Ky. has 82 syringe exchange programs in 63 counties, the most of any state, but state drug-control official says 'That's not enough'

Stars show syringe-exchange sites; colors show district departments; white counties are independent. 

By Melissa Patrick
Kentucky Health News

Kentucky still has more syringe service programs than any other state, but 57 counties still don't have one, including 21 of the 54 that the Centers for Disease Control and Prevention considers vulnerable to a rapid outbreak of HIV or hepatitis C among people who inject drugs.

"My God, if you've been identified by the CDC as being a county for a rapid HIV outbreak, you need an SSP. There's no ifs, ands or buts about it," Van Ingram, executive director for the Kentucky Office of Drug Control Policy, said at the annual Kentucky Harm Reduction Summit in August. "So we've got work to do yet."

Syringe exchanges are part of "harm reduction programs," which offer a host of strategies to minimize the negative physical and social impacts of drug use. They are also called syringe service programs or needle exchanges.

Such programs have been legal in Kentucky since 2015, but to have one, a community must have approval from its local board of health, the county fiscal court and the city where the exchange is located. 

As of August, Kentucky had 82 exchange programs operating in 63 of its 120 counties, but Ingram said that despite efforts to expand these service programs, "That's not enough. We need more." 

One program that had been approved is no longer operational.

Estill County (Wikipedia map)

Elizabeth Walling, public health director at the Estill County Health Department, told Kentucky Health News that its program closed in September 2020 because the Irvine City Council took away its approval, citing complaints from the community about an increase of needles in public spaces. 

Walling said the health department has made several attempts to get the council to reinstate the program. "We have patients that call about it weekly," she said. "We're still having to refer them out of the county. . . . We still have a lot of requests for it, which we've expressed to the Irvine City Council."

Syringe exchanges provide a range of services that extend beyond the exchange of clean needles for dirty ones in order to decrease the spread of blood-borne diseases like hepatitis C and HIV. Those services include education on safe use and distribution of wound-care kits and Naloxone, which blocks a drug overdose. Other services are infectious-disease screening, vaccinations, and linking people to housing, food access, insurance, medical care, substance-use treatment and behavioral-health services. 

At the Harm Reduction Summit, Alex Elswick, an assistant extension professor for substance-use prevention and recovery at the University of Kentucky, pointed to the value of the exchanges as a place that connects people who use drugs to care, even if they are not yet seeking treatment.

"This is a population that if syringe-access programs did not exist, would be utterly unengaged," said Elswick, who is in long-term recovery. "Think about that. . . . If you didn't have a syringe-access program in your community, where would these folks be going for any kind of care? Not just for syringes, but for care of any kind, for connection of any kind. They're utterly unengaged when you don't have harm reduction in your community."

Fentanyl test strips in short supply

One service that fewer than 30 of the state's exchanges offer is the distribution of fentanyl test strips, even though the powerful opioid was involved in about 73% of the state's 2,250 overdose deaths in 2021.

According to the CDC, Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine. The strips only show if fentanyl is in the drug or not, not the amount of Fentanyl.  

A key reasons some programs have been slow to offer the strips is that they are considered drug paraphernalia under Kentucky law, causing some local officials not to support the use of them. 

Susan Dunlap, spokeswoman for the state Department for Public Health, said in an e-mail that the strips require different levels of approval, depending on how a program has been set up and its local protocols.

Scott Lockard, public health director of the Kentucky River District Health Department, said it is exploring the benefits of offering fentanyl strips in their programs and were working to address any legal concerns.

That said, Lockard noted that such strips may not be as important as they once were because fentanyl has become so prevalent. He said his agency is telling all its harm-reduction participants that they should automatically expect that fentanyl is present in every substance they use right now. 

"We want to make sure that we're using them appropriately, that we have all our legal bases covered and that they're beneficial for those people who are coming into our harm reduction," Lockard said. 

Ingram, asked about this at the summit, said the state was still trying to figure out the best way to respond to this challenge.

"I think fentanyl test strips are important," he said. "I think we've got to make ourselves available of them some way, somehow. It's on our radar and it's something we're trying to figure out." 

Russ Read, CEO of the Kentucky Harm Reduction Coalition, called fentanyl test strips an "essential tool" to help save people's lives and to have an opportunity for another chance to seek treatment and get better. 

"Each one of those test strips represents an opportunity for somebody not to die," he said. "And it's a real opportunity for somebody to make a decision . . . that I don't want to use anymore, or I need some help. It gives them another chance. . . . That's what harm reduction is all about." 

Read said the coalition has distributed more than 120,000 fentanyl test strips across the state. 

To learn more about harm reduction programs in Kentucky, go to the KDPH SSP webpage or the new KDPH Harm Reduction Program page.

CDC says 108 counties have elevated Covid-19 risk; Ky.'s new-case rate ranks 2nd; Beshear urges use of new booster vaccine

CDC map, adapted by Kentucky Health News

By Melissa Patrick

Kentucky Health News

The pandemic in Kentucky remains on a rough plateau, but it's a high plateau.

Seventy of Kentucky's 120 counties have a high level of Covid-19 risk and 38 have a medium level, with very little change in the last two weeks, according to the latest Centers for Disease Control and Prevention's risk map. 

Only 12 counties show a low level of risk, and The New York Times ranks Kentucky's seven-day new-case rate second among the states, so most Kentuckians still need to take some level of precaution to avoid the virus. 

Last week, the CDC map, which is based on new coronavirus cases, hospital admissions and hospital capacity, showed 70 counties in orange, at high risk; 42 in yellow, at medium risk; and eight in green, at low risk. 

In high-risk counties, the CDC recommends that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

If you live in a medium or high-risk county, the CDC advises wearing a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

Some of the counties in which the risk of coronavirus grew in the past week were in Western Kentucky: Hickman, Ballard, McCracken, Graves, Livingston, Crittenden, Marshall and Lyon. Counties showing improvements included a cluster around Louisville that moved from orange to yellow, and a cluster around Christian County that moved from orange to green. 

Jefferson County's move to the yellow zone means masks will no longer be required in its public schools, starting Monday. District policy requires universal masking if the county is at high risk. (Olivia Krauth of the Courier Journal notes that the district has not made an official announcement of the change.) 

The best way to protect yourself from the coronavirus is to get fully vaccinated and boosted. 

The new, updated Covid-19 booster shot that targets the original strain of the coronavirus and major Omicron subvariants has already been distributed to some parts of the state and will soon be available statewide. The new booster is recommended for all persons 12 years and older who had their last dose two months ago. 

"It doesn't matter if you've had three or four shots, you need to get this one if it's been at least two months since you got your last one," Gov. Andy Beshear said at his weekly news conference. 

He added that he and his family will get the new booster: "It is safe and it is going to protect us from, or better protect us from, the variant that is out there." 

Asked if funding or programs are scheduled to promote the booster, the Democratic governor said there would not be because "most if not all of the funding that would support that has either been cut or not provided in the current budget" by the Republican-controlled legislature.

He said others must pick up the slack.

"Now is an important time for everybody that's out there with any type of megaphone, whether that's business leadership or running for office, to say very clearly that these new Omicron booster shots are safe, are effective, and people should get them. It's part of our civic duty to protect one another," Beshear said. "And the fastest way to get out of this pandemic -- because we all want it to end -- is for people to get out there and get boosted."

State data shows that only 67% of Kentuckians have received at least one dose of a Covid-19 vaccine;  58% have been fully vaccinated and 46.6% of those who are fully vaccinated have been boosted.

With no exceptions for rape or incest, Kentucky's near-total abortion ban can force children as young as 9 to deliver a baby

Courier Journal graphic; for a larger version, click on it; to download, right-click.

While pregnancy in very young girls is rare, it does happen. 

"In Kentucky, the two youngest patients to receive an abortion over the past two years were age 9. Under Kentucky law, sexual intercourse with a 9-year-old is considered first-degree rape," Deborah Yetter reports for the Louisville Courier Journal.

"In 2021, and again this year, one 9-year-old each year had a pregnancy terminated, according to data from the Kentucky Office of Vital Statistics obtained by The Courier Journal through an open records request. The records provide no other details about the individuals. In all, 34 girls ages 15 or younger received abortions in 2021, according to state statistics, with 16 generally regarded as the age where minors are able to consent to sexual intercourse."

As the laws stand today in Kentucky, those abortions would be illegal, even if a pregnancy resulted from rape and despite the age of a parson, Yetter notes. 

That's because a ban on almost all abortions in the state was triggered when the U.S. Supreme Court overturned Roe v Wade, the 1973 decision that created a constitutional right to abortion. The law has exceptions to prevent the woman's death or serious impairment of a life-sustaining organ; a law revived by the court decision bans abortion after six weeks of pregnancy.

A Louisville judge blocked the law pending resolution of a lawsuit against it, but a Pikeville judge on the Court of Appeals vacated that ruling, and the Supreme Court left it in place until it hears arguments in the case Nov. 15. The Nov. 8 ballot has a referendum that would make the case moot by making the state constitution say it guarantees no right to abortion or funding of it.

Yetter reports that such stringent abortion bans outrage abortion-rights advocates, including medical professionals who care for young girls.

"Do we expect a fourth-grader to carry a pregnancy to term, deliver and expect that child to carry on after this horror without permanent psychological trauma," asked Dr. Anne-Marie Amies Oelschlager, a University of Washington professor of pediatric and adolescent gynecology. "Are we really expecting this of our pregnant youth, even if the pregnancy may not result in death?"

Furthermore, Oelschlager said, young girls and teens aren't physically mature enough to carry a pregnancy to term, which increases risks to the patient as well as the fetus. Her comments were provided by the American College of Obstetricians and Gynecologists, which considers abortion to be essential health care.

Abortion opponents in Kentucky appear unwilling to allow exceptions beyond those in the trigger law. 

Rep. Joe Fischer, R-Fort Thomas, told a legislative committee in 2019 that the trigger law, which he was sponsoring, "will reflect what I think are Kentucky values and will protect all human life from the moment of conception." Fischer is running to unseat state Supreme Court Justice Michelle Keller in a nonpartisan election.

Addia Wuchner, executive director of the Kentucky Right to Life Association, declined to say whether an exception should be made for girls as young as 9 who become pregnant. Instead, she asked who was there to protect that child and whether the rape had been reported to the authorities. "It is still a life that has been formed," she told Yetter. "All life is sacred and we're in an area where this child, this unborn child, is being punished because of the father."

Planned Parenthood disagrees. 

“Every person, in every circumstance, deserves access to health care when and where they need it," Katie Rodihan, a spokeswoman for the six-state Planned Parenthood group that includes Kentucky, told Yetter. "Shame on lawmakers in Kentucky for abandoning victims of rape and incest ― including children ― and subjecting them to the immense trauma of forced pregnancy by their predator. This law is cruel and inhumane."

Yetter reports that Kentucky's abortion numbers for 2021 are not available, but in 2020, 4,104 abortions were performed, with 36 of the patients 15 or younger; 368 were 19 or younger, according to a state report.

Young mother who had a rare Stage 4 cancer is now in remission

Anne Sydney Parrish and family (Photo by Amani Nichae) 

By Elizabeth Chapin
University of Kentucky

With around-the-clock feedings, diaper changes and sleepless nights, the weeks after bringing home a new baby can feel surreal and overwhelming.

After giving birth to a healthy baby girl on Aug. 21, 2020, Anne Sydney Parrish of Lexington was ready for the joys and challenges that come with adjusting to life with a newborn.

Then, Parrish’s world was turned upside down in a way she could have never imagined.

A day after having her daughter, Parrish noticed abdominal pain but figured it was an expected side effect. After all, she’d just had a cesarean section. But day after day, the pain continued. And worsened.

“I thought it was maybe gas or heartburn, and I took over-the-counter medications, but nothing really helped,” Parrish said. “It would almost be okay one day, and then the next the pain would be back.”

After one particularly bad morning, Parrish realized the pain wasn’t a normal part of postpartum recovery. Something wasn’t right.

Her brother-in-law, an emergency-room doctor, insisted she go to an ER for a CT scan. The scan showed a bowel obstruction and Parrish underwent emergency surgery the next morning to remove the mass from her colon.

Five days later the 33-year-old was diagnosed with Burkitt lymphoma, a rare type of blood cancer.

As a physician assistant, Parrish says she’d heard of Burkitt lymphoma, but didn’t know details of the diagnosis because it was so uncommon. And like many other patients, she couldn't keep herself from looking to the internet for more answers.

“The first things I read online were that ‘It's rare and very aggressive’,” Parrish said. “So I’m thinking I'm going to die.”

Burkitt lymphoma can be rapidly fatal if left untreated. Parrish needed to act fast.

Hours after her diagnosis, she and her husband were in an appointment at the UK HealthCare Markey Cancer Center, developing a plan for treatment. She had a positron emission tomography (PET) scan, which showed her lymphoma was stage 4, and it had spread throughout her abdomen.

Burkitt lymphoma is a type of b-cell lymphoma, a group of cancers that affect the immune system. Fast-growing b-cell lymphomas can be deadly because they release toxins that can damage vital organs and cause many other adverse effects. But when treated early and aggressively, outcomes for patients with Burkitt lymphoma are good, says Dr. Chaitanya Iragavarapu, a member of the hematology and blood-and-marrow transplant team at Markey, and part of Parrish's larger care team.

“With an exceptionally aggressive lymphoma in such an advanced stage, Mrs. Parrish needed to begin treatment immediately,” Iragavarapu said. “The good news for Mrs. Parrish is that Burkitt lymphoma does have high rates of remission for patients that start treatment right away.”

Parrish was admitted to Markey’s inpatient unit in the Albert B. Chandler Hospital four days after her diagnosis and just four weeks after the birth of her daughter. She stayed there for the next 15 days as she took intensive chemotherapy treatments daily.

For two weeks, she wasn’t able to hold her newborn, and it was also the longest she’d been away from her 4-year-old daughter. Parrish says it was hard on her and her family, but also a blessing.

“UK was the only hospital in the area that had the ability to treat my type of lymphoma because it was aggressive and required inpatient chemotherapy,” Parrish said. “Living in Lexington, I was so thankful that this level of care was right in my backyard. I know there are so many people that drive hours to come to Markey.”

Treatment lasted more than five months. Parrish had than 570 hours of chemotherapy, plus transfusions, lumbar punctures, bone-marrow biopsies, and near-constant CT scans, MRIs and ultrasounds.

Family and friends rallied to support her. Parrish’s mother and mother-in-law moved in to help care for her and her daughters.

“I remember after I got out of the hospital the first time, I was too weak to really do anything, even put my daughter to bed at night. I'd just had two surgeries, I had a C-section and then a colon resection, so I was swollen and distended and I was in a lot of pain,” Parrish said. “Honestly, I was so sick for the first six months of the baby's life that I was afraid she wouldn’t know who I was. I was in bed most of the time.”

The chemotherapy took an emotional and physical toll. But it was working.

Her last treatment was on Jan. 10, 2021. In February, she got the word that the cancer was in remission. Parrish says she was amazed that the treatment worked so well, and so quickly.

“It's like one of those things, where it was almost gone as quickly as it came on,” she said. “But gosh, my body went through so much in order to get the cancer to go away. But from the very beginning, I knew I was in good hands with the team at Markey. My doctors and nurses became like family.”

“Her primary oncologist and team at the time moved very, very quickly in terms of trying to get her started on the right chemotherapy combination,” said Iragavarapu. “And that essentially saved her life.”

Parrish’s latest scan shows no signs of cancer. Iragavarapu says Burkitt lymphoma, especially if it's responsive to chemotherapy, is unlikely to come back once in remission.

“Two years ago, my life changed in an instant. This experience just made me appreciate my health and my family a lot more than I did before,” Parrish said. “It's easy to get caught up in little things and in everyday life. It’s such a blessing to have my kids and my family.”

Kentucky will get at least $14 million from states' $438.5 million agreement with Juul after probe of the causes of teen vaping

Image from Juul.com

By Melissa Patrick

Kentucky Health News

Electronic cigarette manufacturer Juul Labs will pay $438.5 million to 33 states and Puerto Rico to settle a two-year investigation into the company's marketing and sales practices related to teenagres' use of electronic cigarettes. At least $14 million of that will go to Kentucky, according to Attorney General Daniel Cameron said in a news release. 

“Deceptive marketing and sales practices have no place in Kentucky,” Cameron said. “This tentative agreement resolves allegations that Juul illegally marketed vaping products to underage youth and misled consumers regarding the nicotine content of their e-cigarettes. It secures at least $14 million for the Commonwealth and requires the company to revise their marketing and sales practices.”

Even though Juul products are no longer the most popular e-cigarette product used by teens, having been replaced by disposables like Puff Bar, Juul products have long been blamed for causing the national surge in teen vaping. 

The release notes that the investigation revealed Juul advertised its products to youth, knowing the underage purchase of e-cigarettes is both illegal and unhealthy. It also found that Juul targeted underage users by offering free samples, popular flavors, and relentlessly marketing its products through launch parties, social media posts, and advertisements depicting young, trendy models.

In addition, it found that Juul’s original packaging misled consumers about the presence and amount of nicotine in its products. The company also misrepresented its product as a smoking cessation device without Food and Drug Administration approval to make such claims.

In June, the FDA moved to ban all Juul e-cigarettes from the market, but Juul challenged the ruling and the FDA has since reopened its review of the products.

Under the tentative settlement, the release says, Juul has agreed to obey restrictions related to sales and the distribution of product displays, retail and online sales limits, and age verification requirements. 

Juul said in a statement that the settlement "is a significant part of our ongoing commitment to resolve issues from the past" and that the terms of the agreement are "aligned with our current business practices. . . . We remain focused on the future as we work to fulfill our mission to transition adult smokers away from cigarettes – the number one cause of preventable death – while combating underage use."

New coronavirus cases in Kentucky keep going up and down; fell 10% last week, with 29% of new cases in people 18 and younger

New York Times map shows Kentucky and Central Appalachia remain hot spots. (Click it to enlarge)

By Melissa Patrick
Kentucky Health News

Last week, most metrics to measure the impact of the coronavirus in Kentucky dropped after showing increases the week before, again suggesting the state remains on a rough plateau. 

The state's report for the Monday-through-Sunday reporting week showed 12,830 new cases, down 10% from the 14,312 the previous week. The daily average decreased to 1,832 from 2,044. 

Of the week's new cases, 29% are in people 18 and younger. That's down from 37% in last week's report. 

The incidence rate of new cases last week was 39.72 cases per 100,000 population, also down from the prior week when it was 46.98. Kentucky's rate ranks third among the states, according to The New York Times.

The counties with the 10 highest rates were Rowan, 160.6; Rockcastle, 131.8; Owsley, 123.0; Wayne, 113.8; Perry, 111.5; Harlan, 102.2; Powell, 98.3; Clay, 96.9; Wolfe, 95.8; and Knox, 89.4. The Times says Harlan, Rockcastle, Perry and Powell counties' rates are among the highest in the U.S.

The state report showed the share of Kentuckians testing positive for the coronavirus in the past seven days fell to 18.4%, down from 20.1% the week prior. The numbers do not reflect results from at-home tests. 

The report showed 629 patients with Covid-19 in Kentucky hospitals, down eight from the prior week. Those in intensive care numbered 102, down two. The number on mechanical ventilation rose by eight, to 36. 

The state attributed 78 more deaths to Covid-19, up a bit from 76 the week before. The state's pandemic death toll is 16,757.

Monkeypox cases in Ky. remain low, but keep inching up slowly; vaccine is available for those at high risk of getting the disease

By Melissa Patrick
Kentucky Health News

Even as new cases of monkeypox inch up in Kentucky, overall cases remain low. On Sunday, when the Centers for Disease Control and Prevention had confirmed 19,962 cases nationwide, 33 had been confirmed in the state. 

That's two more than had been reported by Thursday, Sept. 1, when the state put out its latest weekly report, showing Kentucky had 31 cases in nine counties. Of those, 18 owere in Jefferson County, three in Fayette, three in Warren, two in Christian, and one each in Barren, Kenton, McCracken, Montgomery and Oldham counties. 

The state report also shows 23 of the 31 cases were in people between the ages of 30 and 64. eight were in those aged 18 to 29, and all but one were male. 

Men who have sex with men represent most of the cases, according to the CDC, but anyone can contract monkeypox. It is not a sexually transmitted disease. It can be spread through close, personal contact, often skin-to-skin; by touching objects and surfaces that have been used by someone who has the virus; and through contact with respiratory secretions.

The risk of children getting infected with monkeypox is low, according to the American Academy of Pediatrics. As of Aug. 21, AAP reports that 17 cases have been reported in U.S. children younger than 15, and 134 cases have been reported in those aged 16 to 20.

Monkeypox is a viral disease that is part of the same family of viruses as smallpox that causes flu-like symptoms and a rash. It is not related to chickenpox.

Symptoms can include chills, fever, body aches, swollen lymph nodes, headache, respiratory symptoms and a rash. The CDC says you may experience all or only a few of these symptoms.

The rash may be located on or near the genitals or anus, and could be on other areas like the hands, feet, chest, face or mouth. The rash initially looks like pimples or blisters and may be painful or itchy.

Symptoms usually start within three weeks of exposure to the virus and the illness typically lasts two to four weeks.

Individuals are infectious from the time the symptoms start until the rash has completely healed, meaning that every scab has fallen off and a fresh layer of skin has formed.

If you have symptoms of monkeypox or have had close personal contact with someone who has it, talk to your health-care provider about testing and treatment options. 

Currently, only people at highest risk of getting monkeypox can get vaccinated for it. As more doses of the vaccine become available, eligibility criteria may change to allow for more widespread distribution. Click here to see who is eligible to get vaccinated. 

The vaccine is given in two doses at least four weeks apart. Vaccine recipients are considered to have best immunity two weeks after the second dose. The vaccine helps prevent getting monkeypox and makes it less severe if you do contract the disease.

To find a location that offers the monkeypox vaccine, go to the state Cabinet for Health and Family Services monkeypox website and find the link to Monkeypox Vaccination Locations.

Monkeypox is rarely fatal.  According to the CDC, “Over 99% of people who get this form of the disease are likely to survive. However, people with weakened immune systems, children under 8 years of age, people with a history of eczema, and people who are pregnant or breastfeeding may be more likely to get seriously ill or die.”

That said, on Aug. 30, state health officials with the Texas Department of State Health Services reported the first death of a person who had been diagnosed with monkeypox. They noted that the  patient, who was not identified, was an adult resident of Harris County (Houston) who was severely immunocompromised. The news release said the case is under investigation to determine what role monkeypox played in the death. 

Opioid Abatement Advisory Commission plans eight town-hall meetings around the state, starting in Pikeville Sept. 19

The state commission overseeing distribution of $478 million in opioid-settlement funds in Kentucky has scheduled a series of town-hall meetings to discuss drug addiction, treatment and recovery in the state.

The Opioid Abatement Advisory Commission also announced at its Aug. 29 meeting that it plans to open an online application portal for addiction programs wanting to apply for aid by Oct. 15.

Executive Director Bryan Hubbard said the commission's goal is to start distributing grants by Jan. 1, reports Alana Watson of WKU Public Radio.

The town-hall meetings will be held from 6 to 8 p.m. local time on these dates and at these places:
Sept 19: Pikeville – The Overlook, 891 Bob Amos Dr.
Sept. 27: Ashland – The Train Depot, 99 15th St.
Oct. 11: Hazard – The Forum, 101 Bulldog Lane
Oct. 18: Covington – Kenton Co. Government Center, 1840 Simon Kenton Way

Oct. 26: Lexington – UK Student Center, 160 Avenue of Champions

Nov. 1: Louisville – Simmons College, 1000 S. Fourth St.
Nov. 9: Bowling Green – WKU, 2355 Nashville Road
Nov. 29: Paducah – Convention Center, 415 Park St.

Ky. abortion ban makes more women seek sterilization; doctors try to clarify uncertainty about the limited exceptions to the ban

With Kentucky's near-total abortion ban in place at least until November, and state law unclear about the very limited exceptions, there has been a "swell of demand" for surgical sterilizations, doctors calling for clarity around when an abortion is allowed, and to top it off, uncertainty around who is going to provide that clarity, Alex Acquisto reports for the Lexington Herald-Leader.

Kentucky's abortion ban was triggered when the U.S. Supreme Court overturned Roe v Wade, the 1973 decision that created a constitutional right to abortion. The law immediately banned abortion in the state, with exceptions to prevent the woman's death or serious impairment of a life-sustaining organ; another law bans abortion after six weeks of pregnancy.

A Louisville judge blocked the law pending resolution of a lawsuit against it, but a Pikeville judge on the Court of Appeals vacated that ruling, and the Supreme Court left it in place until it hears arguments in the case Nov. 15. The Nov. 8 ballot has a referendum that would make the case moot by making the state constitution say it guarantees no right to abortion or funding of it.

The sudden lack of access to abortion care has resulted in hundreds of Kentucky women seeking surgical sterilization, what is often called having your tubes tied or a tubal ligation, Acquisto reports. 

Ashley Watson (Herald-Leader photo)

Ashley Watson, a 36-year-old from Wilmore, told Acquisto that she decided to seek permanent sterilization because she had severe postpartum depression following each of her daughters' births. 

“My mental health wouldn’t survive another pregnancy,” Watson told Acquisto. 

She added, "We live in a very conservative state, and there’s this fear that birth control is going to be the next thing on [legislators’] agenda." To avoid remaining pregnant against her will, she told Acquisto that permanent sterilization “is the only thing I can do to guarantee that I’m never going to be put in that position.”

Destinee Ott, a 25-year-old Beattyville teacher, told Acquisto that she decided to have her tubes tied because she would be have no option to terminate a pregnancy if her birth control failed.

Acquisto reports that Ott has polycystic ovary syndrome and endometriosis, and that if she gets pregnant, the PCOS creates a high likelihood of an ectopic pregnancy, which is when a fertilized egg implants outside of the uterus, often in a fallopian tube.

"Though an ectopic fetus can have a heartbeat, none are viable," Acquisto notes. "If not treated early enough, an ectopic will rupture and cause serious medical complications for the pregnant person, even death." She reports that treatment for an ectopic pregnancy is either a surgical or medical abortion, which means it is regulated by Kentucky's trigger law. 

"An ectopic pregnancy will eventually become life-threatening. But it might not be life-threatening, initially, depending when it’s diagnosed in a pregnancy," Acquisto writes.

Herein lies the gray area and Otts knows this, she writes: "Under the law, if she were to have an ectopic pregnancy, she worries she wouldn’t reliably be able to get an abortion until it progressed to the point of endangering her life, which is partly what’s propelling her to get a tubal now," she writes.  

“I hadn’t really worried about it before now, just because there were other options if something did go wrong,” Otts told Acquisto, referring to in-state abortion access. “But now I’m wanting that security, just because, with my medical issues, I don’t want to risk it.” 

Both women quickly learned that they were just two of hundreds of Kentucky women seeking sterilization in a post-Roe state, Acquisto reports: "It’s a swell in demand that remains two months later, according to seven board-licensed obstetrician-gynecologists at Baptist Health, Lexington Women’s Health, Women’s Care of Lake Cumberland and University of Louisville Health."

Three of the OB-GYNs spoke with Acquisto on the condition of anonymity, fearing retaliation from their employer, which has demanded they not speak publicly about this topic, she reports.

Doctors are worried too

"The anxiety felt by Kentuckians around the future of abortion care extends to their doctors, too," Acquisto writes. "Some say legal gray areas are creating challenges in their practices and could have lasting impacts on health care." 

She adds, "Though clinics and hospitals did not have quantifiable data available, Baptist Health, Kentucky’s largest health-care system, said its patient demand within a week of Roe falling was 'significant' and 'notable'" for tubal ligations, vasectomies and other long-term birth-control measures.

The doctors Acquisto interviewed said there has been a shift in who is asking for tubal ligations; before, it was largely women with biological children, but now it is driven by women in their 20s with no children. Now the waiting list for the procedure, in some cases, is now months long. 

"Roe was tossed on Friday, June 24. The following Monday, an OB-GYN at Lexington Women’s Health told the Herald-Leader their front desk fielded a staggering 91 requests for tubals," Acquisto reports. "On July 12, Dr. Lynne Simms said her Baptist Health clinic provided 22 tubal consults,” and said at least five patients asked "what their options would be in the future regarding birth control."

"In short, women in Kentucky guarding their bodies against the possibility of pregnancy have descended in droves," Acquisto reports. 

A "vaguely worded law" 

Acquisto reports that doctors are trying to figure out "how to give medically necessary abortion care under a vaguely worded law, the violation of which could result in a felony charge or jail time."  

"No provider who spoke with the Herald-Leader had a clear understanding of the exact conditions and ailments that count as medical exemptions, but most agreed that an abortion is only legally allowed in the event of a medical emergency," she writes. 

The law says a licensed physician can perform an abortion without risking a Class D felony (punishable by one to five hears in prison) if it’s “necessary, in reasonable medical judgment to prevent the death or substantial risk of death due to a physical condition, or to prevent the serious, permanent impairment of a life-sustaining organ of a pregnant woman.” 

The law requires the physician to make “reasonable medical efforts under the circumstances to preserve both the life of the mother and the life of the unborn human being in a manner consistent with reasonable medical practice.”

But Acquisto writes that obstetrician-gynecologists she interviewed "want to know: what about anomalies that are un-survivable to a fetus, but aren’t a health risk to the mother?" 

Such conditions include anencaphaly, in which a fetus never develops parts of its brain or skull, but does not pose a risk to the pregnant person to carry it to term. 

"Before Kentucky’s trigger law took effect, the typical treatment route was a palliative induction, or inducing labor early to abort the fetus, which won’t survive outside the womb," Acquisto reports." But since no medical risk is posed to the pregnant person, and since the fetus could still have a heartbeat, is abortion in this scenario illegal under the trigger law?" 

Or, she asks, "What if one’s water breaks early in a pregnancy — a pre-term pre-labor rupture of membranes — likely fatally limiting fetal development and increasing the risk of severe infection in the pregnant person. Is an abortion lawful only if a severe infection develops, even if the fetus isn’t viable?" 

The Kentucky Medical Association told Acquisto that Kentucky's abortion laws "raises a number of legal questions for Kentucky physicians" and that they are working with their legal experts to analyze them before issuing official guidance. 

Meanwhile, a Lexington obstetrician-gynecologist told Acquisto that there is a push to “document the crap out of these discussions,” and to get second and third opinions. She then went on to describe a miscarriage situation where she would have performed a surgical abortion prior to this law, but because of it ordered a second ultrasound to prove beyond a reasonable doubt that the patient needed it. 

“I know it’s a miscarriage, but I don’t want to risk anything,” she said. “It’s wasting health-care dollars, but I don’t want a felony charge.” 

Acquisto reports that care for a Kentucky woman with an ectopic pregnancy was delayed because a physician assistant in an emergency room refused to fill a called-in order from the patient's gynecologist for an injection of methotrexate because he didn't want his name on the order. Methotrexate is a drug used in medical abortions.

Acquisto reports in detail that some other states' abortion bans cite specific medical conditions that are exempt from them, including ectopic pregnancies and miscarriages; and notes differing interpretations between physicians in states where laws don't have them such specifics. 

In Kentucky, Acquisto reports, it is unclear which state agency is charged with translating or clarifying the trigger law, since the Department for Public Health told her it does not bear that responsibility. 

“Each provider should be exercising their clinical judgment and treating patients accordingly,” department spokeswoman Susan Dunlap said. “DPH does not have a role in this.”

CDC risk map shows 93% of Ky. counties with high or medium risk of Covid-19 infection, increased risk in Bowling Green area

Centers for Disease Control and Prevention map

By Melissa Patrick
Kentucky Health News

Kentuckians in general have about the same risk of catching Covid-19 as they did a week ago, with 93% of the state's counties at a high or medium risk of transmission and The New York Times ranking Kentucky second among the states for new coronavirus cases in the last seven days. 

Last week, 92% of the state's counties were at high or medium risk. And even though the latest Covd-19 risk map, issued Thursday by the Centers for Disease Control and Prevention, shows some shift among counties moving to a lower level of risk of Covid-19, most of the state's counties remain in the high- and medium-risk groups.

Some of those in which the risk grew were Warren, site of Bowling Green, the state's third-largest city; Hardin, another very populous county; and every county adjoining Warren: Butler, Edmonson, Barren, Allen, Simpson and Logan.

The CDC map, which is based on new coronavirus cases, hospital admissions and hospital capacity, shows 70 Kentucky counties in orange, at high risk, four fewer than a week ago; 42 in yellow, at medium risk, six more than a week ago; and eight in green, at low risk, two fewer than the week before. 

In high-risk counties, the CDC recommends that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

If you live in a medium or high-risk county, the CDC advises wearing a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

The CDC also publishes a map showing levels of community transmission, Every county in Kentucky is ranked high except Ballard, Lyon, Edmonson, Metcalfe and Robertson, all small counties. State officials say the other map, estimating risks, is the best one to guide preventive actions,

At his weekly news conference Wednesday, Gov. Andy Beshear again urged Kentuckians to stay home if they are sick, consider wearing a mask until you know you don't have Covid-19, get tested if you think you have been exposed, and treatment if the test is positive, and get vaccinated and boosted. 

"We continue to recommend that everyone six months of age or older stay up to date on their vaccinations and receive any booster doses," he said.

His advice comes as a new, updated Covid-19 booster shot that targets the original strain of the coronavirus and major Omicron subvariants has been approved. Beshear said the new booster could be available to Kentuckians as early as next week. 

So far, state data shows that fewer than half (46.6%) of the 2.6 million fully vaccinated Kentuckians have been boosted.

'Youth Mental Health: A KET Forum', about youth suicide and ways to help, will air live Sept. 13 and be repeated and online

One out of seven Kentucky high school students report having seriously considered taking their own life, and suicide is the second leading cause of death for teens and young adults in Kentucky.

Kentucky Educational Television is airing a forum that examines teen and young-adult suicide in the state and how to prevent it.

"Youth Mental Health: A KET Forum," hosted by Renee Shaw, will examine the youth-suicide problem by talking with students, educators and mental-health professionals about the root causes of anxiety and depression. It will also discuss ways to help young people in crisis. 

It premieres at 8 p.m. ET Tuesday, Sept. 13, on KET. It will also be shown Thursday, Sept. 15, at 2:30 a.m. on KET and at 7:30 a.m. on KETKY; and at 2 p.m. Sunday, Sept. 18, on KET.

If you have a question about youth mental health that you would like to see addressed in the forum, send the question to publicaffairs@KET.org. 

After the live forum, KET will air "Facing Suicide," a PBS program that explores the powerful stories of those impacted by suicide, taking us to the frontiers of science, medicine and health policy to show us what we know about suicide and what that knowledge tells us about helping those at risk. "Facing Suicide" will air Tuesday, Sept. 13, at 9 p.m. ET.

After the Kentucky program airs, it will be available for streaming at KET.org and on the PBS video app. September is National Suicide Prevention Month. 

Help is available for anyone who is thinking about suicide or knows someone who is considering it. To get help, dial 988, which is the new suicide and crisis lifeline. The new three-digit mental health crisis hotline offers free, confidential support and is available 24 hours a day.

For more KET programs about mental health and related topics, visit KET.org/mental-health.

Dr. Monalisa Tailor, an internal-medicine physician in Louisville, is the new president of the Kentucky Medical Association

Dr. Monalisa Tailor
Norton Healthcare photo

Dr. Monalisa Tailor, a Louisville internal-medicine physician, is the new  president of the Kentucky Medical Association. She is both the youngest and first female president of color in the association's history. She was sworn in as the 172nd president at the organization's annual meeting. 

Tailor, a native of Bowling Green, is board-certified in internal medicine and advanced cardiac life support, and is employed by Norton Healthcare. She previously served as vice speaker of the KMA House of Delegates as well as on numerous KMA commissions and committees. 

She was president of the Greater Louisville Medical Society in 2020-2021 and now chairs the GLMS board. She has received several community leadership awards. 

In her inaugural address, Tailor discussed her goals for the year, including a focus on “rejuvenating medicine,” given the challenges the profession has faced over the last several years.

“For those of us working in healthcare, the Covid-19 pandemic has left an indelible mark on our lives. Stress and burnout are at an all-time high in our profession, while mistrust and misinformation among our patients could be considered an epidemic in itself," Tailor said in a news release. "Now more than ever, we need to come together as physicians to combat these issues and reinvigorate ourselves so that we can continue to provide the best care for the people of the commonwealth."