Whipsawed by the system, dozens of independent pharmacies closed in Kentucky last year, and more are expected to follow suit

“No one can withstand this onslaught,” independent pharmacist Rosemary Smith of Beattyville told the Lexington Herald-Leader of the factors causing stores like hers to close. (H-L photo by Silas Walker)

Kentucky Health News

In the past year, at least 67 independent pharmacies have closed in Kentucky, and more are expected to close because of a recent change in the system that favors big pharmacy chains. 

So reports Alex Acquisto of the Lexington Herald-Leader, in a significant story for rural Kentucky. 

"Pharmacists are often the first – and most accessible – health-care-provider point of contact in their communities, particularly in rural parts of Kentucky," Acquisto writes. "Independent pharmacies in Kentucky filled more than half of all prescriptions statewide and before 2023’s closures, independents operated in all but one of the state’s 120 counties."

That's according to Rosemary Smith, who owns six pharmacies across Eastern Kentucky with her husband, Luther, and is co-founder of the Kentucky Independent Pharmacists Alliance. KIPA is seeking help from the Kentucky General Assembly, which has previously tried to insulate independent pharmacists from the middlemen between insurance companies and pharmacies, pharmacy benefit managers.

The sponsor of earlier bills aimed at PBMs, Sen. Max Wise, R-Campbellsville, told Acquisto that he will probably file a bill similar to the recent “commercial pharmacy PBM reform” bills in Tennessee and West Virginia. The Tennessee law "gives independent pharmacies greater control over the PBM contracts they agree to, including by mandating those groups reimburse no less than the actual cost for a prescription drug," Acquisto reports. "That is an aspect not currently mandated by law in Kentucky."

The system

Acquisto explains how it got this way: "Each time an independent pharmacist fills a patient’s prescription, how that pharmacy is reimbursed by insurance companies — and what amount in fees are levied for filling it — is decided by a somewhat arbitrary and complex tangle of decisions by entities outside a hometown pharmacy’s control. This lack of control and contractual obligation to pay every fee levied has paved the way for independents to be financially gouged from multiple angles: Low or break-even reimbursement rates set by insurance companies often blunts a pharmacy’s ability to make a profit on every prescription they fill."

Pharmacy benefit managers charge pharmacies direct and indirect remuneration fees. "Federal regulations have historically dictated these fees be collected retroactively, up to six months after a prescription is filled. But that changed Jan. 1, when DIR fees began to be collected at the point of sale," Acquisto reports. "Pharmacists told the Herald-Leader they expect this temporary overlap, where DIR fees from as far back as June 2023 continue to be retroactively deducted as new fees are levied on prescriptions filled currently, will inevitably force more closures."

“This increase in DIR fees has resulted in many independent pharmacies being left with little to no capital funds to survive 2024,” Maysville druggists Dr. Michael Berry and Elizabeth Berry wrote in a Dec. 31 email to Chiquita Brooks-LaSure, adminstrator of the Centers for Medicare and Medicaid Services. “Most independent pharmacies have been on life support for the last several years. We are witnessing the initial stages of an industry in collapse.”

FDA hasn't OKd ketamine for mental health, so treatments vary widely, creating a new 'wild West' and generating big markups

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By Dawn Megli
KFF Health News

In late 2022, Sarah Gutilla’s treatment-resistant depression had grown so severe, she was actively contemplating suicide. Raised in foster care, the 34-year-old’s childhood was marked by physical violence, sexual abuse, and drug use, leaving her with life-threatening mental scars.

Out of desperation, her husband scraped together $600 for the first of six rounds of intravenous ketamine therapy at Ketamine Clinics Los Angeles, which administers the generic anesthetic for off-label uses such as treating depression. When Gutilla got into an Uber for the 75-mile drive to Los Angeles, it was the first time she had left her home in Llano, California, in two years. The results, she said, were instant.

“The amount of relief I felt after the first treatment was what I think ‘normal’ is supposed to feel like,” she said. “I’ve never felt so OK, and so at peace.”

For-profit ketamine clinics have proliferated over the past few years, offering infusions for a wide array of mental health issues, including obsessive-compulsive disorder, depression, and anxiety. Although the off-label use of ketamine hydrochloride, a Schedule III drug approved by the FDA as an anesthetic in 1970, was considered radical just a decade ago, now between 500 and 750 ketamine clinics have cropped up across the nation, including in several Kentucky cities.

Market researcher Grand View Research pegged industry revenues at $3.1 billion in 2022, and projects them to more than double to $6.9 billion by 2030. Most insurance doesn’t cover ketamine for mental health, so patients must pay out-of-pocket.

While it’s legal for doctors to prescribe ketamine, the FDA hasn’t approved it for mental health treatment, which means that individual practitioners must develop their own treatment protocols. The result is wide variability among providers, with some favoring gradual, low-dosage treatments while others advocate larger amounts that can induce hallucinations, as the drug is psychedelic at the right doses.

“Ketamine is the wild West,” said Dustin Robinson, the managing principal of Iter Investments, a venture capital firm specializing in hallucinogenic drug treatments.

Ketamine practitioners stress that the drug’s emergence as a mental-health treatment is driven by a desperate need. Depression is the leading cause of disability in the United States for individuals ages 15-44, according to the National Institute of Mental Health, and around 25% of adults experience a diagnosable mental disorder in any given year.

Meanwhile, many insurance plans cover mental-health services at lower rates than physical health care, despite laws requiring parity. Thus many patients with disorders receive little or no care early on and are desperate by the time they visit a ketamine clinic, said Steven Siegel, chair of psychiatry and the behavioral sciences at the University of Southern California.

Matthew Perry (Wikipedia)

But the revelation that “Friends” star Matthew Perry died in part from a large dose of ketamine, along with billionaire Elon Musk’s open use of the drug, has piqued fresh scrutiny of ketamine and its regulatory environment, or lack thereof.

Commercial ketamine clinics often offer same-day appointments, in which patients can pay out-of-pocket for a drug that renders immediate results. The ketamine is administered intravenously, and patients are often given blankets, headphones, and an eye mask to heighten the dissociative feeling of not being in one’s body. A typical dose of ketamine to treat depression, which is 10 times lower than the dosage used in anesthesia, costs clinics about $1, but clinics charge $600 to $1,000 per treatment.

Ketamine is still shadowed by its reputation as the party drug known as “Special K.” Siegel’s first grant from the National Institutes of Health was to study ketamine as a drug of abuse. It has the potential to send users down a “K hole,” otherwise known as a bad trip, and can induce psychosis. Research in animals and recreational users has shown chronic use of the drug impairs both short- and long-term cognition.

Perry’s death in October raised alarms when the initial toxicology screening attributed his death to the acute effects of ketamine. A December report revealed Perry received infusion therapy a week before his death but that the fatal blow was a high dose of the substance taken with an opioid and a sedative on the day of his death — indicating that medical ketamine was not to blame.

Variety of protocols

Sam Mandel co-founded Ketamine Clinics Los Angeles in 2014 with his father, Steven Mandel, an anesthesiologist with a background in clinical psychology, and Sam said the clinic has established its own protocol. That includes monitoring a patient’s vital signs during treatment and keeping psychiatrists and other mental health practitioners on standby to ensure safety. Initial treatment starts with a low dose and increases as needed.

While many clinics follow the Mandels’ graduated approach, the dosing protocol at MY Self Wellness, a ketamine clinic in Bonita Springs, Florida, is geared toward triggering a psychedelic episode.

Christina Thomas, president of MY Self Wellness, said she developed her clinic’s procedures against a list of “what not to do” based on the bad experiences people have reported at other clinics.

The field isn’t entirely unregulated: State medical and nursing boards oversee physicians and nurses, while the FDA and Drug Enforcement Administration regulate ketamine. But most anesthesiologists don’t have a background in mental health, while psychiatrists don’t know much about anesthesia, Sam Mandel noted. He said a collaborative, multidisciplinary approach is needed to develop standards across the field, particularly because ketamine can affect vital signs such as blood pressure and respiration.

The protocols governing Spravato, an FDA-approved medication based on a close chemical cousin of ketamine called esketamine, are illustrative. Because it has the potential for serious side effects, it falls under the FDA’s Risk Evaluation and Mitigation Strategies program, which puts extra requirements in place, said Robinson. Spravato’s REMS requires two hours of monitoring after each dose and prohibits patients from driving on treatment days.

Generic ketamine, by contrast, has no REMS requirements. And because it is generic and cheap, drugmakers have little financial incentive to undertake the costly clinical trials that would be required for FDA approval.

That leaves it to the patient to assess ketamine providers. Clinics dedicated to intravenous infusions, rather than offering the treatment as an add-on, may be more familiar with the nuances of administering the drug. Ideally, practitioners should have mental health and anesthesia expertise, or have multiple specialties under one roof, and clinics should be equipped with hospital-grade monitoring equipment, Mandel said.

Siegel, who has researched ketamine since 2003, said the drug is especially useful as an emergency intervention, abating suicidal thoughts for long enough to give traditional treatments, like talk therapy and SSRI antidepressants, time to take effect. “The solutions that we have and have had up until now have failed us,” Mandel said.

The psychedelic renaissance in mental health is accelerating. A drug containing MDMA, known as ecstasy or molly, is expected to receive FDA approval in 2024. A drug with psilocybin, the active ingredient in “magic mushrooms,” could launch as early as 2027, the same year a stroke medicine with the active ingredient of DMT, a hallucinogen, is expected to debut.

Robinson said many ketamine clinics have opened in anticipation of the expanded psychedelic market. Since these new drugs will likely be covered by insurance, Robinson advises clinics to offer FDA-approved treatments such as Spravato so they’ll have the proper insurance infrastructure and staff in place.

For now, Sarah Gutilla will pay out-of-pocket for ketamine treatments. One year after her first round of infusions, she and her husband are saving for her second. In the meantime, she spends her days on her ranch in Llano where she rescues dogs and horses, and relies on telehealth therapy and psychiatric medications.

While the infusions aren’t “a magic fix,” they are a tool to help her move in the right direction.

“There used to be no light at the end of the tunnel,” she said. “Ketamine literally saved my life.”

UPDATE, Feb. 8: Ketamine’s promise as a treatment for severe depression is growing, but major questions remain, the University of Michigan says in a research report.

House has passed Guthrie's bills to increase health-care price transparency, allow inmates to file for Medicaid before release

U.S. Rep. Brett Guthrie (BG Daily News photo by Jack Dobbs)

Kentucky Health News

Second District U.S. Rep. Brett Guthrie of Bowling Green told his hometown newspaper that the House has passed his bills to increase transparency in medical costs and allow inmates to pre-file for Medicaid benefits before they are released.

The Lower Costs, More Transparency Act is intended to "drive prices down organically rather than through direct congressional action," Jack Dobbs of the Bowling Green Daily News reports. "Guthrie said the bill requires medical providers to offer quotes for procedures and medications before taking action, allowing both individual patients and employers to know how much they will pay beforehand.

“We want to engage these big employer groups so that they can drive the market to get control of the cost, because the costs keep getting passed on to the point where it's just unsustainable,” Guthrie said.

Dobbs writes, "The act would also require any rebates be returned to a patient rather than absorbed by an insurance company’s profit. Guthrie said this was a policy passed during the Trump administration but undone through the Inflation Reduction Act.

The House has also sent to the Senate a Guthrie-sponsored reauthorization of the SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act. The current law was passed in 2018.

"The act, in part, creates grant opportunities that help states bolster substance abuse treatment capabilities. It also offers substance abuse treatment coverage for children in foster care," Dobbs reports. "Guthrie said jail is no solution to addiction issues, but many who suffer from addiction end up incarcerated anyway."

The reauthorization bill would allow inmates to pre-file for Medicaid benefits when they know their release date. “So on day one, they qualify for Medicaid when they walk out of the jail and can go right into a treatment program,” Guthrie said.
 

If someone on Medicaid is jailed, the federal-state program no longer covers their expenses and the state government picks up all the cost. Guthrie told Dobbs that it can take up to 30 days to reapply for Medicaid, posing risks to those in need of substance-abuse intervention.

"Guthrie said he wants to see more continuing services readily offered, such as sober living facilities or halfway houses, to remove people with addictions from environments that put them at risk," Dobbs reports. "He added that employment training adds another layer to treatment by removing individuals from harm and encouraging stability. It’s a win-win both for those in recovery and businesses needing employees, Guthrie said."

The reauthorization bill would also put on the federal controlled-substances list Xylazine, an animal sedative that is known as "Tranq" and sometimes mixed with drugs like fentanyl for illicit use. "Guthrie said Xylazine is particularly dangerous because Narcan can not revive someone who has overdosed on it," Dobbs reports.

Politics: Guthrie, a relatively moderate Republican, told Dobbs that he plans to support former President Trump if he is nominated and thinks “the primaries are over” but former South Carolina Gov. Nikki Haley is “a good candidate and would be a good president.”

Despite Guthrie's equivocation, he posted on X (formerly Twitter) Jan. 22 that he had endorsed Trump.

“There are experts saying 250,000 people in five to seven states are going to determine who the next president is,” Guthrie told Dobbs. “I think Republicans need to get together and know that that we offer a better solution than where we are today.”

Up to 75% of people say they've hidden illnesses, raising risks

Newswise graphic

Kentucky Health News

A startling number of people conceal an infectious illness to avoid missing work, travel, or social events, the University of Michigan says in reporting on research conducted there.

The findings were published in Psychological Science, a journal of the Association for Psychological Science, and announced in a university news release.

Reserachers did a series of studies involving healthy and sick adults and found that 75% of the 4,110 participants said they had either hidden an infectious illness from others at least once or might do so in the future. Many of them reported boarding flights, going on dates, and making other social interactions while secretly sick.

More than 61% of health-care workers in the studies said they had concealed an infectious illness.

The research report is titled “When and why people conceal infectious disease.” The basic answer is they want to avoid "social exclusion," writes the lead author, Wilson N. Merrell, a Ph.D. candidate at Michigan.

"But just because concealment is common does not mean it is costless: Masking signs of illness can facilitate interpersonal disease transmission," Merrell writes, citing a 2014 survey in the United Kingdom found that that 82% of workers there believed they had become sick because a coworker came in not feeling well.

The researchers found a difference between how people believe they would act when ill and how they actually behave, Merrell said in the news release: “Healthy people forecasted that they would be unlikely to hide harmful illnesses—those that spread easily and have severe symptoms—but actively sick people reported high levels of concealment regardless of how harmful their illness was to others.”

In the first study, Merrell and his colleagues recruited 399 university health-care employees and 505 students who reported the number of days they felt symptoms of an infectious illness, starting in March 2020, when the Covid-19 pandemic began. They then reported how often they actively concealed symptoms, came to campus or work without telling anyone they were feeling ill, or falsified mandatory symptom screeners that the university had required for anyone using campus facilities.

More than 70% of the participants reported concealing their symptoms. Many said they hid their illness because it would conflict with social plans, while a small percentage cited pressure from institutional policies such as lack of paid leave. Only five participants reported hiding a Covid-19 infection.

In a second study, the researchers recruited 946 participants online and randomly assigned them to one of nine conditions in which they imagined being either moderately or severely sick while in a social situation. In each condition, the risk of spreading the illness was designated as low, medium, or high. To control for the special stigma associated with Covid-19 at the time, the researchers asked participants not to imagine being sick with that disease. Participants were most likely to envision themselves hiding their sickness when symptom severity was low, and least likely to conceal when symptoms were severe and highly communicable.

In another study, Merrell and colleagues used an online research tool to recruit 900 people—including some who were actively sick—and asked them to rate the transmissibility of their real or imagined illness. The participants were also asked to rate their likelihood of covering up an illness in a hypothetical meeting with another person. The actively ill were more likely to conceal their illness than those who just imagined being sick, regardless of the illness's transmissibility.

“This suggests that sick people and healthy people evaluate the consequences of concealment in different ways, with sick people being relatively insensitive to how spreadable and severe their illness may be for others,” Merrell said.

The Covid-19 crisis may have shaped the way the participants thought about concealing an illness, Merrell said, adding that future research could explore how ecological factors such as pandemics and medical advances such as vaccines influence people’s disease-related behavior.

Merrell said, “People tend to react negatively to, find less attractive, and steer clear of, people who are sick with infectious illness. It therefore makes sense that we may take steps to cover up our sickness in social situations. This suggests that solutions to the problem of disease concealment may need to rely on more than just individual good will.”

Top floor of UK hospital tower opening, completing its occupancy

The tower of the Chandler hospital (UK photo)

By Allison Perry
University of Kentucky

Beginning next week, the medical and cardiovascular intensive-care units inside the University of Kentucky Albert B. Chandler Hospital have a new home: the 12th floor of Pavilion A, the final floor of the hospital's tower to be completed sice the ground-floor emegency department opened in 2010.

The hospital’s ICU patients have been spread across multiple floors of the tower. The new space moves the units into one floor with a number of modifications and upgrades from the previous locations, driven by patient and staff experience in UK HealthCare’s various ICUs during the Covid-19 pandemic.

“As the state’s academic health system in a comprehensive campus, we leverage the strengths of multiple experts and advanced options, as Kentuckians look to us to provide the highest level of complex care for seriously ill patients,” said Robert S. DiPaola, co-executive vice president for health affairs at UK. “These new ICUs incorporate the best of all worlds: state-of-the-art technology that allows us to handle the most complex health issues, a functional and aesthetic approach to floor and room design, and of course, the compassionate care that our staff has always provided to critically ill and injured patients.”

Eric N. Monday, executive vice president for finance and administration and co-executive vice president for health, said “UK HealthCare is the state’s center for advanced subspecialty care because we have the outstanding healers – the physicians, professionals and medical staff – who provide the care than only we can. . . . This final floor represents, in many ways, the culmination of what we have learned in developing the facilities that Kentuckians need and deserve in the provision of care.”

Access port (top left) allows more frequent monitoring
of infectious-disease patients. (UK photo by Shaun Ring)

The 12th floor will house 64 ICU rooms, eight more than the current number of ICU beds at Chandler. New features include:

• All rooms have negative-pressure capability.
• All rooms have built-in tubing access ports that enable IVs and monitors to remain outside the room, allowing health-care providers to monitor infectious-disease patients more frequently and easily.
• During a state of emergency, all rooms can be doubled to handle an influx of patients.
• Eight patient rooms have built-in antechambers to allow both a positive- and negative-pressure environment for immunocompromised patients with more serious infectious diseases.
• The floor houses a Serious Communicable Disease Lab, which allows for quicker blood and tissue testing.
• Donning/doffing stations for personal protective equipment are seperate.
• The ICU has its own dedicated pharmacy and a clinical nutrition room.

“The only constant in medicine is the imperative to learn, improve and prepare for the needs of current and future patients,” said Dr. Nicholas Van Sickels, director of infection prevention and control at UK HealthCare. “Taking what we learned during the Covid-19 pandemic and directly implementing it into the foundation of the new ICU floor allows staff to be better prepared to care for patients who need true intensive care for infectious diseases.”

The floor was designed with the physical and mental health of its staff in mind, with advice from UK HealthCare’s Nursing Wellbeing Committee, ICU staff nurse, and ICU physicians.

Many of the interior walls of the staff workspaces are clear glass. This allows more natural sunlight into the space and contributes to a more “open” environment, while also allowing staff to more easily keep an eye on patients up and down the halls.

“When we first began seeing Covid patients in early 2020, no one knew how to handle those specific needs,” said Dr. Ashley Montgomery-Yates, Department of Internal Medicine senior vice chair of strategy and director of UK’s ICU Recovery Clinic. “We adapted and created makeshift solutions as we went along to help staff better care for those patients. Now, those solutions are built into the floor design. That, along with the intentional thought give to our staff’s health to help prevent burnout, better prepares us for future patients who need the complex care of our ICUs.”

Once the existing ICUs on floors nine and 10 are moved to the new floor, those spaces will be backfilled from other areas of UK HealthCare and will include beds for orthopaedics trauma, OB/GYN postpartum and hospital medicine.

The pandemic slightkly delayed construction of the final floors. Last spring, the UK Board of Trustees approved a plan to begin design for a new patient-care tower.

“As the medical needs of Kentuckians grow, so do we,” said Dr. Christopher DeSimone, acting executive chief medical officer for UK HealthCare. “We’re here to meet the ever-evolving health care needs of the state. We’re continuing to build a health care system that not only provides what Kentuckians need now, but what they’ll need in the future. Finishing out Pavilion A with one of the country’s best ICUs is just one step toward achieving that goal.”

Glaucoma, leading cause of irreversible blindness, can be detected and treated; get an eye exam every 2-4 years after 40

Regular eye exams are the key to detecting glaucoma.
(Photo from peakSTOCK, iStock/Getty Images Plus via UK)

By Dr. Elham Ghahari
University of Kentucky

Glaucoma is a disease of the optic nerve that can cause vision loss. It is the second leading cause of blindness in the U.S. and the leading cause of irreversible blindness worldwide, and 111.8 million people worldwide will have glaucoma by the year 2040.

Glaucomatous damage is the loss of optic nerve cells, which leads to changes in the head of the optic nerve at the eye, with damage to the field of vision. Glaucoma cannot be cured, but it can be controlled and stabilized with proper treatment.

The most common form of glaucoma is primary, open-angle glaucoma. It is associated with several risk factors such as family history, African ancestry, other eye diseases such as diabetes or inflammation, past eye injury, and elevated eyeball pressure.

High eye pressure is the most important risk factor because it is the only effective target of therapy for glaucoma. Although some forms of glaucoma develop even when the eye pressure is normal, the risk of abnormally high eye pressure increases with age.

Early detection and intervention can help prevent vision loss from glaucoma. However, most patients don’t know they have the disease because it is generally asymptomatic in the early stages, which means symptoms don’t present themselves.

A routine eye exam can identify the risk for glaucoma and early signs of the disease. During an eye exam, glaucomatous optic-nerve damage can be assessed by clinical examination of the optic nerve head and eye pressure can be checked.

The risk of having abnormally high eye pressure as the most important risk factor for glaucoma increases with age. Glaucoma screenings are suggested beginning at age 40 and should continue after that in intervals suggested by your eye doctor, usually every two to four years.

There are usually no early symptoms of glaucoma, so screening exams are very important. Gradual dimming or weakening of vision is sometimes reported. Some patients with acute glaucoma develop severe eye pain and rapid visual changes.

Glaucoma treatment consists of reducing eye pressure using medications, lasers or surgery. Most glaucoma patients can be stabilized with prescription eye drops or in-office laser treatment.

Once the pressure is stabilized, it is important to continue regular follow-ups to make sure the pressure remains low enough. Less frequently, glaucoma surgery may be required.

Elham Ghahari, M.D., is an assistant professor of ophthalmology at UK HealthCare Advanced Eye Care.

Seasonal respiratory illness in Kentucky has declined for three weeks, but the numbers are still considered elevated

Ky. Dept. for Public Health graphs, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

Emergency-department visits and hospital admissions for respiratory disease in Kentucky have dropped for three weeks in a row, but the Kentucky Department for Public Health still considers the rate of respiratory virus activity to be elevated and the number of hospitalizations to be high. 

Respiratory illness-related ED visits have dropped 47% since the last week of 2023, when the health department showed the highest number of ED visits during this respiratory-illness season, 6,147. 

In the three weeks since, there has been a steady decline in such visits, dropping to 3,243 visits in the week ended Jan. 20.

Of those, 2,379 were for flu, down 15% from the week prior; 663 were for Covid-19, down 30% from the week prior; and 201 were for respiratory syncytial virus (RSV), down 38% from the week prior.

Hospital admissions associated with respiratory disease have also dropped steadily for three weeks in a row, to 530. That's down 47% from the season's high of 1,002 in the week ended Dec. 30. 

In the latest report, 236 admissions were for Covid-19, down 33% from the week prior; 216 were for flu, down 22% from the week prior; and 78 were for RSV, down 27% from the week prior.

Kentucky has no counties with high Covid-19 hospital admission rates in the week ended Jan. 20, according to the Centers for Disease Control and Prevention. However, it does have 24 counties with between 10 and 20 Covid-19 hospitalizations per 100,000 people, a rate the CDC considers "medium." These are largely in the easternmost part of the state and in a strip down the middle of the state. 

In the week ended Jan. 20, the state reported 2,042 laboratory-confirmed cases of Covid-19, down 32% from the prior week. It reported 2,745 lab-confirmed cases of the flu, down 16% from the week prior. 

Among children 4 and younger, the number of respiratory-illnessemergency-department visits also dropped for the last three weeks, to 697 in the week ended Jan. 20. That's down 53% from a season-high of 1,489 on Dec. 30. 

In the latest report, 471 vists of those 4 and younger were for flu, down 11% from the week prior; 125 were for RSV, down 33% from the prior week; and 101 were for Covid-19, down 30%.

Respiratory-related hospitalizations for children 4 and younger have dropped for six weeks in a row, down to 38 in the week ended Jan. 20 from a season-high of 134 in the week ended Dec. 16, a drop of 72%

In the latest report, 18 of the hospitalizations were for RSV, down 44% from the week prior; 12 were for flu, down 48% from the week prior;  and 8 were for Covid-19, 2 more than the week prior. 

Hospital visits also dropped among children 5 through 17, with 633 respiratory-related ED visits reported in the week ended Jan. 20, down 18% from the week prior. 

In the latest report, 565 of the yoith visits were for flu, a drop of nearly 19%; 54 were for Covid-19; and 14 were for RSV. The Covid-19 and RSV numbers have fluctuated little for several weeks.

The number of ED visits in this age group has declined from a high of 1,000 in the week ended Dec. 23, but it has not been a steady decline; there were nine hospitalizations in the week ended Jan. 20 among children aged 5-17, the same as the week before.

Of those, seven were for flu, up one from the prior week; one was for Covid-19, down from three the week prior; and one was for RSV, up from none the prior week. 

Since the first week in October, 236 Kentuckians have died from Covid-19 and eight have died from the flu. One of the Covid-19 deaths and one of the flu deaths have been children. 

In the week ended Jan. 6, there were two Covid-19 deaths and one flu death reported in Kentucky. These numbers follow two weeks where the state saw 23 Covid-19 deaths during each week.

You can test your home for invisible radon gas, leading cause of lung cancer among never-smokers; Kentucky has many hotspots

By Stacy Stanifer
University of Kentucky

January is National Radon Action Month, making it a great time to prioritize the health of those in your household by testing for the presence of radon gas. Radon is the second leading cause of lung cancer in the U.S., and the leading cause of lung cancer among never-smokers.

Radon is a radioactive gas that comes from the natural decay of uranium found in rocks and dirt in the earth. When radon under a home leaks in through openings in the ground, it can build up to dangerous levels inside. The longer a person is exposed to high levels of radon, the greater the risk of developing lung cancer later in life. 

For this reason, it is important to act now to not only reduce your exposure, but also children’s exposure to radon.

State radon map shows cancer risk is based mainly on geology.

Radon may be present inside any building or home, without regard to its location or type of foundation (slab, crawl space, or basement). Radon risk potential across Kentucky is variable, yet it is recommended that all homes be tested for radon. 

Despite the risk, only 13 of every 10,000 homes in Kentucky test for radon annually. Radon can’t be seen, tasted, or smelled and causes no immediate symptoms — so it’s easy for radon to go unnoticed. The only way to know if you have a radon problem is to test your home. 

The good news: Radon tests are simple to use and inexpensive or often free.

The Kentucky Radon Program provides radon test kits free of charge to Kentucky residents. You can request a free test kit by completing the form on the Free Radon Test Kit Offer website. You can also request a free kit from your local health department if it is on the radon program list. 

In addition, those with library cards from the Christian, Logan, Pulaksi or Rowan county libraries can borrow a digital radon detector. The detector kits are being made available for checkout through the Radon on the RADAR project, which aims to increase access to affordable home radon testing by partnering with public libraries.

Follow the instructions that are included with the kit. Depending on the type of test, it may take just a few days or several months to finish the test. If your test results show a radon level of 4 picocuries per liter (pCi/L) or higher, it is recommended that you take action to lower radon inside your home.

Your home should be tested:

• if it’s never been tested or radon levels are unknown, and then every two years.
• if you are preparing to buy or sell.
• before and after any home renovations, including after making repairs to reduce radon levels.
• before making any lifestyle changes in the home that would cause someone to spend more time in the basement or lower level (like converting a basement to a bedroom).

Finding out that your home has high radon levels can be alarming, but you can make your home safer. Radon-reduction repairs can be done with the help of a certified radon mitigation contractor. The National Radon Proficiency Program offers an online resource to find a contractor near you. Planning to build a new home this year? Ask you contractor about using radon-resistant new construction techniques to minimize radon entry in the home.

Home radon testing is easy. Making the choice to test your home this January is a healthy resolution you can keep.

Stacy Stanifer is a member of BREATHE at the UK College of Nursing and a member of the UK Markey Cancer Center’s Cancer Prevention and Control Research Program. BREATHE is an acronym for Bridging Research Efforts and Advocacy Toward Healthy Environments. 

Ky. Center for Smoke-free Policy seeks nominations by March 15 for smoke-free advocates to be honored at next conference

The Kentucky Center for Smoke-free Policy is accepting nominations for local smoke-free advocates who deserve to be recognized for their dedication to improving smoke-free policy and secondhand smoke education in Kentucky. Self-nominations are welcome. 

The winners will be honored at the 2024 Kentucky Tobacco Control Conference, to be held April 23-24. One of the advocates will be awarded the Dr. David B. Stevens Smoke-free Advocate of the Year Award. 

Nominations are due March 15. The nomination form requires a minimum of 500 characters to describe the advocate’s smoke-free work. Also, please remember that the Advocate of the Year Award is intended for individuals and that nominations of groups or organizations will not be considered. 

Submit nominations here: https://uky.az1.qualtrics.com/jfe/form/SV_2osikEukP52JfWS

Bill filed in Kentucky that would allow judges to temporarily take guns from those at risk of harming themselves or others

Sen. Whitney Westerfield (Legislative photo)

By Sarah Ladd
Kentucky Lantern

Admitting it faces a “tough uphill climb,” Republican state Sen. Whitney Westerfield filed a bill Jan. 25 that would allow judges to temporarily remove firearms from Kentuckians at risk of harming themselves or others.

“There is more support for it than you hear,” Westerfield said of his measure, which he calls the Crisis Aversion and Rights Retention Orders bill, or CARR.

Westerfield, of Christian County, said Senate Bill 13 is the “cleanest” version and comes after feedback from his colleagues during a December interim hearing before the Joint Committee on Judiciary.

Draft language of the bill says:

• Law enforcement cannot enter a person’s home “or interior premises” to gather their guns unless that person needs and requests assistance in doing so.
• Police must give a receipt to the respondent detailing what guns were taken.
• While the CARR order is in effect, the respondent cannot possess or buy guns.
• The court must tell the respondent that they are not being charged with a crime and that they have the right to rebuttal. 

“We don’t want to take away guns from people who are law-abiding citizens,” Westerfield said Thursday to a supporter rally. “We want to step in temporarily to keep people safe. We don’t want it to be abused. We want to do something responsible, constitutional, to keep people safe. That’s what CARR does.”

The bill has four co-sponsors, all Democrats, led by Sen. David Yates of Louisville. He says judges who are entrusted with complicated child-custody situations can also be trusted to know when people can’t be trusted to have guns.

“This is not a gun-grabbing bill,” said Yates. “Public safety has got to be a top priority. And right now, we are in a crisis.”

The other Democratic sponsors are Sens. Carrie Chambers Armstrong and Denise Harper Angel of Louisville and Reginald Thomas of Lexington.

Sheila Schuster, a licensed psychologist and the executive director of the Kentucky Mental Health Coalition, previously told the Lantern that “People with a mental illness are 10 times more likely to be a victim of violent crime than to be a perpetrator.”

She also said suicidal people taking their lives happens at an “astronomical percentage higher if there’s a gun within reach than if there’s not.”

The nonprofit Whitney Strong, which works to end gun violence, reports that a majority of gun deaths in Kentucky were suicide in 2021 — 534 compared to 364 homicides. That same year, there was a suicide by firearm every 16 hours in Kentucky, according to Whitney Strong data shared Thursday. The National Suicide Prevention Lifeline is 988.

Westerfield called his bill “constitutionally sound” and said he hopes it gets a hearing this session. As of Friday, Jan. 26, the bill was still in the Senate Committee on Committees, made up of the chanber's leaders. Westerfield is chairman of the Judiciary Committee.

Louisville's 'Bos' Todd, national leader in mental health, dies at 93

Bosworth Todd

Kentucky Health News

Bosworth M. "Bos" Todd Jr., who co-founded a pathbreaking treatment center in Louisville for mentally ill youth and the foundation that makes the most mental-health research grants in the nation, died Jan. 22. He was 93.

Todd, a Frankfort native and University of Kentucky graduate, earned an MBA at Harvard Business School and worked in the investment industry. After his oldest son Sam was hospitalized with schizophrenia, he and his wife Joan, who died last year, joined with other parents to form the Schizophrenia Association of Louisville, now part of the National Alliance on Mental Illness.

In the early 1980s, he joined attorney Philip Ardery, real-estate broker Malcolm “Mac” Matthews Jr. and Barry Bingham Sr., editor and publisher of The Courier-Journal, to found Wellspring as a transitional home for young people with schizophrenia. "It now has a $40 million budget and offers a variety of services to 1,000 people at multiple locations across Louisville, The C-J's Andrew Wolfson reports.

Todd, Ardery and University of Louisville psychiatrist Herbert Wagemaker also launched the American Schizophrenia Foundation, which became the Brain & Behavior Research Foundation, "the nation’s top nongovernmental funder of mental-health research grants," Wolfson reports. "It has backed the research of more than 5,400 scientists in more than 599 institutions around the world."

A celebratory visitation will be held from 5 to 7 p.m. Friday, Jan. 26, at the River Valley Club on River Road in Louisville. Burial will be private. Wellspring is accepting memorial gifts in lieu of flowers.

Lt. Gov. Coleman reflects on her preventive double mastectomy

Lt.Gov. Jacqueline Coleman (KL photo by Sarah Ladd)

By Sarah Ladd
Kentucky Lantern

Kentucky Lt. Gov. Jacqueline Coleman knew for a long time that one day she might learn cancer was at her door.

Her family history put her on heightened alert; her mother, aunt and cousin all had breast cancer. So she “wasn’t shocked” when, in September, a routine mammogram — her first — concerned her health-care provider.

She went for more tests, including magnetic resonance imaging and biopsy. After the biopsy she learned she needed surgery, either way. Her doctors were concerned about several areas in her breasts, and she was facing “biopsy and remove, biopsy and remove, times four.”

She knew immediately: “I don’t want to live like that.” Without the mastectomy, she faced “scans and screens and biopsies every six months for the rest of my life.”

“In a way, it was almost like I was waiting for this news,” she told the Kentucky Lantern during a sit-down interview in her Capitol office on Jan. 23. She would eventually undergo a double mastectomy on Dec. 18.

But as she wrapped up the last leg of a statewide re-election campaign with Gov. Andy Beshear, Coleman found herself in medical limbo. Screenings and tests defined her personal October and November, even as she debated her opponent on KET, traveled the state meeting voters and celebrating on election night.

“I’m going through the end of a campaign, which is … the most intense time, and I have all these questions,” she said. “And it was really hard to not know what was going to happen.”

The tests “just kind of get a little bit more invasive each time,” said Coleman, 41. “And of course, it takes time to … do the test, to have them read, to schedule the next one. It’s a frustrating process because you have more questions than answers, it seems, the entire time. But you’re also grateful that your doctors are being so thorough, and making sure to cover all the bases.”

In early December, Coleman was “relieved” to learn she could get a double mastectomy at Baptist Health in Lexington.

“I felt it would be irresponsible to have a three-year-old, and to not be as aggressive as I could be,” she said.

Coleman did not have cancer, but she didn’t know that until after her surgery, when her pathology results came back clean. “The one place that was a great concern came back benign, but had malignant potential,” she said. “And so I felt like I got ahead of it. And I feel like I made the right decision.”

At the mercy of disease

Coleman says she's “not the best person about going to the doctor,” but “I also know that being preventative gives you a chance.”

“When you’re reactive, you’re at the mercy of … It could be a disease,” she said.

Still, medical issues wait for no one.

“You’re fighting for your life, and you still have to pick the kids up, and you still have to go to the grocery, and you still have to go to work,” Coleman said. “The world doesn’t stop.”

If anything, she said, the whole experience left her with less patience for what she called “petty politics.”

“There are real problems in the world,” she said. “I think about the importance of women being empowered to protect their own health, to be trusted.”

 
Not alone 

After her surgery, Coleman got cards and letters from people all over the state telling her their stories about going through similar health challenges.

“It was a message of: ‘You’re not alone’,” she said. “But it was also a message of reassurance. And it was remarkable.”

Coleman said she finally feels like herself again, and is looking forward to getting back out in communities across Kentucky. And she plans to keep using her story to encourage others to seek preventive care — and to know there is a community of Kentuckians who relate to their journeys.

“I know how alone I felt when I got the news and when I tried to find my way and what was the right path for me,” she said. “And I don’t want other women to feel that way.”

Women from 40 to 49 should get mammograms every two years, and from 50 to 74, they should get the exam every year, according to the state Department for Public Health. To find out how to get a free or low-cost mammogram or cervical cancer screening, call 844-249-0708. Click here for more information.

Cancer is a leading cause of death in Kentucky, which has high rates of breast cancer. In 2021, Kentucky lost more than 10,000 people to cancer, according to the Centers for Disease Control and Prevention. Breast cancer is second only to lung cancer in its mortality nationwide, according to the American Cancer Society.

Ky. health-care workers can apply for loan relief until Jan. 31

The UK Center for Excellence in Rural Health has the Health Care Worker Loan Relief Program, run by Rural Project Manager Sierra Williams (left) and Center Director Fran Feltner. (Photo by Beth Bowling)

By Beth Bowling
University of Kentucky

In just over a year, the University of Kentucky Center of Excellence in Rural Health has helped provide more than $1.3 million in loan relief for health-care workers.

The center is accepting the next round of applications for the Healthcare Worker Loan Relief Program of the Commonwealth through the end of January.

The legislature established the program in 2022 to increase the recruitment and retention of health-care professionals to practice in underserved areas of Kentucky.

“We are grateful for this much-needed funding and it is already making a positive impact in underserved communities across the state,” Center Director Fran Feltner said. “In just a little more than one year, we have been able to award more than $1 million in loan relief to more than 20 health professionals across 13 communities in Kentucky."

The program was designed to complement the state's federally funded loan-repayment program by filling in gaps and expanding eligibility to additional medical specialists including ophthalmologists, optometrists and audiologists. It is geared toward professionals who provide direct patient care in these disciplines and specialties: physicians, optometrists, ophthalmologists, audiologists, physician assistants, nurse practitioners, certified nurse-midwives, registered nurses, dentists, registered dental hygienists, licensed clinical social workers, licensed professional clinical counselors, health service psychologists, marriage and family therapists, psychiatric nurse specialists, alcohol and substance use disorder counselors and pharmacists. Additional specialties will be considered.

Applicants selected to participate could be awarded up to $100,000 depending upon provider type, level of loan indebtedness and sponsor commitment. Awardees are required to work 24 to 40 hours a week, up to 4,160 hours over a two- to three-year period. Participants receive tax-free student loan repayment in exchange for their service commitment.

Additional requirements include serving in an officially designated health-professions shortage area and working at an eligible clinical site that serves as a sponsor. Examples of eligible sites include federally qualified health centers, rural health clinics, community mental health agencies, health department clinics, prisons, private practices and critical access hospitals.

The deadline to apply is 5 p.m., Wednesday, Jan. 31. Apply or learn more about applicant eligibility, clinical site eligibility and program guidelines here, or contact Sierra Williams at HWLRPCommonwealth@uky.edu or 606-439-3557.

Ky. health-care providers lobby for bill that would ease health insurers' required prior authorization for medical procedures

OPINION by health-care provider groups listed below

It’s a situation all of us will find ourselves in at some point. You’re sick, or get diagnosed with a chronic condition, or need to have surgery. Thankfully, your physician diagnosed the issue quickly and a treatment plan was made, and you have health insurance to cover it. You should be on your way to health and healing, right?

Unfortunately, thanks to something called a “prior authorization,” there’s a good chance your care is about to get delayed or denied by your insurance company.

Prior authorization is a complicated, time-consuming, “cost-control process” utilized by health-insurance companies that requires physicians to obtain advanced approval from them before a specific service or medication is delivered. That’s right: your health plan can delay or deny the care that your physician prescribes in an effort to sway them towards a less effective treatment or service. There is no question that this negatively impacts patients and providers by leading to care delays for patients, administrative burdens for you and your physician, and increased overall costs to the health-care system.

Photo illustration from MedicalAlgorithms.com

Recent surveys and reports support the need to reform this system. A 2022 Kentucky Medical Association survey found that 82% of physicians said that issues related to the prior authorization process sometimes, often, or always lead to patients’ delays or changes to patients’ recommended course of treatment. Another national survey found that physicians spend a median of four hours per week on drug utilization management, while nurses spend 15 hours and other staff spend between 3.6 and 10 hours per physician per week. That is time that medical practices and professionals could surely put to better use on patient care.

However, the biggest impact is, of course, on the health of patients. 81% of those surveyed by KMA said the prior-authorization process delays access to necessary care for patients sometimes, often or always. One physician told of an oncology patient denied anti-nausea medication because of a required prior authorization. In the approximately three-day interval it took to get the authorization from the insurer, the patient was readmitted to the hospital with nausea, vomiting, dehydration, renal failure and electrolyte abnormalities. Another physician described a diabetic patient who did not receive their insulin as prescribed due to need for a prior authorization and had to go to the emergency department for care.

Of course, hospital admissions and visits to emergency rooms don’t save money, as prior authorizations are “intended” to do. Delaying necessary care can lead to complications and worsen the health of patients. And in the end, the vast majority of prior authorizations are approved, either initially or on appeal. This process is, therefore, unnecessary.

That’s why our organizations and thousands of our physician members across the state are calling for reform. During last year’s legislative session, KMA advocated for the passage of a bill which would have streamlined this process. The new program would ensure patients have timely access to the care they need, reduce administrative burdens for physicians, and lower healthcare costs. Together, we will be advocating for the passage of this legislation in the 2024 session.

Kentucky patients who are already suffering from chronic conditions and illnesses don’t need their care delayed by an insurance company. Let’s reform the prior authorization process to improve the health of our commonwealth.

This was written by the Kentucky Medical Association; Falls City Medical Society; Kentucky Association of Indian Physicians; Kentucky Chapter of the American College of Physicians; Kentucky Academy of Family Physicians; Kentucky Society of Anesthesiologists; Kentucky Dermatological Association; Kentucky Chapter of the American College of Cardiology; Kentucky Psychiatric Medical Association; and Kentucky Society of Addiction Medicine, via Ashley Bitters at ashley@runswitchpr.com. For a health care journalist’s guide to prior authorization, from Journalists' Resource at Harvard University, click here. The legislation, House Bill 317, was filed Thursday by Republican Reps. Kim Moser of Taylor Mill and Robert Duvall of Bowling Green. 

Lesser-known health benefit of Dry January: cancer prevention

National Institute on Alcohol Abuse and Alcoholism graphic

By Rachel C. Miller

University of Kentucky

As we begin 2024, resolutions to eat healthier and exercise more are likely on many minds. This year, you may consider adding another: reducing alcohol or taking a break altogether. Many people have also started to participate in “Dry January” – a month-long vow to go alcohol-free.

Beyond the well-known health benefits of improved sleep, clearer skin, increased energy and shedding extra weight, ditching alcohol offers another often-overlooked advantage – reducing your risk of cancer.

Research shows a link between alcohol consumption and an increased risk of several cancers, including head and neck, esophageal, liver, breast and colorectal. Emerging evidence also suggests a connection to melanoma, prostate, and pancreatic cancers.

Alcohol damages the DNA in our bodies’ cells, impairs nutrient absorption, promotes inflammation, and disrupts hormones – all factors that can increase cancer risk.

Whether you're considering Dry January or a long-term reduction in your alcohol intake, here are some tips for success: 

• Set clear goals. Decide if you want to abstain completely or adopt a low-alcohol approach.
• Find your "why." Remind yourself why reducing alcohol is important to you, whether it's cancer prevention, improved sleep, or simply a desire to feel your best.
• Find alternatives. Explore non-alcoholic beverages that satisfy your cravings. Sparkling water with a splash of fruit juice, herbal teas, and mocktails are great options.
• Plan ahead. Stock up on your favorite alternatives and choose situations where alcohol less of a center of activity.
• Get support. Tell family and friends about your goals – their encouragement can make all the difference. You may also consider joining online communities or connecting with friends who share the same goals.

Dry January serves as an excellent starting point for adopting a healthier relationship with alcohol all year long. Even for those who choose to drink, moderation is key. 

Federal dietary guidelines recommend limiting alcohol to two drinks or less per day for men and one drink or less for women. A standard size drink is 12 ounces of regular beer, five ounces of wine, or 1.5 ounces of 80-proof liquor.

Quitting alcohol "cold turkey" can be dangerous for some individuals. If you engage in binge or heavy drinking, it is best to first consult your doctor for guidance and safe reduction strategies.

If you or a loved one is experiencing a problem with alcohol, help is available via the Substance Abuse and Mental Health Services Administration Helpline at 1-800-662-HELP. NIAAA also has resources online to help you find treatment options.

Rachel C. Miller is a registered dietitian at the UK Markey Cancer Center.

Impact of cannabis use during pregnancy is the focus of UK Cannabis Center's next online seminar, to be held Feb. 26

Kelly Young-Wolff (Tyson School of Medicine photo)

The University of Kentucky Cannabis Center is sponsoring an online seminar titled  “Cannabis Use During Pregnancy: Research from Policy to Practice" on Feb. 26. The seminar will be held via Zoom from 2-3 p.m.  Click here to register. 

The seminar is part of the center's series featuring national and international experts on cannabis science, according to a news release.  

It will feature the work of  Kelly Young-Wolff, a licensed clinical psychologist and research scientist at the Kaiser Permanente Northern California Division of Research. She is an adjunct associate professor in the Department of Psychiatry at the University of California, San Francisco, a consulting assistant professor at the Stanford University School of Medicine, and a professor at the Kaiser Permanente Bernard J. Tyson School of Medicine.

Young-Wolff’s research focuses on substance use, focusing specifically on cannabis use among pregnant persons and the impact of changes in local, state and national policy.

“We are honored for Dr. Young-Wolff to share her scientific expertise with our research community here at UK,” said Shanna Babalonis, UK Cannabis Center director. “As the cannabis landscape continues to change in Kentucky and the country, it is critically important to have valuable insights on beneficial health effects and associated risks. We look forward to learning more about Dr. Young-Wolff’s contributions to this field and to better understand the impact of prenatal exposure to cannabis.”

The UK Cannabis Center, based in the UK College of Medicine’s Center on Drug and Alcohol Research, conducts research on the health effects of cannabis, including its risks and benefits when used to treat certain medical conditions. It was established in 2022 by the General Assembly.  Click here to learn more about upcoming events from the UK Cannabis Center.

Kentucky leads the nation in use of new class of drugs that fight diabetes and obesity; more than 2% of Kentuckians use them

Kentucky Health News

This story has been updated, as underlined.

Kentucky has the nation's highest rate of dispensed prescriptions for a new class of diabetes and obesity medications, according to the analytics company PurpleLab and published by Axios.

"For every 1,000 people in Kentucky, roughly 21 were prescribed a drug that belongs to a buzzy class of diabetes and anti-obesity medications last year," Tina Reed of Axios reports.

The drugs are GLP-1 agonists, which mimic a hormone that triggers the release of insulin, which lowers blood sugar; slows digestion; and increases the feeling of fullness after eating. They were developed to treat diabetes but have become popular in treating obesity, in which Kentucky ranks high.

"GLP-1 agonists alone can’t treat Type 2 diabetes or obesity," the Cleveland Clinic cautions. "Both conditions require other treatment strategies, like lifestyle and dietary changes." The drugs are costly, running between $900 and $1,300 a month, and most must be injected into fatty tissue.

Axios reports that after Kentucky, West Virginia had the next highest prescribing rate, at 18.9 prescriptions dispensed per 1,000 residents. That was followed by Alaska (17.5), Mississippi (16.1) and Louisiana (15.4). Rhode Island had the lowest rate (3.7), and Massachusetts was second lowest (4), followed by Wisconsin (4.3) and Hawai'i (4.3.)

The figures come from a collection of 1.9 billion claims to private insurers, Medicare (which only covers GLP-1s to treat diabetes) and Medicaid. "The data lumps the prescriptions together, so it's not possible to tease out how often these drugs are being prescribed for obesity versus diabetes," Axios notes. Kentucky Medicaid does not cover the drugs, but health insurance for state workers does.

In another story Reed reports, "Doctors are getting inundated with patients' requests . . . including from many who don't really need them. Primary-care doctors in particular, who typically have little training in obesity, have found themselves as gatekeepers for a class of injection drugs, including Novo Nordisk's Ozempic and Wegovy, that are effective but still face questions about who should take them."

Bipartisan 'momnibus' bill aims to improve health of mothers, kids

State Rep. Kim Moser, a Republican from Taylor Mill in Northern Kentucky, spoke with other female legislators at a press conference Wednesday to announce their "Momnibus" bill. (Legislative photo)

Kentucky Health News

Legislators are accustomed to seeing "omnibus" bills that deal with many subjects, sometimes related, sometimes not. Now the Kentucky General Assembly has a "momnibus" bill intended to improve the health of children and mothers, including expectant ones.

House Bill 10 was developed by an informal, bipartisan group of female legislators concerned about the state's poor maternal health, said its main sponsor, Rep. Kim Moser, R-Taylor Mill.

"Addressing Kentucky's high maternal mortality rate and saving mothers and babies is obviously a priority for all of us," Moser said at a Wednesday press conference. Kentucky had the nation's sixth highest maternal death rate, 38.4 deaths per 100,000 live births, from 2018 through 2021. The national rate for that period was 23.5 per 100,000.

More than 90% of the state’s maternal deaths are preventable, Dr. Jeffrey M. Goldberg, legislative advocacy chair of the Kentucky chapter of the American College of Obstetricians and Gynecologists, told a state Senate committee last year. Just over 14 percent of Kentuckians lack access to adequate prenatal care, according to the March of Dimes.

Moser, a mother of five who was a neonatal intensive-care nurse, spoke from her own experiences: “I’ve really worked with mothers and babies and sick newborns, in their newborn phase, oftentimes through their first year, and I was able to really see some of the reasons for poor health disparities, especially in our poor areas of our state.”

Citing the advocacy group Every Mother Counts, Moser said “The leading causes of maternal death in the U.S. [are] lack of access to health care, including a shortage of caregivers, a lack of insurance, inadequate postpartum supports and certainly socioeconomic disparities, including the stress of racism and discrimination.” In Kentucky, she added, the risks are greater because of the prevalence of heart disease and diabetes.

HB 10 would:

• Add pregnancy to the list of "qualifying life events" that allow people to get health-insurance coverage outside normal enrolment, which could encourage more prenatal care.
• Create the Lifeline for Moms Psychiatry Access Program, for which Kentucky has received a $750,000 grant. Moser said she will also ask for an appropriation in the state budget “to make sure that’s a sustainable program.” It would be required to operate a hotline from 8 a.m. to 5 p.m. Mondays through Fridays.
• Expand the HANDS (Health Access Nurturing Development Services) home-visitation program for new and expectant parents to include breastfeeding counseling and assistance, education on safe sleep, as well as expanding the program to include telehealth, which Moser said she believes will help “reach moms in underserved areas or areas where she may have a transportation issue.”
• Require the Cabinet for Health and Family Services to study and make recommendations about the role of doulas, who provide assistance with the birth experience. 
• Strengthen an advisory council that provides policy guidance to increase collaboration, improve data collection, and suggest additional improvements.

Some Kentucky Republican legislators began paying more attention to such issues after the U.S. Supreme Court eliminated the federal right to abortion, activating a state "trigger law" that bans abortion except to save the mother's life or prevent permnent damage to a life-sustaining organ. 

"The wide gulf between abortion-rights and anti-abortion lawmakers was felt when Moser invited Addia Wuchner, executive director of the Kentucky Right to Life Association, to speak at the end of the press conference," reports Rebecca Grapevine of the Courier Journal. "That prompted most of the assembled Democratic lawmakers . . . to quietly walk out of the room."

State Rep. Sarah Stalker

One Democrat who remained, Rep. Sarah Stalker of Louisville, told the Courier Journal, "If we're going to force people to have children when they are not prepared to, when they are not ready to, when they are not interested in the family, it is critical that we give them the access to the health insurance . . . It doesn't help me and it doesn't help Kentucky, you know, Kentuckians at large and particularly women, to dig in my heels."

The second listed sponsor of the bill is Rep. Nancy Tate, R-Brandenburg, a leading anti-abortion legislator. Other Republican sponsors are Reps. Danny Bentkey of Russell, Emily Callaway of Louisville, Stephanie Dietz of Edgewood, Robert Duvall of Bowling Green, Ken Fleming of Louisville, Mark Hart of Falmouth, Kiom KIng of Harrodsburg, Amy Neighbors of Edmonton, Rebecca Raymer of Morgantown, Tom Smith of Corbin, Nick Wilson of Williamsburg and Susan Witten of Louisville.

Besides Stalker, the bill's Democratic sponsors are Reps. Lindsey Burke and Cherlynn Stevenson of Lexington. Democratic Reps. Lisa Willner of Louisivlle and Rachel Roberts of Newport initially attended the press conference but left and are not listed as sponsors.

Information for this story was also provided by the Kentucky Lantern.

CHI St. Joseph Health to be new satellite site of nursing school

In the foreground of the CHI St. Joseph Health campus in Lexington is the office park where the Lincoln Memorial University nursing-education program is set to begin this fall. St. Joseph Hospital is in the right background. Far beyond it is the University of Kentucky hospital. (Photo by Mark Mahan)

By Sarah Ladd
Kentucky Lantern

Lincoln Memorial University of Harrogate, Tenn., near Kentucky's southeastern corner, will launch a nursing-education site with CHI Saint Joseph Health in Lexington later in 2024, the private school said Wednesday.

Students will be able to enroll for the fall 2024 semester at the new Caylor School of Nursing campus, LMU said in a statement.

The school, including classrooms, simulation rooms and laboratories, will go into a renovated office space in the Saint Joseph Office Park across Harrodsburg Road from the hospital, according to the university. Students will get their clinical experience through CHI Saint Joseph and other partners.

“Recognizing the severe shortage of nurses that continues to plague Kentucky, we were pleased to work with Lincoln Memorial University to bring more nursing education opportunities to Central Kentucky,” CHI executive Anthony A. Houston said in a statement. (CHI stands for Catholic Health Initiatives.)

Kentucky has an “acute shortage” of healthcare workers, Kentucky Health News reported in November. The state’s well-documented nursing shortage was only exacerbated by Covid-19 burnout and an aging worker population, the Lantern has reported. Additionally, shutdowns and restrictions stunted the normal education trajectory for Kentucky’s next generation of nurses during the worst of the coronavirus pandemic. Now, multiple initiatives hope to fix the issue.

Students pursuing an bachelor of science in nursing degree from Lincoln Memorial can get it in an accelerated 16-month path. Otherwise, the program is 122 credit hours.

LMU's nursing school already has a site in Corbin, 50 miles from Harorgate. For information, email Ethan Fultz, coordinator of the Lexington site and nursing recruitment, at Ethan.Fultz@LMUnet.edu.