For second time during big outbreak of hepatitis A, state health officials fire the manager of their Infectious Disease Branch

For the second time during the nation's worst outbreak of hepatitis A, state health officials have fired their top infectious-disease leader.

Hepatitis A is a liver disease.

"Dr. John Bennett, the state's Infectious Disease Branch manager since last fall, told the Courier Journal on Monday that he was dismissed last Friday," Chris Kenning reports for the Louisville newspaper. Bennett told Kenning that he wasn't given a specific reason for his dismissal. That is typical in such cases. He "said he had no information to suggest it was related to the state's recently criticized response to its hepatitis A outbreak," Kenning reports.

"First declared in November 2017, the outbreak later exploded in rural Kentucky, mainly among drug users, and grew into the nation's deadliest," Kenning notes. "The outbreak has since sickened 4,419 and killed 52, according to the latest state report released Monday. Kentucky has had more deaths than any of the other 17 states with similar hepatitis A outbreaks."

Bennett was hired last September to replace Dr. Robert Brawley, who was allowed to resign in lieu of fired on June 4, 2018. Brawley had "lobbied for a more aggressive state response to the outbreak," Kenning notes. "He recommended $6 million for vaccines and $4 million for temporary workers in thinly staffed local health departments and also called for a public health emergency declaration to help pave the way for federal assistance." Instead, "The Department for Public Health sent $2.2 million in state funds to local health departments and declined to declare an emergency."

The department's commissioner, Dr. Jeffrey Howard, "has told the Courier Journal that he was willing to seek more funding if needed."

Two activists in recovery say addiction doesn't discriminate (one says recovery does), say it should be treated as a chronic disease

By Melissa Patrick
Kentucky Health News

The shared message of two Kentuckians in long-term recovery during a discussion about addiction, recovery and activism at the University of Kentucky was that addiction doesn't discriminate – but one said recovery does.

Alex Elswick and Ashley McCarty Dufour talked about their
addiction, recovery and activism. (Photo by Melissa Patrick)

Alex Elswick of Lexington and Ashley McCarty Dufour of London told a room full of health advocates about their struggles with addiction – Elswick to heroin and Dufour to methamphetamine and opioid painkillers – that started with prescription opioids. They talked about their rocky roads to recovery and said they've been "clean" for almost six years.

Another thing they had in common is that they came from stable, loving homes and had families that supported them.

"I was born in a middle-class, well-known family in Laurel County. People like that don't have children who are addicted to drugs – but they do," said Dufour, a community liaison for Addiction Recovery Care. "Addiction does not discriminate."

Yes, but recovery does, said Elswick, co-founder of the UK Collegiate Recovery Community and an extension specialist for substance-use prevention and recovery at UK.

Elswick explained that because of his "privilege," which he acknowledged was a term many are uncomfortable with, he had had all kinds of  "recovery capital" available to him – his parents' church found him a home, one of his father's patients found him a job, and he was able to see a therapist for his anxiety disorder because he had insurance. "The list just goes on and on," he said.

"Recovery does discriminate," he said. "There are huge disparities in access to resources in terms of race, socioeconomic status, in terms of sexual orientation."

Elswick said it was this realization that prompted him to focus his doctoral research at UK on long-term recovery for substance-use disorder. He focuses on "recovery capital," defined in a white paper on the topic as "the breadth and depth of internal and external resources that can be drawn from to initiate and sustain recovery from severe alcohol and other drug problems."

Elswick said the resources are in three main areas: personal, social, and community.

"What my experience taught me, and what subsequent research has taught me, is that people like me, people who come from really fortunate backgrounds, are able to leverage an immense amount of resources when the time comes to recover," he said.

Elswick, who is also the co-founder of Voices of Hope, said the organization offers recovery coaches who help people in recovery determine their available "recovery capital," then helps them figure out how to fill in the gaps, like finding safe housing or job training.

DuFour and Elswick spoke at an event sponsored by UK College of Public Health during National Public Health Week, in the first week of April.

Another shared topic was the importance of meeting people in addiction wherever they are, and treating it as a chronic disease like diabetes or high blood pressure.

Dufour said that in her work as a peer-support specialist with several syringe-exchange programs across the state, it's important to "meet them where they are," whether that is to make sure they are using clean needles to keep from spreading infectious diseases, like hepatitis C and HIV, to offer them access to screening and treatment for these diseases, or to help them get into treatment.

"IV drug users are five times more likely to enter treatment through a syringe-exchange program," Dufour said. "Five times more likely. Why? Because that's that population that nobody is touching. Nobody is talking with them. But when they come in, somebody is loving on them and caring about them and giving them hope, so they are five times more likely to go into treatment."

Dufour said Addiction Recovery Care offers peer support in 16 counties with syringe exchanges, and in those locations, 75 people have entered treatment in the last six months.

Elswick spoke at length about the "false dichotomy" that the only way to help someone in addiction is treatment. Rather, he said, you have to meet them where they are.

For example, he said Voices for Hope's telephone recovery-support program isn't clinical in nature and isn't meant to push treatment, but offers a safe place for someone in addiction and recovery to get help with their issue of the day.

"The intervention is the phone call," he said, adding that the program, like syringe exchanges, also serves as a touch point for those in addiction that provides them with a safe place to turn to when they are ready for treatment.

Elswick suggested that the concept of meeting someone with an addiction where they are is becoming accepted but has a long way to go. He said it's important to keep the doors open at other points of contact, such as arrest, jails and emergency rooms, as a way to help get people into treatment when they are ready, since they may not be ready at the initial point of contact.

And as he often says, the most important takeaway to remember is: "Addiction is a chronic disease."

He said the traditional approach to addiction care, treatment of 30 to 90 days with no support other than a pamphlet on how to follow a 12-step program upon discharge, is a recipe for relapse.

"It's because we are mismanaging a chronic disease with acute care," he said.

Like any other chronic disease,  Elswick says that if we want to improve recovery success, people with addictions need recovery support services for their lifetime, "so that we can match their chronic disorder with chronic disease management."

Erin Calipari's research explores how women's hormones may make them more vulnerable to addiction and relapse

Erin Calipari (Photo by Larry McCormack, The Tennessean)

Erin Calipari is getting noticed, and no longer just because she's the daughter of University of Kentucky coach John Calipari. As a researcher at Vanderbilt University, she has "dedicated herself to making groundbreaking discoveries about women's vulnerability to drug cravings and the immune system's role in the fight against the opioid crisis," reports Jessica Bliss of the Nashville Tennessean.

"When she was a girl, it used to bother her that people saw her only as the coach's daughter," Bliss writes. "Now she embraces the fact that she is the child of a man who leads one of the nation's most successful college sports programs. She sees it as a platform to share important scientific breakthroughs with people who might not otherwise be paying attention."

Addiction research has primarily focused on men, but "Calipari's work changes that," Bliss reports. "Her team has found 'massive differences' in what males and females value" when making decisions about whether to use a drug. "Her latest study found that, when fertility-related hormone levels are high, females . . . are more prone to seek rewards. That means women's hormonal cycles may make them more prone to drug addiction and relapse."

Calipari explains, "The hormonal cycle primes your brain to be more responsive to your environment. This is evolutionary, because, if you are more responsive, you are going to seek out rewarding environments and sexual experiences that propagate the species. That same process is hijacked by drugs. . . . And that makes women more vulnerable."

Her father said on Twitter, “I’m very proud of her because she’s working on important stuff. Addiction and the effects, especially on women, is an epidemic.” In another tweet, he said, “She’s trying to bring light to a serious problem in our country. She’s on a great path to having an impact to improve lives.”

Ky. has half the cases in odd, 5-state outbreak of E. coli infection

Video from The Washington Post

Kentucky has about half of the cases in an outbreak of infections from a strain of E. coli bacteria that has also sickened people in Ohio, Virginia, Tennessee and Georgia. The federal Centers for Disease Control and Prevention said Friday that the source of the 72 infections has not been identified.

The CDC said Kentucky had 36 cases, but the day before, the state Department for Public Health said 46 people in the state had been sickened by the O103 strain of E. coli, which is among those that produce Shiga toxin.  Spokeswoman Barbara Fox said six had been hospitalized. The toxin usually sickens people two to five days after they swallow the germ, the health department says.

"Most people get diarrhea (often bloody), severe stomach cramps and vomiting," The CDC says. "Most people recover within a week, but some illnesses can last longer and be more severe. Talk to your doctor if you have symptoms of an E. coli infection. . . . Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out."

The Mercer County Health Department said in a Facebook post, "These cases have been found in children and teenagers with an extensive exposure to fast food," but added, "The outbreak is not limited to young people."

That report, and the median age of those infected, 17, indicate that “It’s probably some convenience, fast food consumed by kids,” Bill Marler, a Seattle food-safety lawyer, told The Washington Post. "One silver lining, he added, is that people in this age range are typically healthy and not prone to further complications from E. coli," reports the Post's Michael Brice-Saddler.

Still, Marler said it is “concerning” that health officials haven't been able to trace the pathogen to a food source. “Given the size and the number of states that are involved, what you’re seeing is very unusual,” he told the Post. “If it was five people or 10 people, that’s a little harder to figure out. But when there’s 72 people and they’re being interviewed by epidemiologists, it’s pretty unusual you don’t have a culprit. The real question is, what do 72 people have in common over five states? It has to be something.”

"That something, Marler said, is likely a food or water product that people can’t remember they ate," the Post reports. "State and local health officials are required to interview ill patients and determine what they consumed in the week leading up to their symptoms, but recalling one’s dietary choices is often easier said than done, he said. Condiments, garnish, toppings, and spices can all contain traces of E. coli."

Marler said, “That’s probably why it’s taking longer to figure out, because people can’t remember what was in their meal.”

"Citing a CDC data set that dates to 1998, Marler noted outbreaks of E. coli O103 are relatively uncommon. Eighteen such outbreaks have been reported in the United States since 2000, with the highest number of reported illnesses being 29 during a 2010 outbreak in Minnesota. That makes this O103 outbreak by far the largest in recent memory, he said."

The state Department for Public Health says E. coli infections can be prevented by:

• Washing hands frequently for at least 20 seconds with soap and warm water, especially before eating, after going to the bathroom, handling raw meat and eggs, and after handling or petting animals;

• Thoroughly washing produce before eating;

• Thoroughly cooking meat;

• Cleaning and sanitizing food preparation areas;

• Avoiding swallowing lake or pool water;

• Drinking only pasteurized milk;

• Frequently cleaning and sanitizing restrooms, including door knobs and faucets; and

• Reporting diarrheal illnesses to your physician.

More information can be found here: https://www.cdc.gov/ecoli/ecoli-prevention.html.

Addict in recovery resumes writing his column for Appalachian newspapers after relapsing and going into treatment

Phillip Lee's book

A recovering drug addict who writes a column for newspapers in Appalachian Kentucky and Tennessee, and published a book, has relapsed, gone back into treatment and resumed his column.

Phillip Lee's return column for the Clinton County News in Albany emphasizes the nature of addiction, the humanity of those suffering it, and the promise of treatment. He writes: 

"I am a client at Hickory Hills Recovery and Treatment Center in Eastern Kentucky. This is a long-term treatment house for men who, like myself, suffer from the disease of addiction. Now, I know that some who read this may stop right here and say 'OK, I don’t want to read another word. Addiction is not a disease.' What I usually say to that is, absolutely nothing. Each person on God’s green earth has the free will and choice to decide if they believe addiction is a disease or not. I’m not here to debate anyone. I’m quite simple, just a guy with a pen who would much rather remain anonymous than anything, however, that is not possible if I wish to publish my work — so it may reach others in newspapers, in hopes of helping someone in need."

Lee writes that a client at the center noticed "a very poor man in the nearby community walking around in very worn out and distressed shoes. The client, without giving thought or second instinct to his own comfort, walked over and gave the gentleman in discomfort and need the very shoes off his feet. To many, this man would have been marked up and chalked off as a man of bad character, based solely on what they thought they knew or have seen from someone in active addiction. To this I must ask each of you, does this sound like a man of bad character? Does this sound like a man who should be thrown to the wolves for the slaughter? Does this sound like the kind of man you would rather not have in your communities? To me, it simply sounds like he’s a man who, through this program, has discovered his heart and true passion for his fellow."

He continues, "I’ve seen many great acts of both kindness and love, while here. I’ve seen and felt the spirit of God while here. I feel it even now as I write this small story for you. You see, folks, most of us here are not bad people at heart. Most here would much rather lift another up than to tear him down. We do suffer from a disease, and it is called addiction – and, yes, we have lost our way. But here, we are found. Here we are given every tool needed to recover and maintain and treat our disease. Here, we are taught how to utilize these tools in the most effective manner once we rejoin the communities in which we live. We are taught how to use these tools to regain our sanity and to gain or regain our love for life, in general. And here, we are taught how to reconnect with reality, entirely. So, if you know someone who is living the life of a using addict here in Kentucky, there are several Kentucky Recovery Centers all across the state like this one, where new life is born, every day."

Health advocates offer tips for getting reluctant local governments to OK syringe exchanges, now called 'harm reduction programs'

By Melissa Patrick
Kentucky Health News

Kentucky leads the nation in syringe exchanges for drug users, as a way to prevent the spread of disease, but local officials in some counties at risk of disease outbreaks from intravenous drug use have resisted pleas from experts to allow exchanges.

At a public-health panel discussion at the University of Kentucky, advocates of the exchanges shared some advice on how to overcome the opposition: persistence, partners, new terminology, realizing that politicians want to get re-elected, and having plenty of arguments at hand,

"Also remember that logic and rationality doesn't always win out, passion and persistence does," said Sheila Schuster, executive director of Advocacy Action Network, an umbrella organization of lobbies, who has lobbied the state legislature for more than 40 years.

The importance of early prevention, and access to care for mental health and substance-use disorders, were other topics of the panel, hosted by the UK College of Public Health during National Public Health Week, which falls during the first week of April.

Dr. Ardis Hoven, an infectious disease specialist and consultant with the state Department for Public Health, called Kentucky's syringe exchanges a "bright spot" when it comes to tackling the issue of substance abuse and addiction, adding that she was "exalted" that they had taken off as they had.

Kentucky lawmakers approved such programs in 2015 in an anti-heroin bill, as a way to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They require both local approval and funding. Since, local governments have approved 52 syringe exchanges, with all but four operational.

State health department chart as of February; click on it for a larger version

However, exchanges exist in only about half the 54 Kentucky counties that the federal Centers for Disease Control and Prevention has identified among about 250 in the nation as most at risk from an outbreak of HIV (the virus that leads to AIDS) or hepatitis C as a result of intravenous drug use.

Hoven said people who advocate for exchanges should be prepared to defend them. She calls them "harm reduction programs," saying that the term more accurately describes what they do. She said they not only pass out clean needles and syringes, but also provide health screenings and vaccines, access to treatment, and a place to build trusting relationships between clients and workers.

Former Gov. Steve Beshear, who was governor when the anti-heroin bill passed, said that while it's important to recognize that politicians are always working toward re-election and don't want to deal with controversial issues, they often "answer to the squeaky wheel." He added that "persistence and leadership" are key to any advocacy work, adding that success often requires several attempts.

Dr. Hatim Omar, a pediatrics professor at UK, advised the advocates to make sure they put a human face to the problem, because that makes it real, and to present their case in a way that would benefit local officials, reiterating that their main concern is to get re-elected.

Schuster, who has worked with the legislature since 1978, said she learned early on that you have to show up with a better argument than "It's the right thing to do."

Schuster, who lobbies on mental-health and disability issues, said advocates need to find unlikely partners, such as the faith community; get to know local government and health officials; learn from communities that have succeeded; have multiple arguments ready; and, most important, just show up.

"You've got to stir the pot," Hoven said. In addition to being armed with data and information, she encouraged building coalitions that truly understand the issue and are able to articulate it and to work with their local health departments. She also encouraged them to make sure they bring the police to the table.

"The other thing that you need to be ready to do at any given moment is to defend what a syringe service program or exchange program is and what it is not," she said. "And you ought to be able to do that in your sleep. That's crucial."

Opponents of syringe exchanges often base their criticisms on belief, not fact, and that's sometimes true of policymakers, Schuster said. For example, she said some legislators tell her that they think the programs enable drug use, which they don't, according to research; or that they need to be a strict one-for-one exchange, which undermines the goal of thwarting infection.

"We need to be educating our policymakers, because they are operating on wrong information," said Schuster.

Prevention and underlying causes discussed

On another front, Omar said the best way to treat addiction is to prevent it.

He pointed to the National Longitudinal Study on Adolescent to Adult Health, which found that teens who have a solid support systems, like having an adult to talk to and living in a safe environment, along with having something useful to do, are more likely to be successful in school and are protected against many things, including addictions, suicide and early sexual activity.

"This is I think where we are failing our young people," he said. "We are not providing adequate support systems."

He stressed that we also have to be honest when we talk to children about these topics, adding that the U.S. has to get over the "repetitive myth" that providing factual information to young people about drugs, sex and suicide will prompt them to do it.

"All the science in the world shows it's exactly the opposite," he said. "Knowledge is power, it improves things. . . . People do it because they don't know any better."

Beshear, who expanded Medicaid to Kentuckians who earn up to 138 percent of the federal poverty level, spoke to the importance of having access to health insurance as a way to combat substance-use disorders. He said that since the expansion in 2014, Kentucky's uninsured rate has dropped from over 20 percent to 7.5 percent.

He pointed out that the Patient Protection and Affordable Care Act is also the reason health insurance plans now cover mental health and substance-use disorders, including the Medicaid expansion population. He added this coverage to the traditional Medicaid population. Schuster added that in the first three years after the state expanded Medicaid, there was a 700 percent increase in the utilization of substance-use-disorder treatment.

Everyone on the panel agreed that until Kentucky addresses its social determinants of health, which are things like housing, education, employment, and environmental exposures that are known to affect health and well-being, it's unlikely that the state will truly improvements in its health outcomes.

"For us to ultimately get somewhere we've got to address all of those things," said Beshear.

Hoven, who called this issue "the elephant in the room," said that when it comes to social determinants, "We can flap our gums all day long," but until Kentucky dedicates policies that are completely funded and that empower the leaders of communities to deal with these issues, the state won't make much progress.

Schuster reminded the group that we also have to overcome the stigma that continues to exist around mental health and substance use disorders: "Stigma is alive and well."

Appeals court upholds law requiring doctors to show and describe ultrasound, and play fetal heartbeat, for women seeking abortion

By Melissa Patrick
Kentucky Health News

On a 2-1 vote, a federal appeals-court panel has upheld a 2017 Kentucky law that requires women to have an ultrasound before having an abortion while their doctor displays the image and offers a medical description of the fetus with the heartbeat played loud enough for the woman to hear.

The law allows the woman to avert her eyes from the image and to ask for the heartbeat volume to be turned off, but not to refuse the procedure. Failure to comply with these requirements could result in the physician being fined and referred to the state's medical-licensing board.

A district judge blocked the law last year, saying it was unconstitutional because it violated free-speech rights of physicians. Gov. Matt Bevin appealed that decision to the Cincinnati-based 6th U.S. Circuit Court of Appeals.

The majority opinion on "The Ultrasound Informed Consent Act" found that because the law "requires the disclosure of truthful, non-misleading, and relevant information about an abortion, we hold that it does not violate a doctor's right to free speech under the First Amendment."

The opinion was written by Judge John Bush, who was appointed by President Donald Trump. He was joined in the majority opinion by Senior Judge Alan E. Norris, who was appointed to the appeals court by President Ronald Reagan.

Bush wrote, “The information conveyed by an ultrasound image, its description and the audible beating fetal heart gives a patient greater knowledge of the unborn life inside her. This also inherently provides the patient with more knowledge about the effect of an abortion procedure: it shows her what, or whom, she is consenting to terminate. That this information might persuade a woman to change her mind does not render it suspect under the First Amendment."

Bevin, in a news release, called the ruling "a major pro-life legal victory."

"Today is a historic day, as Kentucky continues to lead the charge in implementing strong pro-life protections for its citizens," Bevin said. "Patients should be well equipped with relevant information before making important medical decisions. I am grateful to be governor of a state that values every human life, and we are committed to continue our fight on behalf of the most vulnerable among us."

In a harsh dissent, Judge Bernice Bouie Donald, who was appointed to the appeals court by President Barack Obama, said the majority decision "opens the floodgates to states in this circuit to manipulate doctor-patient discourse solely for ideological reasons."

She wrote, "The Commonwealth has co-opted physicians’ examining tables, their probing instruments, and their voices in order to espouse a political message, without regard to the health of the patient or the judgment of the physician."

The American Civil Liberties Union, which represented EMW Women's Surgical Center in Louisville, the only abortion clinic left in Kentucky, said the law serves no medical purpose and is opposed by The American Medical Association, The American College of Obstetricians and Gynecologists and the American Public Health Association.

"Today’s ruling allows Kentucky politicians to continue enforcing a law with no medical basis whose sole purpose is to shame and coerce a woman who has decided to end her pregnancy," Alexa Kolbi-Molinas, senior staff attorney with the ACLU’s Reproductive Freedom Project, said in a news release. "Regardless of how you feel about abortion, such extreme political interference in the doctor-patient relationship should be a cause of serious concern to anyone seeking medical care.”

Since taking complete control of both state houses in 2016, the General Assembly has passed several bills to restrict or eliminate abortion. At this time the Bevin administration is defending three of them in federal court and has appealed the ruling of an older one that required abortion clinics to have signed agreements with a hospital and an ambulance service.

Bruce Schreiner of The Associated Press reports that the ACLU is disagreeing with Kentucky's Democratic attorney general over how to challenge the law that requires abortion clinics to have signed agreement with a hospital and an ambulance service.

Attorney General Andy Beshear is asking the appeals court to rule against the regulation, but not against the law underlying the regulation. The ACLU wants the law struck down, saying that otherwise it will remain an ongoing threat to the state's only abortion clinic.

Beshear is the leading Democrat for the May 21 nomination to face Bevin, who is seeking a second four-year term.

Northern Kentucky judge rules in favor of health department, denies unvaccinated student's request to return to school

A judge has ruled against a Catholic high school student in his lawsuit against the Northern Kentucky Health Department, which barred him from school and all extracurricular activities during a chickenpox outbreak because he hadn't been vaccinated against the disease, Anne Saker and Max Londberg report for the Cincinnati Enquirer.

Jerome Kunkel, 18, testified in Boone Circuit Court April 1.
 (Photo by Liz Dufour, The Cincinnati Enquirer)

WLWT-5 reports that Boone County Circuit Judge J.R. Schrand denied the student's request to return to school, writing that Kentucky law requires the health department to "enforce such rules and regulations as it deems efficient in preventing the introduction or spread of the varicella and to accomplish this, it is required to establish and strictly maintain quarantine and isolation at such places as it deems proper."

Assumption Academy senior Jerome Kunkel, 18, sued the department after he wasn't allowed to play basketball during the statewide league playoffs because he hadn't been vaccinated and didn't show immunity from the disease.

The case prompted Gov. Matt Bevin to say in a radio interview that the government "should not be forcing this upon people," after explaining that he had exposed his nine children to chickenpox instead of vaccinating them, a practice that is strongly opposed by health officials as risky.

Kunkel told the Enquirer earlier that he is not against all vaccines, but only the ones that used aborted fetal cells in their making, including the chickenpox vaccine, Saker and Londberg report.

The chickenpox vaccine was first developed using tissue from a pair of aborted fetuses in the 1960s, but the modern vaccine contains no fetal cells. It became available in the U.S. in 1995. The National Catholic Bioethics Center approves the use of the vaccine, and even encourages it.

The health department's ban called for all students without proof of immunity from chickenpox to not come to school or participate in any extracurricular activities until 21 days after the last case of chickenpox appeared. The health department called for the ban after 32 students, or about 13 percent of the student body, got the disease.

Kunkel's lawyer, Christopher Wiest of Covington, said about 30 other students were out of school under the ban and had joined Kunkel in his lawsuit, the Enquirer reports. The students either attend Assumption or Our Lady of the Sacred Heart, an elementary school on the same property.

Parents were sent a warning in mid-February, after the number of suspected chickenpox cases jumped from six to 18.

Evidence at the court hearing showed that only about 18 percent of the students at the two schools had been vaccinated against childhood illnesses, like the chickenpox. The state's vaccination rate for chickenpox is about 90 percent, the Enquirer reports.

Kunkel asked the judge to let him go back to school, saying the ban was imposed on him because of religious retaliation, which the health department denied.

“This is not a case of religious discrimination,” Jeff Mando of Covington, who represented the health department, said. “Instead, it presents this question: Do unvaccinated students at Assumption have the right to attend school, play basketball and attend other extracurricular activities in the face of an outbreak of a very serious and infectious disease at the school?”

Mando pointed out that the state-issued religious exemption form that the Kunkels signed to get Jerome exempted from vaccines contains this warning: "This person may be subject to exclusion from school, group facilities or other programs if the local and/or state public-health authority advises exclusion as a disease-control measure."

Mando said the ruling "upheld the health department's mission to protect public health and the welfare of folks in Northern Kentucky."

The department said in a statement that the ruling "follows on the heels of the Northern Kentucky Health Department receiving national recognition through re-accreditation by the Public Health Accreditation Board, underscores the critical need for public health departments to preserve the safety of the entire community, and in particular the safety of those members of our community who are most susceptible to the dire consequences when a serious, infectious disease such as varicella, is left unabated and uncontrolled."

St. Joseph only Kentucky hospital in Healthgrades' Top 250

Saint Joseph Hospital of Lexington is the only Kentucky facility to get the America’s 250 Best Hospitals Award from Healthgrades, an online source for information about physicians and hospitals, owner Catholic Health Initiatives announced in a press release.

The hospital and Saint Joseph East, also in Lexington, earned several awards for patient care in the latest ratings. “These awards are made possible by the outstanding ministry and service of our dedicated physicians and hospital employees,” said Bruce Tassin, CEO of CHI Saint Joseph Health and president of Saint Joseph Hospital.

Saint Joseph was also judged to be one of the 100 best hospitals recognition for stroke care, critical care and pulmonary care. It and Saint Joseph East achieved high ratings in several other service areas. For information on how Healthgrades determines awards, visit www.healthgrades.com/quality.

CHI Saint Joseph Health says it is a system with 135 locations in 20 Kentucky counties, including hospitals, physician groups, clinics, primary care centers, specialty institutes and home-health agencies, serving Kentuckians in 35 counties. Its flagship hospital was established in 1877 by the Sisters of Charity of Nazareth. "The hospital’s original mission was to provide compassionate care to the poor and underserved – a tradition still carried out today," the news release said.

Andy Beshear's first TV ad in primary casts him as friend of Medicaid expansion, coverage of pre-existing conditions

In the opening television commercial of his campaign for governor, Attorney General Andy Beshear "highlights his efforts to defend the Affordable Care Act and Kentucky’s Medicaid expansion," which his father, Steve Beshear, instituted as governor, Bruce Schreiner reports for The Associated Press.

The ad contrasts the Democrat's health-care stands with those of Republican Gov. Matt Bevin, who first wanted to end the expansion of Medicaid under the 2010 law to people earning up to 138 percent of the federal poverty level. Now Bevin wants "able bodied" Medicaid recipients to work, go to school or perform other "community engagement" 80 hours a month, but a federal judge has twice blocked that plan. Meanwhile, "The Trump administration told a federal appeals court it wants former President Barack Obama’s health care law struck down in its entirety," Schreiner notes.

"Beshear’s 30-second ad starts out by showcasing Lukas Stevens, a young boy with diabetes, as Beshear touts his efforts as attorney general to protect health coverage for pre-existing conditions," a key part of Obamacare, Schreiner writes. Beshear says in the ad that the end of such coverage “would hurt Lukas and nearly half of all Kentuckians. I’m not going to let that happen. As attorney general, I’m helping lead a national effort to protect coverage for pre-existing conditions.”

Beshear is one of several Democratic attorneys general opposing a lawsuit by Texas and other Republican-led states to overturn the law, which Bevin has long argued is unconstitutional. As a candidate, he first said he would repeal the expansion, but backed off to the community-engagement plan. But he has issued an executive order saying that if the plan is finally rejected by the courts, the expansion would end six months from that point, because it is too expensive.

Beshear says in the TV spot, “I’ll protect expanded Medicaid to provide access to affordable health care. Governor Bevin won’t.” 

Beshear is opposed in the May 21 Democratic primary by state House Minority Leader Rocky Adkins and former state auditor Adam Edelen, who has been running ads for a few weeks and is also featured in ads run by a political committee that says it is independent of his campaign.

Foundation for a Healthy Kentucky is updating its directory of health coalitions; deadline to submit information is April 15

The Foundation for a Healthy Kentucky is updating its directory of local health coalitions and is asking groups that work to improve health in their communities to provide their contact information online by April 15 if they want to be included.

The Kentucky Health Coalitions Directory provides a way to "grow and strengthen health coalitions in the Commonwealth" and includes any group of individuals or organizations that have joined forces to improve health and health care in Kentucky.

"We can get a lot more done when we get out of our silos and come together to work on common goals, and that's a key part of the foundation's philosophy and mission," Ben Chandler, president and CEO of the foundation, said in a news release. "The directory helps enable community advocates, health care providers, educators, public officials, business leaders and others to connect and collaborate with one another."

The efforts of the coalitions in the directory vary: some increase access to healthy food and physical activity; others plan needed health screenings and provide health education for people at risk for serious health problems such as cancer, diabetes and other chronic diseases; and others advocate for smoke-free or complete-streets ordinances.

Chandler also noted that the foundation offers a series of webinars and workshops for coalitions, nonprofits and other health organizations to enhance their skills and otherwise grow their capacity to improve health in Kentucky. Click here for a list of upcoming "Health for a Change" events as well as recordings of previous ones. Click here to enter your coalition's information for the directory, which will be published online this summer.

Louisville health department offers fentanyl strips to safeguard drug users; fentanyl responsible for more than half of 2017 ODs

Buzz Feed News image

As a way to protect drug users from deadly fentanyl, Louisville's health department has started passing out test strips, Beth Warren reports for the Louisville Courier Journal.

Fentanyl was initially added to heroin, but has increasingly been hidden in many other drugs, including methamphetamine and pills that are made to look like legal ones, Warren reports.

Fentanyl is a synthetic opioid that can be up to 50 times more potent than heroin. It was responsible for more than half of the 1,565 overdose deaths in 2017, according to the annual Kentucky Office of Drug Control Policy report.

That number could be even higher in this year's report, preliminary numbers in Louisville suggest. An analysis by the Courier Journal found that fentanyl and its derivatives were responsible for 210, or two-thirds, of the 313 overdose deaths last year in Jefferson County. The analysis found that 46 of the deaths were from heroin and 103 were from methamphetamine.

The test strips are controversial, Warren reports, but a growing number of states are using them, including California, Rhode Island, Massachusetts, Delaware and Maryland. She describes how they work, noting that they are much like a home-pregnancy test and show results in 30 seconds.

"It's just enough time where someone wouldn't be impatient and go ahead and use," Takeisha Nunez, supervisor of the Louisville Metro Department of Public Health and Wellness syringe exchange program, which hands out the test strips, told Warren.

Opponents of the strips include including three veteran police officers who told Warren that the strips endorse illegal drug use but asked to not be named. Another critic, Dr. Elinore McCance-Katz, assistant secretary for mental health and substance use at the U.S. Department of Health and Human Services, has cautioned that "It is not inconceivable to think that people who are severely addicted will actually use the test strips to seek fentanyl," as a way to get a stronger high.

indeed, Warren reports that people with addictions have told her that they have used the strips to seek a stronger high, while others have told her they use them to avoid fentanyl, "not wanting to die like some of their friends."

Dr. Sarah Moyer, Louisville's health director, told Warren that she researched the use of the test strips before deciding to offer them, telling Warren that "surveys of participants who used test strips showed that more than 70 percent of them decided to change their behavior with the knowledge gained from the test," Warren writes.

Moyer said the health department is first targeting "high-risk" participants, including those just leaving jail or rehab, who are vulnerable to relapse. The department recently ordered 2,000 strips, paying 80 cents a piece for them, Warren reports.

"Fentanyl test strips and naloxone don't increase drug use," Moyer told Warren. "They reduce the harms and deaths from substance-use disorder." Naloxone is a drug that reverses opioid overdoses.

Warren reports that many illicit drug users don't know that fentanyl is being added to drugs other than heroin, and that the health department is working to educate them that they need to use the strips on all illicit drugs.

Further, harm reduction efforts like providing fentanyl strips, Naloxone and access to syringe exchange services provides a touch point for people who have addictions so that when they are ready to seek recovery, they will know where to go for help, Moyer told Warren.

For more information about treatment programs in Louisville and beyond, go to findhelpnowky.org.