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Friday, August 12, 2022

Panel to study mental-health issues in criminal-justice system

Chief Justice Minton, Justice Lambert, Gov. Beshear
The Supreme Court of Kentucky has created a commission to investigate mental-health issues in the state's criminal-justice system. Its membership has not been announced, but it will be chaired by Justice Debra Hembree Lambert.

“I’m excited to focus on mental health and substance-use cases, but this will also be the first time there will be an all-hands-on-board effort to assess and improve the way the court handles intellectual disabilities,” Lambert said in a news release. “No group this broad and with this many resources has ever come together to tackle all three of these important issues.”

The Kentucky Judicial Commission on Mental Health "will potentially have a great deal of latitude," report John Cheves and Aaron Mudd of the Lexington Herald-Leader. "According to Lambert, the body will examine where the court system touches cases involving mental health, substance use and intellectual disabilities, she said in the news release. The commission will also be empowered to make recommended changes where appropriate," including training for judges, other court personnel, law-enforcement officers, mental-health providers and community advocates, she said.

Chief Justice John Minton, who named Lambert chair, said Kentucky is the latest state to tackle "the growing mental-health crisis in the justice system."

But Cheves and Mudd write, "This is not the first time the commonwealth has tried to address severe mental illness in the people caught up in the state’s justice system. So far, its efforts haven’t been all that successful." They note that "Tim's Law," which lets district judges order seriously mentally-ill people into outpatient treatment, apparently has been used only once, in Jefferson County.

The commission is scheduled to have its first meeting Sept. 22. It apparently will have some members from the executive branch of state government, since the Supreme Court announcement was accompanied by a photo of Minton, Lambert and Gov. Andy Beshear.

Thursday, August 11, 2022

CDC eases some Covid-19 guidelines, says 89 Ky. counties are at high risk of Covid-19; state's infection rate is highest in U.S.

CDC map estimates ranges of risk for contracting Covid-19.
By Melissa Patrick
Kentucky Health News

As the Centers for Disease Control and Prevention loosened some of its Covid-19 recommendations, even more Kentucky counties moved into the high-risk category for coronavirus transmission on the CDC's weekly risk map.

And The New York Times reports that Kentucky has the highest infection rate among the states.

The number of Kentucky counties in the high-risk category, orange on the CDC map, increased to 89, from 80 in last Thursday's report. The number of yellow counties, indicating a medium risk of Covid-19, dropped to 20, down from 31.    

The good news is that for the second week in a row, the state still has green counties on the map, indicating a low risk of Covid-19 transmission. The number of low-risk counties increased by two, to 11: Fulton, Calloway, Simpson, Logan, Butler, Edmonson, Green, Taylor, LaRue, Fleming and Bracken. 

In the high-risk counties, the CDC recommends that you wear a well-fitting mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed. If you live in a medium or high-risk county, the CDC advises wearing a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

The CDC's new guidance says people who are exposed to the virus no longer need to quarantine at home, regardless of vaccination status, although they should wear a high-quality mask for 10 days and get tested on day five. It also not longer recommends routine surveillance testing for people without symptoms and says contact-tracing is only necessary in health care settings or high-risk congregate settings. 

With schools starting, the CDC made several changes in its recommendations for schools, no longer mentioning its "test-to-stay" option and no longer recommending routine testing, unless it is in response to high-risk activities during high Covid-19 community transmission or in response to an outbreak. 

Masks continue to be recommended only in areas where community transmission is high, or if a person is at high risk of severe illness. The CDC publishes maps showing the level of community transmission in each county; all Kentucky counties but four (Hickman, Lyon, Todd and Metcalfe) have high levels. 

One CDC recommendation that remains the same is that people with Covid-19 should isolate for at least five days as long as they are without a fever for 24 hours without the use of fever-reducing medication and all other symptoms have improved. They should then wear a mask through day 10, or test negative twice over 48 hours before they stop wearing a mask. 

Beshear's view: At his weekly news conference, Gov. Andy Beshear said that with the state's weekly coronavirus cases going up and down, the hope is that we are heading toward a plateau. He said cases increasing for a while and then going down is what some experts see going forward. 

Beshear noted that hospitalizations continue to go up and while they are still relatively low, he said, "That's still a lot of people in the hospital, folks, so make sure you get vaccinated . . . Make sure you get boosted as well and if you are over 50, get that second booster."  

He added, "Everybody now has all the information on how Covid spreads, what you can do to stop it. Please try to make the best decisions for you knowing that at this point, we all know how this thing works and how we can protect ourselves." 

The data shows that the pandemic is clearly not over, even though 31.7% of Kentuckians think it is, and 53% of them say it is over for them, according to a Foundation for a Healthy Kentucky poll taken June 4-July 13. 

Asked what can be done to persuade Kentuckians that the pandemic is not over,  Beshear said Kentuckians are tired of it, and of wearing masks, then said the most important thing we can do is to get more people vaccinated and boosted. He also said Kentucky will keep sharing pandemic information with Kentuckians even as other states quit. 

He said that at this point in the pandemic, Kentuckians need to recognize that they will just need to change their behaviors, like wearing masks, for a few weeks at a time, instead of forever. 

Beshear spoke as the CDC was relaxing its guidance, while sharing a similar message as the governor. 

“We’re in a stronger place today as a nation, with more tools—like vaccination, boosters, and treatments—to protect ourselves and our communities, from severe illness from Covid-19,” CDC epidemiologist Greta Massetti said in a news release. “We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing, and improved ventilation. This guidance acknowledges that the pandemic is not over, but also helps us move to a point where Covid-19 no longer severely disrupts our daily lives.”

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."