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Thursday, August 11, 2022

UK health workers in flooded areas work to provide care

By Hillary Smith
University of Kentucky

HAZARD, Ky. — More than a week into recovery and relief efforts following the devastating floods in Eastern Kentucky, Dr. Key Douthitt sums up the experience with two words: “I’m exhausted.”

But what he and his community are going through is not so simple. Douthitt is the medical director for UK HealthCare’s North Fork Valley Clinic in the hard-hit city of Hazard.

He considers himself one of the lucky ones.

“My wife told me this morning, think how exhausted you would be if you didn’t have a home, you didn’t have electricity, you didn’t have a car,” he said. “So at the end of the day, whatever I’m going through is small in comparison to what a lot of our neighbors are.”

A mobile dental unit donated by Ronald McDonald House was converted to
a basic-care unit for wound care and vaccinations. (UK photo by Hilary Brown)
Two weeks ago, parts of several communities were virtually wiped away by the floodwaters, with some homes being swept off their foundations and carried away. In Eastern Kentucky, it’s common for generations of families to put their homes on the same strip of land. For those who had the misfortune of being along the path of the historic flooding, pieces of their families’ homes and many of their belongings are now scattered along creek banks and even up in trees, showing just how high the water rose. Anything left behind, including the insides of homes, are now caked in layers of mud.

Along with family keepsakes, electronics, clothes and food, many residents are also left without crucial items like lifesaving medications, identification and insurance cards, glasses, dentures, walkers, canes and more.

Several homes that were spared have been without electricity for days, which is problematic, especially for those who rely on things like oxygen and CPAP machines. Getting generators to those homes is a top priority. Health care workers are working tirelessly to try to meet the growing list of needs in their communities and know that these needs are dire — and will only continue to grow.

UK HealthCare operates two clinics in the flooded areas. The North Fork Valley Clinic in Hazard is still operational; however, the June Buchanan Clinic in Hindman experienced significant flooding.

“When we see someone who is down, we are going to pick them up and try and pull them back up as best we can,” said Douthitt. “So we're used to hard times here but we're also used to coming together as a community.”

With support from UK’s Center of Excellence in Rural Health in Hazard and volunteers, the staff from the two clinics have spent the past several days out in the community offering aid. They have been a shining example of what a community health care worker is.

“In a lot of these communities, we find people that either can’t or don’t want to leave what is left of their homes. They are worried about looting, and it is where they are comfortable,” said Douthitt. “They won’t come to us; we know we are going to have to go to them. And after all they have been through, that’s the least we can do.”

While crews have worked tirelessly to clear main roads throughout the mountains, the reality is that dozens of bridges, culverts and small roads remain impassable — or have even been wiped from existence.

“Unless you are from this area, you don’t really know what rural means … especially flooded rural,” said Pam Cornett, who is working out of one of UK HealthCare’s mobile clinics. Cornett, a Letcher County native, typically works as a dental hygienist in the dental mobile units but is using her skills and expertise to help with wound care and vaccinations for flood survivors.

Rescue teams have needed to get creative in finding ways to provide help for some of these hard-to-reach areas. CERH Director Fran Feltner noted that one of their mobile teams were unable to reach someone in need even on an ATV — so they instead got to the person and delivered necessary supplies by horseback.

“Our rural Kentucky mountains are beautiful places to live, a place we call home, a place where family, friends and neighbors lend a helping hand or shoulder to lean on in times of disaster,” said Feltner. She says as their teams are out working to access those impacted by the floods, they are often joined by neighbors who also want to help by providing extra hands, an ATV or their own horse.

“That is what we do here. You go out into these communities, and you just see the absolute devastation,” said Douthitt. “We were out the other day and came across a man who was all cut up. It was because he was out looking for his wife’s body. When you see that stuff, you just know we need to do everything we can for these people.”

UK's two dental units operated out of its Hazard clinic have been converted for basic wound care and tetanus vaccinations. As one lady rolls up her sleeve to receive her shot, she quietly tells the team member, “We lost everything.”

Her husband is also there, being inspected for a puncture wound on his foot. The family, including an 84-year-old, had waded through water up to their necks to get to safety.

“Everyone is kind of bewildered and overwhelmed,” Cornett said. “One gentleman told me that he doesn’t know where to even start.”

As they travel, the mobile clinics are also handing out backpacks with a day or two supply of hygiene items and food that have been collected and organized by the Center for Excellence in Rural Health.

“I’m trying to stay focused on the medical needs knowing we have people working hard to get the other supplies out,” said Douthitt. “Together, we are going to make sure the whole person is taken care of.”

The team members in the mobile care units are also helping connect those in need with the appropriate contacts and services.

“I met a man yesterday who lost his prosthetic leg in the flood, so we are working to get him set up and get that replaced,” said Cornett. “Basically, we’re trying to get anything they need in order to get back to some sort or normalcy.”

While these health care heroes work tirelessly to help their community, they are also living the experience as an Eastern Kentuckian.

“We have staff trying to come and concentrate on providing medical care to people when the whole time they're thinking, ‘I need to be doing X, Y or Z for my family. My family needs me right now,’” said Douthitt. “And it's a lot. That's a lot to put on people.”

Next, the hope is to have the June Buchanan Clinic cleaned up and operational soon.

“We are just going to get through this one day at a time, one moment at a time,” said Douthitt. “Eventually we will be able to look back and say, ‘Look how we picked ourselves back up.’”

The region is far more complex than many understand. From its hills to its valleys, the area is rich in tradition and pride. Those are all things that the floodwaters could not wash away.

“I’m very proud to be from this area,” said Cornett. “We have some really good people, really strong people. We will bounce back. It might take years, but we will bounce back.”

In the aftermath of the floods, there are many moving parts and a constantly changing list of needs, some which could mean the difference between life and death. It can be overwhelming at times, which is why the health care workers try to keep the focus on what really matters — the strength in their community and unwavering support from strangers — all while taking it one step at a time.

“When you say to someone, ‘Hey, I know you aren’t from here, but can you get on an ATV and run this up to the next holler over and they say, Yes!’ It just warms your heart,” said Douthitt. “To see people come together for a common goal, it just shows at the end of the day we are all on this same earth, and we're just going to pitch together to do the best we can.”

Monday, August 8, 2022

Kentucky children's well-being ranks 37th in U.S., foundation says

Data book ranks states in four major domains with 16 indicators to produce an overall rating.
By Melissa Patrick
Kentucky Health News

The annual Kids Count Data Book on children's well-being, released Aug. 8 by the Annie E. Casey Foundation and Kentucky Youth Advocates, again ranks Kentucky 37th in the nation for the overall well-being of its children.

The Data Book rates children's overall well-being through 16 indicators in four major domains: health, economic security, education and family and community. 

Overall, Kentucky saw improvement in 10 of the 16 indicators, did worse in four and stayed the same on one. One indicator did not show a comparison. 

"Though the commonwealth made progress on a number of indicators of child well-being over the past decade, rankings continue to show that we are not making progress as quickly as other states," KYA Executive Director Terry Brooks said in a news release. "In fact, Kentucky is in the bottom 10 of states for six of the 16 indicators."

Nearly one in four Kentuckians are children. Here is a look at each domain. 

Charts from Kids Count Data Book
Health: Kentucky's health ranking dropped for the second year in a row, with two of the indicators used to measure it worsening. This year's report ranks the state 38th, down from 35th in last year's report. The year before, Kentucky's health ranking plummeted from 25th to 42nd after Kids Count changed measured childhood obesity instead of youth alcohol and drug abuse. 

This year's report says 39% of Kentucky's children were either overweight or obese in 2019-20, up from 37% in 2016-2017. The national rate is 32%. Kentucky continues to have the highest obesity rate in the nation in children 10 to 17.  

Kentucky also saw an increase in the rate of deaths of children per 100,000 residents 19 and under. That rate increased to 35 deaths per 100,000 in 2020 from 32 per 100,000 in 2010. The national rate is 28 deaths per 100,000. 

The good news is that Kentucky continues to have a low rate of children without health insurance, 4%. The national average is 5%. 

Another indicator of children's health is the rate of babies born weighing less than 5.5 pounds. That rate was 8.5% in Kentucky in 2020, slightly lower than in recent years. 
Education: Kentucky ranked 26th in the report's Education domain, up from 30th last year. 

The good news is that 91% of the state's high-school students graduate on time, well above the national rate of 86%. 

Also, the state saw a slight decrease in the share of Kentucky eighth-graders who were not proficient in math, dropping to 71% in 2019 from 73% in 2009. And while that's good news, it still means only 29% of them are proficient in math. 

Two indicators in this domain worsened. The share of preschool-age children not in nursery school, preschool or kindergarten increased to 59% in 2016-20 from 56% in 2008-12. And the share of fourth-graders not proficient in reading inched up to 65% in 2019, from 64% in 2009.
Economic well-being: Kentucky ranks 38th in economic well-being, up from 40th in last year's report, with all four indicators showing improvement since 2008-2012. 

The percentage of children in poverty dropped to 22% in 2016-20, from 26% in 2008-12; children whose parents lacked secure employment dropped to 31% from 36%; and teens not in school and not working dropped to 8% from 10%. 

Also, the percentage of children living in households with a high housing cost burden dropped to 24% in 2016-20 from 30% in 2008-2012. 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.
Family and Community: Kentucky ranked 42nd in the family and community domain, up from 43rd in last year's report.

Kentucky improved in three family-and-community indicators, including children living in high poverty areas (14%), children living in families where the household head lacks a high school diploma (10%) and teen births. 

In 2020, there were 24 births per 1,000 females aged 15-19. In 2010, that number was 46 per 1,000. The current national average is 15 per 1,000. 

The percentage of children living in single-parent homes in 2016-2020 stayed the same as it was in 2008-2012, 35%. 

Focus on mental health

For the first time, the annual Data Book focuses on youth mental health, noting that the number of young people with mental-health issues was high before the pandemic, and has only gotten worse. 

"The coronavirus upended everyday life to an extent not seen since World War II," said Lisa M. Hamilton, president and CEO of The Annie E. Casey Foundation. "It is no surprise that millions of parents, caregivers and other adults are feeling overwhelmed. So are children, who face what the U.S. surgeon general has called a 'mental health pandemic' for youth." 

The Data Book reports that children across Kentucky and the nation were more likely to encounter anxiety or depression during the first year of the pandemic than they were before. 

In Kentucky,  there was a 28% increase in the number of children aged 3 to 17 who had been diagnosed with or reported to have anxiety or depression by a doctor or a health-care provider between 2016 and 2020. The share increased from 12.4% to 15.9%. 

"This increase represents 29,000 more children who are struggling to make it through the day," KYA said.

Brooks said, "The pandemic years have taken a toll on everyone — from our health professionals and educators to our families — including the rising crisis in mental health for children and youth. And, in addition to experiencing mental health challenges as a result of the pandemic, children still contend with the conditions that were making life harder well before the coronavirus — such as poverty, community violence, and hunger. Policymakers must continue to prioritize policies and investments that ease mental health burdens on children and their families — and don’t leave anyone behind." 

Call for action

KYA called on the state legislature and Congress to prioritize the basic needs of Kentucky' children, including policies to ensure financial stability for families and that ensure access to nutritious foods, stable housing and safe neighborhoods. KYA also calls on the state to ensure that every child has access to trauma-informed mental-health care that is available when and where they need it.

"All kids deserve the chance to thrive, no matter their zip code, race, or family’s income. That vision will only come to fruition when our lawmakers prioritize what’s best for all kids and families," said Brooks. "That means that Kentucky laws are written by Kentuckians and not by external national groups. That means the interests of vulnerable kids are the priority and rather than succumbing to the influence of dark money. Whether you are an elected legislative leader or a candidate for governor, there can be no more ethical priority than the interests of Kentucky's boys and girls."

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.

New coroanvirus cases went up again last week, after a week of decline; N.Y. Times says state's infection rate still 2nd highest

New York Times map, adapted by Kentucky Health News, shows Kentucky is a national hot spot.

By Melissa Patrick
Kentucky Health News

After dropping 7.7% the previous week, new coronavirus cases in Kentucky increased 6.8% last week and the share of Kentuckians testing positive for the virus continued to rise. 

The state's report for the Monday-to-Sunday reporting period, says Kentucky had 15,652 new cases last week, an average of 2,236 cases per day. That's a 6.8% increase from the prior week when it was 2,093. 

Nearly 16% of the new cases were in people 18 and younger. Health officials continue to urge families to get their children vaccinated against Covid-19 as schools begin to start. So far, state data shows that fewer than 46% of Kentucky's school age children have been fully vaccinated, and that number is even lower for children between 5 and 11: only 20%. 

The percentage of Kentuckians testing positive for the coronavirus increased to 18.41%, up from 17.89% the week before. This rate does not include at-home tests. 

The statewide incidence rate of new cases declined again, to 39.05 per 100,000 residents. Last week that rate was 40.52. The top 10 counties were: Leslie, 137.4; McCreary, 116.1; Perry, 103.7; Floyd, 77.5; Knott, 77.2; Harlan, 68.7; Rowan, 66.0; Knox, 64.2; Lee, 63.7; and McLean, 62.1.

The New York Times still ranks Kentucky's infection rate second among the states, with a 38% increase in cases in the last 14 days. It says Perry County has the nation's highest rate, 148 per 100,000. State officials have attributed the disparities to differing methodologies, including the state's removal of duplicate test results.

Hospitals reported that Covid-19 hospitalizations increased, but fewer Covid-19 patients were in intensive care. Kentucky hospitals reported 623 Covid-19 patients on Monday, up 21 from a week earlier. They reported 74 intensive-care patients, down 15, and 27 on mechanical ventilation, down six. 

The state attributed 67 more deaths to Covid-19 last week, up from 45 the week before. That was the largest weekly total since 79 in mid-May, when the numbers were falling after four months with most weeks in triple digits. The pandemic death toll is now 16,464.

Sunday, August 7, 2022

Senate passes bill to limit Medicare drug costs, keep Obamacare discounts; Ky. senators vote no, citing tax increases, inflation

Kentucky Health News

Senate Democrats passed a bill Sunday titled the Inflation Reduction Act, which would allow Medicare to negotiate with drug manufacturers to lower prices, as well as limiting out-of-pocket drug costs for Medicare beneficiaries and continuing pandemic-lowered rates for federally subsidized health insurance.

Mitch McConnell and Rand Paul of Kentucky joined all other Republican senators in voting against the bill, which would also pay for several measures to combat climate change. It passed the Senate on Vice President Kamala Harris's tie-breaking vote and is expected to pass the House this week.

The bill targets climate change mainly through tax credits for electric vehicles, and would be paid for with "substantial tax increases, mostly on large corporations, including establishing a 15 percent corporate minimum tax and imposing a new tax on company stock buybacks," The New York Times reports. It also aims to boost tax revenue by boosting the payroll of the Internal Revenue Service.

Republicans said the economy is in recession, so it is no time to raise taxes, and cited official estimates that the bill would have little economic impact. McConnell said in a press release that Democrats' "response to the runaway inflation they’ve created is a bill that experts say will not meaningfully cut inflation at all. The American people are clear about their priorities. Environmental regulation is a 3% issue. Americans want solutions for inflation, crime, and the border."

Florida Sen. Rick Scott said on CBS's "Face the Nation" that because drug companies will have less money for research, "there will be lifesaving drugs that seniors will not get." Told that the Congressional Budget Office estimates that only 1% of drugs would be so affected, Scott said a viewer's grandmother might be in the 1%.

Those provisions would not take effect until 2026 and would apply to only 10 drugs, but would include more drugs in later years.

The bill would put a $2,000 annual cap on seniors' out-of-pocket costs for prescription drugs, and would guarantee that they could get vaccines without charge. Medicare patients would pay no more than $35 a month for insulin; the bill would have set the same limit for private insurance plans, but Republicans forced removal of that, based on the parliamentary rules governing the bill.

People on federally subsidized health insurance, known as Obamacare, would continue for three years the discounts that Democrats pushed into law last year and that would otherwise expire this fall, just before the annual enrollment period for Obamacare policies. About 90,000 Kentuckians have such policies.

Saturday, August 6, 2022

Deadline is nearing for nominations for the Dan Martin Award for lifetime contributions to rural health in Kentucky

Since 2003, the Kentucky Rural Health Association has presented an individual with an award for lifetime contributions to rural health in Kentucky. The award is named for its first recipient, Dr. Dan Martin of the Trover Foundation in Madisonville. 

The Dan Martin Award is given to someone who has provided many years of service to rural health, whether in patient care, administration, health-professions education, health administration, health promotion or public advocacy.

The rural heath association is seeking nominations for this year's award. To nominate someone, complete this form. The deadline for nominations is Wednesday, Aug. 31. 

KRHA members who would like to serve on the Dan Martin Award Committee should email Garrett Anspach at gban222@uky.edu. The committee ranks the candidates using established criteria and makes a recommendation to the  KRHA Executive Committee, which selects the honoree, if one is deemed appropriate.  The award will be presented at the KRHA Annual Conference Nov. 16-17 at the Center for Rural Development in Somerset.

"There are many dedicated, compassionate people at work in rural health in Kentucky and we look forward to being able to give them some well-deserved recognition," the KRHA said in a news release. "Now is your chance to help us thank someone that you think deserves recognition. We need and appreciate your input."

Friday, August 5, 2022

State senator selected for national fellowship on population health

State Sen. Ralph Alvarado
State Sen. Ralph Alvarado, R-Winchester, is one of 23 fellows from 20 states selected for the 2022-23 class of the Milbank Fellows Program for senior executive-branch and legislative leaders who are committed to improving population health in their states and communities.

The fellowship is funded by the Milbank Memorial Fund, a nonpartisan foundation focused on improving population health and health equity.

“I’m honored to be selected for a fellowship for which so few are even considered,“ said Alvarado, who is a physician. “Improving health outcomes for Kentuckians remains a focus area for me in my role both as a physician and as a state legislator.”

Working in partnership with the Colorado Health Institute and the Public Leadership Group, Milbank will support the fellows gaining knowledge about population health issues, interdisciplinary health and human services systems, and evidence-based approaches to improving population health; expanding their personal insight and leadership capacities in support of defining and advancing a population health vision and agenda; and creating meaningful connections with a network of colleagues from within the cohort and the Milbank State Leadership Network, so they can leverage their new knowledge and capacities to take action in their states.

“Each Fellow in our new cohort brings a remarkable wealth of health policy expertise as well as diversity of life experience,” Milbank program officer Kate McEvoy, who oversees the state leadership programs, said in a news release. “We look forward to engaging with the Fellows and supporting them in continuous learning and the development of successful population health initiatives.”

Since 2015, Alvarado has represented the 28th Senate District, now Bath, Clark, Menifee and Montgomery counties and part of eastern Fayette County. He was then-Gov. Matt Bevin's choice for lieutenant governor in 2019. His current responsibilities include co-chair of the Interim Joint Committee on Health, Welfare and Family Services; member of the Medicaid Oversight and Advisory Committee, the Administrative Regulation Review Subcommittee, and the Cabinet for Health and Family Services Organizational Structure, Operations and Administration Task Force; and liaison member of the Budget Review Subcommittee on Human Resources.

Thursday, August 4, 2022

9 counties drop to low risk of Covid-19, but 80 remain at high risk; Kentucky infection rate second highest among the states

CDC map, adapted by Kentucky Health News
By Al Cross
Kentucky Health News

Kentucky's risk from Covid-19 fell slightly last week, based on the county-by-county risk as estimated by the Centers for Disease Control and Prevention.

The state still had 80 of its 120 counties in the high-risk zone, indicated by orange on the CDC map released Thursday, but unlike last week, it has some counties at low risk. There are nine: Fulton, Logan, Edmonson, Grayson, Green, Adair, Pulaski, Nicholas and Bracken. Another 31 are at moderate risk.

In the 80 high-risk counties, state guidelines call for wearing masks in indoor public spaces, limiting in-person gatherings, limiting the size of gatherings, and social distancing. People in the 31 moderate-risk counties who are immunocompromised, or at high risk for severe illness from the virus, should talk to a health-care provider about whether they need to wear a mask or take other precautions, the CDC says.

The CDC provides other maps, including one that shows the level of coronavirus transmission. It shows every county has a high level except Carlisle and Lyon counties in West Kentucky, which are moderate. State officials say the risk map, which is based on new coronavirus cases, hospital admissions and hospital capacity, is the best guidance for preventive measures.

The improvement in the risk map reflected a slight decline in new cases last week, but Kentucky's seven-day infection rate remains the second highest among the states, trailing only Alaska, according to The New York Times. It says Perry County has the highest rate in the U.S., not counting parts of Puerto Rico and the Northern Mariana Islands. Greenup and Letcher counties also rank very high nationally.

Beshear noted a dip last week in the percentage of Kentuckians testing positive for the coronavirus, to 17.89% from the previous week's 19.11%, but said it takes more than one week to make a trend.

"If you are a vulnerable Kentuckian, with age or health conditions, you really need to be vaccinated," he said. "So many people are getting it, that we are seeing more bad outcomes than with the last variant."