UK is again the top Ky. hospital in U.S. News rankings, followed by St. Elizabeth in Northern Ky. and Baptist Health Louisville

By Melissa Patrick

Kentucky Health News

 

Three Kentucky hospitals, in the state's three largest metripolitan areas, have been named among the nation's "Best Regional Hospitals" in the annual ranking by the U.S. News & World Report magazine. 

The No. 1 hospital in Kentucky is again the University of Kentucky hospital, followed by St. Elizabeth Healthcare in Edgewood and Covington and Baptist Health Louisville.

To make the list, a hospital must offer a full range of services; rank nationally in one of 11 measured specialties, or have seven or more high-performing rankings for procedures and conditions; and have at least three more "high performing" than "below average" rankings for procedures and conditions. 

The report offers an overview of 121 Kentucky hospitals with a breakdown of each of the measured categories, according to the services a hospital provides. 

UK HealthCare, for the ninth straight year, ranks No. 1 in the state with its Albert B. Chandler Hospital.

In cancer care, UK's Markey Cancer Center moved up to No. 36 from No. 44 last year. Markey is Kentucky's only National Cancer Institute-designated cancer center, and one of 72 in the nation. 

“Together, these recognitions firmly establish Markey among the nation's top cancer centers, affirming that patients can access world-class cancer care right here in Kentucky,” Dr. Mark Evers, director of the cancer center, said in a news release. 

UK's hospital system also ranked nationally in two other adult specialties: ear, nose and throat and obstetrics and gynecology; and three children specialties: pediatric cardiology and heart surgery, orthopedics and urology.

Six UK HealthCare adult specialties – four more than the previous year’s rankings – also received the “high performing” designation: gastroenterology and gastrointestinal surgery, geriatrics, neurology and neurosurgery, orthopedics, pulmonology and lung surgery and urology. 

The system also was rated "high performing" for 14 procedures and conditions, including heart attack, heart-bypass surgery, heart failure, colon-cancer surgery, kidney failure, back surgery (spinal fusion), stroke, gynecological-cancer surgery, leukemia, lymphoma and myeloma, hip replacement, chronic obstructive pulmonary disease (COPD), lung-cancer surgery, pneumonia and prostate-cancer surgery. 

Chandler Hospital was also named Best Regional Hospital for Equitable Access, a new category that recognizes success in caring for patients in historically underserved communities. UK HealthCare was one of 98 medical centers nationwide and the only hospital in Kentucky to receive this recognition.

“We diligently examine our data and metrics to help us identify and quantify disparities that are unique to our underserved populations. That allows us to execute targeted strategies and solutions to address these issues. We are truly the university – and the hospital – for Kentucky," Tukea Talbert, who oversees health equity efforts at UK HealthCare, said in the release.

St Elizabeth's Edgewood and Covington hospitals ranked high performing in 15 procedures and conditions: leukemia, lymphoma and myeloma, colon-cancer surgery, lung-cancer surgery, prostate cancer surgery, abdominal aortic-aneurysm repair, heart attack, heart-bypass surgery, heart failure, kidney failure, stroke, maternity care (uncomplicated pregnancy), hip replacement, knee replacement, COPD and pneumonia.

This is the 11th time that Baptist Health Louisville has ranked No. 1 or tied for that ranking in Jefferson County. The hospital ranked high-performing in nine procedures and conditions: leukemia, lymphoma and myeloma, colon-cancer surgery, abdominal aortic-aneurysm repair, heart attack, aortic-valve surgery, heart-bypass surgery, hip replacement, knee replacement and COPD. The hospital ranked below average for diabetes. 

“We’re incredibly excited to be recognized by U.S. News and World Report for being number one in metro Louisville. It’s a recognition that comes as a culmination of a lot of work from the entire team at Baptist Health Louisville who strive every single day to ensure that the care that we provide is the highest quality and the safest it possibly can be,” Dr. Jonathan Velez, president of Baptist Health Louisville, said in a news release. 

The 35th annual rankings compared hospitals in 15 specialties and 20 common procedures and conditions. Data from the report came from the Centers for Medicare & Medicaid Services, the American Hospital Association and professional organizations. This year, the report also includes Medicare Advantage data in the rankings, including risk-adjusted mortality rates for its beneficiaries in 11 adult specialties.

Nationally, the report named the top 22 hospitals to the national "Honor Roll." The top hospitals were not ranked again this year, but were instead listed in alphabetical order. Regionally, 466 hospitals were recognized as "Best Regional Hospitals." Click here for a FAQ about how and why U.S. News ranks hospitals.

As blood runs short in Ky. and the U.S., Red Cross seeks donors

Gov. Andy Beshear and first lady Britainy Beshear listen to Steve Cunanan, regional CEO of the American Red Cross, as they prepared to donate blood in the state Capitol rotunda. (Photo by Al Cross)

By Al Cross

Kentucky Health News

Responding to a potentially dangerous shortage of blood, Gov. Andy Beshear and his wife set an example Monday by donating blood in the state Capitol and hosting a blood drive in the Capitol Education Center.

First lady Britainy Beshear said before they donated that the number of blood donors in the U.S. is at a 20-year low. Steve Cunanan, regional director for the American Red Cross, said that means the organization is getting 40 percent less blood than usual. It declared a national emergency last month.

Cunanan noted that blood is a perishable product, and is needed an average of every two seconds in the U.S., and only 3 percent of Americans donate blood.

The governor said the shortage could lead to delays in surgeries in Kentucky and would become even more dire in the event of a disaster. He said he and his wife have become regular donors in recent years.

The Red Cross is coordinating with the Kentucky Blood Center, the largest blood bank in the state. Its website has a page where you can enter your ZIP code to find drives in Eastern and Central Kentucky, including Louisville. The Red Cross has a site where you can find blood drives anywhere in Kentucky or the U.S.

If you smoke pot, lay off before surgery; you could wake up early

Photo illustration from OR Management

Regular users of marijuana may need up to three times more anesthetic to keep them unconscious during surgical procedures, so they need to tell surgical personnel about it, say doctors who have studied the phenomenon. And a preliminary study suggests that cannabis users have more pain after surgery.

"Why this might be is, like anasthesia itself, something of a mystery," reports The Economist. "The problem is magnified by a growing number of Americans getting high," with recreational cannabis legal in 20 states. "A 2021 federal survey found that 18.7% of people age 12 or older had used marijuana in the past year," The Wall Street Journal reports.

"More doctors say they are asking about marijuana use—and urging honesty—before surgeries or procedures because habitual users may need more anesthesia and painkillers," the Journal reports. "It isn’t clear if the anesthesia complication is largely limited to people who use THC, the main psychoactive component of marijuana and what causes the high, or also extends to people who take cannabidiol, or CBD. The latter doesn’t produce the high that THC does and is sometimes used as a remedy for pain, sleep or anxiety. Many cannabis products such as edibles contain a combination of the two."

Published studies of the problem have been limited, mainly because federal law thwarts studies of cannabis. Studies have focused on endoscopy, a procedure in which a long tube with a lens and a light is passed down the throat to the digestive tract. A study in Ontario found that daily users of cannabis needed more profopol, a common surgical sedative, than weekly or monthly users.

"Smoking weed before surgery can make patients confused, irritable and sometimes even violent when they wake up," The Economist reports. "A working paper presented in October, which has yet to be peer-reviewed, suggests that weed can hinder recovery, too. Of the nearly 35,000 Cleveland Clinic patients assessed, those who used marijuana within 30 days of their operation experienced 14% more pain in the day after surgery and took 7% more prescription opioids to ease it." A study published in 2018 "found that cannabis users had higher pain scores and consumed 25% to 37% higher quantities of opioids compared with nonusers," The Wall Street Journal reports.

The American Society of Regional Anesthesia and Pain Medicine said in January that pregnant women should be discouraged from smoking cannabis, "and non-emergency surgeries should be postponed by at least two hours if the patient comes in blitzed. A slew of other new reports warn anaesthesiologists of the mounting risks," The Economist reports. "The common perception that marijuana eases nerves works against doctors. Some people seem to be getting stoned before they arrive at the hospital in order to calm themselves down. New users may be particularly likely to smoke for such a purpose. For a better experience, patients should forgo the parking-lot hit."

Covid-19 can cause psychological problems; UK case is an example, and also of surgery that can prevent epileptic seizures

From left: Sally Mathias, M.D.; Aleina Milligan; her sister Kelly Milligan, the patient; Farhan Mirza, M.D., and Timothy Ainger, Ph.D. (University of Kentucky photo by Pete Comparoni)

By Hillary Smith

University of Kentucky

Aleina and Kelly Milligan of Columbia are more than sisters; they are truly best friends. For Kelly, her older sister has been a lifeline during the past two years.

“I was so excited when she decided she wanted to move down here because I thought, ‘This is awesome! I’m going to get to have my sister,’” Aleina said. “And then she got so sick.”

Kelly has dealt with seizures her entire life. She lived and worked in a sheltered employment program in Michigan and had worked as a custodian for 29 years. After experiencing some health issues while at work and after their mother passed away, Kelly decided to move in with her sister.

“She had no support system in Michigan, and it was just too much,” said Aleina.

But Aleina became concerned when she noticed a change in Kelly’s seizure patterns, so they came to see UK HealthCare’s Dr. Sally Mathias, an assistant professor of neurology who specializes in epilepsy.

“When I first saw her, I knew we needed to know more,” Mathias recalled. “She had never had some of the basic testing that is required for epilepsy, so we started off with that.”

The fact that Kelly’s seizure patterns had changed stood out to the epilepsy specialist, but that wasn’t all. “What is very rare is that her heart was actually stopping with every seizure — it is called ‘ictal bradycardia’,” said Mathias. “We noticed that on the Epilepsy Monitoring Unit. The longest her heart stopped while she was in our hospital was 20 seconds.”

To explore this further, they sent her home with a heart monitor for a few weeks. While at home, the heart monitor detected 30 seconds when Kelly’s heart had stopped.

“This was very serious and needed immediate attention,” said Mathias. “We directly admitted her to cardiology, and she got a pacemaker.”

Kelly was shocked to learn about what was happening with her body. This was all new for Aleina, but as they learned, she more says it did start to make sense.

“I was with her several times and experienced when she would just drop,” Aleina said. “There was one time I kept looking at her and thought ‘She is not breathing … surely not though, she must be breathing.’ After we found this out, I’m like, ‘OK, she wasn’t breathing.’ We are very fortunate that nothing has happened, and her heart continued to restart.”

After receiving her pacemaker, the next step for Kelly was epilepsy surgery, something she had never considered before meeting the doctors at UK HealthCare.

“It still baffles me that no one ever did basic testing for epilepsy on her, and that when I discussed epilepsy surgery with them, it was the first time they had heard of it,” said Mathias.

In August 2020, Dr. Farhan Mirza, assistant professor of neurosurgery and director of epilepsy surgery, successfully did surgery on Kelly’s brain. For the first time, she or her sister can remember, Kelly was seizure-free.

“We could go places and not have to go through the thought process of ‘What if?’” said Aleina. “For example, I had been thinking it would be wonderful to visit the beach and go swimming, but I was always afraid to get her in the water, because, what if she dropped?”

Mirza said, “Kelly's journey, like so many of our patients with refractory epilepsy, highlights two important things: No one should have to suffer from uncontrolled epilepsy for decades, and all patients who are resistant to anti-epileptic medications deserve to be evaluated for possible surgical options in a timely fashion. This can be done effectively only at highly specialized centers like UK where we offer advanced multi-disciplinary care for refractory epilepsy.”

The sisters were thrilled to have a greatly improved quality of life as Kelly celebrated her 50th birthday complete with a crown and a sash, less than two months after her epilepsy surgery.

“She was not limited anymore, and that is fantastic,” said Aleina.

Second chapter: Just weeks after celebrating her 50th birthday, two and a half months after her brain surgery, Kelly contracted Covid-19. She started showing symptoms about a week after Aleina came down with the virus. As Aleina recovered, Kelly’s symptoms worsened.

“She started telling me that she was having these strange neurological symptoms – tingling, burning, rushing feelings in her hands and feet, and continuous thoughts that she could not control,” said Aleina. “Kelly had never had any mental problems other than minor anxiety.”

After a few months of feeling like they could finally enjoy life together, Aleina was again reaching out to doctors with great concern for her sister.

“I read some articles about studies looking at the possibility that Covid can attack the weakest part of a person,” said Aleina. “I just assumed that would be her brain because she just had this major surgery.”

At that point, Covid-19 was still relatively new. Aleina says the doctors she spoke with did not know much about the virus other than to tell her that if Kelly’s breathing was okay, then she was okay.

“She continued to get worse … her brain, the tingling,” said Aleina. “It never presented in her lungs, but she just kept acting more strangely. She would say she was on fire and that she felt there was something evil after her.”

Kelly does not remember much of that time, and Aleina says that's a good thing. After about 10 days, Aleina took her to their local emergency department because she was afraid her sister was having another seizure. She wasn’t, though she had a fever and a low level of sodium.

The sisters continued to live like this for several more days and found themselves in the midst of the holiday season. Kelly continued to have a growing feeling that something was invading her body and mind. She then ended up back in the hospital with pancreatitis, which doctors attributed to her Covid-19 infection. Then just a few days after Christmas, Kelly tried to harm herself, and she was admitted to Eastern State Hospital.

“She was in full-blown psychosis,” said Aleina. “She was hallucinating and thought she was being told to harm herself or us.”

Her neurology doctors “were very concerned for her, but at that time there really were not any reports of COVID harming anybody mentally,” Aleina said. “They just didn’t know if it could be related.”

After three weeks at Eastern State, Kelly returned home on some medication that helped a little while, but quickly took a turn for the worse.

“She had gotten so bad … she was no longer my sister,” Aleina said. “It was horrible.”

Kelly was not eating. She would not communicate. Then, she began abusing her medications.

“I got ahold of Dr. Mirza and Dr. Mathias, and I was very honest with them and begged them to get her in for an appointment,” said Aleina. “I said, ‘I don’t know what is going on, but something is wrong, and she is going to die if we do not figure this out.’”

Drs. Mirza and Mathias, and neuropsychologist Timothy Ainger met with Kelly and decided that she couldn’t be sent back home. They knew right away that something was not right because she had undergone a neurocognitive evaluation as part of her pre-surgical workup, and the new results were much different.

“It is a very comprehensive evaluation of your cognitive abilities and how well your mind is functioning,” Ainger said. “She had gone from being talkative, engaged, and polite to being terrified, psychotic, and reserved.”

Her epilepsy doctors, Mirza and Mathias, had seen this surgery done successfully on so many patients and knew that this reaction was not typical. Mathias recalled, “We were naturally thinking, ‘Okay, what else is going on?’”

They said they felt good about Kelly’s surgery, but also knew that these issues occurred not long after it.

“She was doing great from a procedure perspective and didn’t have any issues,” said Mathias. “After surgery, some issues can develop. So that is what we were thinking … Maybe it wasn’t entirely because of the surgery … but I did have that in the back of my mind, because I can’t exclude that.”

The doctors also said operating on that area of Kelly’s brain wasn’t a likely cause for the type of psychiatric symptoms she was having. When Ainger looked through Kelly’s medical notes and history, he discovered the culprit.

“It then became very obvious,” Ainger said. “Right after she had just come out of the acute Covid illness, she had this rapid and sudden onset of symptomology. It was very similar to what the literature has been suggesting in the few cases that existed and very similar in one or two other patients that we had treated.”

They treated Kelly's case as some form of Covid-induced encephalitis, swelling of the brain, starting immunoglobulin therapy and changing one of her seizure medications.

“Within one week, my sister was back,” Aleina recalled. “She was still medicated with the anti-psychotic medication, but she was Kelly again.”

Since then, Aleina says they have been able to back Kelly off from 20 milligrams of her antipsychotic medication to one milligram.

“We completely believe we are going to be able to have her off that completely very soon,” Aleina said. “She is doing great. It has been a real journey.”

In the course of a year, Kelly has been on a roller coaster with her health: a dramatic brain surgery to rectify seizures, a bout of ovid-19, the development of psychosis, and then - thanks to intervention - back to normal and seizure-free. Through all those ups and downs, she and her sister are thankful for the team at UK.

“Because of the way this team works together, it was not six months, nine months, or even 12 months of working with other hospitals and dealing with referrals,” said Ainger.”We were able to just walk into each other’s offices, have meetings, and get this managed right away. That is not the kind of service people get from hospitals that don’t have multidisciplinary teams like this.”

In this case, the teamwork even went outside of the neurology department – it also included cardiology, considering Kelly’s prior heart issues and pacemaker.

“This one was different and a lot of cross-functional teamwork, but we do this for every patient,” said Mathias. “We come together to help our patients especially when they are going through such difficult times.”

Thanks to their teamwork and dedication, Kelly and Aleina are now finally getting to enjoy living in the same place.

“I’ve got her back and so now we can grow old together,” said Aleina. “I’m kind of already there, but we are so looking forward to it.”

“Kelly's story is truly one of years of anguish, a glimpse of seizure freedom, a calamitous decline, followed by a complete recovery,” said Mirza. “We are thrilled to see her faring so well and are honored to have been a part of Kelly and Aleina's inspirational journey.”

As the Omicron variant of the coronavirus rages through Kentucky, some hospitals are stopping inpatient elective surgeries

Baptist Health Lexington (Baptist Health Foundation photo)

By Melissa Patrick
Kentucky Health News

As the Omicron variant of the coronavirus skyrockets in Kentucky, hospitals and their intensive-care units continue to fill up, and a few Kentucky hospitals have begun to scale back on some elective surgeries. 

One is Baptist Health Lexington. Dr. David Dougherty, an infectious-disease specialist at the hospital, said Tuesday that the hospital will postpone or scale back inpatient elective surgeries starting Wednesday. He said it will continue to do outpatient elective surgeries. 

"The elective surgeries that we're postponing right now are mostly the ones that are requiring an overnight stay, and they're, you know, non-urgent or emergent cases," he said. "And this is a fluid thing, you know, we're assessing on a daily basis when this will end and we can do elective surgeries again." 

St. Elizabeth Healthcare in Northern Kentucky is also scaling back elective procedures by not scheduling any additional same-day and elective surgeries that require admissions through Jan. 8, and halting any non-emergency add-on cases until mid-January, the Northern Kentucky Tribune reports.

“Our community is in the midst of a surge from a mix of Delta-variant infections and Omicron-variant infections, the latter strain having a much shorter doubling time and infection rate,” said a statement from St. Elizabeth. “At the conclusion of the holiday season and people gathering, we are expecting to see incidence rates in our region over the next few weeks.”

Dougherty said the best way to slow down Covid-19 hospitalizations is for people to get vaccinated or boosted, noting that an influx of Covid-19 patients affects care for everyone. 

"The more people we get vaccinated and boosted the more we can help to slow this down and decrease hospitalizations," he said. "A lot of us are going to be exposed to Omicron, but if you're vaccinated and especially if you're boosted, your chances of getting hospitalized are much lower."

Dougherty said the decision to postpone some elective surgeries is the result of both staffing issues and bed space, which go "hand in hand." He said 85 of the 450 beds at his hospital are occupied by Covid-19 patients, and the number will increase; and Omicron puts hospital staff at increased risk of infection.  

Doctors from CHI Saint Joseph Health and UK HealthCare said at the same press conference that they have not had to curtail elective surgeries, but said both Lexington hospitals consider it daily. 

Dr. Ashley Montgomery-Yates, chief medical officer for inpatient and emergency services at UK, said "I would speculate that with our numbers continuing to rise, with the alarming rate, it's not out of the realm of possibility." 

Yates also pointed to the real-life challenges associated with canceling elective procedures, noting that often what is considered elective may not feel very elective to patients who are dealing with diseases like cancer. 

Dr. Dan Goulson, chief medical officer at CHI Saint Joseph Health, said hospitals are still caring for patients who had elective procedures cancelled earlier in the pandemic.

UK HealthCare again best Ky. hospital in U.S. News & World Report rankings; Baptist Health has two of top six in the state

By Melissa Patrick
Kentucky Health News

Six Kentucky hospitals have been named among the nation's "Best Regional Hospitals" in the annual ranking by U.S. News & World Report magazine.

They are, in order: the University of Kentucky hospital; hospitals in Covington and Edgewood; Baptist Health Lexington; Baptist Health Louisville; and Louisville's Norton Hospital and UofL Health-Jewish Hospital.

Dropping off the list this year is Saint Joseph Hospital-Lexington.

To make the list, a hospital must:

• Offer a full range of services;
• Rank nationally in one of 11 measured specialties, or have six or more high-performance rankings for procedures and conditions; and
• Have at least three more "high performing" than "below average" rankings for procedures and conditions. 

The report offers an overview of 122 Kentucky hospitals with a breakdown of each of the measured categories, according to the services a hospital provides.

UK HealthCare, for the sixth straight year, is No. 1 with Albert B. Chandler Hospital. It ranked in the top 50 for cancer care for the fifth consecutive year. Its Markey Cancer Center is the only National Cancer Institute-designated cancer center in the state, and one of only 71 in the nation. 

“These rankings recognize UK HealthCare as the major health system best equipped to meet the needs of patients across Kentucky, and they recognize the incredible work and dedication of our physicians, nurses and health care providers across our academic health system,” Dr. Mark F. Newman, UK executive vice president for health affairs, said in a news release. “At UK HealthCare, our commitment has been and always will be to provide the most advanced specialty care to the citizens of the commonwealth, without the need to travel far from home.”

UK also ranked as high-performing in gastroenterology and gastrointestinal surgery; geriatrics; orthopedics; and urology.

The 32nd annual rankings compared more than 4,750 medical centers nationwide in 15 specialties and 17 procedures and conditions. This year's report expanded to cover seven new procedures and conditions. It also added a new health-equity measure. Of the 4,750 hospitals, 175 were nationally ranked in at least one specialty and 531 were ranked among the Best Regional Hospitals in a state or metro area, according to a news release. 

Baptist Health Louisville was the top rated hospital in Louisville. Baptist CEO Gerard Coleman said in a news release, that the rankings "reflect the unrelenting dedication of our physicians, staff and support teams in providing exceptional and compassionate care to our patients. I am proud of the work that we do. We’ve been tested by the pandemic, which has made us more mindful of what’s important and that our mission to serve the needs of our communities has never been more vital."

The report recognizes hospitals that are "high-performing" for 17 common adult procedures and conditions, including abdominal aortic aneurysm repair; aortic valve surgery; back surgery (spinal fusion); chronic obstructive pulmonary disease; colon cancer surgery; congestive heart failure; diabetes; heart attack; heart bypass surgery; hip fracture; hip replacement; kidney failure; knee replacement; lung cancer surgery; pneumonia; stroke; and transcatheter aortic valve replacement.

UK HealthCare ranked high-performing in all those categories except abdominal aortic aneurysm repair,  aortic valve surgery, transcatheter aortic valve replacement, diabetes, back surgery (spinal fusion), knee replacement, hip fracture. It ranked average in each of these categories. 

St. Elizabeth in Edgewood and Covington ranked high performing in all the categories except aortic valve surgery, heart bypass surgery, transcatheter aortic valve replacement, back surgery (spinal fusion), hip fracture. It ranked average in each of these categories.

Baptist Health Lexington ranked high performing in all categories except aortic valve surgery,  transcatheter aortic valve replacement, diabetes, kidney failure, knee replacement, hip replacement, and pneumonia. It ranked average in each of these categories. 

Baptist Health Louisville ranked high performing in all categories except lung cancer surgery, heart failure, transcatheter aortic valve replacement, kidney failure, back surgery (spinal fusion), hip replacement, hip fracture and pneumonia. It ranked average for each of these categories.

Norton Hospital ranked high performing in all categories except colon cancer surgery, lung cancer surgery, abdominal aortic aneurysm repair, aortic valve surgery, heart bypass surgery, transcatheter aortic valve replacement, back surgery (spinal fusion), hip fracture and pneumonia. It ranked average for each. 

UofL Health-Jewish Hospital ranked high performing in all categories except colon cancer surgery, lung cancer surgery, abdominal aortic aneurysm repair, aortic valve surgery, heart bypass surgery,  transcatheter aortic valve replacement, knee replacement, hip replacement, hip fracture, and pneumonia, ranking average for each of those; and back surgery (spinal fusion), where it ranked below average.

Click here for a list of frequently asked questions about how the magazine ranks the hospitals. 

Nationally, the Mayo Clinic in Rochester, Minn., claimed the No. 1 spot, followed by Cleveland Clinic and UCLA Medical Center in Los Angeles.

Kentucky hospitals say pandemic has cost them $1.34 billion, net

By Lisa Gillespie
Kentucky Health News

Kentucky hospitals say they have had collective financial losses of $1.34 billion due to the covid-19 pandemic, with the biggest hit from elective procedures that were canceled or postponed.

In a new report, the Kentucky Hospital Association tracks the hits hospitals have taken and the federal assistance they got to stay afloat. They say federal relief money, not counting almost that much in loans from Medicare, reduced their losses by $1.03 billion, and they reduced their expenses by $200 million.

“While it sounds like we've gotten a lot of money, which of course we have, the losses are much greater than that,” KHA President Nancy Galvagni said.

The report says the losses came mainly from fewer patients seeking care not related to covid-19, new limits on hospital capacity in case of a local outbreak, and stockpiling supplies like personal protective equipment.

Elective procedures were put on hold during the three months Kentucky was in lockdown mode. Galvagni said the procedures include anything that could wait without a patient deteriorating or dying, such as knee replacements and preventive services.

“There are procedures that hospitals are able to make a margin on, and they subsidize all the money-losing services that hospitals provide,” Galvagni said. “That period of time when we didn't have that volume, we're never going to recoup those losses. That's just money out the door.”

The pandemic has added other burdens. Hospitals must have 30 percent of their beds at stand-by in case of a local outbreak, and treatment of a covid-19 patient is much more expensive than other patients. KHA cited research indicating that hospitals lose between $1,200 to $8,000 per day on covid-patient care that won’t be paid by insurers.

Another big question that’s weighing on hospitals is the money they owe the federal government. Hospitals were able to request six months of advance payments from Medicare, but at some point Medicare will have to recoup  that money. KHA is asking Congress to forgive the loans.

Galvagni said she didn't know many hospitals had received those advance payments. A Medicare report said Kentucky hospitals and other health-care facilities got $1.16 billion; nationally, hospitals got almost 85% of the money; if that percentage held true in Kentucky, the state's hospitals were advanced about $950 million.

The KHA report says the pandemic has put rural hospitals at higher risk of closure. Kentucky has 68 rural hospitals, which compose 56% of hospitals in the state, employing more than 24,000 people.

“Those hospitals that were already struggling, could be even more struggling,” Galvagni said.

Most rural-hospital patients are covered by Medicaid, the federal-state program that covers people with incomes up to 138% of the federal poverty level. These hospitals already operate under tight margins because Medicaid typically pays less than commercial insurance, Galvagni said: “It's really a reflection of the payer mix of our hospitals in those areas where they’re serving a vulnerable population.”

In the report, KHA asks the Kentucky legislature to not increase a health-provider tax that would mean hospitals give more money to the state to help fund Medicaid.

Hospitals overall are losing money, and it's likely to get worse; Cynthiana hospital says it's 'at a negative 25% margin'

A report prepared for the American Hospital Association predicts half of the nation's hospitals will be losing money by the end of the year unless Congress gives them more relief money, and some of those hospitals are in Kentucky.

Overall, hospitals usually have an operating margin of 3.5 percent, but that is expected to be minus 3% for the second quarter of this year, once the figures are compiled, and could sink to minus 7% in the third and fourth quarters -- and half of all hospitals are likely to operate with a negative margin, said the report by Kaufman Hall, a health-care consulting firm.

"That drop would have been negative 15% without funding from Congress, which gave providers $175 billion a few months ago," Robert King reports for Fierce Healthcare. Hospitals had to give up their most profitable function, elective surgery, in the early months of the pandemic, and now many Americans are reluctant to enter a hospital.

AHA organized a call with reporters and hospital executives, including Sheila Currans, CEO of Harrison Memorial Hospital in Cynthiana. She said the hospital tries to get an 0.6% operating margin in a good year, but “We are at a negative 25 percent margin.”

Rural hospitals like Cynthiana's have struggled most, and that's par for the course, says Alan Morgan, CEO of the National Rural Health Association. “For the last 20 years, rural hospitals have been struggling,” Morgan said. “That’s kind of who they are.” NRHA says "Many rural hospitals are also facing workforce reductions at a time when residents need care most," and quotes Debrin Jenkins of the West Virginia Rural Health Association: “I think it’s redline dangerous … I think it will be a huge increase in death.”

UK HealthCare again best Ky. hospital in U.S. News & World Report rankings; Baptist Health has two of seven on state list

By Melissa Patrick

Kentucky Health News

Seven Kentucky hospitals are included in the nation's "Best Regional Hospitals" in the latest annual rankings by the magazine U.S. News & World Report. 

They are, in order: the University of Kentucky hospital; in a tie for second, Baptist Health Louisville and St. Elizabeth Healthcare Edgewood-Covington Hospitals, Louisville's Norton Hospital and Baptist Health Lexington; and in sixth, the University of Louisville's Jewish Hospital and Saint Joseph Hospital-Lexington. 

To make the list, a hospital must offer a full range of services; either be ranked nationally in one of 12 measured specialties or have three or more high-performance rankings for procedures and conditions; and have at least two more high-performing than below-average rankings for procedures and conditions. The last criterion is new.

The report offers an overview of 122 Kentucky hospitals with a breakdown of each of the measured categories, as relevant to the services the hospital provides. 

UK HealthCare, for the fifth consecutive year, claimed the No. 1 ranking with its Albert B. Chandler Hospital. The hospital also ranked in the top 50 for cancer care for the fourth straight year, and moved up to its highest ranking yet in that specialty, 29th. The hospital's Markey Cancer Center is the state's only National Cancer Institute-sponsored center, one of 71 in the nation. 

Dr. Mark F. Newman, UK executive vice president for health affairs, said in a news release, “This has been a challenging year, to put it mildly. But in these times, it’s more important than ever that Kentuckians with complex health problems have a medical center they can come to for best treatment options possible.”

UK also ranked as high-performing in these specialties: gastroenterology and gastrointestinal surgery, geriatrics, nephrology (kidneys), orthopedics and urology.

The 31st annual rankings compared more than 4,500 hospitals in 26 specialties, procedures and conditions. A release said 134 were nationally ranked in at least one specialty, and 563 were ranked among the Best Regional Hospitals in a state or metro area. Data used for the rankings predate the covid-19 pandemic.

Baptist Health had two of the state's top seven hospitals. Baptist Health Paducah fell off the Best Regional Hospital list this year, after being added last year for the first time ever, but it continued to be rated high-performing in heart failure and COPD.

Baptist Health CEO Gerard Colman said in a news release, “Baptist Health has long been known for its compassionate clinical care, and the U.S. News & World Report Best Hospitals rankings validate the high quality care provided by our physicians, nurses and staff as they live out our mission of leading in clinical excellence, compassionate care and growth to meet the needs of our communities.”

The report recognizes hospitals that are "high-performing" for 10 common adult procedures and conditions, including repair of abdominal aortic aneurysms, aortic valve surgery, trans-catheter aortic valve replacement (added this year) chronic obstructive pulmonary disease, colon-cancer surgery, heart-bypass surgery, lung-cancer surgery, hip replacement, knee replacement and congestive heart failure.

UK Healthcare ranked high-performing in all those categories except abdominal aortic aneurysms and trans-catheter aortic valve replacement, both dealing with the body's main artery, and knee replacement. It ranked average in those three categories. 

Baptist Health Louisville ranked high-performing for all procedures and conditions except trans-catheter aortic valve replacement and lung-cancer surgery. It ranked average in both.

St. Elizabeth Healthcare ranked high-performing in all the categories except aortic valve surgery, trans-catheter aortic valve replacement and heart-bypass surgery, in which it ranked average. It ranked high-performing in one specialty, orthopedics.

Baptist Health Lexington ranked high-performing in all but four categories, in which it ranked average: aortic valve surgery, trans-catheter aortic valve replacement, colon-cancer surgery and hip replacement.

Norton Hospital ranked high-performing for four procedures and conditions: heart failure, hip replacement, knee replacement and COPD. It ranked average for the other seven. 

Saint Joseph Hospital-Lexington ranked high-performing for colon-cancer surgery, heart failure and COPD, and average for the rest.

UofL Health-Jewish Hospital ranked high-performing for lung cancer surgery, heart failure and COPD. It ranked average for the remaining categories. 

Click here for information about how the magazine ranks the hospitals, including details on this year's methodology changes. 

Nationally, the Mayo Clinic in Rochester, Minn., claimed the No. 1 spot, followed by Cleveland Clinic and Johns Hopkins Hospital in Baltimore, according to a news release. 

Beshear ends non-essential retail, elective medical procedures; calls out violators, including a church; Sen. Paul has the virus

As news develops in Kentucky about the coronavirus and its covid-19 disease, this page will be updated. Official state guidance is at https://kycovid19.ky.gov.

Sunday, March 22, 2020

• Gov. Andy Beshear said he would order all non-essential retail businesses to close by 8 p.m. Monday, March 23. His order applies to "all in-person retail businesses that are not life-sustaining." It includes auto-dealer showrooms; clothing, furniture, electronics and sporting-goods stores; opticians and bookstores. It does not include banks; pharmacies; grocery, drug, pet, liquor, building-supply, lawn-and-garden and auto-parts stores; gas stations, vehicle rental and "the lawful sale of firearms and ammunition." Businesses can still do online and phone orders, and curbside and delivery service. Beshear warned Kentuckians to sanitize hands after using gas pumps: "This virus can live on just about any surface."
• The order continues Beshear's approach of gradually escalating restrictions. "We have already done a whole lot of things that a lot of other states have done maybe in one scary order," he said. He encouraged Kentuckians to use the social media hashtag #HealthyAtHome, saying that this would be the term he uses instead of "shelter-in-place," which he has said doesn't fit. 
• Beshear said that starting Monday, all medical facilities must cease elective procedures, because not all have complied with the request he made a week ago, in an effort to keep hospital beds available. "A group of chiropractors have been exceedingly difficult," he said.
• Some churches violated Beshear's order against mass gatherings. He called out one in Lewis County, saying "You can't do that. Bringing together some of the most vulnerable in a small room -- when we know that this virus has been passed around in churches -- means that you are harming your congregation and it undermines the sacrifice of every other church, every other church that is doing the tough thing and canceling their in-person services." 
• "God makes a way," pastor Paul Prather wrote in his faith column for the Lexington Herald-Leader. "This past Sunday I preached to the biggest congregation I’ve ever spoken to. Without leaving my house." Prather canceled services at his church and went online.
• Responding to a question the day before, Beshear said Jen Harris of the Todd County Health Department is working with Amish and Mennonite populations there to make sure they are informed about covid-19, and is willing to work with other such communities. 
• U.S. Sen. Rand Paul announced that he had tested positive for the virus. His Twitter account said, "He is feeling fine and is in quarantine. He is asymptomatic and was tested out of an abundance of caution due to his extensive travel and events. He was not aware of any direct contact with any infected person." Paul was criticized for going to the Senate gym Sunday between getting the test and the results; Sens. Mitt Romney and Mike Lee of Utah said they would self-quarantine because they had contact with him.
• Paul may have caught the virus at the March 7 fundraiser at the Speed Art Museum in Louisville. Joe Sonka of the Courier Journal writes, "Kentucky's governor, Louisville's mayor and a high-ranking member of Congress, all clad in tuxedos, made their way to the dinner table at the glitzy ball inside the art museum — but little did they know that the bourbon heiress and prominent philanthropist sitting next to them were unknowingly infected with the virus that was well on its way to becoming a global pandemic. The opening to a bad novel? No, it unfolded two weeks ago in Louisville, as the emergence of the coronavirus continues to be as strange as dystopian fiction."
• Two University of Kentucky professors wrote a letter to Kentucky newspapers warning rural Kentuckians and their hospitals to get more serious about the threat, recommending public-service announcements about social distancing, handwashing and so on; coordinated local testing; and state coordination to make sure hospitals have what they need.
• Beshear noted the shortage of personal protective equipment, such as masks, respirators and gowns, and said "We are doing everything we can" to secure them for medical facilities in the state. He said the shortage is the most limiting factor for mass testing, and such equipment must be saved for those who are the sickest. 
• He said two more laboratories can test for the virus: the University of Kentucky and Diatherix.
• The governor said he misspoke a few days ago when he said the state had eight times the number of applications for unemployment assistance compared to last year, and it was actually 30 times that amount. He encouraged anyone who needs unemployment benefits, Medicaid or food stamps (now called the Supplemental Nutrition Assistance Program) should apply. "There is no stigma on public assistance," he said. "We want to make sure that everybody gets the help they need coming through this." 
• Beshear said Kentucky now has 103 confirmed cases of covid-19. He said there have been more than 2,000 tests and that the average age of someone identified with the virus is 53.3 years old. He said the hospitalization rate for those with it was "somewhat high" but the share of cases in intensive care is down to 6 percent, which he said was encouraging.
• He said the covid-19 hotline (800)-722-5725 was getting about 2,400 calls a day. He said it should be called by Kentuckians who are ill but would a have not otherwise sought care, and not by those who are well but nervous.  
• Repeating an earlier assurance about the food supply, he said, "These are not the times to hoard. These are not the times to react in fear. These are the times to understand that how we treat each other is what gets us through this."

50 Kentucky hospitals get semi-annual ratings on how well they protect patients from infections, injuries and other safety issues

More Kentucky hospitals are doing better at protecting patients from infections, injuries and other in-hospital threats, according to the latest national rankings, on an A-to-F scale. The ratings improved slightly from the spring; two additional hospitals got As, and fewer got Cs and Ds.

However, two of the University of Kentucky's hospitals dropped to a D, as did Sts. Mary & Elizabeth Hospital in Louisville, which is being renamed U of L Health – Mary & Elizabeth Hospital after its purchase by the University of Louisville.

Louisville's Jewish Hospital, which will also get a U of L prefix as part of the university's purchase of some KentuckyOneHealth units, got an F on patient safety in the latest rankings by the Leapfrog Group, a nonprofit watchdog organization.

Other Kentucky hospitals with Ds were the Hazard ARH Regional Medical Center and Highlands Regional Medical Center in Prestonsburg.

Methodist Hospital of Henderson, which got an F in the spring, got a C, the most common grade for the 50 Kentucky hospitals rated. Most of Kentucky's 125 hospitals were not rated, since rural hospitals with "critical access" status don't have to report quality measures to the federal government.

Leapfrog bases its grades on data about "infections; surgery and safety problems; error-prevention practices; and metrics on doctors, nurses and staff to determine its rankings and grades twice a year," the Lexington Herald-Leader notes. Leapfrog says its data come from the Centers for Medicare & Medicaid Services (CMS), its own surveys and other sources.

One tab rating The Medical Center at Bowling Green,
which got a C overall, breaks down how it did on infections.
(For a larger version of the chart, click on the image.)

The Leapfrog site offers details on each of the measures under headings titled infections, problems with surgery, practices to prevent errors, safety problems, doctors, nurses & hospital staff. It also includes an easy-to-read, color-coded scale that indicates how the hospital is performing.

UK's Albert B. Chandler Hospital and Good Samaritan Hospital got Ds this fall after Cs in the spring. "In other rankings, UK does very well," the Herald-Leader notes. "Chandler Hospital was ranked as the No. 1 regional facility in Kentucky by U.S. News and World Report and has been for four years.

Dr. Mark Newman, UK’s executive vice president for health affairs, told the Herald-Leader, “Like many academic medical centers, UK HealthCare serves a disproportionate number of patients with complex medical needs, which is not accurately represented by Leapfrog. . . .The quality of care and safety of our patients is of utmost importance at UK HealthCare and we continue to invest in substantial resources to continually improve in these areas.”

Chandler Hospital's rating cited surgery problems such as objects left in patients' bodies; surgical wounds that split open; death from serious treatable complications; collapsed lungs; serious breathing problems; and dangerous blood clots. It also got lower marks for antibiotic-resistant infections and surgical-site infection after colon surgery. "Dangerous bedsores and patient falls/injuries also were issues," the Herald-Leader notes. "Good Samaritan received below-average scores in many of the same areas."

The Centers for Disease Control and Prevention reports that the U.S. has about 35,000 deaths a year from drug-resistant infections. That's one about every 15 minutes, CNN notes.

Jewish Hospital also had problems with infections, surgery, bedsores patient falls and injuries, and communication with patients. U of L Health told the Courier Journal that the ratings of some of its hospitals (U of L Hospital got a D, as usual) didn't reflect "the complex nature of the patient cases they handled or the high-risk population they serve," CJ reporter Morgan Watkins writes.

U of L "noted that some of the information Leapfrog took into account dates back to early 2016," when its hospital was managed by KentuckyOne Health. "The university resumed control of U of L Hospital in mid-2017 and officially acquired Jewish and other Louisville-based KentuckyOne facilities on Nov. 1."

Chief Medical Officer Jason Smith said, "Since 2018, U of L Hospital has reported almost perfect compliance with the Leapfrog Safe Practices. We have reviewed our publicly reported data since July 2017, and utilizing the Leapfrog Group’s own calculator for scoring with that data, our calculated grade would have been a C."
On the positive side, two Kentucky hospitals earned As for the first time: Flaget Memorial Hospital near Bardstown and Jewish Hospital-Shelbyville. The other As went to Baptist Health Lexington, Clark Regional Medical Center in Winchester, Georgetown Community Hospital, Cynthiana's Harrison Memorial Hospital, Louisville's four Norton Healthcare hospitals, and the St. Elizabeth Healthcare hospitals in Edgewood, Florence and Fort Thomas.

The most common grade was a C, given to 20 hospitals. The 10 with B grades are Owensboro Health, Glasgow's T.J. Samson Community Hospital, the three CHI Saint Joseph Health hospitals in Lexington and London, Baptist Health Paducah and Mercy Health Lourdes in Paducah, and Whitesburg ARH Hospital.

Crusade for Children grants help 3 CHI St. Joseph hospitals

The WHAS Crusade for Children has given the Saint Joseph London Foundation $100,000 to establish a Level II neonatal intensive care unit at Saint Joseph London hospital. The unit will be one of only two Level II NICUs in southeastern Kentucky.

The unit “will be equipped to continue providing the best care to infants affected by premature birth, neonatal abstinence syndrome, fetal anomaly and respiratory disease,” said Leslie Buddeke Smart, president of the foundation.

The crusade also gave the foundation $36,000 to enhance patient care in the NICU and birthing center at the Women’s Hospital at Saint Joseph East in Louisville, and $35,000 to the Flaget Memorial Hospital Foundation to make its emergency department and operating rooms at Flaget Memorial Hospital more accommodating for young children. The Bardstown hospital gets more than 4,000 visits from children each year, CHI St. Joseph Health said in a news release.

First man on moon may have died because he chose the wrong Cincinnati-area hospital for surgery; don't make the same mistake

By Trudy Lieberman
Rural Health News Service
    Last month The New York Times ran a cautionary tale about the heart surgery and care astronaut Neil Armstrong received and his death two weeks later at a community hospital in the Cincinnati suburb of Fairfield in 2012.
    The Times had received documents from an anonymous tipster who said he/she was “compelled to share this information” so “others can be saved as a result of the dissemination of this information to the public because this American hero did not have to die an untimely death.”  

    The hospital had made a secret $6 million settlement with the family, the Times reported, and consulted cardiac experts who pointed out numerous trouble spots in Armstrong’s care. One of those experts, Dr. Ashish Jha, a professor of medicine at Harvard University, told the paper, “It feels to me like his death was wholly preventable. It’s not completely clear to me he needed the cardiac surgery that he got.”

    The Times noted that the records did not say why Armstrong or his family chose a community hospital rather than the University of Cincinnati Medical Center, a larger academic institution that perhaps had more experience dealing with patients like Armstrong.
    That’s the takeaway for countless others considering surgeries and procedures, especially ones that are complex. You want your surgeries done at facilities by surgeons who have experience and expertise at doing them.
    Shortly before the Times published its stories, a Washington-based organization, The Leapfrog Group, released a report on minimum volume requirements for eight high-risk procedures.
    Leapfrog is one of many organizations that make public information about hospital safety. I believe it is one of the most credible. Its warnings about hospitals performing too few complicated procedures that carry a high risk of complications, even death, are to be taken seriously.
    Now Leapfrog has a new standard that sets minimum targets that both hospitals and individual surgeons should meet for patient safety. Previously they had standards only for hospitals.
    “Studies that have looked at correlation show you have a greater risk of dying when you’re at a lower volume hospital,” says Leah Binder, who heads the group.
    Her group does not believe it is safe for patients if their surgeons have not done a minimum number of eight complicated procedures. Those are surgeries, she said, where compelling evidence shows that volume is crucial to positive outcomes.
    The procedures are bariatric surgery for weight loss; carotid endarterectomy; esophageal resection for cancer; lung resection for cancer; mitral valve repair and replacement; open abdominal aortic aneurysm repair; pancreatic resection; and rectal cancer surgery.
    For example, for a cancer lung resection, only about 22 percent of hospitals and 17 percent of surgeons met Leapfrog’s standard for adequate experience with these procedures. Bariatric surgeries for weight loss had the best numbers, with about 68 percent of hospitals meeting the standard and 51.5 percent of the surgeons doing the same.
    Why? Binder said health insurers have imposed regulations for covering the procedure, and they may require preauthorization and other checks. “Because of that scrutiny, we think they are better.”
    In other words, insurance-company oversight may be a good thing, especially since three-quarters of hospitals overall had not established criteria to determine whether the other seven procedures on Leapfrog’s list were appropriate for the patient.
    Binder said rural hospitals were most likely to fall short of the volume requirements. They struggle because sparse populations in their areas mean they don’t perform the same procedure often enough to gain expertise.
    “The priority has to be not the hospital, but the people served by their hospital.”
    Patients must understand the level of risk they face if they choose to have complicated procedures done at a hospital with such low volume.
    “Some people may not want to drive to a facility that’s further away, but at least they should understand that the procedure is not that safe,” Binder warns.
    The hospital industry maintains that attributing surgical expertise only to the numbers of procedures performed ignores other safety improvement strategies.
    Binder says she can’t say performing 100 surgeries is better than 90, but “I do know that 100 is better than one, two, or three. “People in health care know it, and it’s time the rest of the people know that, too.”
What’s been your experience with hospitals or surgeons harming a loved one? Write to Trudy at trudy.lieberman@gmail.com.

London doctor convicted of implanting unneeded pacemakers sentenced to 3½ years, fined $50,000, told to repay $257,515

Image from MGN Online via WKYT-TV

A Kentucky doctor convicted of "implanting pacemakers that weren’t medically necessary in order to make money" was sentenced Oct. 30 to three years and six months in prison, fined $50,000 and ordered to repay insurance companies and taxpayer-funded health programs $257,515, Bill Estep reports for the Lexington Herald-Leader.

Dr. Anis Chalhoub, 60, is expected to appeal his April conviction and ask U.S. District Judge Gregory F. Van Tatenhove to allow him to remain free while appealing. At sentencing in London, the judge told Chalhoub, “You’ve engaged in conduct that has harmed our community.”

Chalhoub was charged with implanted pacemakers into patients who didn’t need them between March 2007 and July 2011. He implanted about 230 pacemakers at the St. Joseph London hospital during that period, U.S. Attorney Robert M. Duncan Jr. said in a news release.

The unneeded pacemakers “will adversely impact these patients’ lives as they age and may compromise their ability to seek certain medical treatments in the future,” Asst. U.S. Attys. Andrew E. Smith and Paul C. McCaffrey said in a sentencing memorandum.

"Former coal miner Mark Meadows, for instance, told Van Tatenhove the experience had helped doom his marriage of 30 years and eroded his trust in doctors," Estep reports, quoting him: “It’s a dirty low-down rotten shame.”

Chalhoub practiced at the hospital "during a period when the hospital and doctors there allegedly took part in performing hundreds of unnecessary heart procedures," Estep notes. "Saint Joseph Health Systems agreed in January 2014 to pay $16.5 million to settle allegations that it engaged in a scheme to pump up revenue by billing federally-funded health programs for unnecessary procedures from January 2008 to August 2011. That was before the company merged with two others in 2012 to form KentuckyOne Health."

Weekly newspaper tells the story of a transgender woman, 19

Crystal Stine Hahn (CMW Photography)

The Lebanon Enterprise, which under Editor-Publisher Stevie Lowery has a record of tackling sensitive subjects, broke new ground last week with a story about a 19-year-old transgender woman.

The story by reporter Emily LaForme is mainly about the experiences of Crystal Stine Hahn, 19, and started out by calling her "smart, honest, kind, bold… brave."

But it touches on some health aspects, and is an example of how to report and write about a sensitive subject, as some health topics are. It gets to a key point very quickly:

Born in a male body, Crystal, formerly known as Christian, always knew there was something wrong, but it took years to put those feelings into words. And, it took nothing short of fate to place the right champion into her life to answer her cries for help - her stepmother, Lebanon native Jeri Stine Hahn.
“She came to me and said there was something wrong with her, and that she needed to go to the doctor,” said Jeri. “I asked her what was wrong, and she wouldn’t say right away.”
Crystal eventually professed that she didn’t feel right in her body.
“She finally told me there was something wrong ‘down there,’” Jeri said. “I asked her if she wanted the doctor to make it bigger.”
Crystal said no.
“I finally said, ‘Do you want the doctor to take it away?’ Jeri said. “And, she said ‘yes.’” 

Hahn at 11, then named Christian

Crystal Hahn began her transition, which is still continuing, in the fifth grade in Lawrenceburg, LaForme reports: "Most of the staff and students were accepting, she said, but there were still lingering tensions between the community and extended family, so they opted to move to Lexington for a fresh start." At first she told no one but "a select few teachers" that she was transgender, but "keeping such a big secret was weighing heavily on her and her relationships with classmates, so she came out to her entire school in the ninth grade."

Hahn explained to LaForme, “I can’t date a boy without disclosing that to them, and I was tired of lying to my friends and not being true to myself. My parents were worried it would make my life harder, but I felt like my life was harder by lying to myself and to everyone else.”

Jeri, Crystal and stepfather Marty Hahn

The Enterprise shows it knows its audience with this paragraph: "Wrapping your head around the existence of transgender people is still not easy for everyone. However, thinking about the idea that some people are born with an extra finger, or no hands, or even conjoined with their twin, makes the idea that someone could have been born with the wrong sexual organ not seem so outlandish."

And the weekly paper, published by Landmark Community Newspapers, lists eight "important terms to know, from glaad.org and transstudent.org," and Jeri Hahn's tips for parents of transgender Kentucky children. Here they are:

Terms to know
Transitioning: Altering one's birth sex is not a one-step procedure. It is a complex process that occurs over a long period of time. Transition can include some or all of the following personal, medical and legal steps: Telling one's family, friends, and co-workers; using a different name and new pronouns; dressing differently; changing one's name and/or sex on legal documents; hormone therapy; and possibly (though not always) one or more types of surgery. The exact steps involved in transition vary from person to person. Avoid the phrase "sex change.”

MTF: male to female

FTM: female to male

Transgender: An umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth.

Top surgery: Chest surgery such as double mastectomy, breast augmentation, or periareolar (keyhole) surgeries.

Bottom surgery: Genital surgeries such as vaginoplasty, phalloplasty, or metoidioplasty.

Gender dysphoria: Anxiety and/or discomfort regarding one’s sex assigned at birth.

Body dysmorphia: A disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one's appearance.

Tips for parents

* Educate yourself by reading as much as you can about the transgender diagnosis. 

* Allow your child to dress in a way that he/she is comfortable and not in a way that makes you comfortable.

* Also allow your child to play with opposite-gender toys if they enjoy them. 

* Call Cincinnati Children's Hospital's gender clinic to make an appointment with a gender specialist if your child is displaying insistent, consistent and persistent cross gender play or dress. This consistent behavior is usually not a "phase.”

* Health insurance plans are beginning to cover cross-gender surgeries.

Appalachia has high rates of hereditary pancreatitis; relatively new surgery to treat it is available to children 4 and older

People from Appalachia have some of the highest rates of hereditary pancreatitis in the nation, which often means living a life of uncontrollable pain, but a relatively new treatment may offer some hope.

The pancreas produces enzymes that help break down and digest food, and also insulin that controls blood sugar levels. Inflammation of the pancreas is called pancreatitis.

Pancreatitis can be caused by outside factors, like gallstones or alcohol abuse, but it can also be hereditary, which is common in Appalachia.

"In my first year working at Kentucky Children's Hospital, I saw more cases of hereditary pancreatitis than in 14 years at my previous institution," Dr. George Fuchs, a pediatric gastroenterologist, wrote in an article for UK HealthCare, republished in the Lexington Herald-Leader.

Dr. George Fuchs and Mackenzee Walters, an 11-year-old
with hereditary pancreatitis who underwent an innovative
surgery. (UK HealthCare photo)

One of Fuchs's patients with hereditary pancreatitis is 11-year-old Mackenzee Walters from Kenova, W.Va.

In January, Mackenzee underwent a new surgical procedure at Cincinnati Children's Hospital to treat the disease and it has already changed her life, making it one "free of sharp, unrelenting pain," Fuchs reports. Cincinnati Children's is one of the few children's hospitals in the nation to offer this innovative procedure.

The surgery, known as a total pancreatectomy with islet autotransplantation (TPIAT), "involves removing the entire pancreas, saving the islet cells, which produce insulin, and then re-planting those cells in the liver, where they take up residence and ideally resume their essential function," Fuchs wrote.

"The surgery is a new offering for pediatric patients ages 4 and older expecting a life of pain stemming from the disease," UK HealthCare says in a separate article about Mackenzee and the procedure. It described Mackenzee's life before the surgery as one of pain and hospitalizations that required her to miss many school days. She has had to follow a strict diet since she was 3, consisting mostly of liquids.

The story explains that most of MacKenzee's relatives, including her mother, died early in life from complications related to the hereditary pancreatitis. Kim Walters, Mackenzie's current mother and biological aunt, is the oldest surviving family member with the disease.

"Hereditary pancreatitis is pretty much all we've ever known in my family," Walters said. "It's very excruciating every day. I had my children naturally without an epidural; I would rather have a child every day for the rest of my life than live with this disease."

In December 2015, after seeing many doctors around the country, Walters consulted with Fuchs at Kentucky's Children's Hospital because Mackenzee "was suffering from unmanageable pain and taking a potentially dangerous level of medications without much relief," UK HealthCare reports. Fuchs recommended her for the 12-hour TPIAT surgery and after much consideration, Walters and Mackenzee agreed to it.

“I came to the conclusion, if nothing else if she would just be pain-free,” Walters said. “If God chose to take her six months later, at least she would have six months of no pain. And that was our goal: to make her not have pain and be able to play and do what normal kids do.”

Since the surgery, Mackenzee's islets are producing insulin, and every day the amount of supplemental insulin she needs has dropped. Now she no longer requires pain medication, UK HealthCare reports.

“I would predict she has a very high likelihood of becoming insulin-independent,” Fuchs said. “She will no longer live in the hospital, which is what these children do before the procedure because they are in so much pain. I anticipate she will get on with her life, including getting into mischief as most kids do when they become teenagers. Hopefully go on to have a productive, full life.”

Fuchs said he hopes to extend this treatment to all who qualify for it in Eastern Kentucky and surrounding areas.

Pediatric heart surgery has resumed at UK, in partnership with Cincinnati Children's Hospital

Magdalen Wilson, one of the first
UK pediatric heart surgery patients
since it re-opened, with parents Thom
and Lauren Wilson of Nicholasville

By Melissa Patrick
Kentucky Health News

After a five-year hiatus, Kentucky Children's Hospital is performing pediatric heart surgeries again, this time in partnership with Cincinnati Children's Hospital Medical Center – and it has already performed more than 12 since it opened in May.

"It is an important day here at the University of Kentucky and UK HealthCare to acknowledge that we've resumed the pediatric congenital heart program," said Bo Cofield, the hospital's chief clinical operations officer. "While we've got a fantastic pediatric cardiology program, we paused our surgical program a couple of years ago because it wasn't what we wanted it to be – a world class program – and we really believe that we've got that now through this partnership."

UK voluntarily suspended heart surgeries on children in 2012 after five died in 11 months. The program's chief surgeon, Dr. Mark Plunkett, left the program in 2013 with a $1 million settlement and an agreement to not talk to the news media. The letter of intent to partner with Cincinnati Children's was signed in 2015 and finalized in January 2016.

An internal review of the program didn't say why it was suspended. UK refused to release the program's death rates, but did so after the state attorney general ruled that it had to and CNN reported on the problem. The annual mortality rates averaged 5.8 percent, ranging from 5.2 percent in 2010 to 7.1 percent in 2012. The national average for a program of similar size was 5.3 percent.

The new program is a "one program, two sites" model that benefits both facilities, said Dr. Andrew Redington of Cincinnati Children's. He said the partnership allows UK's program "to provide the same level of care as we provide in Cincinnati" and Cincinnati's program to focus on "that high level of surgery that perhaps UK doesn't do," such as transplants.

Asked what specific changes they made to re-open, Cofield said, "We think there was some requirement for investment in certain things – more people, more training for the people that we brought in and clearly a focus on ensuring that we have the clinical infrastructure necessary to safely care for patients," including a "tele-video-conferencing" system that allows for seamless communication between the locations.

"What we want to do is provide the best level of care to as many children as possible, as close to home as possible," said Redington. "For patients and children who travel maybe a hundred or two or three hundred miles to get to Cincinnati, that's a burden and we recognize that."

Choosing care close to home was important to a Nicholasville family, whose infant is one of the first pediatric patients to undergo surgery in the new program.

Five-month-old Magdalen Wilson, who was born with several congenital heart defects, underwent open-heart surgery July 5 at Kentucky Children's Hospital and is doing well, said Thom and Lauren Wilson, her parents.

After learning about Magdalen's heart defect when Lauren was about seven and a half months pregnant, the Wilsons traveled between Nicholasville and Louisville twice a week to see specialist during the pregnancy. The Wilsons have three other children.

Magdalen was able to go home after she was born, but at about three months, she quit eating and her parents took her to UK's pediatric emergency center where she was admitted and assessed by the pediatric heart team. They learned about UK's new pediatric heart surgery program.

"We made the decision at that point to transfer our care to UK because it was close to home and the doctors and cardiologists we encountered in the pediatric intensive care unit were attentive and showed great concern for Magdalen's well-being," Lauren Wilson said in the news release.

Thom Wilson thanked all of their caregivers at UK and said they had received "excellent care." He later added that they appreciated that UK's pediatric heart surgery program was part of "a very well-known established program."

Magdalen's surgery was performed by Dr. James Quintessenza, who Cofield described as a "world-class pediatric cardiothoracic surgeon" and Redington called "one of the best surgeons on the planet." Quintessenza described the new program as a fine-tuned "orchestra." He added, "We are off to a great start."