, by adding another $50 million largely from Medicaid spending. Lembo’s calculation, however, does not take into account reduction of the deficit resulting from the governor’s recent emergency cuts.

As of press time, the General Assembly was expected to meet on the matter during the week of December 17.

 

Donovan’s Dashed Aspirations

The state House Speaker’s bid for the 5th congressional district seat faltered in mid-August when former State Rep. Elizabeth Esty won the Democratic nomination. On November 6, Esty won the seat outright, defeating the Republican challenger, State Sen. Andrew Roraback.

 

A union-backed candidate, Christopher Donavan was heavily favored to prevail in the primary until May 31, when federal prosecutors announced the arrest of his campaign finance director Robert Braddock Jr. for alleged illegal fundraising. A federal grand jury investigation led to seven more arrests.

 

Medical Marijuana

The state’s Department of Consumer Protection is gearing up to implement legislation allowing the palliative use of marijuana for certain medical conditions, which became law on May 31.

 

“The doctors are the gatekeepers, and have to start the process by certifying that the patient is qualified,” explains department Commissioner William M. Rubenstein. Approved conditions include cancer, glaucoma multiple sclerosis, Crohn’s disease, posttraumatic stress disorder and testing positive for HIV/AIDS. Qualified patients can register if they are Connecticut residents who are older than 18 and do not live in a correctional facility.

 

“As of October, we set up a temporary registration for qualified patients,” Rubenstein says. Around 65 people had registered as of late November.

 

The department has until July 1, 2013 to submit regulations regarding permanent patient registration, production and dispensing of marijuana.

 

In crafting those regulations, Rubenstein and his staffers are examining how other states have put similar legislation into practice. Since 1996, 17 other states and Washington, D.C. have enacted laws legalizing medical marijuana. 

“We want to make sure we’re considering everything, so we can provide for a product that can guarantee quality and consistency, and that growing and dispensing places are safe from theft and diversion,” Rubenstein says. Medical marijuana, he adds, typically is produced from clones, not seeds, and is grown inside buildings rather than greenhouses.

 

Rubenstein hopes production will be underway before the end of 2013. “We can license up to ten growers, with a minimum of three,” he says.

As his department fields inquiries from aspiring producers, local municipalities are taking action.

 

Citing security and other concerns, the Bridgeport zoning commission recently turned down a proposal to grow marijuana in a warehouse.

 

In September, Canton’s zoning commission passed regulations authorizing the sale of medical marijuana only in pharmacies, and is considering others allowing indoor production of pot in industrial buildings. The Simsbury zoning commission is considering public feedback on the subject, such as whether the town might benefit from allowing marijuana growing.

 

“What we’re advising towns is to wait until they see the proposed regulations,” Rubenstein says. “A lot of their concerns and fears may be alleviated by looking at the regulations.”

 

Rubenstein anticipates a statutory requirement stipulating that the product can be sold only in pharmacies will be a problem. “We don’t think they will sell it,” he says, “because of a conflict with federal control substance law, [which does not recognize the use of marijuana for medical purposes].

 

One option could be “standalone dispensaries, which look and feel a lot like pharmacies.”

 

Under the new law, Rubenstein says, employers cannot discriminate against employees “merely because they’re a registered patient [authorized to use marijuana palliatively] but they’re free to set their own rules in the workplace.”

Jonathan B. Orleans, an attorney with Pullman & Comley does not believe “the impact on employers is going to be enormous. 

“The most important thing is to recognize that this statute does not affect the employer’s right to prohibit the possession or use of marijuana in the workplace.” 

 

Connecticut Health Care Exchange

The quasi-public agency was established on July 1, 2011 to meet the requirements of the federal Affordable Care Act (a/k/a Obamacare), which requires everyone to have health insurance purchased privately or through exchanges that must start enrolling customers in October 2013 for plans effective on January 1, 2014.

The Connecticut exchange will be an online marketplace to shop for health insurance plans.

Insurance rates will be based on a percentage of income, with subsidies for low-income residents.

Around 350,000 state residents are uninsured, according to recent estimates.

Using a  $107 million federal grant to help implement the law, Connecticut, along with 15 other states, is creating its own exchange. Others will use a federal health insurance exchange.

Connecticut’s exchange will offer four tiers of coverage–– bronze, silver, gold and platinum –– based on level of benefits. It also will have “navigators,” another federal requirement, to help consumers understand the system. 

Connecticut Health Care Exchange CEO Kevin Counihan predicts the Nutmeg State’s exchange will be the “most sophisticated” exchange in the nation.

Under the federal law, employers with 51 or more employees face a $2,000 fine per employee for not providing insurance or a $3,000 penalty per employee if they drop insurance.

Rather than provide traditional health coverage, employers may choose to offer employees a monthly dollar amount to purchase their own “defined contribution” health plan through the exchange.

Steve Glick, president of Chamber Insurance Trust [CIT], which offers insurance services to businesses and chambers of commerce in Connecticut, says the chambers “are already developing a defined contribution program which will be the model for distribution of health care.”

Glick also said the state’s for-profit private carriers are going to have competition on the exchange from companies like Harvard Pilgrim, a non-profit health insurer, and HealthyCT, a new non-profit co-sponsored by the Connecticut State Medical Society.

 

 FARMINGTON — Health insurer ConnectiCare is launching a new product in the state that it says will offer employers more flexibility and employees more choice when choosing a health plan.

The ConnectiCare BeneFIT insurance product offers employers the ability to set their contribution levels while providing employees with a choice of health-plan options to meet their individual needs. The product is provided through an online portal that offers personalized shopping for employees, the company said.

The offering is designed for companies with 51 or more eligible employees and is now available for group coverage beginning January 1.

“The combination of flexible contributions for employers and a choice of ConnectiCare plans for employees addresses both employer and employee priorities,” said Michelle M. Zettergren, senior vice president and chief sales and marketing officer for ConnectiCare.

“Employers choose a contribution level that fits their budget and employees choose a plan to fit their needs,” added Zettergren. “Providing this product through the ConnectiCare BeneFIT online environment brings a whole new level of convenience and support to our customers.”

Highlights of the product include:

• Flexible contribution: Employers set their contribution level and select a suite of health plans to offer employees, covering medical, pharmacy, vision, and dental benefits.

• Choice of plans: Employees choose the health plan that best meets their needs through a personalized shopping experience.

• Ease of use: Websites for both employers and employees allow them to select BeneFIT options and manage items such as enrollment, invoice payment and payroll deductions, all online.

 The American College of Physicians (ACP) has named Jensa Morris, MD of Yale-New Haven Hospital a top hospitalist in the United States. This honor is awarded to hospitalists — physicians specializing in the care of hospitalized patients — who are making significant contributions to the medical field through their innovation, leadership and clinical skills. The award also considers contributions in the areas of patient safety, community involvement and quality improvement.

Morris, who lives in Guilford, earned a bachelor’s degree from Princeton University and her medical degree at Mount Sinai School of Medicine. She completed her internship and residency at Brigham & Women’s Hospital in Boston. She is also an assistant clinical professor of medicine at Yale School of Medicine.

Dr. Morris has been a hospitalist at YNHH since 2002 and she is one of just 10 hospitalists from throughout the country selected for this award this year.

“The award is well-deserved,” said YNHH Chief of Staff Peter Herbert. “Dr. Morris is a highly skilled and extremely caring physician who is applauded by her peers, patients and students alike. Her exceptional dedication to her work, our hospital and our patients made her an outstanding choice for this wonderful accolade.”

 WALLINGFORD — Gaylord Specialty Health Care is debuting the Ekso Bionic Suit, a wearable robotic exoskeleton that enables standing and walking to people with lower-extremity paralysis or weakness.

Gaylord is one of only 20 rehabilitation centers in the United States (and the only one in Connecticut) using this bionic suit for physical therapy. A live demonstration of the Ekso Bionics’ Robotic Exoskeleton technology was scheduled for November 8 (after this issue of BNH went to press. This new technology was to be demonstrated by patient Mike Loura who, after being struck by a vehicle while riding his bicycle, was paralyzed in 2008 with a T5 complete injury. The father of two lives in Darien and has been an outpatient at Gaylord Specialty Healthcare since 2009. 

 NEW HAVEN — Gateway Community College’s (GCC) Nuclear Medicine Technology program has been awarded continued accreditation for the next seven years by the Joint Review Committee on Educational Programs in Nuclear Medicine Technology.

The visiting committee praised the new facility at GCC which features a state-of-the-art nuclear medicine laboratory. They also commended the supportive relationship that GCC has fostered with the 13 different clinical sites where students train.  “They visited few of our clinical sites and were very pleased with the training and support our students receive there  and how much it complements what they learn in the classroom and in our own lab,” said Beata I. Gebuza, MS, CNMT, RTN, NCT, associate professor and program coordinator of GCC’s Nuclear Medicine Technology. “It takes a lot of effort to build relationships with the hospitals so that we can provide learning opportunities for our students. We are very happy to have received the seven-year accreditation.” 

GCC’s associate in science degree and certificate programs in nuclear medicine technology afford students an opportunity to train at health-care facilities around the state including Yale-New Haven Hospital, YNHH-St. Raphael Campus, VA Connecticut Health Care’s West Haven campus, Griffin Hospital, Milford Hospital, Midstate Medical Center, Middlesex Hospital, Backus Hospital, Waterbury Hospital, Cardinal Health Nuclear Pharmacy, Lawrence and Memorial Hospital, St. Francis Hospital and the UConn Health Center.