2-1 appeals court ruling will interrupt gender-affirming care for Ky. transgender youth as the new law against it moves through courts

Judges Jeffrey Sutton, Amul Thapar and Helene White are pictured in front of the Potter Stewart Courthouse in Cincinnati, where their Sixth Circuit U.S. Court of Appeals sits. (L.A. Blade illustration)

By Melissa Patrick
Kentucky Health News

A federal appeals court panel voted 2-1 last Monday to allow Kentucky to enforce a recently enacted ban on gender-affirming care for transgender youth while the law that imposed the ban works its way through the courts. The ruling will have a health impact on transgender youth undergoing treatment.

The provisions in 2023 Senate Bill 150 under legal challenge are the ones that ban gender-affirming medical care for minors diagnosed with gender dysphoria, such as hormone therapy and puberty blockers.  

The American Civil Liberties Union of Kentucky has filed a motion asking that the entire Sixth Circuit Court of Appeals review the ruling, which would involve all 16 judges instead of the three-judge panel.

ACLU Communications Director Angela Cooper said the motion was filed because the ruling risks "irreparable harm" to some transgender youth.

"Youth who are already receiving puberty blockers and hormone therapy are being forced to taper off that service or seek it out of state," Cooper said. "We don't advise clients on what to do about their medical choices, but they are being forced to make very serious decisions about their health that go against the advice of their physician and the prevailing standard of care." 

She added that the medications are "prescribed by their doctor, in accordance with the prevailing standard of care. It's the same as any other medication and it should not be denied." 

Gender-affirming care is considered the accepted standard of care and is recommended by a broad range of medical associations, including the American Medical Association and the American Academy of Pediatrics. 

In early August, the AAP reaffirmed its policy to support gender-affirming medical care for transgender youth, while also taking steps to commission a systematic review of medical research and treatments. The group said it opposed "any laws or regulations that discriminate against transgender and gender-diverse individuals, or that interfere in the doctor-patient relationship." 

The AMA has strongly opposed laws that ban gender-affirming care for transgender youth, while voicing concerns about the increased risk of mental-health conditions, including depression, anxiety and suicidality, that transgender youth often experience – especially when they lack appropriate supports.

"It is important to note that this higher suicide risk is not unavoidably associated with transgender or nonbinary status, but instead is the result of stigma, discrimination and mistreatment," Dr. Jack Resneck, immediate past president of the AMA, wrote last August. "A large body of medical literature demonstrates that with support at home, school and in the community – and with access to gender-affirming care – transgender youth do as well on mental-health measures as their non-transgender peers." 

Kentucky's ban was set to take effect in late June, but on June 28 U.S. District Judge David Hale placed a temporary block on the section of the law that dealt with gender-affirming care. After the same Sixth Circuit panel issued a similar ruling in a Tennessee case, Hale lifted his injunction. Four days later, on July 18, the ACLU filed for emergency relief that would allow gender-affirming care while the lawsuit worked its way through litigation. On July 31, the request was rejected. 

Attorney General Daniel Cameron, the Republican nominee for governor against Democratic Gov. Andy Beshear, applauded the appeals court ruling, which allows SB 150 to be enforced in full. "Last night’s ruling was a win for Kentuckians and a win for our values," he said in an Aug. 1 news release.

The ruling was not unexpected, given the Tennessee ruling. It was written by Chief Judge Jeffrey Sutton, an appointee of George W. Bush, and Judge Amul Thapar, an appointee of Donald Trump.  

They said the issues involved – irreparable harm, the balance of harms, the public interest and the ACLU's likelihood of success on the merits – are best left to the legislature rather than judges: “The people of Kentucky enacted the ban through their legislature. That body, not the officials who disagree with the ban, sets the Commonwealth’s policies.”

Judge Helene White, who was first nominated by former President Bill Clinton and later nominated by Bush, dissented.

She wrote that the need for an injunction to block the ban in Kentucky was greater than in Tennessee because "Kentucky's law provides no grace period during which patients receiving care may continue treatment. Instead, health-care providers must immediately cease treatment or "institute a period during which the minor's use of the drug or hormone is systematically reduced."

Tennessee's law allows minors that are receiving treatment to keep getting it until March 31, according to the appeals court's decision. 

The decision ruling is preliminary. An expedited final ruling on the lower court's ban is expected by Sept. 30. 

"At least 20 states have now enacted laws restricting or banning gender-affirming medical care for transgender minors. Most of those states face lawsuits. A federal judge struck down Arkansas’ ban as unconstitutional. In other states, judges have issued disparate rulings on whether the laws can be enforced while the cases are being litigated," The Associated Press reports.   

If you’re looking for transgender peer support, you can reach Trans Kentucky at 859-448-5428 or online at transkentucky.com. You can also contact the Trevor Project, which provides free, confidential counselors who specialize in helping LGBTQ youth.

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Mobile unit provides addiction recovery, other medical services in Glasgow, Leitchfield, Hodgenville, Bardstown and Lebanon

The Intensive Health mobile unit serves five rural communities in
    Kentucky. Photo by Michael Crimmins with Glasgow News 1. 

A drug-recovery company based in Glasgow is using a mobile health-care unit and partnerships with businesses to bring an array of health services to people in the area, Michael Crimmins reports for Glasgow News 1. 

The white-panel van, run by Intensive Health, part of Stepworks, is housed with "medical equipment such as gloves, AEDs [automatic external defibrillators], blood-drawing equipment and a small room in the back for telecommunication," Crimmins reports.

Jonathan Fondow, the mobile unit's data coordinator, told Crimmins that the unit offers both recovery services and general medical services in Glasgow, Hodgenville, Lebanon, Bardstown and Leitchfield, going to a different location on each of the five days it operates.

The unit provides medication-assisted treatment, mental-health counseling, Hepatitis C screening and treatment, HIV screenings, health assessments, primary care, and general medical services, according to its website.  Fondow said the unit also offers peer-support services for people who need addiction care. 

Fondow told Crimmins that they provide mental-health care via telehealth with two therapists in Elizabethtown, where the company began.

 “We’re trying to put the stigma behind us, so someone that needs to talk to someone can also go in the back of this mobile unit and speak to therapists," he said. 

He added that patients who need further assistance would be referred to a pharmacy or healthcare service in the community. And, he said, they can help people with gas cards or transportation if needed.

Crimmins reports that the mobile unit has been a great service to homeless people, who often don't have medical insurance. 

“So far, since we started last week, around 70 percent of our patients are homeless,” Fondow said. “They have nothing except their backpack that they’re carrying.”

According to Fondow, Crimmins writes, "The mobile unit is run through a four-year federal grant of $2 million to help the people, primarily in rural areas, that are without insurance and either are forced to forgo treatment or pay entirely out of pocket. In that same vein, he said, a goal of the unit was to get patients at least started on the path to Medicaid."

This mobile health-care model will soon expand in Kentucky via the state-federal Medicaid program.

In mid-July, the Centers for Medicare & Medicaid Services announced that Kentucky will join five other states in providing mobile Medicaid crisis intervention teams later this year, Sarah Ladd reports for Kentucky Lantern.  It will take effect Oct. 1 and funding will come from the American Rescue Act of 2021.

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As a drug-resistant fungal disease, Candida auris, adapts to the warmer climate, cases of it rise; up 214% in Kentucky in 2022

Cases of a potentially fatal fungal disease called Candida auris have increased by 1,200 percent since 2017 and the warmer climate could be to blame, Camille Fassett reports for The Associated Press and Grist.

All of Kentucky's 29 clinical cases of C. auris were reported in 2021 and 2022. However, there was a 214% increase between the years, with seven in 2021 and 22 in 2022, according to the Centers for Disease Control and Prevention. 

Fungal disease expert Arturo Casadevall, a microbiologist, immunologist and professor at Johns Hopkins University, told Fassett that humans normally have tremendous protection against fungal infections because of our temperature. 

“However, if the world is getting warmer and the fungi begin to adapt to higher temperatures as well, some … are going to reach what I call the ‘temperature barrier’,” he said, referring to the threshold at which mammals’ warm bodies usually protect them from infection.

In other words, Fassett writes, "Over time, humans may lose resistance to these climate-adapting fungi and become more vulnerable to infections. Some researchers think this is what is happening with C. auris." 

And while C. auris is not usually dangerous for healthy people, it can be for older patients, people with pre-existing medical conditions and people in health-care settings. The death rate is estimated to be between 30% and 60%, according to the CDC. 

The pathogen was first identified 14 years ago in Japan and early on most cases in the U.S. were linked to people who had traveled from other places, Meghan Marie Lyman, an epidemiologist for mycotic diseases at the CDC, told Fassett. Now, she said, most cases are acquired locally, generally spreading among patients in health-care settings.

"In the U.S., there were 2,377 confirmed clinical cases diagnosed last year," Fassett reports. She adds, "In the U.S., the most cases last year were found in Nevada and California, but the fungus was identified clinically in patients in 29 states. New York remains a major hot hotspot."

Dr. Luis Ostrosky, a professor of infectious diseases at McGovern Medical School at UTHealth Houston, told Fassett that he thinks C. auris is “kind of our nightmare scenario.”

“It’s a potentially multidrug-resistant pathogen with the ability to spread very efficiently in health care settings,” he said. “We’ve never had a pathogen like this in the fungal-infection area.”

The problem is so bad that the CDC issued a news release in March, calling the fungus "an urgent antimicrobial resistance (AR) threat" and noted that it "spread at an alarming rate in U.S. health-care facilities in 2020-21." 

"CDC has deemed C. auris as an urgent AR threat, because it is often resistant to multiple antifungal drugs, spreads easily in health-care facilities, and can cause severe infections with high death rates," the release says.

The article is published in Grist, an online journal of environmental news and commentary, as part of a collaboration with AP called Climate Connections, to explore how a changing climate is accelerating the spread of infectious disease around the world, and how mitigation efforts demand a collective, global response.

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UK HealthCare again top Kentucky hospital in U.S. News & World Report rankings, with four more in the state listed among the best

By Melissa Patrick
Kentucky Health News

Five Kentucky hospitals have been named among the nation's "Best Regional Hospitals" in the annual ranking by the U.S. News & World Report magazine. 

The No. 1 hospital in Kentucky is the University of Kentucky hospital, followed by St. Elizabeth Healthcare Edgewood-Covington. Tying for third place were Baptist Health Lexington, Norton Hospitals and St. Joseph Hospital-Lexington. 

To make the list, a hospital must:

• Offer a full range of services;
• Rank nationally in one of 11 measured specialties, or have seven or more high-performance rankings for procedures and conditions; and
• Have at least three more "high performing" than "below average" rankings for procedures and conditions.

The report offers an overview of 121 Kentucky hospitals with a breakdown of each of the measured categories, according to the services a hospital provides.

UK HealthCare, for the eighth straight year, ranks No. 1 with its Albert B. Chandler Hospital. It also ranked in the top 50 hospitals for cancer care for the seventh straight year, ranking 44th. Its Markey Cancer Center is Kentucky's only National Cancer Institute-designated cancer center, and one of 72 in the nation.

"Excellence in health care is not merely a title to be held but a relentless pursuit to improve the lives of our patients,” Dr. Robert S. DiPaola, UK's provost and acting co-executive vice president for health affairs, said in a news release. “To be consistently ranked among the best in the nation requires a commitment to exceptional care, groundbreaking research, innovative education and compassionate service from our faculty, providers and staff across UK HealthCare as we serve Kentucky and beyond."

The evaluation of the UK hospital includes data from its Kentucky Children's Hospital and Good Samaritan Hospital. The hospital system was also nationally ranked in two other adult specialties: ear, nose and throat and obstetrics and gynecology and three children's specialties: pediatric cardiology and heart surgery, pediatric orthopedics and pediatric urology. 

It rated high-performing in the adult specialty of gastroenterology and GI surgery, and the following procedures and conditions: chronic obstructive pulmonary disease, colon cancer surgery, diabetes, heart attack, heart failure, hip replacement, kidney failure, leukemia, lymphoma and myeloma, lung cancer surgery, ovarian cancer surgery, pneumonia, stroke, and uterine cancer surgery.

St. Elizabeth ranked high-performing in these procedures and conditions: colon cancer surgery, lung cancer surgery, prostate cancer surgery, abdominal aortic aneurysm repair, heart attack, heart bypass surgery, heart failure, diabetes, kidney failure, back surgery (spinal fusion), stroke, ovarian cancer surgery, uterine cancer surgery, hip replacement, knee replacement, COPD, and pneumonia. 

Baptist Health Lexington rated high-performing for leukemia, lymphoma and myeloma, colon cancer surgery, heart attack, back surgery (spinal fusion), stroke, hip replacement and knee replacement. 

Norton Hospitals (Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Healthcare Pavilion and Norton Women's and Children's Hospital) rated high-performing in prostate cancer surgery, heart attack, aortic valve surgery, heart bypass surgery, heart failure, stroke, maternity care (uncomplicated pregnancy), hip replacement and knee replacement. It ranked below average for hip fractures. 

St. Joseph Hospital-Lexington rated high-performing for colon cancer surgery, heart attack, heart bypass surgery, heart failure, kidney failure, COPD, and pneumonia. 

 

Data from the report came from the Centers for Medicare & Medicaid Services, the American Hospital Association, professional organizations and medical specialists. Ratings for procedures and conditions were based entirely on objective quality measures, the news release said.  

The 34th annual rankings compared hospitals in 15 specialties and 21 common procedures and conditions. Nationally, the report named the top 22 hospitals to the national "Honor Roll."  The top hospitals were not ranked this year, but were instead listed in alphabetical order. Regionally, 494 hospitals were recognized in 49 states and 92 metro areas as "Best Regional Hospitals." 

Click here for a list of frequently asked questions about how the magazine ranks the hospitals.

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Some experts say Alzheimer's drug is brilliant first step to a cure; others say it's a waste of money that shortchanges the poor

Photo from Eisai Co., maker of the drug

By Arthur Allen
KFF Health News

The first drug purporting to slow the advance of Alzheimer’s disease is likely to cost the U.S. health care system billions annually even as it remains out of reach for many of the lower-income seniors most likely to suffer from dementia.

Medicare and Medicaid patients will make up 92% of the market for lecanemab, according to Eisai Co., which sells the drug under the brand name Leqembi. In addition to the company’s $26,500 annual price tag for the drug, treatment could cost taxpayers $82,500 per patient per year, on average, for genetic tests and frequent brain scans, safety monitoring, and other care, according to estimates from the Institute for Clinical and Economic Review (ICER), a nonprofit that evaluats the cost-effectiveness of health care.

The Food and Drug Administration gave the drug full approval July 6. About 1 million Alzheimer’s patients in the U.S. could qualify to use it. The drug is still in a clinical trial being conducted at many unversities, including the University of Kentucky.

Patients with early Alzheimer’s disease who took lecanemab in the trial showed mental decline five months later than other subjects over an 18-month period, but many suffered brain swelling and bleeding. Although those side effects usually resolved without obvious harm, they apparently caused three deaths.

The great expense of the drug and its treatment raises questions about how it will be paid for, and who will benefit.

“In the history of science, it’s a significant achievement to slightly slow down progression of dementia,” said John Mafi, a researcher and associate professor of medicine at UCLA. “But the actual practical benefits to patients are very marginal, and there is a real risk and a real cost.”

To qualify for Leqembi, patients must undergo a PET scan that looks for amyloid plaques, the protein clumps that clog the brains of many Alzheimer’s patients. About 1 in 5 patients who took Leqembi in the major clinical test of the drug developed brain hemorrhaging or swelling, a risk that requires those taking the drug to undergo frequent medical checkups and brain scans called MRIs.

In anticipation of additional costs from the Leqembi drug class, the Centers for Medicare and Medicaid Services (CMS) in 2021 increased monthly premiums for Medicare patients by 15%, and premiums may rise again in 2024 after a slight decline this year.

Such increases can be a significant burden for many of the 62 million Medicare subscribers who live on fixed incomes. “Real people will be affected,” Mafi said. He contributed to a study that estimated lecanemab and related care would cost Medicare $2 billion to $5 billion a year, making it one of the most expensive taxpayer-funded treatments.

In its analysis, ICER suggested that Leqembi could be cost-effective at an annual price of $8,900 to $21,500. In an interview, David Rind, ICER’s chief medical officer, said $10,000 to $15,000 a year would be reasonable. “Above that range doesn’t seem like a good place,” he said.

Whatever its price, patients may be delayed getting access to Leqembi because of the relative shortage of specialists capable of managing the drug, which will require genetic and neuropsychological testing as well as the PET scan to confirm a patient’s eligibility. A similar drug, Eli Lilly’s donanemab, is likely to win FDA approval this year.

Already there are long waits for the testing needed to assess dementia, Mafi said, noting that one of his patients with mild cognitive impairment had to wait eight months for an evaluation.

Such testing is not readily available because of the lack of effective treatment for Alzheimer’s, which has helped to make geriatrics a relatively unappealing specialty. The United States has about a third as many dementia specialists per capita as Germany, and about half as many as Italy.

“Time is of the essence” for the neuropsychological testing, Mafi said, because once a patient’s cognitive ability declines below a certain threshold, they become ineligible for treatment with the drug, which was tested only in patients in the earliest stages of the disease.

Mafi’s study estimates that patients without supplemental Medicare coverage will have to pay about $6,600 out of pocket for each year of treatment. That could put it out of reach for many of the one in seven  “dual eligible” Medicare beneficiaries whose income is low enough to simultaneously qualify them for Medicaid. The two programs are responsible for about 20% of physician bills for drug infusions, but they don’t always cover the full amount.

Some practitioners, such as cancer centers, cover their Medicaid losses by charging privately insured patients more. But since almost all lecanemab patients are likely to be on government insurance, that “cross-subsidization” is less of an option, said Soeren Mattke, director of the Center for Improving Chronic Illness Care at the University of Southern California.

This poses a serious health-equity issue because “dual eligibles are low-income patients with limited opportunities and education, and at higher risk of chronic illnesses including dementia,” Mattke said in an interview. Yet many doctors may not be willing to treat them, he said. “The idea of denying access to this group is just appalling.”

Eisai spokesperson Libby Holman said the company is reaching out to specialists and primary-care physicians to make them aware of the drug, and that reimbursement options were improving. Eisai will provide the drug at no cost to patients in financial need, she said, and its “patient navigators” can help lock down insurance coverage.

“A lot of clinicians are excited about the drug, and patients are hearing about it,” said David Moss, chief financial officer of INmune Bio, a company that has another Alzheimer’s drug in development. “It’s a money center for infusion centers and MRI operators. It provides reasons for patients to come into the office, which is a billing thing.”

Outstanding doubts about Leqembi and related drugs have given urgency to efforts to monitor patient experiences. CMS is requiring Leqembi patients to be entered into a registry that tracks their outcomes. The agency has established a registry, but the Alzheimer’s Association, the leading advocacy group for dementia patients, is funding its own database to track those being treated, offering physician practices $2,500 to join it and up to $300 per patient visit.

In a letter to CMS on July 27, a group of policy experts said CMS should ensure that any and all Leqembi registries create and share data detailed enough for researchers and FDA safety teams to obtain a clear picture of the drug’s real-world profile.

The anti-amyloid drugs like lecanemab have created a polarized environment in medicine between those who think the drugs are a dangerous waste of money and those who believe they are a brilliant first step to a cure, said ICER’s Rind, who thinks lecanemab has modest benefits.

“People are as dug in on this as almost anything I’ve ever seen in medicine,” he said. “I don’t think it’s healthy.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at the Kaiser Family Foundation, an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Covid-19 vaccines: What parents need to know now

Photo illustration via Children's Hospital Los Angeles

The Covid-19 pandemic is no longer a national emergency, but the virus that caused it isn’t gone—and neither is the risk of getting the disease, says Children's Hospital Los Angeles. It published a Q and A with Dr. Michael Smit, the hospital's medical director of infection prevention and control:

Who is eligible for the bivalent Covid-19 vaccine that was approved last fall? Everyone who is 6 months and older should get a bivalent booster dose as long as it has been at least two months since they received a monovalent vaccine dose, which was the original Covid vaccine. People who are 6 years and older and who are immunocompromised can also receive a second dose of bivalent vaccine at least two months after their first dose of the bivalent. If you have questions about the eligibility of you or your child to get the booster, you should check with your medical provider.

For children who are getting their first Covid-19 vaccine shot, will they receive the original monovalent series or the bivalent vaccine? The current Covid-19 vaccine guidelines from the Centers for Disease Control and Prevention, which were updated in May 2023, recommend that unvaccinated children 6 months and older get the bivalent vaccine.

Are children who received the original Covid vaccine series eligible for the bivalent booster? Yes. Children who already received the original vaccine series are eligible for the bivalent vaccine. The guidelines can be complicated if your child has previously received the original vaccine, so I recommend consulting public health guidelines and your medical provider.

Coronavirus cases are waning in most places in the U.S. Do you recommend getting the bivalent vaccine if you haven’t gotten it? I recommend following vaccine guidelines provided by U.S. public health agencies such as the CDC and the California Department of Public Health. Although Covid-19 cases are currently low, it is still a serious disease that can cause illness, hospitalization and death.

What does the research show about side effects of the Covid-19 vaccine in children? Side effects of the Covid-19 vaccine tend to be mild and temporary. The most common side effects for children ages 6 months to 3 years include pain on the leg or arm where the shot was given, swollen lymph nodes, irritability or crying, sleepiness and loss of appetite. For children 4 to 17, side effects also include pain at the site where the shot was given, swollen lymph nodes and fatigue. This age group can also experience headaches, chills, muscle aches and loss of appetite. In some rare cases, adolescent boys have been found to experience myocarditis, a rare inflammation of the heart, after vaccination. However, the risk of this condition is higher for children who get infected with Covid-19 than for those who have received the vaccine.

The CDC has indicated that people will get a Covid-19 vaccine shot once a year. Is that for everyone? People 65 and older can receive a dose of the bivalent vaccine at least four months after the first dose. I recommend that people discuss whether to get the additional booster with their medical provider.  The CDC has not announced a second booster shot for groups other than those who are 65 and older or people who are immunocompromised.

Can children get long Covid? Is there a way to protect against long Covid in kids or adults? Yes, children get long Covid. The best way to protect anyone against long Covid is to remain up to date on Covid-19 vaccinations. If you do not get Covid-19, you will not get long Covid. If you do get Covid-19 after being vaccinated, you are less likely to develop long Covid.

Are there medications available for adults or children if they get infected with Covid-19? Yes, there are medications available for both adults and children if they get Covid-19. These medications can have interactions with other medications or have specific indications for use based on an individual’s health status. I recommend discussing taking any Covid-19 medications with your medical provider.

What are the isolation rules today if someone is infected with Covid-19? If you test positive for Covid-19, current isolation guidelines from the CDC depend on whether or not you have symptoms. Regardless of symptoms, if you test positive you should isolate for five days. If you must be around others, you should wear a high-quality mask and avoid contact as much as possible. If you do not have symptoms, isolation is completed after day five, with day zero being the day you had a positive test. If you do have symptoms, then you may end isolation after day five as long as you are fever-free and your symptoms are improving. If you are experiencing moderate symptoms, including shortness of breath, you should isolate for 10 days. For moderate or severe cases, you should discuss specific isolation details with your medical provider.

What are the best ways to avoid Covid-19 at this point? The best way to avoid Covid-19 is to stay up to date on your vaccines. This decreases your chances of catching Covid-19, which, in turn, greatly decreases your chances of developing long Covid. You can also decrease your chances of getting Covid-19 by avoiding crowded situations where you cannot maintain physical distancing of about 3 feet—arm’s length—from others. If crowded situations cannot be avoided, then wearing a well-fitting mask may decrease your chances of getting Covid-19, but only if the mask is worn correctly and consistently.

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'Forensic nursing' idea of online Frontier Nursing University student could help victims of domestic violence in rural areas

Unseen and unspoken, rural victims of domestic violence are more likely to suffer alone because of geographical isolation, lack of medical support networks, and an "everybody knows everybody" small-town culture that can keep victims from asking for help.

Leslie Copp (Photo from The Daily Yonder)

With the help of a Tillman Foundation scholarship, Leslie Copp, a nurse who grew up in a home with domestic violence, aims to change some of that in rural Indiana, reports Liz Carey of The Daily Yonder. "Copp is an online graduate student at Frontier Nursing University, located in Versailles. Her nursing work includes caring for trauma victims and gathering evidence for prosecutors. She wants her graduate education to help her specialize in trauma care and establish trauma care centers in rural communities like her hometown of Odon, Indiana, pop. 1,400."

Forensic nursing is an emerging field that many students may not know exists. Copp began her medical career as a Certified Nurse Assistant, then earned a bachelor's degree in nursing, but along the way, "realized she enjoyed taking care of trauma victims and helping as a forensic nurse to collect evidence to assist in prosecuting abuse cases. She said she feels born to work as a forensic nurse examiner." She told Carey: "I was raised at the very first of my life in a home where I dealt with watching my mother go through domestic violence. I didn't realize that the trauma that I had been through as a young adult would set the base for something that I would grow to love. I turned my trauma into something that I could do to help others." Carey reports, "She intends to pursue a doctorate in nursing practice and to become a mental health nurse practitioner."

Copp told Carey: "In Indiana alone, there are wide areas where there are no resources or care for victims of trauma or violence. My goal is to start with one (rural trauma care center) and plant it in a place that has the widest area of no coverage so that we can at least start providing medical exams (for trauma victims) and point people in the right direction." Part of the dilemma in gathering prosecutorial evidence from victims is timing and victim bandwidth for the process, Carey writes. By the time a victim is treated at their local hospital, they don't have the energy to go to a metro hospital for another work-up. "Even if a nurse sees them in a metropolitan area, the patients get lost in the system without access to resources like trauma therapy, advocacy services, and support systems."

Frontier Nursing University Assistant Professor Dr. Joshua Faucett told Carey, "Copp's experience as a nurse and violence survivor made her a good candidate for the scholarship. . . . Leslie is a sexual assault nurse examiner and has testified on behalf of sexual assault victims to bring their abusers to justice." Carey adds, "Copp's goal is to create a trauma center in a rural area that could both do medical exams and help victims gain access to social workers, prosecutors, and emergency housing."

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