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.”

Boyle County named Kentucky's first Recovery Ready Community

Boyle County Judge-Executive Trille Bottom accepts the Recovery
Ready Community certificate from Gov. Andy Beshear. (Screenshot)

Boyle County is Kentucky's first Recovery Ready Community, a designation that reflects commitment to providing residents with access to addiction treatment and recovery support and removing barriers to the workforce. Applications for the designation opened in January.

The certification is designed to encourage communities to provide transportation to and from employment services and job interviews, allowing people to make positive changes while filling the state's need for workers at a time of record-low unemployment, said a news release from Gov. Andy Beshear.

“Boyle County has set a strong precedent that can serve as a model for the rest of Kentucky’s communities,” Beshear said in the release. “I continue to encourage each of the commonwealth’s counties and communities to apply for certification. If we work together to build a safer, healthier commonwealth, we can rise above drug and alcohol addiction in our state once and for all.”

Beshear said at his weekly press briefing that more communities are soon to follow. He was joined at the announcement by several leaders from Danville and Boyle County. Their efforts include free training for overdose response and Narcan distribution, hiring a social worker as an opioid-outreach coordinator to make EMS runs involving suspected overdoses to connect the individuals with treatment, counseling and other addiction support services.

Boyle County (Wikipedia map)

“When we came face to face with the effects of the opioid crisis on our families, institutions and workforce, we got to work to be informed, responsive and proactive,” Judge-Executive Trille L. Bottom said in the release. “We started a harm-reduction syringe-exchange program. We took a hard look at our jail becoming a place of rehabilitation. We encouraged new treatment and transitional living providers to come to Boyle County, and we trained a lot of citizens in saving lives from overdoses.”

Pam Darnall, chair of the state Recovery Ready Communities Advisory Council, which apprpoved the designation, said “We are inspired by Boyle County’s commitment to continue strengthening its local recovery-oriented system of care through persistent cross-agency collaboration and a willingness to try innovative programs and interventions aimed at increasing positive public health and safety outcomes.”

To learn more about the program and apply for certification as a Recovery Ready Community, click here.

Northern Kentucky jail offers treatment and care after release as part of drug treatment for inmates who want it

Photo: Liz Dufour/The Enquirer

A jail in Northern Kentucky has embraced science-based research for inmates with addiction for inmates who want it since 2015, and now that program includes care after release, Terry DeMio reports for the Cincinnati Enquirer.

DeMio walks through what the Kenton County Detention Center in Independence offers inmates, while regularly reminding readers that while the program is not what standard incarceration looks like, "It is still a jail." 

"But it is rare for jails and prisons in the United States to offer a full continuum of treatment for inmates with addiction, and especially, to include medication – even though it is the standard of care," she writes. 

In 2015, the detention center hired Jason Merrick, a certified drug and alcohol addiction counselor with degrees in social work who was in recovery himself to a newly created role: addiction services director. Merrick designed the program around what addiction specialist consider best practices, DeMio reports. 

In 2018, the jail partnered with Hazelden Betty Ford Foundation in a program called Strong Start Comprehensive Opioid Response with 12 Steps and Reentry, which includes three months of treatment that includes opioid-use disorder medications, followed by three months of aftercare. 

DeMio reports that it appears to be working. Only 24% of those who completed both the jail and aftercare program have been rearrested and jailed after three years, said John Clancy, director of strategic partnerships at the Life Learning Center, a focal point of the aftercare program. That compares to 68% recidivism after three years nationally, according to the Department of Justice.

The program, which is voluntary, has evolved to include two deputy/counselors, two re-entry specialists, a population management specialist and three social-work interns from Northern Kentucky University.

The staff makeup is just what people with substance-use disorder need, says Lindsey Vuolo, vice president of health law and policy for the Partnership to End Addiction, a national nonprofit dedicated to transforming how the United States addresses addiction.

“It is really important for jails and prisons to include medical professionals and individuals with lived experiences when designing this type of program,” Vuolo told DeMio, citing research from the National Council for Behavioral Health.

And all along, the University of Kentucky Center on Drug and Alcohol Research tracks and evaluates the Kenton County treatment plan, DeMio reports.

DeMio reports how the Life Learning Center in Covington, which offers the aftercare, helps the former inmates. She notes that it offers a range of services that include helping the former inmates connect with health care providers who offer medication assisted therapies to providing job-readiness skills and job-finding help. 

She also notes that the center helps the former inmates find appropriate clothing for work, offers childcare, helps them find affordable dental care and offers an on-site location that will remove their tattoos for free. 

DeMio also walks through how the program is funded and how officials say it ultimately saves taxpayers money. 

She writes, "Here's how: A year of incarceration costs about $24,000 for one person. Almost every inmate in the treatment program is spared a conviction likely to yield an 18-month jail sentence. The inmate is jailed instead for 90 days – which yields 15 months not served. That 15 months would cost $30,000 if served in jail. Merrick's records show that about 450 graduates have gone through women's and men's programs each year. That's $13.5 million saved every year, he says. Beyond that: Without evidence-based treatment in jail, it's likely inmates with opioid use disorder will relapse after release. And if they don't overdose and die, it's likely they'll be arrested again and return for more jail stays." 

For Bethany Ball, associate director of Addiction Services, and her staff, it's not just about the dollars, DeMio reports.

"We are trying to address the areas that we see people struggling with consistently, especially those that aren’t always addressed: culture, mental health, trauma, childhood trauma," Ball told DeMio. "We are committed to not just saving lives, but helping to show that there is a life worth living and they are worthy of that life."

Vaccinations may come to Kentucky state prisons next week, after an increasing number of questions about why it took so long

By Bruce Maples and Al Cross
Kentucky Health News

As the state's coronavirus vaccination program has gradually expanded, so have questions about the very limited vaccinations of inmates in the state's prisons. Questions have been raised recently by families of inmates, their advocates, the news media and state legislators.

During his press briefing Wednesday, Gov. Andy Beshear noted the questions and announced that the state was expecting to offer the vaccine to all state inmates next week, a week earlier than first suggested, with the only exceptions being two facilities still recovering from Covid-19 outbreaks.

Beshear credited that to an earlier-than-expected shipment of the Johnson & Johnson one-shot vaccine, to come Friday or Monday, April 2 or 5. The state is using the one-dose vaccine for inmates so they don't have to follow up with those who might have been released to get their second shot.

After Beshear's briefing, The New York Times reported that a factory mixup had led to a halt in shipments of the Johnson & Johnson vaccine, which could delay the prison vaccinations.

Kentucky has one of the nation's highest incarceration rates, so many of its jails and prisons are overcrowded, many jails extremely so. Add that to normal confinement, in which people are often in close contact for meals and other activities, and you have an almost ideal setting for a virus to spread.

The state has the third-highest death rate among state prisoners from Covid-19, and the third highest rate of coronavirus cases, according to The Marshall Project, a nonprofit news organization that deals with criminal-justice issues and has tracked prison cases and deaths during the pandemic.

State Sen. Robin Webb

A longtime state legislator and criminal-defense lawyer said Tuesday the state needs to vaccinate inmates in prisons and jails as soon as possible.

As she voted to spend millions of dollars in federal relief, including $30 million for county jails, Sen. Robin Webb, D-Grayson, told other members of the Senate Appropriations and Revenue Committee, "The best thing we can do for the jails and people in them are to get vaccinations to the inmates; I don’t understand why that’s not been mandated."

Told afterward that helping people behind bars is not politically popular among some voters, Webb said, "This is Holy Week. I don't think that’s the way Jesus would look at it, or the way we’re supposed to be looking at it."

She's taking it personally: "I'm not getting a vaccination until the inmates are vaccinated. . . . People who don’t have a choice where they're going should have been a priority."

Webb said vaccinations are critical in prisons and jails because inmates are more likely to have underlying health issues. Among prisoners, "We have grave health problems with the use of needles, blood-borne disease, people needing dialysis," she said.

"If you're not into the humanitarian side, let's look at the fiscal side," she said. Long-term, "We’re gonna be spending a lot more money on these populations than the vaccine costs."

Also, she said the situation makes it even more difficult to recruit corrections workers: "How are we gonna recruit officers? They were busing 'em to LaGrange last year from my area" in northeastern Kentucky.

Asked if she had discussed the issue with the Beshear administration, she said Justice Secretary Mary Noble "was very responsive. … I know her heart's in the right place when it comes to these issues." Noble appeared at some of Beshear's early pandemic briefings to discuss prison cases, but hat task has since been handled by J. Michael Brown, secretary of the Executive Cabinet and a former justice secretary.

Early in the pandemic, Beshear tried to reduce risk in state prisons by releasing almost 1,900 older, nonviolent offenders who were nearing the end of their sentences. 

The state has prioritized vaccination of employees in prisons, but only last week did it say it would start vaccinating inmates, starting this week with those over 70. Many employees have been unwilling to be vaccinated; on Monday, the Corrections Department said 1,845 employees and contractors have received a shot, and another 338 were pending, for total of 2,193. That is barely half of the agency's 4,288 employees and contractors.

Several prisons have had serious Covid-19 outbreaks, most recently at the Kentucky State Penitentiary and the Western Kentucky Correctional Complex, both in Lyon County. Those two prisons will not be included in next week's vaccinations, and will join in when it is medically safe, Beshear said.

The infection rate at individual prisons is hard to pin down. Inmates come and go from facilities, so the total number who have been incarcerated during the pandemic is greater than the current population.

Some reported case numbers are striking. In some cases, as much as 70% of the population in a state prison has tested positive for the coronavirus.

The Northpoint Training Center near Burgin had an average daily population in 2019 of 1,252 inmates and 337 staff, for a total population of 1,589. The latest Corrections Department report shows it has reported 1,040 cases.

Or take the Correctional Institute for Women near Pewee Valley. Its average daily population was 215 inmates and 174 staff in the 2019 annual report, for a total average population of 399. In the latest DOC report, 470 cases have been reported since the pandemic started.

In correctional facilities run by the state, with a population of 11,674 inmates and 3,100 staff as of 2019, there have been 9,275 cases, according to the Corrections Department: Bell County Forestry Camp, 217; Blackburn Correctional Complex, Lexington, 266; Eastern Kentucky Correctional Complex, West Liberty, 1,343; Green River Correctional Complex, Central City, 440; Kentucky Correctional Institute for Women, 470; Kentucky State Penitentiary, 1,082; Kentucky State Reformatory, LaGrange, 620; Lee Adjustment Center, 764; Little Sandy Correctional Complex, 635; Luther Luckett Correctional Complex, LaGrange, 1,089; Northpoint Training Center, 1040; Roederer Correctional Complex, LaGrange, 778; Southeast State Correctional Complex, Wheelwright, 95; and Western Kentucky Correctional Complex, 436.

The New York Times reports that in federal prisons in Kentucky, which have 6,123 beds, there have been 2,586 cases of Covid-19, led by the Federal Medical Center in Lexington, with 843. Others: Federal Correctional Institution Manchester, 765; FCI Ashland, 434; United States Penitentiary McCreary, Pine Knot, 282; and USP Big Sandy, Inez, 262.

In local jails, there have been 3,678 cases among those with more than 50 cases, according to the Times: Lexington, 708; Louisville, 547; Warren County, 351; Boyd County, 276; Marion County, 213; Daviess County, 192; Boyle County, 134; Barren County, 132; Hart County, 115; Franklin County, 113; LaRue County, 111; Kenton County, 110; Bourbon County, 101; Powell County, 88; Butler County, 80; Clay County, 80; Wayne County, 75; Madison County, 72; Nelson County, 70; Carroll County, 57; and Simpson County, 53.

N.E. Ky. Substance Use Response Coalition gets national award after winning $1 million grant to help newly released inmates

The Northeast Kentucky Substance Use Response Coalition has been named the Outstanding Rural Health Program of 2021 by the National Rural Health Association as part of its annual Rural Health Awards, given to individuals and organizations in rural health care who have "dedicated their time and talents to improving the health and well-being of others," NRHA says.

Founded in 2018, NKSURC is a formal network of health care and social service organizations that represents 18 counties and is focused on building a community-based approach to address the region’s opioid crisis. The organization aims to create educational, clinical, and preventive interventions for those who struggle with substance use disorder.

The Coalition's activities have included: expanding/implementing medication-assisted treatment of opioid use disorder within four rural health clinics; establishing a series of MAT trainings and a MAT mentorship program for local health care providers; delivering prevention education presentations to hundreds of young students; distributing naloxone (an opioid overdose-reversing medication) and training community members on its use; and creating a jail reentry program called First Day Forward, which pairs incarcerated individuals with a trusted peer recovery support specialist for in-jail programming and post-release linkages to treatment and recovery resources.

Coalition members include St. Claire HealthCare in Morehead and its hosted Northeast Kentucky Area Health Education Center (AHEC), Achieving Recovery Together, the Clark County Health Department, Comprehend Inc., the Gateway District Health Department, the Kentucky Rural Healthcare Information Organization, Pathways Inc. and Tri-State Primary Care.

"We are extremely honored to accept this award," said KaLeigh Hemminger, the Northeast Kentucky AHEC’s outreach services coordinator and director of the Coalition. "When it comes to the work we do, we have a saying within our Coalition: 'if we can reach just one person, help one person, this is all worth it.' To know our efforts are now being recognized on a national scale, and that other health care organizations may observe and model the types of programming we do, that adds another level to the impact we can have in addressing this epidemic."

Pandemic keeps waning, but Ky. new-case rate ranks 6th; positive test rate falls under 8%; hospital numbers best in nearly 2 months

Screenshot of New York Times interactive map (available here), with line about Kentucky added.

By Al Cross
Kentucky Health News

Every major measure of the pandemic in Kentucky declined Sunday, from new cases to hospital figures to deaths.

It was the end of the state's Monday-to-Sunday reporting week, which was the fourth straight week with fewer cases, Gov. Andy Beshear said on social media.

Final numbers will be reported Monday, but there were a total 14,949 cases on the state's initial, unadjusted, daily reports. That was almost as low as the week that ended Dec. 27, just before a post-holiday surge.

The seven-day rolling average of new cases is 2,136 per day. It has declined every day but four since reaching a high of 4,002 on Jan. 10.

But new cases are declining nationwide, so Kentucky remained among the top states in new cases per person, ranking sixth in a New York Times compilation. It was fifth on Saturday. The list is led by South Carolina, followed by Arkansas, North Carolina, Oklahoma and Texas.

Another sign of a waning pandemic was the percentage of Kentuckians testing positive for the novel coronavirus in the last seven days: 7.97%, the first time it has been below 8% since Nov. 10.

The state recorded 31 more deaths from the virus's Covid-19 disease, 29 confirmed and two probable. Deaths are listed after a review process that can take weeks. The two-week average stands at 45 per day, just below the record 45.3 average of Friday and Saturday.

 

Kentucky hospitals reported 1,235 Covid-19 patients, 290 of them in intensive-care units, and 140 ICU patients on ventilators. All those figures were the fewest since Nov. 10.

Three of the 10 hospital-readiness regions reported their ICU beds more than 80% full, but two just barely. The east and northeast were at 81% and Lake Cumberland, usually the fullest, was at 93%.

The state's case-incidence rate fell again, to 41.9 per 100,000 population in the last seven days. Counties above 60 on the state's daily report were Allen, 83.1; Webster, 76.2; Butler, 72.1; Washington, 72; Daviess, 71.9; Madison, 67.9; McCreary, 63.8; Nelson, 61.2; and Ohio, 60.7.

Counties with 10 or more new cases Sunday were Jefferson, 245; Fayette, 130; Kenton, 84; Daviess, 70; Boone, 65; Madison, 37; Hardin, 36; Warren, 36; Jessamine, 30; Nelson, 29; McCracken, 27; Ohio, 27; Shelby, 26; Boyd, 24; Campbell, 23; Barren, 22; Bullitt, 20; Scott, 20; Henderson, Logan and Muhlenberg, 18; Christian, 17; Clay and Laurel, 16; Grant, 15; Graves, Grayson and Trigg, 14; Caldwell and Hopkins, 13; Floyd, Greenup, Hart and Oldham, 12; Bell, Harrison, Marion, Rowan and Wayne, 11; and Boyle, 10.

In other coronavirus news Sunday:

• The Russell County Detention Center stopped accepting new inmates after 22 tested positive for the virus and several others were exposed, WJRS Radio reports. Tests were conducted after two inmates who had been released to halfway houses tested positive, Jailer Bobby Dunbar said.
• In state prisons, case counts were down from last week, according to the Corrections Department report last updated Friday. The Eastern Kentucky Correctional Complex in West Liberty remained the main trouble spot, with 113 active cases among inmates and 13 among employees.

Legislators tell Beshear they'll talk with him after votes to override vetoes; he says 'See you in court,' warns of fourth surge in cases

Department for Public Health graph, relabeled by Kentucky Health News; click it to enlarge

By Melissa Patrick and Al Cross

Kentucky Health News

The dispute between Democratic Gov. Andy Beshear and the Republican-controlled General Assembly over legislators' efforts to limit his emergency powers during the pandemic is headed to court.

Leaders of the legislature told Beshear Monday that they would hold votes to override his vetoes of bills they passed to limit his powers before discussing "what modifications might improve the legislation."

Legislators, who have voiced displeasure with Beshear's emergency orders and his attitude toward them, are all but certain to override his three vetoes, and he made clear what he would do after that.

“If their comment is ‘We are going to override your vetoes no matter what and maybe we can talk later,’ I guess mine is ‘We are going to see you in court’,” Beshear said after revealing their plans at a regular briefing, at which he warned that there could be another surge in cases of the novel coronavirus.

“I cannot and will not let the health and lives of the people of Kentucky be put in this danger when we are so close to getting out of it,” he said. “This would mean Kentucky would have the least ability of any state in the United States to respond to this crisis and save lives.”

But not if a judge issued an order blocking the legislation, which has its own emergency clauses to make it effective immediately. However, the case would differ from the one Beshear won at the state Supreme Court, which said he was acting lawfully; the legislature writes the laws, and can change them.

The day's events dashed hope of a negotiated settlement. 

After the legislature quickly passed the bills Jan. 5-9, Senate President Robert Stivers indicated that it might be willing to negotiate with Beshear before bringing the bills up for override votes. Beshear responded with a two-page letter Jan. 20 to Stivers and House Speaker David Osborne to see if they would be willing to compromise.

“We put an offer on the table,” Beshear said Monday. “We followed up numerous times about whether it had been seen and whether we were going to meet, and then the day before the session is about to start we got a letter saying we don’t have time, we are going to override your vetoes and maybe we can talk after.”

The letter, which Beshear's office gave the Lexington Herald-Leader in response to an open-records request, said "We will be happy to sit down with you as soon as schedules allow and talk about what modifications might improve the legislation and its application to the ongoing pandemic." The leaders did not respond to a request for comment, Jack Brammer reports.

Also Monday, Beshear extended for another 30 days his mandate to wear face coverings in indoor public spaces, and said it will be  necessary to wear them until Kentucky reaches herd immunity, which would be reached when 70% of the state's population has been vaccinated.

Beshear noted that if the General Assembly prevails in their dispute, such measures could become voluntary. One bill would limit emergency orders to 30 days unless approved by the legislature.

Pandemic status: New coronavirus cases and positive-test rates have fallen for three consecutive weeks, and hospitalizations and intensive-care use are also down, but Beshear cautioned Kentuckians to remain vigilant and remember that this is still a "dangerous time" because the numbers are still too high. 

“Folks, this isn't over. We may face another increase before we get through this,” he said, adding a reference to his orders that have restrained commerce and personal behavior to thwart the virus: “We've got to make sure that, given that we have known how to stop it three straight times, we don't do something silly and remove our ability to do what works and what's worked three straight times.”

Beshear announced 1,623 new coronavirus cases on Monday, raising the seven-day rolling average by 50, to 2,390 -- mainly because the new-case number was 355 higher than the previous Monday's. 

The share of Kentuckians testing positive for the virus in the last seven days remained below 9 percent for the fourth day in a row. Today, the average was 8.85%, 0.04 percentage points higher than Sunday. 

“We have seen our positivity rate decreasing” since Jan. 10, Beshear said. “That shows you that our decrease in case numbers isn’t because of any change in testing, there is less disease out there. Fewer people by percentage are getting the virus week over week.”

Vaccines: For four weeks, Beshear said the state has administered more initial doses than it has received from the federal government.

“If you’re having a hard time signing up, it’s because there just aren’t enough doses,” he said. “But we are working hard and everybody is going to get their turn.”

Kentucky's first four regional vaccination sites are opening this week. One, in partnership with Kroger Health, opens Tuesday, Feb. 2, at the Kentucky Horse Park's Alltech Arena. Another will open in Danville, through a partnership with Ephraim McDowell Regional Medical Center. Two will open in Paducah, through partnerships with Western Baptist Hospital and Mercy Health-Lourdes Hospital. More are in the works.

Speaking about the challenges of supply, Beshear said the Danville hospital has already received 170,000 calls from people wanting a vaccine, but has only 300 slots. 

In Clark County, Indiana, across the Ohio River from Louisville, as many as 30 people lied about their eligibility to get the coronavirus vaccine over the weekend, according to the local health department, Sarah Ladd reports for the Louisville Courier Journal.

Asked if this was happening in Kentucky, Beshear said the state has not seen much of it, noting that some people have been vaccinated out of order when locations need to reach their 90% goal of giving all of their vaccines within seven days of receiving them. 

A news release from Beshear's office said, "422,500 initial vaccine doses have been sent to Kentucky and 362,271 have been administered: 341,575 initial doses have been sent to the state’s distribution program and 305,757 have been administered through that program; 80,925 initial doses have been sent to Kentucky through the federal long-term care vaccination program that contracts with CVS and Walgreens and 56,514 have been administered through that program."

Beshear said one thing he would do differently, if he had it to do over, would be to reject those contracts and work with local, independent pharmacies, as one state, West Virginia, is doing with great success. 

The Centers for Disease Control and Prevention's data tracker ranks Kentucky 27th for the percentage of vaccine doses received that have been administered, Becker's Hospital Review reports. It shows that as of Jan. 31, 659,150 doses have been distributed to Kentucky, and 404,705 of those have been administered, or 62.25%. Those numbers combine the state and long-term-care programs.

Schools: Last week, at least 1,330 students and 563 staff tested newly positive for the virus, and at least 6,886 students and 911 staff were quarantined, The K-12 school dashboard shows that 319 schools did not provide any data to the state. Beshear said 18 high-school sports teams are quarantined. 

Beshear said all K-12 employees who want the vaccine will have received their first dose by the end of this week, which allows for significant expansion of in-person instruction. 

Deaths: Beshear reported 35 new Covid-19 deaths, all but three of them confirmed, saying that for the first time only six of the deaths were from long-term-care facilities.

"I hope that's a sign that our early vaccinations and steps in long term care are making a difference," he said. " But again, it should be a warning to all the rest of us that this can impact you whether you're in a long term care facility, or not."

The state's Covid-19 death toll is 3,780. The seven- and 14-day death averages are both down, to 45.7 and 43.8, respectively, from highs of 47.3 and 44.4, three days ago and two days ago.

Long-term care: A CDC report published Monday said that between Dec. 18 and Jan. 17, 77.8% of residents and 37.5% of staff in the nation's long-term care facilities had received at least one dose of the vaccine in the first month of the CDC Pharmacy Partnership for Long-term Care Program.

The report does not have state-specific numbers, but a color-coded map shows less than 40% of Kentucky's long-term care staff and between 40% and 79% of residents had received at least one dose.

Asked for the state's numbers, Beshear said staff members have been given three chances to get vaccinated, which allows those who were initially hesitant to get vaccinated at the second or third visit. He added that some staff who initially declined the vaccine simply didn't want to go first and are much more willing now.  

He said he would again work to get the exact percentages, noting that the challenge is that the program is fully run by CVS Health and Walgreens for the federal government. He added that they "work and push" to get more information from them, "but it is not under our direct control." 

Beshear did not respond to the second part of the question, asking which communication and outreach strategies the state is employing to improve these numbers. 

The report notes several limitations to the study, including a possible underestimation of staff numbers because they could have been vaccinated elsewhere, and scheduling challenges for staff members who may not have been at the facility when the vaccines were offered.

Long-term-care facilities reported 18 new resident cases and 30 new staff cases Monday, bringing the number of active cases to 576 in residents and 322 in staff. Beshear said nine more long-term-care deaths were attributed to Covid-19, bringing the total number to 2,169. 

"The growth there as our overall percentage of deaths, it's not growing, it's actually now decreasing, which means we're doing a better job, especially as the vaccinations happen," he said. 

In other coronavirus news Monday: 

• Today's fatalities were an Adair County woman, 88; three Boone County men, 67, 69 and 71; a Boyle County man, 56; two Bullitt County women, 72 and 89; four Bullitt County men, 78, 79, 81 and 81; a Calloway man, 67; a Clay County man, 76; a Clinton County woman, 74; a Fayette County woman, 97; two Fayette County men, 87 and 94; a Grayson County woman, 79; a Harlan County woman, 81; a Harlan County man, 60; a Harrison County man, 60; two Jefferson County women, 45 and 78; seven Jefferson County men, 59, 67, 71, 77, 78, 79 and 95; two Kenton County men, 68 and 79; a Lawrence County man, 90; a Madison County woman, 88; and a Monroe County man, 68.
• Counties with 10 or more new cases were Jefferson, 284; Fayette, 114; Madison, 111 ; Daviess, 83; Kenton, 58; Warren, 51; Boone, 49; Shelby, 39; Franklin, 38; McCracken and Oldham, 32; Bullitt and Campbell, 28; Grant, 27; Boyd, 26; Floyd and Jessamine, 24; Pike, Pulaski and Trigg, 21; Caldwell and Graves, 19; Hardin, 17; Laurel and Mason, 16, Hopkins, 15; Scott, 14; Calloway, Grayson and Henderson, 13; Powell, Simpson, Spencer and Whitley,11; Greenup, Harlan, Knox and Taylor, 10.
• Kentucky hospitals has 1,314 patients hospitalized with Covid-19 on Monday, 337 of them in intensive care and 178 of those on ventilators. 
• In four hospital regions, more than 80% of intensive-care beds are occupied: 83% in Barren River and the northeast, 81% in the easternmost region; and Lake Cumberland, 91%. 
• The Herald-Leader, in several articles, answers a range of questions about vaccines, including one titled "Should you get your Covid vaccine if you currently have coronavirus? What to know"; another, "Will Covid vaccines need a booster shot to combat variants? Here's what to know"; and another, "The Covid-19 vaccine is free to you, but have your insurance info ready anyway."
• The one-dose Johnson & Johnson vaccine announced Friday has an overall effective rate of 72% in the United States, which is not as high as the other two vaccines, which are about 95% effective. But three researchers who conducted clinical trials of the vaccine in Kentucky said they were pleased with the vaccine overall, noting that it prevents serious illness and death from Covid-19, had no allergic reactions and has shown few to no side effects, Deborah Yetter reports for the Courier Journal. Another benefit is that it can be stored for several years in a freezer and three months in a refrigerator, compared to the Pfizer and Moderna vaccines, which require ultra-cold storage. Johnson & Johnson has said it will seek emergency authorization this week from the U.S. Food and Drug Administration.
• New polling from the Covid States Project shows about 34% of Kentuckians are receptive to getting vaccinated and  4% would refuse it. Others, 22% and 19% respectively, wanted to wait until some or most of the people they know had received it first, the Courier Journal reports. 
• In an opinion piece for the Courier Journal, Dr. Kevin Kavanagh, a retired Somerset physician and the chairman of Health Watch USA, walks through the dangers of the coronavirus variant that originated in the United Kingdom, noting that it may be 70% more infectious, 30% more lethal and more likely to infect children. He adds that the Brazil and the South Africa variants "are even more concerning." That said, he said there is hope in President Biden's seven-point plan that aims to create a standardized pandemic approach. He also writes that "For many, the virus is becoming a litmus test for reliable news sources," noting that "unreliable sources rarely if ever correct reporting errors, which have led to the deaths of hundreds of thousands of Americans." 
• The Biden administration hopes to start administering vaccines to children by late spring or summer, Dr. Anthony Fauci said during a Jan. 29 White House news briefing.
• A Kaiser Health News analysis of 23 states that provide demographic data for residents who have been vaccinated for the coronavirus shows that African Americans are still receiving the vaccine at "dramatically lower rates" than white people. Kentucky was not included in the states providing such data.  The state's daily Covid-19 report shows 8.5% of the state's Black residents have tested positive for the coronavirus and 8.8% of them have died from it, about equal to the their approximate share of the state's population, 8.5%. This is a marked decline from June, when Blacks' death rate was about double their share of the Kentucky population.  Beshear said the state would start providing vaccine demographic information next week. 
• More than 3,000 inmates and 500 employees in Kentucky's local jails have been infected by the coronavirus since the pandemic began 10 months ago, according to a state public health database obtained by the Herald-Leader. John Cheves reports that these numbers are likely even higher, since no state agency is required to track coronavirus infections or deaths inside the locally run detention centers that house more than 19,000 people. By contrast, federal and state prisons update their case and death numbers daily, Cheves reports. Again, Beshear said the state is focusing vaccinating the correction officers and those in the state who are over 70 and those in high-risk categories. He did not say when prisoners would be allowed to be vaccinated.

Positive-test rate goes above 5.5%, making Beshear consider recommending another delay of in-person schooling

Ky. Health News adaptation of chart shown by Health and Family Service Secretary Eric Friedlander

By Al Cross
Kentucky Health News

More Kentuckians are testing positive for the novel coronavirus, and that could prompt Gov. Andy Beshear to recommend another delay in the start of in-person schooling this month.

Nine days ago, Beshear recommended that schools wait until the third week of August, due to a surge in coronavirus cases in July. Asked Wednesday if schools are in a position to open then, he said, “I’m watching the numbers very carefully this week. If it were today, I would suggest that they delay. We’re still in a very uncertain area and I'd like to see that positivity rate rate lower.”

The governor reported that 5.51 percent of Kentuckians tested for the virus in the last seven days, a noticeable jump from Tuesday, when the state's seven-day rolling average was 5.24%. The previous Wednesday, it hit 5.81%, the highest since testing became widespread in the state. The 5% rate is a generally recognized threshold for greater concern.

Asked if it was possible that he would recommend another delay, Beshear said, “That's certainly possible.” He said some schools that opened early in other states have had to close due to surges in cases. In Kentucky, such decisions are up to local school officials. 

Daily numbers: The governor reported 546 new cases of the virus Wednesday, lowering the state's seven-day rolling average to 577. The three-day average is 523, and Beshear noted that the same Monday-Wednesday period last week had 104 more cases, for an average of 558.

As he gave the daily number, Beshear alluded to much smaller numbers reported a month ago, when the surge began: “It’s hard to believe that that could be good news, and it’s not in so many ways . . . but the trajectory we were going on was terrifying,” he said. “I believe it’s evidence of facial coverings working.” On July 9, he ordered that masks be worn in public indoor spaces, and outdoors when people can't stay six feet apart.

“It looks like we are stopping a very dangerous situation from occurring. We need to keep it up,” Beshear said, adding that it's important for local and state leaders to set good examples by wearing facial coverings: “It shows to other people that we’re willing to walk the walk, and we need leaders at every level that are doing this.”

Noting that 21 children under 5, one 18 days old, were among the day's new cases, Beshear said, “Let’s wear our masks for the 18-day-old. Let’s make sure were protecting one another when it could harm the very youngest among us.”

Only one death from covid-19 was reported Wednesday, "the lowest in a long time," Beshear noted. The death of a 71-year-old woman from Logan County raised the state's toll to 752.

Current hospitalizations for covid-declined to 620, from the record 638 reported Tuesday; 131 of them are in intensive care, a decline of four. Beshear said hospitalizations are counted as covid-19 cases if the admitting physician believes they are; he said the state hopes to differentiate between those suspected cases and those that are confirmed by a test.

State chart, adapted by Ky. Health News; for a larger version click on it.

In nursing homes and other long-term-care facilities, the state is doing a good job thwarting the virus, said Eric Friedlander, secretary of the Cabinet for Health and Family Services. He displayed charts showing that the state's case and death rates are low compared to other states, especially for a state with relatively poor health overall: "When you look at our relative heath status, we have done a very good job."

More than 63% of Kentucky's covid-19 fatalities have been residents of long-term-care facilities. The daily report on those facilities says there are 454 active cases among residents and 208 among employees.

Counties with more than five new cases on the daily report Wednesday were Jefferson, 104; Fayette, 59; Warren, 52; Hardin, 20; Madison, 15; Daviess, 12; Barren, Bullitt and Kenton, 11 each; Jessamine and Scott, 10 each; Franklin and Pike, 9 each; Greenup, 8; Fulton, Logan, Perry, Whitley and Woodford, 7 each; and Boone, Campbell Clark and Knox, 6 each.

Campus concerns: Asked about reopening of the University of Kentucky, which began testing as many as 30,000 students this week, Beshear said the challenge is how to monitor and trace the contacts of infected students and discourage them from "activity we wouldn’t consider reckless on a college campus anytime other than now." Asked how much faith he had in students to make good decisions, Beshear replied:

“That’s a heck of a question . . . I can’t claim I made all the best decisions at 18, 19 and 20, but I also wasn’t in the middle of a worldwide health pandemic . . . We’re asking so much of our young Kentuckians at a time when they’ve been separated from their friends in a way that they never have before, at a time when their emotional and social health is so connected to those interactions, and I hurt for ‘em. . . . We need to reduce the number of places they could go to make bad decisions, and then we need to be consistently talking to them as adults, 'cause we’re asking them to be really responsible adults at a time in their lives where we probably shouldn’t have to ask that.

“Do I have faith in them? Yes; the challenge is, there’s so many of them . . . We need our young adults . . . if they want to be in their university settings, to know it’s probably contingent on the vast majority of them making good decisions.”

In other covid-19 news Wednesday:

• Beshear said he would consult with the White House Coronavirus Task Force before allowing bars to reopen or increasing indoor capacity at restaurants, and if bars open, seating rules will have to be strictly enforced. He said a curfew for bars would also apply to restaurants and would probably be at 10 p.m.
• The state Fair Board appears likely to announce soon tighter restrictions for the state fair, scheduled Aug. 20-30 in Louisville, a hotbed of the virus. Beshear said Health Commissioner Steven Stack met recently with board Chair Steve Wilson and CEO David Beck after health officials made recommendations and Beck replied.
• Asked about college football, Beshear said he waiting to see what conferences decide, suggesting they might further delay the season. As for limiting fans, he said, “If you really thin it out and you do enforcement, then you can do it, [but] we see similar venues across Kentucky not doing enforcement at all, and the result can be really concerning.”
• And the Kentucky Derby, set to run Sept. 5 with Churchill Downs at 60% capacity? "There's a lot of different ways that event could happen," said the governor, who would present the trophy on national television. 
• Beshear said more cases are being reported in county jails, but said he didn't have current information on state prisons.
• Midway Mayor Grayson Vandegrift told his constituents in a monthly covid-19 update that they needed to resist anti-mask peer pressure, which he hopes is not intentional, and find ways to confront it: “Nobody wants to be, so to speak, the wet blanket. . . . I think we need to work on being that person; I think that’s what leadership really is.”
• Carl Hulse, chief congressional correspondent of The New York Times, writes: "Senator Mitch McConnell has put himself in one of the toughest spots of a political life that has seen plenty of them.
  "Up for re-election in the middle of an unforgiving pandemic, the Kentucky Republican and majority leader is caught in a family feud between a group of endangered incumbents in his party who are desperate for pandemic relief legislation that is tied up in slogging negotiations, and a significant portion of Senate Republicans who would rather do nothing at all. He is also up against Democratic leaders who do not see the need to give an inch on their own sweeping coronavirus relief priorities, administration negotiators who badly want a deal that boosts President Trump — even if it ends up being one that most Senate Republicans oppose — and the president himself, who has played his usual role of undercutting the talks at every turn.
  "All that is at stake is the health and economic state of the nation, control of the Senate and Mr. McConnell’s own reputation and future."

Ky. Chamber of Commerce starts campaign to help substance abusers, develop recovery-friendly work environments and more

One of the major obstacles to dealing with substance abuse is the stigma it still has among many people, so the Kentucky Chamber of Commerce says it has launched a major effort "to help Kentuckians struggling with substance-use disorder, assist businesses in developing recovery-friendly work environments, and engage Kentuckians interested in smart criminal-justice reforms."

The campaign is called “Kentucky Comeback: Hope, Healing, and a Fair Chance.” Its mission is "building a broad-based coalition to dramatically transform the state’s approach to addiction and criminal justice, including "criminal-justice reforms to control corrections costs and help Kentuckians recover and obtain employment while protecting public safety," the chamber said in a news release. "Kentucky’s business community is in a unique position to help change Kentucky’s attitudes, policies, and approach to criminal justice and addiction."

The chamber says the opioid epidemic is largely responsible for admissions to Kentucky prisons increasing 32 percent from 2012 to 2016. “It’s time for change in Kentucky,” said Chamber President and CEO Ashli Watts. “The number of people affected by the criminal justice system and opioid epidemic grows each and every day. Those who believe in Kentucky’s future know we have to help people come back from addiction and incarceration to rejoin their communities and families.”

The project is funded by the Kentucky Chamber Foundation and the Chan Zuckerberg Initiative, the foundation created by Facebook founder Mark Zuckerberg and his wife. It says its website "seeks to build a criminal-justice-reform network and attract a greater number of businesses and leaders across the state to engage in criminal justice reforms with the goal of fewer Kentuckians incarcerated, more individuals gainfully employed, and a stronger, healthier Kentucky economy."

The site has "tools for employers, resources connected to recovery centers, legislative priorities and victories, and much more," the chamber says. "The initiative will also include the launch of a statewide marketing and advertising campaign in coordination with Gray Kentucky Television to inform and bring Kentuckians together to make positive changes on these issues."

Most cases in one day, but Beshear cites testing and still sees a plateau; releases 352 inmates in jails; 2nd prison death reported

As news develops about the coronavirus and its covid-19 disease, this item will be updated. Official state guidance is at kycovid19.ky.gov.

By Al Cross
Kentucky Health News

As Kentucky reported the most coronavirus cases in a single day, its main challenges were in institutions: prisons, jails and long-term-care facilities.

Gov. Andy Beshear announced 322 new cases, for a corrected total of 3,779, and nine more deaths, for a total of 200, but said he still believes the state is "still generally plateaued" because more cases are being found by more testing, which is more extensive than ever.

He said there had been five more deaths in long-term-care facilities, for a total of 91, and a second death at the Green River Correctional Complex in Central City. He said he had ordered that each of the 900 inmates be tested; eight more were reported positive for the virus yesterday, for a total of 60; two more staffers were, for a total of 20.

Justice Secretary Mary Noble said in a video report that the prison undergoes multiple bleach cleanings daily, officers' shoes are sanitized when they arrive; masks are required; and officers are required to wear gloves and be checked for temperature and symptoms. She said inmates can have no visitors; spend most of the day in their cells, where they get medical attention; and are allowed out in small groups. Quarantine is imposed on those who show symptoms, and those with whom they have had close contact. An inmate who tests positive is contained in his cell, and is sent to the hospital if needed.

Many state prisoners are housed in county jails. Beshear said he has commuted the sentences of 352 such inmates, using the same criteria he used to release about 750 from state prisons: 339 non-violent and non-sexual offenders who are near the end of their sentences and at elevated risk for covid-19; and 13 who are over 65. He said their release is conditional: They can’t have covid-19; they must have a residence where they can quarantine for 14 days; and can't commit any crimes in their period of release.

River's Bend Retirement Community in Kuttawa, one of
the first with an outbreak, said one of its residents, Lucy
Goodwin, had recovered, and Beshear showed this slide.

Beshear said 61 of the state's approximately 280 long-term-care facilities have had residents or employees test positive for the virus, with 48 more residents and 17 employees added to the list Friday. Two facilities have reported 13 deaths each: Rosedale Green in Kenton County and Ridgewood Terrace in Hopkins County, which reported a death Friday.

Asked about that facility, Beshear said it has had 56 cases among residents and 16 among staff, after all were tested. "It doesn't mean anybody has necessarily done something wrong," he said. The state has sent certified nurse assistants and medical students to the facility to help, he said.

Even as restrictions are eased elsewhere in the coming months, “Visitation is going to be extremely, extremely restricted” at long-term-care facilities, Beshear said.

He disputed the notion expressed by Vice President Pence that "by Memorial Day weekend we will have this coronavirus epidemic behind us."

"Our pandemic, covid-19, won’t be behind us by Memorial Day," Beshear said, adding that even when many restrictions are lifted, life will be different.

"We're gonna reach a point real soon where everybody in public and everybody at work is gonna need to wear masks," he said. At the start of his daily briefing, he reminded his audience about handwashing and acknowledged he hasn't always been diligent about it: “As we’re allowed to have more contacts it’s gonna be really important.”

Immediately after announcing the number of new cases in each county, Beshear indirectly rebuffed a request that he differentiate among counties.

The Clark County Fiscal Court voted 5-2 Thursday night for a resolution asking him "to evaluate counties individually and allow Clark County to enter phase one" of the reopening process, reports Fred Petke of The Winchester Sun. "That would include reopening restaurants for inside dining, theaters and churches, as well as the possibility of an in-person graduation for George Rogers Clark High School."

But Beshear said, "This virus doesn’t care if there's a county line … We’ve got to be sure we're unified in our approach." He said as he makes decisions, "We’re gonna listen to everybody’s input," and local officials "will be full partners."

LaTasha Buckner, Beshear's chief of staff and general counsel, said easing of restrictions will tend to be by economic sector and groupings, which will be determined over next two weeks. She said more than 500 businesses had submitted proposals for reopening, but that won't guarantee that they will, and businesses aren't required to submit plans. She said the administration has talked with local officials and state and local chambers of commerce, and will talk with other states as it decides when and how to ease restrictions.

Screenshot of Adams speaking as Beshear listens (Facebook)

Beshear and Secretary of State Michael Adams agreed on procedures for the June 23 primary election, calling on Kentuckians to vote by mail and saying the State Board of Elections would create an online portal to request absentee ballots, and issue regulations to protect voters who voter otherwise, starting with in-person absentee voting at county clerks' offices, beginning by June 8.

At his daily briefing, the Democratic governor introduced the Republican secretary of state, saying he “deserves a lot more credit on this than I do. He has worked very hard on it; he has been very flexible on it.”

Adams thanked Beshear “for your personal graciousness” and willingness to listen. He said their bipartisan cooperation avoided conflicts like those in Ohio and Wisconsin that caused some voters to be disenfranchised and others to get sick. "Usually in a negotiation, we have different goals," he said. "The governor's goals and my goals were the same, to avoid those two things.

On another point of bipartisanship, Beshear was asked about Senate Majority Leader Mitch McConnell's suggestion that states declare bankruptcy instead of seeking federal aid to address problems that preceded the pandemic, such as pension funding, where Kentucky ranks at or near the bottom among the states.

“Senator McConnell and I have had a very good relationship, not just now but when I was attorney general … but on this piece, I disagree with him, as does every other governor in the United States,” Beshear said. Without direct aid, “We won’t have the dollars we need for teachers and firefighters and police officers; the basic services people need to survive will be cut.” Noting that McConnell voted for direct aid to states in the 2008-09 financial crisis, he said, “I hope the senator thinks about that and hears us.”

In other covid-19 news Friday:

• Beshear said the state had a record week of testing, and will have 11 sites next week. He said the state has results from 45,000 tests, not including thousands done in the last two days.
• "Here's why the U.S. can't get its coronavirus testing act together," The Washington Post reports: "Labs straining to increase testing are up against unprecedented demand and a hugely complex supply chain that doesn’t just turn on a dime. . . . A host of people and things need to be in the right places doing the right things to achieve widespread testing. The United States isn’t there yet. . . . The companies selling testing machines typically also make the chemical reagents needed to actually carry out a test, so labs are often limited by brand. . . . There’s a shortage of the supplies needed to process tests. But it’s unclear exactly where the chain is breaking down. . . . The federal government is mostly staying out of it."
• The counties reporting 10 or more new cases were Jefferson, 121; Warren, 35; Muhlenberg,19; Adair, 17; Daviess, 13; Grayson, 13; Hopkins, 11; and Kenton, 10.
• The deaths included three women in Graves County, aged 93, 88 and 82; a 59-year old man in Muhlenberg County, an 89-year-old woman in Adair County, a 74-year-old man in Shelby County, a 79-year-old woman in Jackson County, a 90-year-old woman in Hopkins County, and a 54-year-old man in Hopkins.
• State unemployment director Josh Benton said his agency is "really close" to getting checks to “a significant number” of people whose benefits have been delayed. “Nationally, we really are ahead of the curve overall, but that does not diminish the issues that we do have,” he said. Beshear said, “Josh is working hard . . . Don’t blame him. I’m the governor. It comes back to me.”
• Noting the start of the Muslim holy month of Ramadan, Beshear said, "To my knowledge, every single mosque across Kentucky has agreed not to conduct in-person services."
• The Centers for Disease Control and Prevention has listed additional symptoms of covid-19: chills, repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell. These are in addition to the previously symptoms: fever, cough and shortness of breath or other breahting difficulty.
• The U.S. Department of Health and Human Services extended the deadline for hospitals to apply for some of the $10 billion allocated for hospitals in areas hit hardest by the pandemic; they have until 2 p.m. CT tomorrow to apply. The original deadline was yesterday.

Editorial in Frankfort's newspaper says drug addiction should be treated as a health issue, not a crime

The State Journal

With rising inmate populations and crumbling prison infrastructure depleting the state of much-needed funding, it is time to stop treating drug addiction as a crime and start regarding it as the public health issue that it is.

We agree with the Kentucky Chamber of Commerce that reclassifying drug possession charges to misdemeanors and investing in treatment over incarceration will serve a dual purpose — save the state money on prison costs, which grew 15.9 percent between 2016 and 2020, and help to break the cycle of drug addiction through education and treatment.

The cost to incarcerate a state inmate in Kentucky is $18,406 per year. The approximately 4,500 inmates in prison for drug offenses in 2016 cost taxpayers more than $82 million per year.

According to data from the Criminal Justice Policy Assessment Council, a working group established by former Gov. Matt Bevin charged with developing “fiscally-sound, data-driven criminal justice policies,” the number of offenders imprisoned for drug trafficking between 2012 and 2016 jumped 25.6% (1,525 in 2012 to 1,916 in 2016). However, there was a 101.5% increase in the number of offenders (911 in 2012 to 1,836 in 2016) jailed on drug possession charges.

In fact, it was a year ago this week that a Franklin County Regional Jail inmate was discovered dead in his cell after what a lawsuit alleges were days without treatment for withdrawal symptoms related to drug use.

Dylan Stratton, 21, was booked into the jail Jan. 17, 2019, on a drug charge and was placed in the detox holding cell for observation. According to the lawsuit, he refused meals and began vomiting. A day later he had a seizure, reportedly from benzodiazepine withdrawal, and died.

This case is just one of many that illustrate how Kentucky’s jails are ill-equipped to handle drug addicts. Instead of spending money to punish drug users, the state should increase funding for substance abuse treatment.

State health department is sending nurses to jails, treatment centers, homeless shelters, other sites to give hepatitis A shots

Nurses administered vaccinations at the Fayette County
Detention Center. (Cabinet for Health and Family Services photo)

The state Department for Public Health has sent a team of nurses to give hepatitis A vaccinations at county jails, state probation-and-parole offices, homeless shelters, treatment centers and drug stores, the Cabinet for Health and Family Services announced in a press release.

"Since April, the team has provided more than 2,100 vaccines at 40 different sites," the release says. "The state is collaborating with local partners on harm-reduction programs, aimed at reaching those who are most at risk. At least 18 additional vaccination events are scheduled through August."

“We have found it particularly challenging to reach the at-risk population in rural Kentucky,” said Dr. Jeffrey Howard, commissioner of the department. “One reason is the stigma associated with substance-use disorder. In some of our rural communities, more than 80 percent of hepatitis A cases have occurred in those with SUD. Due to the stigma surrounding SUD, the at-risk population is often hesitant to seek preventative care.”

The department identified the outbreak in November 2017, and has been criticized for not reacting more robustly to it. It has identified 4,700 cases, almost half of them requiring hospitalization, and 58 deaths have been linked to the outbreak.

"Kentucky was the first state to experience a large, rural spread of the disease," the press release says. "Similar to outbreaks in other states, the primary risk factors have been illicit drug use and homelessness. A contaminated food source has not been identified, and transmission of the virus is believed to have occurred through person-to-person contact. Hepatitis A is a highly contagious liver infection."

What state-level strategies work against the opioid epidemic?

The opioid epidemic is a major issue in every state, but not all are tackling it in the same ways. The National Academy for State Health Policy, a nonpartisan group of state health officials, met recently with policymakers from a dozen states to talk about what they find challenging and what is effective. "States generally share a few common goals: prevent addiction, stop people from dying, and get people into treatment," Kitty Purington writes for NASHP. The group identified strategies that are showing results:

• Track opioid prescribing to keep drug-seeking patients from getting pain-pill prescriptions from multiple doctors.
• Invest in harm reduction by training more people to administer naloxone and making the anti-overdose drug more readily available. 
• Build capacity for medication-assisted treatment. MAT is the gold standard for treating opioid addiction, but many areas, especially rural, don't have access to it because of a lack of qualified prescribers or treatment facilities.
• Watch newly freed addicts. The first two weeks after an opioid addict's release from prison or jail is particularly dangerous, since users are much more likely to fatally overdose then. Rhode Island is trying to counter this by offering MAT to inmates statewide. While inmates can't receive Medicaid benefits, NASHP suggests that states begin enrolling them before their release so they can access treatment as soon as possible. 
• Ensure access in rural areas. Rural residents often face higher barriers to treatment than suburban and urban residents, including transportation difficulties, lack of facilities and/or qualified prescribers, lack of broadband to access telehealth addiction services, and stigma. 
• Expand Medicaid. Addicts in states that have expanded Medicaid generally have more access to affordable treatment.