Kentucky's abortion bans deny standard health care to women who have non-viable pregnancies, Herald-Leader reports

The Kentucky laws banning abortion "do not legally permit the standard-of-care treatment for a nonviable pregnancy," writes Alex Acquisto of the Lexington Herald-Leader. "As a result, doctors must refer patients needing otherwise medically recommended terminations out of state in droves, along with people desiring elective abortions, according to interviews with seven providers across four hospital systems. Though this scenario is increasingly common statewide, it’s one arbiters of the state’s laws have yet to remedy, and one lawmakers are not publicly working to resolve."

While legislators in the General Assembly don't seem to be on the case, they have a possible excuse: The state Supreme Court is still trying to decide whether to allow abortions to resume in the state while courts consider a lawsuit challenging the "trigger law" that took effect when the U.S. Supreme Court overturned Roe v. Wade. The law made abortion illegal in Kentucky except in case of threat to the woman's life. The ruling also reactivated a law banning abortion after detection of a fetal heartbeat, about six weeks into pregnancy, before some women realize they are pregnant.

To illustrate the problem, Acquisto writes about the examples of Amy English of Louisivlle and Leah Martin of Lexington.  

Amy English (Herald-Leader photo by Ryan C. Hermens)

At her 20-week ultrasound, English learned that her fetus had acrania, the absence of a skull, which can cause anencephaly, underdevelopment of the brain. "Pregnancies with either of these conditions are nonviable," Acquisto notes. "Amy’s baby, which they learned was a boy, had both. He would not survive into childhood, likely not beyond a few minutes after birth."

Before the trigger law, such a condition would normally be treated by early induction of labor, but because the fetus had a heartbeat it couldn't be aborted. “I don’t know what was more shocking: to find out the baby had anencephaly, or that I would have to go out of state to get this care,” English told Acquisto.

English had two options: Complete the pregancy and have  Caesarean section, or have an abortion or preterm induction of labor. “No part of me wanted to be pregnant anymore,” English told Acqusto. “Every flutter and kick he gave felt like a literal gut punch reminder that I would never get to take him home.” A physical therapist, "Her patients at work often asked how far along she was. It seemed emotionally unthinkable to continue subjecting herself to a life where, at any moment, she would be forced to repeat that her growing body was nurturing a baby that wouldn’t live, she said."

Englsh's sister, a nurse anesthetist at a hospital in northern Illinois, arranged for an induced labor there. "After driving close to 400 miles, Amy was induced and gave birth to a son she and her husband named Solomon Matthew. He didn’t cry. His heart beat for about two minutes before it stopped," Acquisto writes.

Leah Martin (Herald-Leader photo by Ryan C. Hermens)

Martin, 35, learned just before 12 weeks into her pregnancy that "her fetus had triploidy, a rare condition that causes the development of 69 chromosomes per cell instead of the regular 46. It causes not only severe physical deformities, but triploidy stunts development of crucial organs, like the lungs and heart. It means a fetus, if it even survives to birth, will likely not live beyond a few days. What’s more, Leah was also diagnosed with a partial molar pregnancy, which causes atypical cells to grow in the uterus and, as Leah’s doctors told her, could lead to cancer," Acquisto reports.

"Like Amy’s, a medically necessary abortion under these circumstances would typically take place at a hospital, doctors interviewed for this story said. Leah’s health insurance had already agreed to cover it. It was also the quickest way to help Leah to her end goal: getting pregnant again in order to birth a child that would survive." But Baptist Health’s legal counsel blocked her doctors from giving her a dilation-and-curettage abortion. (English was also a Baptist Health patient.)

Martin "desperately wanted a baby, but she didn’t want to birth a child into a painful existence," Acquisto wries. "Already faced with a gutting dilemma, she felt further burdened by having such an intimate choice ripped from her. And she was furious at now being forced to remain pregnant despite there being no chance for survival, despite the risks continuing such a pregnancy posed to her own body."

Her doctor wrote her: “You’ve been on my thoughts a lot. Words cannot express the dismay I feel right now. I’ve spent my whole adult life learning how to care for mothers in heart-wrenching or dangerous situations like yours, and the politics now make it not only impossible, but to work to take care of patients like they deserve — with compassion and science — in these horrible situations is wrong and immoral.”

Martin got a abortion in Louisville in the brief window created by a Jefferson Circuit Court judge's injunction against the trigger law. A Court of Appeals judge stayed the injunction pending fiurther action in the lawsuit, which claims a right to abortion in the state constitution. The state Supreme Court took the case but delayed oral arguments until Nov. 15, a week after an election in which voters rejected a proposed constitutional amendment saying the state's foundational law has no right to abortion.

The court has yet to decide whether to reinstate the injunction. Since Nov. 15, it has gained two new justices, who may rule on the case on the basis of the written pleadings and video of the oral arguments. That could happen as early as this month.

The situtation "has created a legal thicket for health-care institutions," Acquisto writes. "As a result, the final say on some critical medical decisions affecting pregnant patients is falling not to medical experts, but to hospital attorneys and administrators, who are worried about legality, liability and reputation." Baptist Health and the hospitals at the University of Kentucky and the University of Louisville were largely unresponsive to Acquisto's questions about how they handle the issue.

Zika cases become rare, but CDC cautions travelers to maintain vigilance when traveling in infected areas

As of mid-August, only one confirmed case of locally transmitted Zika had been recorded in the continental U.S., compared to hundreds of locally transmitted cases last year, John Cohen reports for Science.

That's because Zika cases have "plummeted" in Latin America and the Caribbean, which were hit hard by the virus, and now much of their population is immune to it, Cohen writes. And that means fewer Americans are being infected while traveling and bringing it home with them, which reduces the chances of local transmissions in the U.S.

Zika is a virus that is spread primarily through the bite of an infected mosquito. It can also spread through sexual transmission and from a mother to her child during pregnancy. Click here for more information about Zika.

Infectious disease experts told Cohen that this respite could last for years.

They had expected the Zika virus, much like dengue, West Nile and yellow fever, to initially surge through the population, then decrease as people developed immunity, but "few predicted that cases would disappear so quickly," Cohen writes.

Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, told Cohen that this "herd immunity" has reduced the number of vulnerable people to the point that the virus can't easily move between humans and mosquitoes.

But caution was advised by Lyle Petersen, head of the vector-borne disease division of the Centers for Disease Control and Prevention. "Just because cases go down, it doesn't mean we should stop worrying about it," he told Cohen. "We need to maintain our vigilance."

Peterson said the decline in Zika cases doesn't lessen the need for a vaccine against the virus, but Cohen says the sharp decline in cases will make it hard to perform clinical trials for a vaccine.

The CDC cautions that anyone living in or traveling to areas with the risk of Zika should continue to protect themselves from mosquitoes, especially if you are pregnant or going to become pregnant.

Last year in the U.S., the CDC recorded 224 cases of local transmission, all in Florida and Texas, and 4,830 travel-related cases. This year, the CDC has recorded no locally transmitted cases and 213 travel-related ones, though Cohen reports that one case of locally transmitted Zika was recorded on July 26 in Hidalgo County, Texas, which borders Mexico.

"I think it's highly unlikely we will see any resumption of significant transmission for at least a decade," Neil Ferguson, a mathematical biologist at Imperial College London, told Cohen.

Biostatistician Ira Longini of the University of Florida in Gainesville disagreed. He said his models predict Zika "will still thrive in susceptible populations that have yet to be hit by the first wave of transmission, leading to 'flare-ups here and there'," Cohen writes.

The Zika virus has come to Ky. through travelers, and could spread at any time, but few people know or do much about it

This species of mosquito carries Zika.

By Melissa Patrick
Kentucky Health News

As temperatures and travel increase, so does the possible threat from the Zika virus, which can cause dangerous or even deadly birth defects, but many potential victims are uninformed and unprepared.

The best prevention for now may be vigilance by property owners against standing water where mosquitoes breed. Experts say those who travel to Zika-affected areas such as Florida and Texas should use insect repellents after they return to keep local mosquitoes from picking up the virus, which causes no symptoms in some people.

Nearly two out of five people who had traveled to an area affected by the Zika virus hadn't heard or seen any information about how to protect themselves or others from it, and even those who knew how to protect themselves didn't always do so, according to a recent poll.

A senior research scientist at the Harvard T.H. Chan School of Public Health presented the poll results at the 2017 Zika Conference in Lexington May 11. Dr. Gillian SteelFisher said the results emphasized the need for more preventive education, noting that many people don't realize that it "just takes one bite" to become infected.

A Kentucky study of 55 women of childbearing age who had traveled to Zika-affected areas found a similar need for more information, especially among Spanish-speaking women with less education under the age of 30, said Kristen Heitzinger, a Centers for Disease Control and Prevention fellow at the state Department of Public Health.

State Health Secretary Vickie Yates Brown Glisson called on the more than 400 conference attendees to go back to their communities and become "unwavering" in their efforts to get and deliver a simple, easy-to-understand message about Zika, its dangers and how to fight it.

Dr. Ardis Hoven (file photo)

State infectious disease specialist Dr. Ardis Hoven told the conference that local health departments will educate community leaders about the virus. For an 86-second audio clip of her remarks, via Stu Johnson of WEKU, click here.

"Our research tells us that not nearly enough pregnant women in particular, or those who are of the age to become pregnant, know about the Zika virus and what they should do to protect themselves and their unborn baby, or a potential unborn baby," Glisson said. "Overwhelming evidence has shown a link between Zika and dangerous birth defects that cause delayed development and sometimes even death in infants."

Zika is spread mostly by the bite of an infected mosquito, though it can also be transmitted through sex, and from a pregnant woman to her fetus. It circulates in many parts of the world where Kentuckians vacation, do mission trips or work.

So far, only Florida and Texas have had locally transmitted infections in the U.S., but Kentucky has the mosquito that is known to carry it. Click here to see the locations where Zika is a risk.

The virus can cause microcephaly, a condition where a baby's head is smaller than normal because the brain does not develop properly, and other birth defects in infants born to women infected during pregnancy.

It is also associated with adult Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks its nerves.

The most common symptoms of Zika are fever, rash, joint pain and red or burning eyes, though many who are infected have few if any symptoms, which can be so mild they go unrecognized.

There is no vaccine to prevent Zika, and no antiviral treatment for it.

According to the CDC, 5,000 cases of Zika have been identified in the U.S. and its territories including 37 in Kentucky and 1,367 in pregnant women. Among those women, 65 gave birth to babies with some type of Zika-related birth defect.

Of the 37 Kentucky cases, four were pregnant women whose children have had no complications, but are still being monitored. All the Kentucky cases were a result of travel to Zika-affected areas or through having sex with someone who had traveled to those areas.

The state health department has adopted the tag line "Dress, Drain and Defend -- to Fight the Bite Day and Night" to help Kentuckians remember to be vigilant about mosquito control:

• Dress in light-colored, long-sleeved shirts and pants;
• Drain all standing water where mosquitoes can breed, such as birdbaths, tires, buckets, gutters and anything, however small, that may act as a vessel for rainwater;
• Defend against mosquitoes with approved insect repellents for outdoor activities at all times.

Luke Mathis, the environmental health supervisor at the Lexington Fayette County Health Department, said citizens must do their part to make sure Kentucky doesn't have a Zika outbreak.

"We could work ourselves to exhaustion, we could spend every dime of money, and it would have little effect on the mosquito population," Mathis said. Instead, he said it would be more effective to "have every homeowner check out their yard for a few minutes every couple of weeks and kick over those buckets or get rid of those tires."

"We need to begin changing people's attitude to make it socially unacceptable to breed mosquitoes in and around their property," Brown said. "It's going to take decades."

The state health department has advice for those considering travel to Zika-affected areas:

• Pregnant women and their partners should not travel to Zika-affected areas;
• Consult with a health-care provider prior to travel if you are pregnant or planning to conceive;
• Couples who are planning to become pregnant should postpone conception for six months after travel to a Zika-affected area, and should discuss plans for pregnancy with their health provider
• Follow steps to prevent mosquito bites: Dress and defend!
• Wear a condom every time you have sex, including vaginal, oral and anal sex, or practice abstinence, while in a Zika-affected area.

Advice for those who have been to a Zika-affected area after they get home:

• Women who have been exposed to the virus should use condoms or abstain from sex for at least eight weeks after symptom onset or last possible exposure.
• Men who have been exposed to the virus should use condoms or abstain from sex for at least six months after symptom onset or last possible exposure.
• Male travelers with pregnant partners should wear condoms throughout the pregnancy.
• Travelers to Zika-affected areas who have symptoms within two weeks of their return to Kentucky should contact their health-care provider.
• Travelers returning from Zika-affected areas should wear mosquito repellent for three weeks after returning, so they won't infect other mosquitoes that could bite others.
• Remember that these precautions are necessary because many infected people have no symptoms.

Dr. Grayson Brown, professor of entomology at the University of Kentucky and director of the Public Health Entomology Laboratory, said many people are concerned about the safety of insecticides, but that they shouldn't be. He said "insecticide technology has changed" in the last 50 to 60 years and that products today are "nontoxic to humans and other vertebrates, but so powerful against mosquitoes."

"If we don't use them," Brown said, "the suffering is going to be absolutely enormous." He said South Florida officials averted a crisis last summer by using insecticides to kill Zika-carrying mosquitoes. Without that, there could have been "hundreds of thousands of cases, and thousands of micrcocephalic babies. . . . They avoided a serious, serious public-health crisis."

Kentucky sprays for mosquitoes each year, but Brown said the spray in mosquito trucks kills very few Zika-carrying mosquitoes, which require a different product that is hand-applied under bushes and brush.

For further information or to sign up for health alerts, visit http://healthalerts.ky.gov/zika or the CDC website at www.cdc.gov/zika. The UK College of Agriculture, Food and Environment website also offers Zika updates.

State health officials urge spring-break travelers to use caution against the Zika virus

State officials are warning spring-break travelers to take precautions against the Zika virus if they are traveling to areas where the virus has been identified. Specifically, they are encouraging travelers to take steps to prevent mosquito bites, advising against unprotected sex and warning pregnant women to not travel to these areas

“This is the time of year that universities, school districts and other organizations observe spring break and many Kentuckians will be traveling for vacation or mission and service trips,” Health Commissioner Hiram Polk said in the news release. “If that is the case, we urge you to research the area in which you’ll be traveling. If Zika has been documented in the area, make sure you take appropriate steps to prevent mosquito bites.”

Detailed information about Zika infected areas can be found on  the Centers for Disease Control and Prevention’s Travelers’ Health Website http://wwwnc.cdc.gov/travel/

Advice to avoid the Zika virus when travelling:

• Wear long-sleeved shirts and long pants. In warmer weather, wear lightweight, loose-fitting clothing that covers exposed skin. Wear socks that cover the ankles and lower legs. 
• Use  EPA-approved repellents such as DEET, picaridin, IR3535, oil of lemon eucalyptus or para-menthane-diol, or 2-undecanone. Reapply as directed.
• Apply sunscreen before insect repellent if using both. 
• Do not use insect repellents on babies under two months of age. Instead, dress your baby in clothing that covers the arms and legs, or cover crib, stroller, or carrier with mosquito netting.
• Treat clothing and gear with permethrin. Do not use permethrin directly on your skin. 
• Pregnant women should postpone travel to areas with Zika virus transmission. 

Also, if you are planning to get pregnant and are traveling to a Zika virus-affected location, you should talk to your provider before going to discuss the risk and options available, the release says.  

To keep travelers from spreading the virus when they return home, the health department reminds travelers to wear mosquito repellent for three weeks after returning, so as not to infect other mosquitoes that could bite others and to wear condoms during any sexual activity to prevent any sexual transmission of the virus.

The CDC recommends women should use condoms for at least eight weeks and men for at least six months after potential exposure, noting that those who are pregnant should use condoms throughout the pregnancy.

Increasing scientific evidence suggests a link between infection in pregnant women and infants born with birth defects such as microcephaly, a condition where the head is smaller than normal and is likely to be associated with significant nervous-system abnormalities and life-long complications.

Symptoms of the virus include fever, rash, joint pain, red inflamed eyes, or other acute symptoms, though many who are infected never show symptoms. Travelers with these symptoms should consult with their medical provider within two weeks of returning to the state. Currently there is no vaccine to prevent Zika infection.

Kentucky has had 35 confirmed cases of Zika virus, all of which involved contracting the illness while traveling to Zika-infected areas.

For further information or to sign up for health alerts visit http://healthalerts.ky.gov/zika or the CDC website at www.cdc.gov/zika. To get the CDC Zika text updates, text PLAN to 855-255-5606.  In Kentucky, follow KYHealthAlerts on Twitter or @martymosquito on Instagram.

McConnell continues to blame Democrats for lack of Zika funding, not mentioning details of what they call GOP 'poison pills'

By Al Cross
Kentucky Health News

As the Zika virus spreads in Florida, Senate Majority Leader Mitch McConnell of Kentucky continues to press his argument that Senate Democrats are responsible for the lack of funding to fight it. But as with most political arguments, the latest column he sent Kentucky newspapers left out some details.

Senate Democrats did block a bill with $1.1 billion in Zika funding, saying Republicans had added "poison pills." The one that got the most attention was a provision to prevent Planned Parenthood from receiving any funding for birth control in Puerto Rico, where there is an epidemic of the virus, which causes a serious birth defect and can be spread through sexual contact.

McConnell didn't get that specific in his column, but wrote: "Democrats continue to make a lot of excuses for their vote, but it seems apparent they’re answering to the beck and call of a third-party interest group—Planned Parenthood. The common-sense bill that Senate Republicans proposed does not prohibit funding or deny access for birth control. In fact, it would expand access to women’s health care through Medicaid, community health centers, public health departments, and hospitals rather than earmarking those resources to one controversial interest group."

Democrats also objected that the bill, primarily for military construction and veterans, did not include a provision banning display of the Confederate flag at federal veterans' cemeteries, "a ban that the House, including 84 Republicans, voted in favor of just a month earlier," Amber Phillips notes for The Washington Post. That's fewer than a third of House Republicans, and the House-Senate conference committee was dominated by Republicans on both sides. It also added restrictions on Obamacare spending and other provisions Republicans liked.

"House leaders shaped the bill so that a majority would vote for it; in a conservative House, that meant making the bill more amenable to conservatives" who don't like additional spending, Phillips writes. "The end result was a proposal Democrats said was untenable."

Meanwhile, the urgency grows. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on CBS's "Face the Nation" Sunday, "We're gonna rapidly run out of money if we don't get to real soon. . . . We're getting to that critical point very quickly."

Fauci said, however, that outbreaks of Zika are likely to be spotty. "We don't believe it's going to be widely disseminated." He said the most important thing to keep the virus in check is aggressive control of mosquitoes and the standing water where they lay eggs.

Lexington baby tests positive for Zika virus but shows no effects; later found not to be infected

UPDATE: The federal Centers for Disease Control and Prevention says further testing of the original sample shows that the infant was not infected. "These findings indicate that the infant was not exposed to the virus in the womb, as was originally thought in July," says a news release from the Lexington-Fayette County Health Department.

Read more here: http://www.kentucky.com/news/local/counties/fayette-county/article96518197.html#storylink=cpy

A baby born in Lexington showed antibodies for the Zika virus but no apparent effects of it, the Lexington-Fayette County Health Department announced Friday. It is Kentucky's 10th confirmed case of Zika, which can cause birth defects such as an abnormally small head and brain.

Health Director Kraig Humbaugh said the mother had traveled early in her pregnancy to an unspecified area known to have been affected by the virus. "Health officials say the infant's mother never described symptoms of illness," Victor Puente of WKYT-TV reports.

While the baby showed antibiodies for Zika, it showed no other evidence of the virus, and apparently fought it off, Puente reports. Humbaugh said the mother and child present no risk to public health. He said pregnant women, or those planning to become pregnant, should cancel or postpone travel to Zika-affected areas.

Congress leaves for summer without funding Zika fight; McConnell and Reid trade barbs of blame

Congress left Washington for a summer recess without providing any more money to fight the spread of the Zika virus that causes birth defects.

"In what has become a familiar ritual, Democrats and Republicans pointed the finger at each other over who is to blame. It’s a gamble by leaders in both parties that voters will hold the other side accountable for gridlock come November," report Kelsey Snell and Karoun Demirjian of The Washington Post.

President Obama had asked for $1.9 billion to fight Zika. The Senate approved a bipartisan package of $1.1 billion, but House Republicans approved only $622 million. Then Republicans in both chambers agreed on the Senate's $1.1 billion figure but added what Democrats called "poison pill" restrictions on Planned Parenthood.

Senate Democrats blocked a vote on the package, also citing what they called "ill-advised cuts to other federal health programs," the Post reports. Senate Minority Leader Harry Reid of Nevada said Majority Leader Mitch McConnell of Kentucky "has been stringing us along. He never had any intention of coming back to the negotiating table. Republicans have no desire to work with us to get a bipartisan Zika funding bill to the president – now, or any time in the future. It’s all been a charade."

Asked for a reply, McConnell's office cited a speech in which the top Republican senator said Democrats should "start worrying less about pleasing outside political groups and start worrying more about actually helping the Americans who are counting on us."

The Obama administration redirected $589 million to Zika from anti-Ebola efforts, but health officials have warned that is not enough, the Post reports.

Congress goes home for July 4 after another Zika impasse

Congress took a break for the July 4 holiday after reaching another impasse on funding to combat the Zika virus that has caused birth defects in Mexico and the Caribbean.

"Senate Democrats on Tuesday shot down a House-passed bill that would have provided $1.1 billion to fight the mosquito-borne virus, citing opposition to the measure's changes in pesticide regulations and restrictions on money for birth control," Fox News reports. The bill would also "rob Obamacare of funding, impose new restrictions on Planned Parenthood and provide some $800 million less than the Obama administration is seeking," Politico reports, and "allow the Confederate flag to fly at veterans' cemeteries."

"In the short term, Democrats are more open to criticism: After clamoring for new Zika funding for months, they are set to vote against a bill at funding levels they’ve already agreed to," Politico notes. "But given the history on legislative impasses, Democrats are betting that the majority party will be held responsible by voters."

Republicans remained firm. Senate Majority Leader Mitch McConnell of Kentucky "suggested that, barring a sudden deal, there may be no vote until the upper chamber returns in September."

Senate Democratic Leader Harry Reid of Nevada "pressed for negotiations to resume and bemoaned that both parties agreed in May to a $1.1 billion Zika bill, only for House Speaker Paul Ryan to make changes," Fox reports. "Reid argues those changes appeased the chamber’s conservative conference, but resulted in an unacceptable piece of legislation."

President Obama asked for $1.9 billion for Zika in February. "The Republicans controlling Congress instead forced the administration to redirect more than $500 million in unspent Ebola-fighting funds to combat Zika," Fox notes. After the House passed a bill with less than a third of the money Obama wanted, Republicans in the House and Senate agreed on a $1.1 billion plan with the added provisions and spending cuts to pay for it.

"Democrats particularly opposed a provision that restricts the use of $95 million worth of federal grants to provide services such as birth control to women in Puerto Rico threatened by the virus. Democrats charged that the restrictions were targeted at clinic on the island run by Planned Parenthood, a group loathed by many anti-abortion Republicans," Fox reports. "In addition to the limits on Planned Parenthood, the bill would temporarily lift Clean Water Act permitting requirements on pesticide spraying for municipalities and other large-scale users."

A lobbyist for the March of Dimes, which advocates for maternal and fetal health, told Politico that the Republican bill was “doomed from the start.” Cindy Pellegrini continued, “We have a hard time imagining an issue that could be more of an emergency than an infectious disease transmitted by mosquitoes that destroys babies’ brains in utero. The package looked like it was not designed to be successful and that was deeply troubling for us.”

Obama said Friday that a Zika vaccine could be developed in "fairly short order" once Congress enacts the funding. University of Kentucky researchers are among those working on that.

Rogers, other Republicans agree on $1.1 billion to fight Zika, but Democrats don't like where the money would come from

U.S. Rep. Hal Rogers of Somerset and other Republican leaders in Congress "are closing in on a $1.1 billion funding deal to combat the Zika virus, but Democratic leaders are threatening to oppose it over cuts to crucial health-care programs," Sarah Ferris reports for The Hill.

Rogers, the chair of the House Appropriations Committee, and his Senate counterpart, Mississippi Republican Thad Cochran, are trying to meet GOP leaders' goal to approve a Zika funding bill by the July 4 holiday recess. They "expect to finalize a deal on the long-awaited funding package sometime Wednesday evening, according to their offices," Ferris writes.

A Democratic aide told Ferris that the deal would use the Senate’s figure of $1.1 billion, more than double what the House approved, but "would use many of the controversial offsets used in the House Republicans’ bill, such as money for the Ebola virus response and programs under Obamacare. It would also include politically thorny restrictions targeting funding for women's health programs." President Obama has asked for $1.9 billion.

Senate Democrats threatened to block the bill, saying "they’ve been frozen out of the talks," Ferris reports. “There is no bipartisan 'deal' on Zika. The only 'deal' is House and Senate Republicans agreeing to launch more attacks on women's health,” Adam Jentleson, a spokesman for Senate Minority Leader Harry Reid, tweeted Wednesday. Jentleson also called the GOP proposal “deeply unserious.”

Obama asks public to tell Congress to fund the $1.9 billion Zika fight he wants; Senate passed $1.1 billion, House $622 million

The Zika funding package of Appropriations Committee Chair Hal Rogers and other House Republicans "doesn't make a lot of sense" and the somewhat larger Senate package backed by Majority Leader Mitch McConnell and a bipartisan Senate majority falls well short of what is needed, President Obama told reporters Friday.

The Senate has passed a $1.1 billion package and the House approved $622 million. Obama wants more than three times the House figure, $1.9 billion, to fight the virus that causes a serious birth defect.

"We didn’t just choose the $1.9 billion from the top of our heads," Obama said. "This was based on public-health assessments of all the work that needs to be done. And to the extent that we want to be able to feel safe and secure, and families who are of childbearing years want to feel as if they can have confidence that when they travel, when they want to start a family that this is not an issue -- to the extent that that's something that we think is important, then this is a pretty modest investment for us to get those assurances."

Obama said the House package is not only inadequate, "That money is taken from the fund that we're currently using to continue to monitor and fight against Ebola. So, effectively, there’s no new money there. All that the House has done is said, you can rob Peter to pay Paul. And given that I have, at least, pretty vivid memories of how concerned people were about Ebola, the notion that we would stop monitoring as effectively and dealing with Ebola in order to deal with Zika doesn’t make a lot of sense."

The president added, "This is something that is solvable. It is not something that we have to panic about, but it is something we have to take seriously. And if we make a modest investment on the front end, then this is going to be a problem that we don't have to deal with on the back end." He said each child who has a small brain as a result of Zika "may end up costing up to $10 million over the lifetime of that child in terms of that family providing that child the support that they need. . . .  It doesn’t take a lot of cases for you to get to $1.9 billion. Why wouldn't we want to make that investment now?"

Part of the money would go to develop a vaccine for Zika, and part of that work is going on at the University of Kentucky. "You don't get a vaccine overnight," Obama said. "You have to test it to make sure that any potential vaccine is safe. Then you have to test to make sure that it's effective. You have to conduct trials where you're testing it on a large enough bunch of people that you can make scientific determinations that it's effective. So we've got to get moving."

Obama said the Centers for Disease Control and Prevention and the National Institutes of Health are "taking pots of money from other things -- universal flu funds or Ebola funds or other funds -- just to get the thing rolling. But we have to reimburse those pots of money that have already been depleted and we have to be able to sustain the work that’s going to need to be done to finish the job. So, bottom line is, Congress . . . needs to get me a bill that has sufficient funds to do the job."

The president said that should happen before the summer congressional recess in August, "to provide confidence to the American people that we're handling this piece of business." He said the money would be insurance for young families or couples thinking about having children.

"To the extent that we're not handling this thing on the front end, we're going to have bigger problems on the back end," Obama said. "Tell your members of Congress, get on the job on this. This is something we can handle. We should have confidence in our ability to take care of it. We've got outstanding scientists and researchers who are in the process of getting this done, but they’ve got to have the support from the public in order for us to accomplish our goal."

Ky. has plan to keep Zika virus out of state, but needs your help; travelers to Zika-affected areas need to take precautions

By Melissa Patrick
Kentucky Health News

State officials launched a mosquito prevention campaign May 9 at the Kentucky State University Research Farm near Frankfort as part of the state's efforts to combat the Zika virus, with an emphasis on the need for Kentuckians to do their part at home and when they travel.

"Zika prevention is mosquito prevention," Health Secretary Vickie Yates Brown Glisson said at the news conference where she introduced the campaign, "Fight the Bite Day and Night."

To date, six cases of Zika have been confirmed in Kentucky, all in people who were infected abroad and then returned to the U.S. But Glisson said it is "very possible" that Kentucky could have a local outbreak because the state has the species of mosquito that transmits the virus.

Of the 59 mosquito species in Kentucky, only one, Aedes aegypti, a small, black mosquito that bites mostly during the day, has been confirmed as a Zika carrier, and it is "very rare," accounting for "roughly one out of every 5,000 or so mosquitoes that we catch here in Kentucky," said Grayson Brown, director of the Public Health Entomology Laboratory at the University of Kentucky. However, Brown said six or seven other species in the state could be Zika transmitters, including the state's most common monquito, Aedes albopictus, better known as the Asian tiger mosquito.

The major concern is that a Zika-infected person will return to the U.S., get bitten by a mosquito that can transmit it to the next person it bites, with the cycle continuing.

Symptoms of the virus include fever, rash, joint pain and red eyes, although about 80 percent of people who are infected with the Zika virus never show symptoms.

Those in greatest danger from the infection are women in early pregnancy. Infants born to Zika infected mothers are at high risk for microcephaly, a condition where the infants head is smaller than normal, as well as other possible severe fetal brain defects. It has also been associated with Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks its nerves, in adults. The World Health Organization has declared Zika an international health threat.

Dr. Ardis Hoven, infectious disease specialist with the Kentucky Department of Public Health, urged travelers to protect themselves from mosquitoes by using EPA-approved repellents and wearing protective clothing while in affected areas, and doing so for three weeks after returning home to prevent transmission to local mosquitoes.

"If everyone does this, it greatly reduces the risk of Zika ever getting into Kentucky's mosquito population," said Hoven, who is also chair of the World Medical Association. "We are counting on you, so please take this advice seriously."

The state has created an extensive action plan to monitor Zika infected mothers and their infants that includes a monitoring schedule, and access to many social and healthcare services as needed. The state health department has reported that one of the confirmed Zika cases in the state is a pregnant woman.

Hoven advised pregnant women to not travel at all to affected areas and specifically said, "Pregnant women should not attend the Olympics," which will be held in Rio de Janeiro in August.

Concerns about Zika in Rio prompted Amir Attaran, a professor in the School of Public Health and the School of Law at the University of Ottawa, to write a commentary for the Harvard Public Health Review, calling for the Olympic Games to either be postponed or moved to another country.

"Does it really make sense to send a half-million [Olympic tourists] into Rio, which is, to be very clear, not the fringes of the outbreak? It's the heart of the outbreak," Attaran told NPR. "But is it at the end of the day sensible to run the risk of a global epidemic of, let's face it, brain-damaged babies, when that could be avoided by simply postponing the games or moving them elsewhere?"

Attaran, whose wife is from Brazil, told NPR that while the risk is quite low for individual athletes or individual tourists, "when you multiply (that) by 500,000, the odds are extremely high that somebody will take the disease elsewhere and seed a new outbreak."

Zika can also be transmitted sexually, which has occurred about 10 times now in the United States, Hoven said.

Shelley Wood, nurse consultant for Zika at the state health department, said male travelers without symptoms should use condoms for eight weeks after departure from a Zika-affected area. Men with Zika symptoms should get tested and use condoms for six months, and male travelers with pregnant partners should wear condoms throughout the pregnancy .

Wood also said couples should take steps to prevent conception for at least eight weeks after returning from a Zika-affected area, and women should not travel to such areas eight weeks before they are trying to conceive.

State officials urged Kentuckians to be vigilant about mosquito control and reminded them to remember the "3 D" approach to decrease the risk of infection by mosquitoes:

• Drain all standing water where mosquitoes breed such as bird baths, tires, buckets and gutters
• Defend against mosquitoes with approved insect repellents at all times for outdoor activities.
• Dress in light colored long sleeved shirts and pants.

State Agriculture Commissioner Ryan Quarles announced a partnership between his Agriculture Department and the health ahency as part of its Zika prevention plan. This partnership allows health officials to mobilize "strike teams" and use Agriculture Department equipment if the state begins to have local transmissions of Zika. Typically, the Agriculture Department sprays for mosquitoes at the request of local officials or local health departments.

Hoven said, "As with all public health issues, the best form of protection is prevention, not clean-up."

The University of Kentucky College of Agriculture website has the latest updates on Zika and its spread.

Zika update: Local anti-mosquito action needed; McConnell, Rogers at center of debate over Obama's request for more funds

Mosquitoes can carry Zika. (NPR photo)

By Melissa Patrick
Kentucky Health News

While all 388 Zika virus cases confirmed in the continental U.S., including six in Kentucky, have been in people who were infected abroad and then returned to the states, a health official said on "Fox News Sunday" that it is likely the U.S. will have its own outbreak.

"It is likely we will have what is called a local outbreak," said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, Diane Bartz reports for Reuters.

Fauci said he did not expect a large number of people to become ill: "We're talking about scores of cases, dozens of cases, at most."

Dr. Ardis Hoven, infectious disease specialist for the Kentucky Department for Public Health, agreed and said the potential exists for Kentucky to have a local outbreak.

"I think it would be unreasonable for us to assume that we would not be at risk," she said in a telephone interview. "So therefore, we have to plan accordingly."

Hoven said mosquito control in the state is a "top priority," but said the bulk of this will have to happen at a local level.

She encouraged Kentuckians to talk about mosquito prevention with their friends and family and ask themselves, "What can I do in my community, in my yard, on my street to prevent mosquitoes from hatching and infecting those around me?"

Zika virus prevention strategy: Dress, Defend and Drain

The state has adopted a "3 D" approach to decrease the risk of infection by mosquitoes: Dress in light-colored long sleeved shirts and pants; Defend against mosquitoes with approved insect repellents; and Drain all standing water.

"If we can control mosquitoes in our region, we will go a long way to minimize the potential risk from infected mosquitoes," Hoven said.

The World Health Organization declared Zika a global health emergency in February. Those who have traveled to affected areas, such as Central and South America, are at the highest risk of contracting the virus, which is spread primarily by infected Aedes aegypti mosquito. It can also be spread through sexual intercourse. Aedes aegypti can be found in about 30 U.S. states, including Kentucky.

Zika virus is especially dangerous to pregnant women because it has been linked to thousands of cases of microcephaly, a condition where the infants head is smaller than normal, as well as other severe fetal brain defects, according to the federal Centers for Disease Control and Prevention. The state health department has reported that one of the confirmed Zika cases in the state is a pregnant woman.

The CDC is investigating the link between Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks its nerves. And Fauci said there could be other neurological conditions caused by Zika that affect adults, Bartz reports.

"There are only individual case reports of significant neurological damage to people, not just the fetuses, but an adult that would get infected. Things that they call meningoencephalitis, which is an inflammation of the brain and the covering around the brain, spinal cord damage due to what we call myelitis," Fauci said. "So far they look unusual, but at least we've seen them and that's concerning."

Common symptoms of the virus are fever, rash, joint pain and red eyes, with symptoms lasting for about a week, though many with the virus have no symptoms. Currently there is no vaccine for Zika.

Funding to fight Zika held up in Congress

In February, President Obama asked Congress for an additional $1.9 billion in emergency funds to fight the Zika virus, including funds to develop a vaccine. This is in addition to $589 million in previously appropriated funds that have already been transferred to the effort.

That money should last through Sept. 30, the end of the federal fiscal year, but "There's going to need to be additional money, I don't think there's any doubt about that," Rep. Tom Cole, R-Okla., who chairs the House health appropriations subcommittee, told Susan Cornwell of Reuters April 13.

Top senators from both parties said "they are getting close to a deal to provide at least some emergency funding to fight the Zika virus, making it likely that the Senate will move ahead on the issue without waiting for the House," David Nather writes for STAT, an online health journal.

Senate Majority Leader Mitch McConnell, R-Ky., said at a news conference April 19 that congressional Republicans were working with the administration on the funding details, Peter Sullivan reports for The Hill.

“We're working with them on it to figure out exactly the right amount of money,” McConnell said at a press conference. “You know, how is it going to be spent? And I don't think, in the end, there will be any opposition to addressing what we think is going to be a fairly significant public health crisis."

Nevertheless, House Republicans kept saying they don't have enough information to approve the request.

On April 20, House Appropriations Committee Chairman Hal Rogers, R-Ky., said the Obama administration “continues to delay response efforts by refusing to provide basic budgetary information to Congress on their Zika funding request. This includes not answering our most basic question: ‘What is needed, right now, over the next 5 months in fiscal year 2016, to fight this disease?’ In the absence of this information, the House Appropriations Committee will work with our colleagues in the House and the Senate to make our own determinations on what is needed and when, and to provide the funding that we believe is necessary and responsible.”

Five days earlier, White House Press Secretary Josh Earnest said Republicans have all the information they need to move forward, ABC reports. He said, “They've had ample opportunity to collect information, to ask questions of senior administration officials, to read letters, to read the legislative proposal that was put forward by the administration.” 

First case of Zika confirmed in Ky., from traveler to Central America; no threat to Kentuckians unless they visit affected areas

By Melissa Patrick
Kentucky Health News

After the first case of Zika was confirmed in Kentucky March 9, health officials held a news conference at the Capitol to raise awareness of the virus, noting that the state was coming up on the spring travel season.

Mosquitoes carry Zika. (CNN image)

Gov. Matt Bevin, Health Secretary Vickie Yates Brown Glisson and Dr. Kraig Humbaugh, senior deputy commissioner of the Department for Public Health, emphasized that only those who have traveled to affected areas, like Central and South America, need to worry about contracting the virus, which is commonly transmitted through mosquitoes.

"Many areas, including most of our surrounding states, are reporting Zika cases," Humbaugh said in the news release. "For now, these positive results have only occurred in individuals who have traveled outside the country to places where the virus is currently spreading."

The infected male patient in Kentucky had recently returned to Louisville from Central America. Humbaugh said he presented with signs of fever and rash, which a "very astute" health-care provider suspected as symptoms of Zika.

Common symptoms of the virus are fever, rash, joint pain and red eyes,with symptoms lasting for about a week, according to the U.S. Centers for Disease Control and Prevention. Although many with the virus will not show symptoms, Humbaugh said.

Health officials stressed that Kentucky is not at risk, but said the state has a plan in case the Zika virus spreads. Glisson encouraged health-care providers to be alert to the symptoms of the virus.

She also noted that the Cabinet for Health and Family Services was partnering with Kentucky Emergency Management and the Kentucky Department of Agriculture to increase the monitoring and control of the state's mosquito population this year.

The CDC recommends that pregnant women or those trying to become pregnant postpone travel to affected areas. However, if they must travel to one of these areas, the CDC asks them to talk to their healthcare provider before they leave and strictly follow steps to avoid mosquito bites during the trip.

Humbaugh noted that increasing evidence has found a link between infection in pregnant women and infants born with microcephaly, a condition where the infants head is smaller than normal, which can lead to a variety of other health challenges.

The Washington Post reports that the Zika virus has "growing links to a broad array of birth defects and neurological disorders ... worse than they originally suspected, increasing the risk for devastating harm during pregnancy."

Until Zika, "there has never been a mosquito-borne virus that could cause serious birth deffects on such a large scale," CDC Director Thomas Frieden told reporters.

There is no vaccine or treatment for Zika.  The virus can also be spread through sexual intercourse, and it is still unknown how long the virus stays in semen, Humbaugh said.

Kentucky has at least one mosquito known to transmit Zika.

“We do have Aedes aegypti, but  they are a very small populations, from what I understand from our mosquito experts,” Humbaugh said. “Our entomologists at the University of Kentucky have been advising us on this particular area. However, we have other types of mosquitoes that may be what they call competent vectors. In other words they may be able to spread the disease, but at this point that hasn’t been shown that these other mosquito types are competent vectors.”

Humbaugh encouraged Kentuckians to take normal precautions to limit exposure to mosquitoes like using approved insect repellents, wearing long sleeves and pants when outdoors, to stay inside during dawn and dusk when mosquitoes are most active, minimize standing water and screening windows.

More information about Zika can be obtained from the department's Health Alerts website at http://healthalerts.ky.gov/Pages/Zika.aspx. For a full list of affected countries and regions visit http://www.cdc.gov/zika/geo/index.html.

Zika virus, which can cause small heads and brains in newborns, will get to Kentucky, but experts disagree on its likely impact

The Zika virus that has been linked to birth defects (abnormally small heads and brains in newborns) is exploding in South America and will eventually show up in Kentucky, but its impact in the state is hard to predict.

The virus, for which there is no cure or vaccine, "seems destined to reach the United States, and probably sooner rather than later," Lena H. Sun and Brady Dennis report for The Washington Post. "What is far less certain, say public health and infectious disease experts, is Zika’s potential reach and impact here. The South is seen as especially vulnerable because of its warm, humid climate and pockets of poverty where more people live without air conditioning or proper window screens. Plus, the region is already home to mosquitoes that can transmit the virus."

The mosquito of main concern, the Asian tiger mosquito, has been reported many times in Kentucky; one of potential concern, the yellow-fever mosquito, has been reported in Indiana.

Washington Post graphic emendated by Kentucky Health News

"Nearly three dozen cases have been confirmed to date in 11 states and the District of Columbia," but the federal Centers for Disease Control and Prevention "acknowledges that the number is growing rapidly," the Post notes. "In each, the person was believed to have been infected while out of the country." The CDC has extended its travel warning northward to the Caribbean.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, "is playing down the potential for a significant eruption of Zika here," the Post reports. "He notes that dengue and chikungunya, diseases transmitted by the same kinds of mosquitoes, are widespread in Latin America, but their foothold in the United States has been controlled, with only small clusters of cases."

However, Peter Hotez, dean of the National School of Tropical Medicine at Baylor University in Waco, Texas, told the Post, “I think we’re in for real trouble in the United States,” because Zika can spread quickly. "He focuses on conditions throughout the Gulf Coast, where stagnant water sources — in uncollected garbage, discarded tires, untended bird baths — can be ideal breeding grounds for mosquitoes much of the year."

January is National Birth Defects Prevention Month; here are some lifestyle tips to help avoid them

Kentucky's Department of Public Health is working to raise awareness to help prevent birth defects this January during National Birth Defects Prevention Month, an issue that affects about 7,000 Kentucky babies each year, according to a Cabinet for Health and Family Services news release.

"Women can increase their chances of having a healthy baby by managing health conditions and adopting these healthy behaviors before becoming pregnant,"Dr. Ruth Shepherd, director of the Department of Public Health Division of Maternal and Child Health, said in the news release.

Every four and a half minutes in the United States, a baby is born with a birth defect, according to the federal Centers for Disease Control and Prevention. Nationally, about 120,000 babies are affected by birth defects each year.

While some birth defects are inevitable, research shows that many can be prevented with the adoption of healthy habits and lifestyle choices prior to pregnancy.

This understanding has prompted this year's National Birth Defects Prevention campaign, which calls for women who are pregnant or are planning to become pregnant to follow the following four steps, or make a "PACT," to increase their chances of having a healthy baby:

• Plan ahead. Get as healthy as possible before becoming pregnant and take 400 micrograms (mcg) of folic acid every day.
• Avoid harmful substances. Don't drink alcohol or smoke and be careful with harmful exposure to chemicals or noxious substances at work and home.
• Choose a healthy lifestyle. Primarily eat fruits, vegetables, whole grains, low-fat dairy, lean proteins, and healthy fats and oils. Be physically active and make sure you manage any chronic conditions, like diabetes and high blood pressure.
• Talk to your health care provider. Make sure to share a complete family medical history with your provider, including any medications that you take. 

In addition to these efforts, "Public awareness, expert medical care, accurate and early diagnosis, and social support systems are all essential for optimal prevention and treatment of these sometimes deadly conditions," says the release. To learn more, please contact Kentucky's Birth Surveillance Registry Program at 502-564-4830 ext. 4394 or click here.

As session nears end, bills on heroin, dating-violence orders, managed-care appeals and lawsuit review panels are hanging fire

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The General Assembly has sent Gov. Steve Beshear four health-related bills, and several more could reach his desk in the legislative session that ends Wednesday. Legislators will return briefly after 10 days to reconsider any bills Beshear vetoes; they could also pass more bills, but would not be able to override any vetoes.

Here are some of the health-related bills that were pending on Monday; bills with two readings are ready for floor action.

Heroin: tougher penalties and needle exchanges?

Both the Senate and the House have heroin bills and both remain in committee in the other chamber, but hope remains high in both chambers that a compromise can be reached so that a heroin bill will pass this session. Senate Bill 5 is sponsored by Sen. Christian McDaniel, R-Latonia; House Bill 213 is sponsored by Rep. John Tilley. The main differences are how traffickers would be punished and whether to start needle-exchange programs for addicts. The Senate's penalties are tougher and it has opposed needle exchanges, which advocates say prevent disease and death from dirty needles and can lead addicts to treatment.

Now the Senate is moving toward accepting needle exchanges, James Pilcher reports for The Cincinnati Enquirer. Rep. Dennis Keene, D-Wilder, and Sen. Wil Schroder, R-Wilder, said exchanges "are much more likely to be included than when the session started," Pilcher writes. Schroeder told him, "I think there is a real possibility that we could include needle exchanges and then get our tougher penalties." Pilcher reports, "The possible legislative position shift comes as health officials throughout the Tristate have expressed deep concerns about the spread of diseases that can be contracted using dirty needles."

Protective orders for dating violence

House Bill 8, sponsored by Rep. John Tilley, D-Hopkinsville, has received its second reading and is awaiting passage in the Senate. This bill would allow dating partners to petition for interpersonal protective orders if they have been the victim of domestic violence, sexual abuse or stalking. Such orders are now available only to those who are married, live together or have lived together, or an unmarried couple with a child in common.

Kentucky is the only state that offers no protection for such victims. Legislation to do that has stalled in the Senate in earlier sessions, but a Senate committee substitute addresses a key objection, by creating a new chapter in the statutes for the bill, separate from the existing domestic-violence chapter.

Advocates say domestic violence is a health issue not just because of the physical injuries it causes. They say victims are more likely to be depressed, have unplanned and premature pregnancies, go to fewer prenatal visits, and to miss more well-child visits with their children.

Prescription synchronization, managed-care appeals

Senate Bill 44, sponsored by Sen. Julie Raque Adams, R-Louisville, has had its second reading in the House. This bill would allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

House Majority Caucus Chair Johnny Bell, D-Glasgow, has filed a floor amendment on an unrelated issue, to create a state appeals process for health-care providers to appeal decisions of Medicaid managed-care companies. It is the same as or similar to Senate Bill 120, sponsored by Sen. Ralph Alvarado, which has given it a first reading without assigning it to a committee. The Cabinet for Health and Family Services opposes a state appeals process, saying it would have a conflict of interest (successful appeals would cost the state money) and providers have the courts available to them to resolve contractual issues. UPDATE: Bell withdrew his floor amendment to Senate Bill 44 March 9. 

Review panels for suits against health-care providers: Senate Bill 6, filed by Alvarado, remains in the House Judiciary Committee, but a discharge petition was filed March 4 to bring it to the floor, bypassing leaders of the House's Democratic majority. This bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court, but not legally binding. Opponents say that Kentucky already has laws to punish attorneys for filing frivolous cases and that this just adds another barrier for patients seeking justice.

Newborn screenings for fatal disease: Senate Bill 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, has had two readings. It would require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur. Treatment with stem cells from an umbilical cord blood transplant is sometimes successful it the infant is treated early enough. The cabinet opposes the bill, saying the screening will cost half a million dollars a year at a time when local health departments are suffering budget cuts.

Spina bifida: Senate Bill 159, sponsored by Sen. Julie Raque Adams, R-Louisville, is in the House and the three-day posting rule has been waived. This bill would require medical providers to supply written, up to date, accurate information to parents when their unborn child is diagnosed with spina bifida so parents can make informed decisions on treatment

Physician assistants: House Bill 258, sponsored by Rep. Denver Butler, D-Louisville, is awaiting Senate passage. This bill allows a physician to supervise up to four physician assistants at the same time, rather than two.

In-home care: House Bill 144, sponsored by Rep. Tom Burch, D-Louisville, is awaiting Senate passage. It would establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services. The daily cost would have to be less than the average daily nursing home payment allowed by Medicaid. The bill would also provide non-medical support services to the applicant as needed.

BILLS SENT TO THE GOVERNOR

Colorectal cancer screening: Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, received final passage in the House March 4. This bill requires that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The bill would apply to health plans issued or renewed on or after Jan. 1, 2016, if it becomes law. A similar measure, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, is awaiting passage in the Senate with a committee substitute by Sen. Julian Carroll, D-Frankfort, calling for a Medicaid savings study.

Medical order scope of  treatment (MOST) form: Senate Bill 77, sponsored by Sen. Tom Buford, R-Nicholasville, received final passage in the House March 3. This bill creates a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care. It is considered a physician's order, travels with the patient between health care facilities, and must be reviewed annually. The bill clearly defines the order of controlling documents for end-of-life care: the living will first, the MOST form second and the health-care surrogate, which is chosen by the patient and listed on the form, third. The MOST form is already used in 32 states.

Emergency care for strokes: Senate Bill 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, received final passage in the House March 4. The bill requires that a list of all acute stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky be posted to the cabinet's website and be made available to all emergency medical services providers, who are required to set their own internal protocols toward assessment, treatment and transport of stroke patients.

Funding for UK cancer research center: House Bill 298, sponsored by Rep. Rick Rand, D-Bedford, received final passage in the Senate March 4. This bill authorizes the state to appropriate $132.5 million, half of the cost, for construction of a new medical research center at the University of Kentucky. The university will raise money to cover the other half. The facility will target prevalent diseases in Kentucky, including cancer, diabetes and cardiovascular disease. The bill required a 60 percent vote in each chamber because it affects the state budget and the legislature is in a non-budget session; it passed the House 83-9 and the Senate 36-1 (Sen. John Schickel, R-Union).

Attorney general says UK should hand over records on children's heart surgeries, which have been suspended pending review

Attorney General Jack Conway has ruled that the University of Kentucky hospital violated the state Open Records Act by refusing to give a reporter for the university-owned radio station records relating to the work of the chief of cardiothoracic surgery, who has stopped doing surgery on children. UK refused to let Conway's staff examine the records to evaluate UK's claimed need for confidentiality.

After inquiries by Brenna Angel of WUKY, "UK announced that the hospital had stopped performing pediatric cardiothoracic surgeries pending an internal review," John Cheves writes for the Lexington Herald-Leader. Angel reports that she sought records on Dr. Mark Plunkett, left, who was also director of the pediatric and congenital heart program: "the date of Plunkett’s last surgery, the mortality rate of pediatric heart surgery cases, and documentation related to the program’s review." She sought no patient-specific information.

UK denied her request, citing the federal Health Insurance Portability and Accountability Act and arguing that release of the information could lead to the identification of one or more patients because Plunkett was doing so few surgeries on children. It also cited HIPAA in refusing to let Conway's staff review the records. Conway rejected that argument, noting that HIPAA does not supersede state laws and even make allowances for them.

Because it deals with the Open Records Act, Conway's decision has the force of law. UK can appeal the decision to circuit court within 30 days of March 27, the date of the decision. "UK spokesman Jay Blanton says officials are considering whether to file an appeal," Angel reports. The decision was publicly released Monday, the same day UK held a press conference about "the progress UK Healthcare has made in cardiology," she notes. "Yet the pediatric cardiothoracic surgery program remains under review, and patients from Central and Eastern Kentucky are being referred to hospitals out of state. Dr. Mark Plunkett remains on staff."

When Angel asked Dr. Michael Karpf, UK's executive vice president for health affairs, to comment, he replied, “We’ll have something to say about that in a little while.” Cheves notes, "UK recruited Plunkett, a noted surgeon at the University of California at Los Angeles, in 2007 to strengthen its pediatric heart program. He makes $700,000 a year, one of the highest salaries at UK." (Read more)

Read more here: http://www.kentucky.com/2013/04/01/2582150/uk-violated-open-records-law-in.html#storylink=cpy

Read more herehttp://www.kentucky.com/2013/04/01/2582150/uk-violated-open-records-law-in.html#storylink=cpy

Study indicates risk of fatal birth defects is higher in counties with mountaintop-removal coal mining

"Children born in counties home to mountaintop coal mines had a 26 percent higher risk of suffering" a fatal birth defect "compared to ones born in non-mining regions," according to a new study, Dan Vergano of USA Today reports. The study, led by health economist Melissa Ahern of Washington State University in Spokane, will appear in the upcoming Environmental Research Journal. (Map shows counties with coal mines in 1996-2003, with "mountaintop" mining counties in darker gray)
Air and water pollution from mountaintop mining led Ahern and her colleagues "to look for health effects on infants" in West Virginia, Kentucky, Tennessee, and Virginia, Vergano writes. The researchers found birth defects in mountaintop mining areas were elevated above non-mining areas in six of seven categories, including heart, lung and gastrointestinal. Because of an already established connection between poverty and birth defects, the researchers then "controlled for social factors such as smoking, drinking, mother's education, race and other poverty-related factors" and found a 26 percent increased risk of fatal birth defects in mountaintop-mining counties, Vergano reports.

A spokesman for the National Mining Association "suggested adding more demographic factors to the study might remove the elevated birth defects," Vergano writes, then quotes environmental and pediatric-health expert Lynn Goldman of George Washington University as saying "It isn't proof of cause and effect" and paraphrases her: "Because the study is the first of its kind, public health researchers will need to reproduce the study results to feel confident it has uncovered a real link, she cautions. Further studies will be needed to show how exposures in mountaintop mining communities could lead to more birth defects." (Read more)