Doctor at UK says you don't have to live with pelvic pain

Photo by Colorblind Images, DigitalVision / Getty Images Plus

By Dr. Johnnie Wright Jr.

University of Kentucky

Pelvic health is crucial to a woman’s overall well-being but is often misunderstood or overlooked. When symptoms such as urinary incontinence, pain or discomfort, or pain during intercourse occur, they are dismissed as a byproduct of pregnancy and childbirth or just something that comes with age like arthritis. But those symptoms can have a profound effect on a woman’s physical, emotional and social well-being and can lead to more serious complications if untreated.

One of the most common conditions is pelvic organ prolapse. This condition occurs when the muscles, ligaments and fascia of the pelvic floor weaken, causing one or more of the pelvic organs – uterus, vagina, bladder or bowel – bulges into or out of the vagina.

Symptoms of prolapse include:

• A heavy dragging feeling in the vagina or lower back
• Feeling of a lump in the vagina or outside the vagina
• Bowel symptoms, such as difficulty moving the bowel or a feeling of not emptying properly
• Pain or discomfort during sexual intercourse
• Urinary symptoms such as slow urinary stream, a feeling of incomplete bladder emptying, urinary frequency, urgency and urinary stress incontinence

Prolapse occurs in one of three women who have had one or more children. Prolapse can occur immediately after childbirth or take years to develop. Aging and menopause can lead to further weakening of the pelvic floor. While prolapse is common, only one in nine women need corrective surgery. Obesity, chronic cough, chronic constipation and heavy lifting or straining can put excessive pressure on the pelvic floor and exacerbate prolapse. Depression and anxiety are linked to urinary dysfunction; someone who feels they no longer can control their bladder may withdraw and become more socially isolated.

Physical therapy can help restore strength and function to the pelvic floor. Light-intensity exercises such as walking and yoga can stretch and strengthen the pelvic floor muscles, and there are a number of free apps with exercises for maintaining continence and preventing prolapse.

If you are experiencing pelvic pain or urinary issues such as urgency or a feeling of not completely emptying the bladder, talk to your primary care provider about a referral to a urogynecologist to discuss treatment options.

Johnnie Wright Jr., M.D., is division firector, Female Pelvic Medicine and Reconstructive Surgery, at UK HealthCare.

Unidentified pregnant woman in Ky. sues for right to get abortion

Abortion-rights supporters chanted April 13 on the second floor of the
state Capitol, where the state Supreme Court meets, one floor below
the legislature. (Associated Press Photo by Bruce Schreiner)

By Bruce Schreiner & Kimberlee Kruesi

Associated Press

A pregnant woman in Kentucky filed a lawsuit Friday demanding the right to an abortion, the second legal challenge in days to sweeping abortion bans that have taken hold in more than a dozen U.S. states since Roe v. Wade was overturned last summer.

The suit, in state court in Louisville, says Kentucky's near-total ban of abortion violates the plaintiff's rights to privacy and self-determination under the state constitution.The plaintiff, identified as Jane Doe, is about eight weeks pregnant and wants to have an abortion in Kentucky but cannot legally do so because of the state's ban, the suit said. She is seeking class-action status to include other Kentuckians who are or will become pregnant and want to have an abortion.

“I am a proud Kentuckian and I love the life my family and I have here, but I’m angry that now that I’m pregnant and do not want to be,” the plaintiff said in a statement released by the American Civil Liberties Union, one of the groups backing her challenge. “The government is interfering in my private matters and blocking me from having an abortion. This is my decision, not the government or any other person’s."

State Attorney General Daniel Cameron's office said it is reviewing the suit but offered no other comments. Cameron, a Republican who lost last month's race for governor to Democratic Gov. Andy Beshear, has defended the state's anti-abortion laws in other court proceedings.

The lawsuit came a day after a judge in Texas gave a pregnant woman whose fetus has a fatal diagnosis permission to get an abortion. The restraining order issued Thursday stopped Texas from enforcing the state’s ban on the mother of two, who is 20 weeks pregnant. Late Friday, the court stayed the ruling, pending closer consideraiton of the case. UPDATE, Dec. 11: The woman, citing the delay, said she was leaving Texas to get an abortion in another state.

Unlike the Texas case, little is known about the Kentucky plaintiff or her pregnancy. Legal challenges across the nation have largely highlighted stories from women who were denied abortions while facing harrowing pregnancy complications. But in Kentucky, the plaintiff's attorneys insisted they would fiercely protect their client's privacy, stressing that Jane Doe believes “everyone should have the right to make decisions privately and make decisions for their own families,” said Amber Duke, the ACLU of Kentucky's executive director.

Earlier this year, the Kentucky Supreme Court refused to halt the state's near-total abortion ban and another outlawing abortion after the sixth week of pregnancy. The justices focused on a narrow legal issue, saying an abortion clinic didn't have the right to sue on behalf of women, but didn’t resolve larger constitutional questions about whether access to abortion should be legal in the Bluegrass State.

The ACLU, Planned Parenthood and other activists say they've been searching for a plaintiff ever since that February ruling. The suit filed Friday marks the launch of their new assault against the state's abortion bans.

“These bans have harmed countless Kentuckians since going into effect last year, and we are relieved to be back in court to try to restore abortion access in Kentucky,” Brigitte Amiri, deputy director of the ACLU Reproductive Freedom Project, said in the news release.

The lawsuit says Kentucky women are suffering “medical, constitutional and irreparable harm” by being denied the right to obtain abortions.

“Abortion is a critical component of reproductive healthcare and crucial to the ability of Kentuckians to control their lives,” the suit says. “Whether to take on the health risks and responsibilities of pregnancy and parenting is a personal and consequential decision that must be left to the individual to determine for herself without governmental interference.”

Kentucky voters last year rejected a ballot measure that would have denied any constitutional protections for abortion, but abortion-rights supporters have made no inroads in the Republican-controlled legislature in chipping away at the state's anti-abortion laws.

The legal challenge revolves around Kentucky’s near-total trigger law ban and a separate six-week ban — both passed by Republican lawmakers. The trigger law was passed in 2019 and took effect when Roe v. Wade was overturned in 2022. It bans abortions except when carried out to save the life of the patient or to prevent disabling injury. It does not include exceptions for cases of rape or incest, which Beshear used to his advantage in the race with Cameron.

As Kentucky's near-total abortion ban largely eliminates the procedure in the state, Kentuckians go to other states for it

From January to July of this year, the Kentucky Cabinet for Health and Family Services received reports of 13 abortions in the state, compared to 2,591 in the same time frame in 2021, showing the impact of state laws that were invoked when the U.S. Supreme Court nullified the right to abortion in late June 2022, Alex Acquisto reports in an in-depth article for the Lexington Herald-Leader. 

Acquisto writes, "The marked cliff is a direct result of Kentucky’s trigger law and six-week ban," which legislators passed in hope of such a ruling. "The trigger law bans all abortions except when a pregnant person’s life is immediately threatened, and the six-week ban, or fetal-heartbeat law, outlaws abortions after fetal cardiac activity develops ... usually around six weeks gestation."

The trend is mirrored in more than a dozen states that have enacted similar policies since the decision in Dobbs v. Jackson Women's Health Organization, according to estimates from the Guttmacher Institute, a policy research center that supports abortion rights. However, "In states that have preserved access, like Illinois, demand for the medical procedure has ballooned," Acquisto writes. 

"From January to June of this year, the number of abortions provided in Illinois grew by an estimated 69% (from 26,000 to roughly 45,000) compared with 2020, according to Guttmacher’s report. Across the board, states without abortion bans saw similar increases. Abortions in Virginia increased by 60%."

Southern Illinois has the closest abortion access to Western Kentucky; the closest to Eastern Kentucky is in Bristol, Virginia.

Acquisto notes that these estimates are  based on abortions reported by providers working in brick-and-mortar clinics and doctor’s offices, so "The true figures are likely even higher, since an estimated increase in abortion medication received by mail is not factored" into the estimates. 

The Guttmacher Institute report did not include numbers from Kentucky. Acquisto got them through an open records request. She writes that the health cabinet is expected to publish its annual abortion report for 2022 this month; state law requires it to be published by Sept. 30 of each year.

Acquisto writes that before the state's near-total abortion ban, "in a given month in Kentucky, between 300 and 400 abortions were provided, state data from recent years shows. . . . Most of the 13 were medication abortions, and most occurred in the second trimester, the latest being 21 weeks."

She adds that the cabinet did not release the ages of the individuals who received abortions in Kentucky so far this year, stating that doing so could create an "unwarranted invasion of personal privacy" because so few abortions were reported. Historically, this information has been public. 

Acquisto reports that piecemeal data provides some insight into how many Kentuckians are traveling out of state for this type of medical care. 

"Before Indiana’s near-total abortion became law in August, state data showed 340 Kentuckians had traveled to the Hoosier state for abortions between January and March, representing roughly 90% of all abortions provided to non-residents," she writes. " In 2022, a total of 950 Kentuckians got abortions in Indiana, WFPL reported in June." 

That shows many people will continue to seek such care despite state bans, Tamarra Wieder, Kentucky state director of Planned Parenthood Alliance Advocates, told Acquisto.

“Kentuckians didn’t stop needing abortions, they’ve just been forced to go elsewhere,” Wieder said. “Those who had the means and the ability to leave the state are leaving the state for that type of care.”

Organizations that help women travel across state lines for reproductive health care say the demand for their help is not letting up, Acquisto reports: "Kentucky Health Justice Network, which offers assistance to people who need help paying for their abortion, fielded more than 500 calls from January to July of this year (421 received donations from KHJN to pay for their abortions)." 

Savannah Trebuna, co-director of KHJN’s abortion support fund, told Acquisto that before August, when Indiana banned abortion, 44% of people who the network's hotline traveled to Indiana for abortions, and since then, KHJN has sent nearly 30 callers to Illinois.

Acquisto also notes the challenges Kentucky women face when they need a medically necessary abortion but their life is not immediately threatened, a situation that current law doesn't allow a doctor to address. 

Trebuna told Acquisto, “There have been cases where we’ve had callers who would have died had they continued their pregnancy, but because they weren’t actively dying in front of a doctor, they were still referred out of state.”

Cameron, other GOP AGs challenge Biden rule that would block access to medical records of women leaving state for abortions

Attorney General Daniel Cameron

By Melissa Patrick
Kentucky Health News

Attorney General Daniel Cameron joined fellow Republican attorneys general in opposing a proposed federal privacy rule to shield the medical records of patients who get reproductive health care services, such as abortions, in other states.

The June 16 letter that Cameron co-signed with 18 other attorneys general to the U.S. Department of Health and Human Services argues that the agency's proposed rule would upset the framework that safeguards the privacy of individual health information while permitting disclosure of information to state authorities to protect public health, safety and welfare. 

Under the proposed rule states that have banned abortions would not be able to collect personal health information about these services from other states for investigations, lawsuits or criminal charges. This would “unlawfully interfere with states’ authority to enforce their laws and does not serve any legitimate need," says the letter.

Kentucky has no law forbidding women from going to other states to get abortions.

The proposed privacy rule would prevent states from obtaining private medical information “for a criminal, civil, or administrative investigation into or proceeding against any person in connection with seeking, obtaining, providing, or facilitating reproductive health care … outside of the state where the investigation or proceeding is authorized” and “is lawful in the state where it is provided.”

HHS defines "reproductive health care" broadly in the proposed rule and says it is inclusive of all types of health care related to an individual's reproductive system. These would include, but not be limited to, pregnancy, contraception, fertility, prenatal care, miscarriage management and abortion.  

The AGs' letter says that while the broad definition of reproductive heath care includes “health care related to reproductive organs, regardless of whether the health care is related to an individual’s pregnancy or whether the individual is of reproductive age.” 

This, they argue, may allow the Biden administration "to advance radical transgender-policy goals" and "obstruct state laws concerning experimental gender-transition procedures for minors (such as puberty blockers, hormone therapy, and surgical interventions).”

Cameron said in a news release that the federal health-privacy law, the Health Insurance Portability and Accountability Act, or HIPAA, balances privacy and public-interest concerns by allowing disclosure of certain information to law enforcement. Cameron says the proposed rule would interfere with this.

Cameron writes, "HHS’s proposed rule exceeds the department’s legal authority. HIPAA authorizes HHS to set standards for protecting privacy in 'health information.' But HIPAA does not empower HHS to shield from authorities evidence of legal wrongdoing based on a claimed connection to 'reproductive health care.' The administration’s claims to the contrary could incentivize health-care providers to break state laws on everything from protecting unborn life to gender-altering surgeries."

The AGs' letter says the proposed rule would "curtail the ability of state officials to obtain evidence of potential violations of state laws." 

Kentucky has two laws that largely ban abortion in the state. One bans abortion except to save the mother's life and another bans abortions after six weeks of pregnancy, when many women are still not aware that they are pregnant. These laws have forced women who want or need an abortion to do so in states where it is still legal. 

This year, the General Assembly passed a law to ban gender-affirming medical care for transgender youth, which took effect last week when an injunction to block it was stayed, pending a future court ruling. This also creates a situation where families will likely seek care out of state.  

The same day Cameron and other Republican AGs sent their letter, all 23 Democratic state attorneys general submitted a letter supporting the rule, with suggestions for how to make it stronger. "Given this rapidly changing backdrop of extreme legal risks and increasing uncertainty, it is critical that additional guardrails be added to the privacy rule to protect against the disclosure of reproductive health information,” they wrote.

In a pepared statement, Angela Cooper of the American Civil Liberties Union of Kentucky called the attorney general's opposition to the proposed rule “another in a long line of actions indicating Daniel Cameron's unwillingness to stay out of Kentuckians’ private medical decisions. . . . The government has no place inserting themselves between families and their doctors, whether the issue is reproductive care or medically necessary care for transgender youth."

The letter in opposition of the proposed rule was led by Mississippi Attorney General Lynn Fitch and includes attorneys general from Mississippi, Alabama, Alaska, Arkansas, Georgia, Idaho, Indiana, Louisiana, Missouri, Montana, Nebraska, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Texas, and Utah.

Three anti-abortion bills advance out of legislative committees

Three abortion bills advanced in the legislature last week, one to give the state's attorney general more power to enforce abortion laws, one to require fetal remains to be buried or cremated after the procedure, and one to give the state auditor power to audit reports about abortions.

Abortion-rights supporters dressed as characters from "The
Handmaid's Tale" at the  March 4 House Judiciary committee,
which passed two abortion bills. (Photo by Melissa Patrick) 

House Bill 370, sponsored by Rep. Nancy Tate, R-Brandenburg, would require abortion providers to either cremate or bury aborted fetuses in a licensed funeral facility. Parents could also decide the final disposition of the fetal remains.

“The abortion provider currently has to provide for the disposal. This is merely directing respectful disposal as opposed to being incinerated with other medical waste,” Cathie Humbarger, an abortion opponent with Northeast Indiana Right To Life, told the House Judiciary Committee March 4.

HB 370 is similar to a 2016 Indiana law that was upheld by the U.S. Supreme Court last year.

No one spoke against the bills, though abortion-rights activists sat in the audience wearing white bonnets and red robes like characters from "The Handmaid's Tale," the dystopian novel and award-winning Hulu show in which women are treated as property of the state and forced to bear children. 

The committee also approved House Bill 451, sponsored by Rep. Stan Lee, R-Lexington, would expand the power of Attorney General Daniel Cameron, an anti-abortion Republican, to regulate abortion facilities, including bringing injunction relief as well as civil or criminal penalties for violations.

Current law only allows the attorney general this power if it requested by the Cabinet for Health and Family Services, which licenses and inspects health facilities.

"Several committee members expressed concern about expanding these powers, with Rep. Maria Solaris, D-Louisville, asking about the potential for a "rogue attorney general." Lee said the courts could handle such problems," Deborah Yetter reports for the Louisville Courier Journal. 

Cameron is the first Republican to hold the office since 1947, and "many of his staff members worked in former Republican Gov. Matt Bevin's legal team, defending abortion restrictions in several high-profile legal battles and attempting to close the state's only abortion facility," Ryland Barton reports for Louisville's WFPL.

Since taking office in December, Democratic Gov. Andy Beshear has ended the state's licensure battle with abortion providers and allowed Planned Parenthood of Indiana and Kentucky to offer abortions in Louisville.

Tamarra Wieder of Planned Parenthood told Yetter that the group chose to remain silent after members were cut off from speaking at a recent hearing on another abortion bill, with the chairman saying the committee was out of time.

"Today was a statement about how we've been treated in the past," said Wieder, the organization's public affairs and policy director. "It's a statement on the power grabs that are taking place around Kentucky on reproductive health."

Kate Miller, with the American Civil Liberties Union of Kentucky, told Yetter afterward that her organization also opposes both bills as "a continuing effort to force every Kentuckian to stay pregnant against their will."

State Auditor Mike Harmon and Rep. Stan Lee present Lee's
bill to let the auditor audit abortion reports. (Melissa Patrick photo) 

House Bill 391, also sponsored by Lee, would  expand the state auditor's powers to audit reports about abortions, including audits of whether facilities that perform abortions are following state requirements to report all abortions to the state Office of Vital Statistics.

It was approved March 5 by the House Health and Family Services Committee.

Yetter reports in a separate article that the bill prompted "heated debate, largely along party lines, about it's true purpose."

"Rep. Tom Burch, D-Louisville, questioned whether the measure is a Republican "method of harassing providers" by the party of Ronald Reagan, the president who argued for smaller government.

Lee said it is to ensure abortion statistics are being reported accurately, citing Reagan's famous "'trust but verify' comment about nuclear disarmament with the former Soviet Union," Yetter writes. Lee said, "I would like to think that this piece of legislation is verifying abortion providers who are taking the lives of unborn babies are complying with the law."

Several Democratic women on the committee questioned why abortion clinics, already regulated by the health cabinet, would fall under the purview of the state auditor; one questioned why the auditor, whose main role is to ensure proper use of public funds, was being called to audit facilities that get no state money; another asked Lee and state Auditor Mike Harmon what other private entities his office investigates, and got no direct answer.

Yetter writes, "State law requires any facility where an abortion is performed to report information including the age, race and state of residence of the patient; age in weeks of the fetus; and the type of abortion, such as surgical or by medication. It does not include reporting any identifying information regarding the patient."

An annual report required by law shows that 3,203 abortions were reported in Kentucky in 2018, 18 of them at hospitals and the rest at EMW Women's Surgical Center in Louisville, the state's only abortion clinic.

Jackie McGranahan of ACLU-Kentucky, spoke against the bill, saying she believed it was part of an effort "to make abortions inaccessible to all Kentuckians."

This prompted Rep. Robert Goforth, R-East Bernstadt, to suggest strongly that McGranahan violated the oath she took to tell the truth before testifying. When McGranahan tried to reply, Goforth cut her off more than once before saying "That's your opinion."

Tamarra Wieder of Planned Parenthood, told Yetter that the bill is part of an ongoing effort by the legislature to erode reproductive rights and to expand authority over abortion. "It is a chilling prospect for the future of abortion in Kentucky," she said. At least eight anti-abortion bills are being considered in this legislative session.

In a region and state with many teen births, E. Ky. program helps young women teach sex education outside the classroom

All Access EKY trains young Eastern Kentucky women to
push reproductive health. (Photo by Hero Images/Getty Images)

A group called All Access EKY is hiring young women between 17 and 22 to create media campaigns for reproductive health, with a focus on increasing access to a full spectrum of birth-control options in Eastern Kentucky, Ivy Brashear reports for Yes! Magazine.

Barriers to getting birth control in Eastern Kentucky are "profound," Brashear reports, and extend way beyond the ordinary obstacles of cost and access to care, to things like having access to reliable transportation (there is no public transportation), knowing if the employees at the clinic go to the same church as your parents, or simply finding a doctor who is willing to prescribe it.

"This is all assuming she knows anything about her birth-control options in the first place," Brashear writes, adding that many young women in Eastern Kentucky "must battle abstinence-only sex education in their schools and a cultural veil of secrecy about their bodies in order to fully understand their options."

She reports that only six of the 19 health departments and federally qualified health clinics in All Access EKY's seven counties offer the full range of birth-control options, and have only four nurse practitioners at public health clinics who are qualified to insert intrauterine devices (IUDs).

All Access, which began in 2016, is working to overcome these barriers by offering young women from the region an eight-week paid fellowship to create educational films that focus on birth control, with interviews of local women about their reproductive health experiences.

The women have also produced social-media campaigns, set up tables at local festivals, and distributed printed materials through clinics and local businesses, Brashear reports in her story, titled "Where Birth Control is Scarce, Young Women Create Sex Education Outside the Classroom."

All Access is a collaboration between the Kentucky Health Justice Network, the national nonprofit Power to Decide, and Appalshop, the media and arts organization in Whitesburg, where the project is housed.

Project director Stacie Sexton told Brashear that All Access works to bridge the reproductive health information gap between the publicly funded health-care providers and community members and helps clinics educate providers about birth control, using materials created by the fellows.

“That’s what makes this project unique,” Sexton told Brashear. “It’s community-centric rather than focusing on just the media side of it, or just the institutional side of it.”

Brashear reports that All Access has completed two eight-week fellowships, hired 13 fellows, and produced 20 media pieces. This summer, seven are in a six-week media workshop in partnership with Appalshop’s youth media program, Appalachian Media Institute.

“We’re trying to build some of these bridges in our communities so it’s not just teenage girls on an island and health care providers on an island and educators on an island,” All Access Media Director Willa Johnson told Brashear. “They all need to be working together to give young people a better opportunity.”

Johnson added that the program has allowed the fellows to explore a career path other than nursing or education, and that many of them have provided birth control education outside of the fellowship.

The program has also worked with policymakers on this issue. Sexton noted that Rep. Chris Harris, a Democrat from Pikeville, sponsored a bill to make it easier for women to get their birth control, and even though it didn't pass, she said their work with him was important.

She said they have also worked to find ways to work with Sen. Brandon Smith, a Republican from Hazard, who sponsored a successful bill in 2017 to ban abortions after 20 weeks. She told Brashear that his political views don't deter her from reaching out to him, stating that that would be a disservice to the the region to not work with as many people as possible to increase access to birth control.

“At the end of the day, if [Smith] wants to increase access [to birth control] to reduce abortions, we have a common goal,” Sexton told Brashear. “We come from different places, but I think we both have our hearts in the right place based on our personal value systems. He’s doing what he thinks is right; I’m doing what I think is right, but we do have a shared interest in increasing access to birth control. I can work with that.”

Why does it matter?

The 2017 Youth Risk Behavior Survey found that 38 percent of Kentucky's high-school students report that they'd had sex, and 29 percent reported being sexually active, defined as having had sexual intercourse with at least one person during the three months prior to the survey.

Of the 29 percent who were sexually active, 16.5 percent of them reported not using any method of birth control the last time they had sex; and nearly 89 percent of them didn't use both a condom and another method of birth control as is recommended.

The survey also showed that Kentucky's sexually active teens aren't using the most reliable forms of birth control; 75.5 percent reported that they did not using birth control pills the last time they had sex; 92.3 percent did not use an IUD or an implant; 94 percent did not use a patch, birth control ring or get a shot; and 51.3 percent of them did not use a condom.

And while teen birth rates in Kentucky continue to drop, to an average of 34.6 per 1,000 between 2013 and 2015, down from 37.9 between 2012 and 2014, and 48.9 five years ago -- Kentucky's teen pregnancy rate continues to be significantly higher than the national average of 22.3 per 1,000, according to the 2017 Kentucky Kids Count report.

The report also found that 16 Kentucky counties had teen-birth rates of 60 or more per 1,000, with Wolfe County leading the way at 80.9 per 1,000. That's up significantly from 68.2 five years ago. The report shows teen birth rates for every Kentucky county.

Brashear reports that out of all the pregnancies in Kentucky, 47 percent are unplanned.

A much debated bill about sex-education standards, passed during the past legislative session, requires any Kentucky school that offers sex ed to include instruction that says abstinence is the desirable goal for children, that abstinence is the only certain way to avoid unintended pregnancy or getting a sexually transmitted disease, and to teach students that the best way to avoid sexually transmitted diseases is to establish a "permanent, mutually faithful, monogamous relationship."

The new law does not require abstinence-only education, but opponents say it should have required comprehensive sex education in Kentucky schools, and by that omission sends a message to schools to teach abstinence-only curriculums, which the critics say have been proven ineffective.

Kentucky has no specified standards for sex education curriculums, though the state Department of Education has said that it is working on them. That was before the recent ouster of the department's commissioner.

Federal judge strikes down new abortion law that required narrated ultrasound; Bevin administration says it will appeal

A federal judge has struck down a new Kentucky law that required a physician to perform an ultrasound and display and describe the image of the fetus to the patient before providing an abortion, Darcy Costello and Deborah Yetter report for The Courier-Journal.

In a one-page opinion, District Judge David Hale ruled Sept. 27 that House Bill 2, which also required the physician to play an audible heartbeat of the fetus to the patient, violates a physician's First Amendment rights. Supporters of the law, which was enacted in January, say it was meant to better inform women seeking an abortion.

Hale wrote in his 30-page opinion: "HB 2 is intended to dissuade women from choosing abortion by forcing ultrasound images, detailed descriptions of the fetus and the sounds of the fetal heartbeat on them, against their will, at a time when they are most vulnerable."

The Courier-Journal reports that a lawyer for EMW Woman's Surgical Center in Louisville, the state's only abortion clinic, called the ruling a victory for patients, but supporters have promised an appeal to the U.S. Court of Appeals for the 6th Circuit.

"We are disappointed in the court's ruling and will appeal immediately to the 6th Circuit," Amanda Stamper, a spokeswoman for Gov. Matt Bevin, told the newspaper. "We are confident the constitutionality of HB 2 will be upheld."

But Andrew Beck, a lawyer with the American Civil Liberties Union's Reproductive Freedom Project, told the Courier-Journal that he expects Hale's permanent injunction to withstand an appeal. "It's an extremely solid ruling," he said.

Hale said the law is "designed to convey the state's ideological, anti-abortion message" and goes "well beyond" the basic information that a physician should give a patient. He added that the law "appears to inflict psychological harm on abortion patients."

HB 2 permits a woman to look away from the image and cover her ears, but physicians who failed to attempt to show and describe the fetus to the patient could face fines of up to $250,000 and action against their medical license. State law already requires counseling 24 hours in advance of an abortion.

The ultrasound law is one of two abortion bills the legislature passed during its first week this year after Republicans took control of both chambers. The second measure, Senate Bill 5, bans abortions at or after the 20th week of pregnancy. An attorney with the ACLU told The Courier-Journal that they don't plan to challenge that law, but will continue to monitor it.

Meanwhile, the state's only abortion clinic awaits a judges ruling to determine if it can remain open.

The Bevin administration revoked its license in March, claiming it lacked appropriate agreements with a hospital and ambulance service in the event of a patient emergency. After a three-day trial earlier this month, it was granted a temporary restraining order so it can remain open until the judge rules on the case, which is expected later this year.

State Senate panel OKs bill to deny most taxpayer dollars to Planned Parenthood; Ky. affiliate gave up funding in 2015

Feb. 22 Update : SB 8 passed out of the full Senate with a 31-6 vote and now heads to the House for consideration. 

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A bill that would effectively deny most tax dollars to Kentucky's Planned Parenthood locations in Louisville and Lexington passed out of a state Senate committee Feb. 17.

Senate Bill 8 would create a three-tier system to direct how federal family planning dollars are distributed in the state, with money first going to community health departments and federally qualified health centers, followed by private organizations that provide comprehensive primary and preventive health services, with Planned Parenthood third in line.

In 2015 Planned Parenthood's Kentucky affiliate stopped accepting its federal funding of about $300,000 per year, but Wise said the law is still necessary because "there is currently nothing in law that should prohibit them from in the future needing access to Title X family funds."

The bill would prohibit Planned Parenthood from receiving state or local funds, but it could still be paid by Medicaid, which is mainly funded by the federal government. Federal money does not pay for abortion.

Sen. Max Wise

The bill passed 8-3 along party lines out of the Senate Veterans, Military Affairs and Public Protection Committee, though Sen. Julian Carroll, D-Frankfort, said his vote was a "reluctant no" because of concern that it would reduce women's access to health services.

Texas, Kansas and Ohio have similar laws. The legislation wouldn't take effect until Congress repeals a regulation that prohibits family planning money from being allocated through a tiered structure. The U.S. House has already scheduled a vote on that, said Sen. Max Wise, R-Campbellsville, the bill's lead sponsor. It passed the measure Thursday.

“I come before you today thankfully more optimistic about the prospects of protecting unborn life than I was last year when the committee heard this similar bill,” Wise said.

Opponents of abortion have stepped up efforts to defund Planned Parenthood, which performs abortions but not in Kentucky, since undercover videos released in 2015 purported to show that it sells unborn baby parts for profit.

Wise cited the videos as a reason to support the bill, but they have been found to be heavily edited and misleading. FactCheck.org, a nonpartisan service of The Annenberg Center at the University of Pennsylvania, says, "The full, unedited video they cite as evidence shows a Planned Parenthood executive repeatedly saying its clinics want to cover their costs, not make money, when donating fetal tissue from abortions for scientific research." Experts also said the amount of money mentioned in the videos was not enough to create a profit.

Tamarra Wieder, director of external affairs at Planned Parenthood Advocates of Indianan and Kentucky, said in an interview after the meeting. "The ultimate agenda here is not women's health, it's about outlawing abortion and restricting people's ability to choose what's right for them."

Wise said another reason to withhold funding from Planned Parenthood is because it has a "vested, financial interest" in directing women toward abortion, noting that in 2013-14 the organization had provided 323,653 abortions and made 1,880 adoption referrals.

Federal and state law does not allow tax dollars to be used to pay for abortions, but Wise suggested that it is difficult to ensure that this money isn't crossing over for abortion services: "Under Title X grants, abortion providers can pro-rate expenses such as staff and waiting rooms, carving a portion of the fixed cost of the abortion related staff and facilities."

Opponents of SB 8 (L-R) Dr. Mary Sterrett, Sage Martin and
Tamarra Wieder speak to committee (Photo by Melissa Patrick)

The committee chair, Sen. Albert Robinson, R-London, chairman of the committee, had six opponents of the bill to speak for a little over 15 minutes before Wise presented it.

Wieder told the committee that as a military wife, she was referred to Planned Parenthood because the base was unable to care for her gynecological needs.

"As one of the state's leading and most trusted providers of comprehensive reproductive health care, Planned Parenthood in Kentucky serves more than 7,000 patients a year, a vast majority being low-income women of childbearing age," she said.

Sen. Denise Harper Angel, D-Louisville, the only woman on the committee, voted no and said, "With all the serious issues facing Kentucky, I don’t understand why we spend our time just taking away services for the women of Kentucky."

Wise said that if women need family-planning services, they could go to their local health department or federally qualified health center. But Wieder said, "They say you can go to the health department for this care ... and that's not true. Louisville and Lexington, there is no family planning services from the health department, they contract out. . . and that's not unique to just Louisville and Lexington."

The Louisville Metro Health Department confirmed that, and said it contracted with Planned Parenthood until it stopped taking Title X money. It now sends patients to Family Health Centers, which is a federally qualified health center.

Wieder said the FQHCs in Louisville often refers patients to Planned Parenthood for reproductive health services because "they are inundated with patients seeking other services and they don't have experts in the field that can manage that care, so we do get a lot of referrals from the FQHCs throughout the state, and specifically in Louisville and Lexington."

Bevin administration seeks maximum fines against Planned Parenthood, alleging 23 abortions at Louisville facility were illegal

The administration of Gov. Matt Bevin has filed a lawsuit seeking fines against Planned Parenthood of Indiana and Kentucky, alleging that it performed 23 abortions without proper authorization in December and January.

PPINK says an official of the previous administration allowed it to start offering abortions as part of the licensing process, but the lawsuit by the Cabinet for Health and Family Services says any pre-license authorization was contrary to state law, and six abortions were performed before the supposed authorization was given on Dec. 7.

The suit also says the facility's patient-transfer agreements with other health-care facilities "were a complete sham" and didn't identify the hospital involved, and that PPINK was "attempting to accelerate the process" before Bevin took office Dec. 8.

The suit asks Jefferson Circuit Judge Mitch Perry to fine PPINK $684,000, based on state law allowing a fine of up to $10,000 for each violation and $1,000 a day for continuing violations. The suit was signed by Bevin's general counsel, Steve Pitt, as attorney for the cabinet.

PPINK said in a statement Thursday that it had complied with directions from the cabinet's Office of Inspector General. "We ask that the executive branch continue the licensure process rather than continue to make politically motivated accusations."

"Planned Parenthood said cabinet officials directed it to begin providing all its reproductive health services including abortions so the clinic could be inspected prior to final issuance of a license," Deborah Yetter reports for The Courier-Journal. "The inspection was not scheduled because it is supposed to be unannounced."

Judge rules University of Louisville's hospital is public and subject to Open Records Act; it may appeal

The University of Louisville's hospital is a public entity, a Jefferson Circuit Court judge has ruled in a lawsuit filed to get access to the university's deals with other health providers.

Judge Martin McDonald ruled yesterday in favor of The Courier-Journal, WHAS-TV and the American Civil Liberties Union, noting that the university makes or approves all appointments to University Hospital's board of directors. The university had argued that the board, and thus the hospital, was not a public agency under the state Open Records Act.

The hospital said it might appeal the ruling. McDonald gave it 30 days to give him the records being sought, along with arguments about why they should be exempt" under exceptions to the law, reports The C-J's Andrew Wolfson. "He gave the news organizations at the ACLU 20 days to respond to any claimed exemptions." The hospital has said revealing contracts would put it at a competitive disadvantage.

The suit began after the university refused to let the plaintiffs see records related to its proposed merger with Jewish Hospital & St. Mary's HealthCare and Lexington-based St. Joseph Health Care System. Gov. Steve Beshear vetoed the merger on grounds that a public hospital should not be bound by a religious organization's health-care policies. This month the hospital announced a new deal with KentuckyOne Health, which includes the faith-based entities, but said reproductive services would not be affected despite a policy of "respect" for Catholic health directives. (Read more)

U of L and KentuckyOne Health announce partnership that keeps women's health services intact at University Hospital

The University of Louisville and KentuckyOne Health have reached a partnership agreement that will leave the resolution of any "moral roadblocks" up to a higher authority. U of L President James Ramsey said the partnership will allow the hospital board to continue its control over the public entity, a principle that scuttled an earlier deal with Catholic Health Initiatives, which then formed KentuckyOne with Jewish Hospital. Gov. Steve Beshear signed on to the agreement, after killing the first one.

The goals of a public institution that provides all women's health services -- including reproductive and end-of-life care -- were not the same goals of those espoused by the Roman Catholic Church. The new agreement seems to have solved that issue by continuing to allow the hospital's pharmacy and Center for Women and Infants and to provide the same services as they did before, reports Laura Ungar of The Courier-Journal. The services will be provided by the same people as currently, the partners said. This includes all reproductive services.

The Archdiocese of Louisville said in a statement that it was not part of the negotiations but that there were no more “moral roadblocks” to its continued official recognition of KentuckyOne as a Catholic entity. The archdiocese said the partners involved “have committed to respecting one another’s traditions, missions, and values, including our own Ethical and Religious Directives for Catholic Health Care Services.” (Read more)

Health care is strong second to economy among concerns of Ky. registered voters; candidates compared on handling of issues

Health care ranks high among the concerns of Kentucky voters, according to the latest Kentucky Health Issues Poll taken for the Foundation for a Healthy Kentucky.

The poll, taken Sept. 20 through Oct. 14, asked registered voters to name the two most important issues in the Nov. 6 presidential election. The economy was mentioned by 65 percent; health care was second, with 42 percent. Foreign policy was a distant third, at 21 percent. The error margin on the sample of 1,160 voters is plus or minus 2.88 percentage points.

The poll did not ask voters whom they favored for president, but did ask which candidate they trusted to do a better job on certain issues. Romney, who is considered certain to win Kentucky, had a clear advantage on two issue areas, listed first:

• Dealing with the federal budget deficit: Romney 49%; Obama 36%

• Dealing with the economy and jobs: Romney 48%; Obama 36%

• Dealing with the future of the health reform law: Romney 45%; Obama 40%

• Addressing terrorism: Romney 43%; Obama 42%

• Dealing with the situation in Afghanistan: Romney 42%; Obama 40%

• Improving education: Obama 45%; Romney 40%

• Looking out for the best interests of women: Obama 42%; Romney 40%

• Making decisions about women's reproductive health choices and services: Obama 41%; Romney 38%

"This poll gives us a reliable snapshot of the issues most important to Kentucky voters as they decide who they will vote for on Nov. 6," said Dr. Susan Zepeda, president/CEO of the foundation. "Regardless of the outcomes of the election, our foundation believes it is essential for our elected officials to know what Kentuckians think about these issues." To download the full report by the Institute for Policy Research at the University of Cincinnati, click here.

Eastern Kentucky native wants to alert Appalachian women about their high rate of cervical cancer and how to prevent it

University of Kentucky physician and Pike County native Baretta Casey, right, has spent most of her career providing health care and education throughout the state, with a focus on Appalachian Kentucky. The health disparities between Eastern Kentucky and the rest of the state, especially high rates of cancer, are of "special concern" to Casey, reports Ann Blackford of UKNow.

Cancer is prevalent in her Casey's own family, and this is why she "has taken on the challenge of helping reduce cancer rates in Kentucky, especially cervical cancer and other Human papillomavirus cancers," Blackford reports. Cervical cancer rates are highest in rural and Appalachian Kentucky. According to the Kentucky Cancer Registry from 2005 to 2009, the cervical cancer rate in the region was 9.85 per 100,000 people. The state rate was 8.6. The average of deaths per year in the region from cervical cancer was 258.

"We have the tools to change these high rates and make a real difference in people's lives," Casey said. "I feel the best thing I can do for the people of Eastern Kentucky is to educate about prevention and screening of cervical cancer." Casey became the director of the Cervical Cancer-free Kentucky Initiative at UK's College of Public Health's Rural Cancer Prevention Center in 2010. Through this position, she makes connections with county health departments, community organizations and health advocacy groups that provide education and funding for cervical cancer prevention projects.

"Casey is passionate about educating people on the importance of vaccinating their children against HPV," Blackford writes. She said she wants people to look past the controversy of vaccinating their children and realize the importance of the vaccine. "The vaccine given for the appropriate reason can save a life," Casey said. (Read more)

The Courier-Journal, continuing to explore Louisville hospital merger, says many more questions still need answering

The proposed merger of the University of Louisville hospital with Jewish Hospital & St. Mary’s Healthcare and with St. Joseph Health System of Lexington, which follows the teachings of the Roman Catholic Church, continues to draw heavy attention from The Courier-Journal. Sunday's newspaper had a long column by editorial writer Pam Platt, and an editorial that online was packaged with a video discussion among the editorial board and U of L President James Ramsey, David Laird of Jewish and St. Mary’s, Dr. Daniel Varga of St. Joseph and James Taylor, CEO of University Hospital.

"On many levels, the merger . . . is appealing," the editorial began, saying the new system would be broader and more efficient and secure the three Louisville hospitals as they compete with Baptist Hospital-East and Norton Healthcare, which recently announced an affiliation arrangement with the University of Kentucky" hospital. "Two significant issues continue to make the merger problematic, however." In addition to the issues of reproductive care, the editorial wonders whether advances in medical science that conflict with Catholic teaching could cause the merger to "unwind," as hospital officials put it, and what the ramifications of that would be. (Read more)

In her column, Platt, right, focused on the merger's impact on women, saying it remains unclear. For example, "The partners say transportation will be provided for pregnant women wanting tubal ligations, as well as for their infants. But what will be the process for them accessing that? What are the details? . . . Many of us need more answers to additional questions . . . before we know if this merger is the answer not only for the business end of things, but for all the people who depend on the hospitals for their care." The merger needs state approval to proceed. (Read more)

Baptist Hospital East would allow U of L docs to perform tubal ligations there after merger with Catholic system

Since the merger between Jewish Hospital, University Medical Center and Saint Joseph Health Systems will prevent female patients from getting their tubes tied there — because St. Joseph is owned by a Catholic-based parent company — Baptist Hospital East will provide a facility where University of Louisville doctors can perform the procedure.

"This will ensure our ability to provide reproductive services for our patients after the merger occurs," said Dr. David Dunn, U of L executive vice president for health affairs, addressing perhaps the largest single concern about the merger. University Hospital CEO James Taylor called it a "very small" compromise. "We compromised only a location, not a population."

Through a $15 million fund "that will be set aside from the assets of University Hospital and given to U of L for that purpose once the merger closes," uninsured women will be able to have tubal ligations at Baptist, whether they're being done after giving birth via C-section or vaginally, reports Patrick Howington of The Courier-Journal. They can also be done even if the procedure is unrelated to childbirth. University of Hospital performed 301 tubal ligations last year.

University Hospital has historically provided care for indigent patients who cannot afford to get care elsewhere. Because these patients are not wealthy enough to choose which hospital they go to, they have no choice but to adhere to Catholic directives. Though the issue of female sterilization has been addressed, there is still the issue of how end-of-life care will be handled at University Hospital. That includes how living wills and the removal of a feeding tube will be dealt with.

The merger, which would create Kentucky's largest health-care system, still needs the approval of Gov. Steve Beshear and the Catholic Church. "We have a public institution with a public mission that has been supported by the public dollars and public leadership for many years," said state auditor Crit Luallen. "And we have to look at how a merger with a religious organization changes the public's access and the public's protection." (Read more)