Events, trends, issues, ideas and independent journalism about health care and health in Kentucky, from the Institute for Rural Journalism at the University of Kentucky
Gov. Andy Beshear, signing and vetoing bills on Thursday, April 7 (KHN photo by Melissa Patrick)
By Melissa Patrick Kentucky Health NewsKentucky lawmakers will return to Frankfort Wednesday to consider overriding Gov. Andy Beshear's vetoes of several bills, including two related to health. They would put new limits on abortion and set new rules for public assistance programs, including Medicaid.
The General Assembly will also consider passing other bills, but because it is required to adjourn by Friday, the Democratic governor could veto them without fear of being overridden by the Republican legislature.
The wide-ranging anti-abortion measure, House Bill 3, would ban mailing of medications that have become the means for most abortions in Kentucky, strengthen parental-consent rules and ban abortion after the 15th week of pregnancy, mimicking a Mississippi law that is awaiting a decision from the U.S. Supreme Court.
In his veto message, Beshear noted that the bill makes no exemptions for pregnancies caused by rape or incest, and described how the proposed parental-consent rules would require both parents to be notified if a girl under 18 wants an abortion. He said that could create a situation where a young girl who has been raped and impregnated by her father would have to notify him of her intent to get an abortion or go through an onerous process of getting a court order to allow it.
"Rape and incest are violent crimes," Beshear said. "Victims of these crimes should have options, not be further scarred through a process that exposes them to more harm from their rapists or that treats them like offenders themselves."
Further, he said the bill is likely unconstitutional and that the new reporting and oversight systems would create an "unfunded mandate" for the state Cabinet for Health and Family Services.
Beshear said he vetoed the public-assistance reform bill, HB 7, "because it will hurt Kentuckians by threatening access to health care and making it harder for those in need to access crucial benefits." He said the administrative burdens could cause people to lose benefits, said the bill could violate federal Medicaid requirements, and said it provides no appropriations for the health cabinet to implement the bill's requirements. He pointed out that when Kentuckians lose health and food benefits, that not only affects them, but physicians, hospitals and the economy.
The bill's sponsor, Rep. David Meade, R-Stanford, has said the added rules in Medicaid and food-benefit programs are needed to reduce fraud and encourage able-bodied adults without dependents to get off Medicaid and other public-assistance programs and back into the workplace.
It is expected that both bills, priorities for Republicans, will be repassed over Beshear's vetoes, just as they overrode his veto of a resolution ending the Covid-19 state of emergency about a month early, costing 544,000 Kentuckians an extra $100 a month in pandemic-related food benefits.
Federal law required the state to have a state of emergency were needed to get those additional benefits as long as the national state of emergency is in place, but also allowed Kentucky to apply for a "phase out" month of the benefits after its state of emergency ended, and that has been approved.
On March 30, a spokesperson for the U.S. Department of Agriculture, which houses the Supplemental Nutrition Assistance Program, formerly called food stamps, told Kentucky Health News that the additional month of Covid-19 benefits had been approved for April.
Bills hanging fire
One of the health bills to watch is HB 174, sponsored by Rep. McKenzie Cantrell, D-Louisville, that would extend Medicaid coverage to new mothers up to 12 months after giving birth. This bill sailed unanimously out of the House in February, passed out of its Senate committee unanimously on March 23 and was placed on the consent calendar, used to pass bills without debate.
Since then, five floor amendments have been filed, including one by Sen. Adrienne Southworth, R-Lawrenceburg, that includes provisions ofHB 51, sponsored by Rep. Lynn Bechler, R-Marion, that would allow a parent or guardian to opt out of any masking, testing or vaccination requirements imposed in response to the coronavirus. HB 51 passed the House 56-35 on March 8, but has lingered in the Senate Health and Welfare committee without a hearing.
Another bill to watch is HB 604, sponsored by Rep. Kim Moser, R-Taylor Mill. It would create the Kentucky Center for Cannabis Research at the University of Kentucky. It is supported by Senate President Robert Stivers, who has said the idea of medical marijuana needs more study to become law.
It also appears that three health bills that were added to a catch-all bill, Senate Bill 58, are set to pass. They are HB 645, sponsored by Rep. Danny Bentley, R-Russell, to create the mobile crisis service fund; HB 751, sponsored by Majority Caucus Chair Suzanne Miles, R-Owensboro, to create the Commonwealth West Healthcare Workforce Innovation Center; and HB 573, sponsored by Moser, to establish the Healthcare Worker Loan Relief Program for qualifying health-care workers.
If you vote for Ketanji Brown Jackson, you’re “pro-pedophile,” according to QAnon darling Rep. Majorie Taylor Greene, and if you talk about acceptance in Estill County, you’re a groomer, according to my twitter feed. That’s what it seemed like this week, in Kentucky, in Florida, all around the country. “Pedophile” and “child abuser” are the latest insults du jour. The Washington Post did an entire story about, and I’m not kidding on this, “groomer rhetoric.” This is, of course, disgusting, and should be the latest and most important reason for decent Republicans to rise up against their right wing. There could be nothing more horrifically cynical than taking one of the most heinous crimes on the planet and politicizing it with lies to win support and votes.
Most awful is the fact that child sexual abuse is a real and terrible problem here in Kentucky and elsewhere. But it’s not at Democratic Party headquarters or the Estill County music department. It’s at your family reunion or vacation Bible school, hidden away in shame and secrecy. “These are offensive political maneuvers,” said Terry Brooks, director of Kentucky Youth Advocates. “To politicize child abuse should shock our moral compass and should render those people unqualified for office. I get politics, but this is outrageous.”
These political battles conflate gender identity and sexuality with child sex abuse, making it harder to pinpoint how the problem needs to be solved. Advocates say the vast majority of child sex abuse perpetrators are “heterosexual,” most of them adult men abusing little girls. Abuse occurs everywhere, across socioeconomic levels, religion, race. Political affiliation has nothing to do with it either.
In one of those bizarre twists of life, it just so happens that all these political maneuvers and made up scandals are happening in April, which is Child Abuse Prevention Month, so a lot of advocates are out and about to talk about the real and serious issues. Such as: One in four girls and one in 14 boys will experience child sexual abuse at some point in childhood; and 90 percent of child sexual abuse victims know their abuser. Last year, Kentucky reported 1,853 substantiated cases of child sex abuse, which represents 8 percent of all abuse and neglect cases. It’s not a teacher with rainbow flags in the classroom and it’s not a teacher hosting a group of kids, “It’s the teacher or coach who invites one child to a barbecue after school,” said Winn Stephens, executive director of the Children’s Advocacy Center of the Bluegrass, which provides a full spectrum of victim services, from physical exams to counseling to advocates through the court system. “It’s the coach or the church pastor or the uncle, mom’s boyfriends, step grandparents — the people who are grooming and doing this crime are not strangers.”
Someone’s sexuality does not make them more likely to abuse, Stephens said. The the vast majority of cases he sees are what we would describe as heterosexual men abusing little girls or women abusing little boys. About 65 percent of the center’s clients are girls. Kentucky ranks somewhere near the top of national rankings for child abuse, although advocates are wary of these rankings because they compare different things and because it might be caused by some of Kentucky’s progress in the area. For example, Kentucky is a mandatory reporting state for everyone, which means every single person is required to report suspicions of abuse and neglect, not just teachers and policemen. (The reporting line is 1-877-KYSAFE1.) In addition, Lexington’s first child advocacy center, started by former commonwealth’s attorney Ray Larson and current Commonwealth’s Attorney Lou Anna Red Corn back in the 1990s, gave birth to 15 more in the state’s area development districts.
On Wednesday, Prevent Child Abuse Kentucky started a new campaign called “Safety and Awareness for Every BODY,” aimed at getting communities to recognize and talk about child sexual abuse.
“We know people want to prevent child sex abuse,” said Jill Seyfred, the group’s executive director. “We also know that no one wants to talk about it.” Shame and stigma means children are ignored and adults stay silent. “We can’t make kids responsible for their own safety,” said Janna Estep Jordan, director of operations. “We have to talk about it in the open.” That means talking about correct body parts and being honest and open with kids so they understand the potential dangers.
Angie Bailey
Angela Bailey, director of development for the Bluegrass Children’s Advocacy Center, who is herself a survivor of child sex abuse, says that’s what she would like to see above all else. “For me it starts at home, with talking to your kids and making sure they’re comfortable with saying no and their own bodies,” she said. “How many times did people say go hug Uncle So and So? Those little simple things that we do with kids send them messages that they’re not allowed to say no. In a recent editorial, Bailey wrote about how she taught her kids to use the proper names for body parts because she didn’t want them to feel shame about their bodies. “That is not grooming or sexualizing children, it’s about making all children feel comfortable with their bodies.
She also wants people to know that if something happens, it’s imperative to get help. Her abuser had many victims, she said, and one of the others was one of her cousins. Unlike Bailey, her cousin did not ever get treatment or counseling and her life was one of chaos and crisis, one she did not survive.
“We talk about the financial costs of untreated child sexual abuse, but the human toll is much greater,” Bailey said. There will also be a toll to conflating the politics of gender identity with this grave problem. ‘I makes me very sad,” she said. “Gender identity and pedophilia are not the same things — empowering people to not be ashamed of who they are is not the same thing as hurting a child.”
The child abuse reporting hotline is 1-877-KYSAFE1. On Monday, April 11 at 10:30 a.m. the Children’s Advocacy Center of the Bluegrass will hold a pinwheel planting to raise awareness of child sex abuse at their office at 162 N. Ashland Ave. Prevent Child Abuse Kentucky will hold a similar event on the front lawn of the Capitol in Frankfort Monday at 10 a.m. with Gov. Andy Beshear and First Lady Britainy Beshear.
Linda Blackford writes columns and commentary for the Herald-Leader. She has covered K-12, higher education and other topics for the past 20 years at the Herald-Leader, which published this first.
Covid-19 cases are on the wane across Kentucky, but influenza cases are on the rise and one person has been reported as dying from a co-infection of both.
The state Department for Public Health reports that in the week ended April 2, Kentucky had 613 new confirmed cases of flu, up from 334 the previous week. The week before that, 303 cases were reported, after a month with fewer than 174 cases per week. The state has recorded 4,478 cases this season and three flu-related adult deaths. One of those was attributed to a dual flu/Covid-19 coinfection.
In December, Brooke Hudspeth, chief practice officer at the University of Kentucky College of Pharmacy, told Kentucky Health News that it is safe to get both the Covid-19 vaccination and the flu shot at the same time, and it's actually important to get both, since having Covid-19 and the flu at the same time can increase a person's risk of severe complications.
"There aren't any complications or any risk when those are given at the same time," she said.
The health department has considered Kentucky's flu level "widespread" for four weeks because increases in cases were seen in more than half of the state's 16 health regions; that was the case with 13 regions in the latest reporting week.
Kentucky is follow a national trend of an increase in flu activity. Most of the increases have been seen in central and south-central regions of the country and they are increasing in the Northeast, according to the Centers for Disease Control and Prevention.
The CDC says, "An annual flu vaccine is the best way to protect against flu. Vaccination can prevent serious outcomes in people who get vaccinated but still get sick."
The flu shot is recommended for everyone 6 months and older as long as flu activity continues. Everyone 5 years of age and older can get a Covid-19 vaccine.
A few counties in the latest flu report have been hit especially hard with the flu, including Floyd, with 124 new cases, and Pike, with 74. Lincoln had 34 and Laurel 22.
Between March 30 and April 5, the Lexington-Fayette County Health Department reported 172 lab-confirmed flu cases, up from 15 in this latest state report. It also reported another flu-related death.
The health department cautions that the number of flu cases could be even higher.
"Please remember that lab-confirmed cases only reflect a small percentage of flu cases actually in Lexington," says the news release. "Many providers use rapid testing, which is not required to be reported to your state/local health departments."
Screenshot of Centers for Disease Control and Prevention map highlighting Kentucky
This story has been updated.
By Melissa Patrick Kentucky Health News
Anderson County is the only one in Kentucky with a medium level of coronavirus transmission, according to the latest Centers for Disease Control and Preventionmap of risks posed by the virus based on cases and health-care capacity. The rest of the state has a low level of the virus.
That means Anderson County's residents and visitors who are immuno-compromised or at high risk for severe illness should talk to a health-care provider about whether they need to wear a mask or take other precautions, says the CDC. The county is one of only 123 U.S. counties and county equivalents at the medium level.
The Anderson County Health Department blamed its unique status on a data backlog caused by short staff, Lexington's WKYT-TV reported April 11.
Everyone elsewhere can take off their masks, Health Commissioner Steven Stack said at Gov. Andy Beshear's weekly news conference April 7.
Stack encouraged Kentuckians to continue to make a "risk-based assessment" when it comes to decisions about the virus, but said it's all right to go unmasked if you are in a "green" county.
"It is okay to be in places with other people without masks," he said, adding later, "We can keep ourselves safe and enjoy a lot more of our lives the way we once knew them."
Beshear, asked if we are in an endemic phase of the pandemic (typically the final phase), said it is too early to tell. He said it will be a "good sign" if the latest version of Omicron does not cause a spike in the U.S.
"We'll only know when we don't see surges, just like we've seen in the past. And I think it's going to take some time to know that's the case," he said. "I think we are learning to live in the moment with a pandemic that is thankfully at a very low level, and we all hope it's already become endemic, we just won't know about it yet."
The CDC's color-coded map uses green for counties with low risk of transmission, yellow for counties with medium risk and red for counties with high risk. The ratings are based on new coronavirus cases, Covid-19 hospitalizations and the percentage of staffed inpatient beds occupied by Covid-19 patients.
Clay County, Tennessee, is at a medium level and borders Monroe and Cumberland counties in Kentucky. Livingston, Crittenden and Union counties border four red counties in Illinois, but Livingston has no direct connection to them across the Ohio River; Crittenden has a ferry and Union has a bridge.
Stack said Kentucky is a bit behind the rest of the nation when it comes to the circulation of the newer version of Omicron, called BA.2. Nationally, he said 72 percent of the virus is BA.2 and 25% is the original Omicron, BA.1. In Kentucky, it's about 60% BA.2 and 40% original Omicron, he said.
Stack said his Department for Public Health would stay vigilant in monitoring the coronavirus, but he encouraged the general public to not worry and to keep doing the things that we know work to slow the spread of the virus: get fully vaccinated, get boosted, and respect those who chose to wear a mask.
He said, "I strongly recommend you tune out the buzz and the chatter about the variant du jour," French for "of the day." "It just adds to anxiety and worry about things you can't control anyway."
FRANKFORT — State Senate President Robert Stivers said he favors funding more research on medical marijuana before making it legal in Kentucky, but Gov. Andy Beshear says medical cannabis has overwhelming support in the state and should pass when the legislature returns to reconsider vetoed bills.
At separate press conferences in Frankfort Thursday, the two leaders also discussed the Republican legislature's rejection of the Democratic governor's plan to give Kentuckians who worked throughout the pandemic a "hero bonus;" and Stivers said a House bill to rein in pharmacy benefit managers died in the Senate for fear it would raise consumers' and employers' costs.
Medical marijuana: Stivers said the House-passed cannabis bill "would be difficult" to pass the Senate next week, but he supports a bill by Rep. Kim Moser, R-Taylor Mill, to create a cannabis research center at the University of Kentucky and expects it to pass. "I think it not only would be good locally but nationally and internationally to understand the medicinal and therapeutic values of marijuana," he said.
Senate President Robert Stivers
Stivers acknowledged that studies show cannabis helps with certain medical conditions, "but every study I've read said the sample sizes have been too small, the duration is too long and therefore more study is needed."
Moser's House Bill 604 has had two of its three required readings, so it could clear the Senate Appropriations and Revenue Committee and the full Senate quickly on April 13 and/or 14.
Beshear urged the legislature to pass the medical-cannabis bill in those two remaining days, which would require suspension of the three-readings rule. "Its time has certainly come."
He added, "Kentuckians deserve the passage of a medical-marijuana bill. They overwhelmingly support it. When 70-plus percent of a state is in favor of something, it's time for the General Assembly to step up and do something about it. Represent the people."
Asked later if he could do anything by executive order to make it easier for people with certain conditions to have access to medical cannabis, Behsear said, "We're going to explore that. . . . I am for medical marijuana and I will continue to push it until we make it a reality."
The House passed its cannabis bill, HB 136, by a vote of 59-35, with just over half of the Republicans who voted on the bill favoring it. A similar bill passed the House in 2020 but died in the Senate.
Pharmacy benefit managers: House Bill 457 would ensure that patients could pick their pharmacy, instead of being required to use one affiliated with a pharmacy benefit manager; increase transparency between insurers and PBMs; and ban PBMs from retroactively denying a pharmacy claim after adjudication, commonly referred to as "clawing back." It passed the House 88-3.
Asked why the bill didn't gain any traction in the Senate after such overwhelming support in the House, Stivers said, "When it got here, we started getting, from business sector and provider sector, various questions and comments about what the overall cost would be to various plans."
The bill was opposed by one of the session's heaviest lobbying campaigns. The Pharmaceutical Care Management Association, the PBM trade group, spent $38,369 to get its message to lawmakers before March, when it ran television commercials urging voters to ask their legislators to defeat it.
Stivers said it had been assigned to the Appropriations and Revenue Committee "because it has potential fiscal impact -- local, individual, personal and state fiscal impact." He indicated that the bill would not pass, since that would require suspension of the three-readings rule, and more education would be needed among Republican senators about what it would do.
Hero bonuses: Stivers said the General Assembly took a different approach to hero bonuses that he said would benefit everybody, mainly because it was too hard to determine just who would qualify for bonuses. He said the legislature is giving income-tax reductions and workforce incentives, and investing in infrastructure and higher education.
Gov. Andy Beshear
Beshear disagreed, reflecting on how scary it was early in the pandemic when the mortality rate from the virus was 10 percent in some places and essential workers were asked to show up at work every day.
"I believe this legislature needs to spend some of the last two days including hero bonuses. They deserve those hero bonuses. . . . I think it's really disappointing."
Health bills become law: Beshear signed three more health-related bills into law Thursday.
House Bill 525, sponsored by Moser, would allow Medicaid to pay certified community health workers. CHWs aren't trained medically, but are trained as patient advocates who come from the communities they serve. They help clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy, and deliver education on prevention and disease self-management.
Senate Bill 10, sponsored by Sen. Robby Mills, R-Henderson, addresses the nursing shortage with both short-term and long-term solutions, including streamlining the process for out-of-state and foreign trained nurses to practice in Kentucky without compromising the standards of care; improving access to nursing education by removing "arbitrary" enrollment limits without compromising the quality of the programs; and adding term limits and geographic requirements for the Board of Nursing.
Senate Bill 105, sponsored by Sen. Max Wise, R-Campbellsville, will increase awareness and screenings for the cytomegalovirus (CMV), a virus that can cause childhood deafness and other health conditions. Most CMV infections are not diagnosed without newborn screening, resulting in missed opportunities for needed care. It is titled Bella Dawn Streeval’s Law, after a woman who died two years ago Thursday after suffering from CMV.
The Kentucky Rural Health Association is devoting a one-day conference to discuss a vaccine that can protect against infections and cancers caused by the human papillomavirus.
The HPV Vaccine Conference, which was to be held in Bowling Green, will now be held virtually on April 14 between 9 a.m. and 3 p.m. ET. Click here to register.
Among other topics, speakers who will talk about strategies to improve HPV immunization rates, rural HPV data, HPV vaccine resources and inter professional collaborations to increase HPV vaccination.
HPV is the most common sexually transmitted infection in the U.S. and can cause cancers of the cervix, vagina, vulva, penis, anus, rectum, throat and the back of the tongue. More than 90 percent could be prevented by the vaccine, according to the Centers for Disease Control and Prevention.
The vaccine is recommended for all 11- and 12-year-olds, but can be given up to the age of 45. In 2020, only 55.7% of Kentucky teens aged 13 through 17 had received all recommended doses of the HPV vaccine, slightly below the national rate of 58.6%, according to the America's Health Rankings. Kentucky ranks 29th among the states.
The foundation of the Kentucky Chamber of Commerce is offering a three-day "Fair Chance Academy" to help employers foster employment opportunities for Kentuckians in recovery from substance use disorders who are ready to re-enter the workforce.
“Employment is a critical component of long-term recovery, and the business community has an important role to play in helping individuals return to the workforce and reducing stigma around recovery in the workplace,” Morgan Kirk, director of the Kentucky Chamber Foundation’s Workforce Recovery Program, said in a news release. “We’re excited to begin offering this training to help employers transform lives, and we encourage businesses of all sizes and across all industries to apply.”
The Chamber will select 15 companies to participate in the inaugural Fair Chance Academy which will involve three, full-day training workshops at the Kentucky Chamber Headquarters in Frankfort on May 11, May 25 and June 8. Applications for the academy close on Friday, April 15. Click here to apply.
Following the training, participants will spend three months implementing actionable steps within their companies to become fair chance employers, a practice that reduces many of the roadblocks that make it difficult for candidates in recovery or with a criminal conviction to get hired.
"Certifying employers as ‘fair chance’ can provide stable employment for someone, which is a critical component of long-term recovery," Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said in the release. "This can provide Kentuckians with the purpose and motivation they might need to stay in remission and get their lives back.”
Employers will also have the opportunity to participate in a discussion with Sam Quinones, author of “The Least of Us,” who has been nationally recognized for his writings on the opioid crisis.
The Fair Chance Academy is part of the foundation’s Transformational Employment Program, which launched last year. This program provides a bridge from recovery to employment by lessening the risk of employers who hire or retain people with substance-use disorder, if the employees sign up for treatment and complete it. To date, 55 Kentucky employers are signed up, which impacts more than 11,000 employees.
In yellow counties on this adapted Centers for Disease Control and Prevention map, the CDC says residents who are immuno-compromised or at high risk for severe illness should talk to a health-care provider about "additional precautions, such as wearing masks or respirators indoors in public. If you live with or have social contact with someone at high risk for severe illness, consider testing yourself for infection before you get together and wearing a mask when indoors with them."
By Melissa Patrick Kentucky Health News
The good news about the Covid-19 pandemic is that all metrics to measure the coronavirus in Kentucky continue to drop – including deaths, for the second week in a row. The bad news is that the addition of last week's Covid-19 deaths means that more than 15,000 Kentuckians have died from the disease.
The state attributed 135 more deaths to Covid-19 last week, an average of 19.3 per day. That's down from 33.7 per day last week and approximately 40 a day recorded in each of the three weeks prior to that. The state's pandemic death toll is now 15,028.
From last Monday through Sunday, the standard reporting week, the percentage of Kentuckians testing positive for the coronavirus dropped again, to 1.97%. The last time the state saw a positivity rate this low was in June 2021, just before the highly contagious Omicron variant hit. The low was 1.79%.
The state's weekly report showed 3,948 new cases of the virus during the week ended April 4, an average of 564 per day. The week before, the average was 790 per day.
The state's seven-day infection rate fell to 4.13 daily cases per 100,000 residents. A few hotspots remain. Counties with rates more than double the statewide rate were Pike and Trimble, 8.4; Cumberland. 8.6; Perry, 9.4; Wolfe, 12; Hickman, 13; Clinton, 23.8; Taylor, 24.9; and Anderson, 42.1.
The New York Times ranks Kentucky's infection rate fourth among states, even though the number of cases has declined 46% in the last 14 days.
Of the week's new cases, nearly 24% were in people 18 and younger.
Hospitals reported 240 patients with Covid-19, less than a third of the 782 reported a month ago; 36 of them were in intensive care and 18 were on mechanical ventilation. Five of the state's hospital regions are using at least 80% of their intensive-care beds, but very few of their patients have Covid-19. Overall, 53% of beds were in use, 77% of ICU beds were, and only 22% of ventilators were.
Although observational studies have indicated that moderate alcohol consumption is good for your heart, a new genetic and medical study of 371,000 people in the United Kingdom determined that any level of alcohol consumption is linked with a higher risks of heart disease – and the more you drink, the greater the risk.
Not only does the study suggest that alcohol can lead to cardiovascular disease, there are "unequal and exponential increases in risk at greater levels of intake," the researchers conclude. They said that "should be accounted for in health recommendations around the habitual consumption of alcohol."
The study, published in JAMA Network Open, found that the risk of cardiovascular disease is "relatively modest" for those who consume up to seven drinks per week, but that risk increases exponentially with more alcohol.
The researchers question whether an average consumption of two drinks per day should be considered low-risk behavior and emphasize the need for "aggressive efforts to reduce alcohol intake among heavy drinkers."
The researchers define light alcohol consumption as up to eight drinks per week; moderate consumption as 8 to 15 per week; heavy consumption as 15 to 24; and abusive consumption as more than 24 drinks per week.
While this study found that moderate drinkers have less heart disease than heavy drinkers or those who abstain, it suggested another cause for that: Those with light to moderate alcohol consumption also had healthier overall lifestyles, such as smoking less or not at all, exercising more, and eating healthier.
"The reported cardioprotective effects of light to moderate alcohol consumption may be the product of confounding lifestyle factors," says the report.
The study looked at the connection between genes that are linked to alcohol consumption and cardiovascular disease for more than 371,000 people who participate in the U.K. Biobank, a large-scale biomedical database that allows researchers to study participants' genes and their relationship to health. Their average age was 57 and they reported consuming an average of 9.2 drinks per week.
Understanding your alcohol intake can help assess how alcohol may affect your health, Dr. Danielle Anderson, an addiction medicine specialist with UK HealthCare, said in a recent article titled, "When One More Drink Can be Dangerous to Your Health."
Assessing alcohol intake starts with counting the number of “standard drinks” you have in a week, Anderson writes. A “standard drink” is a 12-ounce beer containing 5% alcohol, a 5-ounce glass of wine, or 1.5 ounces of liquor containing 40 percent alcohol (80 proof).
The federal government's Dietary Guidelines for Americans recommend that men of legal drinking age either abstain or limit intake to two drinks or less in a day, and that women abstain or limit intake to one drink or less in per day. The guidelines say drinking less is better for health than drinking more.
The National Institute on Alcohol Abuse on Alcoholism defines binge drinking as consuming five drinks for men or four drinks for women on the same day within a couple hours.
If you have alcohol-use disorder, the current medical term for was once called alcoholism, treatments are available that include medications, therapy and involvement in mutual support programs such as Alcoholics Anonymous or the Supportive Medication And Recovery Treatment (SMART), Anderson notes.
Anderson, an assistant professor in the UK Department of Psychiatry, advises, "Talk to your provider about your health conditions and medications prior to using alcohol. If you are drinking above the recommended amounts of alcohol, talk with your provider about your concerns."
University of Kentucky Professor Sharon Walsh and Lexington Fire Battalion Chief Marc Bramlage have been named the Dr. Rice C. Leach Public Health Heroes for 2022 by the Lexington-Fayette County Health Department.
The award, announced Monday at the start of National Public Heath Week, is given annually to those who have demonstrated their dedication to improving the health of Lexington residents. It is named for the late Rice C. Leach, who was commissioner of health for Lexington and the state and spent more than 50 years as a public-health physician.
Walsh is the principal investigator on UK's largest grant ever, an $87 million study to determine how to reduce opioid overdose deaths in Kentucky and create a national model. It involves Jefferson, Fayette, Franklin, Kenton, Campbell, Mason, Greenup, Boyd, Carter, Bourbon, Clark, Madison, Jessamine, Boyle, Knox and Floyd counties.
Walsh and her team have established partnerships with behavioral-health and criminal-justice agencies to implement an integrated set of evidence-based practices to combat the opioid epidemic, including communication campaigns, expanding capacity to medication-assisted treatment for opioid-use disorder, providing overdose education and distributing 4,600 units of naloxone, a drug that reverses overdoses.
“I’m honored to receive the award created in memory of Rice C. Leach, a true public health hero committed to improving the health and well-being of Lexingtonians and all Kentuckians,” Walsh said in a news release. “Kentucky was one of the first and is among the states hardest hit by the nation’s opioid crisis. Combating this epidemic must happen in the communities where affected people live.”
Chief Marc Bramlage (Photo by Frank Handshoe)
Bramlage received the award for supporting the health department's Covid-19 vaccination clinics. "it is an honor to be awarded for doing a job you love," he said. He and Walsh will be recognized at the April 11 Board of Health meeting and at the April 14 Urban County Council meeting.
UK's College of Public Health has organized daily events this week to celebrate Public Health Week, including a panel discussion at 6 p.m. Thursday, April 7, to discuss health equity and social determinants of health. Click here to register.
University of Kentucky video; for captions, click on play, then click the CC icon on the bottom line. If using a mobile device, click on the "thought bubble" in the same area.
April Ballentine uses new equipment to walk. (University of Kentucky photo by Mark Cornelison)
By Allison Perry and Steve Shaffer University of Kentucky
“Deep breaths, April. Deep breaths.” April Ballentine nods, steeling herself. As she sits inside the lab of the University of Kentucky’s Sports Medicine Research Institute, her anticipation stirs up an incredible amount of pure nervousness. This is the day the Lexington native has been waiting for, working for – for weeks, months, even years. A crowd has gathered to witness this moment, including April’s friends and family, UK faculty, and physical therapy students from the UK College of Health Sciences. With great trepidation, she shifts her body into position, channeling her mindfulness to conquer this new task. Then, she is asked the million-dollar question. “You ready?” April looks up at the physical therapist in front of her, unflinching. “Yes.” Today, the 51-year-old will stand and walk for the first time in more than eight years.
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In August 2013, April was out with friends at a happy hour when an ex-boyfriend showed up, gun in hand. As he raised it toward her face, she blocked his first shot. But in the chaos, she blacked out and fell to the ground. He then unloaded the chamber on her in front of more than 50 witnesses. At some point, April woke up, covered in a white sheet. Her ears were ringing, and all she could utter was one phrase, over and over. “I’ve got to get up.” She then heard a voice gently reply, telling her to lie still, followed by sirens. She couldn’t breathe. Then, everything went black again. When April woke up for the second time, she was at UK's Albert B. Chandler Hospital. She had survived five gunshots at close range. A trauma team led Dr. Andrew Bernard, the trauma medical director, had stopped the bleeding, saving her life. Because she was hooked up to a respirator, April’s medical team gave her a dry-erase board to communicate. “I wrote my daughter’s name with a question mark, and they said she was fine,” April said. “Then they asked me if there was anything they could get for me. And I said I was hungry as hell.” That fighting spirit kept April going during her stint in the ICU – a time she calls “one of the greatest challenges I’ve had to go through in my life.” After several weeks of intensive care, she was discharged to Cardinal Hill Rehabilitation Hospital. “That’s when I learned I was paralyzed,” April said. “I had never heard that word before – or if I did, it just never registered because I was so highly medicated.” At Cardinal Hill, April began working with a team of therapists led by physical medicine and rehabilitation physician Sara Salles. She had to learn how to live with her new normal: paralyzed from the chest down due to a T4 spinal-cord injury. “Dr. Salles explained everything to me,” April said. “And I said, ‘OK.’ I never asked why. I never cried about it. The pain was more overbearing than anything else I could have imagined because it was constant. [It’s] something I never want anyone to experience.” April spent 90 days at the facility. She’d heard of companies that made robotic exoskeletons, which allowed users to stand up and walk again with bracing and support from the upper body. Occasionally during her therapy, April would try to stand, holding herself with her arms. It was far harder than she had expected. “It was so difficult,” she said. “I recall trying to push myself up, and it almost seemed impossible. That dream was shot really easily. I had to learn that I had to live for today and not tomorrow. Because I lived for walking, I couldn’t live in the moment.”
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In October 2015, April was speaking about her experience at a church to raise awareness for Domestic Violence Awareness Month. Fayette County Sheriff Kathy Witt heard her story and approached April with a proposition. “She said, ‘I want you on my team’,” April said. “She’s been a great advocate for domestic violence awareness for a very long time.” April began working with the sheriff’s office, first as a volunteer, then as an employee. She now serves as a victim advocate intake specialist in Amanda’s Center, a 24-hour point of contact for victims of domestic violence located in the Fayette District Courthouse. In this role, she helps ensure victims have access to the resources and help they need. April describes the work as “a calling” that has helped her heal, process and understand her own trauma. “I understand what it’s like to be a victim, and I understand what it’s like to be afraid and to not be afraid,” she said. “And I believe that I’m a good resource to help someone escape, or to help them understand the extreme behavioral issues they’re experiencing.” April also began volunteering at Cardinal Hill, playing a mock “patient” for physical-therapy students to learn how to work with people who have spinal-cord injuries. “[I want to show] that for anyone with a spinal-cord injury, life is possible and life can be good,” she said. “And I make it fun, too. I think my personality fits because I break the ice, make them laugh, and say the unexpected.” Several years ago, she was contacted by ReWalk Robotics, a company that makes bionic devices to help people with spinal cord injuries. ReWalk’s exoskeleton has been available since 2014 and was the first such device to be cleared for market in the U.S. by the Food and Drug Administration. The company was looking for an opportunity to start a program in Lexington. April passed their information on to her contacts at Cardinal Hill, not really expecting to hear anything further. But that contact lit a spark in her. She decided to start focusing on her physical fitness. “I started thinking, ‘OK, I’ve got to take better care of myself,’” April said. “And then Covid hits. I said, ‘I’m not going to sit here and do nothing.’” April sought out a trainer and got to work, noting playfully that one of her goals was to develop “Angela Bassett arms.” Over the past two years, she’s lost 180 pounds and developed incredible upper-body and core strength. Although April’s spinal-cord injury is at her T4 vertebra – around chest height – she still has some sensation and strength in her core, which helps her do things that many others with her same injury classification can’t do. Last August, April began to build strength in another way. She bought her own house, regaining the independence she lost that traumatic day in August 2013. “Taking on my health and being able to live independently with such a high injury level made me dream,” she said, “and recognize, and remember that I can do anything.”
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Denise O’Dell is relatively new to UK, having joined the College of Health Sciences as an associate professor last summer. As a physical therapist, she specializes in working with patients who have neurological impairments, including brain and spinal cord injuries. O’Dell teaches students in UK’s Doctor of Physical Therapy program and works with patients in the Kentucky Neuroscience Institute’s ALS Multidisciplinary Clinic.
O’Dell took a group of UK students to Cardinal Hill last fall, where April was volunteering again as a mock patient. In addition to the physical therapy techniques students will perform, O’Dell says she often reminds them how important it is to listen to their patients during therapy. And listening to April’s story, O’Dell and her students were impressed.
“I could see the drive that she has to give back to society, to better herself, to stay engaged,” O’Dell said. “Given my background and having worked with a lot of individuals with spinal cord injury, I saw sparks there that I hadn’t seen in others for quite some time.”
Encouraged by April’s overall strength, O’Dell asked if she’d ever stood up. April had been medically cleared via bone-density screenings for standing – with support – in her power chair, but she had never tried to stand another way. O’Dell brought her to a set of parallel bars. “Denise was like, ‘We’re going to do something different’,” April said. “She said, ‘I’m going to have you stand using these parallel bars.’ And I just kind of looked at her and said OK. I’m open to it.” With O’Dell supporting her legs, April grabbed the bars and pushed up into a standing position. “She literally just popped up into standing,” O’Dell said. “The first time she was up for two or three minutes. That’s pretty unheard of for someone who hasn’t done it for so long.” Shortly after, April asked to stand again. “Even though we were out of time, we did it again,” O’Dell said. “The students were like, ‘We’ll stay.’ They could see that this was a better learning moment than I think they had expected.” In a previous job, O’Dell had been part of a team that helped evaluate and train patients following spinal cord injury, including evaluations for standing and use of exoskeletons. Based on her experience – and what she had just witnessed – she thought April could be an ideal candidate. She made some calls to her colleagues at UK HealthCare and the College of Health Sciences and contacted ReWalk to come up with a plan for April to trial an exoskeleton device. “Next thing I knew, I had a phone call with a date,” April said. “So here we are.”
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Back in the Sports Medicine Research Institute lab, April’s big moment is here. She’s officially “trialing” the exoskeleton, which will help the ReWalk team determine if she’s an eligible candidate to begin training with the device. From the crowd, a voice calls out: “Use those Angela Bassett arms!” April smiles and offers a correction: “These are April Ballentine arms.” She swings a set of forearm crutches back, tilts forward, and prepares to use her considerable upper body strength. The exoskeleton beeps and whirs. Guided by therapists from ReWalk, April pushes into the crutches and powers up to a full standing position. Now, she’s standing taller than the therapist in front of her. Her audience cheers. From there, the team takes April through some of the basic movements she will need to master: holding a neutral standing position, shifting her weight laterally, pivoting, and finally, walking. The machine will move her legs for her, but she will use the forearm crutches to support, balance and guide her body as she moves. When it’s time to walk, the therapists clear a path in the room and tell April she’ll be walking toward a man in a blue suit – Bernard, the UK trauma surgeon, who stopped by to show his support. Seeing him, her eyes fill with tears. April’s first few steps are big, lurching. The team stops to recalibrate the machine to her gait. Her trainer, David Asbury, comes to stand by her side and coach her through the walk. She grins. “Hey, I’m taller than you!” she exclaims to Asbury, and everyone laughs. With the machine recalibrated, she tries again. This time, she takes off, walking across the room, only stopping when she reaches a curve that requires a pivot. Sitting down to rest, she’s overcome with emotion as her friends and family hug and congratulate her. “I’m just overwhelmed right now,” she says, voice shaking. “It’s been eight and a half years.”
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For patients with a spinal cord injury, a ReWalk exoskeleton isn’t just about the chance to walk again. The mobility it offers comes with a number of health benefits that can improve the patient’s overall quality of life – better circulation, muscle spasticity, bowel and bladder function, and even nerve pain. “The opportunity to stand and walk is multifaceted,” O’Dell said. “Physiologically, being upright, your gastrointestinal system works better. Your heart, your lungs work better. An individual such as April will rate their quality of life higher from a participation and health standpoint.” But April still has more work ahead of her. Although insurance will cover the cost of training with the device, it does not cover the cost of the device itself for non-veterans. ReWalk continues to pursue insurance coverage opportunities, but for now, April will need to cover the cost of her own exoskeleton. To help fundraise for the device, April is working through a nonprofit organization called I GOT LEGS, which set up a donation page for her. Once she has her down payment, she can begin working with ReWalk-trained physical therapists to become proficient with the exoskeleton, a process that usually takes 20-30 sessions. She isn’t deterred by the cost. Where there’s a will, there’s a way, and April Ballentine always finds a way. “Throughout the last nine years, there have been people saying, ‘You can’t do this, you can’t do that’ – whatever,” April said. “I’m going to prove you wrong every time.” Besides, she has another ambitious goal to meet. In November, April’s daughter is getting married. And she’s determined to walk her daughter down the aisle. It’s that determination that makes her such a light and role model for the community, said Bernard. Despite her tragedy, she has persevered. “She was a victim, but she’s not a victim anymore,” Bernard said, adding that her situation “was minutes of crisis, and then it’s a lifetime of potential impact.” When she woke up under that sheet in 2013, April had only one thought in her mind: I’ve got to get up. Eight and a half years later, she’s done it. And she’s hungry to do it again. She just needed that little extra push – one that came in the form of a chance meeting with someone who saw her potential and had the right experience to make it happen. Denise “is pretty phenomenal,” April said. “Recently, I told her, thank you for seeing my ability instead of my disability. If it wasn’t for her, I would not be here today.”
FRANKFORT – The latest bill to help independent pharmacies compete with pharmacy benefit managers sailed out of the House with overwhelming support but came to a resounding halt in the Senate. No one is saying why, but the PBMs mounted one of the session's heaviest lobbying campaigns.
PBMs determine what drugs are offered in insurance plans, where and how a patient gets their drugs, how much is paid for the drug, and how much the pharmacist gets. The leading PBM in Kentucky is CVS Caremark, a sister company to one of the nation's largest pharmacy chains.
House Bill 457 passed the House 88-3 on March 21, with 56 sponsors. The next day it went to the Senate Appropriations and Revenue Committee, not a usual location for such a bill, and never got a hearing. It has had none of its regularly required three daily readings, and only two legislative days remain.
Key parts of the bill would ensure that patients could pick their pharmacy, instead of being required to use one affiliated with the PBM; increase transparency between insurers and PBMs; and ban PBMs from retroactively denying a pharmacy claim after adjudication, commonly referred to as "clawing back." Opponents say the bill would raise costs for consumers.
Rep. Steve Sheldon, R-Bowling Green
Republican Rep. Steve Sheldon of Bowling Green, the bill's prime sponsor, said he was surprised that it didn't move in the Senate after getting such overwhelming support in the House. He said he couldn't say why leaders of the Senate's Republican majority had not supported it, but did say that many big companies opposed it.
Those companies' heavy lobbying efforts appear to have worked.
The Pharmaceutical Care Management Association, PBMs' trade group, was one of the state's top 10 lobbying spenders in the first two months of the legislative session, spending $38,369 to get their messages to lawmakers, according to reports they filed with the Kentucky Legislative Ethics Commission.
That ranked the PCMA ninth in spending, and it seems likely to end the session at a higher rank, because it spent thousands of dollars from March 21 to April 1 on television commercials asking viewers to contact their legislators and ask them to vote against HB 457, saying it would raise drug prices.
Sheldon fought back on his Facebook page March 28, pleading with senators to consider the bill.
"I would appreciate the Senate looking at HB 457," he said. "We are down to 2-3 days … I realize bills that inject millions back into Kentucky and allow our seniors patient choice are not as glamorous as the status quo, but please take a real close look at this. Don’t let your Kentucky dollars get mandated by PBMs out of state while our seniors wait by the mailbox for their medicine !! Don’t believe the lies, propaganda and rhetoric. It’s not TOO late."
The only group that appeared to spend money lobbying in favor of the bill through February was EPIC Pharmacies, a nonprofit buying group for independent pharmacies, which reported spending $7,416. Lobbying groups' spending reports for March are due April 15.
CVS Health reported spending $21,528 through February. In a statement dated March 21, it said, "House Bill 457 will only increase the costs of prescription drugs in Kentucky, making it more difficult for Kentuckians to access affordable medications. Dozens of Kentucky employers are opposed to this bill because it does not help control the cost of prescription drugs and hurts their employees. We urge the Senate to reject HB 457. We should protect consumers from increased health care costs, and lawmakers should focus on the high prices set by big drug companies."
The Kentucky Association of Health Plans, comprising companies selling health insurance in the state, reported spending $11,316 on legislative lobbying through February, and the Kentucky Association of Health Underwriters reported spending $5,000. Both spoke against the bill in a House committee.
Individual insurance companies, which have a wide range of interests, also opposed the bill. Anthem Inc. and its affiliates reported spending $35,597 on lobbying in the first two months, ranking 11th; United Healthcare reported spending $14,000.
Senate Appropriations and Revenue Committee Chair Sen. Chris McDaniel, R-Ryland Heights, did not respond to several e-mails from Kentucky Health News asking why he did not give the bill a hearting.
Angela Billings, spokeswoman for the Senate majority, said in an e-mail that she had reached out to McDaniel with the question and that it would have to be "tabled" until the General Assembly returns April 13 to reconsider bills and budget lines vetoed by Gov. Andy Beshear.
"I daresay that he was extraordinarily busy with the budget and could not get to many bills worthy of hearing," Billings said.
Sen. Max Wise, R-Campbellsville, who has been instrumental in getting PBM-control bills passed in prior legislative sessions, said he didn't know why this one hadn't moved in the Senate, but said in a text message, "I do support the concept and the language of HB 457." Asked if it was discussed in Republican senators' private caucus, he said, "Policy discussions stay within the caucus."
Kentucky lawmakers have been working on PBM issues for years, most recently passing 2020 Senate Bill 50 to make the state hire a single PBM to manage Kentucky Medicaid's prescription-drug business of more than $1 billion a year. A 2019 state analysis found PBMs made $123 million through spread pricing.
During the bill's House hearing, Sheldon, a pharmacist and businessman who is not seeking re-election, said it had taken three years of collaboration to produce, with upwards of 20 organizations supporting it. Not all of them lobby.
Lobbying groups must list the bills on which they are lobbying, but not whether they are for or against them. Other than those above, those that listed HB 457, and their total expenses between Jan. 1 and Feb. 28, were: American Pharmacy Services Corp., $550; Appalachian Regional Healthcare, $10,209; Chewy Inc., $10,000; Ford Motor Co., $17,500; GE Appliances, $5,000; St. Elizabeth Healthcare of Northern Kentucky, 16,358; and University of Louisville Health, $6,000.
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