Legislators expect to address youth vaping, maternal mortality, insurance issues and maybe abortion in upcoming session

State Rep. Kim Moser, Sen. Stephen Meredith, Rep. Rebecca Raymer and moderator Mark Marsh of Owensboro Health discuss issues at the Legislative Preview Conference. (Photo by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

State legislators expect to address youth vaping, workplace violence, data collection, maternal mortality, and prior insurance authorization for medical procedures during the legislative session that begins Jan. 2.

And they could deal with abortion. So said lawmakers who participated in a health panel or otherwise attended the Kentucky Chamber of Commerce's 2024 Legislative Preview Conference Nov. 13.

Sen. Stephen Meredith, R-Leitchfield; Rep. Kim Moser, R-Taylor Mill; and Rep. Rebecca Raymer, R-Morgantown, spent the early part of the discussion talking about  health-care workforce issues and what could come out of the legislature's Certificate of Need Task Force.

Meredith and Moser agreed that the push to remove CON requirements as a way to level the playing field to create a true free market competition doesn't fit the current payment system, but the legislature could find efficiencies in the application process for health-care facilites.  

"Whatever comes out of our task force will probably be more administrative in nature," said Meredith. 

Raymer said she would be working on a bill that would address youth vaping, noting that it would likely include an education component, and a bill to get more sexual assault nurse examiners in rural areas. 

Moser said she will work on a bill to decrease maternal mortality.  One way to do this is to consider a bill that ensures women have health insurance during pregnancy. Since working on this issue, she said she has learned that pregnancy is not considered a qualifying life event that makes a person eligible to enroll in a federally subsidized or "qualified health plan" through Kynect during a special enrollment period. Having a baby or adopting a child are both considered qualifying life events. 

"We know that because of Kentucky's poor health metrics around obesity, hypertension, heart disease, cancer, that . . . those issues are affecting our maternal mortality," she said. "And so the best way to address that is with better prenatal care, and identifying those issues when you can control them." 

Other elements of a maternal-mortality bill would involve increasing access to psychiatric care, expanding the HANDS (Health Access Nurturing Development Services) program, a voluntary home-visitation program for new or expectant parents, and also include a section about doulas, women who provide assistance during labor.

Moser also said she will introduce another prior-authorization bill to reduce administrative burdens on health-care providers and provide better patient care. "I think this is the year that we're going to get that passed," she said. 

Around the issue of data collection, Moser said she was "looking at data and how we collect data around health care, how we better utilize it, and what's the best way to provide some transparency, and better inform policy decisions." One way to do that would be through an all-payer claims database, which is a policy priority of the Foundation for a Healthy Kentucky. 

Moser said when it comes to health-care workforce issues, she is working on a workplace-violence initiative. And she said she would "love to work on liability reform, tort reform" to limit lawsuits but says this is difficult because there needs to be a constitutional amendment to make meaningful changes. 

"I don't foresee that in the near future, but certainly, I think that's a conversation that we need to have," Moser said. "It really does affect the practice of medicine and the ability to attract and to retain our health-care workforce." 

The health panel did not discuss abortion, but after the meeting House Speaker David Osborne and Senate President Robert Stivers told the Lexington Herald-Leader that they were open to adding exceptions for rape and incest to the state's near-total ban on abortions.

“There is some interest in our caucus in passing those exceptions,” Osborne said, adding that opinions range widely among Republicans who control the House. They also control the Senate.

Stivers told the Herald-Leader, "We’re getting ready to have our caucus and kind of go through this. This will be a decision that everybody has varying opinions as to what should happen or what shouldn’t happen. . . . It is such a personal issue to people, we’re gonna have to have that type of discussion amongst ourselves and then collaborate with the House."

Abortion was a key issue in the recent governor's race, won by Democratic Gov. Andy Beshear, who criticized Republican Attorney General Daniel Cameron's opposition to rape and incest exceptions. Cameron then said he would sign such a bill if the legislature passed one.

Health-care workers are more likely than law-enforcement officers to have injuries and illnesses that keep them away from work

Axios graphic

Kentucky Health News

"Health-care workers are increasingly being assaulted or shot on the job, making hospitals and clinics among the most dangerous workplaces in America," report Tina Reed and Jason Millman of Axios. 

They report that health-care workforce violence was a problem long before the pandemic, and then pandemic stressors such as backlash against public health measures and inadequate staffing have made matters worse.

In fact, "Data shows American health-care workers now suffer more nonfatal injuries from workplace violence than workers in any other profession, including law enforcement," according to  The Associated Press. And all of this can result in disrupted patient care and "alarming levels of burnout among the pandemic-fatigued health care workforce." 

"It used to be people had a respect for what was done in hospitals and the people who worked in those hospitals. That's not there anymore," National Nurses United Vice President Cokie Giles told Axios. 

Axios reports that "about three in four nonfatal workplace violence injuries involved workers in health care and social work in 2020, the most recent year for which statistics are available. And, "the frequency of injuries from workplace violence in health care has risen almost every year since 2011, reaching 10.4 per 10,000 full-time workers in 2018, up 62% from 6.4 per 10,000 in 2011, per the Bureau of Labor Statistics." 

Reed and Millman cite several examples that suggest that this trend has continued throughout the pandemic, with an increasing number of assaults involving guns. 

They also note a recent survey of health-care workers from Premier and the federal Agency for Healthcare Research and Quality that found 40% of health-care workers experienced workplace violence in the last two years.

Axios notes that hospitals are stepping up their efforts to "identify security risks, training staff on violence prevention and calling in counselors to de-escalate tense situations" and are beginning to invest in technology to help detect guns entering the building. Further, The authors write, there are ongoing efforts in Congress and statehouses to make health-care settings safer.

Overdose deaths in Ky. workplaces tripled in 2019-2021; in the latter year they were the 2nd leading cause of occupational fatality

Graph by Kentucky Injury Prevention Research Center

By Melissa Patrick

Kentucky Health News

Drug-overdose deaths in Kentucky workplaces tripled from 2019 to 2021, according to the latest annual report from the Kentucky Fatality Assessment and Control Evaluation program.

The program, part of the Kentucky Injury Prevention and Research Center, found that from 2017 to 2021, the state had 47 overdose fatalities in the workplace, reaching its highest number ever of 18 fatalities in 2021. That was a 260 percent increase from 2017.

Of the 96 occupational fatalities recorded in Kentucky in 2021, drug-overdose deaths accounted for 19%, an increase from 13% in 2020 and 8% in 2019. That put overdose deaths second to motor-vehicle crashes, which were 29% of the total. In third place (17%) were "struck by" and "striking against" injuries, forcible contact or impact with an object that creates an injury.

Most of the occupational drug-overdose deaths in 2017-2021 occurred in the trade, transportation and utilities industries (38%), followed by manufacturing (19%), construction (19%) and the leisure and hospitality industry (11%). The remaining 13% took place in services and public administration.

The report notes that all of the occupational overdose deaths in the leisure and hospitality industries happened in 2020 and 2021.

It also points to the jump of occupational-overdose deaths in Jefferson County. In 2021, seven of the state's occupational overdose deaths, nearly 40% of the total, occurred in Jefferson County. That was one short of the total for the previous four years combined.

Suit claims Morehead hospital refused to grant all requests from workers for religious exemptions from Covid-19 vaccine mandate

St. Claire Medical Center (Photo from The Daily Yonder)

A woman who says she was fired by St. Claire Medical Center for not getting a Covid-19 vaccine is suing the hospital in federal court, alleging that the Morehead hospital denied the religious exemption she claimed, and those of all other employees who claimed such an exemption.

Teffany Smith of Olive Hill filed the lawsuit in federal court, but cited the state law banning religious discrimination by employers. Smith, who was a lab assistant, says she was fired Sept. 15, 2021, the day that each hospital employee was required to be vaccinated.

The suit says Smith submitted an exemption citing several passages of Scripture and a letter from a pastor, Joyce Stapleton of New Life Victory Church in Olive Hill, who said the vaccine “violates laws put forth within us by a higher power at the time of conception. . . . We believe in healing and that is what our God provides.” The church website lists different pastors.

Smith also "alleges the hospital did not engage in a good-faith dialogue and consideration of proposed accommodations for not receiving the vaccine," Taylor Six of the Lexington Herald-Leader reports. "St. Claire Healthcare officials did not respond to request for comment."

Services Monday for Dr. Russell Travis, health-care leader, 87

Russell Travis, M.D.

Funeral services will be held Monday in Lexington for Dr. Russell Travis, a retired surgeon who was a longtime leader in Kentucky's health-care community. He died Oct. 29 at the age of 87.

Travis served as chair of the state Board of Medical Licensure and the state Workers' Compensation Board and held various positions with the American Academy of Occupational Medicine. He was president of the American Association of Neurological Surgeons and a longtime member of the Joint Washington Committee of Neurosurgery, which helped set national policy for neurological medicine. 

He was a visiting professor at medical schools in Kentucky, South Carolina, Michigan, Mississippi and Virginia. His many awards included the Lifetime Achievement Award from the International Academy of Independent Medical Evaluators and the Service to Mankind Award from the Kentucky Medical Association.

Travis grew up in Glasgow but was born in Jenkins, on the Virginia border, and he "would often speak fondly of his years in the mountains," his obituary said. "He gave back to the Appalachian community for over 30 years, by providing on-site neurosurgical care to those residents who lacked access."

He is survived by his wife, Jill Travis, four children, a brother and six grandchildren. Visitation will be held from 4 to 8 p.m. Sunday, Nov. 6, and 9:30 to 10:30 a.m. Nov. 7, with funeral services following immediately, at Kerr Brothers Funeral Home on Harrodsburg Road. In lieu of flowers, the family suggests donations to Kentucky Easter Seals or the Lexington Humane Society.

State Labor Cabinet reminds employers to protect employees as heat indexes hit triple digits and a hot workweek is forecast

CDC photo

As heat indexes went well into the triple digits Monday and weather forecasts predicted a hot workweek, the state Labor Cabinet reminded employers to protect employees working in hot conditions.

Labor Secretary Jamie Link urged employers to "establish a heat illness prevention plan, closely monitor workers in hot indoor and outdoor environments, and learn how to recognize and treat various heat-related illnesses," a cabinet press release said.

“Employers are responsible for providing safe workplaces free of known hazards, and that includes extreme heat conditions,” Link said in the release. “Asking workers to perform physically exhausting work in dangerously hot conditions without providing breaks, water and shade can result in serious illness and even death.”

The federal Occupational Safety and Health Administration recommends regular water, rest and shade breaks for those working in hot environments, outdoors or indoors. OSHA and the National Institute for Occupational Safety and Health have free mobile application for Android and iPhone users that provides real-time heat index information and hourly forecasts by location, as well as occupational safety guidance and health recommendations. The tool can be found on Google Play and in Apple’s App Store.

Kentucky's program provides free, confidential heat exposure assessments by request, and offers a Heat Stress Awareness training module on its website. The cabinet is offering a class on heat stress during a population center training event June 21-24 in Frankfort.

UK HealthCare spending $5 million on security upgrades, setting new policies amid gun violence at health facilities in other states

Screenshot from UK Police website, adapted by Kentucky Health News

The University of Kentucky is bolstering security at health-care campuses "in response to increasing reports of violence taking place across the nation in health-care settings," a news release said Friday.

UK said its police began using handheld metal detectors on all patients and visitors entering emergency departments in April 2021, followed by installation of fixed metal detectors in July 2021. Other recent measures include having at least one police officer at each of the emergency departments around the clock.

The release said UK will spend $5 million on health-care safety, including:

• Addition of electronic access control to all perimeter doors to restrict public access as well as replacement and modernization of aged entryways.
• Utilization of emerging technology to enhance threat detection and expanding panic alarms and lockdown capabilities.
• Increased security camera coverage to improve situational awareness.
• Addition of UK Blue emergency towers to walkways where staff and patients travel frequently.
• Enhancement of exterior lighting to improve visibility around UK HealthCare facilities.

At a virtual forum for UK HealthCare employees, Executive Vice President for Health Affairs Mark Newman and UK Police Chief Joe Monroe discussed their efforts to improve the safety and security of employees, patients and visitors.

“We also are researching better ways to make UK HealthCare a weapons-free location through screening technology and looking at strategic efforts to increase dedicated police presence on the UK HealthCare campus,” Monroe said.

The moves were announced in the wake of the June 1 killings of four people at a Tulsa hospital by man who blamed his doctor for pain after back surgery and also killed himself, but the news release said UK Police have worked for a year with a security consultant on the first phase of a continuing security review "with an initial focus on enhancing perimeter security and fortifying the emergency departments at UK Chandler Hospital and UK Good Samaritan Hospital," the news release said.

"Hospital trauma departments are on the front lines whenever there's a mass shooting, but when those spaces are targeted, staff must mobilize to not only protect their patients but themselves," Axios Vitals reports. "And yet, efforts to fortify health facilities could also conflict with their traditional roles as community resources and safe spaces.

Axios Vitals notes that "From 2010 to 2020, shootings resulted in 39 deaths at health-care facilities accredited by the Joint Commission. From 2000 to 2011, researchers found there were 154 hospital-related shootings in the U.S. A survey from the American College of Emergency Physicians in 2018 concluded that nearly half of emergency- room doctors have been assaulted at work."

All Ky. adults can get booster; new-case rate and hospitalizations up over 2%; cases in unmasked Warren County schools jump

New York Times map, adapted by Ky. Health News, shows cases increasing with colder weather.
To enlarge any image, click on it; for the interactive version of this map, with local data, click here.

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear has signed an executive order to allow all Kentucky adults to get a Covid-19 booster shot, citing the recent upticks in coronavirus cases and Covid-19 hospitalizations as the reason for this change. 

“Folks, you really need to get vaccinated and get this booster, and now it should be fairly easy. It’s going to make you much safer over the next several months,” Beshear said in a news release. 

Previously, boosters were officially available only to people 65 and older, adults at high risk of severe Covid-19, and those with high exposure to the virus through their jobs or living situation.

At least five other states (Arkansas, California, Colorado, New Mexico and West Virginia) have expanded eligibility, the release says. So has New York City. The U.S. Food and Drug Administration is expected to authorize Pfizer-BioNTech Covid-19 booster shots for all adults this week, The New York Times reports.

Under Beshear's order, all adults in Kentucky may get a Covid-19 booster six months after their second Moderna or Pfizer shot, or two months after the single-dose Johnson & Johnson vaccine. 

As of Wednesday, more than 437,000 Kentuckians had received a booster and 2.6 million, or 59% of the total population, had received at least one shot. 

 The state reported 2,195 new coronavirus cases Wednesday, raising the seven-day average by 31 (2.2 percent), to 1,431. Of Wednesday's new cases, 29% are in people 18 and younger. 

The share of Kentuckians testing positive for the virus jumped more than half a percentage point, to 6.24% from 5.73% on Tuesday. The rate is the highest since Oct. 21. Beshear has cautioned that the rate is not the best measurement of the pandemic because it tends to rose when there is an increase in disease in communities because more people get tested.

A more reliable metric, the seven-day infection rate, is 27.94 daily cases per 100,000 residents. That's a noticeable jump from Tuesday's 27.08. Counties with rates more than double that rate are Magoffin, 98.7; Breckinridge, 82.3; Robertson, 81.3; Bourbon, 72.2; Monroe, 61.7; Powell, 61.3; and Harrison, 58.2.

Seventy-three of the state's 120 counties have rates over 25, considered a high level of transmission and represented by red on the state infection map. That's six more than Tuesday. 

The New York Times ranks Kentucky's infection rate 25th among the states and says it has increased 16% in the last 14 days.

Kentucky hospitals reported 757 Covid-19 patients, 18 more than Tuesday (up 2.4%); 200 of them in intensive care (down 4); and 100 on mechanical ventilation (down 15).  Eight of the state's 10 hospital regions are using at least 80% of their intensive-care beds, five of them more than 90%. 

Kentucky reported 36 more Covid-19 deaths Wednesday, raising the pandemic death toll to 10,354. 

Other pandemic news Wednesday: "Active Covid-19 cases among Warren County Public Schools students have more than tripled since the district dispensed with its universal masking policy Nov. 1," the Bowling Green Daily News reports. The district has 73 cases; Bowling Green Independent Schools, "which has chosen to keep its universal masking requirement for at least one more month – reported 17 active student cases on its district dashboard Tuesday morning."

To increase immunization among young adults, "Some public health experts are turning to ad campaigns that feature 20-somethings talking about their struggles with fatigue, memory loss and other symptoms associated with long Covid," the term used to describe lingering effects after basic recovery from the disease, reports Derek Hawkins of The Washington Post. "The testimonials are devastating. One 20-year-old chokes up as she describes how she can't remember first dates with her boyfriend, even after looking at photos."

U.S. Sen. Rand Paul of Bowling Green issued a report on the economic cost of President Biden's vaccine-or-test mandates in Kentucky, saying 677,458 Kentucky workers, or 34% of the state's workforce, are at risk of losing their jobs if they do not comply with the mandates for employers of more than 100. It says 35% of retail workers risk losing their job if they resist the mandate. A report for all 50 states will be released tomorrow, said the release from the Republican senator, who is seeking re-election.

The Occupational Safety and Health Administration has suspended enforcement of the mandate for businesses with more than 100 employees after a federal appeals court upheld a stay of it last week, The Hill reports.

Ky. OSHA complaints rose 45% in 2020, partly due to pandemic; issues are likely to linger as workplaces try to get back to normal

Courier Journal graph, adapted by Kentucky Health News

Kentucky workers filed 45 percent more occupational safety and health complaints in 2020 than in 2019, but only 8 percent of them have been investigated, reports Matt Mencarini of the Courier Journal.

The increase could have had causes other than the pandemic, since the volume of complaints can be cyclical, the state Labor Cabinet told Mencarini. But he cites examples, such as a November complaint against the Kroger Distribution Center in Louisville, alleging that employees had Covid-19 and managers were not informing others about it.

The state's low investigation is actually above the national average, Mencarini reports. "Across the U.S., complaint investigations decreased dramatically during the pandemic," he writes. "Critics for years have derided weak worker safety laws and enforcement, decrying dwindling budgets and staffs in worker safety agencies. The pandemic only exacerbated the problem, they say."

Bill Londrigan, executive director of the state AFL-CIO, told Mencarini, "There needs to be some sort of recognition that even though the rates of transmission and death from Covid have decreased due to the increase in the vaccination rates, that certainly it is not in the rearview mirror. Protections should still be in place."

"Many of the complaints lodged in 2021 suggested the national polarization around masks extended to the workplace," Mencarini reports. "As Covid rates drop and more people return to workplaces, new challenges are arising." Londrigan told him that some workplaces shouldn't abandon mask-wearing, though "no one really likes it."

Free, day-long webinar Wed., July 15, will explore the global consequences of the coronavirus pandemic on frontline workers

Health Watch USA and the Massachusetts Nurses Association are co-sponsoring a free, day-long webinar Wednesday, July 15, to examine the global consequences of the coronavirus pandemic on frontline workers.

"Through the Eyes of the Frontline: Covid-19," will include health-care and other frontline professionals from Singapore, the Netherlands, Spain and the United States, who will discuss the challenges they faced during the initial surge of the pandemic, with recommendations for strategies to lessen the impact of a resurgence.

The webinar will be held from 8:45 a.m. to 4:45 p.m. Click here to register. Questions can be directed to the Massachusetts Nurses Association at 781-821-4625 or mnainfo@massnurses.org, with "Covid Webinar" in the subject line. Contact hours will be provided.

'Fatal Flaws' series on Ky. workplace safety wins national award for Kentucky Center for Investigative Journalism

http://fatalflaws.kycir.org/?utm_source=KyCIR&utm_campaign=13addb68bb-EMAIL_CAMPAIGN_2019_03_28_02_25&utm_medium=email&utm_term=0_3fe1cce7ce-13addb68bb-166990137&mc_cid=13addb68bb&mc_eid=4bc9d6d2c3