31% of Kentucky women live more than half an hour from a hospital with a maternity unit; across the U.S., only 9.7% do

Map from 2023 March of Dimes report

By John McGary, WEKU

“Estill Medical. This is Madisyn. How may I help you?”

It’s a few minutes before lunch at Estill Medical Clinic, in Irvine. The practice is owned by nurse practitioner and Estill native Donna Isfort. It offers many services, but, like every other medical facility in the county, no obstetrician/gynecologist.

Isfort said, “Many, many of my patients at least have to travel anywhere from 30 minutes to 60, 70, minutes just to get to obstetrical care. There's just not any here. We have no nurse midwives. . . . I do family practice, so I do a lot of women's health at my clinic, but not prenatal care.

Estill County does have a hospital, but a spokesman for Mercy Health-Marcum and Wallace Hospital said it hasn't delivered babies since 1986, not counting unplanned births in the emergency room.

According to a 2023 report by the March of Dimes, women living in what some call “maternity care deserts” like Estill and several nearby counties must travel more than twice as far to get the care they need. Multiple studies conclude that greater distance puts women, expectant and otherwise, at greater risk.

The report says 31 percent of Kentucky women live more than 30 minutes form a birthing hospital; the national figure is 9.7%.

Isfort says she and her staff work closely with the Estill County Health Department to provide the help they can and out-of-county referrals for services they can’t provide.

Some think Kentucky’s maternity care deserts may spread. At a June 24 rally in Lexington to mark the two-year anniversary of the Supreme Court’s toppling of Roe v. Wade, second-year medical student Shriya Dodwani painted a bleak picture.

“The Accreditation Council for Graduate Medical Education requires that OB/GYN residents have access to abortion training,” Dodwani said. “This isn't about politics. It's about ensuring that we have the comprehensive skills needed to provide the best possible care for our patients. Without this training in Kentucky, we're left with no choice but to leave and pursue our education elsewhere.”

In a recent survey of students at Kentucky’s three medical universities, 62 percent of respondents said they’re considering finishing elsewhere because of the state’s near-total abortion ban.

A week later, University of Kentucky HealthCare officials unveiled a plan that could help some women in rural areas. The outreach division of UK Women’s Health OBGYN announced they’d add services at 19 new sites, several in Eastern Kentucky, and expand telehealth services.

Dr. Emily DeFranco is chair of UK’s Department of Obstetrics and Gynecology, said “We'll send a sonographer with an ultrasound machine to the site, and they'll perform the ultrasound and then virtually, by telemedicine, the physician who is in Lexington is able to view the images from the ultrasound, and then have a video conference with the patient on that site and counsel her about the findings.”

That sort of outreach could eliminate some of the long trips many women must make for routine care. Another program, funded in part by Medicaid and tobacco-settlement dollars, helps expectant and new mothers: HANDS, which stands for Health Access Nurturing Development Services. It’s available to all women during pregnancy through a child’s third birthday.

At the Estill County Health Department, Teresa Talbott is the ongoing home visitor, dropping in weekly with 15 to 20 families per year for the last 17 years.

“We're not coming in to look at your home. We're not coming, you know, to tell you what t“o do, Talbott said. “We're just coming in and giving you the information and helping you along with it.”

One woman she’s helping now is Whitney Bingham, who happens to be the health department’s Women, Infants and Children program coordinator. Talbott, who Bingham calls TT, is assisting her and her two-year-old son through challenges ranging from potty training to car-seat installations.

But Bingham says that when it’s time for her to leave for an OB-GYN visit, she makes the hour-long drive to Lexington.

The state Cabinet for Health and Family Services declined our request for an interview with the Department for Public Health’s director of women’s health.

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More than 3,700 calls from Kentucky to the 988 suicide-and-crisis lifeline have been routed to the Veterans Crisis LIne

By Lisa Autry
WKU Public RadioMore than 16,000 Kentucky veterans struggling with their mental health have used the national 988 hotline since it launched two years ago.

The suicide and crisis lifeline doesn’t require callers to disclose personal information, but veterans' overall use can be tracked because callers can be directed to the Veterans Crisis Line. In Kentucky, more than 3,700 calls have been routed to the veterans line so far this year, according to the state Cabinet for Health and Family Services.

In a recent speech to the Veterans of Foreign Wars state convention in Bowling Green, Gov. Andy Beshear urged veterans to seek help.

“We see an epidemic of suicide among our veterans and even our active service members that is unacceptable," Beshear said. "It’s important we have all of the services to make that individual whole at the ready.”

Since the 988 line was launched in July 2022, more than 80,000 calls have been received from residents of Kentucky.

The line connects those in distress to trained counselors 24 hours a day, via calls, chats or text messages. Thirteen of Kentucky's 14 regional mental health centers serve as call centers, and the 14th is in the process of becoming nationally certified. That means 988 calls in all 120 counties can be served by a local center instead of the call being answered out of state.

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Brooke A. Flinders, a double graduate of Frontier Nursing University, will become its next president on Aug. 1

Brooke Flinders

Kentucky Health News

Brooke A. Flinders, who earned her advanced degrees from Frontier Nursing University, has been named the next president of the Versailles institution. 

Flinders has extensive experience as an advanced practice nurse, educator, and college administrator. She will leave her position as a nursing professor and associate provost at Miami University in Ohio and become president of FNU on Aug. 1. She holds a Master of Science in Nursing and a Doctor of Nursing Practice degree from FNU. 

“We are thrilled that Dr. Flinders has accepted the offer to become the next president of Frontier Nursing University,” said FNU Board Chair Michael Carter.  “Dr. Flinders’ wealth of experience as an educator, practitioner, and administrator will be a tremendous asset to our students and to our faculty and staff who support them. We are extremely excited about the future of Frontier under Dr. Flinders’ leadership.”

Flinders will succeed Susan E. Stone, who was with the university for more than 30 years, the last 23 as president. Stone will be president emeritus and chair of midwifery and nursing on FNU's board.

Flinders obtained her Associate Degree of Science in Nursing (1994) and Bachelor of Science in Nursing (2003) degrees from Miami. In addition to acute care and community-based care experience as a registered nurse and full-scope practice as a certified nurse-midwife, Flinders has been a nurse educator, nursing department chair, and associate dean.

“I am proud and honored to accept the position of president of Frontier Nursing University,”  Flinders said. “My connection to Frontier extends nearly two full decades, and I am so proud to be one of its more than 9,000 graduates. . . .  I believe wholeheartedly in Frontier’s mission to provide accessible nurse-midwifery and nurse practitioner education that integrates the principles of diversity, equity, and inclusion, and I am excited to carry it forward.”

Flinders received the 2021 Distinguished Alumni Award from Miami's nurisng department, and in recognition of their service efforts during the Covid- pandemic, she and each of her nursing colleagues received the President’s Service Medallion. Flinders became a fellow of the American College of Nurse-Midwives in 2021, as a recognition of her demonstrated leadership, clinical excellence, scholarship, and professional achievement.

“As a proud graduate of Frontier School of Midwifery and Family Nursing and Frontier Nursing University, I am eager to build upon the amazingly strong foundation that already exists,” Flinders said. “Health-care provider shortages and the maternal mortality crisis plague our country. Frontier has a long history of finding unique solutions to complex problems, and we will continue to be a leader in identifying and implementing solutions by producing highly prepared nurse-midwives and nurse practitioners who have answered the call to serve.”

FNU was founded in 1939 as the Frontier Graduate School of Midwifery by the Frontier Nursing Service, a group of nurses and nurse-midwives who have served rural areas of Kentucky since 1925. Formerly located in Hyden, FNU completed its transition to Versailles in 2022 and is "one of the largest not for profit universities in the United States for advanced nursing and midwifery education, its website says.

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Coleman reappoints two members to state opioid commission

By Melissa Patrick
Kentucky Health News

Attorney General Russell Coleman has reappointed two members to the state opioid commission, thus not changing the balance of votes on the issue of syringe-exchange programs, which he says he opposes.

Those members are Jason Roop, an assistant professor of business and theology at Campbellsville University, who represents victims of the opioid crisis, and Van Ingram, who works for Gov. Andy Beshear as executive director of the Kentucky Office of Drug Control Policy and fills a slot representing the drug treatment and prevention community. Each of their terms expires in 2026. 

The Kentucky Opioid Abatement Advisory Commission has nine voting and two non-voting members. The legislature created the commission in 2021 to distribute the state's portion of the $900 million in settlements with opioid manufacturers and distributors, with half of the money going to the state and the other half going to local governments. 

The money is provided in installments and so far, the state has awarded 110 grants worth more than $55 million for treatment, prevention and recovery. 

Atty. Gen. Russell Coleman

Coleman's opposition to syringe exchanges was revealed when Chris Evans, the commisison's executive director and a Coleman employee, passed on a vote approving a grant for the Boyle County Agency for Substance Abuse Prevention because it included help for a syringe exchange. 

In passing, Evans said Coleman doesn't support the exchanges. Coleman, a Republican who was elected in November, later said that was especially the case for programs that are not limited to one-for-one exchanges. His spokesman said Coleman would not base commission appointments on the issue.

As of February, 41 Kentucky counties had syringe-exchange programs that operate under a one-to-one rule and 24 counties have needs-based exchanges, according to the state Department for Public Health. It estimates that the overall return rate of syringes is upwards of 90%.

Syringe exchanges are supported by research. The Centers for Disease Control and Prevention says injection drug users who have access to exchanges are five times more likely to get treatment than those who don’t. Another study says the exchanges do not encourage drug use or increase the frequency of drug use among current users.

Exchanges were authorized by the state's 2015 anti-heroin law, in an effort to thwart the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. 

Patricia Freeman, a University of Kentucky pharmacy professor, has also been reappointed to the commission – by UK as a representative of the HEALing Communities study team, which is working on reducing drug-overdose deaths. Her term will expire in 2026. 

Two new non-voting members have also been appointed. State Rep. Chris Fugate, R-Chavies (Perry County), was appointed by House Speaker David Osborne to replace retiring Rep. Danny Bentley, R-Russell. Karen Kelly, chief of staff to U.S. Rep. Hal Rogers, R-5th District, was appointed by Senate President Robert Stivers to replace Carlos Cameron. 

Other members of the commission are Republican state Treasurer Mark Metcalf, who also passed on the Boyle County vote; Cabinet for Health and Family Services Secretary Eric Friedlander, who works for Beshear; Von Purdy, a vice president of Simmons College in Louisville, representing citizens at large; Darren "Foot" Allen, a retired state trooper, representing law enforcement; and Karen Butcher, representing citizens at large.

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Cardiologists moving to positron emission tomography (PET) scans to diagnose heart diease, rather than SPECT scans

Image by Artemis Diana, iStock/Getty Images Plus

By Dr. Talal Alnabelsi

University of Kentucky

When it comes to diagnostic imaging of your heart – such as MRI, CT, SPECT, or PET – it can be overwhelming to know what kind of scan is right for you. What is your doctor looking for, and what exactly does the imaging show?

Imaging is vital in assessing and treating coronary artery disease (CAD), a condition in which plaque gradually builds up in the blood vessels. Over time, as the plaque accumulates, the blood vessels become narrower, reducing the blood supply to the heart muscle, which in turn could lead to symptoms such as chest pain or shortness of breath or a heart attack.

Risk factors for CAD are high cholesterol, high blood pressure, family history of heart disease, diabetes, smoking and obesity. It’s important for cardiologists to have a clear image of the heart to determine the extent of the plaque buildup or whether the plaque is causing any blockage in order to develop an effective treatment and prevention protocol.

Traditionally, cardiologists have relied on a type of imaging called single photon emission computed tomography (SPECT) to diagnose coronary artery disease and the extent of blockage in your heart. This involves the injection of a radioactive tracer into the veins while a special camera picks up the traces of the tracer, photographing it as it moves through the heart. The photographs are assembled into a three-dimensional image, showing areas of tissue damage and reduced blood flow.

There is a new movement among cardiologists to use positron emission tomography, or PET scans, to assess coronary artery disease. Although the procedure for a PET scan is similar to SPECT – both involve photographing radioactive tracers as they move through the heart – PET scans are more accurate and have a better image quality than SPECT.

Other benefits of PET scan for cardiac imaging include:

• Overall scan time is shorter than for SPECT imaging, vital for patients who may find it difficult to be in the enclosed space of the imaging machine for a prolonged period
• Allows assessment of not just the blood flow, but how well the heart muscle itself pumps blood
• The ability to determine your coronary-artery calcium score
• Can diagnose patients who continue to have chest pain despite no obvious blockage on cardiac catheterization or heart CT (microvascular disease)
• Lower dose of radiation, beneficial to patients who have to go undergo frequent imaging
• Image and assess patients who are suspected to have other conditions, such as cardiac sarcoidosis or endocarditis, scarring in the heart muscle or an infection from an implantable device such as a pacemaker.

Beyond heart disease, cardiac PET scans can image patients who have other suspected conditions including cardiac sarcoidosis or infections of implanted devices (pacemakers/defibrillators) or prosthetic heart valves.

While PET scans are not as widely available as SPECT, they give cardiologists a more complete picture of your heart’s health, reducing the need for alternative imaging tests or unnecessary invasive procedures. If your local health-care facility does not offer PET imaging, ask your cardiologist for a referral.

Talal Alnabelsi, M.D., is a cardiologist at UK HealthCare’s Gill Heart & Vascular Institute.

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Debunking myths, misconceptions and misinformation about sunscreens: no evidence they cause cancer, but they do expire

Photo illustration from M.D. Anderson Cancer Center

By Gina Van Thomme and Kellie Bramlet Blackburn

MD Anderson Cancer Center

Sunscreen is a hot topic – and not just because it’s a summertime staple!

There are also many myths and misconceptions surrounding sunscreen’s safety, effectiveness and usefulness.

So, if you’ve ever been confused about when – or if! – to use sunscreen, you’re not alone.

We asked MD Anderson Cancer Center dermatologist Anisha Patel about common sunscreen myths. Read on for her answers.

Myth 1: All sunscreens work the same way.
False. Sunscreens can prevent sunburn in different ways:

• Chemical sunscreens: The active ingredients in chemical sunscreens absorb ultraviolet (UV) rays as they hit the skin, Patel explains.
• Physical blocker sunscreens: Physical sunscreens, which are also called mineral sunscreens or sun blocks, use ingredients such as zinc oxide and titanium dioxide to form a barrier on the skin’s surface that reflects UV rays.

Not sure whether to use a chemical or physical sunscreen? Hybrid sunscreens contain both chemical absorbers and physical blockers.

When selecting a sunscreen, Anderson dermatologists recommend choosing a broad-spectrum product with at least sun protection factor (SPF) 30. 'Broad spectrum' means the product protects from both UVA and UVB rays which can lead to sun damage and skin cancer. SPF refers to the amount of UVB rays it blocks.

Myth 2: It doesn’t matter what kind of sunscreen I choose.
False. While wearing sunscreen is always a good choice, each type of sunscreen has instructions that must be followed to ensure your skin is protected.

Sunscreen comes in formats including cream, lotion, spray, powder and stick.

Each type of sunscreen has benefits and limitations. For example, many spray sunscreens are clear and absorb into the skin quickly, but this feature can make it challenging to see if you’ve missed a spot.

Overwhelmed by options? Anderson dermatologists recommend physical blocker sunscreens. Patel says this is because they have the broadest range of UVA and UVB protection.

Whatever type of sunscreen you choose, always review its instructions for information on how – and how frequently – to apply and reapply.

Myth 3: Sunscreen causes cancer.
False. There is no medical evidence that sunscreen causes cancer. However, there is a lot of evidence that UV rays from the sun and tanning beds do.

In the past, some sunscreens were recalled for being contaminated with a chemical called benzene. Benzene is not normally found in sunscreen. This recall doesn’t mean you should stop wearing sunscreen, dermatologists say.

Still, some may feel more comfortable using sunscreens that don't absorb into the skin – that is, those physical blockers sunscreens described above.

Additionally, sunscreen isn’t the only way you can practice sun safety. “There are a lot of sun protective options outside of just the creams and sprays,” Patel says.

Other ways to protect yourself from sun damage include:

• Wearing protective clothing that is dark and tightly woven, with ultraviolet protection factor (UPF) 50+
• Wearing a wide-brimmed hat
• Wearing sunglasses with UVA and UVB protection
• Seeking shade between 10 a.m. and 4 p.m. when sun rays are strongest

Myth 4: I have dark skin. I don’t need to wear sunscreen.
False. Dark skin is susceptible to sun damage.

It takes more sun exposure for darker skin types to get sun damage, Patel says. She explains this is because melanin, which gives skin its color, provides DNA with a small amount of sun protection. Still, this small amount of protection doesn’t prevent sun damage altogether.

“Darker-skinned people can still get a sunburn, still get skin cancers and definitely still get photoaging from UV exposure,” Patel says.

Regardless of your skin color, apply sunscreen liberally 30 minutes before going out in the sun, and don’t forget to reapply every two hours or after swimming or sweating.

Myth 5: My sunscreen is waterproof, so I don’t need to reapply it after swimming or sweating.
False. According to the Food and Drug Administration, there is no such thing as waterproof sunscreen.

There is, however, water-resistant sunscreen. The FDA says these products offer water-resistant sun protection according to the time and SPF level specified on each product.

Heading for a beach day or outdoor workout? Choose a water-resistant sunscreen and follow the product instructions on how often to reapply.

 
Myth 6: My sunscreen is SPF 50, so I don’t need to apply it as often.
False. No matter the SPF number, chemical absorber sunscreens only work for about two hours and should be reapplied after swimming or sweating.

Regardless of the SPF level you choose, you need to reapply with the same frequency, Patel says.

If you have trouble remembering to reapply, Patel suggests using a physical blocker sunscreen. These products don’t rub in or disappear into the skin, so it is easy to determine when to reapply.

“If you can see the white on your face, it's still working,” she says.

Myth 7: There is SPF in my makeup. I don’t need to wear sunscreen.
False. While Patel says that sunscreen in makeup counts, it usually doesn’t provide the recommended SPF levels.

“It's typically only 5 to 15 SPF, and we recommend 30,” she says.

Check that your makeup offers at least 30 SPF, and supplement with additional sunscreen as needed. Finally, don’t forget to apply sunscreen to other exposed areas of your body, and make sure you reapply sunscreen as directed throughout the day.

Myth 8: I only need sunscreen when it is sunny.
False. Sunburn and sun damage may be associated with hot, sunny weather, but they can also occur in cold, cloudy conditions.

“Even when it's cold, sun is getting through the clouds,” Patel says.

While clouds filter some UVB rays, they don’t block UVA rays which are a risk factor for melanoma, she adds.

So even if it’s cloudy or cold, you need to apply your sunscreen the same way you would if it were a warm sunny day.

Myth 9: Sunscreen doesn’t expire.
False. “You cannot rely on expired sunscreen,” Patel says. “Nothing bad is going to happen if you use an expired one in terms of increased toxicity. It just won't work.”

It is also important to store sunscreen properly. Specific storage instructions can be found in the product’s ‘Drug Facts’ section.

For example, if you store your sunscreen in a hot car or in direct sunlight, Patel says the product could degrade earlier than its expiration date.

"You have to look at the storage recommendations. Sunscreen will only last until the expiration date if you keep it within those temperature ranges," she says. "If you go outside of those temperature ranges, the molecules that are protecting your skin will degrade faster.”

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Kentucky can soon provide Medicaid coverage to people nearing release from prison or juvenile detention; jails might come later

By Melissa Patrick
Kentucky Health News

Kentucky is one of five additional states that will soon provide Medicaid health coverage for people nearing release from prison or juvenile detention, according to the U.S. Department of Health and Human Services. 

"We've been eagerly anticipating CMS's approval of Kentucky's healthy re-entry demonstration for years now," said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of health advocacy groups.

The program started as a demonstration focused on treatment for substance-use disorder during incarceration and "has expanded to focus on putting in place all of the physical and behavioral health treatment, care coordination, and wrap-around supports justice-involved Kentuckians need to successfully return to their communities and thrive," Beauregard said in an email. 

This demonstration program is operated under a partial waiver of the Medicaid program's inmate-exclusion policy, which prohibits paying for services to inmates unless they are admitted to a hospital.

"Providing avenues for greater health outcomes is always the right thing to do, and this program does just that," state Cabinet for Health and Family Services spokesman Brice Mitchell said in an email.

Before the state can start the coverage, it must submit an implementation plan to the Centers for Medicare and Medicaid Services, Mitchell said: "Upon receiving implementation approval from CMS, Kentucky will cover a select set of pre-release health-care services through Medicaid and the Kentucky Children’s Health Insurance Program for up to 60 days before an individual’s expected date of release."

Kentucky didn't take full advantage of the waiver, which allows states to provide coverage up to 90 days before the expected release date. Eligibility is based on income; the limit is 138 percent of the federal poverty level.

Mitchell added, "The individual must be eligible for Medicaid or KCHIP to qualify and must be a state inmate housed in one of Kentucky’s 14 prisons or a post-adjudicated juvenile in the custody of the Department for Juvenile Justice."

Mitchell provided data from the state Department of Corrections, which said "There are 19,220 individuals serving felony convictions in state prisons or jails, as well as an additional 49,700 on active supervision with the Division of Probation and Parole. At least 95% of the state inmate population will be released from incarceration at some point." 

Kentucky's waiver doesn't allow inmates in jails to participate, because its jails are operated by counties, not the state. Beauregard said, "We've advocated for allowing jails to opt in, if they are willing to meet requirements and participate fully." She said the state Department for Medcaid Services "has said they will consider [jails] as a future phase of this project."

Coverage will be available not only to adult prisoners, but incarcerrated youth, under the Children's Health Insurance Program, called KCHIP in Kentucky. Beauregard praised the inclusion of youth in the coverage, which was not part of the original demonstration program for substance-use-disorder treatment and not part of the orignal application for its expansion. 

"Another important expansion from the original waiver is that youth who are in detention facilities will also get these services and wrap-around supports, which has the potential to reduce recidivism," Beauregard said.

 

A July 2 news release from HHS noted that incarcerated people often report higher levels of substance-use disorders, chronic health conditions and other health concerns, and that people transitioning out of jail or prison can experience delays in obtaining access to Medicaid or CHIP. 

HHS Secretary Xavier Becerra said in the release, "For people involved in the justice system, ensuring a successful transition back into the community includes having the health-care supports and services they need."

Kentucky is the first Southern state in the program. The other newly approved states are Illinois, Oregon, Utah and Vermont; California, Massachusetts, Montana and Washington had already been approved.

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