Legislature passes public-assistance reform bill with changes that please advocates; health cabinet secretary still sees 'red tape'

By Melissa Patrick
Kentucky Health News

Legislation aimed at getting able-bodied adults off Medicaid and other public-assistance programs and back into the workforce, and decreasing fraud in the programs, has passed the General Assembly in a watered-down form.

Rep. David  Meade, R-Stanford

"The goal is to make sure that the folks who truly need these benefits are receiving them and that we're cutting down on fraud and cutting down on those who are ineligible," House Speaker Pro Tem David Meade, R-Stanford, said in presenting his House Bill 7 to the Senate Health and Welfare Committee March 28.

The Senate made several changes that made the bill less restrictive and passed it 24-12. The House concurred with the changes and sent the measure to Gov. Andy Beshear on a 70-22 vote.

The Senate adopted an amendment by President Pro Tem David Givens, R-Greensburg, with three changes that further eased some of the original bill's restrictions. 

The changes would allow fluctuating income data to be used when determining eligibility, instead of the most recent data available; let Medicaid applicants self-attest their personal information as a last resort to determine their eligibility; and allow the Cabinet for Health and Family Services to apply for a waiver of work requirements in the Supplemental Nutrition Assistance Program under certain circumstances when the legislature is not in session. 

The bill would still require new documentation required for self-attestation, and that would create a hardship for many Kentuckians, said Emily Beauregard, executive director of Kentucky Voices for Health: "It creates roadblocks; it creates major delays."

Asked his biggest concern when it comes to the new Medicaid requirements, Cabinet for Health and Family Services Secretary Eric Friedlander said, "The increased red tape for individuals." 

Senate Minority Leader Morgan McGarvey said in the floor debate that he appreciated Givens' changes, but still opposed the bill because it could keep tens of thousands of Kentuckians from receiving benefits.

"I think this does make this a better bill," said McGarvey, D-Louisville. "I think the overall bill is still lacking. I thinks it is still punishing people, potentially punishing people just for being poor."

Sen. Ralph Alvarado, R-Winchester, who carried the bill in the Senate, said, "The only way you can lose benefits is if you’re doing something illegal or [are] able-bodied with no dependents at home."

The latter part of that became less certain with one of the Senate changes. It would give the cabinet one year to implement a "community engagement" program for able-bodied adults without dependents who have been enrolled in Medicaid for more than a year, but one without the specific requirements of the original bill.

The original would have required the cabinet to seek a federal waiver to let Kentucky Medicaid require able-bodied adults not primarily responsible for a dependent to participate in at least 80 hours a month of "community engagement," including work. Federal courts say federal law doesn't allow that, but the House bill would have required the cabinet to apply annually, subtly hoping for a political change in the federal government that would allow it.

The final version would make the cabinet implement the program "to the extent permitted under federal law" but does not specify a number of hours or a work requirement, leaving the details to the cabinet.

Beauregard told Kentucky Health News that they could support voluntary community-engagement programs because they are great ways to help people get back to work or find better jobs, especially if combined with child-care and transportation support. 

The bill would also make the Education and Workforce Development Cabinet establish a job-placement assistance program for adults on Medicaid who are able-bodied and not primarily responsible for a dependent.  

It would also create a task force to study the "benefits cliff," the great adjustment faced by many people who go off public assistance but still lack the resources to access health care and other needs.

Even though she voted against the bill, Rep. Angie Hatton, D-Whitesburg, told her House colleagues that the Senate changes allayed many concerns of health advocates.   

"I just think it's a matter of what keeps you up at night," she said on the House floor. "For me, it doesn't keep me up at night worrying that there's a tiny percentage of people who might get benefits who didn't deserve them. What keeps me up at night is worrying that there might be people hungry, who couldn't jump through hoops and get their benefits." 

Meade disputed Hatton's assertion, saying a study by the Gatton College of Business and Economics at the University of Kentucky shows that it costs the federal government $1.86 billion and Kentucky taxpayers $186 million per year to pay for all Kentuckians who are enrolled in Medicaid improperly. 

He said Kentucky ranks third in the nation for the biggest increase in improper Medicaid enrollment under the Patient Protection and Affordable Care Act. "You can see that we actually do have a major problem in this state," he said, "and that is what we are going to try to start taking care of."  

Here are some other provisions related in HB 7 related to Medicaid:

• After the federal government lifts the pandemic-era limit on the state's ability to disenroll people, the health cabinet would have 12 months to do a full audit of the Medicaid rolls.
• Medicaid coverage for treatment of substance-use disorder for prisoners, included in the 2020 budget, would be put into law.
• The cabinet could not make approve someone for Medicaid under presumptive eligibility before their qualifying paperwork is completed.
• The bill would ban the cabinet from developing a state basic health program for low-income people not eligible for Medicaid without first obtaining specific legislative authorization. 
• The cabinet must must seek a federal waiver to authorize anything it needs to implement the legislation, tell the legislature if it is denied, and reapply "with or without modifications based on instructions from the General Assembly."
• The task force would investigate and report on the cost of using a single electronic benefits card for Medicaid and the Supplemental Nutrition Assistance Program, formerly food stamps. 
• The attorney general, currently Republican Daniel Cameron, could bring action against the cabinet if he thinks provisions of the bill are not appropriately implemented.
  

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Cameron, 20 other Republican attorneys general sue to overturn CDC's mask mandate in public transportation hubs

Attorney General Daniel Cameron has joined 20 of his Republican counterparts in a lawsuit to overturn the Centers for Disease Control and Prevention's rule requiring masks to be worn in public transportation hubs.

The suit "argues that the mandate exceeds the authority of the CDC, noting that the Biden administration continues to use a failed interpretation of a quarantine statute that has been ruled against in court several times," Cameron's office said in a press release.

Cameron said, “With most states now relaxing their Covid-19 requirements, the CDC should follow suit and eliminate the mask mandate for airports, train stations, and other transportation hubs. We believe the current mask mandate exceeds the authority of the agency, and the Biden administration should end it immediately.”

The attorneys general argue that the law used to justify the mandate does not authorize such broad measures. only authorizes rules directly related to preventing interstate spread of disease, and does not permit mask requirements for individuals who show no sign of infection, the release says. The suit also argues that the rule is arbitrary and capricious and does not consider preventive actions by states.

The other plaintiff states are Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Mississippi, Missouri, Montana, Nebraska, Ohio, Oklahoma, South Carolina, Utah, Virginia and West Virginia. To read the lawsuit, click here.

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Most in nationwide poll say they have contracted the coronavirus, but concern about serious Covid-19 illness in their family declines

Most Americans say they have contracted the coronavirus, and the infected are more likely to be Republicans, says a new poll by Monmouth University in New Jersey. "This appears to be the first poll to show a majority of Americans saying they’ve been infected at some point," reports Aaron Blake of The Washington Post. "Other polls from recent months have shown a sharp uptick in those who report testing positive — particularly during the rise of the omicron variant — but Monmouth’s poll brings in those who believe they’ve contracted the virus but lack a diagnosis."

In the March 10-14 telephone survey, 52 percent of respondents said they had contracted the virus, up from 40% in late January, and 57% percent of Republicans said they had been infected, but only 38% of Democrats said they had. In January, the numbers were 50% and 28%. "This tracks with polls that more narrowly surveyed self-reported positive tests. It also suggests the gap has grown since the pandemic began," Blake notes.

Blake casts a skeptical eye: "Is the gap really this big? Polls asking people to self-report things like an infection are prone to response bias. Democrats might be less willing to acknowledge falling ill: Given the emphasis on mitigation on their side of the political aisle, they might view infection as some kind of moral failing. Republicans, by contrast, have long been more likely to argue that mitigation efforts have gone overboard and the virus is overblown. What better way to prove that than to say you personally contracted the virus and lived to tell the tale?

"But if that were a major factor, you might expect the gap between Republicans and Democrats to be greater when it comes to one specific self-reported measure: non-diagnosed cases. This would seem a prime opportunity for Republicans to say they believe they’ve had the virus even if they might not have, and for Democrats to downplay their infection status. On both sides, though, about 1 in 5 who say they’ve had the virus lacked a diagnosis.

"Notably, this gap in self-reporting didn’t always exist. Early in the pandemic, the percentage of Republicans and Democrats reporting positive tests was roughly equal — and for much of 2021, the gaps weren’t nearly as wide as they are now. Of course, this difference may be inflated by self-reporting. But the fact that even that self-reporting gap has grown is important. And it provides even more evidence that, as the pandemic has progressed, the virus has hit Republicans harder."

Despite the greater prevalence of infection, "The number of people who are very concerned about a family member becoming seriously ill from the virus (23%) has dropped to its lowest point since last June (also 23%)," Monmouth reports. "This marks a 15-point decrease over the past two months." The biggest drop was among Democrats: 30% in March, compared with 61% in January,

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House-passed bill to expand individuals' vaccine privacy rights fails to make it out of Senate committee as session nears end

By Melissa Patrick
Kentucky Health News

A House-passed bill to keep state and local governments from asking employees and applicants if they have received a Covid-19 vaccination, and to ban colleges and universities from requiring disclosure of immunization status, has failed in a Senate committee with three days left in the legislative session. 

Rep. Savannah Maddox

House Bill 28, sponsored by libertarian Republican Rep. Savannah Maddox of Dry Ridge, passed the House 71-22 on March 10, but Monday the Senate Health and Welfare Committee voted 5-4 against it. 

Sen. Danny Carroll, R-Benton, who has been critical of the restrictions Democratic Gov. Andy Beshear imposed to thwart the Covid-19 pandemic, said he voted no out of concern for what the future may hold.

"It's easy to make policy in retrospect, looking at what has happened," Carroll said. "What is difficult is to make policy and foreseeing the future. There is no way we can know what Covid will bring, what the next variant might be. How important it is that people know someone's vaccination status, that could mean the difference between life and death, depending on the variant and how deadly it is."

Voting yes were Republicans Stephen Meredith of Leitchfield, Michael J. Nemes of Shepherdsville, Max Wise of Campbellsville and Chairman Ralph Alvarado of Winchester, who said he cast his "aye" vote at the end of the roll call for the "sake of the sponsor." Earlier, he questioned her handling of the bill.

Alvarado asked Maddox if she had the votes to pass the bill and if she had reached out to all committee members. Maddox said that when she approached Alvarado last week, it did not have the votes to pass, "but since that time, it has gained a bit of momentum" and that she had spoken to "a great number of them about this bill."

Alvarado said, "I know that you haven't spoken to all of them, at least. And so the question there becomes, why not? I know you had reached out, asked for this bill to be heard and you're right, a brief text message was, you don't have the votes. So I'm curious if you have them. Customarily, if a sponsor asks for a bill to be heard, the presumption is that you have the votes for it to pass. And so typically, it's an important bill, that would be the thing that I would hope to have coming forward."

HB 28 would also ban public entities from mandating or issuing vaccine passports and would allow parents or guardians of children in schools to opt them out of any Covid-19 vaccination requirements on the basis of a conscientiously held belief. Kentucky's public schools do not require Covid-19 vaccinations. The bill defines a public entity as the state, a local government, or any of their agencies or departments.

"This bill is not intended to debate the merit or non-merits of receiving a vaccine," Maddox said, adding later, "It comes down to the fact that Kentuckians are capable of making good decisions for themselves and their families when it comes to their health care without any undue influence force or coercion from the government." 

The Kentucky League of Cities opposed the bill, saying it violates the home-rule powers of local governments.

Brittney Welch of the Kentucky Nurses Association said that if nursing schools could not ask students their vaccination status it would "severely alter the ability of nursing schools" to put them in clinical settings. Maddox said HB 28 would not keep hospitals from following federal vaccine mandates, and nursing students there would have to obey them.

Senate Republican Caucus Chair Julie Raque Adams of Louisville said she voted "no" because the bill would put the University of Louisville Medical Center in direct conflict with federal law.

Also voting no were Republican Jason Howell of Murray and Democrats Karen Berg and Denise Harper Angel of Louisville.

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Pandemic numbers nearing levels seen before Omicron variant hit

Kentucky Health News graph from weekly state reports

By Al Cross
Kentucky Health News

The pandemic in Kentucky has declined to levels not seen since early last summer, when numbers bottomed out just before the surge of the Omicron variant of the coronavirus drove them to record levels.

From last Monday through Sunday, the share of Kentuckians testing positive for the virus was 2.29 percent, less than half the 5% level at which public-health officials say poses the risk of widespread outbreaks.

Since March 7, when the state started issuing weekly instead of daily reports, the rate has declined from 6.04%. The rate was below 2% for 12 days in late June last year, just before Omicron hit.

Omicron's BA.2 subvariant is becoming widespread and is at least twice as transmissible as the original, but hasn't been shown to cause worse disease.

The state reported 5,530 new cases during the reporting week, an average of 790 per day, still well above last summer's low average of 163 in the last week of June 2021.

But the state's seven-day infection rate fell to 4.82 daily cases per 100,000 residents, not too far above last summer's low of 3.13 per 100,000.

Hotspots remain. Counties with rates more than double the statewide rate, putting them into double figures, were Cumberland, 21.6 per 100,000; Perry, 16.1; Taylor, 15.5; Trimble, 15.2; Wayne, 14.1; Magoffin, 12.9; Anderson, 12.6; Adair, 11.9; Pike, 11.8; Floyd, 10.8; and Wolfe, 10.

The state's weekly report said 26 percent of the new cases were in Kentuckians 18 and younger. Generally in Kentucky, the younger someone is, then less likely they are to be vaccinated for Covid-19.

The report said 263 hospital patients had Covid-19, with 50 in intensive care and 25 on mechanical ventilation. The total number of Covid-19 patients is less than the number on intensive care five weeks ago.

One of the more encouraging indicators was a decline in the number of deaths. The state attributed 236 more deaths to Covid-19 last week, just over 33 per day, down from the approximately 40 per day recorded the previous three weeks. The state's pandemic death toll stands at 14,895.

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One mother's story helps show how recovery from addiction, difficult anywhere, is even harder in much of rural Kentucky

Megan Simpson works after group class at Living Clean transitional

housing in Manchester. She recently completed peer support training

and passed her certification test. She started as a peer support specialist

in Corbin and is scheduled to go to court in April to regain custody of

her three children. (Photo by Silas Walker, Lexington Herald-Leader)

Kentucky Health News

The continuing struggle of Megan Simpson of Manchester helps show the difficulty that rural and small-town Kentuckians have getting treatment for substance-use disorder.

Simpson's story of addiction, treatment, relapse and recovery has been told in two long installments by Liz Moomey of the Lexington Herald-Leader. The latest appeared Sunday, along with a story by Moomey about the limited access that rural Kentuckians have to treatment.

She reports, "In many rural areas, resources are often few and far between to get treatment and return to life after recovery. Sober living housing is scarce. Transportation is limited. Childcare is sparse. Broadband internet for telehealth appointments or for virtual recovery meetings is unreliable."

“Many people don’t have all those stars aligned and they have a very difficult path ahead of them,” said Matt Brown, Addiction Recovery Care’s senior vice president of administration, who "struggled with substance use disorder for 18 years," Moomey writes. "He considers himself fortunate to have a wife who stayed with him through his addiction, an education and a job."

Rural areas not only lack a choice of providers for counseling and treatment, there is a lack of anonymity in small towns, Moomey notes, quoting Brown: “Everybody knows everything.”

The Kentucky Access to Recovery program of the nonprofit Federation of Appalachian Housing Enterprises, a 37-county program that "connects participants recovering from opioid-use disorder or stimulant use disorder to housing, childcare, dental care, transportation and other services," Moomey writes. 

KATR map via Herald-Leader, adapted by Kentucky Health News; to enlarge, click on it.

Aaron Brown, a Western Carolina University professor who researched the issue and KATR, "said the types of jobs available and the benefits provided are more limited in rural areas," Moomey reports. From his research on rural areas, good-paying jobs were often more taxing and didn’t always provide the option to take off work to participate in recovery opportunities."

Brown told Moomey that the ideal recovery model has these steps: medical detoxification, inpatient rehabilitation and a sober living facility with intensive outpatient services, such as group and individual treatment. But that's not always realistic in rural areas "because of lack of services and health professional shortages," Moomey writes.

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CDC rates fewer Ky. counties at high risk from virus, but levels in some have increased and state's risk level is still relatively high

State version of CDC map, with additional label by Kentucky Health News

Kentucky Health News

Kentucky as a whole is at lower risk from the coronavirus than it was a week ago, according to the Centers for Disease Control and Prevention. But about the same number of counties are rated at low risk, and the risk ratings increased in a few counties.

On Thursday the CDC listed 10 counties as high-risk. In those places, it still advises masks to be worn in indoor public spaces. The number is fewer than half the 24 listed last week, but two counties, Casey and Powell, moved from medium risk to high risk.

The 52 counties rated at medium risk included Ballard, McCracken, Carlisle and Hickman, in far Western Kentucky, which moved up from low risk.

The CDC says residents in medium-risk counties who are immuno-compromised or at high risk for severe illness should talk to a health-care provider about "additional precautions, such as wearing masks or respirators indoors in public. If you live with or have social contact with someone at high risk for severe illness, consider testing yourself for infection before you get together and wearing a mask when indoors with them."

CDC map, adapted by Kentucky Health News

The number of counties rated at low risk declined from 59 to 58. The ratings are based on new coronavirus cases, Covid-19 hospitalizations and the percentage of staffed inpatient beds occupied by Covid patients.

Kentucky remains one of the higher-risk states, according to the CDC's national map.

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Bills to address Ky. health-care worker shortage are moving

Centers for Disease Control and Prevention illustration

By Melissa Patrick
Kentucky Health News

In the final days of the 2022 legislative session, three bills to address Kentucky's healthcare workforce shortages are moving. One addresses the nursing shortage directly, one works toward recruitment and retention more broadly, and one addresses Medicaid payments for community health workers. 

Senate Bill 10 addresses the nursing shortage with both short-term and long-term solutions, Rep. Kim Moser, R-Taylor Mill, said in presenting the bill to the House Wednesday, March 23. 

Moser said the key components of SB 10 would streamline the process for out-of-state and foreign trained nurses to practice in Kentucky without compromising the standards of care; would improve access to nursing education by removing "arbitrary" enrollment limits without compromising the quality of the programs; and add term limits and geographic requirements for Board of Nursing members. 

The Kentucky Nurses Association says Kentucky will need as many as 16,000 more nurses by 2024.

Sen. Robbie Mills

Asked how many new nurses these provisions would produce, Moser said that the effort is just "a piece of the puzzle" to increase the health-care workforce in Kentucky. "While I don't have hard and fast numbers, I do think that this will certainly help," she said. 

SB 10, sponsored by Sen. Robbie Mills, R-Henderson and Senate President Robert Stivers, R-Manchester, passed out the House 93-1. It awaits Senate concurrence with some minor changes related to the nursing board. 

Another bill, sponsored by Moser, would impact the health-care workforce more broadly by establishing a Healthcare Worker Loan Relief Program for qualifying health-care workers.

"House Bill 573 establishes a much needed recruitment and retention tool for addressing healthcare worker shortage, especially in rural and underserved areas of Kentucky," Moser said in presenting the bill to the House March 23. "It provides financial incentives to attract and retain health-care providers."

The loan program would be aligned with the Kentucky State Loan Repayment Program and administered by the University of Kentucky's Center of Excellence in Rural Health. 

The program would be set up as a trust fund in the state treasury that would consist of state general fund appropriations, gifts and grants from public and private sources and federal funds. 

Rep. Kim Moser

Moser said this program would supplement federal funding, which requires a state match for scholarships and loan forgiveness; would expand the list of  health-care workers eligible to participate; and require recipients to work in under-served areas of Kentucky. 

The bill's House committee substitute calls for the loan relied fund to get $2 million a year, and adds ophthalmologists, optometrists and audiologist to the list of eligible recipients. 

The House sent HB 573 to the Senate on a 91-3 vote. At week's end, it had not received any of its three required readings in the Senate or been assigned to a committee. 

Moser's HB 525, which would allow Medicaid to pay certified community health workers, passed the Senate on its March 25 consent calendar and is back to the House for concurrence with Senate changes. 

CHWs aren't trained medically, but are trained as patient advocates who come from the communities they serve. They help their clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy, and deliver education on prevention and disease self-management.

HB 525 would require the state Department for Medicaid Services to seek federal approval for a state plan amendment, waiver or alternative payment model, including public-private partnerships, for services delivered by certified CHWs. It would also streamline their certification process.

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U of L says it will spend $144 million to upgrade hospital

Artists' rendering from University of Louisville Health

The University of Louisville plans to expand and renovate its 40-year-old hospital in Kentucky's largest city.

Officials say the $144 million project will include a seven-story tower with 20 new patient rooms, for a total of 360 private rooms at the hospital; four new operating rooms; a 24-bed observation unit to ease strain on the emergency department and reduce wait times; and a new lobby and waiting area, with renovations to the gift store and coffee shop.

Officials hope the expansion will be done by 2024. They said it will add 325 new jobs – nurses, clinical and nonclinical staff.

U of L Health CEO Tom Miller said Thursday the upgrades are much needed as more people seek specialty care at the region's only Level 1 trauma center. "Level 1 trauma centers provide the most comprehensive care for serious injuries that require a fast response, according to Medical News Today. They often have surgeons on staff 24 hours a day," WFPL reports.

“Every day this past year, 40 patients a day didn’t get a room in our hospitals [and] had to stay overnight in the emergency departments or in our recovery areas,” Miller said. “Today is the day to prioritize the health of this community. And I will tell you as an academic health care facility, we take that responsibility to heart.”

Gov. Andy Beshear, Louisville Mayor Greg Fischer, U.S. Rep. John Yarmuth and acting U of L President Lori Gonzalez also spoke at the news conference. Beshear praised U of L for its Covid-19 response and vaccine rollout.

“This expansion is great news for the commonwealth because you treat patients from all 120 counties,” Beshear said. “Now you’ll be able to serve even more people and hopefully we can put this pandemic behind us and then address so many challenges in health that afflict our people.”

U of L will pay for the project with its own funds, private donations and borrowing through tax-free bonds and revenue bonds, a news release said.

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After changes to appease county governments, the bill to address ambulance transfer times is raring to go for its final dispatch

Dwayne Oliver and Doug Byers of Lee County's ambulance service
refit one after a run. (Photo by Ryan C. Hermens, Lexington Herald-Leader)

By Melissa Patrick
Kentucky Health News

After yet another round of negotiations, a House bill aimed at improving ambulance transfer times nears a vote on the Senate consent calendar, used to pass bills without further discussion.

"All parties came to the table and I think we all agree," Rep. Ken Fleming, R-Louisville, the bill's sponsor, told Kentucky Health News. "We know it's not perfect. We do have a lot of work ahead of us in the task force, and then we're gonna really peel this whole issue back even further to make sure that we deliver the best quality of care for patients." 

Fleming told the Senate Health and Welfare Committee March 16 about a friend's sister who died while waiting on transport, and of organs that had barely made it to the hospital on time to save a life.

The Kentucky Association of Counties objected to parts of House Bill 777 and Chairman Ralph Alvarado asked them to go back to the negotiating table to work our their differences.

Senate President Pro Tem David Givens, R-Greensburg, was touted as being instrumental in finding consensus. He said KACo still does not support the bill, "but I sense that their opposition has now been moved to a place of neutrality." The bill is being pushed by the Kentucky Hospital Association.

Fleming said one change would require the Cabinet for Health and Family Services to send a notice to all cities and counties that a hospital has proposed to establish an ambulance service. The legislative bodies of the affected cities and counties would have 30 days to respond, and lack of response will be deemed support.

Another change would "sunset" the new rules in 2026, while allowing "all actions taken by cities, counties and hospitals, exemptions from obtaining a certificate of need and any certificate of need" granted under these new rules to remain in effect on and after this date.

A certificate of need is, in effect, a license to operate a health-related service. "Kentucky and Hawaii are the only states that regulate ambulance services under a certificate-of-need provision," notes Alex Acquisto of the Lexington Herald-Leader. And Kentucky does that with an independent Kentucky Board of Emergency Medical Services, comprised of EMS personnel.

The bill would make the board an independent agency of the state government, which would investigate all complaints about ambulance services, while leaving discipline to the board, and create a task force to do a thorough review of "the need, or lack thereof, for the certificate-of-need process for ambulance services."

Fleming said that will be one of the task force's biggest assignments. "There are 48 states that do not have certificate of need when it comes to ambulances," he said, "so we've got to figure out why are we an outlier."

Rep. Ken Fleming

The task force was a way to scale back the original version of the bill by deferring action on some points. "We're going to have to roll up our sleeves," Fleming said. "It's just going to be good, healthy discussions." He said it will be important for the task force to look at EMS workforce issues because that is a challenge that keeps coming up. 

Among other things, the bill would reform the certification requirements to allow cities, counties and hospitals to transport patients under certain conditions; make it easier for patients to register complaints; and exempts organ-procurement organizations from speed limits and traffic-flow patterns while transporting a human tissue in an emergency.

Stories of ambulance delays abound.

Acquisto's story begins with the story of an emergency patient at the St. Claire Regional Medical Center in Morehead with a ruptured blood vessel in his esophagus who waited five and a half hours for an ambulance (helicopters were not available because of rain) and was finally transported to Lexington in an ambulance from Ohio, which hospital CEO Donald Lloyd told her is "not permitted."

Acquisto reports that a survey done by the hospital association found that the average wait time for patients to be transported was seven to eight hours, with 90% of those requests to transfer a patient to a higher level of care, according to Nancy Galvagni, president of the association.

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Bill near final passage would delay lab results of cancer or genetic markers from going on electronic health records for 72 hours

By Melissa Patrick
Kentucky Health News

The legislature is nearing final passage of a bill that would give health-care providers a chance to contact patients to go over certain laboratory results before they go on patients' electronic health records.

Rep. Killian Timoney

House Bill 529, sponsored by Killian Timoney, R-Lexington, would require pathology or radiology reports that may show a finding of malignancy, or test results that could reveal genetic markers, to not be disclosed to a patient as part of their electronic health record for 72 hours, unless the health-care provider directs their early release. 

The Senate Health and Welfare Committee approved the bill without dissent and put it on the chamber's consent calendar, which it uses to pass bills without further discussion.

Doctors told the committee that the bill is needed.

"As physicians, we are quite concerned that patients are receiving deadly, life-threatening diagnoses on their phones without any medical care and medical support. We have numerous accounts of patients being harmed because of that, and causing harm to themselves," said Dr. David Danhauer, chief medical information officer at Owensboro Health. "We ask that, with this bill, allow our providers time to review, contemplate a plan, and set up appropriate consultation with those patients."

Dr. Susanne Arnold, a medical oncologist and associate director of the University of Kentucky's Markey Cancer Center, told the committee that they believe 72 hours "is an appropriate length of time" in most situations to be able to have a face-to-face discussion with a patient about such serious diagnoses. 

Sen. Karen Berg, D-Louisville, a physician, praised the bill. "This can be a horrible, horrible situation for patients," she said. "Imagine, honestly, opening up your telephone and seeing the report that says advanced metastatic cancer and it's 5:30 on a Friday night and you don't even have anyone to call. That's unethical."

While presenting the bill March 9 in the House floor, where it passed 84-14, Timoney said it would apply to upwards of 4 percent of all tests, and give patients access to a trained professional instead of "Dr. Google" or WebMD. He referred to the bill as the Compassionate Patient Care Act. 

The bill has an emergency clause that would make it effective immediately upon enactment.

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Bill Wagner, who headed group of health clinics for disadvantaged in Louisville, wins Gil Friedell Memorial Health Policy Award

Wagner, left, with Foundation President and CEO Chandler

William Wagner, retired CEO of Family Health Centers of Louisville, is the latest winner of the Foundation for a Healthy Kentucky's Gil Friedell Memorial Health Policy Award, for his work expanding access to care and coverage.

“Bill’s passion for bettering the health of Kentuckians is a perfect reflection of the spirit of the Gil Friedell Memorial Health Policy Award,” said Ben Chandler, the foundation's president and CEO. “Dr. Friedell was a passionate advocate for access to health care. Bill’s 40-year career is a testament to his commitment to serving others by expanding opportunities for health-care coverage and bringing medical care to underserved areas in rural and urban communities. He has made a profound impact on the health and wellness of countless Kentuckians.”

Wagner established primary-care centers focused on people who are low-income, homeless, immigrants and refugees, then expanded them to include dental, behavioral health, pharmacy services, health education, outreach and enrollment services.

He was influential in the evolution of Kentucky’s Medicaid program, helping develop the nonprofit Passport Health Plan for managed care of Medicaid patients and the Children’s Health Insurance Program, providing medical services for hundreds of thousands of children and adults in Kentucky.

He also helped shape the next generation of social workers and public-health professionals through his work with the Kent School of Social Work and the College of Public Health at the University of Louisville.

“It's an honor to receive the award,” Wagner said. “I accept it on behalf of all the health care providers who work so hard to provide medical care access in underserved areas of Kentucky – urban and rural. They’re the real heroes. I have great respect for them and working with them made my job so fulfilling.”

Wagner retired at the end of 2021, something he delayed due to the pandemic. During it, he worked with non-English-speaking communities to provide testing and education. When vaccines rolled out, Wagner was at the forefront, helping with logistics, outreach, and education, most notably with the homeless.

The Memorial Health Policy Award is named for Gil Friedell, first director of the Markey Cancer Center at the University of Kentucky and cofounder of the Kentucky Cancer Registry. He helped launch a nonprofit advocacy education organization in 2005 that later became the Friedell Committee for Health System Transformation. The Foundation created the award when it united with the Friedell Committee in 2018.

Wagner and Friedell worked in the mid-1990s to create a community partnership for breast and cervical cancer screening in Louisville’s West End, which had extremely high death rates from those diseases.

The foundation makes a $5,000 grant to a Kentucky nonprofit working to improve health policy in the commonwealth in honor of the Friedell Award winner. Wagner selected Kentucky Voices for Health, a nonpartisan coalition that amplifies the voices of individuals, families, and communities in the decisions that affect the health and well-being of all Kentuckians.

Wagner said he selected KVH because of his concern that many Kentuckians could lose the Medicaid coverage to which they gained access in the pandemic. “Having health-care coverage is key to having access to medical care and living a healthier life,” he said. “I’m concerned when the emergency measures for expanded Medicaid expire, we will have many folks who aren’t sure how to recertify or apply through Kynect. KVH can help fill those gaps.”

Wagner was selected from the foundation's 2021 Healthy Kentucky Champions, Kentuckians honored for making a difference in the health of their communities or the state. Nominations for the 2022 awards are due by May 20. For more information and to nominate someone, visit Healthy-KY.org.

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Almost six months after going into hospital with Covid-19, and a double-lung transplant as a last resort, patient is heading home

Staff members congratulate Victor Gonzales-Villatoro on his discharge at UK. (Photo by Hilary Brown)

By Hilary Brown

University of Kentucky

Staff at UK HealthCare gathered Wednesday to celebrate the discharge of patient Victor Gonzales-Villatoro, who was hospitalized with Covid-19 in October. The disease ravaged his lungs, Victor’s family was told he had almost no chance of survival, and they considered withdrawing life support.

As a last effort, UK doctors considered Victor a candidate for a double lung transplant and placed him on extracorporeal membrane oxygenation (ECMO) to see if his body could recover enough to withstand the transplant surgery.

For several months, while on ECMO, Victor remained unconscious. He awoke, and with a determined spirit, worked hard to gain the strength to receive a transplant — including getting up and walking while still connected to ECMO. On March 1, after five months on ECMO, Victor, 37, got a new set of lungs. Within a week, he was off the ventilator and walking.

Victor’s fighting spirit and unwavering determination endeared him to his care providers. After almost six months in the hospital, Victor was discharged amid a chorus of cheers and applause. He will spend the next few weeks at Cardinal Hill Rehabilitation Hospital in Lexington, where he will work to regain his strength and endurance.

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McConnell, Va. senator poke FDA about lack of action on rules to enforce two-year-old minimum age of 21 to buy tobacco products

Sens. McConnell and Kaine at the University of Louisville's
McConnell Center in 2019 (Courier-Journal photo by Pat McDonogh) 

Senate Republican Leader Mitch McConnell of Kentucky and Democratic Sen. Tim Kaine of Virginia have complained to the Food and Drug Administration about the agency's delay in implementing the law they got passed more than two years ago to raise the minimum age to buy tobacco products to 21.

They also needled FDA Commissioner Robert Califf, who was confirmed by the Senate on Feb. 15, about "the lack of communication regarding the inaction, and asking the commissioner for plans regarding the future," reports Halfwheel, blog about cigars and tobacco issues.

McConnell and Kaine sent Califf a letter March 11 "to express concern about the delays in finalizing regulations related to the Tobacco 21 legislation and the lack of transparency around the implementation and enforcement of that legislation," as they put it. Without updated regulations, "FDA is limited in its ability to punish retailers for potentially violating the new standard," Halfwheel notes.

The senators noted that the FDA's compliance checks of retailers fell off greatly in 2020, with less than half the number of inspections and a third as many warning letters as in 2019.

"Many states and local governments had already passed legislation increasing the minimum age to purchase tobacco products to 21 prior to December 2019 and many more have followed through since then," Halfwheel reports. "By changing state and local laws, it allows for state and local law enforcement to issue warnings and citations to those caught selling tobacco products to people under the age of 21."

McConnell and Kaine asked Califf to respond by Friday, March 25, with a timeline for issuance of the regulations, "including details on the rule’s current status in the review process and an explanation for why FDA did not meet the statutory deadline for issuing a final rule," which was June 2020.

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Most of Kentucky's coronavirus measures continue to fall, but Covid-19 death reports continue to average about 40 per day

Kentucky Department for Public Health graph, adapted by Ky. Health News; click it to enlarge.

By Melissa Patrick
Kentucky Health News

Nearly 40 Kentuckians per day were recorded as dying from Covid-19 last week, even as new coronavirus cases and positive-test rates kept falling. 

Kentucky reported 8,639 new cases of the virus in the reporting week that ended Sunday, March 20. That was 9% less than the prior week, when the state reported 9,532 new cases. The daily average last week was 1,234 per day; the prior week's daily average was 1,362. 

One-fourth of last week's new cases, or 2,194 of them, were in Kentuckians 18 and younger. 

The share of Kentuckians testing positive for the virus in the reporting week was 3.08%, down from 4.17% the prior week. The last time it was even close to this new rate was in early July, when the highly contagious Omicron variant of the virus was just taking hold. 

This is the eighth straight week both of these numbers have fallen.

The Kentucky Department for Public Health reports the statewide incidence rate over the last seven days is 10.65 daily cases per 100,000 residents. Counties with rates more than double that rate are Anderson, 44; Knott, 30.9; Green, 30; Jefferson, 29.3; Perry, 28.3; Wayne, 23.2; and Trimble, 21.9.

The New York Times and The Washington Post report much higher incidence rates for the state, respectively 32 and 28 daily cases per 100,000. The more detailed Times report shows 7,747 new cases reported March 14, with very high rates in the 10-county Lake Cumberland District Health Department area. State health cabinet spokeswoman Susan Dunlap said, "KDPH thinks there might be a problem in how they are transitioning from daily to weekly data feeds from the state and counties, so they are getting some strange numbers." 

The Times noted that it has "identified reporting anomalies or methodology changes in the data." It also notes that the state is transitioning to a weekly reporting schedule and that some counties report new data more frequently than others. It also notes that data is sometimes dumped without historical revisions, which can cause an irregular pattern in the daily reported figures and that it tries to exclude these anomalies from the seven-day averages when possible.

Both newspapers rank Kentucky's case rate second among the states, behind Idaho. Last week, Kentucky ranked 20th for this measure. 

The Centers for Disease Control and Prevention map that uses new cases, Covid-19 hospitalizations and intensive-care cases to determine the risk that the virus poses in each county puts only 24 of the state's 120 counties in red, meaning that the CDC still advises wearing a mask in indoor public spaces.

Most red counties are in Eastern Kentucky. In the 37 yellow counties, the CDC advises those who are immunocompromised or at high risk for severe illness should talk to their medical provider about precautions.

Covid-19 hospital numbers in also continue to drop. Kentucky hospitals reported 351 Covid-19 patients Monday, with 68 of them in intensive care and 40 on mechanical ventilation. The Times ranks Kentucky seventh among the states and Washington, D.C., for Covid-19 hospitalizations. 

Only three of the state's 10 hospital regions are using at least 80% of their intensive-care beds, with the Barren River region the highest at 92%. 

In the last week, an average of 2,115 doses of Covid-19 vaccine were administered per day in Kentucky, a 42% decrease from the week before, the Post reports. 

Kentucky attributed 279 more Covid-19 deaths in the week ended March 20, bringing the pandemic death toll in Kentucky to 14,659. The Covid-19 death average for the week in Kentucky was 39.86 deaths per day. This number has remained largely flat for the last three weeks.

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Senate sends House a bill to create a pilot program for treatment of offenders with mental-health or substance-use disorders

By Melissa Patrick
Kentucky Health News

A bill moving through the state legislature would create a pilot program to divert some qualifying low-level offenders away from jail and into treatment for substance-use disorder or mental-health issues.

State Sen. Whitney Westerfield

While getting his bill through the Senate, Judiciary Committee Chair Whitney Westerfield said he has been working on the problem for several years when he realized, at an unrelated meeting about bail issues, that everyone there recognized the need to address behavioral-health issues among prisoners. 

"The long and short of it is this," he told his colleagues. "Everyone in the room, the most hard-nosed prosecutor, the most soft-hearted defense attorney, every judge at every level, everyone agrees that the vast majority of our prison population could benefit from some sort of behavioral-health intervention."

Westerfield's Senate Bill 90 would create a pilot program in at least 10 counties, determined by the state Supreme Court, that would require a mental-health and substance-use disorder assessment for low-level offenders.

If an offender qualified, the prosecution and the defense attorney must agree for the offender to participate in the new Behavioral Health Conditional Dismissal Program.

Charges against the offender would be deferred, meaning that the prosecution would be "set on the shelf," Westerfield said. Those who successfully complete the program would have their charges dismissed. 

To qualify, offenders can't be charged with a felony higher than Class D (punishable by one to five years in prison), and can't have a previous conviction for a higher felony. Also, those charged with violent offenses or sex offenses, among others, would not be eligible.

In addition to treatment, the program would also offers educational, vocational and recovery-housing supports. It's been said over and over again that getting someone a job is the single most effective thing we can do to prevent offenders from committing another crime, Westerfield said: "If we can keep them from coming back, we've saved us all a bunch of trouble and we've saved a future victim."

With some exceptions, the program must last at least a year and cannot exceed the person's maximum incarceration time unless the defendant agrees in writing to extend the treatment period. 

That's important, said Senate President Robert Stivers, a co-sponsor of the bill, who said he had also been working on the problem for several years.

"Every study you will read will say that a person is less likely to be a recidivist or a relapser once you get beyond a year," he said. "If you get them . . . some type of skills and training and a job, your likelihood of relapsing or recidivism even drops greater than that." 

Stivers added, "I don't know if it goes far enough or too far. But truly, if we're thinking about getting into changing the trajectory of people's lives, getting people back to work, getting them off the welfare rolls, medical assistance, Medicaid, this is an alternative that I believe we should try."

Sen. David Yates, D-Louisville, said the program has the potential to be "transformative to the Commonwealth of Kentucky," because a tough-on-crime approach often does not work for people with mental health or substance-use disorder issues. Yates is a lawyer, as are Westerfield and Stivers. 

"This is just an excellent step in the right direction to get people out of jail, into the workforce, into our economy and stopping this terrible cycle that we hear over and over again," Yates said. 

Sen. Robin Webb, D-Grayson, a lawyer who voted against the bill, asked who would have access to the mental-health evaluation that is taken within 72 hours of intake, often before the offender has a lawyer. 

Westerfield said that would be medical information, so only the medical provider would have access to it unless the offender committed a crime during the assessment. He said he would be willing to adjust the bill in the House to ensure that the commonwealth's attorney does not have access to the assessment. 

SB 90 passed the Senate 27-4. In addition to Webb, Republicans Chris McDaniel of Ryland Heights, John Schickel of Union and Majority Floor Leader Damon Thayer of Georgetown voted against the bill.

The bill has a data-collection component to help determine its effectiveness. The program would begin in October and last four years unless extended or limited by the legislature.

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Asked about more money to fight the coronavirus, McConnell says Democrats need to use unspent money from 2021 relief bill

Senate Republican Leader Mitch McConnell said Sunday that Democrats should be willing to "reprogram" some unspent money from their previous pandemic relief bill to get more money to fight the coronavirus.

On CBS's "Face the Nation," McConnell was asked to comment on remarks by President Biden's chief health adviser, Dr. Anthony Fauci, on ABC's "This Week" that Congress needs to appropriate more funds for pandemic work. A partisan dispute kept such funding out of the recent omnibus spending bill.

McConnell said Democrats passed a $2 trillion relief bill last year, "allegedly for Covid . . . on an entirely partisan basis," and "much of that money" has not been spent. He said he is willing to "listen to the evidence" of the need for more money, but said Democrats need to use some of the unspent funds for it.

The Democrats' American Rescue Plan Act, passed about a year ago, gives local communities until 2026 to spend their allocations from it.

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Flu cases in Kentucky have ticked up a bit in the last few weeks, and it's not too late to get a flu shot; season can go through May

Kentucky Department for Public Health graph

By Melissa Patrick
Kentucky Health News

Following nine weeks of decline, influenza cases in Kentucky ticked back up.

The state Department of Public Health reports that in the week ended March 12, Kentucky had 170 new confirmed cases of flu, up from 140 the previous week. The week before that, 174 cases were reported, after a month with fewer than 100 cases per week. The state has recorded 3,228 cases this season and one flu-related death.

Dept. for Public Health map, adapted by Ky. Health News; click to enlarge

The health department raised Kentucky's flu level to "widespread" from "regional" because increases in cases were seen in more than half of the state's 16 health regions. Nine showed increases and two showed decreases.

The recent uptick follows a national trend. The Centers for Disease Control and Prevention reports that in the week ending March 12, "influenza activity is increasing in most of the country," with most of the increases seen in central and south-central regions of the nation. 

Flu season usually peaks between December and March, but can run through May." An annual flu vaccine is the best way to protect against flu," says the CDC. "Vaccination can prevent serious outcomes in people who get vaccinated but still get sick."

The flu shot is recommend for everyone ages 6 months and older as long as flu activity continues.

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Registration is open for April 14 conference in Bowling Green on youth vaccine that prevents certain types of cancer

Screenshot of flyer; for registration information, click here.

By Melissa Patrick
Ky. Health News

The Kentucky Rural Health Association is devoting a one-day conference to discuss a vaccine that can protect against infections and cancers caused by the human papillomavirus.

The HPV Vaccine Conference will be held at the Knicely Conference Center on Nashville Road in Bowling Green from 8 a.m. to 3 p.m. CST on April 14. Click here for registration. 

The conference agenda has not been released, but a draft agenda says it will include, among other topics, speakers who will talk about strategies to improve HPV immunization rates, rural HPV data, HPV vaccine resources and inter professional collaborations to increase HPV vaccination.

HPV, or human papillomavirus, is the most common sexually transmitted infection in the U.S. and can cause cancers of the cervix, vagina, vulva, penis, anus, rectum, throat and the back of the tongue. More than 90% could be prevented by the vaccine, according to the Centers for Disease Control and Prevention. 

Two doses of the HPV vaccine are recommended for all 11- and 12-year-olds, although the series can be started at age 9. It is also recommended for those 13 to 26 if not vaccinated already. A three-dose schedule is recommended for people who get their first dose on or after their 15th birthday and for people with certain immunocompromised conditions. 

In addition, it is also recommended that anyone between 27 and 45 who is not vaccinated should talk to their health-care provider about their risk of infection and the benefits of getting vaccinated. 

In 2020, only 55.7% of Kentucky teens aged 13 through 17 had received all recommended doses of the HPV vaccine, slightly below the national rate of 58.6%, according to the America's Health Rankings. Kentucky ranks 29th among the states. 

Those rates are even lower in rural Kentucky. Research published in the Journal of Rural Health found that HPV vaccination rates are 11% lower than urban rates. 

America's Health Rankings reports that among Kentucky's 13-to-17-year-olds, 65.5% of the HPV vaccines were given to girls and 46.4% were given to boys.

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Rand Paul's resolution to end the federal mask mandate in public transit passes Senate, but not by enough to overcome a veto

The federal rule applies to transport hubs and conveyances. (Photo by Brandon Bell, Getty Images)

By Al Cross

Kentucky Health News

The U.S. Senate passed Kentucky Sen. Rand Paul's legislation to end the mask mandate in public transportation, but not by a margin large enough to overcome a threatened veto by President Biden.

Paul's resolution passed 57-40 Tuesday but it takes a two-thirds vote (67 in the Senate) to override a veto, and the Democrat-controlled House could bottle up the resolution, relieving Biden of the burden of vetoing it. The rule had been set to expire Friday, March 18, but the administration extended it to April 18.

Biden's Office of Management and Budget said requiring masks in public conveyances and in transportation hubs had prevented the spread of Covid, "saving lives." It called them "places where people across communities congregate, often for extended periods and in close quarters. The determination of the timeline and circumstances under which masks should be required in these settings should be guided by science, not politics."

Paul, in a press release, called the rule an "anti-science, nanny state requirement" that is ineffective. "As the entire world is learning to live with Covid, the federal government still uses fear mongering to stubbornly perpetuate its mandates, rather than giving clear-eyed, rational advice on how to best protect yourself from illness."

The rule was issued by the Centers for Disease Control and Prevention in January 2021. On Feb. 25, 2022, it exempted school buses, in conjunction with relaxed guidance for mask wearing in schools. "Travel contributes to interstate and international spread of Covid-19," the CDC says. "Wearing masks that completely cover the mouth and nose reduces the spread of Covid-19."

Tuesday's vote was largely along party lines. Minority Leader Mitch McConnell of Kentucky and all other Republicans except Mitt Romney of Utah voted for the resolution, as did Democrats Mark Kelly and Krysten Sinema of Arizona, Michael Bennet of Colorado, Jon Tester of Montana, Jacky Rosen of Nevada, Maggie Hassan of New Hampshire and Joe Manchin of West Virginia.

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As most Covid-19 numbers in Kentucky continue to fall, Beshear 'pauses' weekly pandemic press conferences for second time

Ky. Dept. for Public Health graph, adapted by Ky. Health News; for a larger version, click on it.

By Melissa Patrick
Kentucky Health News

With almost every metric to measure the pandemic in Kentucky keeping on a steady decline, Gov. Andy Beshear announced that he was putting his weekly Covid-19 press conferences on a "pause." 

"While we still have some struggles, while this pandemic is still with us, things continue to move in the right direction and they are continuing to move at a regular pace," Beshear said. "That means cases, positivity rates [are] all declining, as well as hospitalizations, those in the ICU and those on ventilators. Every metric is moving the right direction."

Beshear stopped regular pandemic briefings last June, but resumed them after the highly contagious Omicron variant arrived. It caused the biggest surge of the pandemic.

"If I can go back in time and change a decision or a way to talk about things," Beshear said, "I really would have talked about how this was going to be a war. None of us have lived through this before so we didn't know. But I would have talked about how you don't win a war in two weeks. That a war may take two years and that's what it's been. And this war will end when we beat the virus or it becomes fully endemic," like influenza and cold viruses.

"We know so much more about the virus and how to fight it. In many ways, it has become a part of our daily lives,” he said. “If today is the last update we give, living with Covid is not ignoring Covid. It is having the information to be empowered to make the right decisions to protect ourselves.”

Beshear pointed to the largely green and yellow Centers for Disease Control and Prevention map, updated last Thursday and Friday, that uses new coronavirus cases and Covid-19 hospitalizations and intensive-care cases to determine the risk that the virus poses in each U.S. county. 

 

The map shows 32 Kentucky counties are red, signifying a high risk of infection and hospitalization, which the CDC says calls for wearing masks in indoor public spaces; 38 are yellow, signifying a medium risk; and 51 are green, indicating a low risk.

"This map is just one way to show how we are moving to a better place," Beshear said, adding that he expects to see many more yellow and green counties in Kentucky next week.

The bad news is that Kentucky's Covid-19 deaths, the pandemic's lagging indicator, keep rising. The state attributed 283 more deaths to Covid-19 in the reporting week ended Sunday, up from 275 the previous week. Beshear said 13 of the deaths were of people under 49, and one was 25. Kentucky's pandemic death toll is now 14,380. 

The governor encouraged Kentuckians to  pray for families of Covid-19 victims, and encouraged them to get vaccinated to prevent more deaths. He said that even with more vaccinations given in the last week, this is the only metric going in the wrong direction.

Actually, Kentucky's vaccination rate more than doubled in the last 10 days. The state averaged 3,662 doses per day last week, more than twice what the average was 10 days ago, when it bottomed out at 1,772 per day, according to CDC data presented by The Washington Post. 

Beshear noted that some people continue to get their first dose. Of the 25,000-plus vaccinations last week, 6,459 were first shots, 8,045 were the second shot; and 10,809 were boosters. 

Kentucky's Covid-19 vaccination rates remain below national averages, with 65% of the state's population having received at least one dose of a vaccine, 56% "fully vaccinated" and 43% of that eligible population with a booster shot.

The percentage of Kentuckians testing positive for the coronavirus in the past seven days is now 4.17%, the lowest this rate has been since July 2021. 

In the week ended March 13, Kentucky reported 9,532 new coronavirus cases, down from 12,010 the week before. It was the seventh straight week this number has fallen. 

Kentucky's new-case rate has finally dropped out of the leaders in the The New York Times rankings; it is now 20th among the states. It had a 78% decline in the last 14 days, the second fastest decline among states. 

However, the state still has many hot spots. The Times reports that Pike County has the highest rate of any county in the nation, with 175 cases per 100,000; the Nome Census Area in Alaska is first among counties and county equivalents, at 239/100K.

Many Kentucky counties are in top 50: Trigg, McCreary, Perry (6th, 7th and 8th); Wayne, Morgan, Taylor (12,13,14); Bath (21), Clinton (24), Pulaski, Adair, Green (28,29,30); Whitley (36), Breathitt (39), Montgomery (42) and Caldwell (48).

Kentucky hospitals reported 470 Covid-19 patients on Monday, with 95 in intensive care and 56 on mechanical ventilation. The Times ranks Kentucky's hospitalization rate fifth in the nation, even though that rate has dropped 49% in the last 14 days.

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House passes bill to allow APRNs to prescribe controlled substances after a four-year collaborative agreement with doctor

American Association of Nurse Practitioners map, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

A bill to create a path for Kentucky's advanced practice registered nurses to prescribe controlled substances independently has passed the state House with only eight members voting against it. 

“We are always talking about encouraging folks to enter the health-care field; we hear discussion about a shortage of nurses that we have,” Rep. Russell Webber said while presenting the bill on the House floor. “This bill will help with that.”

House Bill 354, sponsored by Webber, would allow an APRN to prescribe controlled substances without a collaborative agreement with a physician, after practicing under such an agreement for four years and getting approval from the Kentucky Board of Nursing.

If the board decides an APRN is abusing this authority, it can require them to go back under a collaborative agreement, or it can take further action.

The latest version of the bill would hold independently prescribing APRNs to the same standard of care as other prescribers, and create a Controlled Substance Prescribing Review Panel to monitor them.

"This component adds teeth to this bill. It adds strength," said Webber, a Shepherdsville Republican. "It  may very well help us get to the bottom of some problems that are existing out there, if they are existing, but the data will certainly be worthwhile for us to have. Problems that may surface will be worthwhile for us to know."

Rep. Russell Webber

Webber was alluding to the implicit contention of the doctors' lobby, the Kentucky Medical Association, that APRNs haven't been responsible enough with their prescribing of Schedule II drugs, those with high potential for abuse, to prescribe them independently.

In Kentucky, APRNs have been able to prescribe controlled substances since 2006 under a "collaborative agreement for prescriptive authority-controlled substances," or CAPA-CS. They are allowed to prescribe a 72-hour supply of a Schedule II drug; HB 354 wouldn't change that.

The bill's primary co-sponsor, Rep. Patti Minter, a Democrat from Bowling Green, told the House that it is needed to increase health-care access in a state that has only 57 percent of the primary-care practitioners it needs and 25% of needed mental-health personnel. 

"Nurse practitioners are for many people the primary-care providers," Minter said. "They're the family doctors of the community."

Rep. Jerry Miller, R-Eastwood, said the bill would improve access to health care. "This is a good bill for the people," he said. "It may not be a good bill for the doctors, but it's a good bill for the people of Kentucky." 

House health committee Chair Kim Moser, R-Taylor Mill, a former nurse and a doctor's wife, voted no. Moser said she liked the amendments because "It's critical that all prescribers play by the same rules" but cautioned, "The only thing that we are doing by passing this bill is increasing controlled substances."

The House voted against suspending its rules to let Moser offer a floor amendment to reinstate the requirement that an APRN be licensed to practice for a year before being prescribing controlled substances, to obtain a registration certificate from the Drug Enforcement Administration and pass each component of the federal licensing exam in three attempts, just as physicians must do before prescribing controlled substances. 

Rep. Mary Lou Marzian, D-Louisville, a nurse, said the bill is needed because APRNs need a DEA number to order some diabetic and psychiatric medication, durable medical equipment, and flu and antibiotic shots.

APRNs were allowed to prescribe controlled substances without a collaborative agreement in the pandemic through an executive order that the General Assembly approved, but that ended in January when lawmakers extended the state of emergency but did not extend the APRNs' expanded authority.

Dueling numbers

A before-and-after comparison by the Kentucky Association of Nurse Practitioners & Nurse-Midwives, said there were "no significant differences in the average number of opioid prescriptions by APRNs without the CAPA-CS in place" before the emergency order was implemented and the six quarters it was in place. Similar findings were also noted for dentists and physicians. 

The data came from the state's Kentucky All Schedule Prescription Electronic Reporting system. Other KASPER data provided by the APRN association shows that the average number of Schedule II prescriptions per APRN prescriber dropped 34.9% between 2015 and 2021. 

Webber said, "Nurse practitioners were not writing prescriptions hand over fist for controlled substances and flooding the state with opioids." 

The KMA disputed those figures before the House Licensing, Occupations and Administrative Regulations Committee on March 9.

Cory Meadows, KMA's deputy executive vice president and director of advocacy, said "We have KASPER numbers that show that they are consistently up, way up over the course of a lot of years."

KASPER data provided by the KMA, comparing the total number of prescriptions for Schedule II opioids prescribed by APRNs shows an increase in all but one year since since 2011, the year before lawmakers passed what is called the "pill-mill bill" that placed restrictions on opioid prescribing.

There are some discrepancies, many of them slight, in the year-to-year numbers provided to Kentucky Health News by the two organizations, and they measure different things. 

For example, the APRN group provided the average number of Schedule II opioid prescriptions per the number of prescribers since 2015 and for seven recent quarters, while the KMA provided year-to-year percentage changes for the total number of such prescriptions. 

KMA data shows that Schedule II opioid prescribing by APRNs went up 8.2% between 2020 and 2021, years that the CAPA-CS were no longer required, under the executive order.

The APRN data shows that the average number of Schedule II opioid prescriptions per APRN dropped from 100.68 in 2020 to 99.28 in 2021 and that their quarterly average in 2021 was 25 prescriptions. The average was 50 for physicians and 22 for dentists.

The bill passed the House 84-8 and moves to the Senate, where it will be carried by Sen. Julie Raque Adams, R-Louisville. 

The "no" votes were all Republican: Moser, Joe Fischer of Fort Thomas, Kim King of Harrodsburg, Mathew Koch of Paris, Adam Koenig of Erlanger, Sal Santoro of Union, Nancy Tate of Brandenburg and Killian Timoney of Lexington.

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