Abortion providers drop, at least for now, challenge to state's anti-abortion laws after failing to find a patient to be the plaintiff

Planned Parenthood's Louisville health clinic
Photo by Deborah Yetter, Kentucky Lantern

Kentucky’s two abortion clinics are dropping a legal challenge to the state’s near-total abortion ban, citing the state Supreme Court’s decision this year that they lacked standing to sue on behalf of potential patients. 

Planned Parenthood and EMW Women’s Surgical Center “said they have not given up and will continue seeking such a patient willing to come forward, allowing them to file a new challenge,” Deborah Yetter reports for Kentucky Lantern.

Attorney General Daniel Cameron, an anti-abortion Republican who has been defending the two state laws under challenge, called the voluntary dismissal of the court challenge a "legal victory for unborn life" and announced that "the elective abortion industry is out of business in Kentucky." 

Cameron said in a news release, “A society is judged by how it treats its most vulnerable—especially the unborn.”

One of the laws at issue bans abortion after about six weeks, before some women realize they are pregnant; another bans almost all abortions. Both were invoked by a "trigger law" that took effect in late June 2022 after the U.S. Supreme Court ended federal abortion protections and subsequently almost all abortion services in Kentucky. 

EMW and Planned Parenthood filed a lawsuit last June in state court arguing that the state constitution creates a right to abortion. Early this year a divided Kentucky Supreme Court ruled earlier this year that abortion providers lacked legal standing to challange the anti-abortion laws on behalf of patients, which "meant they had to find a patient affected by the law and willing to sue," Yetter notes. 

The providers' decision to drop the legal challenge was prompted by a deadline of Tuesday, June 20, to produce a plaintiff who is pregnant and wants a pregnancy termination but can't get it as a result of one or both laws, Alex Acquisto reports for the Lexington Herald Leader.

The providers said in a statement, "If you are in Kentucky, seeking an abortion, and want to know more about possibly being a plaintiff in a lawsuit like this, our phone lines are open for them to give us a call or text us at 617-297-7012."

Another case challenging the state's abortion laws remains pending. It involves three Jewish women from Louisville who "argue that the abortion laws — one of which defines life as beginning at conception — clash with Jewish teaching that life begins at birth. They also argue it limits their right to other care, such as in-vitro fertilization," Yetter reports.

Acquisto reports that Planned Parenthood continues to provide reproductive health-care services, but EMW was forced to close its doors after the high court's decision in February. In late May, EMW listed its building for sale. 

'Understanding autism: A KET Forum' premieres June 27

Autism, which is a complicated and often misunderstood neurological and developmental disorder, will be the subject of a forum on KET at 8 p.m. ET Tuesday, June 27 and on KET2 at 9 p.m. ET Thursday, June 29. The program will be available on demand at KET.org and the PBS app.

Kelsey Starks will host "Understanding Autism: A KET Forum" with experts including doctors, therapists and those affected by what some call "a neuro-difference" to help viewers understand how individuals with autism learn and interact with the world around them. They will also discuss education opportunities and the need for early intervention, and suggest ways to navigate the resources available. The studio guests will be:

• Dr. Gregory Barnes, director of the Norton Children’s Autism Center in Louisville and chair of the Kentucky Advisory Council on Autism

• Dr. Marisa Toomey, developmental pediatrics specialist at UK Children’s Hospital in Lexington

• Melanie West, executive director of Families for Effective Autism Treatment of Louisville

• State Rep. Tina Bojanowski, a special-education teacher in Jefferson County Public Schools and parent of a child with autism

• Scott Brinkman of Louisville, attorney and parent of a child with autism, and former state representative and state Cabinet secretary

• Susan Mills of Lexington, founder and executive director of the nonprofit My Autism Tribe and parent of child with autism

• Tanya Sturgill, autism resource specialist with the Fayette County Public Schools.

The program will also include recorded interviews with Kentuckians who live with autism or work in the field:

• Donovan Blackburn, director of the Appalachian Valley Autism Center in Pikeville

• Cody Clark, Louisville-based autistic adult/creator of “Cody Clark Magic”

• Mary & Kris Vaughn of Prospect, parents of a 16-year-old son with autism

• Patrick Elias, a Western Kentucky University senior and participant in the university’s Kelly Autism Program

• Michelle Elkins-Burckhard, director of WKU’s Kelly Autism Program

• Drew Hardison, participant in the LifeWorks transitional program at WKU

• Joy McAlpine, participant in LifeWorks

• Sarah Webb, participant in LifeWorks

• David Wheeler, executive director of LifeWorks

Kentucky ranks 40th in child well-being, 3 slots lower than 2021; child obesity and underweight births up, child death rate way up

By Melissa Patrick
Kentucky Health News

Kentucky, where nearly one in four people are children, ranked 40th among states for the overall well-being of its children, dropping three slots from the last report, according to the 2023 Kids Count Data Book.

“As we look ahead to a contentious gubernatorial race this fall and a state-budget year for the General Assembly, now is the time to look more deeply at the needs of the child care sector and what it will cost the commonwealth – what it will cost our kids – if there’s no action,” Terry Brooks, executive director of Kentucky Youth Advocates, said in a news release. "The Data Book shows concerning trends in education, health, and family economics as we enter a post-pandemic world. Our elected officials must use this as a place of common ground and as a springboard for action in 2024."

The Data Book, released June 14 by KYA and the Annie E. Casey Foundation, rates children's overall well-being through 16 indicators in four major domains: health, economic security, education and family and community.

Overall, Kentucky saw improvements in four of the 16 indicators, all of them in the family and community category, did worse in nine of them and and stayed the same in three. Here is a look at each domain. 

Health: Kentucky's ranking dropped for the third year in a row, with three indicators used to measure health worsening. This year's report ranks the state 40th, down from 35th last year. 

This year's report shows 41% of Kentucky's children are either overweight or obese in 2020-21, up from 37% in 2018-19.  The national rate is 33%. 

The state also saw a big increase in the rate of deaths of children. It rose to 37 deaths per 100,000 in 2021, up from 29 per 100,000 in 2019. 

It also saw an increase in the rate of babies born weighing less than 5.5 pounds, which is considered underweight. That rate increased to 9.1% in 2021 from 8.7% in 2019. 

The only good news in this section is that the share of Kentucky's children with health insurance stayed the same between 2019 and 2021, 4%.

Education: Kentucky ranked 29th in the report's Education domain, down from 26th last year.  The good news was  that 91% of the state's high school students graduate on time, well above the national rate of 86%. And, this rate has held steady between 2018-19 and 2019-20. 

The other three indicators of education worsened. By far, the biggest change was seen in the percentage of eighth-graders not proficient in math, increasing to 79% in 2022 from 71% in 2019.  The percentage of fourth-graders not proficient in reading also increased, to 69% in 2022, up from 65% in 2019. And the share of preschool-age children not in nursery school, preschool or kindergarten increased to 60% in 2017-21, up from 58% in 2012-16. 

Economic well-being: Kentucky ranks 41st in economic well-being, down from 38th in last year's report, with three indicators worsening since 2019. 

The percentage of children whose parents lacked secure employment increased to 33% in 2021 from 31% and teens not in school or working increased to 9% from 8%. Also, the percentage of Kentucky children living in households with a high housing cost burden increased to 24% in 2021 from 23% in 2019. A high housing-cost household is defined as one where more than 30% of monthly household pre-tax income is spent on housing-related expenses, including rent, mortgage payments, taxes and insurance.

The report says that in 2021, 22% of Kentucky's children lived in families with incomes below the poverty threshold, defined then as a family of two adults and two children with an income below $27,479. This rate was the same in 2019. 

Family and Community: Kentucky ranked 42nd in this domain, the same as last year. It showed improvement in all indicators, including children living in high-poverty areas (12%), children living in families where the household head lacks a high school diploma (10%), children living in a single-parent household (33%), and teen births. In 2021, there were 22 teen births per 1,000 females aged 15-19. In 2019, that number was 25 per 1,000. In 2021, the national rate was 14 per 1,000. 

The Kids Count Data Center provides current and trend data for child well-being indicators related to each of the four domains in the report, at both a state and county level. It also offers a feature to create customized tables, maps, bar charts and graphs.

Focus on child care

This year's report also explores how the lack of affordable and accessible child care shortchanges children and causes parents to frequently miss work or even quit their jobs, and those who can find child care pay dearly for it. 

Brooks said, “Without safe child care they can afford and get to, parents face impossible choices, affecting not only their families, but their employers as well. These consistent challenges facing the child care infrastructure – accessibility, cost, and low wages for the workforce – impact the commonwealth’s economy, parents’ ability to advance in careers, and the early learning of our youngest Kentuckians.”

KYA called on the state to invest in child care in the same way it does other core infrastructure, like roads and emergency-response systems. 

It also called on public and private leaders to work together to improve the infrastructure for family child-care homes by increasing access to startup and expansion capital. 

And it called on Congress to reauthorize and strengthen the Child Care and Development Block Grant Act, to increase funding for public pre-kindergarten and Head Start and to expand the federal Child Care Access Means Parents in School program, which serves student parents. 

Kentucky has an uptick in ticks, and people are getting ticked off; UK entomologist says state seems to be 'becoming Kenticky'

Norton Healthcare graphic; to enlarge any image, click on it.

By Melissa Patrick

Kentucky Health News

A warmer February in Kentucky has likely contributed to an uptick in ticks, and Kentuckians aren’t happy about it. Some even sound ticked off.

“We just had the seventh hottest February on record, so some of our [tick] species are going to be more successful because they weren’t exposed to as harsh of a winter as they might otherwise have been,” said Jonathan Larson, an extension entomologist at the University of Kentucky. “They got a head-start on the season.”

The longer season, combined with with Kentucky's tick-friendly living conditions, has resulted in more calls about ticks than Larson has had in the four years he’s been at UK.

“The tenor of calls and inquiries, they're sort of angrier” than in previous years, Larson said. “It seems like people are seeing more of them on their property and getting more on themselves and their animals and are just very agitated by it – understandably so.”

William May of Versailles is one of those ticked-off people. In late April, he told Kentucky Health News that he was overrun with ticks on his 17 acres and said he believes they are largely being carried onto his property by deer. Just about any wild animal can carry ticks, including birds and mice, of which Larson said Kentucky has an abundance.

May was recovering from a bout of Rocky Mountain spotted fever when he talked to KHN, and said he had had Lyme disease last year. Both diseases are carried by ticks.

“Ticks didn’t used to be like this,” he said. “Just in my yard, the numbers are astronomical. It was never like this before.”

Joe Lacefield, a regional wildlife biologist at the Kentucky Department of Fish & Wildlife, said most of Central Kentucky has a “very high deer density."

He said some counties control the tick population is by allowing hunters to get tags to harvest unlimited numbers of antlerless deer, but these unlimited harvests have resulted in a 50/50 split between male and female deer, so it has done little to control the population growth.

The tick problem in Kentucky isn't going away because Kentucky provides a perfect home for the arachnids – with its warm, humid summer days, an abundance of wooded, leafy areas in both rural and urban places, and plenty of other hosts to feast upon.

Jonathan Larson, UK entomologist

“It’s just kind of an unfortunate situation that Kentucky seems to becoming Kenticky,” said Larson. “There’s just a lot of opportunity for them here in the state.”

What can Kentuckians do to protect their property from ticks? Larson said any sort of brush management will reduce the tick population because it removes their habitat and places for their hosts to hide. He also suggests fencing to deter deer and other wildlife that carry ticks. A fence also helps with perimeter spraying with an insecticide-arachnicide such as Bifenthrin every few weeks, he said.

Larson said the best way to avoid getting bitten by a tick is to wear an insect repellent, such as diethyltoluamide, or Deet, when they are outside. And for those who don’t like to wear Deet, he suggested using oil of lemon eucalyptus, IR 3535, or picaridin. All of these products are readily available at stores.

"Putting on that 40 percent Deet product that you find at the store will give you a good level of protection," Larson said. "If you're sweating a lot, or if you're going to be outside for an extended period, maybe moving up to the Deet 80 percent or Deet 100 percent would be advisable, because they'll last longer and give you the longer-term protection that you need."

Other ways to protect yourself from ticks include wearing light-colored clothing, so ticks can be spotted more easily; tucking pants legs into socks or boots and shirttails into pants; taping the area where pants and socks meet, so ticks can't crawl under your clothes; walking in the center of trails, and avoiding other tick-likely areas.

Also important: Check for ticks every time you come inside from being outdoors as long as 10 minutes. And if you’ve been out longer, Larson said you should disrobe and check your whole body, especially around ankles, waist, navel, armpits and the nape of the neck. And check pets for ticks.

How to remove a tick (State health department diagram)

If you get a tick, Larson said it's important to remove it properly by grasping it as close to the skin as possible with a pair of tweezers and pulling it straight out with gentle, even pressure.

He said it is also important to not use home remedies to remove ticks, such as burning them off or putting alcohol or peanut butter on them, because those remedies only aggravate the situation.

“All of that agitates the tick as they're feeding on you and it could induce them to puke . . . into your bloodstream,” Larson said. The tick’s gut is where disease-causing agents reside.

Larson also encouraged people to save any ticks they remove from their bodies in alcohol or nail-polish remover to help health-care providers make a diagnosis if they see symptoms of a tick-borne illness. This is important because symptoms don’t always show up immediately.

The state Department for Public Health says, "Watch for symptoms for 30 days after tick bites. Call your healthcare provider is you get any of the following: rash, fever, fatigue, headache, muscle pain, or joint swelling and pain."

Click here to learn more about tick-borne diseases in Kentucky. The website has much information, including these maps, which show the average annual case rates, by county, for the top three tick-borne diseases in Kentucky: Rocky Mountain spotted fever, ehrlichiosis and Lyme disease.

FDA panel recommends updating Covid-19 vaccines; here's why

The Food and Drug Administration's external scientific committee unanimously recommended Thursday that Covid-19 vaccines be updated to thwart new versions of the virus, which is mutating about twice as fast as the flu, vaccines for which are updated annually, Katelyn Jetelina reports in Your Local Epidemiologist.

Also, "The current Omicron variant (XBB) circulating is meaningfully different than other Omicron variants," Jetelina writes. "Covid-19 vaccines are waning in protection against hospitalization (62% effectiveness has dropped to 24%) and ICU admission, albeit with a smaller decline (69% to 52%). This is happening faster when exposed to XBB virus compared to other Omicron variants."

Hospitals aren't filling up with Covid patients "because vaccine effectiveness now represents the incremental benefit above and beyond the baseline protection in the general population. This is different than when we first introduced vaccines and the general population had a very low immunity wall." In other words, natural immuiity (not just antibodies but other features of the immune system) combined with vaccines provide a relatively high immunity wall.

What's next? "Pfizer, Moderna, and Novavax will start manufacturing millions of vaccines. Once they’re ready, the FDA will approve the updated vaccine," Jeteline writes. Then the committee "will determine who should get the vaccines. Expect this to happen in late summer or early fall."

"Everyone’s curious to see how this year plays out," Jetelina says of her community of interest. "The rest of the year will be very telling as to whether Covid-19 has settled into a seasonal, predictable pattern. Comparing Covid-19 to the flu is helpful, but the viruses, and thus processes, are different. This needs to be communicated better."

She adds, "Don’t let anyone tell you there are no human data on these vaccines. All vaccine manufacturers presented preliminary data on humans and animals. What we do not have yet is the safety of these vaccines when combined with RSV and flu vaccines." RSV is respiratory syncytial virus, which targets mainly the young and the elderly. 

Opioid panel to hold hearings on funding ibogaine drug research, including a promoter; member sees a conflict, chair quashes talk

By Melissa Patrick
Kentucky Health News

The commission that manages the state's opioid-settlement money voted June 13 to hold two public hearings to discuss the idea of funding development of an opioid-use disorder treatment using the psychedelic drug ibogaine.

Two members of the Opioid Abatement Advisory Commission questioned the idea, one saying it seems to benefit a company developing a treatment, but the head of the commission, who proposed the idea, said discussion about his proposal would have to happen at those hearings, not at that meeting.

Bryan Hubbard at the June 13 commission meeting
(Kentucky Health News photos by Melissa Patrick)

"The first order of business is to determine whether this is a pathway that should be pursued with an explanation of what ibogaine is, and make sure we educate ourselves on whether or not what we see here has legitimacy," said Bryan Hubbard, the panel's executive director and chairman.

Hubbard said the first hearing would be "focused on the science" and include "consensus experts on ibogaine." He added that "the very intent of those hearings is to have a full, vigorous examination of any and all aspects of ibogaine and whether or not we should get ourselves involved in it."

Ibogaine is a powerful psychedelic that comes from a plant mainly found in Africa. It is illegal in the U.S. but has been reported to stop withdrawal symptoms of opioid dependence but also cause heart problems.

Hubbard cut off discussion after Rep. Danny Bentley, who joined the meeting virtually, asked when the panel would be able to discuss the idea. State Health and Family Services Secretary Eric Friedlander also voiced concern that there was no discussion by the panel before Hubbard announced the plan May 31.

Bentley, a pharmacist and a Republican from Russell in Greenup County, said, "I think we should discuss it today." Hubbard replied, "The motion on the floor is to adopt the public hearing schedule and that is what the discussion will be centered around." 

Friedlander and another commission member appointed by Democratic Gov. Andy Beshear learned about the ibogaine idea only when Hubbard revealed it at an event hosted by his boss, Attorney General Daniel Cameron, the Republican nominee against Beshear in the fall election, Beshear said last month.

Hubbard said May 31 that the commission would "explore the possibility" of committing "no less than $42 million" to developing the treatment of ibogaine for opioid-use disorder, with a goal of getting it approved within six years from the U.S. Food and Drug Administration. 

Hubbard took a few minutes to address what he said were misunderstandings. He said no funds have been allocated and "At this stage in the game, the only thing that we aim to do is to explore the possibilities related to ibogaine, its applicability as a therapeutic to opioid-use disorder. And then the second question is whether and to what extent this commission would commit funds to help develop Ibogaine as a therapeutic to go through the FDA approval process. We're a good bit away from answering that question."

Sharon Walsh questions the idea.

Sharon Walsh of the University of Kentucky, who oversses a multi-year, interventional research project to find tools for preventing and treating opioid addiction, with federal funding of $87 million, voiced several concerns. 

Walsh asked how the settlement money could be used to explore a drug that has not been approved by the FDA because the commission's guiding law clearly says that the money must be used on evidence-based pursuits.

Hubbard said the law includes language that would support this effort "insofar as it recognizes that the commission may allocate resources for any projects it deems appropriate." Further, he said, "We are well within our legal ability to explore. . . and that's the only thing we're seeking to do here." 

Walsh also pointed out that there are mixed opinions about the use of ibogaine for opioid-use disorder. She asked if there would be "point-counterpoint" participants at the public hearing, or if it would only be people who are trying to develop it.

Hubbard said at least two subject-matter experts will be invited to the first public hearing, including Deborah Mash, founder and CEO of DemeRx, a pharmaceutical company developing ibogaine for treating addiction. He told Walsh that if she had an expert she would like to invite, they would work to include them. 

Friedlander asked if the focus could be broadened to include other psychedelics, but Hubbard said that wasn't possible, because while other psychedelic drugs are closer to FDA approval, they don't appear to be effective against opioid withdrawal syndrome, as ibogaine may be. 

Walsh pushed back: "If the focus is on opioid withdrawal, we have medications that are already approved for opioid withdrawal. It's not something that is difficult to manage clinically. And there are protocols that have been in place for 30-some years. . . . Those are very effective drugs. I'm not sure why we need other drugs to target opiate withdrawal." 

Hubbard replied, "Well, there are others who would seem to believe that this is worth exploring"  and that it has " breakthrough therapy potential. I want to know if that's true, right? And that's why we're having this exploration."  

Walsh also noted that she has known the proposed witness, Mash, for 30-some years and that Mash has been working on ibogaine since the 1990s. 

"She's the CEO of a company that's trying to develop it. So she's going to come and talk to us about the development of this with it, you know, with the hope of getting money. There's a clear conflict of interest from a person who has ownership of a company whose sole purpose is to get the drug to market," Walsh said. "That's why I'm asking for balance."

Hubbard replied, "Insofar as there are individuals who you know, with expert credentials that offer alternative views, please share those with the commission staff and myself."  

Secretary Eric Friedlander also objected.

Friedlander said he wished commission members had been able to discuss the idea before the press conference, which he said presented it as a "a fait accompli," or accomplished fact, even if that was not Hubbard's intention. 

Friedlander said, "Part of what we've been able to do is have these discussions about proposals in subcommittees, among ourselves, and I feel like that didn't happen here -- which is to me a disappointment. I'm just being straight. And even today feels like it's not welcome. . . . If we can have a press conference, surely we can have a discussion." 

Hubbard said he hoped that there would be "uninhibited cross-examination questions and discussions" at the two public hearings and afterward. 

"If we get into this and we find that what I have had my eyes on for the past month is smoke without fire or lacks legitimacy, we will come to that conclusion and move on from this exploratory state without any aim at a predetermined conclusion," he said. 

Bentley and Friedlander were the only two commissioners to vote against oppose the motion to hold two public hearings about ibogaine.  

Friedlander said, "It feels too narrow and it feels too specific. And I would have much rather have had the discussion here before a press conference and before we really were presented with a motion and couldn't have more discussion. So based on those two things, I vote no."

Bentley said he voted no opposed it because "Right now all the research on this drug is outside the United States because the FDA will not give an NDA, a new drug application, for it. So that's the reason I'm opposed."  

The hearings will be held July 17 and Aug. 16, from 9 a.m. to 3:30 p.m. in Room A125 of the Administrative Office of the Courts Building, 1001 Vandalay Dr,, Frankfort, at the northeast quadrant of the I-64/US127 interchange.

Hubbard announced reappointment of three members to two-year terms: Vic Brown, deputy director of the Appalachian High Intensity Drug Trafficking Area, representing law enforcement; and Karen Butcher of Georgetown and Simmons College of Kentucky Vice President Von Purdy of Louisville, representing citizens at large.

The commission's next business meeting will be held Aug. 8 at 1 p.m. in Suite 200 of 1024 Capital Center Dr. in Frankfort. 

Hubbard announced that the Opioid Conference will be held Oct. 8 to Oct.10 in Lexington and the sponsor will be the Kentucky Association of Health Plans.

Correction, June 20, 2023: This article has been corrected to reflect that the public hearing times will be from 9 a.m. to 3:30 p.m. and to recognize that Rep. Danny Bentley did not vote against the hearings, but instead opposed them. That distinction is necessary because he is a non-voting member of the commission. 

Kentucky had 5% fewer drug overdose deaths in 2022 than in '21 but many counties reported an increase in OD deaths

State Department for Public Health map, adapted by Kentucky Health News

By Al Cross

Kentucky Health News

Kentucky is still losing more than 2,000 citizens a year to drug overdoses, but last year's total was less than the year before, the first decline since 2018, according to the state's annual Overdose Fatality Report.

The report, issued Thursday, says 2,135 Kentuckians died from overdoses in 2022. A preliminary report had put the number at 2,127. The final figure is 5.4 percent under the final 2021 figure of 2,257.

However, many counties had more overdose deaths than in 2021, and "Addiction remains one of the most critical public health and safety issues facing the Commonwealth of Kentucky," says the report, issued by the state Office of Drug Control Policy.

The office's director, Van Ingram, said in a news release, “Over the past year, we have heavily focused on increasing access to clinical care for those suffering from addiction while offering more harm reduction measures,” including distribution of naloxone (Narcan), which blocks the effect of overdoses.

Among counties with 10 or more overdose deaths, Bath County, in east-central Kentucky, had the highest rate of overdose deaths in 2022, 18.5 per 10,000 residents. After it came Lee County, 15.1; Floyd County, 13.3; Estill County, 13; and Knott, 12.6. The state rate was 5 deaths per 10,000, down from 5.3 in 2021.

Rates for 65 of the state's 120 counties were not released because they had fewer than 10 drug overdose deaths. The actual numbers of overdose deaths in a county were not released if it had fewer than five.

Opioids were involved in 90 percent of overdose deathss, led by fentanyl with 72.5%, which was 6% less than in 2022. The number of overdose deaths "was also worsened by the widespread availability of potent inexpensive methamphetamine," the report says. Many victims had more than one drug in their system; 50.1% had fentanyl.

The Centers for Disease Control and Prevention recently released a national overdose death report, which listed Kentucky as one of only eight states to record a significant decline (at least 100) in overdose deaths, the release from Beshear's office noted. It said "Beshear has increased the number of treatment beds in the community by 50% and secured the largest number ever of corrections-based addiction treatment beds."

The release also said "A recent article from The Associated Press noted that . . . the decrease in overdose deaths is due to Kentucky’s intentional work to address addiction and offer more treatment services," but that is an overstatement. The article paraphrased Columbia University epidemiologist Katherine Keyes as saying that since Kentucky and other states with declines had high overdose-death rates during the epidemic, their declines (emphasis added) "might be a sign that years of concentrated work to address the problem is paying off. State officials cited various factors for the decline, like social media and health education campaigns to warn the public about the dangers of drug use; expanded addiction treatment — including telehealth — and wider distribution of the overdose-reversing medication naloxone."

Ky. nursing-home company closes 2 Louisville homes, agrees to pay $1 million penalty; inspectors found rodent infestation and filth

Exceptional Living Centers of Lexington, which operates several Kentucky nursing homes. "has agreed to close two of its Louisville facilities, displacing roughly 200 people, after state inspectors uncovered serious problems over the past six months, including a rodent infestation, filthy living conditions and a general lack of care for the elderly and ailing residents," John Cheves reports for the Lexington Herald-Leader.

The company and the federal government entered a settlement last week in U.S. District Court "to voluntarily terminate its Medicare provider agreements at Hillcreek Rehabilitation and Care and St. Matthews Care and Rehabilitation Center. Such a loss is typically a financial death blow for a nursing home," Cheves reports. "The company is working closely with state and federal officials to transfer residents of Hillcreek and St. Matthews to other nursing homes around Jefferson County by July 6, according to its closure plan, obtained by the Herald-Leader. The company also agreed to pay civil monetary penalties of $1,026,408 to the U.S. Centers for Medicare and Medicaid Services."

Inspection reports of the state Cabinet for Health and Family Services, "which inspects nursing homes on behalf of the federal government . . . cited a persistent rodent infestation; unheated bedrooms in freezing winter months; filthy living conditions, including dirty bathrooms, the lingering stench of urine and feces, and trash cans overflowing with adult diapers; a lack of clean linens; blood-testing equipment that was not sanitized between use on different patients; and direct-care employees hired despite having disqualifying criminal records," Cheves reports.

Hillcreek Rehabilitation and Care (H-L photo by Marcus Dorsey)

At Hillcreek, 3116 Breckenridge Lane, "Residents complained that staff did not check on them overnight, between 7 p.m. and 7 a.m., leaving them 'humiliated' and 'feeling dirty' in soiled pajamas and sheets because nobody responded to their calls for assistance, inspectors wrote. A resident who fell in his unheated room the day after Christmas lay uncovered on the floor for more than three hours until he finally was discovered, inspectors wrote. Emergency medical workers described his skin as 'freezing cold.' He died 10 days later at the hospital of hypothermia, they wrote."

The reports say residents and staff told inspectors they were scared by mice and rats scurrying through parts of Hillcreek, "including bedrooms and on a resident’s bed, and by hearing them skitter and shuffle on the floors," and one resident required medical care after a rat bit his thumb, Cheves reports. Inspectors found rodent feces near a nurse's station, and one rat was so familiar that housekeeping staff gave him a nickname, “Ben,” inspectors reported. One nurse “stated the rats were ‘huge’ and as big as cats,” inspectors wrote.

"Hillcreek, which already had a history of critical state inspections, has been hit with about a dozen negligence or wrongful death lawsuits filed by residents’ families since 2021. It is rated with one star, or 'much below average,' on Medicare’s Nursing Home Compare website," Cheves reports.

"At St. Matthews, inspectors cited abuse of residents, including 'a severely cognitively impaired' female resident whom police determined to have been sexually assaulted at the facility, and a resident who said she or he was hit by an employee but whose assault allegation was not reported up the chain of command, as required. As at Hillcreek, inspectors said St. Matthews used blood-testing equipment on different patients without sanitizing it, risking the spread of infectious diseases and blood-borne pathogens, and it hired direct-care employees despite 'disqualifying events' in their past, such as a social services assistant with a conviction for physical harassment."

Exceptional Living Centers President Tom Watts declined to comment to the Herald-Leader, as did the company’s lawyers. The firm continues to operate these facilities listed on its website: Bluegrass Senior Living in Somerset, Clifton Oaks Care Center in Louisville, Green Hill Rehabilitation and Care in Greensburg, Lyndon Woods Rehabilitation and Care in Lyndon, Stanford Care and Rehabilitation, Frankfort Care and Rehabilitation, and Vanceburg Rehabilitation and Care. 

Smoke from Canadian wildfires prompts warnings for Kentuckians, especially those who are working outdoors

By Sarah Ladd
Kentucky Lantern

Poor air quality from Canadian fires prompted a warning Thursday about potential negative health effects for Kentuckians.

Air pollution can negatively affect a person’s health, according to Rachel Keith, an associate professor of medicine at the University of Louisville and the director of human studies at the university's Envirome Institute.

“We know that what goes into your body and what’s around your body has as much if not more impact than the genes you get,” said Keith, who is an advanced practice registered nurse with UofL Health. Environmental interactions account for most chronic illnesses, she said.

People with asthma or chronic obstructive pulmonary disease are more likely to suffer immediately, she said, but air pollution can have long term effects on health as well.

Air pollution can trigger heart attacks, Keith said. Exposure over time can increase the risk of heart disease, some cancers and diabetes.

If people with asthma or COPD feel they need to use inhalers but it’s not helping, “and you still feel like you are having that air hunger or still having an asthma attack,” it’s time to see a doctor, Keith said.

Also keep an eye out for signs of a heart attack: pain and chest pressure, nausea, lightheadedness.

“We should still limit our outside time at these times” when air quality is really bad, Keith said. “We should limit our exposure.”

Even people not predisposed to things like heart disease can experience throat irritation, Keith said, and burning eyes.

If you must be out in poor air quality, an N95 mask can help protect your body, she said. But: “Limiting your exposure is the best prevention.”

The Washington Post reports, "From landscapers to farm laborers, many workers whose jobs require time in the outdoors have plowed on this week, even as smoke from wildfires raging in Canada has created abysmal air quality up and down the East Coast. Their predicament reveals how outdoor laborers, more than any other segment of the workforce, remain vulnerable when it comes to climate change."

Panagis Galiatsatos, a pulmonary medicine physician at Johns Hopkins School of Medicine and a spokesman for the American Lung Association, told the Post, “If it is feasible, I would encourage not working outside.” But he acknowledged that many people in the path of wildfire smoke don't have that option: “If people have to work outdoors, by all means take the proper precautions to stay safe,” he said.

Pike County to be part of pilot project to improve lung-cancer screening rates in Central Appalachia, big hotspot for the disease

National Cancer Institute map shows Eastern Kentucky has a very high rate of death from lung cancer; other maps show its rate of lung-cancer cases is also very high. For larger version, click on it.

By Melissa Patrick
Kentucky Health News

The Appalachian Community Cancer Alliance has launched a pilot project to improve lung-cancer screenings in rural Appalachia, and Pike County is part of it. 

Dr. Michael Gieske, director of lung cancer screening at St. Elizabeth Healthcare in Northern Kentucky, told Kentucky Health News that he had been working with the regional alliance off and on for about four and a half years, most recently on projects that involve diversity, equity and inclusion. 

Dr. Michael Gieske

Gieske said the alliance is recognized by President Biden's Cancer Moonshot Initiative and has been charged with improving cervical, colon and lung cancer screenings in the 13-state Appalachian region. 

"They felt after some of their initial work that lung cancer screening was by far the greatest need and demonstrated the greatest disparities when you were looking at health care inequities," he said. 

This realization prompted the alliance to form the Rural Appalachian Lung Cancer Screening Initiative, a multidisciplinary group of which Gieske is the subject-matter expert. 

Gieske said St. Elizabeth, which has one of the most robust lung-cancer screening programs in the country, has done 33,000 screenings since 2013 and has found 525 cancers – 70 percent of which were in either Stage I or Stage II, which are considered the early stages of lung cancer, ans most treatable.

"We're finding it when the chance of cure can be greater than 90 percent," he said. 

And, he said, because of recent improvements in treatment in lung cancer, it's really important to emphasize that even people with late-stage lung cancers are surviving the disease.  

Pilot project

To decide the location of the pilot project, leaders of the initiative used geospatial mapping to find the intersection of the highest mortality rates and lowest access to care in Appalachia, Meg Barbor writes for the ASCO Post, published by the American Society of Clinical Oncology.

Pike County (Wikipedia map, adapted)

"It was very apparent that there was a glaring area where Kentucky, West Virginia and Virginia came together," Gieske said. "They had the highest incidence of lung cancer, the highest mortality from lung cancer, the worst five-year survival rates, the highest smoking rates, the worst access, the highest poverty rates, the lowest education rates, and all these came together in this region. So we thought, well, this is probably going to be a very difficult challenging area to work in, but at the same time, it would give us an opportunity for the greatest impact." 

The pilot will include 10 counties that Gieske said "really lit up the brightest" on that map. He said Pike County, Kentucky's largest in land area, is the only county in the state in the project. Five of the counties are in Virginia and four are in West Virginia.

Gieske said they would be working with Dr. Aasems Jacob, a pulmonologist at Pikeville Medical Center, on the project. 

Dr. Leigh Boehmer

Dr. Leigh Boehmer, chief medical officer and deputy executive director of the regional cancer alliance, told Barbor that the initiative aims to increase lung-cancer screening rates by identifying and addressing informational, literacy, and cultural barriers that inhibit rural Appalachians from seeking recommended preventive care.

“The alliance was designed to provide a platform to share promising, evidence-based, translatable practices and solutions to improve access and quality of care for patients in this part of the country," Boehmer said. 

Gieske said "education and communication" are key when it comes to reaching out to primary-care providers who are on the front line of care. 

Most electronic medical-record systems "will flag a patient if they meet the criteria, and then it's it's up to the provider to order the test," he said. "Lung cancer is just as important if not more important than breast cancer and colon cancer and cervical cancer screening. Lung cancer kills more patients or more individuals in our state, in our country than prostate, breast and colon cancer combined. Lung cancer kills three times more women than breast cancer, and a lot of women don't realize that." 

The only recommended screening for lung cancer is low-dose computed tomography, also called a low-dose CT scan, according to the Centers for Disease Control and Prevention. Annual CT scans are recommended for adults between 50 and 80 who have smoked at least 20 "pack-years" (a pack-year amounting to one pack of cigarettes a day for a year, or an equivalent amount, such as half a pack a day for two years) and either still smokes or has quit within the last 15 years. Medicare rules are a bit different. 

Bad news and good news

Gieske noted that Kentucky has a long history with lung cancer, largely because of its association with tobacco.

"We're by far the worst state in the country for the incidence of lung cancer, we're 55% above the national average, we have the highest mortality rate, we're fourth from the bottom for five years in lung-cancer survival," he said, "But the good news is . . . we're now number two in the country, if you go by the American Cancer Society data for lung cancer screening, and we are really starting to make a difference." 

Gieske said several state-based initiatives have helped increase screening rates, including the Kentucky Health Collaborative and the Kentucky LEADS Collaborative, for "Lung cancer education, awareness, detection and survivorship," and data from the University of Kentucky's Markey Cancer Center shows a decrease in late-stage lung cancer. 

"We have now seen a 19% reduction in late stage lung cancer – that's Stage 3 and Stage 4 lung cancer  –over the last six years," he said. "And that's strictly a result of screening. And that's two times faster than the national average, that decline." 

Gieske encouraged anyone who qualifies for lung-cancer screening to get tested, noting that it is a simple test that takes about three minutes and does not require any "needles, tubes or dye." 

He added, "It's a very simple screening test with incredible results."

Beshear increases Medicaid reimbursement rates for home and community-based services and long-term care facilities

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear has raised Medicaid reimbursement rates for home and community-based services and long-term-care facilities to help them deal with inflation, workforce shortages and the effects of Covid-19.

"We have a duty to make sure those who need in-home care, community-based care and long-term care get the services they need and the services they deserve," Beshear said at his weekly news conference Thursday. "This increase will provide some interim financial relief for organizations that take care of our parents and our grandparents. And right now they need our help, and we need to be there for them."

Most of the money for the increase will come from the federal government, which funds about 70 percent of traditional Medicaid spending. The state share "is able to fit within our current appropriated budget without the need for additional state funds," said Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services. "The current Medicaid spending trends allow the cabinet access to funds to increase the Medicaid rate."

Dunlap noted that the cabinet "is required to adjust price-based nursing facility rates for inflation every July 1. During the budget process, the cabinet accounts for an inflationary increase in our projections for the inflationary adjustment."

The nursing-home adjustments are retroactive, to make up for underestimated inflationary increases that were provided in the last three years, Beshear said. This will result in $99.6 million more for nursing homes in the next fiscal year, which ends June 30, 2024. The state's share will be $18.9 million. 

The adjustment for home and community-based services will be for services that were delivered from Jan. 1, 2022, to May 1, 2023, at an additional cost of $13 million, according to a news release.  

The main lobbying group for nursing homes and assisted-living facilities told Kentucky Health News that it is expecting an overall adjustment of about 8 percent, and that it will vary from facility to facility. 

Betsy Johnson, president of the Kentucky Association of Health Care Facilities and Kentucky Center for Assisted Living, praised the governor's action, calling it "welcome relief" for struggling long-term care facilities that have been sounding the alarm about the skyrocketing costs required to keep their residents and patients safe and healthy. 

Betsy Johnson

“We are grateful for Gov. Beshear and his administration," Johnson said. "The pandemic had devastating effects and worsened the staffing crisis we were already facing. This funding will be paramount to providing quality care to residents and patients as well as building the foundation for a brighter future.”  

John Muller, chief operating officer for Carespring Healthcare Management in Northern Kentucky, thanked Beshear and his team at the news conference. Muller is also a KAHCF board member. 

“Nursing facilities were on the front lines of the Covid pandemic. The last number of years have been very, very difficult," Muller said. "And as we are coming out of the pandemic, the aftershock is the workforce challenges that we're facing. Nursing facilities are lagging far behind on catching up in the workforce. These much-needed funds will go a long way for the residents we serve . . . as well as the team members we need to retain and the new ones we need to recruit.”

David McKenzie, administrator and owner of The Jordan Center in Louisa, conveyed an urgent need for these increased funds in a letter to Health and Family Services Secretary Eric Friedlander on March 28. He painted a picture of his facility's dire financial situation and asked for a "funding bridge" to allow nursing homes to survive until July 1, 2024, when their rates are scheduled to be recalculated. 

"Our facility will not make it if we don't receive a funding bridge July 1, 2023," McKenzie wrote. "We have never seen price increases like this in our 49 years of business! In February 2022, we had to close half of our facility because we only had enough staff to operate 60 beds and maintain our 5-star staffing rating." 

Beshear has also committed to rebasing the Medicaid rate effective July 1, 2024, but that would require appropriations from the General Assembly next year, and Beshear's term will end late this year unless the voters given him a second four-year term in the Nov. 7 election.

"We're dealing with an election. We're dealing with a budget session. So there are lots of things for us to address," Johnson said. "But as you just stated, right now, where it stands, we understand that the current administration and the Kentucky legislature are very sympathetic to our challenges and we believe that we can all work together so that this money will be appropriated." 

Johnson said nursing homes have received inflation-based increases every July 1, but in many years the raise was only 0.1%, and since 2008 the state has not "rebased" their rates by looking at their cost reports to determine the true cost of running a nursing home. Those costs, she said, have gone up significantly. 

The $29 pandemic boost, which the legislature adopted, was an add-on to the basic rate. It "continues to be a lifesaver for our skilled nursing facilities and the residents that they serve," Johnson said. But she also says it's not enough, and it's time to rebase their rates.

"This funding is a good first step toward getting us back on our feet," she said, adding later, "If you ask any one of our member providers, when we say, 'Oh, post-pandemic world or post-Covid,' they will look you in the eye and say, 'Betsy, we're still in it' because the struggles are real. It has forever changed the way they operate and the staff that they need. It's very, very important that we should all, as Kentuckians, be invested in this taking care of our elderly, and our most vulnerable citizens."

OPINION: Criminologists say baseless anti-transgender claims fuel adoption of harmful laws in Kentucky and other states

By Henry Fradell and Alexis Rowland
Republished from The Conversation

It has been seven years since North Carolina made headlines for enacting a “bathroom bill” — legislation intended to prevent transgender people from using restrooms that align with their gender identity. After boycotts threatened to cost the state more than $3.7 billion, legislators repealed the law in 2017. Since then, however, religious and political conservatives have successfully spread an anti-trans moral panic, or irrational fear, across the United States.

As far back as 2001, Republican lawmakers proposed the first of what are now nearly 900 anti-LGBTQ+ bills. More than 500 of these were introduced in 49 state legislatures and the U.S. Congress during the first five months of 2023. To date, at least 79 have passed.

Many of these laws have been  written and financed by a group of far-right interest groups, including the Alliance Defending Freedom, the Family Research Council, the American Principles Project and Liberty Counsel.

These groups claim the laws protect cisgender women and girls – whose gender identity matches the sex they were assigned at birth – from violent trans people who are often depicted in movies and other media.

But as criminologists, we know these claims are without merit. No reliable data supports the argument that transgender people commit violent crimes at higher rates than cisgender men and women. In fact, transgender people are more than four times as likely to be the victim of a crime as cisgender people.

In the last year, at least 18 states including Kentucky have enacted laws that limit medically age-appropriate gender-affirming health care for trans minors, with similar bills pending in 14 more states. And Florida’s barrage of anti-LGBTQ+ regulations even prohibits the mere discussion of sexuality and gender identity in schools through the 12th grade. Journalist Adam Rhodes called these efforts a “centrally coordinated attack on transgender existence.”

We believe these laws and bills illustrate the increasingly hostile legislative landscape for LGBTQ+ people despite polls showing that most people in the United States want trans people to be protected from discrimination in public spaces on the basis of their gender.

What the data show

A variety of myths, false narratives, bad science, misconceptions and outright misrepresentations undergird anti-trans laws. The reality, however, is that trans-exclusionary laws do not protect cisgender women and girls from harassment or violence. Rather, they result in dramatic increases in violent victimization for transgender and gender-nonconforming adults and children.

When laws permit transgender people to access sex-segregated spaces in accordance with their gender identities, crime rates do not increase. There is no association between trans-inclusive policies and more crime. As one of us wrote in a recent paper, this is likely because, just like cisgender folks, “transgender people use locker rooms and restrooms to change clothes and go to the bathroom,” not for sexual gratification or predatory reasons.

Conversely, when trans people are forced by law to use sex-segregated spaces that align with the sex assigned to them at birth instead of their gender identity, two important facts should be noted.

First, no studies show that violent crime rates against cisgender women and girls in such spaces decrease. In other words, cisgender women and girls are no safer than they would be in the absence of anti-trans laws. Certainly, the possibility exists that a cisgender man might pose as a woman to go into certain spaces under false pretenses. But that same possibility remains regardless of whether transgender people are lawfully permitted in those spaces.

Second, trans people are significantly more likely to be victimized in sex-segregated spaces than are cisgender people. For instance, while incarcerated in facilities designated for men, trans women are nine to 13 times as likely to be sexually assaulted as the men with whom they are boarded.

In women’s prisons, correctional staff are responsible for 41% of women’s sexual victimization, with cisgender women committing the balance of nearly all prisoner-on-prisoner violence. Similarly, trans boys and girls who are barred from using the washrooms and locker rooms that align with their gender identity are respectively between 26% to 149% more likely to be sexually victimized in the locations they are forced to use than cisgender youths.

In society at large, between 84% and 90% of all crimes of sexual violence are perpetrated by someone the victim knows, not a stranger lurking in the shadows – or the showers or restroom stalls. But trans and nonbinary people feel very unsafe in bathrooms and locker rooms, though others experience relative safety there. In fact, the largest study of its kind found that upward of 75% of trans men and 64% of trans women reported that they routinely avoid public restrooms to minimize their chances of being harassed or assaulted.

Lies drive harm

Because criminological data does not support trans-exclusionary laws or policies, advocates of anti-trans laws often resort to lies, flawed anecdotal evidence, or what fact-checkers have called “extreme cherry-picking” to support their position.

For instance, one of us documented how isolated news stories, often from notoriously transphobic tabloids, conflate the actions of sexual predators with the “dangerousness” of trans women. Although there are undeniably examples of actual transgender people committing crimes, even deeply troubling ones, they are not evidence of any behavioral trends among the broader class of trans people. No such data exist.

We believe the spate of anti-trans proposals represents a textbook example of crime-control theater – an unnecessary, ineffective and harmful legislative response to unfounded fearmongering.

Anti-trans laws are not just baseless. They’re hurtful and damaging, especially to LGBTQ+ teenagers. Recent polls indicate that more than 60% of these people experience deteriorating mental health — including depression, anxiety and suicidal thoughts – as a result of laws and policies aimed at restricting their personhood.

The criminological research is clear that anti-trans laws do not help the people they are claimed to protect. In fact, these laws inflict harm on people who are even more vulnerable.

Henry Fradella is a professor in the School of Criminology and Criminal Justice at Arizona State University, where he also holds a law-school appointment . He is the author, co-author, or editor of 13 books, including LGBTQ+ Issues in Criminology and Criminal Justice. Alexis Rowland is a Ph.D. student in criminology, law and society at the University of California, Irvine.