'Forensic nursing' idea of online Frontier Nursing University student could help victims of domestic violence in rural areas

Unseen and unspoken, rural victims of domestic violence are more likely to suffer alone because of geographical isolation, lack of medical support networks, and an "everybody knows everybody" small-town culture that can keep victims from asking for help.

Leslie Copp (Photo from The Daily Yonder)

With the help of a Tillman Foundation scholarship, Leslie Copp, a nurse who grew up in a home with domestic violence, aims to change some of that in rural Indiana, reports Liz Carey of The Daily Yonder. "Copp is an online graduate student at Frontier Nursing University, located in Versailles. Her nursing work includes caring for trauma victims and gathering evidence for prosecutors. She wants her graduate education to help her specialize in trauma care and establish trauma care centers in rural communities like her hometown of Odon, Indiana, pop. 1,400."

Forensic nursing is an emerging field that many students may not know exists. Copp began her medical career as a Certified Nurse Assistant, then earned a bachelor's degree in nursing, but along the way, "realized she enjoyed taking care of trauma victims and helping as a forensic nurse to collect evidence to assist in prosecuting abuse cases. She said she feels born to work as a forensic nurse examiner." She told Carey: "I was raised at the very first of my life in a home where I dealt with watching my mother go through domestic violence. I didn't realize that the trauma that I had been through as a young adult would set the base for something that I would grow to love. I turned my trauma into something that I could do to help others." Carey reports, "She intends to pursue a doctorate in nursing practice and to become a mental health nurse practitioner."

Copp told Carey: "In Indiana alone, there are wide areas where there are no resources or care for victims of trauma or violence. My goal is to start with one (rural trauma care center) and plant it in a place that has the widest area of no coverage so that we can at least start providing medical exams (for trauma victims) and point people in the right direction." Part of the dilemma in gathering prosecutorial evidence from victims is timing and victim bandwidth for the process, Carey writes. By the time a victim is treated at their local hospital, they don't have the energy to go to a metro hospital for another work-up. "Even if a nurse sees them in a metropolitan area, the patients get lost in the system without access to resources like trauma therapy, advocacy services, and support systems."

Frontier Nursing University Assistant Professor Dr. Joshua Faucett told Carey, "Copp's experience as a nurse and violence survivor made her a good candidate for the scholarship. . . . Leslie is a sexual assault nurse examiner and has testified on behalf of sexual assault victims to bring their abusers to justice." Carey adds, "Copp's goal is to create a trauma center in a rural area that could both do medical exams and help victims gain access to social workers, prosecutors, and emergency housing."

Traveling with diabetes? Here are 10 tips for a safe, pleasant trip

By Tami Ross
University of Kentucky

Diabetes requires regular self-management and treatment, even on vacation. That’s why it is important to plan ahead to ensure that your next great adventure does not suspend your diabetes management.

Photo by Julia Amarai, iStock/ Getty Images Plus

Check in with your diabetes care provider: When in doubt, schedule an appointment with your diabetes care provider to discuss how your diabetes management may change while you are traveling. Your provider can let you know if your travels require any immunizations.

Ask your doctor for a letter detailing your diagnosis, how your diabetes is treated and what medication and equipment is required.

Notify the TSA agents about your medical devices: When flying, it is important to let TSA agents know beforehand that you have medical devices in your bag or on your person. This will help prevent any unnecessary hiccups, keep any diabetes devices safe, and speed you through security. It may be beneficial to bring a letter from your doctor stating your diagnosis and what supplies you are traveling with.

Take a TSA medical condition notification card: You may want to bring a TSA notification card to discreetly notify the agents of your diabetes. These cards should be printed and filled out ahead of time. This may be helpful if you have a child who is self-conscious about their diagnosis and does not want the extra attention that comes with notifying the agents.

Request a pat-down screening process: You can request a pat-down screening as an alternative to the airport full-body scanner. Some diabetes devices may be damaged by X-ray baggage machines or full-body scanners, so make sure to follow the device manufacturer’s recommendations.

Know that the 3.4 oz. rule doesn’t apply: Insulin and other liquid medications like glucagon are permitted through airport security even if they are greater than 3.4 ounces. You may travel with a juice box over 3.4 ounces to treat any potential low blood glucose, but it will receive additional screening. Lancets and syringes are also allowed through security but should be accompanied by insulin.

Keep medicines with you: Do not store insulin or other diabetes injectables in checked luggage or the trunk of the car. It could be affected by pressure and temperature changes. Keep any medication or blood testing supplies that you might need with you.

Make sure to have a pharmaceutical label for all your medication to show that it was prescribed by a physician when going through airport security. Try to pack twice as much medicine and diabetes supplies as you think you’ll need to be prepared for any travel delays or unforeseen circumstances.

Take frequent breaks: Since people with diabetes are at a higher risk of developing blood clots, which can lead to heart attack or stroke, try to take frequent breaks to stand up and walk around to help keep blood flowing.

Protect supplies from the sun: Make sure to keep your diabetes supplies out of the sun, and do not leave them in a hot or cold car. If you take insulin, keep it in a cooler, but avoid placing insulin directly on ice as it may get too cold or freeze, damaging it.

Bring healthy snacks: Travel with portable, ready-to-eat snacks in case of meal delays or food unavailability.

Dress comfortably: Wear comfortable clothing and supportive well-fitting shoes with plenty of cushioning. Make sure to never walk bare foot, even on the beach. While traveling, check your feet for swelling and blisters regularly.

Tami Ross is a nationally recognized registered dietitian and certified diabetes care and education specialist and a diabetes education services coordinator with UK's Barnstable Brown Diabetes Center.

16 of Kentucky's 72 rural hospitals are at risk of closing, and 10 of them are at immediate risk, a national advocacy group estimates

Maps by Center for Healthcare Quality and Payment Reform; to enlarge click it.

By Al Cross

Kentucky Health News

Sixteen of Kentucky's 72 rural hospitals are at risk of closing, and 10 of those are at immediate risk of closing, according to the latest analysis of hospitals' Medicare cost reports by the Center for Healthcare Quality and Payment Reform, an advocacy group.

The report doesn't name the 16 hospitals, but it does offer a wealth of financial information about most of the short-term, acute-care hospitals in Kentucky and every other state. The center has said it doesn't name the hospitals it considers at risk because it's hard to say exactly what is going on in each of them without examining them more closely, and doesn't want to imply that they are the only hospitals struggling.

The center says its analysis is based on examinations of the cost reports hospitals file to get Medicare payments, which are based on cost or charges, whichever is less. The center's report notes negative operating margins, losses on patient services and low financial reserves.

Rural hospitals' troubles are often blamed on low rates of reimbursement for Medicare and Medicaid patients, which are a majority of their admissions, but the center says "losses on private insurance patients are the biggest cause of their overall losses."

The center's last report, in 2021, used financial data from 2017 to 2019. The latest report is based on reports for 2020 to 2022. Those were years in which hospitals got extra federal funds due to the pandemic, and fewer rural hospitals in the United States closed; now that they are no longer getting the extra money, the center says it expects closures to accelerate.

The previous report also said 16 Kentucky hospitals were at risk of closing. It said 12 of them were at immediate risk; in the latest report, that number is 10.

According to the report, 14 rural hospitals in Kentucky lost money (defined as "negative total margin") in 2020-22, and 11 others lost money on patient services but not overall.

The 14 that had negative margins are in Albany, Benton, Burkesville, Campbellsville, Greenville, Irvine, Madisonville, Manchester, Martin, Mount Sterling, Pineville, Richmond, Shelbyville and South Williamson (Pike County).

The 11 that lost money on patient services are in Carrollton, Columbia, Danville, Hardinsburg, Hazard, Marion, McDowell, Morehead, Prestonsburg, Russell Springs and Salem (Livingston County).

A map with figures for each hospital is here: https://ruralhospitals.chqpr.org/

The figres are downloadable at https://ruralhospitals.chqpr.org/Data1.html.

Study finds eating ultra-processed foods boosts calories and weight; manufacturers say they make food more affordable

Everyday Health photo illustration

Kentucky Health News

"Would you eat food that's been pre-digested?"

That's how The Washington Post opened a story that digs deep into how industrial processing changes the structure of food in such a way that it is essentially like eating predigested food. And this, experts say, affects how much we eat, how much our body absorbs, increaring our weight and our risk for chronic disease.

"A growing body of research suggests that the extent of industrial processing that your food undergoes can alter its effects on your body, determining its impact on your appetite, hormones, weight gain, and likelihood of developing obesity and chronic diseases," report Anahad O'Connor and Aaron Steckelberg of the Post. 

Scientists call this type of food u"ltra-processed." The Post offers a detailed example that involves two foods made from corn: canned corn and an ultra-processed snack, corn chips.

The graphics show that by the time both foods go through the packaging process, the canned corn has an "intact food matrix," which means its internal structure, which influences the nutrition provided by the product, remains the same. But the chips have a "broken food matrix," meaning that their nutritional value has been degraded, which affects how our bodies use the food and whether we feel full after eating it.

“Ultra-processing breaks the links between nutrients; it creates new links that our bodies may not recognize, and by doing this it disturbs the digestive process,” Anthony Fardet, a nutrition scientist at the French National Institute for Agriculture, Food, and Environment who studies the effects of food processing on health, told the Post. 

The reporters write that ultra-processed foods make up 58 percent of the calories Americans consume, and that government experts are examining the link between the foods and obesity. Their findings could result in the U.S. following the guidance of countries that have urged people to not eat ultra-processed foods. 

NPR reports that ultra-processed foods make up nearly 70% of what children eat. A separate NPR article notes that "a recent analysis by the Access to Nutrition Initiative finds about 70% of food products sold in the U.S. are unhealthy, and much of the food can be classified as ultra-processed." 

Supporters of the packaged-food industry push back on the idea that ultra-processed foods are bad for you, telling the Post that they are an essential part of the food supply. 

“Processed foods in general help create a more affordable, available, and accessible food environment,” Bryan Hitchcock, chief science and technology officer for the Institute of Food Technologists, told the Post in an email. “Processing technologies, particularly at the industrial scale, add value, safety and nutrition while reducing costs and food loss and waste.”

Chart of Nova analysis for processed foods, from Current Obesity Reports; to enlarge, click on it.

Carlos Monteiro, a nutrition professor at the University of São Paulo, has developed a system to identify ultra-processed foods, called Nova. Its four categories are unprocessed or minimally processed foods, such as an apple; processed culinary ingredients, such as home-baked apples; processed foods, such as packaged applesauce cups; and ultra-processed foods, like packaged apple puff snacks. 

Hitchcock told the Post that not all processed foods are bad for you and that the Nova system "does not capture the nuance" of such foods: "Clarifying which to include more often, and which to reserve for occasional consumption, is essential." Rick Mattes, a nutrition scientist at Purdue University, is a "prominent critic of the Nova system" who says more research is needed before telling people to avoid a broad category of foods, the Post reports. 

The Post also writes about a small study led by Kevin Hall, a nutrition and metabolism scientist at the National Institutes of Health, that recruited 20 men and women to live in a lab and eat a mostly ultra-processed food diet for two weeks, and then a mostly unprocessed food diet for two weeks that was matched for nutrients like salt, sugar, fat and fiber.

The participants could eat all they wanted on both diets. They found that people eating the ultra-processed diet consumed about 500 more calories a day. They also ate the ultra-processed meals faster, at a rate of about 50 calories per minute, compared to 30 calories a minute on the unprocessed diet. 

Those who maintain there is a place for ultra-processed foods in our diets applauded the research, but said more research is needed. 

Allison Aubrey of NPR talked to Dr. Chris van Tulleken, the author of Ultra-Processed People, who made himself a test subject for a one-month experiment that swapped his normal, healthy diet full of non-processed foods to one that mostly came from "packages, boxes and bottles." Tulleken told NPR that about 80% of his calories came from ultra-processed foods during the experiment. 

During the experiment, Tulleken measured his weight and his gut hormones, which send signals to stop eating. He said ultra-processed foods interfere with gut hormones. 

"I became very unwell very quickly. I felt terrible. I stopped sleeping, I developed anxiety and became very unhappy . . . .  So at the end of a meal, my hunger hormones would still be sky high," he said. 

Asked why he thinks the ultra-processed foods left him wanting to eat more, even though he'd had sufficient calories, he first noted that the food is energy dense, so you consume calories at a much higher rate than you would while eating whole foods. 

He also noted that it could because this food "may be being absorbed in a different part of the gut than the part that releases the fullness signal. So I suspect you're eating this food faster than your body's ability to send a signal to the brain saying, 'I'm done now'."

Tulleken told NPR that the U.S. should follow Chile's lead and "put a black hexagon label on the packages of ultra-processed food. So governments shouldn't ban it, or tax the food, because it's the only affordable food for many people. But governments can start to warn people that it has negative health outcomes strongly associated with it." 

The New Yorker also took a deep dive into Tulleken's book. Writer Adam Gopnik notes, "The book isn’t just a chronicle of his diet-induced damage; page after exhausting page is given over to the foundations of nutritional science." 

The Economist also writes about the issue, pointing out that Tulleken draws a distinction between ultra-processed food and processed food, while noting that almost everything people consume is processed in some form. Further, The Economist writes that Tulleken points out that the "cocktail of additives and preservatives in ultra-processed foods harm people in ways both known and unknown."

U.S. Senate panel OKs bill to rein in pharmacy benefit managers; Kentucky pharmacist applauds similar efforts by House members

By Melissa Patrick

Kentucky Health News

At least one Kentucky pharmacist is applauding the latest efforts to rein in pharmacy benefit managers.

PBMs are middlemen that negotiate drug prices with drug manufacturers and pharmacies. They also design prescription-drug benefits for health plans.  

Taylor Williams

"Fortunately, lawmakers are hearing our concerns loud and clear," Taylor Williams, a second-generation pharmacist from Hazard and an executive fellow with the Kentucky Pharmacists Association, wrote in an op-ed submitted to  Kentucky Health News and other publications.

"Congressman Brett Guthrie, chair of the Health Subcommittee on House Energy and Commerce, and Congressman James Comer, chair of the house Oversight Committee, are working hard to rein in PBMs’ profit-driven role in our healthcare system and ensure that patients can afford the prescriptions they rely on," she wrote.

Williams submitted the op-ed on the same day the Senate Finance Committee advanced a bipartisan bill to change how PBMs interact with federal prescription-drug programs as a way to help lower costs.  It is called the Modernizing and Ensuring PBM Accountability Act. 

The Hill reports, "While other committees have also passed PBM reform bills, the Finance Committee has jurisdiction over Medicare and Medicaid, which make up a large portion of U.S. health spending. Still, all the separate bills in the House and Senate will need to be combined into one floor-friendly package." 

Among other things, the Senate bill includes provisions that would delink PBMs' compensation from drug prices, which would remove an incentive for PBMs to favor higher-priced drugs. It would also add new transparency and reporting requirements and ban spread pricing, in which a PBM keeps the difference between what it bills Medicaid for medications and what it pays the pharmacy to dispense the drug. Click here for a summary of the Act. 

Kentucky lawmakers have been working on PBM issues for years, most recently passing 2020 Senate Bill 50 that among other things, prohibits spread pricing. A 2019 state analysis found PBMs made $123 million through spread pricing in Kentucky.

SB 50 also required the state to hire a single PBM to manage Kentucky Medicaid's prescription-drug business of more than $1 billion a year. Kentucky has saved at least $38 million from this move. 

This year, companion PBM bills were introduced in the state House and Senate, but neither got a hearing.

PBMs argue that they lower costs for consumers because they negotiate for lower drug costs and pass the savings onto to the insurance plans. 

Williams said she recently met with Kentucky's congressional delegation in Washington to share her concerns about PBMs and their impact on Kentucky's independent pharmacies and the patients they serve. 

"Our profession is facing serious challenges because of largely unknown middlemen in the drug pricing system called pharmacy benefit managers," she wrote. "If we don’t do something about them soon, the local community pharmacies that people trust may become a thing of the past. . . . Without much needed reform, PBMs will continue to find new ways to increase their profit margins at the expense of patients, providers and taxpayers. Even worse, it could leave Kentuckians without a local, trusted health-care advisor as many community pharmacies will be forced to close their doors." 

Study says allergy to red meat is under-diagnosed, probably due to clinicians' limited knowledge of it, and Ky. is a national hotspot

Map from CDC research report, adapted by Kentucky Health News; click on it to enlarge.

Lone star ticks are the main source. (CDC photo)

Kentucky Health News

Thousands of Kentuckians are likely living with an allergy to red meat, and many of them probably don't know it because it hasn't been diagnosed in them, a new study suggests. Another study says most of the people who do the diagnoses -- health-care providers -- have little or no working knowledge of alpha-gal syndrome.

The studies were published Thursday by the Centers for Disease Control and Prevention. In the first one, scientists reviewed laboratory results of people who had been tested for antibodies that identify the syndrome since 2020. They found 110,000 suspected cases, but that figure is probably a significant underestimate," reports Emily Anthes of The New York Times. 

The second study, also done by CDC disease ecologist and veterinarian Dr. Johanna Salzer, "found that 78 percent of health-care providers who were surveyed had little or no knowledge of the condition, and many clinicians who had heard of the syndrome were not sure how to diagnose it," Anthes reports. "When the researchers factored in this knowledge gap, they estimated that the true toll of the syndrome might be closer to a half-million, although Dr. Salzer acknowledged that the figure was 'a crude estimate'."

Extrapolating the national estimate of 450,000, about 6,000 Kentuckians would have the syndrome if they reflected the estimated national prevalence, but a map with the study shows that Kentucky is one of the states with the highest prevalence of the allergy, based on the available antibody tests.

Anna Buckman of the Adair County Community Voice reported in 2019, "Dr. Kourtney Gentry Gardner, an allergist-immunologist in Bowling Green, diagnoses about five people a month with the alpha-gal allergy, and it’s becoming increasingly more common, she says."

Buckman noted that the syndrome "is relatively new to the allergy world," having been identified in scientific literature about 15 years ago. Anthes reports, "Until August 2021, a single commercial lab did nearly all of this antibody testing in the United States. In one of the new studies, researchers reviewed the results of the antibody tests performed at this lab from 2017 to 2022."

The allergy "takes its name from galactose-alpha-1,3-galactose, a sugar present in beef, pork, lamb and the meat of most other mammals. (It is not present in humans or other apes.) Lone star ticks, which scientists believe are the primary culprits of the disease in the United States, can transmit the sugar to people through a bite. Some people’s immune systems may then label this foreign sugar a threat and overreact to its presence the next time they eat meat," Anthes writes.

The more a person is bitten, the more at risk they are of developing the allergy, Buckman reported.

"The symptoms, which often take hours to appear, are wide-ranging, and may include hives, nausea, diarrhea or anaphylactic shock," Anthes reports. "Even patients who have the syndrome may not feel sick every time they eat meat."

Cameron says that if elected governor he would resume efforts, thwarted by federal court, to add work requirement to Medicaid

Attorney General Daniel Cameron

Attorney General Daniel Cameron said Wednesday that if elected governor he would quickly restart Republican efforts to "require some able-bodied adults to work in exchange for health-care coverage through Medicaid," Bruce Schreiner writes for The Associated Press.

When Republican Matt Bevin was governor, he tried to require able-bodied Medicaid recipients who were not caregivers to work, enroll at least part-time in education or job training, volunteer, or perform other “community engagement” activities to qualify for benefits. A federal judge in Washington, D.C., blocked the move, saying it was not allowed under the 1965 law that created Medicaid and Medicare and noting state estimates that almost 100,000 people would lose coverage, mostly 

After Democrat Andy Beshear defeated Bevin in 2019, he dropped the state's appeal of the court decision, saying his action was the “moral, faith-driven thing to do.” Beshear calls health care a “basic human right,” Schreiner notes. Cameron said Medicaid work rules would be “one of the first things I will do as governor.”

Cameron raised the issue in the primary election, and Wednesday in answering a question about Kentucky's low workforce participation rate at a Kentucky Farm Bureau Federation forum that Beshear did not attend.

“If we want the plan and the coverage to exist and remain solvent for those that are means-tested and medically necessary, we need to make the program, as best as possible, transitory – something that folks will come off of if they are able-bodied individuals,” he said.

In a statement issued later by his campaign, he said, “We will protect the truly vulnerable but we will not allow able-bodied people to take advantage of taxpayer generosity.” The campaign said the plan would exclude able-bodied adults who are “truly vulnerable,” including those with children or who are pregnant.

Work rules require waivers from the federal government. Bevin got one from the administration of Donald Trump, but Joe Biden's Department of Health and Human Services has generally resisted the idea.

Schreiner notes, "Medicaid is a joint federal and state health-care program for poor and disabled people. Advocates have said work requirements would become one more hoop for low-income people to jump through, and many could be denied coverage because of technicalities and challenging new paperwork."

Kentucky's Medicaid rolls grew by hundreds of thousands in 2014 when then-Gov. Steve Beshear, the current governor’s father, expanded the program to cover able-bodied adults under the 2010 Patient Protection and Affordable Care Act, generally known as Obamacare. "For many Kentuckians," Schreiner notes, "it was their first time to have health coverage in a state plagued by high disease rates."

Tips on managing the costs of cancer treatment

CDC graphic

By Charles McCann 

University of Kentucky

Managing the financial burden of cancer treatment can add to the already challenging physical and emotional journey for patients and their families. However, there are resources available that can help ease the stress. Here are some tips to help navigate the costs:

See a patient financial counselor: Cancer patients and their families should take advantage of financial counseling available through cancer treatment centers, which can help manage treatment expenses and connect patients to resources for financial assistance. Your cancer doctor or nurse can help connect you to the financial assistance offered at your care center.

Understand your insurance coverage: Because insurance, managed care, or public health care programs pay most of the costs of cancer treatment, it’s important to contact your health insurance company to understand your benefits. This includes your deductible and out-of-pocket maximum costs, as well as prescription drug coverage. Also, be sure to ask your doctor if a generic version of a name-brand medicine is an option and inquire about discount drug programs.

Seek financial assistance programs: There are several government and privately-funded financial assistance programs that can cover both medical and non-medical expenses, like travel costs related to treatment.

UK HealthCare, for example, has its own financial assistance program that can cover up to 100% of medical expenses not covered by insurance. This program can cover inpatient stays, outpatient appointments (Markey visits included) and emergency room visits at any UK medical facility. Most medically necessary procedures are covered by the financial assistance, but there are a few exclusions that may apply. Patients should not be deterred by any active balances, because approved financial assistance will backdate and cover ANY active balances not gone to collection. Interested patients can access the financial assistance application via their MyChart account or the UK HealthCare website.

Many other financial assistance programs are privately funded through organizations dedicated to certain types of cancer, so a quick internet search for financial help based on your diagnosis should provide even more options. At Markey, social workers can also connect patients with these programs.

Taking time off work: Cancer treatment often requires time off from work. Check if your employer offers long-term and short-term disability benefits. The Family Leave Medical Act guarantees 12 weeks of unpaid leave per year, along with job and health insurance security for employees who have worked for their employer for 12 months or 1,250 hours. FMLA is also available for caregivers. Additionally, your employer may provide short-term disability insurance, which pays a portion of your salary if you are temporarily unable to work.

Charles McCann is oncology patient navigator at the UK Markey Cancer Center and a former patient financial counselor.

KET panel applauded Kentucky's 5% drop in overdose deaths in 2022, but cited new challenges and remaining difficulties

By Melissa Patrick

Kentucky Health News

A panel of survivors, drug-recovery experts and providers lauded Kentucky's 5 percent reduction in drug-overdose deaths between 2021 and 2022 on a Kentucky Educational Television program, "Disrupting Addiction: A KET Forum," but said there is still more work to do. 

Host Renee Shaw opened the program by sharing data from the state's latest annual Overdose Fatality Report, It shows 2,135 Kentucky residents died from overdoses in 2022, 5% less than in 2021. Fentanyl was identified in more than 1,500 of the deaths, 72% of them. By age group, people 35 to 44 had the most overdoses.  

Van Ingram, executive director of the state Office of Drug Control Policy, said Kentucky was one of only eight states that reported decreases of 100 or more overdose deaths in 2022, compared to 2021. "That's over 100 families that are impacted," he said. "But still, we're losing six Kentuckians every day to preventable disease, preventable death." 

Ingram said another challenge is that in addition to fentanyl, Xylazine, a non-opioid animal tranquilizer that has been approved for veterinary use, is being added to the drug supply.

"It's really going to cause us to redouble our efforts and look for new ways," he said. "There are Xylazine test strips, we'll be looking at those. It's just unbelievable that if fentanyl wasn't deadly enough, now we have to add something else to it." 

Asked why the top five counties with the highest rates of drug overdose deaths in 2022 (Bath, Lee, Floyd, Estill and Knott) were all in Eastern Kentucky, Ingram reminded Shaw that Appalachia was ground-zero for the opioid epidemic.

"It still remains one of the hardest hit areas in the country," he said. "There's just not the resources a lot of times in those communities that others have, and that makes things more difficult." 

Rep. Kim Moser, R-Taylor Mill, chair of the House Health Services Committee, said she attributed the 5% drop in overdose deaths to strong policies that have been passed in the last nine years, a changing conversation around addiction that makes it easier to pass strong policies, and improving resources. However, noting the more than 2,000 overdose deaths in 2022, she added, "We still have a long way to go."  

Despite last year's drop in overdose deaths, Madison County Coroner Jimmy Cornelison said his county is on track to see more than last year. He added that while fentanyl and methamphetamine ae his main two culprits, he is seeing an upswing in cocaine use, which he said, "was gone for some time."  

Asked what can be done to reverse these numbers, Cornelison said he doesn't know if there is an answer. He said Madison County is fortunate to have a strong support system, including its EMS that distributes Narcan, a drug that can reverse the effects of an opioid overdose. He said the drug is expensive and puts a strain on the EMS budget, but without it, overdose numbers would be much higher. 

Cornelison encouraged policymakers to listen to their local people because they see this situation in a different light: "We see what it does to families and friends." 

State Health Secretary Eric Friedlander also talked about the value of Narcan: "Hopefully that Narcan distribution has helped people survive. . . . You can't get to treatment if you're dead, right? You can't turn your life around if you are seeing the coroner."

There are evidence-based, medication-assisted treatments for substance-use disorders, such as methadone, buprenorphine and Suboxone, but nine out of 10 Kentucky drug users go untreated. 

That is largely due to access issues and the stigma that still exists around these treatments, said Dr. Devin Oller,  primary care and addiction medicine physician at the University of Kentucky.

"I don't have any medication for heart failure, for diabetes, that is as effective in terms of reducing death as buprenorphine and methadone -- 50% drop in mortality if I'm able to get folks started on that. But again, the barrier is that access point," Oller said. 

To the criticism that using these drugs is just trading one drug for another, he said, "We would never say to a patient with diabetes that using insulin is trading one drug for another, right? So why do we do that for addiction?" 

Oller said this criticism often stems from mistaken beliefs that addiction is a choice or that there are no genetics or trauma involved. He said addiction is a chronic disease of the brain that has a great prognosis with effective treatment. 

Asked about ibogaine, a psychedelic drug that is illegal in the U.S. but has been anecdotally reported to stop the withdrawal symptoms of opioid dependence, Oller said, "It may be part of of the long-term solution, but Kentuckians are dying right now. And so we need to do whatever we can to get them access to these evidence-based treatments, that again, reduce the risk of death by 50%."

The Kentucky Opioid Abatement Advisory Commission recently held a public forum to learn about ibogaine as it considers using some of the money the state is getting from settlements with drug makers and distributors to help get the drug get approval from the U.S. Food and Drug Administration. 

Bryan Hubbard, executive director and chair of the commission, the main advocate of the idea, said the commission is in the "exploratory phase" when it comes to ibogaine.

"What we can say is that observational data suggest that ibogaine could be added to the existing treatment options that we have, and that it may represent a breakthrough opportunity to pioneer an additional therapeutic that can deliver some fairly dramatic results, at least when it comes to the front end of the long term recovery process that has been mentioned thus far," Hubbard said. 

Asked about the heart risks associated with ibogaine, Hubbard said it's important to remember that the drug is not administered in a medically or clinically controlled setting outide the U.S., and a panel of experts at the public hearing said the risks can be mitigated with proper screening of patients and appropriate monitoring during treatment.

As host, Shaw also highlighted several recovery programs, talked with Nancy Hale of Operation Unite about the importance of early prevention and education, and talked with staffers at the Estill County Health Department about its mobile harm-reduction program, including a syringe exchange. 

The program can be seen at KET.org and will be bebroadcast on various days, times, and channels through Aug. 9. To see the list of dates and times the program will air go to https:// ket.org/program/ket-forums/.

Weight-loss drugs carry high prices, many questions for seniors

By Judith Graham
KFF Health News

Corlee Morris has dieted throughout her adult life.

After her weight began climbing in high school, she spent years losing 50 or 100 pounds then gaining it back. Morris, 78, was at her heaviest in her mid-40s, standing 5 feet 10½ inches and weighing 310 pounds. The Pittsburgh resident has had diabetes for more than 40 years.

Photo by Mario Tama, Getty Images

Managing her weight was a losing battle until Morris’ doctor prescribed a Type 2 diabetes medication, Ozempic, four months ago. It’s one in a new category of medications changing how ordinary people as well as medical experts think about obesity, a condition that affects nearly 4 in 10 people 60 and older.

The drugs include Ozempic’s sister medication, Wegovy, a weight loss drug with identical ingredients, which the FDA approved in 2021, and Mounjaro, approved as a diabetes treatment in 2022. (Ozempic was approved for diabetes in 2017.) Several other drugs are in development.

The medications reduce feelings of hunger, generate a sensation of fullness, and have been shown to help people lose an average of 15% or more of their weight.

“It takes your appetite right away. I wasn’t hungry at all and I lost weight like mad,” said Morris, who has shed 40 pounds.

But how these medications will affect older adults in the long run isn’t well understood. (Patients need to remain on the drugs permanently or risk regaining the weight they’ve lost.)

Will they help prevent cardiovascular disease and other chronic illnesses in obese older adults? Will they reduce rates of disability and improve people’s ability to move and manage daily tasks? Will they enhance people’s lives and alleviate symptoms associated with obesity-related chronic illnesses?

Unfortunately, clinical trials of the medications haven’t included significant numbers of people ages 65 and older, leaving gaps in the available data.

While the drugs appear to be safe — the most common side effects are nausea, diarrhea, vomiting, constipation, and stomach pain — “they’ve only been on the market for a few years and caution is still needed,” said Mitchell Lazar, founding director of the Institute for Diabetes, Obesity and Metabolism at the University of Pennsylvania.

Given these uncertainties, how are experts approaching the use of the new obesity medications in older people? As might be expected, opinions and practices vary. But several themes emerged in nearly two dozen interviews.

Limited access

The first was frustration with limited access to the drugs. Because Medicare doesn’t cover weight loss medications and they can cost more than $10,000 a year, seniors’ ability to get the new drugs is restricted.

There is an exception: Medicare will cover Ozempic and Mounjaro if an older adult has diabetes, because the insurance program pays for diabetes therapies.

“We need Medicare to cover these drugs,” said Shauna Matilda Assadzandi, a geriatrician at the University of Pittsburgh who cares for Morris. Recently, she said, she tried to persuade a Medicare Advantage plan representative to authorize Wegovy for a patient with high blood pressure and cholesterol who was gaining weight rapidly.

“I’m just waiting for this patient’s blood sugar to rise to a level where diabetes can be diagnosed. Wouldn’t it make sense to intervene now?” she remembered saying. The representative’s answer: “No. We have to follow the rules.”

Seeking to change that, a bipartisan group of lawmakers introduced the Treat and Reduce Obesity Act, which would require Medicare to cover weight loss drugs. But the proposal has languished amid concerns over enormous potential costs for Medicare.

If all beneficiaries with an obesity diagnosis took this new class of medications, known as semaglutide drugs, annual costs would top $13.5 billion, according to a recent analysis in The New England Journal of Medicine. If all older obese adults on Medicare — a significantly larger population — took them, the cost would exceed the total spent on Medicare’s Part D drug program, which was $145 billion in 2019.

Laurie Rich, 63, of Canton, Mass., was caught off guard by Medicare’s policies, which have applied to her since she qualified for Social Security disability insurance in December. Before that, Rich took Wegovy and another weight loss medication — both covered by private insurance — and she’d lost nearly 42 pounds. Now, Rich can’t get Wegovy and she’s regained 14 pounds.

“I haven’t changed my eating. The only thing that’s different is that some signal in my brain is telling me I’m hungry all the time,” Rich told me. “I feel horrible.” She knows that if she gains more weight, her care will cost much more.

Who should take these drugs?

While acknowledging difficult policy decisions that lie ahead, experts voiced considerable agreement on which older adults should take these drugs.

Generally, the medications are recommended for people with a body mass index over 30 (the World Health Organization’s definition of obesity) and those with a BMI of 27 or above and at least one obesity-related condition, such as diabetes, high blood pressure, or high cholesterol. There are no guidelines for their use in people 65 and older. (BMI is calculated based on a person’s weight and height.)

But those recommendations are problematic because BMI can under- or overestimate older adults’ body fat, the most problematic feature of obesity, noted Rodolfo Galindo, director of the Comprehensive Diabetes Center at the University of Miami.

Dennis Kerrigan, director of weight management at Henry Ford Health in Michigan, a system with five hospitals, suggests physicians also examine waist circumference in older patients because abdominal fat puts them at higher risk than fat carried in the hips or buttocks. (For men, a waist over 40 inches is of concern; for women, 35 is the threshold.)

Fatima Stanford, an obesity medicine scientist at Massachusetts General Hospital, said the new drugs are “best suited for older patients who have clinical evidence of obesity,” such as elevated cholesterol or blood sugar, and people with serious obesity-related conditions such as osteoarthritis or heart disease.

Since going on Mounjaro three months ago, Muriel Branch, 73, of Perryville, Arkansas, has lost 40 pounds and stopped taking three medications as her health has improved. “I feel real good about myself,” she told me.

When adults with obesity lose weight, their risk of dying is reduced by up to 15%, according to Dinesh Edem, Branch’s doctor and the director of the medical weight management program at the University of Arkansas for Medical Sciences.

Still, weight loss alone should not be recommended to older adults, because it entails the loss of muscle mass as well as fat, experts agree. And with aging, the shrinkage of muscle mass that starts earlier in life accelerates, contributing to falls, weakness, the loss of functioning, and the onset of frailty.

Between ages 60 and 70, about 12% of muscle mass falls away, researchers estimate; after 80, it reaches 30%.

To preserve muscle mass, seniors losing weight should be prescribed physical activity — both aerobic exercise and strength training, experts agree.

Also, as older adults taking weight loss drugs eat less, “it’s critically important that their diet includes adequate protein and calcium to preserve bone and muscle mass,” said Anne Newman, director of the Center for Aging and Population Health at the University of Pittsburgh.

Ongoing monitoring of older adults having gastrointestinal side effects is needed to ensure they’re getting enough food and water, said Jamy Ard, co-director of Wake Forest Baptist Health’s Weight Management Center.

Generally, the goal for older adults should be to lose 1 to 2 pounds a week, with attention to diet and exercise accompanying medication management. That's important, said Sukhpreet Singh, system medical director at Henry Ford’s weight management program.

“My concern is, once we put patients on these obesity drugs, are we supporting lifestyle changes that will maintain their health? Medication alone won’t be sufficient,” Singh said. “We will still need to address behaviors.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

European quit-smoking drug proven safe, effective in U.S. study

European cystine product (Medpage Today photo)

By Melissa Patrick

Kentucky Health News

Cytisinicline, a drug to help people stop smoking, was found to be safe and effective when used at a higher concentration than is traditionally used in Europe, where it is currently being used. It is not yet available in the United States. 

“Cigarette smoking remains the leading preventable cause of death worldwide, yet no new smoking-cessation medication has been approved by the U.S. Food and Drug Administration for nearly two decades,” Dr. Nancy Rigotti,  director of Massachusetts General Hospital's Tobacco Research and Treatment Center, and lead author of the study, said in a press release. “There is an urgent need for new medications to treat tobacco smoking because existing products don’t help all smokers to quit and can have unacceptable side effects. If approved by regulators, cytisinicline could be a valuable new option to treat tobacco dependence.”

Cytisinicline, which is historically known as cytisine, is a naturally derived, plant-based medication that has been developed as a treatment for nicotine dependence and smoking cessation. It is not licensed in the U.S., but is used in some European countries for smoking cessation. Some researchers have questioned whether the recommended dose and treatment duration are appropriate. 

The study, published in the Journal of the American Medical Association, found that both a six-week and a 12-week treatment of cytisinicline in 810 adults who smoke cigarettes daily and wanted to quit produced "significantly higher continuous smoking-abstinence rates" compared with a placebo during the last four weeks of treatment and from the end of treatment to 24 weeks. 

"Participants in the cytisinicline groups had six- to eight-fold higher odds of continuous smoking abstinence at the end of treatment than participants receiving placebo plus behavioral support," says the study report. 

The study involved a three-group, double-blind, placebo-controlled, randomized trial that compared a six-week and a 12-week duration of either cytisinicline treatment or a placebo, with follow-up through 24 weeks. It was conducted at 17 U.S. sites from October 2020 to December 2021. 

It found that in the six-week course of treatment, in weeks 3-6, continuous abstinence rates with cytisinicline were 25.3% and 4.4%. In the 12-week trial, the rates were 32.6% for cytisinicline and 7% for placebo in weeks 9-12.

Participants taking cytisinicline also experienced a rapid and sustained decline in cravings and smoking urges during the first six weeks of treatment, the researchers said.

The study also found a statistically significant increase in continuous abstinence through six months for both treatment durations.

The manufacturer's recommendation for the drug is for a 1.5-milligram tablet to be taken initially six times a day, and then gradually reduced over a 25-day course of treatment. However, the researchers found that 3 mg of cytisinicline three times a day produced the highest continuous abstinence.

The researchers reported "no adverse events" from taking the drug, with less than 10% of the participants experiencing nausea, abnormal dreams and insomnia.

The researchers concluded, "Both six- and 12-week cytisinicline schedules, with behavioral support, demonstrated smoking-cessation efficacy and excellent tolerability, offering a new nicotine-dependence treatment option." They also noted that no smoking-cessation drug has received FDA approval since 2006. 

“Cytisinicline demonstrated impressive results as a smoking-cessation medication in a rigorous clinical trial that used a new, scientifically based dosing regimen as well as a longer duration of treatment than traditionally done,” said Rigotti. “This agent has the potential to help countless numbers of people quit smoking and, in the process, reduce the enormous toll of premature deaths and disability due to cigarette smoking in the U.S. and worldwide.”

In 2015, nearly 70% of adult smokers said they want to quit. In 2018, about 55% said they had made an attempt to quit in the previous year, but only about 8% were successful in quitting for six to 12 months, according to the latest data available from the Centers for Disease Control and Prevention.

In 2020, the latest year for which statistics are available, 21.4% of Kentucky adults were smokers. 

Many health-insurance plans, including Medicaid, cover FDA-approved smoking-cessation medicines with no copayments. Kentucky offers a free quit line at 1-800-QUIT-NOW that provides personalized coaching to help people quit smoking.

Excess Covid-19 deaths grew in 2nd year despite vaccines; study cites shortage of rural vaccinations; Ky. fared worst during Delta

By Al Cross

Kentucky Health News

Scientists generally believe that the number of deaths attributed to the Covid-19 pandemic has been understated, and they point to what they call "excess deaths," the number of deaths above the number that would have been expected if the pandemic hadn't occurred, based on recent trends. A new study shows that excess deaths in the U.S. increased in the second year of the pandemic even though that is when Covid-19 vaccines became widely available, and that they went up largely because of increases in rural counties, where fewer people were vaccinated.

"In rural counties across the United States—where vaccines were harder to obtain, where vaccine skepticism remained higher, and where access to good health care is often more challenging—excess deaths in year two of the pandemic actually increased, despite the presence of vaccines," Boston University says of the study, done mainly by BU faculty and published in Science Advances. "The study provides the first look at monthly estimates of what the researchers call “excess deaths” for every U.S. county in the pandemic’s first two years."

Andrew Stokes, an assistant professor of global health at BU and corresponding author of the study, pointed to a shortage of rural vaccinations as the main cause. The study reports, "In urban areas, 75% of people aged 5 years and older were vaccinated as of January 2022 compared to only 59% of people aged 5 years and older in rural areas. This urban-rural difference in vaccination rates more than doubled since April 2021." Stokes told the BU public-relations staff, "Inequalities in mortality outcomes in the second year of the pandemic were fundamentally shaped by patterns of vaccine uptake at the community level. . . . There was less vaccination happening in rural areas and that gap between urban and rural areas grew as the second year progressed." The difference rural and urban death rates largely disappeared early this year, The Daily Yonder reported in February.

There were other factors, the study says: "The emergence of partisanship and misinformation further disadvantaged small metropolitan and rural areas during the second year of the pandemic. This partisanship even went as far as deteriorating the quality of surveillance data by affecting the certification of Covid-19 deaths, which were systematically undercounted in rural communities."

The study broke down the results by four main segments of the pandemic: the first six months, the first winter (October 2020 through February 2021), the surge of the Delta variant of the virus (August through October 2021) and the Omicron variant (November 2021 through February 2022). In Kentucky, the highest excess-deaths rates estimates were from the Delta surge.

The study says county-by-county data are important "because counties are the administrative unit for death investigation, excess mortality estimates have the potential to help identify counties where Covid-19 death rates differ from excess mortality rates and who might benefit from additional training and other resources around cause-of-death certification. These estimates may also be valuable for informing local public health workers, community organizations, and residents of the true impact of the pandemic, thus potentially increasing vaccination and uptake of other protective measures."

Here are the Kentucky sections of the county-by-county maps from the study, in chronological order, as adapted by Kentucky Health News. The high-resolution originals can be downloaded here. The study says these are estimates, and are uncertain in small counties.

Libertarians want to repeal 'certificate of need' permit process for health-care facilities; they say it needs reform, not repeal

Kentucky Health News

Should Kentucky have a permitting process for health-care facilities or allow free-market competition? Or something in between? The General Assembly has begun debating the question, amid lobbying from a national libertarian group and health-care facilities that say unfettered competition would further complicate heath care and put some of them out of business.

When stand-alone birthing centers wanted an exemption from the state's "certificate of need" law this year, the legislature said no, but created a task force to examine the law and how it works. The task force heard July 17 from lobbies for hospitals, nursing homes home-health services and hospices, who think the law should be improved but not repealed, Sarah Ladd reports for the Kentucky Lantern. (This article is based mainly on her story.)

Nancy Galvagni

Without certificate of need, some facilities could close or stop offering services that don't make money, Kentucky Hospital Association President Nancy Galvagni told the task force. She said most services “are provided at a loss and must be subsidized by the few services from which hospitals derive revenue, such as elective surgery and . . . outpatient imaging. This is how hospitals pay for services such as behavioral health, obstetrics, emergency care, trauma care, and oncology, just to name a few.”

Noting that government programs pay about three-fourths of hospital bills in Kentucky, Galvagni said that without certificate of need, “Out-of-state entities would quickly swoop in to cherry-pick the few commercially insured patients away from hospitals for the most profitable services hospitals provide. Meanwhile, Medicare and Medicaid and the uninsured would be left to the hospitals. Access would soon end because hospitals will be forced to close unprofitable services and some facilities could close entirely.”

Tim Veno, president of Leading Age Kentucky, a lobby for nonprofits that provide aging services, told lawmakers that “over-duplication of health services can have multiple negative effects” on nursing homes. Too many nursing-home beds in an area could cause a home to close, or make staffing challenges worse, he said.

Home-health services also have staffing issues the inability to compete with hourly wages offered by places like Amazon and Target, said Evan Reinhardt, executive director of the Kentucky Home Care Association.

Hospitce executive Liz Fowler said certificate of need prevents fraud in her industry, which serves people have six months or less to live, usually at home. Fowler, chief executive officer of Bluegrass Care Navigators, said “bad actors” may shortchange vulnerable patients on their benefits.

The week before the task force met, Americans For Prosperity promoted repeal of the certificate-of-need law at an event in Northern Kentucky. AFP is one of the groups funded by energy mangnate Charles Koch of Wichita, known for his spending on libertarian, conservative and Republican causes.

"Both sides of the argument — those seeking to reform or repeal certificate of need and the health care groups in favor of keeping it — have spent large sums of money lobbying Congress and the Kentucky legislature in 2023, so it could impact election and lobbying spending in Kentucky for the foreseeable future," Mark Payne reports for Link NKY (republished in the Kentucky Lantern).

AFP says it recently got the process repealed in South Carolina after 10 years of lobbying. "Kentucky is one of 35 states and the District of Columbia that operate certificate-of-need programs, which vary widely among the states, according to the National Conference of State Legislatures," Payne reports.

State Rep. Marianne Proctor

One speaker at the Northern Kentucky event was state Rep. Marianne Proctor, R-Union, who has field a bill to repeal certificate of need for Boone, Kenton and Campbell counties.

“To have competition always breeds excellence,” Proctor said. Earlier this year, she said, “In Kentucky, we have 23 regulations that require permission from the state to open such as ambulatory care services, dialysis centers, substance abuse, mental-health services.”

The lobbying groups that favor the certificate-of-need process did tell the task force that it needs changes. Galvagni suggested some, including:

• Reform the application and appeals process to save time, allowing providers to apply at any time, and have shorter hearings.
• In formal-review cases, require written statements saying why an application shouod be rejected.
• In expedited-review cases, limit challenges to the issue of need and whether the applicant qualifies for expedited review.
• Allow hospitals to provide services at an additional location in the same county without an additional certificate.
• Allow hospitals to get expedited review for converting beds to adult psychiatric care if the county has no such hospital.

The next meeting of the task force is scheduled for 10:30 a.m. Aug. 21. It is seeking public input by Sept. 1; to submit a written statement, email DeeAnn Wenk at deeann.wenk@lrc.ky.gov.

'Disrupting Addiction: A KET Forum' premieres Monday, July 24, to discuss the work being done to ease this public-health crisis

Kentucky Injury Prevention and Research Center map, enhanced by Kentucky Health News

Kentucky Health News

According to the state's annual Overdose Fatality Report, 2,135 Kentuckians died from a drug overdose in 2022. That was 5 percent fewer than in 2021, but many counties reported an increase in such deaths. 

Kentucky Educational Television is airing a program that includes a panel of survivors, drug-recovery experts and providers about the public-health crisis of addiction and the ongoing work to ease it. 

"Disrupting Addiction: A KET Forum" premieres Monday, July 24, at 8 p.m. ET on KET. It will be aired 21 more times on various days, times and channels through Aug. 9. To see the list of dates and times the program will air go to https:// ket.org/program/ket-forums/. It can also be viewed on the website KET.org.

The panelists include: Jimmy Cornelison, Madison County coroner; Eric Friedlander, secretary of the state Cabinet for Health and Family Services; Jennifer Hancock, president and CEO, Volunteers of America Mid-States; Bryan Hubbard, executive director and chair of the Kentucky Opioid Abatement Advisory Commission in the attorney general's office; Van Ingram, executive director of the state Office of Drug Control Policy in the Justice and Public Safety Cabinet; State Rep. Kim Moser, R-Taylor Mill, chair of the House Health Services Committee; and Dr. Devin Oller, University of Kentucky College of Medicine, primary care and addiction medicine physician. 

The program will also feature reports from Isaiah House Treatment Center; Kungu Njuguna, an attorney who is recovering from alcohol and heroin addiction; and the Estill County Health Department, which now offers a syringe-service program through a mobile clinic after being shut down for several years.

State finds several water systems, most on the Ohio, have levels of 'forever chemicals' above a limit being considered by EPA

Kentucky Lantern graph from state data, adapted by Kentucky Health News

By Liam Niemeyer
Kentucky Lantern

Per- and poly-fluoroalkyl substances, commonly known as PFAS or “forever chemicals,” are in Kentucky’s rivers and lakes. The chemicals are accumulating inside Kentucky’s fish. They are in municipal water treatment systems, and some have levels higher than a proposed federal limit..

That is what the Kentucky Department for Environmental Protection has found the past few years as it has investigated how widespread PFAS is in Kentucky’s drinking water and environment, the department’s commissioner told a state legislative committee Thursday.

“We have gathered a lot of information. None of the information that we’ve gathered has been or ever was intended to be used for regulatory purposes,” said DEP Commissioner Tony Hatton. “We’re looking at it primarily from a public-health standpoint, and primarily from a drinking-water aspect.”

Chemicals classified as PFAS have been used for decades in a wide variety of industrial purposes, from firefighting foam to nonstick cooking ware because they are highly heat-resistant and stick-resistant. The resistance comes from their strong chemical bonds; they are dubbed “forever chemicals” because they don’t break down easily in the environment.

These chemicals also have a wide range of potential detrimental health impacts at high levels: increased risk of some cancers, hormonal changes, increased cholesterol levels, decreased vaccine responses in children and more.

Hatton said the Energy and Environment Cabinet has done its “investigative work” and conducted the testing not only to be aware of how widespread PFAS was in state waters but to prepare for proposed federal regulations setting maximum limits on how much of some kinds of PFAS are allowed in drinking water.

The U.S. Environmental Protection Agency sets legal limits for over 90 contaminants in drinking water, but not for PFAS. EPA has health advisory limits, which are unenforceable, that advise how much PFAS exposure is needed over a lifetime before adverse health effects occur. That limit is set at .004 parts per trillion (ppt) for one version of the chemical.

The legally enforceable maximum limit the EPA is proposing would cap two types of PFAS at 4 ppt. State officials have found much higher levels of PFAS in some municipal water systems in Kentucky.

Sen. Robin Webb

The water in the Greenup County town of South Shore had 23.2 ppt of one type of the chemical, the highest in the state, Louisville Public Media reported. And the 1,100 residents of the Ohio River town were not notified, state Sen. Robin Webb of Grayson said at meeting of the Interim Joint Committee on Natural Resources and Energy.

“No notice requirements, people. And that’s a problem. I think we all have the right to be notified when we’re dealing with the commodity that’s necessary for life,” Webb said. “This is a big deal.”

In the sampling so far, most of the water systems with PFAS levels above the proposed federal limit are on the Ohio River. Earlier this year, the state sued the DuPont chemical company, alleging PFAS pollution in Kentucky from a West Virginia facility upstream on the Ohio. The state is demanding the company pay all past and future costs for monitoring and treating PFAS in drinking water.

Treating water for PFAS won't be cheap

Webb, a Democrat, said the Republican-dominated legislature should consider providing more funding to water systems in the next two-year budget, especially with the pending federal limit on PFAS.

Sen. Brandon Smith, R-Hazard, asked Hatton if forever chemicals had been seen in fish caught in Kentucky waters; the commissioner replied that a state report found PFAS in all of the 98 fish samples taken throughout the state.

Past Democrat-led efforts to regulate PFAS through state legislation have gained little traction. Rep. Nima Kulkarni, D-Louisville, has been the primary sponsor of bills the past three years to set maximum limits in drinking water and discharge limits into state waters. A version of the legislation in 2023 was not even assigned to a House committee.

Hatton said PFAS can be filtered out at water utilities, but treatment is expensive. He said the city of Leitchfield, which draws water from Rough River Lake, is asking the state for financial help to the tune of $1 million to implement a granular activated-carbon filter.

Activted carbon is “great stuff, but once the receptors get filled, it doesn’t want to hold on to anything anymore, you have to regenerate it or replace it. So there’s gonna be ongoing costs,” Hatton said.

He said the state is focusing on how to treat drinking water systems for PFAS before addressing the other “complex” aspects of the issue, including the sources of forever chemicals.

Sen. Cassie Chambers-Armstrong, D-Louisville, urged officials to also address potential sources of PFAS exposure, for example, in children’s products, in addition to focusing on drinking water.