Ky. Nurses Assn. and its school-nurse task force aren't happy with the lack of state funding to reduce the nursing shortage

Centers for Disease Control and Prevention photo

May is National Nurses Month, a reminder of the essential services that nurses have always provided, but especially during the pandemic, which has been so stressful that many have left the profession.

To address the nursing shortage in Kentucky, the General Assembly passed a bill that has both short-term and long-term solutions, but the Kentucky Nurses Association and its school-nurse task force aren't happy with it. 

"If anyone thinks the nursing shortage in Kentucky was addressed by the governor or the legislature during this current session, they are certainly misguided. At best, it has been window dressing by the governor and an attempted appeasement by the legislature to show they were doing something for nursing," Lois Davis, Pat Burkhart and Carol Komara, members of the KNA school nurse task force, wrote in an op-ed.

In a separate statement, the nurses' association said: "Despite the herculean efforts of the Kentucky Nurses Association and nurse leaders across the state that included lobbying, a massive letter-writing campaign, a statewide press conference, state and national news coverage and multiple testimonies in front of lawmakers, Kentucky’s budget did not include any of KNA’s detailed $100 million ask to combat the critical nursing shortage in the commonwealth." 

Delanor Manson, the association's chief executive officer, said in a news release, "While we are devastated by this development, National Nurses Month gives us the opportunity to show our appreciation for nurses by letting them know we will not waver in our commitment to recruiting and retaining more Kentucky nurses."

Manson added that the association will pursue other funding streams and collaborative relationships, calling on businesses, industries and regional organizations to contribute to the cause. KNA says Kentucky will need an additional 16,000 nurses by 2024.

“We encourage all Kentucky residents to reach out to their lawmakers now to solidify relationships that will help us secure funding in the 2023 session and beyond," Manson said. "The conversation about this critical issue must continue – lives are depending on it."

KNA says the association's initial recommendations included "securing private grants, corporate sponsorships for nurse retention bonuses, nursing scholarships and emeritus programs to entice retired nurses to re-enter the profession. In addition, KNA leaders invite organizations dedicated to workplace safety to provide funding and collaborative programming to benefit nurses and those in their care." 

Senate Bill 10, sponsored by Sen. Robbie Mills, R-Henderson, and Senate President Robert Stivers, R-Manchester, is designed to help out-of-state and foreign-trained nurses to practice in Kentucky without compromising standards of care; improve 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 state Board of Nursing.

After pointing to the impact of the pandemic on nursing staffing, and education and the verbal praise they received by the governor and the legislators for their sacrifice, the school-nurse task force also criticized the legislature's lack of funding to decrease the nursing shortage in Kentucky. 

"Did our governor or the legislature think it might need to show some appreciation to nurses by allocating some of the Covid dollars to assist with retention of those tireless professionals?" they asked. "No. Instead, their solution was to recruit nurses from other states and foreign territories through licensure endorsement with minimum requirements. Did they not have the foresight to recognize that there are approximately 89,000 licensed nurses in the state of Kentucky and that, with some creative efforts, could recruit some that are licensed but not currently practicing?" 

The task force said incentive scholarships could have been have been created to attract more nurses into practice, and into higher education as nursing faculty. Or, they wrote, money could have been allocated to provide a nurse in every school, all day, every day. 

"Instead, the legislature created SB 10 and the governor signed it, shifting the burden and responsibility for alleviating the nursing shortage to the Kentucky Board of Nursing," they write. "To declare an emergency during a pandemic and then try to solve it by increasing enrollment for the future, without funding, is both a simplistic and unrealistic solution." 

KNA's school-nurse task force said Gov. Andy Beshear and legislators failed to listen to qualified nursing representatives on the governor-appointed task force, "who provided an in-depth analysis and offered realistic solutions to the nursing shortage. Instead, they chose to rush their decisions and legislate another unfunded mandate, SB10, without allocating any funding to combat the nursing shortage." 

Burkhart, Davis and Komara wrote, "The public needs to stand in support of the nursing profession. Your vote counts in every election."

Not only is this month National Nurses Month, May 6-12 is National Nurses' Week. Nurses will be marching to Congress May 12 at the National Nurses March in support of fair, realistic wages; including no caps; safe staffing patient ratios; no violence against healthcare workers; and changing the culture of the biases and discriminations in the nursing profession.

Number of school-based health clinics keeps growing

Kentucky Primary Care Association map; for a larger version, click on it; to download, right click.

The number of school-based clinics in Kentucky keeps growing, as four community health centers are getting federal grants of $200,000 each to open new primary-care programs based in schools. The funds will help expand school-based clinics of A+ Family Healthcare in Brownsville, Big Sandy Health Care in Prestonsburg, Health Help Inc. (White House Clinics) of McKee, and Shawnee Christian Healthcare of Louisville. They are among 125 grants announced around the nation this week.

Kentucky Primary Care Association CEO David Bolt said on a news release, “School-based clinics operated by our members provide essential services to children and teenagers who might not otherwise have access to care. Many of our clinic members provide multiple services in schools. KPCA members provide a combination of primary care, dental, and behavioral health services in more than 250 school health center locations throughout the commonwealth. Students cannot learn if they are not healthy. Partnerships between our member clinics and schools help keep kids healthy.”

The KPCA said the centers will use the money "to reduce disparities and improve access to care by increasing the number of young people receiving essential health care, including mental-health services. Health centers will also use these funds for activities such as community and patient outreach, health education, and translation support."

A recent federal study published in the American Medical Association’s journal JAMA Pediatrics found that between 2016 and 2020, the number of children from 3 to 17 who were diagnosed with anxiety grew by 29 percent and those with depression by 27 percent.

“There is no doubt that the last two years have been challenging for our kids and we need to do all that we can to support their health and well-being,” said Carole Johnson, administrator of the federal Health Resources and Services Administration, which is issuing the grants. “By expanding our support for school-based health services, we are creating more opportunities for young people to get the help they need to address both physical and mental health needs that have been overlooked for too long.”

KPCA says one in nine U.S. children gets primary health care through a HRSA-funded center. In 2020, 41 percent of community health centers provided services to children and youth at more than 3,200 school-based sites. In Kentucky, more than 250 individual school clinic sites are operating.

Post-Roe, rural women would face more obstacles; retired health director says the issue is about men, women, sex and control

"Trigger laws" would make abortion in Kentucky and 12 other states illegal in almost all cases if Roe v. Wade is overturned. That would disproportionately affect rural women, who are more likely than their urban peers to be impoverished, less likely to have the time or money to drive long distances across state lines to obtain an abortion, and more likely to face stigma over the decision to end a pregnancy.

Abortion isn't often publicly discussed in rural areas, but it is widely felt, as indicated by a recent note to University of Kentucky journalism professor Al Cross, editor and publisher of Kentucky Health News, by Bertie Salyer, retired health director in Magoffin County:

Bertie Salyer

“As a former social worker, social work supervisor, college professor, and health department director, I feel very distraught. Old white Republican men telling all females of childbearing age that they better not have sex unless they can see themselves nine months away successfully having and supporting a family of at least two. Punish the woman, don’t allow her to have sex education in school, don’t give her birth control, don’t give her health care, don’t give her support or any services while pregnant and after birth; just tell her to only have sex for procreation because SHE alone is responsible. Her body must bear the consequences, the lifetime consequences of that weak moment, that rape, that incestuous attack, that failure to think ahead in what could have been a moment of passion. She suffers the societal impact, the disruption of her life through what could have been a lapse in judgement, a mistake, crime victimization. HE can sexually enjoy the moment and move on without a thought. What is fair, equal, and just about that? And don’t allow me the space to discuss the possible outcomes for the child, and the additional social problems for our society.”

Many who oppose abortion rights are just as passionate, saying that all life is sacred and that it begins at conception. Though the topic has been a divisive political football for decades, public sentiment hasn't changed much in the nearly 50 years since the Roe v. Wade decision. "According to Gallup, 21 percent of Americans thought abortion should be illegal in all circumstances in 1975, compared with 19 percent in 2021," Michael Scherer reports for The Washington Post. But in the 13 states with trigger laws, current sentiment is decidedly different: "43 percent of adults on average say abortion should be legal in most or all cases, while 52 percent say it should be illegal in most or all cases," Nate Cohn reports for The New York Times.

A 2014 poll in Kentucky by the nonpartisan Pew Research Center found that 57% of Kentucky adults thought abortion should be illegal in all or most all cases, while 36% said it should be legal in all or almost all cases. More than 90% of abortions are performed in the first trimester of pregnancy.

Panel discusses a post-Roe v. Wade America; journalists are encouraged to treat abortion as a health issue, not a political one

By Melissa Patrick
Kentucky Health News

Two days before the leak of a U.S. Supreme Court draft opinion that proposes to overturn abortion rights under its 1973 Roe v. Wade decision, a panel of experts participated in a roundtable discussion anticipating such a decision. It was titled "Women's reproductive health in a post-Roe world." 

At the 2022 Association of Health Care Journalists conference in Austin, the experts largely discussed what's happening in Texas -- which has a near-ban on abortions since abortions are now illegal after fetal cardiac activity is detected, usually around six weeks of pregnancy and before most women know they are pregnant -- as a way to paint a picture of what it could look like if the Supreme Court strikes down Roe.  

Sonja Miller, interim managing director of Whole Woman's Health Alliance in Austin, a nonprofit abortion provider that has unsuccessfully challenged the new law, talked about how the clinic has had to deny abortion care to the "vast majority of Texans" who come to the clinic since the law took effect. 

"Our staff are constantly in the position of having to look at another human being in the eye and telling them that they can't help them," she said. "We have not seen an abortion ban this inhumane since pre-Roe v. Wade." 

She added that the Texas law, which also deputizes private citizens to sue anyone who aids or abets an abortion after fetal cardiac activity has been detected, has a chilling effect and has placed everyone who works in abortion "on extreme alert." She said it has resulted in many of their patients seeking care long before they have even missed a period or have any idea that they are pregnant and forced many of their patients who don't "qualify" for an abortion to ask: "Where do I go now? What's next?" 

To meet patients' needs, she said the clinic launched the Abortion Wayfinder Program to help pregnant people travel out of state for an abortion. The health alliance has clinics in Texas, Minnesota, Indiana and Virginia. 

Another challenge is that by the time a woman finds out she's pregnant in Texas, which is often beyond the six-week ban, and is able to make out-of-state travel arrangements -- coordinating transportation, housing, care for existing children, time off work and ensuring they have enough money to pay for the procedure -- they are often in their second trimester, which begins at 14 weeks of pregnancy, said Dr. Crystal Berry-Roberts, an obstetrics and gynecological physician at Austin Regional Clinic. 

This matters, she said, because an abortion provided in the second trimester comes with an increased risk of bleeding and infection.  

Further, she said most offices don't offer new obstetric visits until eight to 10 weeks into a pregnancy, and that the first time a woman can find out if there is something genetically wrong or lack of brain development is around 11 or 12 weeks. 

"We're talking about an unrealistic timeline," Berry-Roberts said, referring to the six-week abortion ban. 

Berry-Roberts, who only provides medically indicated abortions, added that laws that limit abortion and the political discourse around this topic increases stigma, drives pregnant people seeking abortion "into the shadows" and makes it harder for women to talk candidly about their pregnancy with their physicians. "It is unfair, it is unrealistic and it is doing harm," she said about the Texas law

Dr. Lisa Harris, an obstetrician-gynecologist at the University of Michigan, pointed to a long list of things that must be considered beyond the impacts on reproductive health care for pregnant people if Roe is overturned, including: issues of equity; medical providers concerns about whether they are breaking the law if they counsel patients to end their pregnancies; increases in births and maternal deaths; and the implications of restrictive laws on self-managed abortions. 

Further, she said the language is vague in states where abortions would be permitted if the mother's life is at risk. "How much risk does someone need to take on to have an abortion count as life saving?" she asked. 

"For example, there are patients with cardiac disease who we will quote a 25 to 30% chance of dying if they continue the pregnancy and give birth. Is that enough of a risk of dying to have qualified, I guess, to use that word, to qualify for an abortion? Or does it need to be 50% or 100%? How are we to know this?" she asked 

Advice for journalists covering abortion

Image from healthlaw.org

Sophie Novack, an independent journalist who has closely covered reproductive rights for the Texas Observer, encouraged journalists at the conference to cover abortion as a health issue, not a political one. 

"So often coverage of it is siloed from other areas of reproductive health care," she said. 

Novack encouraged journalists to look at abortion through the lens of health-care access, and to offer context around percentages of people who are uninsured, teen pregnancy trends, state funding for family planning services, access to maternal health care, access to public assistance, and information that helps audiences understand how abortion restrictions affect the overall, long-term health of women.

"So thinking about all those kinds of factors together and how they fit together in the context of someone's ability to terminate the pregnancy and hurdles that exist," Novack said.

She also encouraged journalists to use medically accurate language. For example, she said the Texas law is not a "fetal heartbeat law" because an embryo does not have a heart at six weeks of pregnancy. 

The Associated Press has recently updated its Stylebook:

Pregnant people
Phrasing like "pregnant people" or "people who seek an abortion" seeks to include people who have those experiences but do not identify as women, such as some transgender men and some nonbinary people. Such phrasing should be confined to stories that specifically address the experiences of people who do not identify as women. See gender, sex and sexual orientation.

And our long-standing entry on abortion:
Abortion
Use the modifiers anti-abortion or abortion-rights; don't use pro-life, pro-choice or pro-abortion unless they are in quotes or proper names. Avoid abortionist, which connotes a person who performs clandestine abortions. Instead of pregnant women, use "pregnant people" or "people who seek an abortion" in stories that specifically address the experiences of people who can get pregnant but are not women. Such phrasing seeks to include people who have those experiences but do not identify as women, such as some transgender men and some nonbinary people.

The Supreme Court is expected to rule on the case of Dobbs v. Jackson Women's Health Organization by the end of June, which will determine the constitutionality of Mississippi's 15-week abortion ban, which raises the issue of whether a state can ban abortion before fetal viability. The court could do that without fully overturning Roe, by setting a stricter standard, but Justice Samuel Alito wrote in a leaked draft opinion that there is no constitutional right to abortion.

CDC says Union, Henderson and McCracken counties have medium levels of virus, so high-risk people there need masks

Centers for Disease Control and Prevention map

By Melissa Patrick
Kentucky Health News

Three Western Kentucky counties are yellow on the national Covid-19 risk map, for counties with a medium level of virus, according to the Centers for Disease Control and Prevention.

Union and Henderson counties are yellow for the second week in a row, and McCracken County moved from green to yellow on this week's risk map. The rest of the state is green, considered to have a low level of the virus. 

The CDC says people in yellow counties who are immunocompromised, or at high risk for severe illness from the virus, should talk to a health-care provider about whether they need to wear a mask or take other precautions.

The weekly ratings are based on new virus cases, Covid-19 hospitalizations and the percentage of staffed inpatient beds occupied by Covid-19 patients.

Nationwide, the CDC reports that 87.7% of counties or county equivalents have a low level of the virus; 9.9% have a medium level; and 2.45% have a high level. 

These low transmission rates are welcomed as the state moves into Kentucky Derby weekend. 

"I'm looking forward to people being able to get out and really enjoy," Gov. Andy Beshear said at his weekly news conference. "We have asked a lot from people over these last couple of years. We asked for a lot of sacrifices and with where we are in Covid, while it hasn't gone away, it's okay to celebrate. With everything that we've given up for a period of time, I want people to enjoy, have a good time and I am really looking forward to feeling that energy and to watching everybody else be able to have a good time." 

Beshear said he and his family will be taking masks with them to the Derby and will use them if they feel they are needed. 

Beshear says Ky. is 'pretty safe' from Covid-19 and he expects 'room for at least some executive order' for medical marijuana

State chart, adapted by Ky. Health News

By Melissa Patrick
Kentucky Health News

As the state heads into Kentucky Derby weekend, Gov. Andy Beshear said all the metrics to measure Covid-19 give Kentuckians little to be concerned about. 

"You're pretty safe from where the virus is right now, if you're fully vaccinated and boosted," Beshear said at his weekly press conference. "If you are unvaccinated, this virus could still be very difficult on your health." 

Crowds pose more risk, even to the vaccinated. Beshear said he and his family will carry masks with them to the Derby and use them as needed, and that was his advice for others: use a mask if they feel uncomfortable. 

State chart, adapted by Ky. Health News

"My kids, my wife, just like everybody else, know all about how this thing spreads now," he said. "They are all fully vaccinated."

The state's coronavirus report for last week showed cases had plateaued, but the state was seeing a steady increase in the share of Kentuckians testing positive for the virus. Covid-19 hospitalizations and intensive-care cases, while up a bit, were still lower than last summer before the Omicron virus variant hit. 

Beshear said he was not concerned about another surge of cases later this summer as new variants keep surfacing and with the state's positivity rate on the rise. He said there would be cause for concern if the severity of the disease was causing increased hospitalizations, which it is not. 

State chart, adapted by Ky. Health News

"So, I don't have cause for concern at this time," he said. 

Beshear also noted that while Covid-19 vaccination rates have slowed down in Kentucky, people are still getting them.

"While our vaccination numbers are smaller than they have been at most times during the pandemic, everyday people still choose to get vaccinated for the first time," he said.

Average daily Covid-19 vaccinations in Kentucky declined 12% in the last week, to an average of 3,244 per day, The Washington Post reports.  

Beshear said the vaccination rate for 65- to 74-year-olds in Kentucky went up one percentage point last week, from 97% to 98%. "This provides a great amount of protection for them, and we are proud of them," he said.

The U.S. Food and Drug Administration announced Thursday that it is limiting its authorization of the one-dose Johnson & Johnson/Janssen Covid-19 vaccine to people who cannot or will not get the Pfizer-BioNTech or Moderna vaccines, citing the rare but clearly identified risk of rare blood clots. 

The FDA said it was making the decision "after conducting an updated analysis, evaluation and investigation of reported cases” of the "rare and potentially life-threatening blood clots" which “warrants limiting the authorized use of the vaccine.”

Through March 18, there had been 60 confirmed cases of the clots, called thrombosis with thrombocytopenia syndrome (TTS), with nine fatalities. That is about three cases for every million J&J vaccines administered, and about 1 death per 2 million doses.

"We’ve been closely monitoring the Janssen Covid-19 Vaccine and occurrence of TTS following its administration and have used updated information from our safety surveillance systems to revise the EUA," said Peter Marks, a top FDA official. 

The Kentucky Department for Public Health shows that 54% of the Covid-19 first doses that have been administered in Kentucky are Pfizer; 38% are Moderna; and only 7% are J&J. 

Medical cannabis

Beshear announced in mid-April that he had asked his legal team to explore whether it would be possible to address the issue of medical marijuana by executive action. 

Asked for an update, Beshear said that the legal analysis is not final, "but I do think that there is going to be room for at least some executive order." Republicans in the legislature have said there is not.

Beshear also said in April that he was creating the Governor's Medical Cannabis Advisory Team to travel the state to hear from Kentuckians about the issue. He said thousands of people have said they want to be a part of it and that the hope is that it will be up and running "pretty soon."

Study: Ky. non-profit hospitals get more in tax exemptions than they give in community benefit; hospitals dispute methodology

By Melissa Patrick and Al Cross

Kentucky Health News

A first-of-its-kind report argues that all of the nonprofit hospital systems in Kentucky are spending less on community investments and charity care than they receive in tax exemptions. The hospitals disagree, saying they're not being given credit for all the services they provide. 

The Lown Institute Fair Share Spending report calculated "fair share spending" by comparing a hospital's charity care and community contributions with the value of its tax exemptions, using 2019 tax information to calculate their findings. (If data were not available from this year, IRS Form 990 from 2018 was used.) The report considers a fair share of charity care and meaningful community investment to be at least 5.9% of overall expenditures. The figure is based on peer-reviewed research published in 2018.

The institute, a nonprofit think tank based in Massachusetts, calculated this measure for more than 1,800 hospitals across 275 nonprofit hospital systems in the U.S. It found that 227 of the 275 systems spent less on charity care and community efforts than what they received in tax exemptions, resulting in an $18.4 billion "deficit" in community spending.

Kentucky's nonprofit hospital systems ranked 39th among states in fair share spending, with a deficit of $424 million. 

Pointing to the 10 hospital systems that account for $5.6 billion of the $18.4 billion total fair share deficit, Dr. Vikas Saini, president of the Lown Institute, asked in the news release whether that money would be better spent by directly funding community efforts, like addiction, food insecurity and homelessness.

Kentucky hospitals dispute methodology

Several Kentucky hospital systems and their associations criticized the report's methodology, saying it doesn't include things like uncompensated and unreimbursed costs, including Medicaid shortfalls, research and support for education in health professions. 

Kentucky Hospital Association spokeswoman Ginger Dreyer said in an e-mail, "The report cherry-picks only certain categories of community investment while ignoring others, including many programs and services which benefit the community but may not be included in a hospital’s community benefit report." 

Rick Pollack, president and CEO of the  American Hospital Association, said in a blog post that the report was "an obvious example of relying on preconceived notions and faulty methodology to draw inaccurate conclusions." He cited a 2019 Ernst and Young report that found for every dollar invested in nonprofit hospitals and health systems via the tax exemption, $11 in benefits were delivered to communities. 

Baptist Health, Kentucky's largest hospital chain, said in an e-mail that it echoes the AHA's comments,  and spokeswoman Kit Fullenlove Barry offered more detailed criticism.

Barry said there are strict standards governing what research can be reported as a community benefit, and contrary to the Lown Institute's understanding, hospitals are not reimbursed for the education of the majority of health professional trainees, who provide health care; and that shortfalls in Medicaid reimbursements are considered a form of uncompensated care, long regarded as a community benefit.

"When all IRS-defined community benefit activities are included, Baptist Health more than covers the $135,093,407 that the Lown Institute has calculated as the system’s 'tax value.' Baptist Health’s community report that covers data from roughly the same time period, shows community benefit spending of $177.6 million," Barry said.  

The Lown Institute's figures are much different. It reports that the hospitals in Baptist Health's Kentucky system got more than $135 million in tax exemptions, but spent just over $62 million on charity care and community investment, for a nearly $73 million shortfall. 

Guy Karrick, spokesman for Saint Elizabeth Healthcare, also criticized Lown's methodology. He said Medicaid losses, health-professions education and research "are indeed recognized by the IRS on our 990 form as counting toward community benefit. . . . “In 2019, our 7.41% of expenses was well above the 5.9% criteria they are using for the fair share amount. The losses on Medicaid are real and the reimbursement from Medicaid is well below the cost of care. The teaching component goes well beyond our residency programs and includes nurses and other healthcare professionals for which there is no reimbursement. All three of these clearly benefit the patients and community we serve."

Of the four Kentucky hospitals in the Saint Elizabeth system, the Lown Institute report shows they received nearly $69 million in tax exemptions and provided nearly $46 million in community benefit spending, for a "fair share spending deficit" of nearly $23 million. 

Norton Healthcare spokeswoman Maggie Roetker said in an e-mail, "As a not-for-profit system our mission is to support the health of the community. Our community benefit numbers are reported on our Form 990, which is based on industry-accepted methodology and within the IRS guidelines for tax exemption. For a complete picture of our community benefit, go to nortoncares.com."

The Lown Institute says Norton got more than $110.5 million in tax exemptions and provided less than $32 million in community benefit, for a $78.5 million fair share spending deficit. 

The Lown Institute's account of its methodology acknowledges all the excluded categories, saying they don't have a direct impact on the community. It says:

"Medicaid shortfall was not included because hospitals are already reimbursed for Medicaid patients by the state. Hospitals offer discounted rates for most insured patients, yet these are not considered community benefits; it is unclear why discounts for Medicaid patients should be an exception.

"Hospital spending on health-professions education and research were not included because these investments do not have a direct impact on the health of its community. The labor [that] hospital trainees provide helps hospitals provide patient care, but their work is not targeted toward particularly underserved patients or specialties. Additionally, hospitals are already reimbursed for trainees. Many hospitals do not report on Form 990 the indirect medical education payments they receive from Medicare for training residents, even though these payments are often greater than the cost of inpatient care. While research funding is a public good, it is unlikely that a hospital’s self-funded research has a direct impact on the health of the surrounding community."

Independent analyst says approach seems appropriate

 Julia F. Costich, Ph.D. 

Julia Costich, the Peter P. Bosomworth Professor of Health Services Research at the University of Kentucky College of Public Health, noted that the Lown clearly states it is only looking at programs that directly impact a community.

"Because the purpose of the report is to compare tax revenue foregone by the community with inputs specifically to the community where the hospital is located, the approach seems appropriate to me," she said.

As for research and education, Costich said, "These hospitals are typically not academic research institutions," and health-professions graduates "are scattered to the four winds," so the benefits to the community in these two areas are likely minimal. (UK's hospital system is not included in the report because it is classified as government-owned.)

"Hospitals for the most part have explicit charitable missions," Costich said, and this report puts "their feet to the fire" to make sure they are accomplishing all of the charity and community work they say they will do in order to get this tax exemption. 

Costich added that the release of the report is badly timed for the nonprofits, because in the last two years "Hospitals have really taken a hit because in the pandemic they have not been able to perform generously reimbursed procedures in the volumes they were used to, so hospital margins have definitely declined. That said, not-for-profit hospital systems often have substantial resources, and if you look at executive salaries in the not-for-profit world, particularly in the gigantic systems, they are intentionally competitive with some parts of the for-profit realm in order to arguably attract the level of expertise that is needed to run these hugely complex systems."

Some of those systems are in Kentucky. The report said the seventh largest "fair share deficit" in the nation, $515 million was incurred by Catholic Health Initiatives, which has 10 of its 76 hospitals in Kentucky; their share of the chain's total was nearly $81 million.

The 16th largest deficit, $249 million, was incurred by Cincinnati-based Mercy Health, another Catholic-affiliated chain that operates Lourdes Hospital in Paducah and Marcum and Wallace Hospital in Irvine. The prorated Kentucky deficit was more than $14 million.

Other Kentucky hospital systems in the report were:

• Appalachian Regional Healthcare with nine of its 11 hospitals in Kentucky and a $35.6 million deficit; the prorated Kentucky amount was nearly $30 million.
• Owensboro Health, with a deficit more than $25 million.
• Ephraim McDowell Health, based in Danville, with a deficit of more than $11 million.

Each of the hospital systems were offered the opportunity to respond to this report.

The Courier Journal reports on illegal abortions in Ky. before Roe v. Wade and asks, 'Will history repeat itself?'

Headlines on 1939 undercover C-J
investigation that found abortion was
 commonplace in Louisville

As the U.S. Supreme Court appears poised to abolish the right to an abortion, Andrew Wolfson of the Louisville Courier Journal writes in detail about illegal abortions in Kentucky from 1866 through 1973, when the Roe v. Wade decision created the right. 

The stories are based on 20 cases decided by Kentucky's highest court and more than 60 stories from the Courier Journal’s archives over that period. The article also come with a warning that the stories contain graphic descriptions that may upset some readers. 

"The Courier Journal found the procedure was widespread, even routine — despite penalties of up to 20 years in prison for those who provided "criminal abortions," Wolfson reports.  

"One woman was beheaded after her boyfriend tried unsuccessfully to give her an abortion, then dumped her body in a field," he writes. "The remains of other women who died in botched abortions were tossed in a well, left by the side of a highway, ditched in a Louisville parking lot and abandoned in a La Grange motel room." 

Wolfson includes a number of other women who experienced illegal abortions in Kentucky prior to it becoming legal and how they often suffered or died in his story. "Some women lingered for months before dying of infections, abscesses and hemorrhages," he writes. 

And then he asks the question, "Will history repeat itself if the U.S. Supreme Court strikes down Roe v. Wade and lets states such as Kentucky decide whether it can be banned?" The Washington Post has a similar story from a national perspective.

Twenty-six states, including Kentucky and five bordering states, are poised to move quickly to ban abortion should Roe be overturned, according to the Guttmacher Institute, a reproductive-health policy organization that favors abortion rights. Kentucky will do so through a "trigger law" that was passed in 2019 that will immediately ban abortion in Kentucky if Roe is overturned. 

Retired Louisville obstetrician Dr. Ronald Levine, 93, who began practicing 13 years before Roe v. Wade and continued to practice after, told Wolfson that when abortion was illegal in Kentucky, "Every day we would see women with infections from back-alley abortions and girls who tried to do abortions themselves with wire hangers or by douching themselves with lye."

If abortion becomes illegal again, “It won’t be as bad, but it will still be bad. Not everyone will be able to get on a plane and fly to Illinois or New York. Teenagers will still try self-abortions," said Levine, who was chairman of obstetrics and gynecology at the University of Louisville. "We will always have abortions. The only question is whether we do them safely or dangerously."

Researchers who have studied the history of abortion told Wolfson that while women with money and means will find a way to have an abortion, those without similar resources will resort to extreme methods -- like having their boyfriend hit them in the belly or finding an "underground" abortion provider. They also said it is likely that abortion medications will increasingly be sold on the black market. 

Wolfson also walks through the history of abortion in Kentucky, from the 17th century to 1973. He writes about the reasons women have sought abortion over the years, including the risks involved with childbirth, social necessity and inabilities to support a child without work or family support. 

As for laws to restrict abortion or even make it illegal, the Courier Journal said in an editorial: “The law never put a stop to abortions. It just made then more difficult, more expensive and more dangerous.”

The U.S. Supreme Court is expected to rule on the case of Dobbs v. Jackson Women's Health Organization by the end of June, which will determine the constitutionality of Mississippi's 15-week abortion ban, which raises the issue of whether a state can ban abortion before fetal viability. The court could do that without fully overturning Roe, by setting a stricter standard, but Justice Samuel Alito wrote in a leaked draft opinion that there is no constitutional right to abortion.

'Trigger law' would end legal abortion in Kentucky if Supreme Court overturns its 1973 Roe v. Wade decision, as leaked

Screenshot of image of Scribd document from Politico

By Melissa Patrick
Kentucky Health News

If a leaked draft of a U.S. Supreme Court decision that would overturn the court's 1973 Roe v. Wade decision becomes final, legal abortion in Kentucky would end immediately because of a "trigger law" the state legislature passed to take effect if Roe is overturned. But for now, abortion services are still available from two Louisville clinics. The decision is expected by the end of June.

The draft opinion in Dobbs v. Jackson Women's Health Organization, published Monday night by Politico, would strike down the decision that has guaranteed the right to an abortion until a fetus can live outside the womb, roughly the 23rd week of pregnancy, as well as Planned Parenthood v. Casey, a 1992 decision that upheld but modified Roe, barring "undue burdens" to abortion. 

"We hold that Roe and Casey must be overruled," Justice Samuel Alito wrote in his draft opinion, which has a circulation stamp of Feb. 10. He adds later, "It is time to heed the Constitution and return the issue of abortion to the people's elected representatives." 

The case will determine the constitutionality of Mississippi's 15-week abortion ban, which raises the issue of whether a state can ban abortion before fetal viability. The court could do that without fully overturning Roe, by setting a stricter standard, but Alito's draft says there is no constitutional right to abortion.

The Kentucky General Assembly recently passed over Gov. Andy Beshear's veto of a wide-ranging anti-abortion bill that also bans abortions after 15 weeks, modeling the Mississippi law. A federal judge has extended until May 19 a modified restraining order that applies to portions of the law, but the judge did not provide specifics, Alex Acquisto reports for the Lexington Herald-Leader. 

Twenty-six states, including Kentucky and five bordering states, are poised to move quickly to ban abortion should Roe be overturned, according to the Guttmacher Institute, a reproductive-health policy organization that favors abortion rights.

In 2019, the legislature passed the "trigger law;" in 2021, it voted to add to the state constitution a statement that it does not secure or protect a right to abortion or funding of abortion; voters have the final say on that this November.

Politico reports that Alito was writing for a majority that includes Justices Clarence Thomas, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett. Chief Justice John Roberts has confirmed the draft's authenticity, stressed that it is not a final position and has ordered an investigation of the leak, a rare breach of the court's confidential processes.

Kentucky has two abortion providers: Planned Parenthood and EMW Women's Surgical Center, both in Louisville.

Alexis McGill Johnson, president and CEO of the Planned Parenthood Federation of America, called the opinion "horrifying and unprecedented" and reminded Americans that for now, abortion is still legal.

Angela Cooper, communications director at the American Civil Liberties Union of Kentucky, pointed out that Kentucky women had to travel out of state for abortion care during the eight days Kentucky's two abortion clinics were closed as they waited on the judges ruling around the latest anti-abortion bill.  That is a preview of what it would be like if abortion care becomes illegal in Kentucky, she said. 

"Abortion is still legal in Kentucky," she said. "We just encourage anyone who is seeking reproductive care to contact the clinic first and to know that that care is still available in the state." 

At a news conference on Tuesday, several Central Kentucky state senators spoke in favor of the draft ruling, including Senate Majority Leader Damon Thayer of Georgetown, Ralph Alvarado of Winchester and Donald Douglas of Nicholasville, Acquisto reports.

Douglas condemned the fact that the ruling was leaked, but said the General Assembly was “ready” to continue to create “some of the toughest laws that there are” on abortion, Acquisto reports.

"In addition to the current challenge to HB 3 enacted this year, three laws remain under challenge in federal courts and have not been enforced," Deborah Yetter reports for the Louisville Courier Journal. "They include a pair of 2019 laws banning abortions after six weeks gestation and if the woman is seeking one because of the race, gender or disability of the fetus. Also, a 2018 law banning a procedure generally used after the 14th week of pregnancy, called dilation and evacuation, remains subject to a legal challenge."

All key metrics to measure the coronavirus in Ky. are creeping up, as state slips to 37th in the share of population fully vaccinated

Map by The Washington Post; for a larger version, click on it.

By Melissa Patrick
Kentucky Health News

Even as the national Covid-19 risk map shows low risk of community transmission in all but four Kentucky counties, all the metrics used to measure the coronavirus in Kentucky went up last week.

The state's report for the last Monday-to-Sunday reporting period showed 3,394 new cases of the virus, an average of 485 per day, up 13 percent from 428 cases per day the week before. 

Of this week's new cases, 22% were in people 18 and younger. 

The share of Kentuckians testing positive for the virus during the week is 5.67%, an increase from 4.35% the week before and up from a low of 1.97% four weeks ago. The figures do not include results of at-home tests. 

The statewide seven-day infection rate also continues to creep up. That rate is 9.65 daily cases per 100,000 residents, up from 6.49 in the prior week's report. The only two counties with rates more than double that rate are Jefferson (23.8) and Caldwell (21.3). 

And as the infection rate goes up, the number of counties with no daily cases drops. Only 10 counties had none in the latest report, and 110 did. The week prior, 100 had cases. 

The New York Times ranks Kentucky's infection rate 26th among the states and Washington, D.C., with an 11% increase in cases over the last 14 days. 

The state attributed 156 more deaths to Covid-19 last week, an average of 22.3 per day. The week before, it was 16.6 per day. The state's pandemic death toll is now 15,568. 

Kentucky hospitals reported 187 Covid-19 patients on Monday, with 31 in intensive care and 13 on mechanical ventilation. Again, all of these numbers are more than the prior week. 

Last week, the Centers for Disease Control and Prevention reported that nearly 60% of Americans, including 75% of children, had been infected with the coronavirus, a rate that increased dramatically from December to February.

That's still no reason for people with detectable antibodies from a previous infection to pass up getting a Covid-19 vaccination, said the CDC director, Dr. Rochelle Walensky: "We do know that reinfections happen, so that's important in terms of thinking forward."

The Washington Post reports that in the week ended May 2, an average of 3,453 doses of the Covid-19 vaccine were given per day in Kentucky, an 11% decrease over the week before, So far, 61% of Kentucky's eligible population, 5 and older, have been fully vaccinated and 44.3% of the fully vaccinated people have received a booster shot.

In percentage of the full population vaccinated, Kentucky has slipped just behind West Virginia in the national rankings, 57.4% to 57.6%, and ranks 37th in the nation. Among the other adjoining states, three are lower than Kentucky and three are higher; Ohio ranks just ahead of West Virginia, and Illinois and Virginia are above the national average of 66.2%.

On that front, Valarie Honeycutt Spears of the Lexington Herald-Leader reports, "A McCracken County High School teacher has been temporarily suspended with pay following an allegation that they created fraudulent Covid-19 vaccine cards for six students to use during a recent field trip."

Jayme Jones, director of public relations for the school district, told the Herald-Leader that the district could not elaborate on specific personnel actions or situations, and "The teacher has been temporarily suspended with pay pending the results of the ongoing investigation."

Paul says if he's re-elected and in the majority, he will subpoena Fauci's records and 'get to the bottom of the origins of this virus'

Paul at rally in state House Speaker David Osborne's barn (Lexington Herald-Leader photo by Austin Horn)

U.S. Sen. Rand Paul, seeking a third six-year term, "promised Saturday to wage a vigorous review into the origins of the coronavirus if Republicans retake the Senate and he lands a committee chairmanship," reports Bruce Schreiner of The Associated Press.

“When we take over in November, I will be chairman of a committee and I will have subpoena power,” Paul said at a rally near Smithfield. “And we will get to the bottom of where this virus came from.”

Paul, an ophthalmologist, repeated his view that “overwhelmingly the evidence points to this virus being a leak from a lab.” That is contrary to the scientific consensus "that the virus most likely migrated from animals," Schreiner notes. "U.S. intelligence agencies remain divided on the origins of the coronavirus but believe China’s leaders did not know about the virus before the start of the global pandemic."

At a Senate committee hearing last summer, Paul told Dr. Anthony Fauci, the country’s top infectious-disease expert, that  “all the evidence is pointing that it came from the lab,” referring to a laboratory in Wuhan, China, the city where the virus was discovered. The lab received some U.S. research funding.

"There is no evidence linking the novel coronavirus to a lab, only speculation," the nonpartisan fact-finding service FactCheck.org reported after the hearing, in which Paul and Fauci accused each other of lying.

Paul and Fauci have also repeatedly clashed in public over the government's pandemic policies, and Paul mentioned Fauci nine times in his latest fund-raising letter to Republicans. He said that if he is re-elected and Republicans regain the Senate majority, "I will subpoena Dr. Fauci and all his records and get to the bottom of the origins of this virus."

Paul is in line to be chairman of the Health, Education, Labor and Pensions Committee, “one of the most important committees in the Senate,” Senate Republican Leader Mitch McConnell told the rally crowd, which cheered Paul's denunciations of what he called government overreach in the pandemic.

Paul "applauded a recent judge’s order that voided the federal mask mandate on planes and trains and in travel hubs," Schreiner reports, quoting him: “Last week I was on an airplane for the first time in two years and didn’t have to wear a mask. And you know what I saw in the airport? I saw at least 97% of the other free individuals not wearing masks.”

Schreiner writes, "In this year's Senate race in Kentucky, Charles Booker is by far the best known of a handful of Democrats seeking their party's nomination for Paul's seat in the May 17 primary. Paul is being challenged by several little-known candidates in the GOP primary.

"A general-election campaign between Paul and Booker would be a battle between candidates with starkly different philosophies. Booker, a Black former state lawmaker, narrowly lost a bid for the Senate Democratic nomination in 2020. He is a progressive who touts Medicare for all, anti-poverty programs, a clean-energy agenda and criminal-justice changes. Paul, a former presidential candidate, has accumulated a massive fundraising advantage over Booker. Kentucky has not elected a Democrat to the U.S. Senate since Wendell Ford in 1992."

'Misinformation is now our leading cause of death,' FDA boss says

FDA Commissioner Robert Califf, M.D., speaks with an
attendee at the event. (AHCJ photo by Paola Rodriguez)

Newly confirmed Food and Drug Administration Commissioner Robert Califf says "the issue that keeps him up at night . . . is the proliferation of false and misleading health information, particularly online — and the distrust in institutions, data and expertise that it has wrought."

So reports Alice Miranda Ollstein of Politico for the Association of Health Care Journalists, from an interview AHCJ patient-safety team leader Kerry Dooley Young conducted with Califf on Friday in Austin at Health Journalism 2022, AHCJ’s annual conference.

“I believe that misinformation is now our leading cause of death,” Califf said, citing resistance to Covid-19 vaccination, the number of people taking the anti-parasite drug Ivermectin, and increasing use of electronic cigarettes.

“Historically, the FDA has been relatively quiet and puts out definitive information through guidance or labels or regulatory actions … that would be transmitted to consumers and patients through trusted intermediaries,” he said. “But the world has changed at this point.”

The shift has fueled the drop in Americans' life expectancy compared to other wealthy nations, Califf said, and he "urged reporters to avoid clickbait, lean into fact checking, make sure the headline matches the copy, and take other steps to responsibly convey news about Covid-19 and other pressing health concerns," Ollstein reports.

Califf said, “People are distracted and misled by the medical information Tower of Babel, but journalists like yourselves play an important role here and your work has a tremendous impact on public trust.”