The percent of? Kentucky kindergarten students who begin school ready to learn dropped by about 3 points from pre-pandemic years to the 2023-2024 school year, according to a report on child welfare released Wednesday.?(Kentucky Lantern photo by Sarah Ladd)

LOUISVILLE — The percent of? Kentucky kindergarten students who begin school ready to learn dropped by about 3 points from pre-pandemic years to the 2023-2024 school year, according to a report on child welfare released Wednesday.?

The KIDS COUNT County Data Book was compiled and released by Kentucky Youth Advocates. Kids Count is part of a national initiative by the Annie E. Casey Foundation and measures child well-being based on a variety of measures — education, family life, trauma, incarceration and more.?

In the school year ending in 2019, the book shows, about 51% of Kentucky’s kids were kindergarten-ready. For the 2023-2024 school year, that was down to 48%.?

Terry Brooks,? executive director of Kentucky Youth Advocates, explained that small things — like letter magnets on the fridge — can help introduce young children to written language and prepare them to read.?

“It’s as simple as reading to your kid,” he told the Lantern. But, once children reach the school, educators need to be willing to meet them where they are as well, he said, because not all children will learn to read the same way.

“I think the primary school experience in Kentucky looks a lot more like an assembly line than a personalized menu,” Brooks said, “and we need to get back to that personalized menu.”

Not all education data was negative, though. The number of fourth graders who are proficient in reading, eighth graders who are proficient in math and high school students graduating on time have all improved.?

Adverse childhood experiences

In 2024, Kids Count says, “more Kentucky children are experiencing adverse childhood experiences than ever before.”?

Adverse childhood experiences, more commonly known as ACEs, refer to traumas or stressors in a person’s life before their 18th birthday. They include, but are not limited to experiencing or witnessing violence, abuse or neglect; living in a home where someone has a substance use disorder or other mental health issues; living through a parental separation and more.?

ACEs have a far-reaching impact on adulthood, too, as survivors are more likely to have chronic health conditions including cancer, diabetes and heart disease; experience poverty; have pregnancy problems; be involved in sex trafficking; suffer from stress; and some may even go on to perpetuate ACEs, feeding a reciprocating spiral of illness and violence. The more ACEs a child lives through, the greater their chance of having long- term complications.?

Almost 1 in 4 — 23% — of Kentucky’s children have experienced at least two ACEs. That’s significantly higher than the national average, which is about 17%.?

“If today is a typical day in Kentucky, one out of five kids woke up living in deep poverty,” Brooks said during a Wednesday press conference to launch the book. “And tonight, if today is a typical day in Kentucky, one in five kids are going to go to bed hungry.”

The state has made some strides over the last decade, according to Kids Count, including passing laws to ensure educators learn about ACEs and “closing gaps” in the background check process for people working with children.?

But gaps remain.?

“Minimal legislative progress” has been made to “teach youth to protect themselves by providing age-appropriate information on healthy boundaries and relationships,” according to the report, which also points out the legislature cut funds for the? Health Access Nurturing Development Services program (HANDS), a voluntary home visitation program for any new or expectant parents.?

To combat ACEs, children need access to positive childhood experiences (PCEs), which can include having supportive and safe family, feeling a sense of belonging, feeling supported by friends, having at least two non-parent adults who care about them and more.

“We emphasize each? year that what gets measured, gets changed,” Brooks said, “and this year, I’m urging our policymakers to hear: what? can be predicted can be prevented. Understanding ACEs and PCEs creates that opportunity to measure? risk and pave the way for prevention.”?

Two youth advocates spoke alongside Brooks and others, detailing how positive experiences have helped them succeed in life.

Aleah Stigall, a Boyle County High School sophomore, said being involved in pageantry helped connect her to mentors and friends that she felt she lacked as an only child. She also founded an initiative called Disconnect to Connect – Let’s Get Real, which she said “strives to teach students how to have real relationships with real people without technology.”

“This goes hand in hand with developing strong connections with mentors so one can learn new skills throughout childhood and even adulthood,” said Stigall, 16.

Another youth advocate, Issabella Cornett from Graves County, said support she’s felt through health challenges helped her develop “resilience.”

“Throughout my childhood, positive experiences have been made by access to reliable health care and the conflict support my teachers, friends, family and my medical team,” Cornett said. ” These positive resources have been essential in allowing me to navigate major health challenges, including chronic migraines, kidney disease and various allergies.”

Shannon Moody, KYA’s chief policy and strategy officer, said everyone can help create a better future for young people.

“What we know is while the prevalence of PCEs, or positive childhood experiences, are just not quite as documented or heavily studied, we do know that they are common, and with these stories that you heard today, I think you can see them on a day to day basis in your community,” she said. “Stable housing, access to health services and safe family and community environments can set young people up for a lifetime of health, stability and success.”

Solutions recommendations?

The book recommends several policy “solutions” to address Kentucky’s child well-being gaps. They include:?

• Implement a state survey on ACEs and encourage screenings on ACEs within social and health services that regularly interact with children.?
• Increase support for programs that mitigate ACEs.?
• Incentivize health care providers to work with underserved communities and accept Medicaid.?
• Prioritize relative and fictive kin placement for children being removed from their home. Increase support given to kinship caregivers. About 55,000 Kentucky kids lived in kinship care between 2021 and 2023, but support for those families is insufficient.?
• Invest in affordable and rural housing trust funds and support programs that help homeowners remove hazardous materials like lead paint. Kentucky is short about 200,000 housing units, and no county in the state has enough housing to meet demands.?
• Encourage schools and other community-based organizations to include mentoring in their programs so youth have access to mentorship. Many youth lack mentorship, which can impact their ability to enroll in college, be a leader and volunteer in their community.?

“The question that I have about all the work that went into Kids Count is really simple: will we see the General Assembly match its rhetoric with action on behalf of kids in 2025,” Brooks said. “I’m both hopeful and scared to death to answer that question.”

To read the whole Kids Count book, go here.?

Sen. Jimmy Higdon, R-Lebanon, shares his plans to file legislation to increase regulations on tobacco retailers. (LRC photo)

A Kentucky Republican will file legislation in 2025 that would license all sellers of vape or tobacco products, giving the Department of Alcoholic Beverage Control (ABC) enforcement authority over those vendors and empowering its officers to enter the businesses without warrants.?

Sen. Jimmy Higdon, R-Lebanon, said state laws limiting the sale of vaping products to buyers 21 or older have “no teeth, no real consequences” for retailers who violate them by selling? to underage customers. He presented his legislation idea Tuesday to the Interim Joint Committee on Licensing, Occupations and Administrative Regulations.?

His 2025 proposal, which is being drafted, would also recommend money from fines go toward programs “to help youth and their peers learn about the dangers of vaping,” he said.?

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Under the legislation, “regulatory authority would be similar to alcohol regulations,” he explained. “It would give the officers the ability to enter and inspect the premises without a warrant. It will also give them the ability to confiscate evidence of criminal activity.”??

Vendors wouldn’t be able to renew their license until they paid any pending fines, and couldn’t re-apply for a new license for a period of two years if their license was revoked.?

First offense fines would be paid by the clerk who sold to a minor, Higdon said, and subsequent fines would be levied on? the retailer.?

During the 2024 legislative session, lawmakers passed House Bill 11, aimed at curbing underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their status with the Food and Drug Administration (FDA). The FDA has authorized ?34 tobacco- and menthol-flavored e-cigarette products and devices.

HB 11 was backed by Altria, the country’s largest manufacturer of cigarettes which also markets FDA-approved vape products. Altria has spent more than $500,000 lobbying the Kentucky legislature since January 2022, according to records filed with the Legislative Ethics Commission.

Abbie Gilbert, a lobbyist with The Denton Group, read a statement from her client, the Vapor Technology Association, which expressed business owners’ concerns with tighter restrictions on their industry.?

“House Bill 11 effectively bans flavor vapor products in the commonwealth. To date, the (Food and Drug Administration) has authorized only 34 e-cigarettes, all of which just happened to be owned by the proponents,” she read. “For all other products, manufacturers and retailers would need to prove their products are in safe harbor, and that the FDA commissioner told Congress that does not exist. FDA has not authorized flavored vapor products.”

She asked lawmakers to extend the effective date of the new restrictions until after the U.S. Supreme Court has a chance to rule in a challenge to the FDA’s refusal to authorize flavored vape products, expected later next year.?

Kentucky new law is set to go into effect Jan. 1. When that happens, Gilbert said, “130 Kentucky small vape businesses will close, eliminating almost 1,000 jobs. Kentucky will lose $63 million in state business and consumption taxes. Further, Kentucky’s economy will suffer the loss of approximately $174 million in economic input.”?

Doctor: Nicotine is ‘highly addictive’?

Dr. Brit Anderson, a Louisville pediatric emergency medicine physician and vice president and president elect of the Kentucky Chapter of the American Academy of Pediatrics, testified before Tuesday’s committee.?

“We know that nicotine is highly addictive, especially for young people, and that many young people who use e-cigarettes go on to smoke traditional cigarettes,” she said. “Nicotine has detrimental effects on a developing brain, including diminished impulse control, learning difficulties, problems with attention — even mood disorders like anxiety and depression.”?

Griffin Nemeth, a youth advisory board coordinator for the hashtag movement, #iCANendthetrend at the University of Kentucky, asked lawmakers to do more to protect his peers from the “very pressing” issue of underage vaping.?

“We’re asking that legislation be passed to effectively enforce the law against underage sales and to ensure that the effects of industry manipulation of our youth are mitigated,” Nemeth said.

Bullitt Central High School student Philena Ash, also part of #iCANendthetrend, said it’s too easy for her peers to get nicotine.?

“In my community, youth can go to any gas station or convenience store and purchase a vape without using their ID,” she said. “Right now, it is too easy for kids to buy these products … being reflected in the number of my peers who are using them.”??

Nemeth pushed back on the idea that the proposed changes could hurt businesses.?

“I’d like to make a point in saying that this move is not anti-business,” he said. “The only businesses who will be negatively impacted by retail licensure are those acting criminally and selling unauthorized products to underage youth.”?

Workers remove a lead service line before it’s replaced by a brass one in Providence, R.I., last year. A new federal rule will require water systems across the country to replace roughly 9 million lead service lines to protect residents from potential poisoning. (Photo by Kevin G. Andrade/Rhode Island Current)

A new federal rule will require water utilities across the country to pull millions of lead drinking water pipes out of the ground and replace them, at a cost of billions of dollars.

States, cities and water utilities agree that the lead pipes need to go to ensure safe water for residents. But they say they may struggle to do so in the 10-year window required under the rule, and they fear some ratepayers will be hit with massive cost increases to pay for the work.

State officials are urging Congress to provide ongoing funding for the lead replacement effort. Local leaders say they’ll need lots of help to meet the deadline. And environmental advocates are calling on states to issue bonds or provide other financial support to water utilities.

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“It took us close to 100 years to get all of these lead service lines in the ground, and the EPA is asking us to get them out in 10 years,” said Tom Dobbins, CEO of the Association of Metropolitan Water Agencies, an advocacy group for publicly owned water systems. “The [Biden] administration grossly underestimated the cost. Obviously, if the federal government doesn’t provide the funding for this, the ratepayers will have to pay for this. That exacerbates certain communities’ affordability issues.”

The new rule, issued by the U.S. Environmental Protection Agency in October, requires cities and water utilities to replace all lead service lines — the pipes that run from water mains to private residences under lawns and sidewalks. Because the lines extend under private property, some water system operators say the rule has created confusion over whether utilities or homeowners will be responsible for the replacement costs.

The EPA estimates that more than 9 million service lines are made of lead, a neurotoxin that can cause nervous system damage, learning disabilities and other health problems, especially in children. If lead pipes corrode, as in the infamous case of Flint, Michigan, they can poison drinking water.

While no amount of lead exposure is safe, the federal rule now requires utilities to notify the public and improve corrosion treatment if lead in their water exceeds 10 parts per billion. Some homes in Syracuse, New York, recently tested at 70 parts per billion.

“This is a significant public health advance,” said Erik Olson, who leads a drinking water protection campaign with the Natural Resources Defense Council, a national environmental nonprofit. “We’ve known for decades that lead service lines are dangerous, and, unfortunately, a lot of utilities just kept putting it on the back burner.”

Under the rule, water systems will have until 2027 to draft a plan for replacing their lead lines, after which they will have 10 years to complete the work.

Olson said President-elect Donald Trump, who has pledged to roll back many environmental regulations, would have a difficult time undoing the lead rule. A provision in the Safe Drinking Water Act prevents “backsliding” for federal protections, he said, and efforts to overturn the rule through Congress could prove deeply unpopular.

Money worries

The federal mandate comes after some states, including Illinois, Michigan and New Jersey, already issued their own lead replacement requirements and directed funding to their hardest-hit communities.

“It’s a challenging goal, but I think we’ve shown it’s achievable,” said Eric Oswald, director of the Drinking Water and Environmental Health Division in the Michigan Department of Environment, Great Lakes, and Energy. “I’m trying to make Michigan the first state to remove all lead service lines.”

The federal rule will accelerate Michigan’s timeline, as state regulations gave utilities a 20-year replacement window. But the initial state requirement has given water systems there a head start. Michigan has somewhere between 300,000 and 500,000 service lines, of which it’s replaced about 50,000 so far. Oswald acknowledged that the work will be expensive.

In New Jersey, water utilities have replaced more than 25,000 service lines since a state lead law was passed in 2021 (that figure does not include a previous effort that replaced 23,000 pipes in Newark). But the state still has more than 120,000 lead service lines, which it said will cost at least $1.8 billion to replace.

“There’s nothing yet that has made me think that it’s not achievable, but right now the focus has been on getting a good inventory,” said Trish Ingelido, director of water supply and geoscience at the New Jersey Department of Environmental Protection. “We’ll have a better sense in the next two years what the replacement?rate is looking like.”

The EPA estimates that the cost of replacing lead pipes nationwide will be about $45 billion. A separate analysis by the consulting firm Safe Water Engineering, funded by the Natural Resources Defense Council, arrived at a similar figure. But the American Water Works Association, a coalition of water system operators, puts the cost at closer to $90 billion.

“This is important on the public health side, but it’s a challenge for local governments,” said Carolyn Berndt, legislative director for sustainability at the National League of Cities, which advocates for municipal governments. “We do see this raising concerns about affordability.”

While local governments worry about expenses, the EPA says that the public health costs of lead poisoning are far greater. A federal analysis estimates that the rule, on an annual basis, will prevent 1,500 cases of premature death from heart disease and protect 900,000 infants from having low birthweight. The agency says the savings from avoiding the poisoning of residents will be 13 times greater than the cost of replacing the pipes.

The feds have provided $15 billion for lead service line replacement through the 2021 infrastructure law passed by Congress, plus another $11.7 billion in state-administered drinking water funds that can be used for new lines. Some communities have used those federal grants and loans, along with pandemic relief funds, to make significant progress on their lead problem.

So far, the EPA says it has distributed $9 billion of the money targeted at service line replacements, enough to change out up to 1.7 million pipes. But many water systems are still working to inventory their lead pipes, leaving them little time to compete for the federal funding that expires in 2026.

“[Federal investments] provided significant new funding for this effort, but it’s absolutely not nearly enough for the successful implementation of the rule,” said Ben Grumbles, executive director of the Environmental Council of the States, a nonprofit association of environmental agency leaders.

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Grumbles noted that state agencies also are facing significant expenses from new federal rules to limit exposure to PFAS, or “forever chemicals,” in drinking water (lead, a naturally occurring metal, is not among the man-made PFAS chemicals).

Cities struggle

At the local level, leaders are scrounging for funding as best they can.

“We’re looking at federal money, we’re looking at bonds, we’re looking at different loans and grants,” said Randy Conner, commissioner of the Chicago Department of Water Management. “We’re making sure we turn over all the couch cushions to find every quarter we can possibly find to put towards this effort.”

Chicago has an estimated 400,000 lead pipes, more than any other U.S. city. Because of the sheer scale of the problem, the EPA gave Chicago an extended deadline of 20 years to replace its lines. Even so, that would require pulling out 19,000 lines a year, well more than the city’s current pace of 8,000. That work will cost about $780 million, according to city officials.

Conner said the city is hoping for more federal and state support to avoid placing a heavy burden on ratepayers.

Meanwhile, state and local leaders say Congress is interfering with a key source of money for lead line replacement. Two loan programs, funded by the federal government but administered by states, provide crucial financing for water infrastructure work. State agency leaders deploy the funding based on detailed assessments of community needs.

But in recent years, members of Congress have bypassed states’ funding strategies to earmark money for projects in their districts. State agencies say they’re receiving less than half of the pool of money after Congress assigns its favored projects. That has left them less able to help the neediest communities. And many of the congressionally designated projects are lagging because they haven’t gone through the rigorous preparation work required by states.

“By diverting so much funding away from the successful [loan programs], disadvantaged communities are less likely to get funding,” said Grumbles, who oversees the coalition of state agencies.

Grumbles and others argue that any earmarks from Congress should only be in addition to the baseline loan program funding.

Other challenges

Costs aren’t the only obstacle water systems are facing. Some are concerned that the rush to replace millions of pipes nationwide will strain the workforce and supply chain capacity.

“The limiting factor is going to be the availability of contractors and professionals and materials to do the actual work,” said Robert Boos, executive director of the Pennsylvania Infrastructure Investment Authority. “That’s going to be a national issue, when you’ve got tens of thousands of communities trying to do this work.”

Pennsylvania has boosted clean water funding in its state budget, and it’s trying to tackle the workforce issue as well. Democratic Gov. Josh Shapiro signed an executive order in 2023 to create a workforce training program for infrastructure jobs, including lead pipe replacement.

Olson, the environmental advocate, pointed to Newark, New Jersey, which partnered with a labor union to train local residents. The city replaced all of its 23,000 lead service lines in just over two years.

“Creative thinking and political will are really what’s needed,” he said. “This is definitely doable.”

Another potential problem is the fact that service lines lie under private property, meaning utilities need cooperation from homeowners to conduct the work. In some cases, they’ve run into opposition from residents or struggled to reach absentee landlords.

“People just don’t trust government; they don’t think that anything is free,” said Conner, the Chicago official. “We want them to understand that we’re not coming into their house to give citations.”

Environmental advocates also note that service lines’ placement on private property has created confusion over who must pay to replace them. The federal rule does not explicitly make water utilities responsible.

“When the city goes to a household and says you have to pay a couple thousand dollars to replace your portion of the lead service line, it may work for higher-income people,” Olson said. “But the studies are showing that lower-income homeowners and landlords will not pay for it. It’s a real exacerbation of environmental injustices.”

He pointed to Michigan, which adopted a rule specifying that water systems are responsible for the costs of replacing lines. He also noted that some cities have passed ordinances allowing residents of a home to authorize pipe replacement if a landlord can’t be reached.

Hal Pyzyna of Lexington was 35 when he died of an opioid overdose a little more than a month after leaving an Addiction Recovery Care facility. (Photo provided)

Striving to stay sober, Hal Pyzyna succeeded for nearly a decade until the COVID-19 pandemic struck in 2020 — the stress causing him to relapse into drug use, said his mother, Kristine Pyzyna.

She hoped he would get help through a court diversion program that in 2022 referred him to Crown Recovery Center in Springfield.

Instead — just days after he became violently ill from an injection of Vivitrol, a powerful anti-abuse drug his mother says her son was pressured to accept — he left Crown Center, operated by Addiction Recovery Care, or ARC, the state’s largest provider of drug and alcohol treatment.

And little more than a month later, Hal died at 35 from a drug overdose.

Kristine Pyzyna believes Vivitrol, a name-brand drug that blocks effects of opioids, was a factor, along with improper administration of the medication at ARC and lack of adequate education for her son. The drug, while considered effective, comes with serious risks including potential for a fatal overdose if a patient uses drugs before the injection wears off because of reduced tolerance to opioids, according to the U.S. Food and Drug Administration.

Now, Pyzyna, a nurse and health lawyer who lives in New Jersey, is relaying those concerns to Kentucky and federal regulatory authorities and some state legislators who oversee health policy, seeking stricter oversight of ARC and its use of Vivitrol.

“There is no doubt in my mind or in the minds of all who knew Hal and loved him that Hal would be alive today, had he not received the Vivitrol injection administered by ARC,” Pyzyna said in an Oct. 26 letter to Sen. Stephen Meredith, R-Leitchfield, chairman of the Senate Health Services Committee, that she provided to the Lantern.?

Meredith’s office didn’t comment.

Pyzyna’s letter was copied to the Inspector General of the U.S. Department of Health and Human Services, which administers Medicaid, a major funder of treatment services in Kentucky, and to the state nursing and medical licensure boards. Copies also went to the private health insurers, or managed care organizations, that handle most of Kentucky’s Medicaid claims, including those of her son.?

‘Heartbroken for this mother’

ARC, in a statement, said it could not comment on individual cases because of medical privacy laws or confirm whether Hal was a patient.

But Vanessa Keeton, vice-president of marketing for the for-profit, Louisa-based company, said ARC remains committed to providing quality care for those affected by drug and alcohol addiction.

“We are heartbroken for this mother who, like too many parents across our nation, has endured the loss of a loved one to the addiction crisis,” Keeton said in an email. “Our mission at ARC is rooted in the belief that everyone deserves a chance to recover and to find their God-given destiny.”

A spokeswoman for Alkermes, a global pharmaceutical company that holds the patent for Vivitrol, said in a statement that the drug is approved for use to aid in treatment of alcohol or opioid dependence and its safety is “well-established” when used under FDA guidelines.

“The medication plays an important role in the addiction landscape,” the statement said.

However, Vivitrol “may not work for everyone” and patient education about the drug is a critical part of its use, the statement from Alkermes said, adding that FDA prescribing guidelines contain several important warnings including “the vulnerability to opioid overdose.”

ARC employs an array of treatment services including medication for drug and alcohol avoidance for patients who are informed of the options and “are given the choice of which treatment pathway is best for their goals,” Keeton said.

And she said ARC’s programs are accredited and employ a “large, comprehensive medical team” to oversee care.

But Pyzyna, who as administrator of her son’s estate has assembled his medical and other records, believes the records show missteps in her son’s care, especially with the use of Vivitrol, which comes with strict FDA protocols.?

She said recent news reports of possible problems at ARC prompted her to pursue complaints she had been considering after she began collecting Hal’s records, some of which she provided to the Kentucky Lantern.

“Hal was a wonderful young man,” she said in her letter to lawmakers and regulatory agencies. “Hal struggled with opioid use disorder, a terrible chronic disease that must be managed throughout one’s lifetime.”

Cuts amid FBI probe

Pyzyna’s complaint comes as ARC is facing other problems, including an FBI investigation into possible health care fraud and major staff cuts. ARC receives almost all of its revenue from Medicaid, the federal-state health plan that covers substance use disorder treatment.

Last year, ARC received $130 million in Medicaid funds, making it by far the largest recipient among treatment programs in Kentucky. The investigation became public in July when the FBI asked for the public’s help in gathering information through a link on its website.

ARC has said it is cooperating with the FBI and stands by its treatment services.

Also, ARC has announced a series of program cutbacks and employee layoffs after reimbursement cuts enacted by some of the private insurers that handle Medicaid claims for the state. It has cut nearly a quarter of its 1,350 employees since September.

But ARC says it remains committed to its work, which has been praised by Gov. Andy Beshear for its role in fighting addiction and helping reduce overdose deaths in Kentucky.

“We are still very committed to our nearly 1,900 patients and our remaining employees,” Matt Brown, chief administration officer told the Lantern last month.

ARC and its founder and CEO Tim Robinson have emerged as prolific political donors in recent years to Republicans but also to Beshear, a Democrat.

A Lantern analysis showed that Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew rapidly from a single halfway house in 2010 to about 1,800 residential beds and outpatient care for hundreds more clients.

In addition, ARC chief operating officer Pat Fogarty, a former executive with Alkermes, the global pharmaceutical company that holds the patent for Vivitrol, gave $2,600 in political donations in Kentucky between 2018 and 2020, the Lantern analysis found. Fogarty joined ARC in 2020 and made the donations while working for Alkermes to Republican candidates.?

Pyzyna said she believes further investigation of ARC is warranted.

Meanwhile, she is asking for tighter controls over addiction treatment programs, an end to Medicaid funding of Vivitrol without more rigorous oversight and an investigation by state authorities into whether any regulations were broken through events she believes contributed to her son’s death.?

She also urges anyone with knowledge of potential problems to contact the FBI.

“That’s a mother’s plea,” Pyzyna said. “I would encourage them to talk to the FBI.”

The $1,700 drug

Medications for opioid use disorder have emerged as a major component of treatment? in recent years and ARC said it offers patients a choice of drugs approved by the FDA, including generic drugs such as? buprenorphine (known by the brand name of Suboxone) and Vivitrol.

“We do not prioritize one treatment option over another,” Keeton, ARC’s s marketing VP, said in an email.

But last year, nearly all of ARC’s billing for drugs used for alcohol and drug treatment was for Vivitrol, an expensive, name-brand drug administered as a single dose through a long-acting injection given once a month.?

It costs around $1,700 a dose for patients who pay cash, though insurers and programs such as Medicaid would pay less through negotiated discounts, according to the website drugs.com.

Kentucky’s Medicaid Department did not respond to requests for what it pays for an individual dose of Vivitrol.

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ARC uses South Creek Drug — a pharmacy owned by CEO Robinson and his wife, Leila, according to records from the Kentucky Board of Pharmacy — to fill prescriptions for its residents in treatment.

Kentucky Medicaid last year paid ARC $8.8 million a year for Vivitrol, 89% of the total cost of all substance use disorder medication ARC billed for that year through South Creek Drug, according to records from the Kentucky Department of Medicaid Services.

By contrast, ARC billed Medicaid just $78,746 for all other drugs it dispensed — mostly forms of buprenorphine.

Buprenorphine, a generic version of Suboxone, costs about $62 for 30 pills, according to drugs.com.??

Overall, last year? Kentucky Medicaid spent $110 million on substance use medication, with $31 million — or 28% — on Vivitrol. The rest of the spending was largely for two other standard, much cheaper drugs, buprenorphine and methadone.

ARC’s Keeton said the company records show that it has served 12,185 individuals with substance use disorder in the past 12 months and that about 22% were prescribed Vivitrol.

Also, the state Medicaid records show only what ARC billed through its pharmacy and may not include prescriptions obtained elsewhere by those in outpatient treatment, she said.

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And she said ARC utilizes “external providers who provide Vivitrol management.”

She said ARC does not receive any direct compensation for the medication but the Robinsons’ South Creek Drug pharmacy is one of the providers used by the external providers to buy Vivitrol. A cheaper, generic version of Vivitrol is not yet available.

Alkermes, its manufacturer, holds the patent until early 2027, according to an article last year in Pharmacy Technology. Vivitrol won FDA approval for alcohol treatment in 2006 and in 2010, for opioid treatment.

Vivitrol has emerged as a blockbuster drug for Alkermes, which listed $1.6 billion in revenues last year, according to a company press release. Vivitrol was its top selling drug last year, with $400 million in sales.

Vivitrol advantage

Suboxone and methadone, which are considered opioids and ease cravings for drugs, are typically taken daily. They are controlled substances and therefore, more tightly regulated than Vivitrol, which comes as a monthly injection which serves to block the effect of opioids.

Because of the tighter regulations surrounding methadone and buprenorphine and because Vivitrol is not a narcotic — reducing risk of diversion — it has become more prevalent in institutional settings, such as jails or prisons, said Dr. Michelle Lofwall, a psychiatrist and addiction medicine physician and professor at the University of Kentucky College of Medicine.?

The Kentucky Department of Corrections, as part of its drug treatment programs, provides Vivitrol as well as all forms of FDA approved medications, a spokeswoman said.

Corrections offers treatment options “that are consistent with the best practices in the field of addiction and allow for different pathways of recovery,” said the statement from Morgan Hall.

Lofwall said evidence shows methadone and buprenorphine significantly reduce the risk of overdose deaths.

“That data is not there for Vivitrol,” she said.

Still, Lofwall said that doesn’t mean it’s not an effective tool for treating addiction.

“What’s right for the patient?” she asked. “The one the patient is willing to take.”

‘Be a man’

Pyzyna said her son’s struggles with addiction began in his late teens, first with alcohol, later with opioid drugs.

He was born in Chicago and later lived in Philadelphia and Indianapolis before settling in Lexington where he had received treatment through the Hope Center that helped him achieve sobriety, find work and buy a home, Pyzyna said in an email.

But after about eight years, her son relapsed and in 2021 was charged with drug possession and driving under the influence in Lexington. He was referred to ARC through a court diversion program, she said.

Soon after he entered ARC’s Crown Center in early September 2022, Pyzyna’s letter said her son told her he was directed to attend a “mandatory Vivitrol meeting,” where he was pressured to take the drug.

When he initially refused, staff increased pressure, she said, telling him he would be fine, the drug was “no big deal,” and to “be a man.” When he still resisted, staff said they would tell his court worker he was uncooperative and “drug seeking,” her letter said.

Finally, she said, Hal agreed to sign a consent form to accept an injection of Vivitrol.

Pyzyna, in her letter, alleges ARC failed to follow proper protocol specified by the FDA , including assessing Hal’s medical history and fully informing him of risks.

Within several hours of receiving the shot, he became violently ill, with severe vomiting, diarrhea, chest pains, shortness of breath and high blood pressure, her letter said. He passed out and was taken by ARC to a local hospital emergency room where it was determined he had experienced a reaction to Vivitrol, her letter said.

The hospital staff recommended ARC “support him through the symptoms” until the drug wore off, she said. When Hal’s symptoms continued, ARC staff took him back to the emergency room a second time where he was again sent back to the Crown Center to try to recover, her letter said.

On Sept. 17, 2022, still suffering effects from the drug a week after the injection, Hal decided to leave the facility and asked his mother to drive to Kentucky to get him, her letter said.

Pyzyna found her son sitting in the parking lot at Crown Center with his possessions, her letter said. She said staff directed him to wait there since he was leaving “against medical advice.”

Her account of his experience is based on what he told her, medical records she obtained and a journal he began keeping while at ARC, which he told her he started because “he was afraid he was going to die and wanted me to know what had happened to him if he didn’t make it out,” the letter said.?

A fatal overdose

Pyzyna was able to line up treatment for Hal in the Lexington area and he did well, she said. But facing a return to court on his pending charges and possible jail time,? he found and used a hidden “stash” of drugs, which caused his overdose death.

A pathologist report found he died from “drug toxicity” with a “potentially fatal” level of fentanyl in his system. A friend found him on the bathroom floor of his home on Oct. 21, 2022, it said.

Pyzyna said both she and her son were aware the risk of overdose was greater if someone had ceased using drugs, therefore lowering tolerance.

What they did not know, she said, is that Vivitrol increased that risk.

That was the subject of a 2019 FDA warning letter to Alkermes, the manufacturer, for not fully describing the potential for the most serious risk — a fatal overdose — in advertisements for the drug.

“While the print advertisement contains claims and representations about the drug’s benefits, it fails to adequately communicate important warnings and precautions listed in the product labeling, including vulnerability to opioid overdose, a potentially fatal risk,” an FDA news release said.

“This is concerning from a public health perspective because of the potential for fatal opioid overdose on this vulnerable patient population,” it said.

The following year, the FDA found the company had corrected the problem.

Pyzyna said she wants authorities and the public to know about her son’s situation in hopes of preventing someone else from going through it.

She misses her son, whom she describes as bright and funny. He loved hunting, fishing and working as a mechanic on cars and his beloved Ford truck.

“He was the most wonderful young man ever,” said Pyzyna, who arranged a memorial service after her son’s death. “Someday I’m going to scatter his ashes after this is all over.”

Tom Loftus contributed to this story.

Speaking at a Wednesday morning new conference, Jody Meiman, the director of Emergency Management Services in Louisville, said his team received about 300 calls in a 30-minute window around the deadly explosion. (Screenshot)

LOUISVILLE — Louisville firefighters pulled a victim from the rubble of an industrial explosion overnight Wednesday, right after midnight.?

Another died at UofL Hospital after being injured in the afternoon explosion at Givaudan Sense Colour, a manufacturing plant on Payne Street in Louisville’s Clifton neighborhood.?

“These two individuals who have passed went to their job (on) an ordinary day to provide for their family when the unthinkable happened,” Louisville Mayor Craig Greenberg said in a Wednesday morning press conference.?

In addition to the two dead, 11 were injured. Dr. Jason Smith, the chief medical officer at UofL Hospital, said injuries his team saw included blast and thermal injuries as well as injuries from falling debris. Three patients were discharged Wednesday morning, Smith said.?

“We took additional steps for (the) decontamination process, given the scene and the chemicals involved and the unknown nature of what was coming in,” Smith said. “All the patients did undergo decontamination procedures prior to coming into the hospital, and subsequently have demonstrated no significant effects from any type of exposure at the time of this morning when we reevaluated them.”??

While crews work the scene, Greenberg said, people who live near the plant shouldn’t touch or attempt to remove any debris on their property. Instead, he said, report it to Metro Safe at 502-574-2117.?

“Getting a handle on all of the debris is going to be incredibly helpful to all of the investigators as they piece together what happened yesterday,” Greenberg said.?

WHAS11 reports the plant is known for producing caramel color in soft drinks. Its owner, Givaudan, is a publicly-traded company based in Switzerland and is described as “one of the world’s leading producers of flavors and perfumes.”?

Louisville Fire Department Chief Brian O’Neill praised the firefighters who searched the rubble until everyone was accounted for, pulling out the last known victim in the night.?

“There was a tremendous trauma to this victim, and it was completely untenable in the area that he was found,” O’Neill said. “But … to show the dignity to the family and to the victim, they still went in there to a very … dangerous situation in the middle of this collapse to recover that victim.”?

What is known about the explosion?

O’Neill said “multiple” 911 calls came in around 3 p.m. Tuesday about the explosion. Jody Meiman, the director of Emergency Management Services, said his team received about 300 calls in a 30-minute window around the explosion, triple the normal amount.?

Firefighting crews were on the scene within “about three and a half minutes” and “found an area that had obviously dealt with a tremendous explosion.”?

“We knew right away that we were dealing not only with a fire, but also a structural collapse and also a hazardous materials incident,” said O’Neill. “These are three disciplines that we all train in, so they were prepared to handle that. But you need to understand that it makes things extraordinarily difficult.”?

In addition to injuries, Meiman said, there were “massive” power outages; he said power was restored by Wednesday morning, with the exception of the explosion site itself.?

First responders issued a shelter-in-place alert for people within a mile of the explosion, and evacuated those within a block and a half.?

The evacuations were “mainly because they couldn’t shelter in place because their windows were broken out due to the explosion,” Meiman said.?

The Tuesday explosion is the second at the site. The first was in 2003 but Tuesday’s blast is not related to the earlier one. “That dealt with a solid anhydrous ammonia that is no longer on site, that was not dealt with here,” O’Neill said. “Our inspections of that plant over the past several years showed no other issues.”??

What is not known about the explosion?

First responder officials don’t yet know the cause of the explosion. Multiple agencies will coordinate an investigation to get at that question, they said Wednesday.?

Shawn Morrow, the special agent in charge (SAC) of the Louisville Field Division for the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) said ATF officials will serve in a support role during the investigation, which will work to uncover the cause of the explosion.?

“We don’t have any reason to believe, at this moment, that there’s any type of nefarious activity,” Morrow said. “But, again, we want to make sure that we have a thorough investigation and we’ll find out what the actual cause was.”?

A pregnant woman who wants an abortion is suing in Jefferson Circuit Court to challenge Kentucky laws banning the procedure, the American Civil Liberties Union announced Tuesday. (ACLU photo by Kira Meador)

LOUISVILLE — A pregnant woman who wants an abortion is suing in Jefferson Circuit Court to challenge Kentucky laws banning the procedure, the American Civil Liberties Union announced Tuesday.?

The plaintiff, identified by the pseudonym Mary Poe in the lawsuit, said in a statement that “ending my pregnancy is the best decision for me and my family.”?

“I feel overwhelmed and frustrated that I cannot access abortion care here in my own state, and I have started the difficult process of arranging to get care in another state where it’s legal,” Poe said. “This involves trying to take time off work and securing child care, all of which place an enormous burden on me. This is my personal decision, a decision I believe should be mine alone, not one made by anyone else.”?

Among others, the lawsuit names as defendantsAttorney General Russell Coleman and Cabinet for Health and Family Services Secretary Eric Friedlander.?

In a statement, Coleman said, “my position has not changed.”

“It’s the Attorney General’s responsibility to defend the laws passed by the General Assembly, and we will zealously work to uphold these laws in court,” Coleman said. “After listening to prosecutors, crime victims and my family, I believe the law should be amended to include exceptions for rape and incest in addition to the existing exception for life and health of the mother. This mainstream position is consistent with my faith, and I believe is shared by most Kentuckians, including so many who consider themselves pro-life.”

‘Irreparable harms’?

Poe, who is about seven weeks pregnant and lives in Louisville, is asking that the state’s abortion bans be overturned and declared “unconstitutional and unenforceable,” according to the 42-page lawsuit. The court document also states “the bans and the irreparable harms they inflict are an affront to the health and dignity of all Kentuckians.”?

‘Between rock, hard place:’ Will anyone ever have standing to challenge Kentucky’s abortion ban?

The lawsuit also states that “Mary Poe and the other putative and future class members are suffering medical, constitutional, and irreparable harm because they are denied the ability to obtain an abortion.”?

Amber Duke, executive director for the ACLU of Kentucky, said in a statement that voters’ rejection of Amendment 2 in 2022 showed “Kentuckians support access to abortion care without government interference.”?

That amendment would have stated that there is no right to abortion in the commonwealth’s Constitution.?

“While that victory at the ballot box kept an abortion ban out of the state Constitution, this lawsuit, brought by a person actively seeking care, is the next step in overturning the bans currently in place,” Duke said. “We hope for an ultimate victory that aligns with the will of the people and overturns these unconstitutional bans.”?

Poe said she wants “to ensure that other Kentuckians will not have to go through what I am going through, and instead will be able to get the health care they need in our community.”

Standing versus merit?

Poe’s lawsuit is the fourth challenging Kentucky abortion laws since the United States Supreme Court in 2022 overturned the landmark Roe v. Wade ruling that had protected the right to abortion for almost 50 years. The ruling triggered Kentucky’s ban into effect.

The first challenge, filed by abortion providers, advanced in Jefferson Circuit Court but was rejected on appeal.

Last December, a woman filed a lawsuit similar to the newest challenge, stating she was pregnant and did not wish to be. Within days of filing her lawsuit, though, the pregnancy lost viability and she ended her challenge of the law.

In two cases, Kentucky courts, including the state Supreme Court, have rejected challenges to the ban on grounds that the plaintiffs lacked standing to bring the action; the U.S. Supreme Court has likewise avoided ruling on the merits of abortion bans.?

Kentucky’s Supreme Court is changing in makeup after the Nov. 5 election. In January, Appeals Court Judge Pamela Goodwine will succeed Justice Laurance VanMeter, the current chief justice, who did not seek reelection. For the first time, Kentucky’s highest court will be majority female.?

This story may be updated.?

Property owners in Kentucky will receive notices if they have lead or galvanized water lines or if the material in a water line is not known. (Getty Images)

Kentuckians will soon get notices from their water utilities as part of a national plan to eliminate water lines made of the neurotoxin lead — along with a chance to replace suspect pipes at no cost to themselves.

The notices will tell property owners if they have lead or galvanized water lines on their property and if there are utility-owned lead lines going to the property that need to be replaced. Property owners will also get a notice if the material in a water line is not known.

Utilities are mailing the notices as part of new regulations finalized last month by the U.S. Environmental Protection Agency that seek to remove lead water lines across the country over the next 10 years. But environmental protection officials and water utilities first need to know where lead water lines are.

Lead is a harmful neurotoxin, especially to children, that can leach into drinking water through aging lead water lines that were primarily installed from the late 1800s to the 1940s. No amount of lead is considered safe in a child’s blood. Congress banned the installation of lead water lines in 1986.?

The federal Bipartisan Infrastructure law is providing $15 billion to pay for new lines. Local utilities, including in Louisville, have developed programs to cover the costs of replacing lead and galvanized pipes for property owners.?

An EPA report from September 2023 projected fewer than 1% of service lines, or roughly 40,000, in Kentucky contain lead. Service lines connect a utility’s water main to a building.The estimate is based on the number of lead lines found in other states that have conducted full inventories. It’s unknown what 265,000 service lines in Kentucky are made of, according to the September 2023 report. The status of more than 500,000 lines had not yet been reported by water utilities.

Joe Burns, the director of operations and management for the utility group Kentucky Rural Water Association, told the Lantern decades-old records, especially for Kentucky’s older cities, make it hard to determine the composition of some water lines.?

Records are spotty even in smaller communities where water systems were developed in the 1950s, Burns said. “We’re talking 70 years ago and paper plans — much of that doesn’t exist.”?

Determining a water line’s status is further complicated because lines on a homeowner’s property are the responsibility of the homeowner, Burns said, and utilities often don’t have information about the status of lines on private property.?

Notices will be sent to property owners if the water line is known to be lead or if the status is unknown, says a release from the Kentucky Energy and Environment Cabinet.

Property owners with known galvanized water lines will also receive notices advising them to replace those lines because lead from pipes elsewhere in a water system can also leach into the galvanized pipe. Utilities are required to replace lead and galvanized water lines owned and managed by the utility within 10 years under the regulations. Such replacements would also include lead or galvanized water lines extending on to a private property to comply with the regulation, though utilities would need a property owner’s consent to replace such a line on their property.?

State officials are encouraging Kentuckians to respond to the mailed notices to have the water utility verify the material of the water line or have the property owner verify the line themselves. The new regulations prohibit the partial replacement of lead water lines when possible, with an EPA advisory board previously finding the partial replacement of such lines can create elevated levels of lead in water systems compared to the complete replacement of such lines.?

The EPA is investing $15 billion — funneled through state revolving loan programs along with other federal loan and grant opportunities. The Kentucky Infrastructure Authority handles the revolving loan programs in Kentucky.

Burns said he thinks the issue of lead lines is much more prominent in Kentucky’s older cities such as Paducah, Owensboro and Louisville compared to rural water districts across the state that were established in the 1960s when lead line use, while not banned, was not favored by water utilities.

Burns said the Louisville Water Co., which is responsible for drinking water infrastructure in the city, is an example of a utility that’s been proactive in removing lead water lines even before new federal regulations went into effect. The Louisville Courier Journal reported that the utility has spent $50 million to replace approximately 74,000 lead water lines in past decades.

A scarecrow greets voters at the Community Ag Building on Election Day, Nov. 5, 2024, in Simpson County. (Kentucky Lantern photo by Austin Anthony)

No counties or cities in Kentucky opted out of allowing medical marijuana businesses to operate in their borders after dozens had the chance to do so Tuesday.?

The legislature legalized medical marijuana in 2023 and licensing is underway for a 2025 program launch, but 106 jurisdictions (53 counties and 53 cities) let local voters decide if they wanted marijuana businesses nearby.?

Of those 106 ballot measures, no counties or cities opted to bar medical marijuana businesses from operating in their borders, according to data compiled by Louisville Public Media.

Eligible Kentuckians — those with ?a history of post-traumatic stress disorder (PTSD), cancer or other approved medical conditions will be eligible to receive a medical marijuana card starting Jan. 1 next year.?

For a list of counties and cities that posed the question on their ballots, visit this page.?

Kentucky has already awarded its first 26 medical cannabis licenses, which went to 16 cultivators and 10 processors.?

Lottery drawings for dispensary licenses are scheduled for Nov. 25 and Dec. 16.

About 700,000 of Kentucky’s 4.5 million residents are considered “food insecure,” meaning they have trouble obtaining enough to eat. (Photo by Justin Sullivan/Getty Images)

Disabled by hip damage and other health conditions, JD Charles of Eastern Kentucky said the $23 a month he received in SNAP benefits (formerly known as food stamps) helped him get by.

“Usually by the last of the month, I’m broke,” said Charles, 59, who lives on Social Security disability income. “I always used that to buy groceries.”

But his benefits ended abruptly in October after new calculations by the U.S. Department of Agriculture, which administers the Supplemental Nutrition Assistance Program, found his income to be $15 over the maximum allowed for eligibility.

“Now I’m just going to be depending on God Almighty,” said Charles, who lives alone in his family home in the tiny town of Lovely in Martin County.

Charles is among 11,800 Kentuckians who lost SNAP benefits after Oct. 1, the start of the federal fiscal year, according to the Cabinet for Health and Family Services, which administers SNAP. Another 370 people saw benefits reduced.

While the changes by the federal government affect only a small portion of the about 618,000 Kentuckians who receive SNAP benefits — nearly half are children or the elderly — the benefits are important to those in need, said Eric Friedlander, secretary of the health services cabinet.

“We hate it for them,” said Friedlander, who said the cabinet is seeking ways to expand SNAP access, especially for seniors. “We see food insecurity.”

Jessica Klein, with the Kentucky Center for Economic Policy, said about 700,000 of Kentucky’s 4.5 million residents are considered “food insecure,” meaning they have trouble obtaining enough to eat.

Friedlander said the federal government recalculates eligibility for SNAP every year and considers individual income, any cost of living adjustments and what it allows for standard deductions for items such as housing, medical expenses and utilities.

One big change: During the COVID-19 pandemic, the USDA allowed an increased deduction for internet costs since many people were working at home. It reduced that to the pre-pandemic level this year, an adjustment that was enough to push some people above the income limit allowed for SNAP eligibility.

Friedlander said Kentucky asked the USDA for exemptions to the changes, but the request was denied.

SNAP benefits vary by income and household size but generally are allowed for people at or below 130% of the federal poverty level. A family of three qualifies if their annual income does not exceed $33,576 a year, according to the USDA.

Most adults between ages 18 and 54 must report work hours to be eligible for more than three months of SNAP benefits a year. Individuals without documented immigration status are not eligible.

The minimum SNAP benefit is $23 a month.

That’s what Charles, of Martin County, received until November when he was notified last month his SNAP benefit was ending.

A former newspaper reporter in West Virginia and Eastern Kentucky, Charles said he was forced to quit working because of his deteriorating health that has included a series of hip replacements and two lengthy hospital stays.

The $23 a month in SNAP benefits helped him stretch his grocery budget, along with some food he’s able to obtain from commodity goods. Rising food prices have made it harder to keep food in the house, he said.

And Charles said he knows he’s not the only one affected — a childhood friend also in his small town also lost SNAP benefits.

“I live in a little tiny town,” Charles said. “If there’s two of us in just this one area, there had to be hundreds, if not thousands.”

Klein said studies show some people who are eligible for SNAP or other benefits are not aware of that and should check into their eligibility.

More information is available by calling the cabinet at 1-855-306-8959 or online at the Kentucky benefits site kynect.

Addiction Recovery Care, Kentucky's largest provider of drug and alcohol treatment, has offices and other facilities in Louisa, photographed June 27, 2024. (Kentucky Lantern photo by Matthew Mueller)

Kentucky’s largest provider of drug and alcohol treatment is continuing to cut staff and expenses, citing “significant reimbursement cuts” by some private insurance companies that manage state Medicaid payments.

Addiction Recovery Care, or ARC, last week reduced its workforce by 105 employees, Matt Brown, ARC chief administration officer said in an email Sunday. Another 300 staff members “received adjustments to compensation, job duties or both,” Brown said.

Two previous rounds of employee cuts in September and October bring to 323 the number of workers let go — nearly a quarter of its former workforce of 1,350 statewide, Brown said.

Addiction care provider sues managed care company for cutting Medicaid payments

The cutbacks come as ARC, founded by CEO Tim Robinson, remains the focus of an FBI probe into possible health care fraud. ARC has said it stands by its services and is cooperating with the investigation.

Meanwhile, the Louisa-based for-profit company also has closed some programs and facilities and reorganized others to cope with what it described as cuts of up to 30% from some of the insurers known as managed care organizations, or MCOs that contract with Kentucky to manage its $16-billion-a-year Medicaid program.

“This reduction in force and staff realignment is a direct result of multiple layers of significant reimbursement cuts for addiction and mental health service providers like ARC,” Brown said. “The reduction in force is not a decision that was made lightly, but one that was made out of necessity.”

Under their contracts with the state, the MCOs are paid a fixed rate for each member enrolled in their health plans. In turn, they have wide latitude in setting rates they agree to pay health providers.

Brown did not identify the MCOs making the cuts, but other providers have identified one of them as Wellcare, the largest of the six MCOs. Wellcare oversees care for about 418,000 Kentuckians.

Wellcare has not responded to requests for comment.

A spokesman for the Kentucky Association of Health Plans, an industry group, said in a statement last month, that insurers are committed to working with “quality, trustworthy providers of behavioral health and substance use disorder treatment services. …?Health plans use many tools to monitor outcomes so that they are rewarding high-performing providers who are delivering strong results.”

Medicaid is a major source of funds for addiction treatment in Kentucky, last year spending about $1.2 billion. ARC took in about $130 million in Medicaid funds.

Robinson, a lawyer and recovering alcoholic, started the company that became ARC in 2008 with a single halfway house for women affected with alcoholism. It has grown into the state’s largest single provider with Robinson and his companies emerging as well-connected, prolific political donors — contributing around $570,000 over the past decade.

The Lantern reported that the donations have been divided among Republican political causes and those of Kentucky Gov. Andy Beshear, a Democrat who has praised Robinson’s company for its work in addiction treatment.

While ARC has been forced to cut costs, it remains committed to its mission of providing treatment for alcohol and drug addiction, Brown said.

“We are still very committed to our nearly 1,900 patients and our remaining employees,” he said.

Carlos Santiago, an ambassador and driver for the Greater Hartford Harm Reduction Coalition (now known as the Connecticut Harm Reduction Alliance), works at a mobile overdose prevention event in 2022 in New Haven, Conn. Nationally, overdose deaths have decreased among white people in recent years but increased among people of color. (Courtesy of Connecticut Harm Reduction Alliance, formerly known as Greater Hartford Harm Reduction Coalition)

The recent decline?in overdose deaths hides a tremendous disparity by race: Deaths have fallen only among white people while continuing to rise among people of color, according to a new Stateline analysis of federal data.

Health experts in nonwhite communities say they’re finding strategies that work in their areas, but that they still struggle for recognition and funding to address the problems, especially among Black and Native people.

In all, nearly 5,000 more people of color died from overdoses in 2023 than in 2021, while deaths among white people dropped by more than 6,000, according to the analysis of provisional data from the federal Centers for Disease Control and Prevention.

As of early this year, based on partial counts, Black and Native people remain the hardest hit, having earlier in the pandemic surpassed white rates. Hispanic and Asian people are still experiencing more overdose deaths as well.

For second year in a row, Kentucky overdose deaths decrease?

White people had the highest rate of overdose deaths in 2019, before the pandemic, at 25.4 deaths for every 100,000 people in the U.S. population. But rates for Black and Native people quickly surpassed white rates and continued to grow as white rates declined between 2021 and 2023. In 2023, the death rates were 49.5 and 39.8 per 100,000 for Black and Native people, respectively.

Tracie Gardner, co-director of the National Black Harm Reduction Network, said Black and Native people often have trouble navigating white-dominated institutions, including many harm reduction agencies. Such agencies need to have more people of color in leadership positions to gain the trust of Black, Native and other people who use drugs, she said.

“It is our contention that Black harm reduction isn’t about drug use, it’s about the harms of not being a white person in this country,” Gardner said. “The only people doing worse or as poorly are Native Americans.”

Different trends

Between 2021 and 2023, overdose deaths among white people dropped in all but a dozen states, most of them in the West. But few states saw any decline in deaths among Black or Native American populations. Deaths among Black people did decline, however, in Indiana (-75), the District of Columbia (-29) and Illinois (-22), while deaths among Native people declined in North Carolina (-34), Colorado (-11) and North Dakota (-9).

Connecticut was one of the few states to see a small rate drop among its Black residents. There was no change in the number of overdose deaths, but the Black population grew between 2021 and 2023.

The Connecticut Harm Reduction Alliance is working to bring more harm reduction tools to the Black community and others, with 100 mobile kits available at a moment’s notice.

Most recently, staff started going to meet people leaving detox programs, also known as withdrawal management, when they choose to leave early and are at especially high risk of overdose.

“The message is, ‘Even though this didn’t work out, we care about your welfare, we care about your safety, we want to see you come back,’” said Mark Jenkins, the alliance’s executive director.

Too few services are specifically designed for the Black community, Jenkins said, even though data shows that the overdose crisis is hitting that population the hardest.

“We know that this disproportionately affects people of color, and we’re right out there where people need to see us,” he said of his organization’s approach. “A lot of our people don’t access services if they’re not right there in their path.”

A lack of funding

The overdose death numbers for American Indian and Native Alaskan people may be even higher than the Stateline analysis indicates, because Native people often are misidentified in death certificates, said Philomena Kebec, an attorney and member of the Wisconsin-based Bad River Band of Lake Superior Chippewa.

“These numbers about the impact on tribal and Alaska Native individuals are really stark,” Kebec told Stateline.

Many tribes struggle to provide overdose-halting naloxone and other medications because of chronic underfunding for health services, Kebec, who also is a fellow on addiction and overdose at Johns Hopkins Bloomberg School of Public Health, said on a Brookings Institution podcast last month.

But increasingly, tribes are turning to mobile programs not unlike Connecticut’s. The Confederated Tribes of Grand Ronde in Oregon is adapting buses to help people get methadone and buprenorphine that help curb opioid withdrawal symptoms.

Kebec said in an interview that her own tribe in Wisconsin began a mail-order naloxone program using private donations, but added it could do more with state funding that has yet to be approved.

“We have programming that’s really keyed into how things have to happen in rural communities. We have a lot of people who have transportation issues, so we have to come to them,” she said.

Tribes and helpers need more funding for research to find root causes and more timely information from hospitals to find overdose outbreaks quickly and intervene, she said. It’s a need everywhere, but means even more in Native communities, which are often spread out in rural areas.

In the Black community, men older than 55 are especially hard hit, said Gardner, of the National Black Harm Reduction Network. She noticed their deaths start to increase in the mid-2010s, when she served as New York state’s assistant secretary of health, and later realized those deaths were “the canary in the coal mine” that signaled deadly fentanyl’s infiltration into supplies of other drugs.

During the pandemic, “older [Black] men lost their communities, their family supports. There are some men who became homeless and there was no safety network,” Gardner said. “Plus, men still associate going out and getting health care with a woman’s thing. A lot of care is geared to women.”

Dr. Edwin Chapman, a District of Columbia physician whose practice serves many older Black men who use drugs, said that like others trying to help Black and Native people, he’s had trouble getting funding. His innovations include early use of buprenorphine to curb opioid cravings.

“There has been more pushback from local officials than help,” Chapman said.
This story is republished from Stateline, a sister publication to the Kentucky Lantern and part of the nonprofit States Newsroom network.

While pregnant with her second child, Cailyn Morreale was assured by her care team that she did not need to discontinue buprenorphine and that her baby would be assessed and monitored using the Eat, Sleep, Console approach. (Taylor Sisk for KFF Health News)

On learning last year she was pregnant with her second child, Cailyn Morreale was overcome with fear and trepidation.

“I was so scared,” said Morreale, a resident of the small western North Carolina town of Mars Hill. In that moment, her joy about being pregnant was eclipsed by fear she would have to stop taking buprenorphine, a drug used to treat opioid withdrawal that had helped counter her addiction.

Morreale’s fear was compounded by the rigidity of the most common approach to treating babies born after being exposed in the womb to opioids or some medications used to treat opioid addiction.

For decades throughout the opioid crisis, most doctors have relied on medication-heavy regimens to treat babies who are born experiencing neonatal opioid withdrawal syndrome. Those protocols often meant separating newborns from their mothers, placing them in neonatal intensive care units, and giving them medications to treat their withdrawal.

But research has since indicated that in many, if not most, cases, those extreme measures are unnecessary. A newer, simpler approach that prioritizes keeping babies with their families called Eat, Sleep, Console is being increasingly embraced.

In recent years, doctors and researchers have found that keeping babies with their mothers and ensuring they’re comfortable often works better and gets them out of the hospital faster.

Despite her worst fears, Morreale was never separated from her son. She was able to begin breastfeeding immediately. In fact, she was told, the trace of buprenorphine in her breast milk would help her son withdraw from it.

Her experience was different because she had found her way to Project CARA, an Asheville, North Carolina-based program, administered through the Mountain Area Health Education Center, that supports pregnant people and parents with substance use disorders. Morreale’s care team assured her she did not need to discontinue buprenorphine and that her baby would be assessed and monitored using the Eat, Sleep, Console approach. The protocol deems babies OK to be sent home so long as they’re eating, sleeping, and consolable when upset.

“By the grace of God, he was awesome,” Morreale said of her son.

David Baltierra, former director of West Virginia University’s Rural Family Medicine Residency Program, chair of WVU’s Department of Family Medicine – Eastern Division, and a family physician, suggests this protocol could simply be called “parenting.”

The method is increasingly being used instead of the long-embraced approach to treating opioid-affected newborns called the Finnegan Neonatal Abstinence Scoring System. That tool includes a list of 21 questions (is the baby crying excessively, sweating, experiencing tremors, sneezing, etc.), the answers to which determine whether the newborn should get medication to counteract withdrawal symptoms, which would then require an extended stay in a neonatal ICU.

Baltierra, though, has issues with the Finnegan method. For example, it often results in a soundly sleeping baby being awakened to be scored. That didn’t make sense to Baltierra. If the baby is sleeping, she’s likely doing fine.

Instead, health professionals should look for the telltale signs of a baby experiencing opioid withdrawal syndrome, he said. “Their body is in tension, they have a high pitch, they don’t calm down.”

Baltierra and his colleagues have been training residents to use an Eat, Sleep, Console approach for a decade, progressively more so in the past six years. The results are persuading more health professionals to adopt the method.

A 2023 study found babies treated this way were discharged from the hospital in nearly half the time and less likely to receive medication than those receiving Finnegan-based care.

Matthew Grossman, an associate professor of pediatrics at the Yale School of Medicine, refers to the introduction of the model of treatment he has helped pioneer as “the least innovative” undertaking imaginable.

Research shows that optimal care for pregnant women who’ve experienced opioid use disorder includes treatment with buprenorphine or methadone, which carries the risk their newborn will have withdrawal symptoms. Grossman and colleagues found a non-pharmacological-first approach works best.

He said the Finnegan tool is useful but often too rigid. Under its scoring, one sneeze too many could send a baby to the NICU for weeks.

Grossman said he observed that some babies receiving medications did well for a few days but began to decline when their mothers were sent home without them. Those observations made him ask, “Did the kid need more medicine, or more mom?”

Research by Leila Elder and Madison Humerick, who each did their residency in WVU’s rural program, found that median stays for newborns in withdrawal dropped from 13 days in 2016 to three in 2020.

Elder said babies born at the 25-bed rural hospital where they performed deliveries received medications to treat their withdrawal symptoms only when unrelated issues sent them to other hospitals for NICU care.

The simpler treatment also means more babies born in rural communities can receive care closer to home and has reduced the likelihood a mother will be released before her baby is cleared to go home.

Grossman suggested that rural hospitals are better suited to employ the Eat, Sleep, Console approach than big-city institutions, given the latter’s generally easier access to a NICU and propensity to choose that option.

Sarah Peiffer recalls the first time, as a medical student, she witnessed a nurse administering the Finnegan protocol, discussing it in clinical terms at a new mother’s bedside.

“And I remember being kind of horrified,” she said. The process was clearly distressing to both mother and child. “I felt like there was almost a punitive feeling to it, like we were telling this mom, ‘Look what you did to your baby.’”

Peiffer is now a Project CARA practitioner and family health physician at Blue Ridge Health in western North Carolina and a vocal proponent of ESC and its approach to partnering with families. “You look at all the nonpharmacologic stuff you’re supposed to be doing — like keeping the lights low in the room, keeping the baby swaddled, doing as much skin-to-skin with mom as possible — and you really treat mom as medicine.”

Research suggests immediate postbirth skin‐to‐skin contact offers “vital advantages” to short‐ and long‐term health and bonding.

That contact, Elder said, “releases endorphins for mom,” which helps lower the risk of postpartum depression.

Grossman said developing the Eat, Sleep, Console protocol was simply a matter of pausing to reassess.

The original intent of the Finnegan tool wasn’t to render the process so rigid. But “everybody is excited to have a tool, and then this approach calcified around it,” he said.

Grossman said the objective of the simpler approach was to place the family at the core of care, and shorter hospital stays for babies was simply a fortuitous outcome. The shift in approach fits into a wider move toward judgment-free, family-centered care for those who’ve experienced addiction and for their children.

Now, he said, after five days, mothers often say “‘Can we go home? I think I got this,’” and they’re treated “with the same respect as any other mom.”

Peiffer said she has witnessed this mother-centric care counter “that sense of shame that people feel instead of families feeling empowered to care for their infant.” It represents “such a major shift in how we think about neonatal withdrawal both medically and culturally.”

This story is republished from?KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Kentucky should consider creating triage centers to temporarily house children in state care who can’t immediately be placed in foster homes, said Kentucky Youth Advocates executive director Terry Brooks. (Getty Images)

After receiving what she called “numerous” complaints about foster children in Kentucky sleeping in office buildings without supervision by trained staff, state Auditor Allison Ball said Tuesday the Office of the Ombudsman will investigate.

Calling it an “ongoing crisis” that is “years” in the making,? Ball said the ombudsman will investigate the Cabinet for Health and Family Services to get at the root causes.?

Terry Brooks, the executive director of Kentucky Youth Advocates, said the problem isn’t new — and solving it won’t be? simple or cheap.?

It involves a “niche population” of high-needs youth who likely need specialized care, he told the Lantern.?

“It’s not typically 5-year-old kids who look like they fell off a TV commercial,” Brooks said. “You’re talking about older kids, teenagers, high levels of acuity, probably some special needs, probably with a history of aggressive behavior. I’m painting a portrait of a young person who we definitely need to care for, but we know it’s going to take creativity and resources to be able to do that.”?

A spokesperson for the auditor said the office thinks the practice has “been going on for two years and has affected about 300 children, but we’ll know exactly once we dig in.”??

The cabinet said in a statement that it has “taken action to address the challenges that come with placing youth with severe mental and behavioral problems or a history of violence or sexual aggression with foster families or facilities.”

“We’ve publicly addressed this many times with lawmakers and have offered more funding to secure additional safe, short-term care options for youth,” a cabinet spokesman said. “When one of these placements are necessary, we work to make sure each youth has a safe place to stay until a placement can be made. We urge those interested in becoming a foster parent to help us meet the needs of all our youth, please visit?KyFaces.ky.gov.”

In 2023, The Courier Journal reported that a shortage of available and willing foster families was a factor in the state’s decision to house some youth in a Louisville office building. WDRB reported earlier this year that the practice has continued, despite concerns raised by a Louisville judge.

“My office has continued to receive numerous complaints of foster children and teenagers sleeping on cots and air mattresses in office buildings, often not supervised by trained staff,” Ball said in a statement. “I have instructed the Ombudsman’s Office to investigate this issue to uncover the problems associated with this ongoing crisis.”

“The vulnerable children of Kentucky deserve to be placed in nurturing environments where they are provided with the resources, stability, and care they need,” Ball said.?

Staff are still trying to confirm how many office buildings are involved, a spokesperson for Ball said, though “we can confirm that this is not exclusively a Jefferson County issue.”?

Sleeping in an office building can compound trauma youth already have experienced, Brooks said. “It certainly is not going to create a positive childhood experience,” he said. “It’s going to create more adversity to kids who have already experienced too much adversity.”?

Kentucky ‘can’t do this on the cheap’?

Kentucky needs more families to foster, but it also needs a better system to support children who can’t be placed, Brooks said. Kentucky must “incentivize” — through higher wages and reimbursements — a “willingness to take on tough cases.”.?

Lawmakers can look to Tennessee, he said, which has faced similar problems and responded by increasing? payments to foster parents and wages to state staff working with higher-needs children.

“They have just owned the fact that,‘if I’m getting paid $15 an hour, I’m probably not going to be volunteering to get bitten, spit on and other issues with tough kids,’” Brooks said.??

Another solution Kentucky should consider, Brooks said, would be? to create triage centers — safe, secure, designated spaces — to temporarily house children who can’t immediately be placed.?

“If the General Assembly cares about those kids sleeping in offices as much as (CHFS Secretary Eric Friedlander) and Auditor Ball, then they’ve got to take action,” Brooks said. “And it can’t be rhetorical. It has to be resources. So I don’t know if that is looking at existing resources, I don’t know if that’s taking the big swing (and) reopening the budget, but you can’t do this on the cheap.”?

This story was updated with response from the cabinet.?

Patients who qualify for medical cannabis — with a history of post traumatic stress disorder (PTSD), cancer or other approved medical conditions — can apply for cards Jan. 1. (Getty Images)

LOUISVILLE — Kentucky awarded its first 26 medical cannabis licenses through a lottery held Monday at the Kentucky Lottery Corporation in Louisville.?

The first round of licenses, drawn by state lottery staff, went to 16 cultivators and 10 processors.?

Monday’s winners will get an email within 24 hours and must pay a licensing fee within 15 days. Failure to do so will result in licensing forfeiting, said Sam Flynn, the executive director of the Office of Medical Cannabis. Winners will have to renew after a year.?

Gov. Andy Beshear called the Monday drawing a “big step forward.”?

“Medical cannabis can help people, especially with really serious conditions,” Beshear said after the drawing. “People will be buying product that is grown here, that is processed here, that is tested here, that would otherwise be in other states.”?

Flynn said the program is focused on equitable access for Kentuckians who qualify for medical cannabis.?

“??We want to make sure that these folks have access points throughout the state,” he said. “We want to make sure they have the safest possible medical products and the best possible care available.”??

In a statement, Kentucky Lottery President and CEO Mary Harville said, “over the 35 years of its existence, the Lottery has been known for conducting drawings for a plethora of its draw-based games, first with machines and balls, and now, with state-of-the-art random number generators.”?

“These drawings are conducted with the highest level of integrity and are in accordance with industry established procedures,” said Harville. “We are happy to be able to bring this level of integrity to the cannabis drawings.”

A bipartisan effort?

In 2023, the legislature legalized medical marijuana for Kentuckians suffering from chronic illnesses.?

Then, the bipartisan House Bill 829 that became law during this year’s legislative session moved up the medical cannabis licensing timeline from January 2025 to July 1, 2024.?

During the application period, July 1–Aug. 31,? the state received 4,998 applications for medical cannabis business licenses, including 918 cultivator and processor applications, according to Beshear’s office.?

Patients who qualify for medical cannabis — with a history of post traumatic stress disorder (PTSD), cancer or other approved medical conditions — won’t be able to apply for cannabis cards until Jan. 1.

Flynn said providers who write certifications for those cards will prescribe types and amounts like any medication.

“We want to make sure that this is safe, that it’s driven by health care and health care decisions,” Flynn said.

“Help is on the way,” Beshear said. “There is a new day coming in Kentucky…where you’re going to be able to get safe medical cannabis to help you with your conditions.”???

A lottery date for the dispensers will be announced on Thursday, Beshear said.?

The winners?

The 10 processor winners are:?

1. KYP LLC – Jefferson County?
2. Kaldem Holdings – Muhlenberg County?
3. Limestone Processing – Fayette County?
4. Hilltop Healing Investco – Warren County?
5. Bijal Kentucky LLC – Boyd County?
6. AJ Alchemy Labs LLC – Barren County?
7. Jill’s Dispensary LLC – Christian County?
8. One Leaf Technologies LLC – Bullitt County
9. Ice House Processing, LLC – Fulton County
10. LMMKY LLC – Warren County

The 16 cultivator winners are:?

1. Natural State GreenGrass CannaCo LLC – Warren County?
2. KSYKAPP, LLC – Barren County
3. NG Health LLC – Fayette County
4. Armory Kentucky LLC – Estill County
5. JMOKY LLC – Warren County
6. Canopy Capital LLC – Grant County
7. L&O Legacies – Boyd County?
8. Synapse Remedies LLC – Jefferson County?
9. CW Bluegrass, LLC – Daviess County?
10. Popp Cultivation LLC – Bracken County?
11. Arizona Bay Investments LLC – Lincoln County?
12. Wong Investments, LLC – Christian County?
13. Joseph Serock – Christian County?
14. Elevated Essence LLC – Bullitt County?
15. Slaughter Branch LLC – Hopkins County?
16. Goeing Blue LLC – Fayette County

A view from Metzler's daughter's bedroom in July 2024. (Photos by Aubrey Metzler)

Editor’s note: Since this investigation was published Oct. 24 in Rolling Stone ?the Army has offered to move both of the Fort Campbell families into new homes. The story is republished from POGO, The Project On Government Oversight.

On the weekends, Aubrey Metzler lets out her frustration with military housing by screaming at strangers in the haunted house where she works, playing the part of “lunatic.” The 23-year-old mother of two has good reason to feel a little unhinged.?

Metzler says her whole family has been sick ever since they moved into privatized military housing last spring on Fort Campbell, an Army base straddling the edge of Kentucky and Tennessee. Her 17-month-old son is so congested that he has trouble breathing. Her 2-year-old daughter often complains of headaches and stomach pain, and both kids can’t use the tub in the upstairs bathroom without breaking out in hives. Her husband, an Army private first class, has recently been hospitalized for cluster migraines. Metzler herself throws up “every single day,” and describes the family’s housing challenges in a gravelly voice that’s punctuated by coughs and sniffles. On top of all that, the stress over housing has taken a toll on Aubrey and her husband’s mental health, she says, comparing her time working at the haunted house to “therapy.”

Metzler thinks the cause of her family’s health problems is mold, but she says it’s been an uphill battle getting taken seriously. Military family housing at Fort Campbell is run by Campbell Crossing LLC, a development of the global real estate conglomerate Lendlease.?

“Every time they tell me there’s no mold, I find mold. Every time without fail,” Metzler says. A spokesperson from Lendlease said the company complies with Army guidance, and emphasized that the safety of military families is the company’s top priority.

Mold is among the most common — and most harmful — military housing issues around the country, according to advocates from organizations that have worked with thousands of families in situations like Metzler’s. But a gap in federal mold standards has been exploited by the military and housing companies to avoid testing and competent mold remediation, according to military housing advocates, attorneys, and experts interviewed by the Project On Government Oversight (POGO).?

Little recourse against private landlords ?

Newly obtained internal documents reveal just how bad the problem is, and the military’s efforts to contain it both within homes and in the court of public opinion. “Can we reframe the ‘problem’ as just a part of life?” reads a presentation slide from an Army counter-mold workshop held in early 2023. The workshop detailed a multi-faceted plan termed “OPERATION COUNTER-MOLD,” for improving conditions — and public sentiment — on mold issues in the nation’s largest military branch.?

But mold woes are not unique to the Army, nor are they limited to specific housing companies.?

Nearly all of military family housing has been privatized, run by companies that have been called “slumlords” amid a series of recent scandals around deplorable conditions, fraud, and a wave of lawsuits by service members demanding accountability.?

Not to be confused with barracks — which are comparable to dorms and typically run by the Department of Defense (DOD) — privatized military family housing tends to be single-family homes. Approximately 700,000 service members and their families live in these homes, run by 14 companies in the U.S. across 78 developments. Several housing companies have been implicated in fraud schemes in recent years, including one that pled guilty in 2021 to defrauding the U.S. military of millions through falsifying home maintenance records, and another that paid a $500,000 settlement with no admission of guilt in a similar federal fraud case in 2022.?

While the military knows it’s a big problem when property managers fail to address mold, the lack of standards may obscure both the true extent of the damage and the dire impacts it wreaks for military families. Standards for mold could apply to prevention, identification (which could entail testing), or remediation (efforts to remove existing mold).

Plus, the fundamental nature of privatized military housing makes these situations harder for military families to escape. “They end up being trapped,” said Ryan Reed, a Texas-based attorney who specializes in military housing.

Service members typically have to move every couple of years, often into unfamiliar communities where they may not have any support structure outside of the military. This frequency of moving can make it hard for military spouses to have steady employment to provide supplemental income. In most cases, military families have the choice of living on or off base, though experts and advocates have cautioned that in some competitive housing markets, living off base may not be a real option: It can be cost prohibitive on a military salary, or have insufficient options for schools or child care.

When service members live in military housing, their rent is automatically deducted from their salary and sent to the housing company. Unlike in civilian housing, families in privatized military housing don’t have the ability to withhold rent when they have a problem in their home that their landlord needs to address, unless they enter into what is known as a “formal dispute process,” a congressional oversight fix that has a host of problems all its own.?

Aubrey Metzler says they can’t afford to live off base, nor can they afford the cost of child care. “We’re barely making it,” she said. “We are constantly stressed about the kids being in a house that is making them sick, and then feeling bad because we cannot afford to live anywhere else.”

$10.3 million settlement is rare, problem is not

Jason and Sarah Kiernan’s 2-month-old son was emergency airlifted to the Dell Children’s Medical Center in April 2019, struggling to breathe. Days after returning home to Fort Cavazos, another son stumbled through a damp wall, revealing a hidden danger: The home was filled with toxic mold.

Now 5 years old, their youngest son will likely need lifelong care because of a range of conditions connected to oxygen deprivation during infancy — conditions that the Kiernans linked to mold exposure in their lawsuit against the company. After a long legal battle, the Kiernans recently won an unprecedented $10.3 million settlement with an arbitration panel finding that the housing company had misled the family about mold in the home.?

The housing company in the Kiernans’ case was Lendlease, the same private business that oversees housing at Fort Campbell where Metzler lives. Lendlease announced that it was planning to sell off its U.S. military housing portfolio just days before the announcement of the Kiernans’ settlement was made public.

While the Kiernans’ legal victory was rare, their problem is less so.

Mold is the “number one” housing issue that military families face, according to Jean Coffman. She would know — she’s the executive director and board chair of the Safe Military Housing Initiative, an advocacy group that works with military families around the country. Coffman said mold tops the list, both in terms of sheer numbers and the potential for devastating harm to the families through health and economic impacts. Reed said roughly 90% of his military housing cases involve mold.?

Mold was also number one when it came to tenant complaints in both Marine Corps and Navy housing in fiscal year 2019, according to a DOD report to Congress that was obtained by POGO through a Freedom of Information Act request. Mold encompassed 61% of Marine Corps complaints and 29% of Navy complaints in the report, which did not include similar data for the other military branches. More recently, DOD Secretary Lloyd Austin revealed in a letter to Senator Elizabeth Warren (D-MA) that in 2023 there were at least 4,588 reports of mold in Air and Space Forces privatized housing.?

There have been more than 20,000 mold-related work orders in Army buildings since October 2022, with more than 1,000 work orders currently open, according to a spokesperson from U.S. Army Installation Management Command. That number encompasses military family housing, barracks, and other Army facilities. Although the spokesperson confirmed that the Army has far more detailed data on mold-related work orders and maintenance costs, including for military family housing specifically, they declined to provide additional data or to provide a narrower range than “more than 20,000.” The DOD and other military branches have not responded to our requests for interviews and mold-related data.

The full health impacts of this problem are unknown, in part because the Pentagon isn’t tracking whether housing conditions are making military families sick, according to a 2022 report by the DOD Office of the Inspector General.

Medical evidence links mycotoxins (the toxins produced by some molds) to a range of health conditions, including respiratory issues, flu-like symptoms, birth defects, immunosuppression, and cancer. Studies have also found a connection between mold and a number of mental health issues, including depression, anxiety, and “brain fog.” Infants and young children are even more susceptible to mold, with increased risk of asthma.

“There are growing numbers of us who are really worried of what happens when these children are exposed early on,” says Dr. Pejman Katiraei, a pediatrician who specializes in mold exposure.

Hiding behind the lack of standards?

Dallas Vann-Jones shares a wall with Aubrey Metzler in their duplex at Fort Campbell and can commiserate with her neighbor’s housing issues. Vann-Jones’s whole family is sick too (she has a 3-year-old son and a 7-year-old daughter), and she says they have had a hard time getting the housing company to even acknowledge whether mold exists in the house, let alone help with getting rid of it.?

“They just gaslight you,” Vann-Jones said, explaining how she has voiced concerns about mold in the house since January 2024 and was repeatedly told by housing company staff that there was no mold. “I literally sat on my couch and I bawled, ‘You are telling me there is no mold here, but my body is telling me otherwise, my children’s bodies are telling me otherwise,’” she said.

Both Metzler and her neighbor say that they have been repeatedly denied requests for mold testing in their homes which are in Pierce Village, a neighborhood in the Kentucky side of the base.

Housing companies and military branches often use the lack of a federal mold standard by the Environmental Protection Agency to justify refusing to test for mold in military homes, according to Coffman. In the Kiernans’ case, court filings indicate that positive test results for mold were the turning point when the family was relocated from the house.?

“The reason we have successes for getting families displaced and for mandating certain protocols is because we’re holding the card that says, ‘Here are the tests,’” Coffman said.

Official documents by the Army, Navy and Marine Corps Public Health Center, and Air Force caution against the use of mold testing, pointing to a lack of federal mold standards. But even though there isn’t a federally established threshold for safe levels of mold, additional documentation by the EPA and some military branches do suggest situations in which testing should be conducted, such as when there are medical concerns linked to exposure — a nuance that may get lost in communications with military families.

“Many, many times our families push for mold testing,” said Heather Hall, founder and chief executive officer of the Military Housing Coalition, a military housing advocacy group. “That’s always thrown out as a no.”?

It is not Army policy to refuse to test, according to an Army spokesperson. The spokesperson said that the leadership of Army installations have trained and certified mold inspectors, and that they follow the Army Public Health Center’s guidance.?

“We are very, very focused on providing that safe, affordable housing for those soldiers and family members, and our command takes this extremely seriously,” the Army spokesperson said.

The Army’s guidance isn’t as thorough as the most widely used industry standard in the U.S., according to Michael Rubino, an air quality expert and the co-founder of the Change the Air Foundation, a national air quality advocacy organization that is pushing for improved federal mold policies.?

Rubino has extensively reviewed the Army’s mold guide as an expert witness in a legal case, and he cautioned that in that housing case, the management company had failed to follow important elements of the Army’s guidance. “It’s equally as important to ensure the staff in charge of property management are educated and trained properly on the standards and ensure that the standards are being adhered to,” he said. Rubino’s organization points to the need for improved standards not only when identifying the problem, but also through requiring that remediation be conducted by accredited professionals.?

The lack of a mold standard is a widely used defense tactic for military housing companies in lawsuits brought by families, according to Reed, with some housing companies even citing language from the military to discredit the use of tests.

“I can go and do a two hour course and now be a mold inspector,” said Katiraei. This is a problem in military housing, advocates say, which can result in incompetence by contractors hired to deal with mold.

A spokesperson for the U.S. Army Installation Management Command said that their mold mitigation specialists receive two hours of training, but emphasized that approximately 80% of these individuals have also received an OSHA Mold Inspection Certification. The spokesperson said there are approximately 280 mold mitigation specialists for the Army in total, across family housing, barracks, and all Army facilities — Army family housing alone encompasses roughly 87,000 housing units worldwide. The spokesperson said they have the goal to have at least four OSHA certified specialists on each Army installation.

“The techs are not properly trained to identify mold,” Hall argues. “They come in, they misspeak. They will say, ‘mold is everywhere.’”

While a handful of states do have mold standards codified in law, whether they apply on military bases within those states is another question, because of the federal enclave doctrine, a legal defense used to exempt military housing from the protections of some present-day state and local laws.

The mold ‘communication playbook’

“Viewing mold as a normal part of life will decrease anxiety and increase trust,” reads one slide. Another claims, “mold is ubiquitous, its [sic] everywhere.” Yet another slide simply states, “MOLD IS MOLD,” while specifying that the Army’s “Mitigation Working Group” decided not to define what counts as “hazardous mold” because all “visible” mold should be mitigated. Coffman says she hears messaging like this all the time when working with military families, and not just from the Army, but across the military branches.?

That framing is “just ignorance,” according to Joseph Reiss, an expert in mold remediation. Reiss has been working with Coffman’s organization on a pilot project intended to model how military and housing companies should respond to mold, and pushing for Congress to implement federal mold standards. So far, Reiss has conducted mold sampling at 22 military homes. Not all molds hold the same health risks for families, which is why he says testing is so useful. “The goal here is, test: Don’t guess,” he said.

Coffman singled out one military housing company that’s holding itself to a higher standard: Corvias, which recently announced it was seeking certification by the International WELL Building Institute, an organization that sets standards for commercial and residential environments — including for mold.

Lawmakers are aware of the issue and taking some strides to address it, but Coffman says more strenuous response is needed. If passed, a proposed amendment to the 2025 National Defense Authorization Act would require a study on the health effects of mold in military housing and new mold standards. Senators Raphael Warnock (D-GA) and Ted Cruz (R-TX) also recently introduced legislation to improve DOD transparency in reporting on military housing conditions.?

A February 2024 DOD memo identified plans for adopting “livability standards” that could apply to family housing, including those for indoor air quality. But that same memo touts the “higher quality” of privatized military family housing in terms of tenant satisfaction, and suggests the Pentagon may move to privatize barracks as well.

For now, Aubrey Metzler is still stuck in housing where her family feels unsafe. She says the mold the housing company treated in the bathroom this summer has come back, and she recently discovered mold in her dishwasher. She has also noticed mold growing quickly on fabric items in the home. A couple weeks ago, she said the housing company told her they were going to conduct some tests after all, but they still haven’t indicated when that will happen. In the meantime, it’s stressful to stay in a home that she worries is making her children sick.?

“I cry a lot, because my daughter constantly tells me she doesn’t want to be here,” Metzler said. “She doesn’t feel good here, and I can’t do anything about it.”

In January 2023, more than 100 participants gathered at Army Installation Management Command headquarters for a “counter-mold” workshop, focused on educating Army “stakeholders” about mold issues in the nation’s largest military branch. The workshop covered strategies and practices for mold identification, prevention, and mitigation. It also included ample guidance for how Army officials should be talking about mold with the public, referencing a 2023 “Counter-Mold Communication Playbook,” campaign talking points, and social media campaigns.

An Army spokesperson emphasized that education of military families is a critical piece of their work countering mold, whether it be through face-to-face interactions or social media, “because obviously we hope we can stop any mold issues before they start.”

The Project On Government Oversight (POGO) is a nonpartisan independent watchdog that investigates and exposes waste, corruption, abuse of power, and when the government fails to serve the public or silences those who report wrongdoing. ?POGO says it champions reforms to achieve a more effective, ethical and accountable federal government that safeguards constitutional principles.?

Katelyn Foust traveled from her Oldham County home to a birthing center in Indiana to give birth to baby Jude. (Photo provided)

After compromises from lawmakers, St. Elizabeth Healthcare in Northern Kentucky is now neutral on legislation to clear the way for freestanding birth centers in the state.?

Representatives for the health system have previously voiced some opposition, saying hospitals are best equipped to handle the unpredictability of birth.?

Marc Wilson with Top Shelf Lobby spoke on behalf of St. Elizabeth Healthcare during Thursday’s meeting of the legislature’s Interim Joint Committee on Licensing, Occupations, and Administrative Regulations.?

“I’m happy to report that St. Elizabeth Healthcare is neutral on this legislation as presented to us in the most recent draft, and thank you for allowing us to have a voice,” said Wilson.?

What to know about the certificate of need debate in Kentucky

He then joked: “I had to read that statement, because I’ve been told if I misspeak, that world markets will crash.”??

Freestanding birth centers are health care facilities that are meant to feel like a home. They do not offer c-sections or anesthesia. They are for low-risk pregnancies, and not every pregnancy will qualify for such a birth.?

Neutrality ‘a big deal’?

St. Elizabeth’s new position removes a political obstacle and is expected to help win some lawmakers’ votes for birthing centers.

Sen. Shelley Funke Frommeyer, an Alexandria Republican who’s sponsored bills on this issue the last two years, told the Lantern St. Elizabeth’s neutrality is a “big deal.”

“They’ve also been a good steward alongside me to convene stakeholders and really listen to: ‘What do the doctors acknowledge are a concern?’ so they have been able to bring together the community that really is only accustomed to hospital-based births, to recognize that there are alternatives, and to acknowledge that this is a very good alternative, or to stay neutral, is an acknowledgement, and I’m very appreciative of that.”?

Funke Frommeyer believes several changes in the draft bill helped turn the tide — specifically, requirements that freestanding birth centers have medical malpractice insurance, are located within 30 miles of a hospital that provides obstetric care and have a licensed physician in oversight. The new version will also allow hospitals to own freestanding birth centers.?

The bill she will file in 2025 — a sister bill to the one Louisville Rep. Jason Nemes will file in the House — notably removes the certificate of need process for freestanding birth centers that have? no more than four beds.

Nemes, who’s repeatedly sponsored freestanding birth center legislation, told colleagues in the committee that 2025 is the year it will pass: “It’s a better bill than it’s been,” he said, “and it’s ready to roll.”?

“St. Elizabeth has a very important voice, both in Frankfort and a big footprint …. in Northern Kentucky,” Nemes told the Lantern after the meeting.?

The Kentucky Hospital Association — a potent force with lawmakers — has opposed making it easier to open birthing centers in Kentucky. A spokeswoman has not yet returned a Lantern email asking whether the organization’s opposition has softened in response to the recent changes in the draft legislation. The hospital association has voiced support for reforming the certificate of need process, but not an outright repeal. KHA president and CEO Nancy Galvagni has also said removing birthing centers from the CON process “would put women and babies at risk” and “roll back decades of progress in maternal care.”

‘Challenging compromises’?

Mary Kathryn DeLodder, the director of the Kentucky Birth Coalition, said she hopes the new St. Elizabeth stance is “meaningful” to the legislators who represent the area.?

But it didn’t come without a price.?

“When it comes to legislation, sometimes you have to make compromise, and sometimes compromise is hard,” she told the Lantern. “This was a time that we … felt we had to make some challenging compromises in order, for the greater good, to get birth centers, because we would rather have birth centers than not have birth centers.”?

Among those compromises, she said, is the point requiring licensed physician oversight.?

“We feel that there are lots of midwives, different types, who are very qualified to serve in that capacity,” she said.

She also cited the worsening physician shortage as a concern.?

“I hope that there will be physicians in Kentucky who want to serve in this role for birth centers,” DeLodder said. “We don’t want it to be a barrier for birth centers. We don’t want it to be something that has an additional cost for centers if they have to pay a position to fill that role.”?

She added: “If you trade one barrier for another, you haven’t really gained anything.”?

Nemes acknowledged this issue is “a concern.”

“We want to get them, first off, that’s the most important thing, and then we’ll see how they work out,” he said. “I think that might be a problem in some places, and in some places it won’t be. So, we’ll just see what happens. But … obviously it’s a concern because there’s a physician shortage.”

Background?

Advocates have iterated that people who want a low-intervention birth will do everything they can to get it. Every year, Kentucky babies are born in neighboring states after their parents traveled for the care they can’t get in the commonwealth.?

In 2022, 110 Kentuckians traveled to Tree of Life, the freestanding birthing center in Jeffersonville, Indiana. That is an increase from 107 in 2021 and 71 in 2020.

And around 60% of the Clarksville Midwifery practice in Tennessee are people who come from Kentucky, the Lantern has reported. That means about 25-30 Kentucky babies every year are being born just beyond the border in the Volunteer State.?

Just between those two practices, hundreds of Kentuckians are leaving the commonwealth to deliver in neighboring states.

In the past advocates have said having freestanding birth centers would offer a middle ground for people who will choose a home birth. Kentucky recorded 177 home births in 1988 and 900 in 2021. Home birth is legal in all 50 states.?

This story may be updated.??

A federal judge in California has ordered the EPA to consider at least requiring a warning on fluoridated water. (Photo by New Jersey Monitor)

A Republican lawmaker will once again push to end Kentucky’s requirement for certain utilities to add or adjust fluoride levels in drinking water.

Rep. Mark Hart, R-Falmouth, filed House Bill 141 in 2024, but it died without clearing either chamber.?

Speaking before the Interim Joint Committee on State Government Tuesday, Hart said he wants to “undo an unfunded mandate” and give communities choice on whether they consume water with added fluoride. The legislation he plans to introduce in the 2025 session wouldn’t? ban the use of fluoride, he said.?

Fluoride is a naturally-occuring mineral, according to the Centers for Disease Control and Prevention, and can be found in most water.?

In August, the National Toxicology Program, part of the U.S. Department of Health and Human Services, said “higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children.” In September, a federal judge in California ordered the Environmental Protection Agency (EPA) to “engage in rulemaking regarding the chemical” ranging from “requiring a mere warning label to banning the chemical.”?

U.S. District Court Judge Edward Chen, an Obama appointee, took care to say his ruling “does not conclude with certainty that fluoridated water is injurious to public health” but that the evidence of its potential risk now warrants some kind of EPA action.

Cindi Batson, a nurse with Kentucky for Fluoride Choice, testified alongside Hart.?

“One of the things Kentucky cannot afford to do,” she said, “is to ignore this risk in our state.”?

Distrust of fluoride ‘mind-boggling’; mineral is ‘time-tested’ and a ‘good thing,’ dentists say

Health advocates sent the committee a letter asking lawmakers to keep fluoride in community water. Those who signed the letter are Delta Dental of Kentucky, Kentucky Dental Association, Kentucky Dental Hygienists’ Association, Kentucky Oral Health Coalition, Kentucky Primary Care Association, Kentucky Voices for Health and Louisville Water Company.??

“Despite our historic issues with poor oral health in Kentucky, we have made strides towards? improvement in oral health by leading the nation with 99% of Kentucky communities with water? fluoridation programs,” the letter states. “We as a Commonwealth cannot afford to move backward.”?

Kentucky water utilities could opt out of putting fluoride in drinking water under advancing bill

Hart said the federal ruling and summer report put Kentucky at risk of liability issues.?

“We mandate this be put in our water,” he said. “Now that the data and the research is showing that it does create an unreasonable health risk, when people start seeing the outcomes — or if they, unfortunately, have a health problem based on the water fluoridation in our water because we’re mandating it — at some point the state’s gonna be responsible for that.”?

The pro-fluoride advocates wrote in their Tuesday letter that they have a “unifying interest to improve the oral health for all people in the Commonwealth? of Kentucky” and “are deeply concerned about any efforts to remove water fluoridation programs in our? communities.”?

The 2025 legislative session begins Jan. 7.

Read the letter supporting fluoridation of water for dental health

Andrew and Libby Potter look over the letter they received in October, telling them that their region’s largest hospital system would no longer be considered in-network for Libby’s Medicare Advantage policy. The Potters live in Huntsville, Ala., where Libby is a retired middle school librarian and Andrew is a professor at a state university. (Anna Claire Vollers/Stateline)

HUNTSVILLE, Ala. — Libby and Andrew Potter usually ignore the avalanche of Medicare Advantage ads that land in the mailbox at their home in Huntsville, Alabama, each fall as Medicare’s open enrollment period begins.

Libby, a retired middle school librarian, has what she considers good health insurance through the state employee health plan. Andrew has insurance through his job as a university professor and plans to join Libby’s insurance when he retires next year.

But this year, a few days before open enrollment began, a letter arrived from UnitedHealthcare, informing the Potters that the region’s largest hospital system would no longer be considered in-network for Libby’s Medicare Advantage plan.

The Potters spent the next couple of weeks worried and unsure what to do. It seemed incredible that 14 area hospitals, including the area’s only Level 1 trauma center, could suddenly become much, much more expensive.

“We were being very careful in how we go up and down stairs,” Libby joked.

Baptist Health, Humana restore ‘in network’ coverage for Medicare Advantage patients

Medicare is the federal health insurance program for people over 65 and those with certain disabilities. Medicare Advantage is a version of Medicare run by private insurance companies that contract with the government. These plans typically offer extra benefits, such as dental, vision and prescription drug coverage, that aren’t included with traditional Medicare. More than half of eligible Medicare beneficiaries now get their coverage through private Medicare Advantage plans.

But this year, as Medicare’s open enrollment season kicks off, more than 1 million patients will have to shop for new health insurance. Facing financial and federal regulatory pressures, many insurers are pulling their Medicare Advantage plans from counties and states they’ve deemed unprofitable. Meanwhile, large health systems in states including Alabama, Minnesota and Vermont have cut ties with some Medicare Advantage plans.

It’s a situation that’s alarmed state insurance regulators, who are fielding questions from older adults concerned about their hospitals and doctors withdrawing from their Medicare Advantage plans. Last month, the National Association of Insurance Commissioners sent a letter to the federal Centers for Medicare & Medicaid Services asking for guidance.

“Beneficiaries are faced with either paying the increased out-of-network costs or rescheduling their necessary medical services with another provider who may not have prompt availability,” the insurance commissioners’ group wrote. “A delay in access to medically necessary services is likely to result in harm.”

The Potters eventually learned that Libby’s copayments at the hospital would remain the same whether or not the hospital was in-network for the state educators’ Medicare Advantage plan. But those with other UnitedHealthcare Medicare Advantage plans will have to pay more — or find another plan.

“When a contract leaves the market, that can threaten continuity of care and access to care,” said Dr. Amal Trivedi, professor of health services, policy and practice at the Brown University School of Public Health. “The beneficiary will have to choose a new plan, and each of these plans is going to have a different benefit structure, different provider network, different prior authorization policies and different [prescription drug] formularies.

“The worry is that’s going to affect their out-of-pocket costs, expose them to catastrophic spending, or compromise their access to care.”

How we got here

Insurance giants such as UnitedHealthcare have been aggressively pushing enrollment in their Medicare Advantage plans for the past several years, luring customers with perks and bonuses not available through traditional Medicare. These plans tend to have low or even no monthly premiums and offer extra benefits such as vision and dental coverage, gym memberships, transportation to medical appointments, and even debit cards for medical supplies.

You’ve covered your copayment; now brace yourself for the ‘facility fee’

And they’re simple: They provide all of a person’s coverage in one plan, unlike traditional Medicare, under which people must get separate prescription drug coverage and supplemental coverage.

But there are trade-offs. Medicare Advantage plans often have a limited network of hospitals and physicians. And while the premiums are typically low, enrollees could end up paying more in the long run in copays and deductibles if they develop a serious illness.

Medicare Advantage programs also are more likely than traditional Medicare to require prior authorization for hospital stays and other high-cost services. The plans’ prior authorization requirements have prompted increased scrutiny in recent years. A congressional investigation by Democratic Senate staff released this month, for example, found the nation’s largest Medicare Advantage insurers denied a quarter of all prior authorization requests for post-acute care in nursing homes, rehab hospitals and long-term care.

Medicare Advantage is popular among large employers, many of which are shifting their Medicare-age retirees into these plans. And most states offer Medicare Advantage plans to retired state employees; in 13 states, it’s the only option. In some of those 13 states, retirees forfeit their health benefits in perpetuity if they choose coverage under traditional Medicare.

North Carolina Treasurer Dale Folwell, whose office administers the state health plan, said its Medicare Advantage plan is popular.

“What we hear from our retirees, is that they are grateful and happy to have such a great offering as a result of their retirement benefit,” the Republican said. “That’s why nearly 89% of our retirees over age 65 have availed themselves of the [Medicare Advantage] product we offer them.”

Insurers retreat

This year, the handful of insurance giants that dominate the Medicare Advantage market have said they’re scaling back or eliminating plans, to shed members and boost sagging profits. They blame new federal changes to their reimbursements, including a small cut to their base payments, and say patients are using more medical services and benefits than they anticipated.

Though most companies haven’t released data on specific counties where they’re making cuts, plans are reportedly shuttering in states such as Alabama, Massachusetts, Missouri, New Hampshire, New Mexico, Texas and Vermont, affecting hundreds of thousands of older adults. Experts say the reasons why a company might find certain markets unprofitable are complex, but can include demographics, availability of providers and plans that are already in the market.

“[T]he industry broadly is going to be trimming benefits and in some cases significantly, and exiting from certain counties that aren’t profitable,” Aetna’s former President Brian Kane told shareholders on an earnings call in May, before he left his position. Aetna, a subsidiary of CVS Health, is the third-largest Medicare Advantage insurer in the nation. “I think that’s an industry issue and I think it’s clearly an Aetna focus as well.”

Executives at CVS Health, Aetna’s parent company, told shareholders the priority for its Medicare Advantage program would be improving profit margins rather than increasing the number of enrollees.

They have not announced publicly which counties will lose Medicare Advantage plans, but noted their changes could push out 10% of their membership, meaning up to 420,000 patients could be forced to shop for a different plan.

Canceled plans

Even with the decline in the number of plans available next year, “there are still a lot of plans and people have a lot of options,” said Jeannie Fuglesten Biniek, associate director of the Medicare policy program at KFF, a health policy research organization. Next year, the average Medicare beneficiary will have access to 34 Medicare Advantage plans that include drug coverage, down from 36 this year, she said.

But that average masks wide variation across states and even counties in how many plans are available.

“There are a handful of counties, more than in previous years, where all Medicare Advantage plans exited and those look to be predominantly rural counties,” said Fuglesten Biniek. “We’re talking fortyish counties out of 3,000. For those people in those counties, that matters, but overall, it’s a smaller number.”

Experts say there isn’t enough data available yet to know whether the plan exits are concentrated in certain states or counties.

But research has shown that Medicare Advantage plans that enroll higher shares of Black beneficiaries are more likely to be terminated, said Trivedi, of Brown University. Black enrollees have?more lower-quality Medicare Advantage plans?available in their counties of residence than white enrollees, research shows; terminated contracts tend to?have lower-quality ratings.

“The consequence is that contract terminations in Medicare Advantage seem to have a disproportionate effect on Black beneficiaries because their contracts are more likely to be terminated,” Trivedi said.

A disproportionate share of Medicare Advantage beneficiaries are Black, Hispanic, and Asian and Pacific Islander. These patients tend to have lower incomes than white beneficiaries, and may by drawn by the lower upfront costs of Medicare Advantage plans.

“[Insurers] like to frame it as, ‘People are choosing us because we’re awesome,’” said Brandon Novick, program outreach assistant at the Center for Economic and Policy Research. “But it’s because financially it makes more sense in the short term” for people with limited incomes.

Meanwhile, at least 28 health systems in 21 states have stopped accepting some Medicare Advantage plans this year, according to an analysis from Becker’s Hospital Review, an industry publication.

Health systems have cited delayed reimbursements, cumbersome prior authorization requirements and high rates of patient claim denials for their decisions to drop Medicare Advantage plans. Nearly 1 in 5 health systems stopped accepting one or more Medicare Advantage plans last year, according to a report by the Healthcare Financial Management Association.

‘A tough ask’

For retirees like Libby and Andrew Potter, losing access to trusted doctors and hospitals can mean going longer without needed medical care. Finding a new doctor and getting an appointment can take months, particularly for specialists. And for older adults living in rural areas, losing an in-network hospital or physician can mean choosing between a long drive for care or high out-of-pocket costs.

“There are really important access-to-care issues when providers no longer contract with your Medicare Advantage plan,” Trivedi said.

He said the sheer number of plans and differences in benefits might be overwhelming for older adults.

“To sort through all of that when somebody also may have frailty or cognitive impairment, that’s a really tough ask,” Trivedi said. “I study health policy for a living and it’d be hard for me to sort through 40 different options.”

This story is republished from?Stateline, a sister publication to the Kentucky Lantern and ?part of the nonprofit States Newsroom network.?

Cuts in Medicaid payments to behavioral health providers are forcing cuts at Kentucky's largest provider of treatment for addiction. (Getty Images)

The state’s largest provider of drug and alcohol treatment is making further cuts in staff and facilities as it faces steep cuts in Medicaid payments from the government health plan that covers nearly all its clients.

Addiction Recovery Care, or ARC, based in Louisa, said it will temporarily close four programs and reduce staff as it plans for cuts of 20% or more from some of the private insurance companies that process and pay most of the state’s Medicaid claims.

The cuts to ARC programs in Boyd, Jackson, Fleming and Pulaski counties follow ARC’s announcement last month it was restructuring some programs and laying off staff after the insurance companies, known as managed care organizations, or MCOs, first notified ARC of the pending cuts.

In a statement, ARC said it remains committed to providing substance use disorder treatment across Kentucky.

“These decisions were not made lightly, and we are dedicated to supporting our team members and communities affected by these changes,” said Vanessa Keeton, ARC vice president of marketing. “Above all, the safety and care of our clients remains our top priority. We are still available 24/7/365 for patients and families in need.”

The cuts come as the MCOs, including Wellcare of Kentucky Inc., are announcing broader reductions in Medicaid reimbursement to other addiction and behavioral health programs that will limit their ability to provide care, said Frankfort lawyer Anna Stewart Whites, who represents about 20 smaller treatment providers.

For example, one of her clients, a small children’s therapy program in Berea, was recently notified of cuts, she said.

“It appears to be very much across the board,” she said.

Wellcare is the largest of six MCOs that manage Medicaid claims for Kentucky, with about 418,000 enrollees.

It did not immediately respond to a request for comment.

ARC’s cuts are the latest setback for the fast-growing, for-profit company that last year took in $130 million in state Medicaid funds and has expanded from a single halfway house to a statewide network of recovery programs and residential centers in 24 counties across Kentucky.

In July, the FBI announced it was?investigating ARC?for possible health care fraud and asking anyone with information to contact the federal agency. ARC said it stands by its services and is cooperating with the investigation.

Kentucky lawyer climbed out of alcoholism, launched a recovery boom

ARC and its founder and CEO Tim Robinson have emerged as prolific political donors in recent years.

A?Lantern analysis?by Tom Loftus showed that Robinson, his corporations and employees have made at least $570,000 in contributions to Kentucky political causes and candidates over the past decade as his company grew from a single halfway house to about 1,800 residential beds and outpatient care for hundreds more clients.?

ARC said it has provided treatment for 75,000 people over the past 15 years.

‘Set back addiction treatment?’

The MCOs contract with the state to manage most of its $1.5 billion a year Medicaid program and have broad latitude in setting rates with providers. They are? paid a fixed rate per member and reimburse providers for care.

In July, ARC was among providers who testified before a legislative committee, warning that cuts by MCOs in payments for addiction treatment could hamper progress Kentucky has made in treatment for several decades of widespread addiction and overdose deaths.

An expansion of treatment services was fueled by expanded Medicaid payments in 2014 for substance use disorder under the Affordable Care Act.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for?Addiction Recovery Care, or ARC, told the interim Health Services Committee. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

Last month, Frontier Behavioral Health, based in Prestonsburg, filed suit against Wellcare over rate cuts of 20% and a new requirement that it review all services before agreeing to pay for them. That lawsuit is pending.

Its lawsuit said that when Frontier tried to follow up with Wellcare over an August letter notifying it of cuts, the number provided in the letter for questions had been disconnected.

‘Booting’ out clients

Whites said some providers she represents have had similar experiences — or worse.

When some providers tried to contact Wellcare about rate cuts, it responded by canceling their contract altogether.

That forced clients in the midst of treatment to find another provider or switch to another MCO, both of which mean delays in care. Some providers have continued to offer treatment without reimbursement until clients can make the necessary changes, she said.

“The risk of booting someone out of your program and finding someone who can take them is just too much of a risk,” Whites said.

ARC’s Brown didn’t immediately identify how many employees will be affected by the reductions announced Wednesday. Prior to the staff cuts last month, it employed 1,350 people.

Programs to be closed temporarily are: Sanibel House in Bloyd County; Beth’s Blessings in Jackson County; Belle Grove Springs in Fleming County, and Lake Hills Oasis in Pulaski County.

Brown said clients will be offered placement in other ARC programs or the option to change to a different provider to continue treatment.

Meanwhile, he said ARC continues to negotiate over the pending rate cuts.

“We are very hopeful to have these negotiations done soon,” he said.

He said lawmakers, state officials and providers are working “to create a solution that preserves access to treatment and long-term recovery.”

DeleteMe expands on Kentucky Safe at Home which lets victims of domestic violence hide their addresses when registering to vote and to use the state Capitol as their address on public records. (Getty Images)

Reach the National Domestic Violence Hotline at 800-799-7233 or text START to 88788.?

Kentucky Secretary of State Michael Adams’ office has launched a program to help domestic violence survivors delete their personal identifying information (PII) from the internet.?

Called DeleteMe, the program is a national privacy company that removes personal information from certain online sites. Eligible information includes addresses and phone numbers, said a spokesperson for the office.

The program is available only to the 125 members of the Safe at Home program, which came out of a 2023 law. Safe at Home lets victims of domestic violence hide their addresses when registering to vote without a protective order from a judge. It also allows the state Capitol to be the address on public records and lets those moving from out of state easily join the program.?

“Last year, I extended protections to domestic violence survivors to prevent their information from being displayed on government records,” Adams said in a statement, referring to the Safe at Home program. “This year, I am proud to extend those protections to information that can be found easily online.”

Since informing members about the DeleteMe program on Oct. 1, about 15 participants signed up immediately, said spokeswoman Michon Lindstrom.?

As of Wednesday, she said, “there have been about 800 total listings removed (an average of 51 a person) and 4,500 PII removed (an average of 322 a person).”?

“It works kind of like Rocket Money, where they contact places to cancel your subscription. DeleteMe contacts these data broker sites and requests to have the PII removed,” she explained. “Some (data) are instantly removed but some can take a couple of weeks depending on the site.”?

Safe at Home participants who want to opt in for the DeleteMe program should call or email the secretary of state’s office.?

Photos of fentanyl victims are on display at a memorial at the U.S. Drug Enforcement Administration headquarters in Arlington, Va. Federal data shows that overdose deaths are rising in Western states even as many states in the East are seeing improvement; the spread of fentanyl may explain much of the geographic movement, experts say. (Alex Wong/Getty Images)

Despite an encouraging national dip in the past year, overdose deaths are still on the rise in many Western states as the epicenter of the nation’s continuing crisis shifts toward the Pacific Coast, where deadly fentanyl and also methamphetamine are finding more victims.

Overdose deaths remain sharply higher since 2019. Many states are working on “harm reduction” strategies that stress cooperation with people who use drugs; in some cases, states are getting tougher on prosecutions, with murder charges for dealers.

Alaska, Nevada, Washington and Oregon have moved into the top 10 for rate of overdose deaths since 2023, according to a Stateline analysis of federal Centers for Disease Control and Prevention data. Meanwhile the biggest one-year improvements were in Nebraska (down 30%), North Carolina (down 23%), and Vermont, Ohio and Pennsylvania (all down 19%).

In Kentucky, overdose deaths declined 18% since 2023. But fatal overdoses remain high in Kentucky at 43 per 100,000 population, the nation’s ninth highest rate.

The spread of fentanyl, a synthetic opioid that can cause overdose and death even in tiny amounts, explains much of the east-to-west movement in the number of deaths, said Daliah Heller, vice president of overdose prevention program at Vital Strategies, an international advocacy group that works on strengthening public health.

“Fentanyl really came in through the traditional drug markets in the Northeast, but you can see this steady movement westward,” Heller said. “So now we’re seeing overdoses going up on the West Coast while they’re going down dramatically on the East Coast.”

The provisional CDC data estimates drug overdose deaths in the year ending with April 2024, and nationally they decreased by 10%, with more than 11,000 fewer deaths than the year before. But they’re still rising in 10 states and the District of Columbia, including 42% in Alaska, 22% in Oregon, 18% in Nevada and 14% in Washington state. Deaths climbed by almost 1,300 in those states and others with more modest increases: Colorado, Utah and Hawaii.

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Experts are still debating why some Eastern states hit early in the overdose crisis are seeing improvements.

“There’s some kind of improvement spreading from east to west and we don’t know exactly what it is yet. Everybody sees their little piece of the elephant,” said Nabarun Dasgupta, a scientist specializing in opioid disorder and overdose at the University of North Carolina’s Injury Prevention Research Center.

In North Carolina and other states with recent improvements, “it feels like we finally got a lid on the pot, but the pot is still boiling over. Things aren’t really cooling down,” Dasgupta said.

It could be a result of better acceptance of harm reduction policies to help those who use drugs, including no-questions-asked testing of street drugs and providing naloxone to counteract overdoses. Or users may simply be getting more wary of fentanyl and its dangers and unpleasant side effects, Dasgupta said.

"It feels like we finally got a lid on the pot, but the pot is still boiling over. Things aren't really cooling down." - Nabarun Dasgupta, University of North Carolina Injury Prevention Research Center

“Fentanyl is very potent, but potency isn’t the only thing. Otherwise we’d all be drinking the highest proof IPAs (India pale ales),” Dasgupta said.Alaska now has the nation's second-highest rate of drug overdose deaths, about 53 per 100,000 population, behind only West Virginia (73 per 100,000). Other Western states that are now in the top 10: Nevada (47 per 100,000), Washington state (46 per 100,000) and Oregon (45 per 100,000).

The CDC data shows Alaska had the largest increase from 2023 — up 42%, to 390 deaths. Republican Gov. Mike Dunleavy in August 2023 proposed legislation making fentanyl dealers subject to murder charges in overdose death cases, writing: “Drugs and drug overdoses have had a devastating effect on our state.” The legislation was signed into law this year.

In May, the state kicked off “One Pill Can Kill,” a national?awareness campaign?warning about the dangers of fentanyl.

Fentanyl, mostly in the form of counterfeit 30 mg oxycodone pills, has become tremendously profitable for smugglers in Alaska who make use of airline passengers and air shipments of other products to get drugs into the state, said state Department of Public Safety spokesperson Austin McDaniel. Pills that sell for less than $1 near the U.S. southern border with Mexico can fetch $20 in Alaska, McDaniel said.

“We want to make the dealers think twice about targeting Alaska,” said Alaska state Rep. Craig Johnson, an Anchorage Republican, who supported the bill signed into law July 12.

Johnson’s 23-year-old nephew died of a fentanyl overdose two years ago. “This is personal. I don’t want other Alaska families to go through what we went through. I hope we never have to use it, because that will mean nobody else died.”

Other state and federal authorities are also trying a more punitive approach to the fentanyl crisis: Under a state program in Wisconsin meant to ferret out suppliers, three people were arrested in September and charged with first-degree reckless homicide in the fentanyl overdose death of a 27-year-old man.

In Michigan, two men pleaded guilty this month to federal charges in a mass fentanyl poisoning that led to at least six deathsSuch punitive approaches can backfire, experts say, if they drive people toward more dangerous solitary drug use — where no one can see an overdose and try to help — and away from programs such as free testing to unearth fentanyl hidden in other drugs.

“It’s sort of nonsensical, like saying you can beat something out of people. People are still going to use drugs,” said Heller, of Vital Strategies. “This should be a call to action to wake up and really invest in a response to drug use as a health issue.”

In Nevada, health authorities in the Las Vegas area are stressing more cooperation with residents who use drugs, increasing naloxone distribution and encouraging people to submit their drug purchases for testing so they’re not surprised by counterfeit heroin, methamphetamine or other drugs that are increasingly cut with cheaper fentanyl, said Jessica Johnson, health education supervisor for the Southern Nevada Health District.

For second year in a row, Kentucky overdose deaths decrease?

A state office coordinates goals for county naloxone distribution based on factors such as hospital reports of overdoses. More overdoses trigger more naloxone distribution to community centers, clinics, entertainment venues and even vending machines.

One puzzle in Nevada and in other states is that increasingly, overdoses involve a combination of opioids, such as fentanyl, along with stimulants such as methamphetamine. Almost a third of overdoses in Nevada are caused by both being used together, according to a state report based on 2022 data.

It could be that some people seek the “roller coaster of effects using a stimulant like methamphetamine and a depressant like fentanyl or heroin,” Jessica Johnson said, but mostly she hears that unsuspecting users get cocaine or methamphetamine that’s been cut with cheaper fentanyl.

“We get people saying, ‘Oh I don’t need naloxone because I don’t use fentanyl,’ and our team is able to say, ‘Well, our surveillance data actually suggests there might be fentanyl in your methamphetamine’ or whatever it is.”

Nationally, both drugs are increasingly a factor in fatal overdoses: Synthetic opioids such as fentanyl contributed to 68% of overdose deaths in this year’s CDC data, up from 48% in 2019. Stimulants such as methamphetamine were factors in 35% of deaths, up from 20% in 2019.

Heroin and other partly natural opioids, such as oxycodone, have diminished as factors, together accounting for 13% of deaths in the latest data compared with 40% in 2019.

Some experts theorize that the high potency of fentanyl makes those who use drugs want to tweak or balance the effect with methamphetamine. Fentanyl itself is often cut with xylazine, a non-opioid animal tranquilizer — often known as “tranq” — that can cause unpleasant side effects, including extreme sedation and skin lesions, Dasgupta said.

“During the pandemic, there were a lot of reasons why people were using substances more. Now that things are different, people are tired of the adulteration, the sedation, the skin wounds,” Dasgupta said. “People may take lower doses, and that in itself can help lower overdoses.”

This story is republished from Stateline, a sister publication to the Kentucky Lantern and part of the nonprofit States Newsroom network.

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Nancy Baker Curtis demonstrates using an adult-size changing table with son Charlie at a rest stop near Adair, Iowa. The table is motorized so it can be lowered when a person needs to get on, then raised for easy changing. (Tony Leys/KFF Health News)

ADAIR, Iowa — The blue-and-white highway sign for the eastbound rest stop near here displays more than the standard icon of a person in a wheelchair, indicating facilities are accessible to people who can’t walk. The sign also shows a person standing behind a horizontal rectangle, preparing to perform a task.

The second icon signals that this rest area along Interstate 80 in western Iowa has a bathroom equipped with a full-size changing table, making it an oasis for adults and older children who use diapers because of disabilities.

“It’s a beacon of hope,” said Nancy Baker Curtis, whose 9-year-old son, Charlie, has a disability that can leave him incontinent. “I’m like, ‘Oh my gosh, we’re finally there.’”

The white changing table is 6 feet long and can be lowered and raised with a handheld controller wired to an electric motor. When not in use, the table folds up against the wall.

The table was recently installed as part of a national effort to make public bathrooms more accessible in places like airports, parks, arenas, and gas stations. Without such options, people with disabilities often wind up being changed on bathroom floors, in cars, or even on the ground outside.

Many families hesitate to go out because of the lack of accessible restrooms. “We all know somebody who’s tethered to their home by bathroom needs,” Baker Curtis said. She doesn’t want her son’s life to be limited that way. “Charlie deserves to be out in the community.”

She said the need can be particularly acute when people are traveling in rural areas, where bathroom options are sparse.

Baker Curtis, who lives near Des Moines, leads the Iowa chapter of a national group called “Changing Spaces,” which advocates for adult-size changing tables. The group offers an online map showing scores of locations where they’ve been installed.

Advocates say such tables are not explicitly required by the federal Americans with Disabilities Act. But a new federal law will mandate them in many airports in coming years, and states can adopt building codes that call for them. California, for example, requires them in new or renovated auditoriums, arenas, amusement parks, and similar facilities with capacities of at least 2,500 people. Ohio requires them in some settings, including large public facilities and highway rest stops. Arizona, Illinois, Maryland, Minnesota, and New Hampshire also have taken steps to require them in some public buildings.

Justin Boatner of Arlington, Virginia, advocates for more full-size changing tables in the Washington, D.C., area. Boatner, 26, uses a wheelchair because of a disability similar to muscular dystrophy. He uses diapers, which he often changes himself.

He can lower an adjustable changing table to the height of his wheelchair, then pull himself onto it. Doing that is much easier and more hygienic than getting down on the floor, changing himself, and then crawling back into the wheelchair, he said.

Boatner said it’s important to talk about incontinence, even though it can be embarrassing. “There’s so much stigma around it,” he said.

He said adult changing tables are still scarce, including in health care facilities, but he’s optimistic that more will be installed. Without them, he sometimes delays changing his diaper for hours until he can get home. That has led to serious rashes, he said. “It’s extremely uncomfortable.”

Iowa legislators in recent years have considered requiring adult changing tables in some public restrooms. They declined to pass such a bill, but the discussion made Iowa Department of Transportation leaders aware of the problem. “I’m sorry to say, it was one of those things we’d just never thought of,” said Michael Kennerly, director of the department’s design bureau.

Kennerly oversees planning for rest stops. He recalls an Iowan telling him about changing a family member outside in the rain, with only an umbrella for shelter. Others told him how they changed their loved ones on bathroom floors. “It was just appalling,” he said.

Iowa began installing adult changing tables in rest stops in 2022, and it has committed to including them in new or remodeled facilities. So far, nine have been installed or are in the process of being added. Nine others are planned, with more to come, Kennerly said. Iowa has 38 rest areas equipped with bathrooms.

Kennerly estimated it costs up to $14,000 to remodel an existing rest-stop bathroom to include a height-adjustable adult changing table. Incorporating adult changing tables into a new rest stop building should cost less than that, he said.

Several organizations offer portable changing tables, which can be set up at public events. Some are included in mobile, accessible bathrooms carried on trailers or trucks. Most permanent adult changing tables are set up in “family restrooms,” which have one toilet and are open to people of any gender. That’s good, because the act of changing an adult is “very intimate and private,” Baker Curtis said. It’s also important for the tables to be height-adjustable because it’s difficult to lift an adult onto a fixed-height table, she said.

Advocates hope adult changing tables will become nearly as common as infant changing tables, which once were rare in public bathrooms.

Jennifer Corcoran, who lives near Dayton, Ohio, has been advocating for adult changing tables for a decade and has seen interest rise in recent years.

Corcoran’s 24-year-old son, Matthew, was born with brain development issues. He uses a wheelchair and is unable to speak, but he accompanies her when she lobbies for improved services.

Corcoran said Ohio leaders this year designated $4.4 million in federal pandemic relief money to be distributed as grants for changing-table projects. The program has led to installations at Dayton’s airport and art museum, plus libraries and entertainment venues, she said.

Ohio also is adding adult changing tables to rest stops. Corcoran said those tables are priceless because they make it easier for people with disabilities to travel. “Matthew hasn’t been on a vacation outside of Ohio for more than five years,” she said.

Kaylan Dunlap serves on a committee that has worked to add changing-table requirements to the International Building Code, which state and local officials often use as a model for their rules.

Dunlap, who lives in Alabama, works for an architecture firm and reviews building projects to ensure they comply with access standards. She expects more public agencies and companies will voluntarily install changing tables. Maybe someday they will be a routine part of public bathrooms, she said. “But I think that’s a long way out in the future, unfortunately.”

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The Centers for Medicare and Medicaid Services is the federal agency charged with enforcing nursing home regulations. (Photo by Getty Images; logo courtesy of CMS)

Kentucky is joining 19 other states in challenging a Biden administration rule that sets minimum staffing requirements for nursing homes.

The nursing home industry has pushed back against the rule, saying it couldn’t afford to comply even if enough new staff could be found amid a widespread health care workforce shortage, Kentucky Health News previously reported.?

Kentucky nursing-home industry says Biden staffing mandate ‘impossible’ to meet

Twenty state attorneys general, including Kentucky’s Russell Coleman, filed a complaint in the U.S. District Court for the Northern District of Iowa, seeking to overturn and reverse the new regulations.?

The Nursing Home Minimum Staffing Rule requires nursing homes that receive Medicare or Medicaid payments to provide 3.48 hours of direct nursing care per resident each day, including a defined number for registered nurses (0.55 per resident per day) and nurse aides (2.45 hours per resident per day).

About 211 Kentucky long-term care facilities do not meet staffing requirements, according to the lawsuit. To comply, they would need to hire 185 registered nurses and 1,336 nursing assistants, the lawsuit states.?

The 66-page court document criticizes the rule as an “existential threat to the nursing home industry” that will put some out of business and cause “irreparable” harm.?

“Senior citizens and other vulnerable members of society rely on nursing homes and similar facilities to meet their needs when family members cannot,” the lawsuit says. “Although the nursing home industry certainly has had its share of challenges, it fills a vital need in our communities that cannot be replaced. Instead of addressing the legitimate challenges nursing homes face, the defendants put forward a heavy-handed mandate.”?

“And the main victims,” the lawsuit says, “will be the patients who will have nowhere else to go.”?

The Kentucky Association of Health Care Facilities said in a statement that it “appreciates the Attorney General’s support in the national effort to challenge the CMS staffing mandate, which, if fully implemented, could place an undue burden on long-term care providers.”

“We encourage the administration to collaborate with the long-term care community to develop regulations that prioritize sustainable, quality care for Kentuckians without jeopardizing the resources essential to achieving this goal,” the association said.

Rep. Kim Banta says constituents tell her their kids are afraid to go to school because of the fear of gun violence. (Kentucky Lantern photo by Sarah Ladd)

This story mentions suicide. If you or someone you know is contemplating suicide, call or text the suicide prevention lifeline at 988.?

A Northern Kentucky Republican will file a bill in the 2025 legislative session to hold parents and guardians civilly accountable for gun violence or misuse carried out by minor children in their care.?

Rep. Kim Banta of Fort Mitchell, which is across the Ohio River from Cincinnati, thinks of the legislation as a “wake up call,” she told the Kentucky Lantern.??

“I have constituents that … tell me their kids are literally afraid to go to school,” she said. “We just need to start kind of zeroing in on: if you’re under 18, your parents are responsible for your behavior.”??

Under her bill, people who are hurt or threatened by a minor using a gun could sue the minor’s parents or guardians and be awarded monetary damages.?

Banta? believes such legislation could incentivize parents and guardians to properly store and secure weapons (or separate them from ammunition), which could in turn lower suicide rates among youth and curb school shootings — and the threat of them.?

In 2023, nearly 4% of Kentucky high school students reported they carried a weapon like a gun or knife on school property at least one day within the month before they were surveyed, according to the Youth Risk Behavior Survey conducted by the U.S. Centers for Disease Control and Prevention and the Kentucky Department of Education. That number rose to around 6% for the year before they were surveyed, and excluded weapons carried for hunting or target sport purposes.?

That survey also found 11% of high school students had at least one day within the month before they were surveyed when they were absent from school because they felt unsafe at school.?

Finally, 8% of students in 2023 reported they were threatened or injured with a weapon on school property at least once during the year before the survey.?

The Kentucky Department of Education also reports 15% of high school students and 17% of middle school students in the state considered suicide “seriously” in the last year. The National Suicide Prevention Lifeline is 988.?

In its annual report, Kentucky’s Child Fatality and Near Fatality External Review Panel found children were increasingly injuring and killing themselves with guns they had wrongful access to.?

Among those, the Lantern reported in February, was a 4-year-old who played with a loaded gun he found in a glove compartment of a car and fatally shot himself. Another instance involved a 14-year-old boy whose friend fatally shot him with a loaded gun found in a parents’ bedroom.?

The panel said at the time that the legislature should research national models and develop legislation to promote safe storage of firearms.

What’s in Banta’s bill??

Banta’s bill, which is being drafted during the interim, would combine the state statutes that hold parents accountable for vandalism their children commit and when parents sign their child’s driver’s license.?

“The proposal is that a parent is responsible, civilly, for any gun violence that their child under 18 years old would perpetrate,” said Banta.?

That includes threatening someone with a gun, shooting a neighbor’s dog or injuring or killing a person. People who were wronged would then have a legal opening to sue the parents or guardians of those minor children.?

Rep. Tina Bojanowski, D-Louisville, will be the primary co-sponsor.?

A draft of the two-page bill, provided to the Lantern, says guardians are civilly responsible for “any negligence or willful misconduct of a minor.”?

The bill draft says parents and other guardians would be considered responsible and subject to paying civil damages under any of these circumstances:?

• They permitted the minor to have the firearm.
• They know that the minor has previously been adjudicated delinquent of an offense that would be a felony if the minor had been an adult.
• They know that the minor has a propensity to commit violent acts.?
• They know or have reason to know that the minor intends to use the firearm for unlawful purposes.?

The bill excludes emancipated minors or government or private agencies or foster parents who, through court order, are assigned responsibility for a minor.?

“My key motivator is just trying to get people to recognize that even though we live in a society where it is perfectly legal to own and use guns, I just think we need to back up for a minute,” Banta said. “We need to say, ‘Okay, I’m a gun owner, but that is going to extend to me being responsible for my children’s use of the guns.’”?

She hopes to get the bill before the House Judiciary Committee as early as possible during the session. She’s confident it passes constitutional and Second Amendment muster, she said.?

“I’m not restricting guns. I’m not telling you you cannot buy your child a gun. But what I’m telling you is: just be aware that you are as responsible for that child with that gun as you are with a car,” Banta said. “So if they do some damage, or they … threaten people… you’re going to be responsible civilly for it.”?

Banta already — favorably — discussed her bill with Speaker of the House David Osborne, R-Prospect, she said, and believes there is appetite to pass such legislation.?

That’s because, she said, “parental responsibility” is “everything that the (National Rifle Association), everything that gun ownership preaches” just “reinforced” with statute.?

“It’s just a matter of being very, very responsible with your gun ownership,” Banta said.? “Rather than a Sandy Hook or a Georgia incident, I’m hoping that parents will say, ‘yeah, no, you’re 16. You’re not old enough to be … on your own with a gun, or where I don’t know where you are with a gun.’”?

“I’m not telling a parent you can’t let your child go hunting by themselves anymore, and he’s 15 or 16,” she added. “I’m just telling you that if he goes and he shoots at the neighbor and kills their cow, you’re responsible. You’re gonna pay for that cow. You are responsible.”?

Banta doesn’t anticipate any funding needs for the bill, calling it an “ink and paper” policy.

“I just want people to feel safer,” Banta said. “And I want to pass something that just … makes sense.”?

An ultrasound machine sits next to an exam table in an examination room at a women’s health clinic in South Bend, Ind. A recent study shows that there was a spike in the number of women seeking sterilizations to prevent pregnancy in the months after the U.S. Supreme Court’s decision striking down the constitutional right to an abortion. (Scott Olson/Getty Images)

In the months after the U.S. Supreme Court struck down the constitutional right to an abortion, there was a spike in the number of women seeking sterilizations to prevent pregnancy, a recent study shows.

Researchers saw a 3% increase in tubal sterilizations per month between July and December 2022 in states with abortion bans, according to the study published in September in JAMA, a journal from the American Medical Association. The Supreme Court struck down Roe v. Wade in June 2022.

The study looked at the commercial health insurance claim records of 1.4 million people from 15 states with abortion bans (Alabama, Arizona, Arkansas, Idaho, Indiana, Kentucky, Mississippi, Missouri, Oklahoma, Tennessee, Texas, Utah, West Virginia, Wisconsin and Wyoming). The study also examined the records of about 1.5 million people living in states with some abortion restrictions and 1.8 million in states where abortion remains legal. The researchers excluded 14 states that didn’t have records available for 2022.

“It’s probably an indication of women [who] wanted to reduce uncertainty and protect themselves,” said lead author Xiao Xu, an associate professor of reproductive sciences at Columbia University. In the first month after the ruling, sterilizations saw a one-time increase across all states included in the study, Xu and her team found. Her team also found continued increases in states that limited abortion to a certain gestational age, but those were not statistically significant.

The researchers compared records for three groups: States with a total or near-total ban on abortion, including states where bans were temporarily blocked; states where laws explicitly recognized abortion rights; and limited states, where abortion was legal up to a certain gestational age.

While the study captures only the early months following the Dobbs ruling that overturned Roe v. Wade, experts say it’s part of an increasing body of evidence that shows a growing urgency for sterilization procedures amid more limited access to abortions, reproductive health care and contraception. Other studies have shown increases in tubal sterilization (commonly known as “getting your tubes tied”) and vasectomy requests and procedures post-Dobbs.

Diana Greene Foster, a professor and research director in reproductive health at the University of California, San Francisco, said the results are not surprising, given the negative repercussions for women who seek to end their pregnancies but are not allowed to do so.

Foster led the landmark Turnaway Study, which for a decade followed women who received abortions and those who were denied abortions. It found that women forced to carry a pregnancy to term experienced financial hardship, health and delivery complications, and were more likely to raise the child alone.

“We have found that women are able to foresee the consequences of carrying an unwanted pregnancy to term,” Foster told Stateline. “The reasons people give for choosing an abortion — insufficient resources, poor relationships, the need to care for existing children — are the same negative outcomes we see when they cannot get an abortion.

“So it is not surprising that some people will respond to the lack of legal abortion by trying to avoid a pregnancy altogether.”

As abortion bans delay emergency medical care, this Georgia mother’s death was preventable

Few doctors and services

States with abortion bans and other restrictions also tend to have large swaths of maternal health care “deserts,” where there are too few OB-GYNs and labor and delivery facilities. That creates greater maternal health risks.

One such state is Georgia where abortion is banned after six weeks. Georgia’s abortion ban was temporarily lifted last week by a Fulton County judge, but on Monday the Georgia Supreme Court reinstated the ban. Dr. LeThenia “Joy” Baker, an OB-GYN in rural Georgia, said she sees patients in their early 20s who have multiple children and are seeking sterilizations to prevent further pregnancies, or who have conditions that make pregnancy dangerous for them. Her state has one of the highest maternal death rates in the nation.

On Monday, a Georgia county judge struck down the state’s six-week abortion ban, meaning that for now, women have access to the procedure up to about 22 weeks of pregnancy. The state is appealing the decision, and it’s expected to eventually be decided by the state Supreme Court.

The county judge’s ruling comes two weeks after ProPublica reported that two women in the state died after they couldn’t access legal in-state abortions and timely medical care for rare complications from abortion pills.

Black and Indigenous women disproportionately experience higher rates of complications, such as preeclampsia and hemorrhage, which contributes to their higher maternal mortality and morbidity rates. Baker said some of her patients say they want to avoid risking another pregnancy because of those previous complications.

“I have had quite a few patients, who were both pregnant and not pregnant, who inquire about sterilization,” she said. “I do think that patients are thinking a lot more about their reproductive life plan now, because there is very little margin.”

Along with the state’s abortion restrictions, Baker said women in her Bible Belt community feel social pressure that can push them toward sterilization.

‘Between rock, hard place:’ Will anyone ever have standing to challenge Kentucky’s abortion ban?

“It is definitely more socially acceptable to say, ‘I’m going to get my tubes tied or removed,’ than to say, ‘Hey, I want to find abortion care,’” Baker said.

In states where lawmakers have proposed restrictions on contraception, women might feel tubal sterilization to be the most surefire way to prevent pregnancy. Megan Kavanaugh, a contraception researcher at the Guttmacher Institute, a reproductive health policy research center that supports abortion rights, said the research doesn’t say whether women who seek sterilization would have preferred another form of contraception.

“We need to both understand which methods people are using and whether those methods are actually the methods they want to be using,” said Kavanaugh, whose team studied contraceptive access and use in Arizona, Iowa, New Jersey and Wisconsin. “It’s really important to be monitoring both use and preferences in terms of heading towards an ideal where those are aligned.”

Tubal sterilizations can still fail at preventing a pregnancy, Foster said. One recent study noted that up to 5% of patients who underwent a tubal sterilization got pregnant later.

“If people are choosing sterilization who would otherwise pick something less permanent, then that is another very sad outcome of these abortion bans,” she added.

Another recent study, by Jacqueline Ellison, a University of Pittsburgh assistant professor who researches health policy, found that more young patients — both women and men — sought permanent contraceptive procedures in the wake of the Dobbs decision. The study focused on people ages 18 to 30 — the age group most likely to seek an abortion and the ones who previous studies suggest are most likely to experience “sterilization regret,” Ellison said.

A troubled history

The issue also can’t be disentangled from the nation’s history of coercive sterilizations, Ellison and other experts said. In the 1960s and 1970s, federally funded nonconsensual sterilization procedures were performed on Indigenous, Black and Hispanic women, as well as people with disabilities.

“People feeling pressured to undergo permanent contraception and people being forced into using permanent contraception are just two sides of the idea of reproductive oppression in this country,” Ellison said. “They’re just manifested in different ways.”

Medicaid, the joint federal-state health insurance program for low-income people, now has regulations designed to prevent coerced procedures. But the rules can have unintended consequences, said Dr. Sonya Borrero, an internal medicine physician and director of the University of Pittsburgh’s Center for Innovative Research on Gender Health Equity.

The process includes a 30-day waiting period after a patient signs a sterilization procedure consent form, Borrero noted. But pregnant women who want the procedure done right after delivery might not reach the 30-day threshold if they go into early labor, she said. She added that some patients are confused by the form.

Borrero launched a tool called MyDecision/MiDecisión, an English and Spanish web-based tool that walks patients through their tubal ligation decision and dispels misinformation around the permanent procedure.

“The importance and the relevance of it right now is particularly pronounced,” she said.

This article is republished from Stateline, a sister publication to the Kentucky Lantern and part of the nonprofit States Newsroom network.

Daniel Cameron looks over the crowd after conceding defeat on election night, Nov 7, 2023, in Louisville. (Kentucky Lantern photo by Matthew Mueller)

FRANKFORT — Kentucky’s attorney general and two University of Louisville physicians waged a legal battle for more than a year that almost no one knew about —? even though it involved the Republican candidate for governor and an issue of intense public interest.

The secrecy around the case – from its outset in June of 2023 – is highly unusual. It ended Monday when the file was unsealed under a Franklin Circuit judge’s order. The Lantern first revealed the case’s existence and reported many of its details in August based on a Court of Appeals ruling and sources with knowledge of the situation.?

The newly unsealed file provides further insights into what happened when the powers of Kentucky’s top prosecutor intersected with abortion politics in an election year.

The dispute involved then-Attorney General Daniel Cameron’s efforts to pursue a criminal investigation against the two U of L physicians who, when it was still legal to do so, performed abortions and trained medical students and residents at EMW Women’s Surgical Center in Louisville. Cameron also was Kentucky Republicans’ nominee for governor last year.

Kentucky appeals court rejects AG’s efforts to get employment records in abortion case

After the U.S. Supreme Court ended the constitutional right to abortion in the summer of 2022, the physicians testified in court against the near-total abortion ban that immediately took effect in Kentucky.

Cameron, whose office was defending the abortion ban, then sought the physicians’ pay, tax and other records from U of L through the civil discovery process. When that didn’t work he used a grand jury to subpoena the records as part of a criminal investigation that he said would discover whether public dollars had been misused.

In the end, the case turned on what two courts determined were Cameron’s misuse of the grand jury process and his lack of evidence of any crime.

Politics alleged

Lawyers for the physicians argued that Cameron’s actions were motivated by politics, that he was using abortion litigation “for political gain in his gubernatorial campaign” — a claim that Cameron’s office branded “offensive” and “slander.”?

The doctors’ lawyers said Cameron “apparently believes that depicting abortion providers as greedy profiteers advances his arguments that abortions should be outlawed.”?

It’s impossible to know how public knowledge of the case might have affected the 2023 race for governor. By September 2023 — less than two months before the gubernatorial election — the politics of abortion had changed in Kentucky.?

That month Democratic incumbent Gov. Andy Beshear began airing powerful commercials featuring a rape victim and a prosecutor criticizing Cameron for opposing exceptions for rape and incest in the abortion ban. And Cameron quickly modified his position, saying he would sign legislation creating exceptions for rape and incest if the Republican-controlled General Assembly approved it.

Franklin Circuit Judge Phillip Shepherd tried to unseal the case at that time, but was thwarted by Cameron who immediately appealed the ruling to quash the subpoena and successfully pleaded to keep the case secret at least until the appeals court ruled on its merits.

Beshear defeated Cameron in the governor’s race by about 5 percentage points, and Cameron has since taken a job as executive director of a non-profit group called 1792 Exchange. (That group’s website says it works to? protect small businesses, other non-profits and philanthropic organizations from “woke” corporations.)

AG Coleman ends appeals

Cameron did not respond to an email from the Lantern sent to 1792 Exchange seeking comment on the outcome of his ill-fated investigation.

Current Attorney General Russell Coleman did not ask the Kentucky Supreme Court to review the August Court of Appeals ruling that upheld Shepherd’s decision to quash the subpoena. Rewa Zakharia, chief of the criminal division in Coleman’s office, declined comment on Friday after a court hearing when Shepherd ordered the case finally unsealed. Zakharia referred questions to the office spokesman Kevin Grout, who did not return phone messages from Kentucky Lantern.

One of the attorneys for the doctors, William Brammell, released a statement that said, “We appreciate the judge’s thoughtful handling of this case and ultimate decision to unseal it, making it available to the public.? In a functioning democracy, it’s critical that citizens know what their government is doing and the judge’s decision in this case balances that right to access with our client’s understandable personal privacy interests.”

On Aug. 9 a three-judge panel of the Kentucky Court of Appeals unanimously affirmed Shepherd’s quashing of the subpoena. Its order said the subpoena amounted to a “fishing expedition” and that Cameron’s premise that tax dollars may have been illegally spent on abortions was not supported by the facts of the case.

The appeals court sent the question of whether the case should be unsealed back to Shepherd. On Friday Shepherd unsealed the case with the exception of one document, and he released 177 pages of records Monday with the names of the physicians redacted.

The U of L physicians and another physician who practiced at EMW Women’s Surgical Center initiated the case on July 21, 2023, asking Franklin Circuit Court to quash a subpoena seeking payroll, personnel and other records

They argued that Cameron unsuccessfully sought the same records in the civil case challenging the constitutionality of Kentucky’s abortion ban and that the material sought was not relevant to any possible criminal charges. They suggested a political motive which Cameron hotly disputed.

“It has become clear that Mr. Cameron will use abortion litigation, against providers and others, for political gain in his gubernatorial campaign.”

Cameron said the subpoena was issued as part of his office’s responsibility to investigate “crimes involving the use of public funds.”

The plaintiffs filed the case under the pseudonyms Jane Doe 1, Jane Doe 2 and John Row, and asked that the case be sealed to protect their privacy. Cameron offered no objection and Shepherd let the case initially proceed under seal.

As the case proceeded, Shepherd, over the objections of the doctors’ lawyers, gave Cameron the opportunity to present a confidential (“in camera”) written explanation “that will set forth the subject matter of the Attorney General’s investigation.”

Cameron did so. That record remains the only part of the file still sealed. But whatever is in it, it did not convince Shepherd.

Grand jury never asked for or asked for subpoena

The judge wrote a 16-page order quashing the subpoena. Shepherd agreed with nearly all points made by the physicians’ attorneys. He said even the confidential submission from the attorney general “provides no information which grants its office jurisdiction.”

Shepherd said the investigation was brought in the wrong county because the doctors work in Jefferson County. “There is no indication that any of the conduct under investigation took place in Franklin County. Nor is there any allegation that state funds were used directly in any manner that would violate the penal code,” he ruled.

Shepherd noted that while Cameron obtained the subpoena from the clerk of the Franklin Circuit Court, the grand jury never asked for the subpoena or voted to authorize it.

And because the subpoena sought the same records Cameron was unsuccessfully trying to get in the separate civil case, the judge concluded, “this subpoena appears to be a classic ‘fishing expedition.’”

He said the doctors had a right to be concerned the information might be used in a way that would “subject them to vilification or harassment by opponents of abortion.”

The judge also said he was inclined to open the case because the public should know what goes on in court. Shepherd issued a lengthy order in which he attempted to unseal the records. “The Court believes that the public has a right to know, and to decide for themselves, whether the Attorney General is wielding the authority granted to him appropriately and in accordance with the requirements of law.”

But Cameron filed an emergency request to keep the entire file sealed, which the appeals court granted.

In August, the Court of Appeals ruling against Cameron sent the case back to Shepherd to decide whether to unseal the case.

The Kentucky Lantern and Louisville Public Media filed briefs asking that the case be opened.?

Abortion politics: A Kentucky timeline

2019 – Kentucky’s legislature votes along party lines to enact two anti-abortion laws: A ban on abortions after six weeks of pregnancy. A ban on all abortions that would take effect only if the U.S. Supreme Court overturns Roe v. Wade, the so-called “trigger law.” Federal courts blocked the six-week ban.

Feb. 26, 2020 – The Family Foundation calls on Attorney General Daniel Cameron to investigate whether medical school faculty at the University of Louisville are violating state law through ties to what was then the state’s only abortion clinic, EMW Women’s Surgical Center in Louisville.

U of L President Neeli Bendapudi firmly rejects the allegations, saying U of L and EMW are separate entities. Residents in obstetrics and gynecology, as part of their training, must learn all aspects of reproductive health care, and abortion provider EMW is the only place they can learn the procedure.

March 30, 2021 – General Assembly approves putting an anti-abortion amendment on the 2022 ballot. It would add a new section stating Kentucky’s Constitution does not secure or protect a right to or funding of abortion.

June 24, 2022 – U.S. Supreme Court ends the constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization, overturning Roe.

EMW and Planned Parenthood, both in Louisville and Kentucky’s only abortion providers, stop performing abortions “out of an abundance of caution.”

June 27, 2022 – EMW and Planned Parenthood file suit in Jefferson Circuit Court seeking to block enforcement of the abortion ban.?

July 6, 2022 – Jefferson Circuit Judge Mitch Perry hears arguments from both sides with Attorney General Daniel Cameron’s office defending the abortion ban. Among those testifying are two University of Louisville OB/GYNs who provide abortions at EMW and say abortion is essential to health care.

July 7, 2022 – Republican lawmakers in Frankfort grill U of L medical dean Toni Ganzel about whether public funds have been used to provide abortions. He tells them U of L does not pay physicians to perform abortions. Rep. Jason Nemes, R-Louisville, tells Ganzel,? “If university funds are used for abortion, the taxpayers ought to know, and the legislature should take that into account when we’re talking about funding the university and other things.”

July 30, 2022 – Judge Perry issues a temporary order allowing abortions to resume in Kentucky.?

Aug. 2, 2022 – Legal abortions stop after the Court of Appeals grants Cameron’s emergency request to reinstate the two laws banning almost all abortions in the state.?

Aug. 3, 2022 – Two U of L professors suspend their work at EMW. U of L pauses its residency training affiliation with EMW until “we can determine the future of the relationship.”

Nov. 8, 2022 – Kentucky voters defeat the anti-abortion constitutional amendment by almost 5 percentage points, 52.3%? to 47.7% or 742,232 votes to 675,634 votes.

Nov. 15, 2022 – Kentucky Supreme Court hears arguments in abortion providers’ challenge of abortion ban.

Feb. 16, 2023 – Kentucky Supreme Court leaves abortion ban in place, saying abortion providers lack standing to challenge the law on behalf of their patients, leaving unanswered questions about the ban’s constitutionality. Calling it a “significant victory,” Cameron says, “We will continue to stand up for the unborn by defending these laws.”

May 16, 2023 – Cameron wins primary, becomes Republican candidate for Kentucky governor, challenging incumbent Andy Beshear, who opposes Kentucky’s no-exceptions abortion ban, calling it “extreme.”

June 2023 – Cameron issues a Franklin County grand jury subpoena for payroll and personnel information for two unnamed U of L employees, seeking evidence that state funds may have been misused. All parties agree to seal the case.

July 2023 – Jane Does and Roe ask Franklin circuit judge to quash the subpoena.

Sept. 1, 2023 – Democrat Beshear’s campaign airs an ad featuring Jefferson County prosecutor Erin White attacking Cameron for opposing abortion ban exceptions, even for rape and incest victims. ?“Cameron believes rapists deserve more rights than their victims. That’s extreme. And it’s dangerous,” she says.

Sept. 18, 2023 – Cameron changes his position on abortion, saying he would sign legislation creating exceptions for rape and incest if the Republican-controlled General Assembly approved it. He later appears to soften that statement to reassure abortion opponents.

Sept. 20, 2023 – Beshear campaign airs ad in which Hadley Duvall says, “This is to you, Daniel Cameron. To tell a 12-year-old girl she must have the baby of her stepfather who raped her is unthinkable.”??

?September 2023 –? Franklin Circuit Judge Phillip Shepherd quashes the subpoena and tries to unseal the case records. Cameron appeals. Court of Appeals grants his emergency request to keep the case sealed, pending a final outcome.

Oct. 4, 2023 – Russell Coleman, the Republican nominee for attorney general says he supports exceptions for rape and incest and will “call on the General Assembly to take a hard look at that issue.”

Nov. 5, 2023 – Beshear and Coleman win their races by comfortable margins.

Aug. 9, 2024 – Kentucky Court of Appeals rejects the attorney general’s subpoena as an improper “fishing expedition” and outside the scope of the Franklin County grand jury because the records sought by the attorney general are from another county. Returns case to Franklin Circuit Court to consider unsealing the file.

Sept. 20, 2024 – Kentucky Lantern and Louisville Public Media file motion asking that records of the case be unsealed.

Sept. 27, 2024 – Shepherd orders the case unsealed with redactions and excluding an “in camera” filing.

A list of Kentuckians who have died because of domestic violence, ranging in age from 19 to 73. (Kentucky Lantern photo by Sarah Ladd)

If you or someone you know has experienced domestic violence, call the National Sexual Assault Telephone Hotline at 1-800-656-4673. Call the National Domestic Violence Hotline at 1-800-799-7233.?

You can also contact any of Kentucky’s 15 domestic violence programs.?

FRANKFORT — Kentucky must examine its gun laws to make sure it’s doing all it can to protect survivors of domestic violence, Gov. Andy Beshear said Tuesday.?

His comments came after he signed a proclamation in the Capitol Rotunda making October 2024 Domestic Violence Awareness Month.?

He joined advocates from ZeroV (formerly known as the Kentucky Coalition Against Domestic Violence) and others to honor 26 lives lost in recent years to intimate partner violence — including Erica Riley, who was fatally shot outside the Hardin County Justice Center in August.

After 2 women die in ‘ambush’ outside Hardin courthouse, what can Kentucky do better?

Beshear said Kentucky needs to provide “real protection” for people leaving abusive situations.?

“We have sadly seen far too much violence after someone takes out (a protective order), and we’ve got to make sure that we are filling all of those holes,” Beshear told reporters. “We’ve got to look at transportation. We’ve got to look at ways to keep people’s current location from reaching their perpetrator, and we’ve got to look at how we navigate the judicial system to where that person doesn’t have to face their perpetrator … every so often in court.”?

Riley was at the courthouse on the morning of Aug. 19 for a hearing on her emergency protective order. Police say the man who she was seeking protection from shot her and her mother, Janet Rylee, in an “ambush” in the courthouse parking lot right before the hearing. They both died.?

“It’s important that we have that system that provides everyone their day in court,” Beshear said, “but at the same time, doesn’t make someone face their abuser face to face, over and over.”?

That could be accomplished virtually, he said, an idea supported by the head of the domestic violence shelter in Elizabethtown, where Riley died. He also said the state “ought to look at” how to uniformly provide court escorts to people headed into hearings for protective orders.?

“We know we had a shooting outside of one of our courthouses where someone should be safe,” Beshear said. “And so whether that’s looking at where the parking lots are, how it’s designed, whether we have other entrances for those involved in these types of cases, or whether an escort in and out would work, we don’t want it to happen again. So the most important thing is we figure out a way to make sure it doesn’t happen again.”?

Beshear also said Kentucky must have a cultural shift in how it views domestic and intimate partner violence.?

“We’ve got far too much toxic masculinity, far too many people speaking in violent terms,” he said. “We should show our families what being a responsible adult is, and that … committing acts of violence doesn’t make you a man, it makes you a monster.”?

Beshear has previously voiced support for a “red flag” law, which would allow temporary restrictions on gun possession by individuals deemed a danger to themselves or others.

Coercive control

The gathering also heard a Kentucky lawmaker call for adding coercive control to Kentucky’s protective order law. Rep. Stephanie Dietz, R-Edgewood, said she will sponsor a bill to help survivors access “court assistance earlier in the process.”?

Dietz’s legislation is a key piece of policy advocates who work in violence prevention support.?

Currently, protective orders are available in Kentucky to people who have experienced physical violence or face immediate threat of physical violence. But some survivors face a more nuanced abuse, like loss of financial and medical autonomy, isolation, surveillance and more.?

“Most folks view domestic violence as that battering, that physical assault,” Angela Yannelli, the CEO of ZeroV, previously told the Lantern. “You’ll see the signs, the billboards, with the black eye … that happens. But what we think is happening a lot more, that we’re not able to see in the homes, are these controls.”?

Coercive control is a “huge indicator” of violence, Christy Burch, the CEO of the ION Center for violence prevention in Northern Kentucky, previously told the Lantern. In adding it to the emergency protective order (EPO) statute, she said, “we could save lives.”??

“Being able to recognize coercive control as a piece of intimate partner violence, or even a lead into intimate partner violence,” Burch said, “would be very important to getting ahead of this issue … not just responding after violence has already occurred.”

Not a ‘private issue’?

Andrea Robinson, president of the ZeroV board of directors, told the gathering that? Kentucky must break the “norm of silence” when it comes to domestic violence.?

“The current social norm of silence is based on the belief that intimate partner violence is a private issue, that it is between a couple, or … that it only affects those individuals in the relationship,” said Robinson. “The norm of silence only serves to hurt, isolate, shame and stigmatize survivors, making it harder for them to flee an abusive partner.”??

Breaking that can include checking on neighbors and loved ones, wearing purple to raise awareness of domestic violence and sharing resources with people who may need them, Robinson said.?

In 2022, about half of Kentucky women — 45.3% — and around 35.5% of men had experienced intimate partner violence — or threat of it — in their lifetimes, the Lantern has reported. ?

In 2023, that number decreased to 44.5% of women and 32.9% of men.?

Across the state in 2024, ZeroV programs provided emergency shelter to 2,788 people, including 1,120 children, and provided 336,145 total services, it says.?

“In Kentucky, we don’t tolerate domestic violence,” Beshear said. “It is every single one of our obligations to say something when we see it, to get over that thought that it’s private.”??

The 83-page court document says Express Scripts is “at the center of the opioid dispensing chain.” (Photo by Getty Images)

Kentucky Attorney General Russell Coleman has sued a pharmacy benefits manager he says played a “role in worsening the deadly opioid crisis in Kentucky.”?

The complaint, filed in Jessamine County Circuit Court Wednesday, names Express Scripts and affiliates as defendants and targets alleged practices over the last two decades.

“The opioid crisis was fueled and sustained by those involved in the supply chain of opioids, with manufacturers, distributors, pharmacies, and Pharmacy Benefit Managers …including Express Scripts, each playing a role,” Coleman wrote in the suit.?

The 83-page court document says Express Scripts is “at the center of the opioid dispensing chain.” It also accuses the company of “colluding with Purdue Pharma and other opioid manufacturers in the deceptive marketing of opioids in order to alter perceptions of opioids and increase their sales,” among other things.?

It also accuses the company of:

• Colluding with Purdue Pharma and other opioid manufacturers to restrict or eliminate utilization management tools on national formularies that would have limited opioid prescribing and/or dispensing.?
• Deciding not to act on the vast amount of data and other information they had about the epidemic in order to limit the overflow of opioids into communities throughout the United States, including in Kentucky.?
• Dispensing prescription opioids through their mail order pharmacies without effective controls against diversion, in violation of Kentucky law and federal law.?

A spokesperson for Express Scripts’ parent company, Evernorth, has not yet responded to a Lantern request for comment.?

The lawsuit says its purpose is to “abate public nuisance caused in substantial part by these Defendants’ unreasonable acts and omissions fueling the opioid epidemic.”?

“Express Scripts’ central role in the opioid crisis was facilitated by their unique combination of knowledge and power that provided them with the extraordinary ability to control the opioid supply throughout the United States.”

He is seeking a jury trial, among other relief.?

“The opioid-fueled drug crisis is the greatest tragedy of our lifetime. It has stolen loved ones, drained scarce public resources and inflicted generational harm on Kentucky communities large and small,” Coleman said in a statement. “Express Scripts and the other pharmacy benefit managers amassed an unprecedented level of power, using it to push opioid pills and conceal unlawful activity. They must be held to account for profiting off Kentucky families’ pain.”?

Read Commonwealth of Kentucky v. Express Scripts

Virginia Moore’s widow, Row Holloway, tears up as she taps a Virginia bobblehead sitting on Gov. Andy Beshear’s lectern. (Screenshot)

Kentuckians who are deaf or hard of hearing can get free radios designed to alert other senses about dangerous weather through a new program named after the late Virginia Moore.?

Moore died on Derby Day in 2023 at 61. Before that, she interpreted? in American Sign Language news of many deaths and announcements about COVID-19’s hold on Kentucky for Gov. Andy Beshear during the worst of the pandemic.?

Moore served as executive director of the Kentucky Commission on the Deaf and Hard of Hearing. People who knew her have described her as a fierce advocate for the hard of hearing community.?

Now, an emergency preparedness program called “Moore Safe Nights” will honor that legacy.?

The Kentucky Division of Emergency Management (KYEM) used federal grant money to buy 700 radios that have vibrating and bright spotlight attachments specifically for people with hearing impairments.?

The vibrating attachment can go under a person’s pillow and shake them during an alarm. The other can be attached to a bed frame and it will brightly flash in the dark. They will also display text of alerts from the National Weather Service.?

“As Kentuckians know all too well, severe weather can strike at any hour; the most dangerous time is when people are sleeping,” Beshear said during a Thursday press conference. “The deaf and hard of hearing community is particularly vulnerable during this time, since they cannot hear the various alarms and severe weather sirens upon which most of us rely.”?

Anita Dowd, who serves as the executive director for the Kentucky Commission on the Deaf and Hard of Hearing, called the radios a “game changer.”?

“As one of the 700,000 Kentuckians with hearing loss, and mama to two daughters with hearing loss, I can personally attest to how profound the impact will be from this program,” Dowd said. “For people like myself who can’t access information through auditory channels, we often depend on our other senses to keep us aware. In a way, our eyes become our ears, and when we close our eyes and go to sleep, that access to awareness is gone.”?

Kentucky sign language interpreters embody others’ words, are servants at heart

Moore’s widow, Row Holloway, teared up as she tapped a Virginia bobblehead sitting on Beshear’s lectern.?

“I’m glad that her memory is still alive as she continues to serve people in Kentucky,” Holloway said.?

How to get a free radio?

You must live in Kentucky and be hard of hearing to qualify for this program.?

Eligible Kentuckians can go to https://www.kcdhh.ky.gov/msn/ or call 800-372-2907 or 502-416-0607 to apply for a radio. They will be distributed on a first come, first served basis, Beshear said.?

To watch a video in American Sign Language about this program, visit this site.?

Funding for the initial 700 radios came from an emergency preparedness grant and Chemical Stockpile Emergency Preparedness Program funds, Beshear said.

“While only 700 radios are available under this initial funding, KYEM and all of us will seek additional funds to try to make sure one of these is available for absolutely everyone who needs them,” Beshear said. “I hope we get all 700 out very quickly.”?

John Bowman, Kentucky campaign organizer for Dream.Org. (Kentucky Lantern photo by Sarah Ladd)

LOUISVILLE — Kentuckians in recovery say the state needs to better educate youth about addiction, digitize expungement for certain crimes and make harm reduction and community-based services more widely available to combat overdoses.?

About 30 people gathered at the Women’s Healing Place in the West End of Louisville Wednesday as part of a “Public Health is Public Safety” tour aimed at finding solutions to the opioid crisis and raising awareness about what addiction looks like person to person.?

That tour has made six stops across the state this year — in Ashland, London, Bowling Green, Hopkinsville, Lexington and, now, Louisville.?

John Bowman, Kentucky campaign organizer for Dream.Org, which organized Wednesday’s panels, said drug criminalization often drives people to harder substances.?

“We made all these laws on prescription opioids. Everybody went to heroin. We made stricter laws on heroin. Everybody went to fentanyl. We’re making stricter laws on fentanyl, and everybody’s going to xylazine,” he said. “The measures that we’ve got in place now are really, really making it hard for us to keep getting the overdose rates lower.”?

Bowman also worries a 2024 law that supporters called the “Safer Kentucky Act” and opponents said would criminalize homelessness could cause overdose deaths indirectly.?

Another provision of? House Bill 5 created a first degree manslaughter charge when a person “knowingly sells fentanyl or a fentanyl derivative to another person,” which results in that person’s death.?

“It’s kind of like a drug-induced homicide law,” Bowman said. “And it’s going to make folks scared to call 911.”?

Carson Justice, a 17-year-old from Eastern Kentucky who said addiction has affected her entire community, including her parents, said the state should invest in more harm reduction and less criminalization.?

“Instead of bad policies like House Bill 5, we could have prison after care, we could have harm reduction resources, we could have IDs, we could have all kinds of things,” she said.?

By focusing more on harm reduction, she said, “Not only could it save us thousands of dollars, it could save thousands of lives.”?

Lawmakers should also focus on revamping reentry programs, lowering what counts as “intent to distribute” and ensuring people can access a full range of treatment while incarcerated, Bowman said.?

Several panelists who discussed their treatment and recovery echoed that point, saying they did not have access to help while behind bars.?

Amanda Bourland, who has lived through addiction and incarceration and is now the vice president of mission advancement at Recovery Now, said “when I got out of prison, there were no resources for me.”?

“Four years in prison, in a row, and nobody said, ‘would you like to learn how to live a life in recovery?’ Nobody said, ‘do you think you have a problem with drugs and alcohol?’ Bourland said. “What they said was, ‘Chow ladies.’ ‘Lights out ladies.’ ‘Meds, ladies.’ That was it.”?

‘Trauma is the gateway’?

Over the course of three hours, two panels and a series of small group discussions at the women’s campus of The Healing Place, advocates and people in recovery emphasized that widespread access to harm reduction is key to lowering the number of Kentuckians dying from overdose.?

Harm reduction is anything that decreases the harm a person may experience — like wearing a seat belt when driving or brushing teeth to avoid cavities. In the context of substance use, harm reduction includes the use of the overdose-reversal Narcan, fentanyl test strips, syringe exchange programs and more. Harm reduction emphasizes engaging directly with people who use drugs to prevent overdose and infectious disease transmission, says the Substance Abuse and Mental Health Services Administration??

Stigma sometimes stands in the way of recovery, advocates said.?

“In this country, we still view substance use disorder as a moral failing,” said Tara Hyde, the CEO of People Advocating Recovery who is also in long-term recovery. “And until we, as a community, really gather together and really start to create more of an argument against that narrative, they’re going to continue with that, because that’s all that they know.”?

Stephanie Johnson with Vocal KY said the word “addiction” is still quite stigmatized — and asked the audience, “how many people would not move or have gotten dressed without a cup of coffee this morning?”?

“Changing the narrative,” she said, “is harm reduction.”?

Focusing on mental health for people in active addiction and recovery is also “huge,” Johnson said.?

“You can have a mental health issue without having a substance use issue,” she said. “You will not have a substance use issue without having any mental health issue. We have got to address mental health. Trauma is the gateway.”?

Youth education and recovery funding?

Lawmakers should codify a requirement for schools to have uniform education on mental health, Hyde told the Lantern. There are “quality” programs available, she said, but “there’s no requirement, so not every school gets that.”?

“This is a systemic problem. And we can’t just, (say) ‘oh well, this school has it, and this school doesn’t,’” she said. “You can’t just make it bounce like that; that’s a really big problem.”?

The state could also save itself money, Hyde said, by funding long-term recovery programs. Usually a person attempts recovery an average of six times before being successful, she said, meaning their treatment could cost around $180,000 by the end of those attempts, which are usually in short-term programs.?

Some research suggests longer programs are more effective, especially in dealing with severe cases.?

“A lot of that money is already being spent,” she said. “Medicaid is paying for each attempt — six on average.”?

Justice’s mother, Beckie Rose, shared a panel with her daughter.?

She’s from Pike County — from “coal mines and coal fields and mountains,” as she described it, as well as “ground zero” of the opioid epidemic.?

Rose is in long-term recovery now, and she advocates for a better future for her daughter and Eastern Kentucky community.?

“We have way more in common than we have differences,” Rose said. “And I would just like to see our communities and our families come together, and instead of incarcerating disease, start treating disease.”??

Cover art from "Kinship Across Kentucky: Recommendations from Caregiver Voices in 2024." Around 55,000 Kentucky children are being raised by a relative or fictive kin, according to the report. (Kentucky Youth Advocates)

Kentuckians who are raising a minor relative need better access to mental health care, housing and other basic support services, according to a new report released Tuesday.

The report, from Kentucky Youth Advocates and the Kinship Families Coalition of Kentucky, is based on two online surveys and nine in-person listening sessions aimed at learning more about the challenges facing kinship caregivers.?

Most of the caregivers surveyed were white women. They reported needing assistance with food, clothing and school supplies. Participants also said they needed help with finances, housing, information technology, peer support, respite care, mental health care and legal assistance, according to the report. They also reported child care as one of the most difficult supports to access.?

Norma Hatfield, president of the Kinship Families Coalition of Kentucky, said during a Wednesday forum discussing the report that sometimes kinship caregivers like herself focus on caring for the youth in their charge and “don’t always take care of themselves.”?

“It’s pretty darn stressful,” she said. “You may need somebody, from a therapeutic perspective, to have some of those conversations, especially if the abuse is really bad and there’s a criminal case going on.”

Kinship caregivers may be caring for a grandchild, for example, who’d been abused by the grandparent’s child.?

“I look at it as: to kind of help me deal with my emotion, process that, and then step back and (see) how can I best help the child at the same time? And that’s hard. That’s why it’s challenging and confusing, because you also have yourself and how you feel, and you also have the child and the system.”?

Sometimes that mental health support may include medication or more intensive services, Hatfield said, but most of the time talk therapy addresses the need.?

Lesa Dennis, the commissioner for the Department of Community Based Services, spoke alongside Hatfield during the KYA forum and said kinship care in Kentucky is a “priority” for her department.?

“We still have a lot of work to do in this space, and we’re very committed to it,” Dennis said.?

During the 2024 legislative session, the General Assembly passed a law that allows relatives who take temporary custody of a child, when abuse or neglect is suspected, to later become eligible for foster care payments. However, a funding dispute that arose after the fact has left that help hanging, more than two months after the law went into effect.?

Policy recommendations?

The report makes numerous recommendations, including:

• Expand community-based mentorship opportunities for youth in kinship care and their caregivers.?
• Provide or facilitate comprehensive reunification services for kinship families to create opportunities for children to return safely to their birth families, when appropriate.?
• Provide judges a bench card related to kinship care utilization and needed supports
• Increase the frequency and accessibility of trainings on the unique experiences and needs of kinship families to DCBS staff, private foster care agency staff and community mental health providers.
• Provide comprehensive informational packets and educational materials for new kinship caregivers.?
• Utilize best practices to actively seek the most appropriate placement for the child when identifying kinship and fictive kin caregivers, including addressing disproportionality in the placement of children of color into foster care instead of kinship care.

• 

It’s not clear yet which of these policies, if any, would require legislation during the next session.?

“I think a lot of those things can be accomplished through working together with the Cabinet for Health and Family Services and the Department for community based services,” said Shannon Moody, chief policy and strategy officer for the nonpartisan KYA. “We would definitely want to have some additional conversations to figure out what would need or require statutory change, but I don’t know if we anticipate any of those recommendations being moved forward for pursuit in the 2025 legislative session.”?

Around 55,000 Kentucky children are being raised by a relative or fictive kin, according to the Tuesday report. That includes both formal (the state is involved) and informal (the state is not involved) situations. In 2023, about 1,500 Kentucky children were placed in a relative or fictive kin home by the state.?

Kentucky’s known prevalence of kinship care is 6%, according to the report, making it twice as high as the national average.

The gravesite of Amber Thurman, at Rose Garden Cemetary in McDonough, Georgia on August, 13th 2024.

The Georgia hospital that failed to save Amber Thurman may have broken a federal law when doctors there waited 20 hours to perform a procedure criminalized by the state’s abortion ban, according to Sen. Ron Wyden, chair of the Senate Finance Committee.

The Emergency Medical Treatment and Labor Act, or EMTALA, requires hospitals to provide emergency care to stabilize patients who need it — or transfer them to a hospital that can. Passed nearly four decades ago, the law applies to any hospital with an emergency department and that accepts Medicare funding, which includes the one Thurman went to, Piedmont Henry in suburban Atlanta. The finance committee has authority over the regulatory agency that enforces the law.

In a letter sent Monday, Wyden, an Oregon Democrat, cites ProPublica’s investigation into Thurman’s death, which was found preventable by a state committee of maternal health experts. The senator’s letter asks Piedmont CEO David Kent whether the hospital has delayed or denied emergency care to pregnant patients since Georgia’s abortion ban went into effect. (Kent did not respond to requests for comment.)

“It is my duty to conduct oversight of potential violations of patients’ rights under these laws,” Wyden wrote. The senator asked for the hospital’s policies covering treatment of patients with emergencies that require abortion care. He also asked for a list of personnel involved in making those decisions. He gave the hospital a deadline of Oct. 24 to provide those and other requested records and answers.

Wyden sent the same letter citing ProPublica’s reporting on Thurman to seven hospitals in North Carolina, Florida, Missouri, Louisiana and Texas. One letter seeks information from a Texas hospital where Yeniifer Alvarez-Estrada Glick died in 2022 from complications of pregnancy including hypertension, as reported by The New Yorker. Other letters seek information from hospitals where women have reportedly been turned away or experienced delayed care.

The hospitals’ answers could lead to proposed legislation or executive actions to strengthen compliance. The federal Centers for Medicare and Medicaid Services investigates complaints and can take actions including levying fines against hospitals that violate EMTALA.

Wyden’s committee held a hearing Tuesday morning, saying in a news release it would “examine how Donald Trump’s successful overturn of Roe v. Wade and subsequent state abortion bans have threatened access to life-saving medical care for women nationwide.”

Piedmont did not respond to multiple requests seeking comment about Wyden’s letter or whether it is aware of an investigation into an EMTALA violation. Doctors who handled Thurman’s care have previously declined to explain their thinking and did not respond to questions from ProPublica.

A spokesperson for the U.S. Department of Health and Human Services, which oversees the regulatory agency that enforces the law, said in an email: “No woman or her family should have to worry that she could be denied life-saving treatment. While we can’t comment on complaints or investigations, we are committed to ensuring that every woman gets the care she needs.”

But some hospitals in abortion-ban states continue to deny or delay emergency care to pregnant women.

A recent Associated Press review of federal investigations found that more than 100 pregnant women in medical distress who sought help from emergency rooms were turned away or treated negligently since 2022, when the Supreme Court overturned Roe v. Wade. Last year, a federal investigation found that hospitals in Missouri and Kansas involved in the care of a patient, Mylissa Farmer, violated the law.

Vice President Kamala Harris has singled out Thurman’s case as evidence that a national law is needed to restore the right to abortion. Harris’ office didn’t respond to ProPublica’s questions about what federal actions she might pursue as president apart from signing a law, which would have to be passed by a divided Congress.

Former President Donald Trump has bragged about appointing three Supreme Court justices who voted to overturn Roe. Project 2025, the controversial playbook and policy agenda for a right-wing presidential administration, calls for doing away with Biden administration guidance that EMTALA requires hospitals to provide abortion care in emergency situations, even in states that ban it, or transfer the patients to a hospital that can provide the needed care.

Trump’s campaign pointed to previous statements by the former president that Project 2025 does not represent his plans for a second term. Leavitt said the former president “has always supported exceptions for rape, incest and the life of the mother, which Georgia’s law provides. With those exceptions in place, it’s unclear why doctors did not swiftly act to protect Amber Thurman’s life.”

Georgia Gov. Brian Kemp, too, has said his state’s six-week ban has clear exceptions to protect the “life of the mother.” In a statement, he blamed “partisan activists and so-called journalists” for spreading “misinformation and propaganda that fostered a culture of fear and confusion.”

But doctors have warned for years that these laws use language not rooted in science and begged for clearer exceptions. The confusion is apparent: In the wake of the bans, some hospitals have refused to even issue written policies informing doctors when and how to provide emergency abortions.

Legal reproductive rights scholars told ProPublica they believe Thurman’s treatment is a clear violation of EMTALA.

“It’s not even a question,” said Sara Rosenbaum, a George Washington University health law and policy professor and former adviser to President Bill Clinton. She helped develop EMTALA while at the Children’s Defense Fund. “I think the hospital, like all hospitals in these situations, is caught between violating EMTALA and state prosecution,” she said.

Thurman was rushed to the hospital on Aug. 18, 2022, in need of immediate care. Days earlier, she had taken abortion medication to end her pregnancy but was facing a rare complication: Some of the tissue remained inside her body, causing a grave infection.

To clear the infected tissue, she needed a dilation and curettage, or D&C, a procedure used to empty the uterus for both abortions and routine miscarriage care. Medically speaking, Thurman’s pregnancy had already ended. But the state’s abortion ban had criminalized performing a D&C and threatened doctors with up to 10 years in prison if prosecutors decided they violated it.

Records obtained by ProPublica show doctors discussed the procedure at least twice as Thurman’s condition deteriorated over 20 hours. Experts on the state maternal mortality review committee agreed there was a “good chance” Thurman would have survived if the D&C was provided sooner.

After the Supreme Court overturned the constitutional right to abortion, the federal government reminded hospitals and doctors they had to follow EMTALA and provide abortion procedures to patients if necessary in emergency situations, regardless of abortion bans. Some Republican officials have aggressively pushed back and said hospitals do not need to follow EMTALA, even for high-risk situations.

In Texas, Attorney General Ken Paxton threatened to prosecute a doctor for providing an emergency abortion to a woman with a high-risk pregnancy, whose fetus had a fatal anomaly and whose pregnancy threatened her health and future ability to have children.

He argued in court that she did not meet the state ban’s criteria. He also filed a lawsuit arguing the federal government cannot force Texas to follow the guidance on providing emergency abortions to patients.

In an opinion written by a Trump-appointed judge, a federal appeals panel agreed. That means enforcement of EMTALA in emergency abortion cases is barred in that state.

The Supreme Court last summer considered a lawsuit brought by the Biden administration challenging Idaho’s abortion ban, which lacks health exceptions and appears to conflict with EMTALA. A lawyer for the state acknowledged that Idaho’s abortion ban was written to prevent doctors from offering abortions even if the woman could suffer a serious medical complication like losing an organ.

Conservative justices in that case raised arguments about the rights of the fetus. The court issued a ruling that meant the case would be returned to a lower court, which upheld EMTALA while the case continues.

Rosenbaum said the federal government is not doing enough to require hospitals to follow EMTALA in states that banned abortion: “The federal government has no resources. It was only recently that the Biden administration has made it clear how to file complaints. The complaints go uninvestigated or poorly investigated.”

Wyden’s letters sum up the perilous landscape for patients and doctors.

“Across the country, there are reports that women are being turned away by emergency departments when they seek emergency reproductive health care, even in instances where medical professionals determine that, without such care, the patient is at risk of serious complications, infection, or even death. These women are caught between dangerous state laws that are in clear conflict with — and preempted by — EMTALA.”

On Tuesday, Thurman’s sister, Cjauna Williams, visited Thurman’s grave near Atlanta. She arrived to find fresh flowers and birthday balloons left there by people she and her family had never met. Thurman would have turned 31 the day before, and the story of her desperate wait for the medical care she needed had reverberated across the country.

“Hopefully her death won’t be in vain and something good can come of it,” Williams said.

Ben Lovely, assistant professor of biochemistry and molecular genetics, looks through a zebrafish tank. Lovely is working with zebrafish to study fetal alcohol syndrome. (Photo provided)

LOUISVILLE — Over the next five years, University of Louisville researchers plan to expose about 1.5 million fish eggs to alcohol in hopes of better understanding fetal alcohol syndrome in humans.

Using a $2.3 million grant from the National Institutes of Health, researchers will specifically study zebrafish as a model for better understanding human facial defects associated with prenatal exposure to alcohol. They started their work in May and will finish in 2029.?

Ben Lovely, the study’s lead researcher and an assistant professor of biochemistry and molecular genetics at the university, said zebrafish are “a really strong model for humans” because they share more than 80% of the same genes.?

“If you have a gene that’s associated with cancer in humans, you’re probably going to find it in fish, and it can lead to cancer in a fish,” Lovely explained.?

Because of this, he told the Lantern, he can study the effects of alcohol on humans via the fish, learning more than he would be able to in a human study. Fish are well equipped for such a study, he said — he can study developing embryos outside the mother.?

“Part of the issue with looking at placental mammals like humans, like mice, is maternal effects and embryonic effects,” he said. “So you have two different things going on here.”?

With his zebrafish, which are raised in a facility on-site and “get fed and mate” for a living, he can take eggs that adult fish laid and? study them in petri dishes — about 100 at a time to ensure they don’t die from over-density. Zebrafish are a freshwater member of the minnow family.?

During their time in the dish, researchers control how much alcohol is added to the solution in each dish, which also has water and nutrients.?

“The alcohol goes right into the fish, gets right across the eggshell and into the fish itself,” he explained. The alcohol dose isn’t enough to kill the fish, he said.?

These fish are also perfect for monitoring early development.?

“They develop pigments once they reach adult stages, but as embryos, they’re transparent,” Lovely said. “You can see right through them. So we can actually watch the cells live in a developing fish over time. You can’t really do that in a placental mammal, because you’d have to remove the embryo to get that to happen.”?

Decreasing stigma?

Babies who were exposed to alcohol while in utero — especially in the early weeks when a person may not know they are pregnant — can be born with? fetal alcohol spectrum disorders (FASDs), which includes the incurable fetal alcohol syndrome.?

People born with this may have “abnormal facial features” like a smooth ridge between the nose and upper lip, a thin upper lip and small eyes, according to the Cleveland Clinic. Other symptoms can include learning problems, attention deficit hyperactivity disorder (ADHD), depression and more.?

Both the alcohol consumption and the facial features he is specifically studying can lead to stigma, Lovely said.?

“The first thing we see as humans is the face. So facial birth defects are hugely stigmatizing,” he said. “To understand their origins, their prognosis, everything about them is going to be key in really helping identify these issues early, if we can, especially prenatally, that would be more ideal.”?

Alcohol, too, “has its own stigma,” he said.?

The Centers for Disease Control and Prevention reported in 2019 that about 42% of pregnancies in the United States are unintended. The early weeks and months of pregnancy are a key time for the developments of FASD, according to the Mayo Clinic.

“So you combine those two: there are a lot of individuals who are drinking and do not know they’re pregnant,” Lovely said. “They don’t want to be accused of harming their child because they didn’t know, right? That’s the stigma. So it’s very difficult for him to do human studies. It’s very difficult to find patients — very few mothers want to admit to this.”?

But through his zebrafish study, he said, he hopes to move in the direction of genotyping a person to see their sensitivity to alcohol and look at the issue more from a gene perspective and less from a social perspective.?

“A lot of researchers now … say ‘prenatal exposure,’ we don’t say ‘the mother drank,’” he said. “We don’t say anything about the mother, to avoid stigmatizing the mother. So we try to couch it from ‘this has happened to the developing embryo,’ not ‘this was done to the developing embryo.’”?

The CDC said this year that about 1 in 20 school-aged children in the country could have FASDs.? Not every fetus that’s exposed to alcohol will develop FASD issues.?

Because of this, the University of Louisville says that “understanding what genes might increase that risk could lead to better therapeutics and help mothers make safer, more informed choices.”?

Baptist Healthcare Corbin, above, and Westcare in Pike County are in line for federal funding to expand access to drug treatment. (Baptist Healthcare Corbin)

Two Eastern Kentucky health care providers have received $5.7 million from the Department of Health and Human Services to expand opioid treatment programs.?

Westcare Kentucky in Ashcamp and Baptist Healthcare System in Corbin received $3 million and $2.7 million, respectively. The grants will be spread over four years.?

They’ll use the funds to “create new or expand existing access points for treatment and recovery services, support the behavioral health workforce and collaborate with social services to ensure coordinated care and sustainable impact in rural communities,” according to the Health Resources and Services Administration (HRSA), which is in the Department of Health and Human Services (HHS).?

Westcare, part of a nonprofit network of behavioral health provicers, is located in Pike County, which was among the five Kentucky counties in 2023 with the most fentanyl and meth-related overdose deaths.?

In 2023, there were 1,984 fatal overdoses in Kentucky, down from 2,135 in 2022. Fentanyl, a powerful synthetic opioid, accounted for 1,570 of those — about 79% of the 2023 deaths. The 35-44 age group was most at risk, the report shows. Methamphetamine accounted for 55% of 2023’s overdose deaths.?

Despite the overall decrease, the number of Black Kentuckians who died from a drug overdose increased from 259 in 2022 to 264 in 2023.?

“We know that where you live should not determine your access to or the quality of the care that you receive,” Carole Johnson, the administrator of HRSA, said in a statement. “And, we are taking action to deliver for rural families by supporting high-quality substance use disorder treatment and by helping rural hospitals continue to serve their communities.”

A 9 mm “ghost gun” pistol build kit with a commercial slide and barrel with a polymer frame is displayed in the Rose Garden of the White House in Washington, D.C. More than a dozen states, including some battleground states, debated and enacted a variety of firearms regulations addressing storage requirements, gun-free zones, bans on firearm purchase tracking and permitless carry. (Carolyn Kaster/The Associated Press)

The deadliest school shooting in Georgia history occurred earlier this month when a 14-year-old gunman, armed with a military-style rifle, killed two students and two teachers and injured nine others at Apalachee High School in Winder, a city about an hour northeast of Atlanta.

And on Sunday, former President Donald Trump was the target of what the FBI described as an apparent assassination attempt at his golf club in West Palm Beach, Florida — just nine weeks after surviving another attempt on his life.

Gun policy has been a topic of debate in America for decades, and its prominence has increased as gun-related deaths and mass shootings have risen nearly every year since 2014, according to the Gun Violence Archive, a nonprofit that tracks gun violence in the United States.

Many Americans despair of ever taming the epidemic, but a new report says certain laws can make a difference.

The report, published in July by Rand, a nonprofit, nonpartisan research organization, found that minimum age requirements for purchasing firearms appear to reduce suicides among young people. Additionally, it indicated that laws aimed at reducing children’s access to stored guns may also lower rates of firearm suicides, unintentional shootings and firearm homicides among youth.

This is the fourth time that Rand has released the report, “The Science of Gun Policy,” since 2018. Earlier editions examined the effectiveness of other gun regulations, such as background checks and concealed carry laws, and their impact on outcomes such as crime and suicide.

The “Science of Gun Policy” report examines laws individually. But a separate Rand study published in July, this one in the peer-reviewed journal JAMA Network Open, explores the combined effects of multiple state-level gun laws, including background checks, minimum age requirements, waiting periods, child access restrictions, concealed carry and stand your ground laws.

“We should try to be looking at policies jointly, because individually, each one may have a small effect, but if you start layering these restrictions on each other, they may start to really make a difference,” Terry Schell, the study’s lead author and a senior behavioral scientist at Rand, told Stateline. “That is worth thinking about.”

The study found that states with the most restrictive gun policies had a 20% lower firearm mortality rate compared with states with the most permissive laws, suggesting that comprehensive policy approaches may be more effective than individual policies in curbing gun violence.

“There should be some hope that there is a policy combination that could drive the firearm death rate down,” Schell said.

A deadly year so far

The Georgia school shooting marked the 30th mass killing in the United States this year, defined as an attack in which four or more people, excluding the perpetrator, are killed, according to a database maintained by The Associated Press, USA Today and Northeastern University. At least 131 people have died in these killings so far.

Mass shootings that occur close to election seasons often have a significant impact on the public’s perception of guns, according to gun policy experts. But much of the discussion and debate surrounding firearms has been clouded by partisan rhetoric and money, said Warren Eller, an associate professor of public management at the John Jay College of Criminal Justice.

“[Gun policy is] going to play a larger role, at least in the dialogue around it –– whether or not it’s meaningful dialogue, I think, is something very different,” Eller said in a phone interview with Stateline.

This year, more than a dozen states enacted a variety of new gun laws, including measures related to storage requirements, gun-free zones, bans on firearm purchase tracking and permitless carry.

Following the deadly shooting at Apalachee High School, both Republican and Democratic Georgia state lawmakers have proposed various measures to curb gun violence.

Georgia’s House speaker, Republican Rep. Jon Burns, wrote in a letter to the House Republican Caucus that lawmakers will consider new policies during the 2025 legislative session to promote student mental health, evaluate technologies to detect guns and encourage safe gun storage.

“While House Republicans have already made significant investments to strengthen security in our schools, increase access to mental healthcare, and keep our students safe, I am committed to not only continuing this work but pursuing additional policies to help ensure a tragedy like this never happens in our state again,” Burns wrote in the letter.

Burns’ proposals, however, fall short of Democratic demands for measures such as universal background checks and a red flag law, which would allow police or loved ones to petition a court to prevent an at-risk individual from purchasing or possessing a firearm.

In February, the Georgia House approved a bill to create a state income tax credit of up to $300 for purchasing gun safes, trigger locks, other security devices or instructional courses on safe firearm handling. This bill did not advance past the Senate, but a similar Senate bill that exempts gun safes and other safety devices from state sales tax went into effect in July.

Two other gun-related bills also took effect in July. The first law bans firearm purchase tracking, while the second law established a tax holiday for guns and related items.

A special panel of Georgia state senators also convened several times this year to explore potential laws aimed at safely locking up firearms and keeping them out of the hands of children.

Pushback against gun measures

The National Shooting Sports Foundation, which represents much of the national firearm industry, argues that universal background checks are ineffective and that they don’t keep firearms from reaching criminals. The foundation also contends that universal background checks would require a national registry of gun owners, which they fear could lead to confiscation.

Many of the existing red flag laws, the group argues, lack sufficient due process protections. The group encourages safe firearm storage but opposes laws mandating specific storage requirements, citing a U.S. Supreme Court decision in which the justices ruled that trigger locks, which render firearms nonfunctional, violate the Second Amendment.

Above all, the group advocates for stricter enforcement of existing laws and emphasizes that mental health should be a primary focus in addressing gun violence.

“We can’t have no-bail policies. We can’t have ‘defund the police.’ … We need to hold people accountable for their criminal actions,” Lawrence Keane, the organization’s senior vice president and general counsel, said in an interview with Stateline. “We believe that a lot of these high-profile, tragic incidents are at bottom about mental health.”

Mental health is often cited as a major factor contributing to gun violence. Although it may play a significant role, aligning specific mental health diagnoses with policy solutions is difficult, according to Eller, of the John Jay College of Criminal Justice.

Much of the gun violence in the United States stems from economic crime, Eller said in the interview, but many policy discussions focus narrowly on school shootings and assault weapons. Those issues should be addressed, he said, but they represent a small percentage of gun violence in this country.

Since 1982, there have been at least 24 mass shootings in U.S. schools, defined as incidents in which four or more people are killed, according to a database maintained by Mother Jones, a nonprofit news magazine. These school shootings account for about 16% of the 151 mass shootings that have occurred in the U.S. during this period.

This article?is republished from Stateline, a sister publication to the Kentucky Lantern and part of the nonprofit States Newsroom network.

Naloxone for reversing opioid overdoses is available to the public at the Lexington-Fayette County Health Department on Newtown Pike. (Lexington-Fayette County Health Department)

The Lexington-Fayette County Health Department has issued an overdose alert for Lexington.

The health department reports a spike in suspected nonfatal drug overdoses with 24 reported in four days, Sept 17-20, according to information from the Overdose Detection Mapping Application System (ODMAP).

“This is an important time to carry naloxone, used to reverse opioid overdoses, especially if you or someone you know has substance use disorder,” said the department’s communications officer Kevin Hall in a news release Friday. “Fentanyl has been found in all types of regulated drugs, so naloxone may help regardless of the drug taken.”

The department’s Harm Reduction Program provides naloxone to anyone who needs it. Naloxone kits are available 11 a.m.-5 p.m. Mondays, 3-6:30 p.m. Wednesdays and 11 a.m.-5 p.m. Thursdays in the Dr. Rice C. Leach Community Room at the Lexington-Fayette County Health Department, 650 Newtown Pike. People picking up the free naloxone also receive a 10-15-minute class in how to use it.?

The department recommends:

• Don’t use drugs alone
• If you or someone you know needs help with substance use disorder, visit https://findhelpnowky.org/ky to search for available treatment options (or call 1-833-859-4357 during business hours or 1-800-854-6813 after business hours)
• Check in on friends, family members, neighbors and others to share this information
• Call 911 if you suspect an overdose.

Community clinics will use $4.7 million in federal money to integrate mental health and substance use treatments more fully into primary care services.?(Getty Images)

Eight community health centers in Kentucky have received nearly $5 million in federal funds to launch and expand mental health and substance use disorder treatments across the state.?

The $4.7 million in grant money comes from the Health Resources and Services Administration (HRSA), housed within the U.S. Department of Health and Human Services (HHS).?

Centers will use the money to integrate mental health and substance use treatments more fully into primary care services.?

“Access to behavioral health care is critical for communities of color and underserved groups,” HHS Secretary Xavier Becerra said in a statement. “HRSA-funded health centers have a proven record of success in reaching underserved communities. This funding expands their access to essential behavioral health services that will benefit entire communities.”??

The grant money is going to these centers:?

• Cumberland Family Medical Center in Burkesville received $600,000.
• Grace Community Health Center in Corbin, $600,000.
• Health First Bluegrass in Lexington, $600,000.
• Health Help in McKee, $600,000.
• Health Point Family Care in Newport $500,000.
• Kentucky Mountain Health Alliance in Hazard, $600,000.
• Lewis County Primary Care Center in Vanceburg, $600,000.
• Sterling Health Solutions in Mount Sterling, $600,000.

Carole Johnson, the HRSA administrator, called mental health and substance use disorder treatments “essential elements of primary care, and there should be no wrong door for families to get the behavioral health care they need.”

Cuts in Medicaid payments to behavioral health providers are forcing cuts at Kentucky's largest provider of treatment for addiction. (Getty Images)

An Eastern Kentucky provider of addiction services has filed a lawsuit challenging cuts in Medicaid payments that it says threaten its business.

The lawsuit, filed Tuesday in Jefferson Circuit Court by Frontier Behavioral Health Center, is against Wellcare of Kentucky Inc. — one of six private insurance companies that handle most of the state’s Medicaid claims and establish rates for health providers.

The lawsuit is the latest development as providers and some insurance companies spar over cuts in payment. A week ago, Addiction Recovery Care, or ARC, the state’s largest provider of substance use disorder treatment, said it is laying off staff and reorganizing programs because of the reductions.

In July, ARC executives testified before a legislative committee in Frankfort to protest the cuts it said affected it and a handful of other providers.

Lawmakers join KY’s largest addiction treatment provider to oppose Medicaid payment cuts

Frontier, a for-profit company based in Prestonsburg, said in its lawsuit that cuts of 20% in payment for addiction treatment that took effect last month threaten its ability to care for patients and pay its 94 employees.

An additional, new requirement that Wellcare review services before agreeing to pay for them will further hinder operations, the lawsuit said.

“Frontier must pay its employees for their work,” it said. “Frontier does not have the luxury of delaying payroll and operational expenses until Wellcare decides whether it will pay Frontier for the medically necessary services Frontier provides to Eastern Kentucky’s vulnerable health behavioral health patients.”

Frontier sees about 50 patients a day, according to the lawsuit.

Frontier CEO Randy Hunter declined to comment on the case. Officials with Wellcare, based in Louisville, did not immediately respond to a request for comment.

Expanded Medicaid funds for addiction services that became available in 2014 have fueled rapid growth in treatment programs amid decades of growing addiction to opioids, methamphetamine and other substances in Kentucky.

Last year, Kentucky spent $130 million in Medicaid funds on addiction treatment, with most of the money from the federal government.?

Kentucky Gov. Andy Beshear has cited the growth as important in battling addiction.

As an indicator of success, the Beshear administration points to the?decline, for the second year in a row, of overdose deaths in Kentucky.

The state’s latest?overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

But the business of addiction treatment has brought complaints about high costs from the six private managed care organizations, or MCOs, that handle most of the state’s $1.6 billion a year Medicaid business. The companies contract with the state and receive a fixed amount per member to cover health costs.

And it has invited federal scrutiny.

In July, the FBI announced it was investigating ARC for possible health care fraud and asked anyone with information to contact them through the agency’s website. ARC, in a statement, has said it is confident in its services and is cooperating with the investigation.

Frontier provides services in Prestonsburg, Salyersville, Paintsville and Harlan, according to its website.

It said in the lawsuit the company first learned in August of a 20% rate cut being imposed by Wellcare.

Wellcare is the largest of the MCOs that oversee health care for most of the 1.5 million Kentuckians covered by Medicaid, with around 418,000 members enrolled in its plan. The other members are divided among the other five MCOs.

The lawsuit alleges when Frontier sought to question Wellcare about the cuts, the MCO claimed it sent Frontier a letter in March 2024 notifying it of the new rates.

“Frontier did not receive any letter from Wellcare notifying it of a rate cut in March 2024,” the lawsuit said.

It said that in August, Wellcare also began sending letters notifying Frontier it was placing its services on “prepayment review,” meaning it would have to review services before deciding whether to pay for them.

The lawsuit said the letters provide a telephone number to call Wellcare with any questions or concerns.?

“The phone number has been disconnected,” the lawsuit said.

Frontier asks the court to find Wellcare in breach of its contract. It also asked for a temporary order barring the MCO from imposing “prepayment review” on Frontier services.

Claims in a lawsuit provide only one side of a case. Wellcare has not yet responded.

The case has been assigned to Jefferson Circuit Judge Annie O’Connell.

Kentucky Auditor Allison Ball, center, spoke to lawmakers on July 30 about access to computerized records of child and elder abuse cases. Ombudsman Jonathan Grate is at left and Alexander Magera, general counsel in the auditor's office, is at right. (Kentucky Lantern photo by Sarah Ladd)

Kentucky’s Cabinet for Health and Family Services must give the office of the ombudsman read-only access to a computer system, iTWIST, that stores information about abuse and neglect cases, according to an agreement approved by Franklin Circuit Judge Phillip Shepherd.

The access must be granted by the end of day Thursday, Sept. 19, Shepherd said in a Wednesday ruling.?

He also requires a report on the status of that access within five business days.?

This comes after months of back and forth between Kentucky Auditor Allison Ball’s office, which now houses the ombudsman, and the Beshear administration.?

On Sept. 4, Shepherd ordered the dispute into mediation and told the parties to agree on a mediator or he would assign one. They agreed on retired United States Magistrate Judge James D. Moyer.?

The memorandum of understanding that Shepherd approved was signed by Jonathan Grate, the new ombudsman, and Eric Friedlander, secretary of the Cabinet for Health and Family Services (CHFS).

Ball’s office assumed oversight of the ombudsman from CHFS on July 1, thanks to a law enacted last? year by the legislature, Senate Bill 48.?

Ball filed a lawsuit for the access in late August that named Gov. Andy Beshear, Friedlander and Ruth Day, the chief information officer of the Commonwealth Office of Technology.??

The ombudsman investigates and resolves complaints about agencies in CHFS, including protective services for children and elderly Kentuckians. Grate, the ombudsman appointed by Ball, can’t do his job without access to iTWIST, (the Workers Information System), Ball previously told lawmakers.

The parties differed in their legal interpretations. The cabinet said access to iTWIST was limited by state law to cabinet social service officials under Kentucky Revised Statute 620.050. The state auditor’s office said the ombudsman is covered under that statute despite moving from the cabinet to auditor’s office.?

In his latest ruling, Shepherd said the parties will work on legislation for the 2025 session to address the issue in statute.?

James Hatchett, a spokesperson for Beshear’s office, said “today’s resolution is similar to many offers made by the cabinet over the last several months to address the situation until the General Assembly can act.”?

“Throughout this process, the governor has agreed the ombudsman should have access to these records, but must do so in a way that complies with applicable state law,” Hatchett said.?

Stephanie French, a cabinet spokesperson, said CHFS is? “happy” with the resolution that allows “the cabinet and ombudsman both to comply with the applicable law” following months of “significant disagreement on how the law applies to the iTWIST system.”?

“We look forward to working with the ombudsman in the upcoming legislative session if necessary,” French said.?

In a statement, Ball said, “While it is unfortunate that it required a lawsuit for the governor and CHFS to agree to restore the necessary iTWIST access to the ombudsman’s office, I am pleased with today’s outcome. The agreed order entered by the court today makes sure that the governor and CHFS can no longer stop the ombudsman from accessing iTWIST. They can no longer try to look over the ombudsman’s shoulder while we fight to help people.”

Gov. Andy Beshear, surrounded by advocates for mental health and LGBTQ Kentuckians, signs an executive order Wednesday banning conversion therapy on young Kentuckians. (Governor's office)

This story mentions suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.?

Calling it a “dangerous practice,” Gov. Andy Beshear signed an executive order Wednesday that bans conversion therapy on minors in Kentucky.?

Speaking in Frankfort, Beshear said such attempts to alter a young person’s gender expression or sexual attractions have “no basis in medicine”? — a view supported by experts in medicine and mental health.

Conversion therapy has been condemned by the American Academy of Child and Adolescent Psychiatry (AACAP), among other medical and psychological organizations. AACAP says conversion therapies “lack scientific credibility and clinical utility” and “there is evidence that such interventions are harmful.”??

The practice involves “interventions purported to alter same-sex attractions or an individual’s gender expression with the specific aim to promote heterosexuality as a preferable outcome” according to the AACAP.?

The American Psychological Association says that people who have undergone “sexual orientation change efforts” are much more likely to be depressed and suicidal. The National Suicide Prevention Lifeline is 988.?

Beshear’s executive order states that neither state or federal dollars can be used “for the practice of conversion therapy on minors.”?

“Today’s action does not force an ideology on anybody,” Beshear said. “It does not expose anyone to anything in a library or school. It simply stops a so-called ‘therapy’ that the medical community says is wrong and hurts our children.”

Beshear’s order comes after Rep. Lisa Willner, D-Louisville, has repeatedly sponsored legislation to ban conversion therapy in Kentucky. Each year, her bill has had bipartisan support. Given that, it’s always been a “mystery” to her why it didn’t pass, she told the Lantern Wednesday.?

“That’s a question I’ve asked myself for six years: Why can’t we get this across the finish line?” she said. “It’s such a discredited practice. It has caused such harm to so many young Kentuckians, including suicide. And it has had such strong bipartisan support.”??

“I’m incredibly grateful for the executive order, and that, at long last, there will be protections in place,” Willner added.?

Snags in 2025??

Beshear’s move could hit snags in the 2025 legislative session.?

Rep. Josh Calloway, R-Irvington, wrote on social media that he would file legislation next year to “stop this governor from pushing his harmful far-left agenda on struggling kids.”?

Calloway shared a screenshot of the email the governor’s office sent to announce the executive order and wrote, “why is @AndyBeshearKY determined to keep vulnerable children confused?”

“I will fight this with every fiber of my being,” Calloway wrote. “I am also exploring other legal options to stop egregious overreach.”??

Meanwhile, 12 Republican Senators slammed Beshear for the order, which they said “disregards the First Amendment rights regarding freedom of religion and speech and violates the fundamental parental rights and responsibilities for their children.”?

“Time and again, the Kentucky Supreme Court has told the governor he lacks the power to create policy in the Commonwealth. Yet again, the governor is defying the Supreme Court, the General Assembly, and the doctrine of separation of powers,” those senators said in a statement. “The executive order uses such vague and overbroad language that health care providers are at risk, and children will be left without needed mental health care.”

The 12 Republican state senators issuing the statement condemning Beshear’s action are: ?Senate President Robert Stivers, Manchester; Robby Mills, Henderson;? Shelley Funke Frommeyer, Alexandria; Lindsey Tichenor, Smithfield; Whitney Westerfield, Fruit Hill; Gary Boswell, Owensboro; Donald Douglas, Nicholasville; Greg Elkins, Winchester; John Schickel, Union; Phillip Wheeler, Pikeville; Majority Whip Mike Wilson, Bowling Green; Max Wise, R-Campbellsville.

Willner is “sure there will be efforts” to block the executive order, she told the Lantern.??

“There are people who, I think, willfully misunderstand what this is about, and that this is a practice that traumatizes people for decades, for the rest of their lives, and that ends lives prematurely,” she said. “And for people to misunderstand this is beyond disappointing. I will do everything I can to make sure that any efforts to turn this back will fail, and I really hope that they will.”?

Protections ‘at long last’?

Advocates for mental health in Kentucky praised Beshear’s action.

Sheila Schuster, the executive director of the Kentucky Mental Health Coalition, called the practice “torture” and teared up as she spoke alongside Beshear in the Capitol Rotunda.?

Her coalition has listed ending conversion therapy as a top priority for the legislature for nearly a decade, citing the “harm” the practice causes.

“While we have not been successful in the legislature, it’s not for lack of effort from our heroines and heroes,” Schuster said.

Chris Hartman, executive director of the Fairness Campaign, said Beshear would “save countless Kentucky kids’ lives” with the move.

“Today, we all join Governor Beshear to send a crystal clear message to all of Kentucky’s queer kids and their families,” Hartman said. “You are perfect as you are.”

Eric Russ, the executive director of the Kentucky Psychological Association, called conversion therapy a discredited practice that “has no place in the mental health care of LGBTQ youth.”?

“We know that survivors of conversion therapy not only do not change their sexual orientation, but have worse mental health outcomes, including self blame, guilt, shame, anxiety, depression,” Russ said. “We know the best thing we can do as mental health providers is to affirm the identity of the kids in our care. When a kid walks into a licensed mental health professional’s office with their family, we have an ethical obligation to provide them care that is supportive, evidence based and affirming to their sexual orientation identity.”?

Johnson City Medical Center, a flagship hospital for Ballad Health, has received a rating of one star out of five from the Centers for Medicare & Medicaid Services. (Brett Kelman/KFF Health News)

Ballad Health, an Appalachian company with the nation’s largest state-sanctioned hospital monopoly, may soon be required to improve its quality of care or face the possibility of being broken up.

Government documents obtained by KFF Health News reveal that Tennessee officials, in closed-door negotiations, are attempting to hold the monopoly more accountable after years of complaints and protests from patients and their families.

Ballad, a 20-hospital system in northeastern Tennessee and southwestern Virginia, was created six years ago through monopoly agreements negotiated with both states. Since then, Ballad has consistently fallen short of the quality-of-care goals, according to annual reports released by the Tennessee Department of Health.

Despite these failures, Tennessee has given “A” grades and annual stamps of approval to Ballad that allow the monopoly to continue. This has occurred, at least in part, because Ballad is graded against a scoring rubric that largely ignores how its hospitals actually perform.

Now that may change. In an ongoing renegotiation of Tennessee’s monopoly agreement, the state health department has pushed for an eightfold increase in the importance of hospital performance, making it “the most heavily weighted” issue on which Ballad would be judged, according to state documents obtained through a public records request. The negotiations appear to be the state’s most substantial response to residents who sound alarms about Ballad hospitals.

After years of complaints from patients and their families, Ballad Health, the state-sanctioned hospital monopoly providing care for patients in a 29-county region of Tennessee, Kentucky, Virginia and North Carolina, may soon be required to improve care or be broken up.

Dani Cook, a community organizer who has led efforts against Ballad for years, including an eight-month protest outside a Ballad hospital in 2019, said a renegotiated monopoly agreement could be a first step toward progress that locals have long sought, but only if it is enforced by the state.

Cook also questioned why Tennessee took years to prioritize something as fundamental as good care.

“That’s what baffles me about this entire relationship: Ballad seems to never be held to account,” Cook said. “And that’s why, when I look at this, I say, ‘Oh that sounds great.’ But let’s see what happens.”

Ballad Health was created in 2018 after Tennessee and Virginia officials waived federal anti-monopoly laws and approved the nation’s biggest hospital merger based on what’s called a Certificate of Public Advantage, or COPA, agreement. Despite the warnings of the Federal Trade Commission, the region’s rival hospital systems became a single system without competition. Ballad is now the only option for hospital care for most of about 1.1 million people in a 29-county region at the nexus of Tennessee, Virginia, Kentucky, and North Carolina.

In an effort to offset the perils of the monopoly, Ballad was required to enter agreements with the states that set expectations for the company and limited its ability to raise prices or close hospitals. Each year, Tennessee grades Ballad against this agreement on a 100-point scale. If the company performs poorly, Tennessee could in theory revoke the COPA, and then enforce a plan to split Ballad into separate companies, according to the monopoly agreement.

The new negotiation documents offer a snapshot of how Tennessee hopes to reshape this agreement, detailing more than a dozen changes the health department proposed in February and a counterproposal from Ballad in May. It is unclear if or how these proposals may have changed in the subsequent months.

Tennessee Department of Health spokesperson Dean Flener said the agency would not comment on Ballad or the ongoing negotiations.

In a written statement, Ballad did not comment directly on the negotiations but said the company “enthusiastically agrees that the most important thing to our patients is the quality of care they receive.” The company said in 2023 that its hospital quality slipped due to the pressure of the coronavirus pandemic and that it was in the process of rebounding.

“We strongly support a shared focus on quality of care as it relates to the COPA,” Molly Luton, a Ballad spokesperson, said in the statement.

Historically, quality of care has been just a small part of how Ballad is held accountable. Twenty percent of Ballad’s annual COPA score comes from measurements of hospital quality, but the company gets full credit on three-fourths of those measurements if it reports any value — even a terrible one. Only 5% of the annual score is determined by real-world hospital performance.

If quality was weighted more, Ballad would have scored much worse in past years. Annual reports released by the Tennessee Department of Health over the last two years show that Ballad failed to meet more than 74% of the state’s quality-of-care benchmarks, including some about mortality rates, readmission rates, emergency room speed, surgery-related infections, and patient satisfaction.

Under Tennessee’s proposed changes, all these metrics would matter much more. But Tennessee would also lower the overall standards for Ballad’s monopoly and ease a charity care obligation that Ballad has repeatedly not met, according to the negotiation documents. Ballad has said it hasn’t met the charity care obligation because changes to Medicaid programs have left fewer patients uninsured and in need of charity.

The documents show that:

• Tennessee has proposed increasing the share of Ballad’s annual score that is attributable to real-world quality of care from 5% to 40% and no longer giving Ballad any points for merely reporting quality statistics. In a counteroffer, Ballad proposed raising this percentage to 34%, with some points still awarded to the company just for reporting.
• Tennessee proposed lowering the minimum overall score that Ballad needs to obtain each year for its monopoly to be considered a “clear and convincing public advantage.” If Ballad falls below this threshold, the COPA agreement could be modified or “terminated.” Tennessee wants to lower the threshold from 85 out of 100 to 75. In its counteroffer, Ballad proposed 70.
• Tennessee would reduce or weaken a requirement for Ballad charity care spending that is largely moot. Ballad has been required to provide more than $100 million in free or discounted charity care to low-income patients each year under the current monopoly agreement, but it has failed to do so five years in a row, falling short by about $194 million in total. Tennessee has waived the requirement each year.

Cook, who described the new documents as a rare glimpse into closed-door dealings that Ballad patients never get to see, said it was striking to witness the company push for lower standards.

“Why would they be pushing back on improving the quality of care that people receive?” Cook said. “If they are really among the nation’s best — because that’s what they tell the entire region — why do you need the standards lowered?”

?KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Amber Nicole Thurman and her son in a selfie she posted online in 2020, two years before her death. (Photo via Facebook)

In her final hours, Amber Nicole Thurman suffered from a grave infection that her suburban Atlanta hospital was well-equipped to treat.

She’d taken abortion pills and encountered a rare complication; she had not expelled all of the fetal tissue from her body. She showed up at Piedmont Henry Hospital in need of a routine procedure to clear it from her uterus, called a dilation and curettage, or D&C.

But just that summer, her state had made performing the procedure a felony, with few exceptions. Any doctor who violated the new Georgia law could be prosecuted and face up to a decade in prison.

Thurman waited in pain in a hospital bed, worried about what would happen to her 6-year-old son, as doctors monitored her infection spreading, her blood pressure sinking and her organs beginning to fail.

It took 20 hours for doctors to finally operate. By then, it was too late.

The otherwise healthy 28-year-old medical assistant, who had her sights set on nursing school, should not have died, an official state committee recently concluded.

Tasked with examining pregnancy-related deaths to improve maternal health, the experts, including 10 doctors, deemed hers “preventable” and said the hospital’s delay in performing the critical procedure had a “large” impact on her fatal outcome.

Their reviews of individual patient cases are not made public. But ProPublica obtained reports that confirm that at least two women have already died after they couldn’t access legal abortions and timely medical care in their state.

There are almost certainly others.

Committees like the one in Georgia, set up in each state, often operate with a two-year lag behind the cases they examine, meaning that experts are only now beginning to delve into deaths that took place after the Supreme Court overturned the federal right to abortion.

Thurman’s case marks the first time an abortion-related death, officially deemed “preventable,” is coming to public light. ProPublica will share the story of the second in the coming days. We are also exploring other deaths that have not yet been reviewed but appear to be connected to abortion bans.

‘Bleed a little bit more’

Doctors warned state legislators women would die if medical procedures sometimes needed to save lives became illegal.

Though Republican lawmakers who voted for state bans on abortion say the laws have exceptions to protect the “life of the mother,” medical experts cautioned that the language is not rooted in science and ignores the fast-moving realities of medicine.

The most restrictive state laws, experts predicted, would pit doctors’ fears of prosecution against their patients’ health needs, requiring providers to make sure their patient was inarguably on the brink of death or facing “irreversible” harm when they intervened with procedures like a D&C.

“They would feel the need to wait for a higher blood pressure, wait for a higher fever — really got to justify this one — bleed a little bit more,” Dr. Melissa Kottke, an OB-GYN at Emory, warned lawmakers in 2019 during one of the hearings over Georgia’s ban.

Doctors and a nurse involved in Thurman’s care declined to explain their thinking and did not respond to questions from ProPublica. Communications staff from the hospital did not respond to multiple requests for comment. Georgia’s Department of Public Health, which oversees the state maternal mortality review committee, said it cannot comment on ProPublica’s reporting because the committee’s cases are confidential and protected by federal law.

The availability of D&Cs for both abortions and routine miscarriage care helped save lives after the 1973 Supreme Court ruling in Roe v. Wade, studies show, reducing the rate of maternal deaths for women of color by up to 40% the first year after abortion became legal.

But since abortion was banned or restricted in 22 states over the past two years, women in serious danger have been turned away from emergency rooms and told that they needed to be in more peril before doctors could help. Some have been forced to continue high-risk pregnancies that threatened their lives. Those whose pregnancies weren’t even viable have been told they could return when they were “crashing.”

Such stories have been at the center of the upcoming presidential election, during which the right to abortion is on the ballot in 10 states.

But Republican legislators have rejected small efforts to expand and clarify health exceptions — even in Georgia, which has one of the nation’s highest rates of maternal mortality and where Black women are three times more likely to die from pregnancy-related complications than white women.

When its law went into effect in July 2022, Gov. Brian Kemp said he was “overjoyed” and believed the state had found an approach that would keep women “safe, healthy and informed.”

After advocates tried to block the ban in court, arguing the law put women in danger, attorneys for the state of Georgia accused them of “hyperbolic fear mongering.”

Two weeks later, Thurman was dead.

Thurman, who carried the full load of a single parent, loved being a mother. Every chance she got, she took her son to petting zoos, to pop-up museums and on planned trips, like one to a Florida beach. “The talks I have with my son are everything,” she posted on social media.

But when she learned she was pregnant with twins in the summer of 2022, she quickly decided she needed to preserve her newfound stability, her best friend, Ricaria Baker, told ProPublica. Thurman and her son had recently moved out of her family’s home and into a gated apartment complex with a pool, and she was planning to enroll in nursing school.

Pregnancy was just past six weeks

The timing could not have been worse. On July 20, the day Georgia’s law banning abortion at six weeks went into effect, her pregnancy had just passed that mark, according to records her family shared with ProPublica.

Thurman wanted a surgical abortion close to home and held out hope as advocates tried to get the ban paused in court, Baker said. But as her pregnancy progressed to its ninth week, she couldn’t wait any longer. She scheduled a D&C in North Carolina, where abortion at that stage was still legal, and on Aug. 13 woke up at 4 a.m. to make the journey with her best friend.

On their drive, they hit standstill traffic, Baker said. The clinic couldn’t hold Thurman’s spot longer than 15 minutes — it was inundated with women from other states where bans had taken effect. Instead, a clinic employee offered Thurman a two-pill abortion regimen approved by the U.S. Food and Drug Administration, mifepristone and misoprostol. Her pregnancy was well within the standard of care for that treatment.

Getting to the clinic had required scheduling a day off from work, finding a babysitter, making up an excuse to borrow a relative’s car and walking through a crowd of anti-abortion protesters. Thurman didn’t want to reschedule, Baker said.

At the clinic, Thurman sat through a counseling session in which she was told how to safely take the pills and instructed to go to the emergency room if complications developed. She signed a release saying she understood. She took the first pill there and insisted on driving home before any symptoms started, Baker said. She took the second pill the next day, as directed.

Deaths due to complications from abortion pills are extremely rare. Out of nearly 6 million women who’ve taken mifepristone in the U.S. since 2000, 32 deaths were reported to the FDA through 2022, regardless of whether the drug played a role. Of those, 11 patients developed sepsis. Most of the remaining cases involved intentional and accidental drug overdoses, suicide, homicide and ruptured ectopic pregnancies.

Baker and Thurman spoke every day that week. At first, there was only cramping, which Thurman expected. But days after she took the second pill, the pain increased and blood was soaking through more than one pad per hour. If she had lived nearby, the clinic in North Carolina would have performed a D&C for free as soon as she followed up, the executive director told ProPublica. But Thurman was four hours away.

On the evening of Aug. 18, Thurman vomited blood and passed out at home, according to 911 call logs. Her boyfriend called for an ambulance. Thurman arrived at Piedmont Henry Hospital in Stockbridge at 6:51 p.m.

ProPublica obtained the summary narrative of Thurman’s hospital stay provided to the maternal mortality review committee, as well as the group’s findings. The narrative is based on Thurman’s medical records, with identifying information removed. The committee does not interview doctors involved with the case or ask hospitals to respond to its findings. ProPublica also consulted with medical experts, including members of the committee, about the timeline of events.

Within Thurman’s first hours at the hospital, which says it is staffed at all hours with an OB who specializes in hospital care, it should have been clear that she was in danger, medical experts told ProPublica.

Her lower abdomen was tender, according to the summary. Her white blood cell count was critically high and her blood pressure perilously low — at one point, as Thurman got up to go to the bathroom, she fainted again and hit her head. Doctors noted a foul odor during a pelvic exam, and an ultrasound showed possible tissue in her uterus.

‘Acute severe sepsis’

The standard treatment of sepsis is to start antibiotics and immediately seek and remove the source of the infection. For a septic abortion, that would include removing any remaining tissue from the uterus. One of the hospital network’s own practices describes a D&C as a “fairly common, minor surgical procedure” to be used after a miscarriage to remove fetal tissue.

After assessing her at 9:38 p.m., doctors started Thurman on antibiotics and an IV drip, the summary said. The OB-GYN noted the possibility of doing a D&C the next day.

But that didn’t happen the following morning, even when an OB diagnosed “acute severe sepsis.” By 5:14 a.m., Thurman was breathing rapidly and at risk of bleeding out, according to her vital signs. Even five liters of IV fluid had not moved her blood pressure out of the danger zone. Doctors escalated the antibiotics.

Instead of performing the newly criminalized procedure, they continued to gather information and dispense medicine, the summary shows.

Doctors had Thurman tested for sexually transmitted diseases and pneumonia.

They placed her on Levophed, a powerful blood pressure support that could do nothing to treat the infection and posed a new threat: The medication can constrict blood flow so much that patients could need an amputation once stabilized.

At 6:45 a.m., Thurman’s blood pressure continued to dip, and she was taken to the intensive care unit.

At 7:14 a.m., doctors discussed initiating a D&C. But it still didn’t happen. Two hours later, lab work indicated her organs were failing, according to experts who read her vital signs.

At 12:05 p.m., more than 17 hours after Thurman had arrived, a doctor who specializes in intensive care notified the OB-GYN that her condition was deteriorating.

Thurman was finally taken to an operating room at 2 p.m.

By then, the situation was so dire that doctors started with open abdominal surgery. They found that her bowel needed to be removed, but it was too risky to operate because not enough blood was flowing to the area — a possible complication from the blood pressure medication, an expert explained to ProPublica. The OB performed the D&C but immediately continued with a hysterectomy.

‘Promise me you’ll take care of my son’

During surgery, Thurman’s heart stopped.

Her mother was praying in the waiting room when one of the doctors approached. “Come walk with me,” she said.

Until she got the call from the hospital, her mother had no idea Thurman had been pregnant. She recalled her daughter’s last words before she was wheeled into surgery — they had made no sense coming from a vibrant young woman who seemed to have her whole life ahead of her:

“Promise me you’ll take care of my son.”

There is a “good chance” providing a D&C earlier could have prevented Amber Thurman’s death, the maternal mortality review committee concluded.

Every state has a committee of experts who meet regularly to examine deaths that occurred during or within a year after a pregnancy. Their goal is to collect accurate data and identify the root causes of America’s increasing maternal mortality rate, then translate those lessons into policy changes. Their findings and recommendations are sent to the Centers for Disease Control and Prevention, and their states publish an annual report, but their reviews of individual cases are never public.

Georgia’s committee has 32 regular members from a variety of backgrounds, including OB-GYNs, cardiologists, mental health care providers, a medical examiner, health policy experts, community advocates and others. This summer, the committee reviewed deaths through Fall 2022, but most states have not gotten that far.

After reviewing Thurman’s case, the committee highlighted Piedmont’s “lack of policies/procedures in place to evacuate uterus immediately” and recommended all hospitals implement policies “to treat a septic abortion on an ongoing basis.”

It is not clear from the records available why doctors waited to provide a D&C to Thurman, though the summary report shows they discussed the procedure at least twice in the hours before they finally did.

Piedmont did not have a policy to guide doctors on how to interpret the state abortion ban when Thurman arrived for care, according to two people with knowledge of internal conversations who were not authorized to speak publicly. In the months after she died, an internal task force of providers there created policies to educate staff on how to navigate the law, though they are not able to give legal advice, the sources said.

In interviews with more than three dozen OB-GYNs in states that outlawed abortion, ProPublica learned how difficult it is to interpret the vague and conflicting language in bans’ medical exceptions — especially, the doctors said, when their judgment could be called into question under the threat of prison time.

Take the language in Georgia’s supposed lifesaving exceptions.

It prohibits doctors from using any instrument “with the purpose of terminating a pregnancy.” While removing fetal tissue is not terminating a pregnancy, medically speaking, the law only specifies it’s not considered an abortion to remove “a dead unborn child” that resulted from a “spontaneous abortion” defined as “naturally occurring” from a miscarriage or a stillbirth.

Thurman had told doctors her miscarriage was not spontaneous — it was the result of taking pills to terminate her pregnancy.

There is also an exception, included in most bans, to allow abortions “necessary in order to prevent the death of the pregnant woman or the substantial and irreversible physical impairment of a major bodily function.” There is no standard protocol for how providers should interpret such language, doctors said. How can they be sure a jury with no medical experience would agree that intervening was “necessary”?

ProPublica asked the governor’s office on Friday to respond to cases of denied care, including the two abortion-related deaths, and whether its exceptions were adequate. Spokesperson Garrison Douglas said they were clear and gave doctors the power to act in medical emergencies. He returned to the state’s previous argument, describing ProPublica’s reporting as a “fear-mongering campaign.”

Republican officials across the country have largely rejected calls to provide guidance.

When legislators have tried, anti-abortion groups have blocked them.

Possibility of prosecution looms over physicians

In 2023, a group of Tennessee Republicans was unable to push through a small change to the state’s abortion ban, intended to give doctors greater leeway when intervening for patients facing health complications.

“No one wants to tell their spouse, child or loved one that their life is not important in a medical emergency as you watch them die when they could have been saved,” said Republican Rep. Esther Helton-Haynes, a nurse who sponsored the bill.

The state’s main anti-abortion lobbyist, Will Brewer, vigorously opposed the change. Some pregnancy complications “work themselves out,” he told a panel of lawmakers. Doctors should be required to “pause and wait this out and see how it goes.”

At some hospitals, doctors are doing just that. Doctors told ProPublica they have seen colleagues disregard the standard of care when their patients are at risk of infection and wait to see if a miscarriage completes naturally before offering a D&C.

Although no doctor has been prosecuted for violating abortion bans, the possibility looms over every case, they said, particularly outside of well-funded academic institutions that have lawyers promising criminal defense.

Doctors in public hospitals and those outside of major metro areas told ProPublica that they are often left scrambling to figure out on a case-by-case basis when they are allowed to provide D&Cs and other abortion procedures. Many fear they are taking on all of the risk alone and would not be backed up by their hospitals if a prosecutor charged them with a crime. At Catholic hospitals, they typically have to transfer patients elsewhere for care.

When they do try to provide care, it can be a challenge to find other medical staff to participate. A D&C requires an anesthesiologist, nurses, attending physicians and others. Doctors said peers have refused to participate because of their personal views or their fear of being exposed to criminal charges. Georgia law allows medical staff to refuse to participate in abortions.

Thurman’s family members may never learn the exact variables that went into doctors’ calculations. The hospital has not fulfilled their request for her full medical record. There was no autopsy.

For years, all Thurman’s family had was a death certificate that said she died of “septic shock” and “retained products of conception” — a rare description that had previously only appeared once in Georgia death records over the last 15 years, ProPublica found. The family learned Thurman’s case had been reviewed and deemed preventable from ProPublica’s reporting.

The sting of Thurman’s death remains extremely raw to her loved ones, who feel her absence most deeply as they watch her son grow taller and lose teeth and start school years without her.

They focus on surrounding him with love but know nothing can replace his mother.

On Monday, she would have turned 31.

New Hampshire collected PFAS-laden firefighting foam during a take-back program for fire departments in August. Disposal is through a technology called the PFAS Annihilator that breaks down the powerful chemical bonds. (New Hampshire Bulletin/Courtesy of Revive Environmental)

Over a lifetime, Kentuckians are repeatedly exposed to environmental pollutants known as “forever chemicals” — and a new study links such exposure to colorectal (colon) cancer.?

Specifically, researchers at the University of Kentucky looked at long-term exposure to PFOS (perfluorooctane sulfonic acid) in mice and confirmed their findings in human cells. Results showed that exposure — commonly in food and water — can chip away at an enzyme in the intestines (HMGCS2) that can help protect against cancer.

Research has established that PFOS can increase risk of other types of cancer, including breast and liver, but this is the first to study the effects of the chemicals on this enzyme.?

One of the researchers, Yekaterina Zaytseva, said it’s “not so easy” to mitigate these pollutants in the environment.?

So, she turned her attention to its effects on the human body, and how to intercept them.??

“We try to understand how these pollutants affect human health and … how we can mitigate the effect of these pollutants,” she said.?

Scientists wanted to learn, she said, “if people live in (an) area with high exposure to these chemicals, how we can help … to prevent the harmful effects of these chemicals, or if they (are) already exposed, how we can mitigate … how they can get rid of these pollutants in their body.”?

PFOS falls under the umbrella of? per- and polyfluoroalkyl substances (PFAS), which are manmade and don’t break down in the environment easily because they have a molecular bond — carbon and fluorine — that’s among the strongest. Thus they have earned the nickname “forever chemicals.”?

Their commonplace applications make exposure more complicated. The National Institute of Environmental Health Sciences explains that PFAS “are used to keep food from sticking to packaging or cookware, make clothes and carpets resistant to stains and create firefighting foam that is more effective.”?

PFOS are among the five “forever chemicals” included in a drinking-water regulation issued by the Biden administration in April. Utilities will be required to reduce PFAS in drinking water to the lowest level that can be reliably measured.

‘Forever chemicals:’ Now that feds have acted, some say Kentucky should do more

In Kentucky, state testing revealed 83 of 194 water treatment plants had at least one PFAS, as did 36 of 40 monitoring station testing surfaces, the Lantern has reported. In 2022, nearly 900 Kentuckians died with colorectal cancer, according to the Centers for Disease Control and Prevention.?

Damage over time?

People who have colorectal cancer or inflammatory bowel disease tend to not have the HMGCS2 enzyme, Zaytseva said, “suggesting that it’s actually … kind of protective against cancer.”?

During exposure to PFOS, she said, “this enzyme is also lost.”??

But this breakdown happens over time, and a person wouldn’t necessarily notice it happening based on side effects in the body.?

“If you have, for example, chronic exposure to PFAS, you don’t see … this enzyme shut down right away,” said Zaytseva. “You wouldn’t notice this. We try right now … to look at this as a potential biomarker of PFOS exposure.”?

The study, led by Josiane Tessmann, a post-doctoral scholar working in Zaytseva’s lab, was published in the journal Chemosphere.

In 2023, the General Assembly passed a law that now requires health plans in Kentucky to cover biomarker testing. The law, sponsored by Rep. Kimberly Poore Moser, R-Taylor Mill, is aimed at lowering cancer mortality in the state.?

Biomarker testing “is a way to look for genes, proteins, and other substances (called biomarkers or tumor markers) that can provide information about cancer,” according to the National Cancer Institute.?

How to protect yourself

Future research will look at specific diets that can help.?

For now, she said, high fiber diets appear to “partially mitigate the harmful effect of these pollutants on liver and also microbiota.” It cannot, however, fully stop the loss of the enzyme.?

There are also several water filters that can help reduce PFAS in drinking water, as well as non-PFAS cooking pans.?

“You just need to be kind of aware of this. But it’s no need to panic,” Zaytseva said. “Just … carefully look (at) what you buy and what you consume.”??

Addiction Recovery Care, Kentucky's largest provider of drug and alcohol treatment, has offices and other facilities in Louisa, photographed June 27, 2024. (Kentucky Lantern photo by Matthew Mueller)

Kentucky’s largest provider of drug and alcohol treatment is cutting staff and restructuring some services, citing significant cuts in Medicaid reimbursement from the government health plan that covers almost all of its clients.

Addiction Recovery Care, or ARC, based in Louisa, said in a statement Thursday that, as a result of cuts in payment for addiction and mental health services, “we have had to make difficult decisions impacting some of our staff members.”

The staff cuts come after a dispute with the private insurance companies that process and pay most of Kentucky’s Medicaid claims.

ARC declined to say how many of its 1,350 employees would be affected but said “we are doing everything we can to support the affected individuals during this transition.” It provided no further details.

“Out of respect for our employees we do not discuss personnel matters,” the company said.

ARC also is reorganizing some of its operations in Louisa, the small Eastern Kentucky town where the for-profit company is based and the home of its founder and CEO, Tim Robinson.

Robinson, a lawyer and recovered alcoholic who started the company that became ARC in 2010, has emerged as a politically well-connected figure and major political donor.

A Lantern analysis by Tom Loftus showed that Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew from a single halfway house to about 1,800 residential beds and outpatient care for hundreds more clients.?

Except for money given to political committees supporting Gov. Andy Beshear, a Democrat, virtually all of the rest went to Republicans like former Gov. Matt Bevin, Attorney General Russell Coleman, U.S. Rep. Hal Rogers and candidates for the Kentucky legislature.

Beshear has praised ARC for its role in helping the state deal with the wave of addiction that engulfed Kentucky in recent decades.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said, speaking at a ribbon-cutting in March for a new ARC facility in Greenup County at the former Our Lady of Bellefonte Hospital in Ashland.

A spokesman for the state Cabinet for Health and Family Services, which administers Medicaid, said that the Beshear administration supports Medicaid services for those in need of addiction or mental health treatment and is seeking ways to expand them.

As for the rate dispute between ARC and the managed care companies, those companies “are contractually obligated to ensure members have access to appropriate medical care,” the spokesman said in a statement, adding: “We have no comment on the operational structure of Addiction Recovery Care (ARC) but these provider types are an essential resource to help individuals break the cycle of addiction.”

Robinson, a lifelong Republican, has praised Beshear as a skilled political leader saying, “I hope he runs for president.”

Enter the FBI

The cuts are the latest setback for the fast-growing company that last year took in $130 million in state Medicaid funds and has expanded from a single halfway house to a statewide network of recovery programs and residential centers in 24 counties across Kentucky.

In July, the FBI announced it was investigating ARC for possible health care fraud and asking anyone with information to contact the federal agency.

An FBI spokeswoman in a statement Tuesday said it has no new information to share about the status of the investigation but said the agency is still accepting information through an online site on its website.

ARC has said it is cooperating.

“We are confident in our program and in the services we offer,” the statement said. “We, and our legal counsel, are cooperating fully in the investigation.”

A few days before news of the FBI investigation became public, Coleman, the attorney general and law school classmate of Robinson at the University of Kentucky, said he was recusing himself from any investigation of ARC, according to Louisville Public Media. It reported Coleman’s top deputy, Rob Duncan, a childhood friend of Robinson who previously has done legal work for ARC, also was recusing himself.

Recovery CEO gives big to support Democrat Beshear and a host of Republicans

Coleman’s office investigates Medicaid fraud.?

Robinson, his corporations and employees gave at least $37,700 to Coleman political committees since late 2022.

‘Significant strides’ threatened

News of the FBI investigation became public just a few days after ARC executives appeared before a Kentucky legislative committee to protest cuts in reimbursement from some of the six national health insurance companies known as managed care organizations, or MCOs, that oversee most of the state’s $1.6 billion a year Medicaid program.

ARC, in a statement, stressed that cuts in reimbursement are driving the staff reductions and facility reorganizations.

“These difficult decisions are a direct result of impending and significant reimbursement cuts for many addiction and mental health service providers in Kentucky,” it said.

The MCOs contract with the state to manage care and provide payments for health services for most of the state’s around 1.5 million residents insured through Medicaid, which gets most of its money from the federal government.

In turn, the MCOs are paid a fixed rate per Medicaid member for overseeing that care.

People with knowledge of the situation have told the Lantern insurers had become concerned about aggressive billing practices and rising costs associated with some addiction treatment companies including ARC.

At the July hearing, ARC officials told lawmakers they and a handful of other providers in Kentucky had been notified they faced cuts of 15% to 20% in reimbursement from some of the MCOs.

Increased access to Medicaid funds and a growth in the treatment industry have helped Kentucky expand to the most treatment beds per resident in the country, an accomplishment touted by Beshear.

That progress could be threatened by the pending cuts, Matt Brown, ARC’s chief administrative office, told members of the interim joint Health Services Committee on July 30.

“Kentucky has made significant strides in access to treatment,” Brown said. “With these cuts it could completely set back addiction treatment in our state 20 years.”

This story has been updated with a response from the Beshear administration.

Measles is highly contagious. (Getty Images)

A Western Kentucky University student has a confirmed case of measles and may have exposed others, according to the Barren River Health District and the Kentucky Department for Public Health.

The student is unvaccinated against the highly contagious disease, the health departments said.?

The student, whose name, gender and other identifying information were not released, recently traveled internationally. This is where they “are presumed to have been exposed to measles.”?

Upon returning, and “while infectious with measles,” the student attended public events on Aug. 28, 29 and 30, the health department said.?

People who were at the following locations may have been exposed:?

• The Commons at Helm Library (WKU)
  • 1906 College Heights Blvd #11067 in Bowling Green?
  • Wednesday Aug. 28, 2024, (7:45 a.m. – 10? am and 8 p.m. – 10:30 p.m.)
  • Thursday Aug. 29, 2024, (7:45 a.m. – 10 a.m.)
  • Friday Aug. 30, 2024, (7:45 a.m. – 10 a.m.)
• WKU student union Starbucks
  • 1906 College Heights Blvd in Bowling Green
  • Wednesday Aug. 28, 2024, 6:30 p.m. – 9:30 p.m.
• Simply Ramen restaurant trivia night
  • 801 Campbell Lane in Bowling Green?
  • Thursday Aug.? 29, 2024, (7 p.m. – 11:00 p.m.)

Measles “spreads easily when an infected person breathes, coughs or sneezes,” according to the World Health Organization. It can cause serious complications and death, according to WHO, which reported most deaths from measles in 2022 were in unvaccinated children.?

Vaccination is the best defense against measles, WHO says.?

The Centers for Disease Control and Prevention recommends a first dose of MMR vaccine for children 12–15 months and a second dose between ages 4–6. Teens and adults should also stay up-to-date on this vaccine, the CDC says, which is generally available at pharmacies.?

Symptoms of measles are fever, cough, watery eyes, runny nose and rash.

If you have questions about exposure or your risk, call your healthcare provider or the Barren River District Health Department at 833-551-0953.

Renderings of the Community Care Campus under construction in Louisville's Smoketown neighborhood. (Volunteers of America)

LOUISVILLE — Construction has begun on Louisville’s Community Care Campus, a multi-building site in the Smoketown area aimed at providing housing, medical and other services to unhoused people in Kentucky’s largest city.?

The campus, funded in part by the General Assembly, is now slated to open in 2027, Louisville Mayor Craig Greenberg announced Tuesday. Demolition of several existing structures on the campus grounds will begin next week.?

Greenberg was joined on the future grounds by Jennifer Hancock, the president and CEO of Volunteers of America, which is planning and will operate the campus.?

“Every day, we see how homelessness has increased on our city streets, and the need for more housing services has become even more urgent,” Hancock said. “My colleagues and I are ready and eager to address this challenge — and opportunity — for our city head on.”?

House Republican Floor Leader Steven Rudy, R-Paducah, and Senate Democratic Floor Leader Gerald Neal, D-Louisville, also spoke.?

How is the campus funded??

The $58 million campus will include shelter for unhoused families, a health clinic, transitional housing for young adults, food services and an office for Louisville Metro Police.?

The campus will also include a playground, activity courtyard and family lawn, according to 2024 floor plans.?

Of the $58 million price projection, $23 million was appropriated by the General Assembly and Louisville Metro Government. Another $19 million came from low income housing tax credits. VOA raised an additional $1 million, and says it will announce a major investment next week, which will go toward the remaining $16 million needed to finish the project.?

During the 2024 legislative session, lawmakers approved a two-year budget, which included $100 million for projects in Louisville, including the Community Care Campus.

Hancock said the police office on the campus is “not built on a premise of enforcement.”?

“If that has to happen, of course, we need them to do their jobs,” she said. “But there is so much upside to having them be part of the community that we are going to create.”?

Greenberg said having a police presence in the campus will be a chance for police to “develop stronger relationships with nonprofit partners” and “build relationships with individuals themselves to show that we are policing in a new way in this city.”?

In August, the Department of Justice said Louisvillians needed better access to community based services to end a cycle of over-policing as a solution to mental health crises.?

Senate President Robert Stivers, R-Manchester, said the Community Care Campus is “a response to the DOJ report, but it is not in response to the DOJ report.”?

What the data shows?

A report from The Coalition for the Homeless showed that between 2018 and 2021, homelessness in Louisville increased 41%, from 7,572 to 10,640. The number of people who sought non-shelter services also increased from 75 to 3,724.?

Of those in need, Hancock said Tuesday, “the greatest problem today is the number of families who are unhoused.” So, while the Community Care Campus will help individuals, she said, it will prioritize families.?

The campus will have an economic benefit to the city, Greenberg and others said.?

In 2023, Greenberg said, 15% of fire department runs “involved encampments or interactions with people experiencing homelessness.” That includes medical responses and runs to fires in homeless shelters, encampments, vacant house fires and fires started by squatters, a VOA spokesperson said.?

Also in 2023, the city spent $400,000 on removal of solid waste — both garbage and human waste — left at encampments. That’s down from $600,000 in 2022, according to VOA data.?

Stivers praised Greenberg’s efforts to make sure Louisville has “a great downtown for the purpose of being functional and aesthetically really good looking.”?

“But it’s not going to be someplace that people want to come to if there’s a large homeless population in and around the area that don’t feel safe,” Stivers said. “I can talk about all the economics, I can talk about all the tourism, but let’s talk about basic humanity. We need to take care of those who most need help.”?

While VOA works on the campus, it will also open a temporary shelter for families and children during the upcoming winter months, Hancock said.?

Rep. Rachel Roarx, D-Louisville, said the campus is “a great step in addressing one of our most important issues” in her county.?

“It’s not only about housing,” she said. “It’s about providing critical services in one place that truly wraps around an entire individual, young person, family and sets them on a path to stable housing in the future.”??

Kentucky Attorney General Russell Coleman, addressing the Opioid Abatement Advisory Commission, proposes putting $3.6 million from settlement funds into youth prevention, Sept. 10, 2024. (Photo courtesy Office of the Attorney General)

Kentucky’s Opioid Abatement Advisory Commission voted in favor of spending $3.6 million over the next two years on a three-part addiction prevention campaign geared toward youth proposed by Attorney General Russell Coleman Tuesday.?

The funds that the commission is in charge of distributing, which come from legal settlements with drug companies, “represent the shared pain of families across this commonwealth,” Coleman said Tuesday.?

He asked the commission for permission to spend a slice of this “blood money” to reach young people across Kentucky between the ages of 13 and 26. No members voted against his request, and no one abstained. The money will be split into $1.8 million each year.

Coleman’s campaign, modeled after a Florida initiative, has three parts. The first is an ad campaign called Better Without It, to be featured on social media, on college campuses and more. Coleman pointed to the well-known “Click it or ticket” campaign as an example that “these types of education campaigns can work.”?

The ads, which will also be pushed by influencers, will be tailored to Kentucky, using photographers and creators who Coleman said can make the material “look and sound and feel and smell like the commonwealth.”?

The second arm of the campaign is to “weave together” Kentucky’s “patchwork” of school-based prevention programs so kids have access to more cohesive resources. Lastly, Coleman said, the campaign will “elevate and draw attention to the ongoing work of this commission.”?

Overdose deaths in Kentucky decreased in 2023 for the second year in a row, according to this year’s Drug Overdose Fatality Report. In 2022, 2,135 Kentuckians died from an overdose, marking the first decline since 2018. Ninety percent of those deaths were from opioids and fentanyl.?

In 2023, the number of fatal overdoses was down to 1,984. Fentanyl, a powerful synthetic opioid, accounted for 1,570 of those — about 79% of the 2023 deaths. The 35-44 age group was most at risk, the report shows. Methamphetamine accounted for 55% of 2023’s overdose deaths.?

From 2021 to 2023, around 460 Kentuckians under the age of 34 died from overdoses, according to that report.?

“We know young people are more likely to be influenced by their peers than (by) someone who looks like me,” Coleman said. “Honest and productive conversations about the dangers of substance abuse among students can be a force multiplier.”?

People in their teens and early 20s and those with a family history of addiction are most at risk for opioid use disorder, according to the Mayo Clinic.?

“I’m asking you to zealously collaborate with us so that we can reach young people where they are to prevent them from taking their first — and in this environment, too oftentimes their last — experimentation … with this poison,” Coleman told commission members.?

Coleman said “as little as one fentanyl pill can — and is — killing our neighbors. … We live at a time where there is no margin of error. It simply does not exist. There’s no such thing as safe, no such concept or notion of safe experimentation with narcotics.”

The commission was created by the state legislature in 2021 and has nine voting and two non-voting members.?

Kentucky receives installments toward $900 million in settlements with opioid manufacturers and distributors. So far, it has awarded 110 grants worth more than $55 million toward treatment, prevention and recovery efforts.??

The commission next meets on Oct. 8.?

Doctors are dealing with 'moral distress' as they try to determine care for pregnant patients in states with abortion ban, particularly those facing medical emergencies, according to the Care Post Roe study led by Dr. Daniel Grossman at the University of California San Francisco. (Kieferpix/Getty Images)

In the two years since the U.S. Supreme Court started allowing states — what has become almost half of the country — to ban all or most abortions, doctors continue to report that these laws have detrimentally changed their jobs and the quality of care they can provide pregnant patients.

A research team led by Dr. Daniel Grossman at the University of California San Francisco has been studying the impacts on medical care of the Dobbs v. Jackson Women’s Health Organization decision that overturned the federal right to abortion under Roe v. Wade. On Monday they released their latest Care Post Roe findings. Having grown from 50 to 86 submissions since the preliminary findings were released in May 2023, the survey details medical situations gone wrong because of legal concerns over a state’s abortion ban.

When Grossman — a clinical and public health researcher who specializes in abortion and contraception — talked to States Newsroom last year about the early findings, he emphasized the patient fear palpable in the narratives of their doctors. They told stories about women traveling outside their ban states just to check if they could be pregnant, or during a medical emergency. But as more submissions continue to flow in, Grossman recently said he’s struck by the distress coming from the medical community.

“One thing that was notable in some of these more recent submissions,” Grossman told States Newsroom, “is how moral distress is being incorporated into medical education, like medical students and residents are essentially now learning about the moral distress as part of their medical education, as they’re learning about the care that they can’t provide.”

The Care Post Roe study details 86 submissions received between September 2022 and August 2024 from health professionals recounting cases involving patients from 19 states that, during the study’s time frame, fully or partly banned abortion. Participants described cases that “deviated from the usual standard” of care because of a state abortion ban, some that resulted in preventable complications like severe infections or the placenta growing too deep into the patient’s uterine wall. The participants were directed not to give details that could identify themselves or their patients.

Grossman said the study was designed this way to protect the identity of health providers and patients, many of whom currently fear prosecution for their medical decisions. Researchers also conducted optional in-depth interviews with more than 30 of the participants, but those findings were not included in Monday’s report.

The majority of submissions so far have come from Texas, Grossman said, the largest of the states and where abortion has been illegal the longest. According to the study, the narratives represent a range of different ages, income levels and racial and ethnic backgrounds, though a high proportion are Black and Latinx. Submissions were also reviewed by two physicians and were rejected if they did not contain information about a specific case or did not relate to a change in care since the Dobbs ruling.

Grossman said the study is limited in size and scope and doesn’t say how common these medical situations are or how they will trend over time. But he said the stories are consistent with ongoing news reports and lawsuits wherein doctors and patients describe denying and being denied care because of abortion bans. He said the study, which includes excerpts from health providers’ narratives, serves as a qualitative representation of the types of medical emergencies that doctors all over the country have been reporting.

The submissions were organized into several categories, including:

Second-trimester obstetric complications

The most common type of reported scenario involving second-trimester complications is the preterm prelabor rupture of membranes (PPROM). A doctor described treating a patient who had ruptured membranes at 16-18 weeks’ gestation but instead of being offered an abortion procedure or an induction termination, she had been sent home, where she had developed a severe infection.

“I meet her 2 days later in the ICU. She was admitted from the ER with severe sepsis…and bacteremia. Her fetus delivers; she is able to hold [the fetus]. We try every medical protocol we can find to help her placenta deliver; none are successful,” the physician writes. “The anesthesiologist cries on the phone when discussing the case with me — if the patient needs to be intubated, no one thinks she will make it out of the OR. I do a D&C.”

Ectopic pregnancies

Ectopic pregnancies occur when a fertilized egg implants outside the uterus. They are medical emergencies, but study participants reported cases of ectopic pregnancy requiring extra steps, such as consulting multiple physicians, as well as patients delaying care because they were too scared to be seen in their home states where abortion is banned.

“If [the patient] had seen [a] provider in [her home state] when bleeding started,” one doctor wrote, “she would have had the ectopic diagnosed about 6 weeks earlier, potentially eligible for [methotrexate] and therefore potentially avoided surgery, and even if [she] needed surgery [it] would have been at home with her family and support. Instead [she] had to… recover alone in a hotel room in a random state she had never been to before.”

Underlying medical conditions?

Some physicians described cases where patients had underlying medical conditions that complicated their pregnancies. In some cases, patients were delayed or denied treatment, worsening their conditions.

“She was mid-second trimester [16-18 weeks] when she presented. She has [more than 5] children at home and had severe postpartum cardiomyopathy when she gave birth a year ago, which has persisted,” a doctor wrote. “The risk of her dying from childbirth would have been extremely high — but she was unable to find anyone in her state willing to do the procedure.”

Miscarriage

Respondents also reported challenges with miscarriage management in states with abortion bans.

“The pharmacy refused to fill the medication until they had confirmation of its use but was unable to list what that confirmation needed to include,” one clinician wrote. “The back and forth delayed the care and ultimately the client could no longer face attempting to pick up the medication and decided to utilize expectant management [i.e. waiting for the tissue to pass naturally] due to the trauma of being refused her prescribed treatment.”

Fetal anomalies

Several submitted narratives involved patients whose pregnancies were complicated by fetal anomalies, many of which were described as being incompatible with neonatal life, though termination was not possible in their state.

“Due to the anencephaly, as soon as the umbilical cord was cut, the pink skin of the baby rapidly progressed to navy, only for the baby to be completely dark navy by the time they were wrapped in a blanket and handed to the mom,” a medical student physician wrote. “The patient was letting out a loud scream throughout the labor due to the sheer pain of giving birth, but the scream and wailing she let out once she saw the baby was soul-crushing.”

Denied other types of medical care?

One of the more shocking examples for Grossman involved a patient with a postpartum hemorrhage who needed a common procedure known as dilation and curettage, or D&C, which is used for abortions, miscarriages and sometimes to empty the uterus after the baby has been born. But according to the narrative submitted, a patient had been told by the labor and delivery staff that “D&Cs were now illegal for any reason.”

In another case, an abortion ban allegedly led to the cancellation of a patient’s liver transplant.

“Patient with… [an intrauterine device (IUD)] in place came in for liver transplant after there was a donor match found,” the physician wrote. “On routine pre-surgical testing she had a positive urine pregnancy test, and her bHCG quant was in the 1000s. Her transplant was cancelled because of her positive pregnancy test despite it being an undesired, very early pregnancy.”

Carceral system

Three submissions highlighted how patients in detention, awaiting trial, or on parole faced additional obstacles obtaining an abortion in states with bans.

“Asked for permission to leave her county (and state) to receive abortion care and was told NO,” a physician wrote. “Patient left the state for abortion care anyway. Given 24-hour waiting period in [state with legal abortion] and need for a 2-day procedure, was away for 3 days (2 separate trips). She also refused any sedation because she needed to be drug tested and couldn’t admit to leaving the state for a procedure.”

Researchers predict more poor-quality care if EMTALA ruled to exclude abortion care

“It is notable that the narratives reported here describing delayed and denied care have occurred with EMTALA still intact and hospitals required to provide emergency abortion care,” the study’s authors write, referring to the federal Emergency Medical Treatment and Labor Act, which the federal government has stipulated includes emergency abortion care, and which states with abortion bans have sued over. The U.S. Supreme Court this summer declined to rule on Idaho’s lawsuit challenging the federal requirements, allowing doctors to provide emergency abortions while litigation continues.

“Although it is difficult to assess from the narratives, some … may have been EMTALA violations since stabilizing care was not provided,” the researchers write. “Other cases, such as those where the patient was admitted to a hospital for observation or those involving a patient pregnant with a fetus with an anomaly incompatible with life, are likely not EMTALA violations. Regardless, we anticipate these cases of poor-quality care would become even more common if the Supreme Court were to rule that EMTALA does not apply to emergency abortion care.”

Overall, participants reported that their patients suffered emotionally and financially, sometimes even insured patients having to pay out of pocket for medical care because it was in another state. Grossman also noted that affected patients could face long-term physical and mental-health consequences because of the medical care they did or did not receive.

“When we came out with our first report, maybe I was a little bit more optimistic and thought that perhaps this information could be used to help streamline care, reduce these delays, and identify workarounds,” Grossman said. “And perhaps that has happened in some places, but I think it’s really clear now, more than two years out, that those kinds of fixes or Band-Aids on a bad policy just aren’t going to work, and that really it’s not possible to provide evidence-based care in these states. These bans need to be repealed.”

Effective Oct. 1, misoprostol, used to treat post-delivery hemorrhages, will become a Schedule IV controlled dangerous substance in Louisiana under a new law. The designation means the medicine will have to be securely stored, raising concerns among doctors who say they rely on immediate access to the medication in life-threatening situations. (Photo illustration by Anna Moneymaker/Getty Images)

Louisiana doctors say they still have plenty of questions about how they will be able to access a lifesaving drug once it’s placed under restricted access starting next month — even after state health officials provided them with new guidance on the law.

On Friday afternoon, the Louisiana Department of Health released a memo with instructions to doctors about how they can use misoprostol in hospitals. Misoprostol has long been one of the go-to options for women who experience excessive bleeding after delivery.

The new law was intended to curtail the use of misoprostol and mifepristone for medical abortions, although they are also used to treat other conditions such as ulcers or some pituitary disorders, respectively. Misoprostol, in particular, is used quite frequently by OB-GYNs to soften the cervix for endometrial biopsies, to induce labor or to insert an intrauterine device.

The health department’s outreach to physicians followed a Louisiana Illuminator report that details “confusion and angst” among health care providers over a new law that reclassifies the misoprostol and mifepristone as controlled dangerous substances. It goes into effect Oct. 1, and doctors have expressed concern that the changes will lead to the vital drug being pulled from postpartum hemorrhage carts.

So far, the LDH memo has done little to reassure the medical community.

It’s “not at all” helpful, said a New Orleans OB-GYN who spoke on the condition of anonymity because she hadn’t received clearance from her hospital to speak to a reporter.

“Whoever wrote this has not spent time on a labor unit,” she said. “This gives no actual guidance to the people who are trying to revise the protocols because it doesn’t actually tell me how to keep track of the drugs on the carts, how often to count them, what to do if we need them, etc.”

The memo tells doctors that mifepristone and misoprostol “may be utilized” to treat postpartum hemorrhage — even though mifepristone is not used for hemorrhaging. The two drugs can be used together for medical abortions but are not interchangeable for other indications.

Doctors grapple with how to save women’s lives amid ‘confusion and angst’ over new Louisiana law

Setting that error aside, doctors’ main concern with the new law is delays in having access to misoprostol because it would have to be stored as a controlled substance. Any holdup in administering the medicine when a patient is bleeding profusely could significantly worsen outcomes.

“Saying that it’s permissible to have them available is actually kind of offensive — we know that,” the New Orleans-based OB-GYN said. She added that it’s also confusing that LDH uses the term “crash cart” because it could be confused for a maternal code blue cart, which is completely distinct and is not related to postpartum hemorrhage medication.

“We were hoping for more guidance on how to have miso available at the bedside because no other controlled substances can ‘float around’ in the hospital like that,” the OB-GYN said. “We were hoping to have guidance on what diagnosis codes are required in order to fill a prescription [for misoprostol] based on the document from the Louisiana Board of Pharmacy that was released this summer.”

‘Unlikely to be a viable solution‘

The state’s board of pharmacy referred to the law in its July newsletter, explaining that the reclassification is part of a law that created the crime of coerced abortion, when a pregnant woman is drugged with abortion medication without her consent.

“A diagnosis or a diagnosis code shall be written on the prescription by the prescriber indicating that the drug is intended for a purpose other than to cause an abortion in violation of this Section of law,” the newsletter states.

Dr. Jennifer Avegno, health director for the City of New Orleans, received a copy of the memo from LDH after speaking to a reporter. She said she doesn’t know how the information will be shared with doctors across Louisiana.

The state health department has two main ways to communicate quickly with providers when they need to, Avegno said. One is a Health Alert Network message that immediately alerts physicians. Another is through the Louisiana State Board of Medical Examiners, which has a database of all licensed physicians in the state. Neither has been used thus far to her knowledge.

The new law requires the state to educate health care providers on how the reclassification of the two drugs will affect their treatment protocols.

“It’s not helpful,” Dr. Stacey Holman, division director at Touro’s maternal child services, said after reviewing the document.

Secure storage not practical

The memo suggests securing misoprostol and mifepristone, the latter of which is not used for postpartum hemorrhages, in a secured automated dispensing system. Holman said these very large machines are not housed inside patient rooms.

“This still creates a delay for a patient who needs the drug urgently as many of the patient rooms are not close to these systems,” she said.

The LDH’s suggestion that scheduled drugs be stored in a locked area of an obstetric hemorrhage cart “may be good in theory.”

“But to do this safely, in accordance with the additional rules now imposed for these drugs, an oversight process requiring more extensive record keeping and pharmacy manpower will be required,” Holman said. “This is unlikely to be a viable solution for most hospitals, especially those in critical access areas.”

After being contacted by a reporter, a family medicine OB practicing at a rural Louisiana hospital reviewed the letter. She asked not to be identified because she wasn’t authorized to speak on the hospital’s behalf.

“That’s all so confusing,” she said. “I don’t even understand most of that document. Nothing is made clear really. What is a secure area?”

She referred to an auto-dispensing system, which in her hospital is called a Pyxis, and said it is an extremely expensive piece of equipment. It wouldn’t be economically feasible to have multiple Pyxis machines on a hospital floor, she said.

“We cannot afford hospital beds with proper stirrups or to even have lidocaine always available,” she said. Her hospital currently uses what she called a “bleed box” — a small plastic box shut with zip ties.

The rural doctor added that her department’s Pyxis is down the hall from the delivery unit in a locked room. The machine won’t open without an order verified by a pharmacy. On nights and weekends, her hospital has to call out to a remote pharmacy.

“Even an in-house pharmacy would take more time, when a lady is gushing liters of blood,” she said. “I often get covered in it.”

Avegno said she hopes more guidance is coming from LDH. She was among 50 doctors who signed an Aug. 22 letter to the department requesting more information on the new law, which Gov. Jeff Landry signed in May.

“They addressed some of the questions that we raised in our letter, but they did not address others,” said Avegno, an emergency room physician. “We asked for specific guidance on prescriptions … in order to make sure that it complied with the act and had the highest chance of being filled for a medically necessary use — and they did not address that at all.

Harris campaign reacts to Louisiana hospitals pulling life-saving drug from post-delivery access

“They appear to address some of the issue of inpatient access, but I am checking with some pharmacy colleagues to see if some of the things that they suggest can happen readily or are going to require a lot of work on each individual hospital’s part.”

Touro’s Holman said she would also like more guidance.

“Creating policies and procedures to explain this could take weeks to months to write and approve,” Holman said. “We have 23 days to figure this out. Just 23 days to test and implement solutions as well as educate physicians on how we are going to continue to provide safe care for our OB patients.”

Pressure on LDH to provide guidance increased this week after the Illuminator’s report, which prompted a statement from Vice President Kamala Harris’ campaign, blaming former President Donald Trump for Louisiana’s law further restricting access to reproductive health care.

“Because of Trump, doctors are scrambling to find solutions to save their patients and are left at the whims of politicians who think they know better,” Harris-Walz spokeswoman Sarafina Chitika said.
This story is republished from the Louisiana Illuminator, a sister publication to the Kentucky Lantern and part of the nonprofit States Newsroom network.

A new federal rule is aimed at reducing coal miners’ exposure to silica dust, a leading cause of black lung disease. (Getty Images)

This Labor Day, as a new federal rule is being rolled out to prevent deadly black lung disease in miners, Christopher Williamson is remembering the coal miners who fought for the creation of his agency and who weren’t afforded the protections that current and future workers hopefully will.

Williamson, assistant secretary for the U.S. Mine Safety and Health Administration, is a native of Mingo County in southern West Virginia which is separated from Kentucky by the Big Sandy River. Since he entered his federal position about two years ago, he’s focused heavily on developing and now? implementing the new silica rule that was finalized earlier this year.

“I come from the southern coalfields. I know mining. This issue is not one that needed to be explained to me … it was a priority for me from the moment I got confirmed and walked in the door at MSHA,” Williamson said. “Looking and reflecting on it in the context of Labor Day — especially in the context of all the labor history in West Virginia that I’m very familiar with and happened in my backyard — all these miners in West Virginia fought for my agency to be created, fought for these regulations that are in place, fought for the Mine Act to be put in place.”

When the Federal Mine Safety & Health Act of 1977 was passed, Williamson said, it’s main goal was made clear in the first sentence on its first page: “the first priority and concern of all in the coal or other mining industry must be the health and safety of its most precious resource — the miner,” the act reads.

Today, Williamson said, the new silica rule will, hopefully, do just that.

The new rule — initially proposed in July 2023 — implements for the first time ever a separate exposure limit for silica dust in mines, cuts the maximum exposure limit to 50 micrograms per cubic meter for a full-shift and creates an “action level” for when exposure comes at 25 micrograms per cubic meter for a full shift. It also establishes uniform exposure monitoring and control requirements for mine operators to follow as well as increasing sampling requirements. It was finalized in April and most of it began to go into effect in June.

The rule’s implementation comes more than five decades after the federal government first recommended limiting silica exposure among workers based on a wide body of evidence and years after other industries adopted similar standards to enforce the exposure limits of silica.

It also comes as younger coal miners in the region are being diagnosed with the disease at rates unseen by their predecessors due to a lack of easily accessible coal and an increase in the amount of silica-rich sandstone they have to dig through to reach what remains.

According to the Centers for Disease Control and Prevention, about 20% of coal miners in central Appalachia are suffering from black lung — the highest rate detected for the disease in more than 25 years. One in 20 of those coal miners are living with the most severe form of the condition, and fatalities tied to black lung are steadily increasing in central Appalachia faster than the rest of the country.

“Unfortunately, there’s been too many generations of miners in West Virginia and other places that have had to sacrifice their lungs just to support their families,” Wiliamson said. “This rule is a huge step forward to try to prevent those types of things from happening.”

The rule grants MSHA, for the first time, the authority to issue citations at mines that report elevated levels of silica dust without efforts to remediate. When levels are too high, the agency can issue a withdrawal order, meaning workers must leave the mine until the levels drop and corrective actions are taken. Williamson said this alone is an improvement that will change how the agency is able to perform its oversight responsibilities.

“We have all these enforcement tools that we can’t use,” Williamson said. “For the first time, we’re going to be able to use the full suite of MSHA’s enforcement authority to protect miners from exposure to silica, and that’s huge. We hope we don’t have to use those things, but we will if we have to.”

The rule isn’t without its challenges, no matter how unlikely they may be to take hold.

In Congress, an appropriations bill for the federal Department of Labor is awaiting consideration by the U.S. House of Representatives. It contains a rider that, if adopted, would halt the use of any Department of Labor funding for the implementation of the rule. That bill previously passed a House subcommittee and the appropriations committee. The Senate’s version of the same appropriations bill, however, does not contain the same language.

Coal mining advocates have decried the efforts to stop the funding, which would complicate enforcement of the rule. Even if it’s not adopted — which is likely — they’ve said efforts by Rep. Robert Aderholt, R-Ala., to include the language is “unconscionable, indefensible and frankly insulting” to the nation’s miners.

For Williamson, until something affecting the rule is actually passed, the efforts in Congress are little more than background noise. Officials at MSHA, he said, are staying busy educating those in the mining community about the new policies and ensuring resources are available to become compliant before enforcement starts next year.

“I appreciate the process and I appreciate that [Congress goes] through it, but we’re full steam ahead. We’re implementing this thing,” Williamson said. “We’ve got a mission to complete, we’ve got miners to protect, and unfortunately, there are too many that are out there that need this rule and need these health protections. We’re not going to sit around and wait. We’re moving full steam ahead.”

This story is republished from West Virginia Watch, a sister publication to the Kentucky Lantern and part of the nonprofit States Newsroom network.

Gov. Jim Justice stands with his family — daughter Jill, wife Cathy and son Jay — at his final State of the State address in Charleston, W.Va., on Jan. 10, 2024. (Office of the Gov. Jim Justice)

Federal attorneys asking a court to hold 23 of West Virginia Gov. Jim Justice’s family-owned coal companies in contempt for nonpayment of health and safety fines entered a filing this week saying the companies shouldn’t have entered into a payment plan if they knew they couldn’t honor it.

The filing, entered Tuesday in the U.S. District Court for the Western District of Virginia and first reported by West Virginia MetroNews, comes in response to a memorandum filed last week by Justice family attorneys. In that filing, they contend that the companies in question are too broke to pay the nearly $600,000 they still owe to the government.

In Tuesday’s filing, the federal attorneys say this claim has been made with no evidence and, as such, should not be considered as a valid defense against putting the companies in contempt. Further, the companies should not have entered into a settlement agreement in 2020 if they knew they would not be able to pay what they owe on the set schedule.

“[The companies] willingly and knowingly entered into the payment plan and consent judgment in this case, representing to the government and the Court that it would comply with the payment plan in the consent judgment,” the filing reads. “However, they now claim that they faced financial difficulties at the time of the consent judgment that preclude them from being able to pay. If [the companies] knew they could not comply with the consent judgment at the time of execution, they should have said so.”

In 2023, according to the filing, representatives for the Justice companies told the government that they “had difficulty” making payments, but that the situation would be remedied by borrowing money from another business to catch up on payments. Federal representatives agreed at that time to adjust the payment plan.

“Yet once again, [the companies] failed to comply with the adjusted payment plan. [They] have not provided any explanation for their noncompliance,” the federal attorneys write. “Between August 2023 and?present, [the companies] did not communicate to the government an inability to pay on the modified schedule, nor did they seek alternative payment arrangements with the government.”

In a memorandum earlier this month asking the court to hold the companies in contempt, federal attorneys provided dozens of emails sent between Aug. 14, 2023 and July 9, 2024 reminding the companies of their debts and the past due amounts.

Responses from the companies’ attorneys were few, even as the companies fell months behind on their payments.

“Instead of notifying the government about their alleged inability to comply with the consent judgment, [the companies] have kept their proverbial heads in the sand,” the federal attorneys wrote in Tuesday’s filing. “Even when the government notified Defendants in July 2024 that the government would have no choice but to seek action with the Court unless payment in full was made, [they] offered no explanation or response.”

In last week’s memorandum from the Justice companies, attorneys argued that it would be improper to hold the companies in contempt since their financial struggles are not self-inflicted and have existed since they agreed upon the payment plan. They said the economic downturn in the coal industry is to blame for the financial challenges at the companies. The federal government, they continue, was aware of these challenges.

Since payments were being made — albeit sporadically — from 2020 on, the feds argued Tuesday that this defense shouldn’t stand.

Also in last week’s memorandum, Justice family attorneys requested discovery for the ongoing case. While alleging a dire financial situation at the companies, they did not provide any exhibits or evidence to back up this claim in their filing.

In Tuesday’s filing, federal attorneys say that the request for discovery is “unnecessary and a delay tactic.” The companies, they say, are responsible for proving they are unable to meet their financial obligations and evidence underscoring that claim can be presented at a hearing for the case if it exists.

The nearly $600,000 the federal government is seeking to collect comes from a decade’s worth of unpaid health and safety fines at Justice-owned coal mines. The debt, at one point, totaled about $5.13 million from hundreds of violations incurred since 2014.

The government initially filed suit against the Justices in 2019 to collect the money. In 2020, the Justice-owned companies and the government entered into an agreement where the family would make monthly payments to pay off the debt by March 2024. The debt, however, was not paid off.

Justice has maintained that he is not at all directly involved in his family’s business empire, leaving the companies in the leadership of his children despite refusing to enter most of his businesses into a blind trust.

He said earlier this month that, “if there’s a problem, it gets taken care of … We may be a few minutes late to the fire, but we always show up at the fire.”

Last week, however, Jay Justice — Jim Justice’s son and president of several of the family’s companies — failed to “show up at the fire.”

A federal judge in Alabama filed an order last Thursday finding Jay Justice and Bluestone Coke — of which he is president — in civil contempt.

The order, according to Inside Climate News, came after Jay Justice failed to attend a hearing — despite being ordered to do so by the federal court — for a lawsuit alleging the coking plant is responsible for polluting groundwater and rivers and violating the Clean Water Act.

“[Jay Justice and Bluestone Coke] have violated three separate court orders requiring them to produce responses and negotiate, in good faith, dates for depositions,” the order reads.

The story is republished from West Virginia Watch, a sister publication to the Kentucky Lantern and part of the nonprofit States Newsroom network.

The Kentucky legislature outlawed the sale of some vaping products, effective Jan. 1, 2025. (Getty Images)

Kentucky vape retailers plan to appeal the dismissal of their challenge to a 2024 state ban on selling some vaping roducts.

A Franklin Circuit judge in late July dismissed their lawsuit challenging the 2024 law.

Greg Troutman with the Kentucky Smoke Free Association, which represents vape retailers, filed a notice of appeal Tuesday with the Kentucky Court of Appeals.

Troutman, on behalf of the retailers, had sued Allyson Taylor, commissioner of the Kentucky Department of Alcoholic Beverage Control and Secretary of State Michael Adams, arguing the new law did not pass constitutional muster.?

In a July 29 opinion, Franklin Circuit Judge Thomas Wingate disagreed. He dismissed the challenge, saying the law did not violate the state Constitution.?

House Bill 11, which passed during the 2024 legislative session, goes into effect Jan. 1. Backers of the legislation said it’s a way to curb underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their status with the U.S. Food and Drug Administration (FDA).?

Opponents have said it will hurt small businesses, lead to a monopoly for big retailers and could drive youth to traditional cigarettes.?

Altria, the parent company of tobacco giant Phillip Morris, lobbied for the Kentucky bill, according to Legislative Ethics Commission records. Based in Richmond, Virginia, the company is pushing similar bills in other states. Altria, which has moved aggressively into e-cigarette sales, markets multiple vaping products that have FDA approval.

A two-year federal investigation focused on access to treatment in Louisville for adults who have mental illness and whether their civil rights are being violated. (Kentucky Lantern photo by Sarah Ladd)

LOUISVILLE — The U.S. Department of Justice says it has “reasonable cause” to believe Kentucky is violating the Americans with Disabilities Act in Jefferson County.?

This finding comes after a two-year federal investigation “focused on whether Kentucky subjects adults with serious mental illness to unnecessary segregation in psychiatric hospitals in Louisville.”?

In a 30-page report Tuesday, the Department of Justice (DOJ) found Kentucky doesn’t adequately treat Louisvillians with serious mental health issues in compliance with the Americans with Disabilities Act (ADA), enacted by Congress in 1990 to protect people with disabilities from discrimination.?

Jefferson County, the report says, relies too heavily on psychiatric hospitalizations, police and detention that could be avoided with community-based mental health services, which it also does not adequately connect people with following hospitalization.?

Key points in the report include:?

• In 2022, 16% of people admitted to psychiatric hospitals in Louisville were also sent to jail.?
• In 2022, 1,100 people were admitted more than once to a psychiatric hospital.
• More than 500 had three or more such hospital admissions.?
• Thousands of others are admitted once.?

“Many” people in the county spend more than a month in such hospitals, according to the report, which calls the facilities “highly restrictive, segregated settings in which people must forego many of the basic freedoms of everyday life.”?

“Admission to these institutions can be traumatizing, and it can upend the lives of people who experience them. With the right community-based services, many of these hospitalizations could be prevented.”??

Louisville expanding an emergency mental health response service

“Because of the lack of community-based services, law enforcement officers are routine responders to mental health crises in Louisville,” the report states. “Many of these encounters could have been avoided with community-based services, and those community services could have provided an alternative to incarceration in Louisville Metro Detention Center.”?

In a Tuesday letter to Gov. Andy Beshear, the DOJ outlined “unnecessary segregation, and serious risk of segregation, in psychiatric hospitals” for people in Louisville with serious mental health issues. It also warned it could file a lawsuit to force Kentucky to comply with the ADA if it cannot reach a resolution.?

The Beshear administration “continues to prioritize Kentuckians’ mental health,” spokeswoman Crystal Staley said, pointing to Beshear’s emphasis on mental health Medicaid coverage and the utilization of 988.

“We are surprised by today’s report as the cabinet has not heard from the Department of Justice since last September,” Staley said. “There are sweeping and new conclusions that must be reviewed as well as omissions of actions that have been taken. We will be fully reviewing and evaluating each conclusion.”

“To?the Louisville area mental health providers, the administration recognizes your hard work and wishes today’s report had fully acknowledged all that you are doing,” Staley added.

Louisville ‘not unique’?

“People with serious mental illnesses in Louisville are caught in an unacceptable cycle of repeated psychiatric hospitalizations because they cannot access community-based care,” Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division said in a statement. “We thank Kentucky for its full cooperation with our investigation, including readily providing access to staff, documents, and data.”?

“We also recognize that Kentucky has already begun taking important steps to expand access to a range of key services, including crisis response services; medication management supports; and housing and employment supports,” Clarke added. “Our goal is to work collaboratively with Kentucky so that it implements the right community-based mental health services and complies with the ADA.”?

Marcie Timmerman, president of Kentucky’s chapter of Mental Health of America, said one of the “largest barriers” to better access to community-based services emphasized in the report is funding.?

“Louisville is not unique in Kentucky in not providing all the available service arrays,” she told the Lantern.?

The legislature needs to put more money into mobile crisis units, Timmerman said, that could help people upstream — before they are experiencing mental health emergencies.?

U.S. Attorney Michael A. Bennett of the Western District of Kentucky said in a statement that the findings go “beyond the violations.”?

“These findings,” he said, “are also about recognizing the dignity and potential of every individual who has mental illness.”

Christina Lee Brown, a philanthropist and supporter of the University of Louisville Christina Lee Brown Envirome Institute, was described as a driver in getting the tree project off the ground. (Kentucky Lantern photo by Liam Niemeyer)

LOUISVILLE — A research project years in the making through the University of Louisville, The Nature Conservancy and other partners has found planting thousands of trees and shrubs in a south Louisville neighborhood has improved the health of hundreds of residents.?

The University of Louisville’s Christina Lee Brown Envirome Institute launched the Green Heart Louisville Project in 2018. It has planted more than 8,000 large trees and shrubs across a four-mile area and studied the health of 745 nearby residents before and after the trees were planted.?

The researchers took blood, urine, hair and nail samples to collect health data from residents while also measuring tree coverage and air pollution levels in the area. The researchers then compared the collected data to city residents outside the research area.?

The results, announced before a crowd of supporters Tuesday in Wyandotte Park in south Louisville, showed residents living in the greener area had 13% to 20% lower levels of biomarkers for general inflammation.

Trees along a walking path in Wyandotte Park are among the thousands planted in neighborhoods and along the nearby highway corridor. “You all see those beautiful trees that are behind me? Well, they are more than beautiful. They are medicine,” said University of Louisville President Kim Schatzel to the crowd of supporters. “They are part of the revolutionary project to document and understand how trees affect the health of people living around them.”?

The biomarkers measured are called high-sensitivity C-reactive proteins, and higher levels of those proteins are strongly connected to cardiovascular disease and, according to a University of Louisville release, are “an even stronger indicator of heart attack than cholesterol levels.” Higher levels of the proteins are also connected to increased risk for diabetes and some cancers.?

Aruni Bhatnagar, the director of the Christiana Lee Brown Envirome Institute, framed the research as having the potential to significantly reduce heart attacks among Louisivillians.?

“We have over 1,800 to 2,000 heart attacks in Louisville every year, and if you can even decrease 10%? — that’s 200 lesser heart attacks,” Bhatnagar said. “If we can work on the scale that we’ve done here for the entire city, there will be a huge benefit. We can only think what it would be for the entire country.”?

Bhatnagar said while past research has shown that people living in “green communities” have a lower rate of mortality, he wasn’t aware of research like the University of Louisville project that compared the health effects of greenery added to a community.?

Toni Smith, 71, is one of the study’s participants and has lived across the highway from Wyandotte Park for the past 17 years. She said the added trees have helped beautify her neighborhood along with block some of the air and noise pollution coming from the highway.?

Smith, sitting under the shade of a tree in the park, said there’s a “certain calming aspect” to tree coverage, especially for those who love the outdoors. She said she’s a big advocate of anything that can help improve the environment and health of her neighborhood, mentioning the study has also served as a helpful health screening for participants.?

She would have had researchers plant a tree in her own yard, but there wasn’t room.?

“Because of my love of nature, I didn’t have a square inch to plant a tree, or I definitely would have had them come,” Smith said.

Sen. Danny Carroll, R-Benton, called on the Kentucky legislature to put more funding into improving treatment and conditions for Kentucky kids being held in detention. (LRC photo)

Sen. Danny Carroll slammed the Kentucky legislature on Friday for not funding his proposal to spend $22 million on a special mental health juvenile detention facility.?

The West Kentucky Republican filed Senate Bill 242 during the 2024 session, which would have also created a process to test and treat minors with serious mental health issues in the Department of Juvenile Justice (DJJ). The bill passed the Senate and died in the House.?

“By that bill dying in the house, we have left DJJ hanging,” Carroll said during a meeting of the Juvenile Justice Oversight Council. “We have directed them to do certain things, and we didn’t give them the money to do it.”??

Kentucky Republican pitches $165 million to improve care, safety of juveniles in state detention

He called the bill’s death “one of the most disappointing times in my entire career in this legislature.”

“We as a legislature, we have pointed fingers at DJJ. We have pointed fingers at the governor. And now, we have some culpability in this problem because we had the opportunity to finish this out. We had the opportunity to establish a mental health detention center to treat the most severe kids that are detained and we didn’t do it. We let the bill die. We have a crisis in this commonwealth that everybody agreed was a crisis, until it came time to pay for it, and then all of a sudden, it wasn’t a crisis.”??

All eight of Kentucky’s youth detention centers are under federal investigation for possible abuses. Meanwhile, advocates worry about a new state law requiring more kids charged with violent offenses to be held in Kentucky’s troubled juvenile jails.??

Another new state law, passed in 2024, allows more minors to be tried as adults, which could also increase the number of juveniles in detention.?

“With (the Department of Justice) being in town, we’re going to probably … end up under another consent decree in the commonwealth,” Carroll said. “And my colleagues in the legislature, it’s on us.”?

Carroll’s bill allocated $90 million for building two all-female regional detention facilities as well. Female juvenile inmates are currently being transferred to Boyd County.?

“Maybe this next session, we finalize how the regional centers are going to be set up, and then we also need to, once again, approach the mental health detention center that we had planned,” he said.?

Kentucky recently finished the fiscal year with a $2 billion General Fund surplus plumping up the Budget Reserve Trust Fund to $5 billion. Both statutory triggers were met for reducing the state income tax rate by another half percentage point in 2025 to 3.5%, which would be the third income tax reduction since 2022. Reducing the income tax is a top priority for the Republicans who control the legislature.

Republican lawmakers in recent years have repeatedly blamed Gov. Andy Beshear for violence and understaffing in juvenile detention facilities and criticized the administration for mismanagement. Sen. David Givens, R-Greensburg,in May said the federal investigation into DJJ should be a “crucial wake-up call for the Beshear administration.”

Beshear criticized the legislature for not funding Carroll’s mental health facility, among other things.?

In January, a report from Republican Auditor Allison Ball found “??disorganization across facilities” and a “lack of leadership from the Beshear Administration” within DJJ. She also criticized the Beshear administration for “the unacceptably poor treatment of Kentucky youth.”

Carroll called for more unity in approaching solutions to the crises within DJJ.?

“There’s been a lot of finger pointing back and forth with this and folks, it’s time for that to stop. We’ve got kids with mental health issues that are sitting in jail cells today and will be there a longer period of time because this legislature failed to act, and that’s unacceptable,” he said. “We cannot point fingers. We cannot start blaming and then just let it die during the session. We’re no better than who we’re pointing fingers at if we do that. And that’s what happened last session.”?

“I’m going to catch heck for this, but at this point, I really don’t care,” Carroll added. “We have let our kids down, no question about it, and we’ve got to fix this, and we’ve got to fix it soon.”?

Staffing issues improving?

During the same meeting Friday, DJJ staff said the staffing issues that have plagued the department are on the mend. Still, there remain 100 funded but vacant positions, according to Myrissa Ritter, a human resource branch manager in the Justice and Public Safety Office.?

From July 2023 to July 2024, DJJ detention staff increased from 344 to 448, Ritter told lawmakers. Security staff increased 274 to 329, making for the “most significant growth,” she said.?

Mental health employees such as social workers, clinicians and psychologists increased from 217 to 241 over the past year as well. Youth workers and administrative staff numbers also improved, from 581 to 615 in the same time frame.?

Ritter credited Senate Bill 162, a law passed by the legislature in 2023 that allocated millions toward improving salaries for DJJ employees. With that money, Ritter said, DJJ can now start correctional employees out at $50,000 a year instead of the previous $30,000.?

“While we have made significant progress in staffing,” she said, “we will continue to seek ways to ensure that the department remains adequately staffed.”?

Sen. Whitney Westerfield, who co-chairs the council, asked about the current conditions of facilities. DJJ Commissioner Randy White, who serves on the council, said that “by and large, the infrastructures are okay right now.”?

One facility has a stuck thermostat that’s being repaired, he said, and there are “some drain lines” in need of repair.?

“We are prepared for heat, but one never knows,” he said, “because repair needs evolve.”?

Rep. Stephanie Dietz, R-Edgewood, will propose expanding protective orders to also cover coercive control. (LRC Public Information)

If you or someone you know has experienced domestic violence, call the National Sexual Assault Telephone Hotline at 1-800-656-4673. Call the National Domestic Violence Hotline at 1-800-799-7233.?

You can also contact any of Kentucky’s 15 domestic violence programs.?

A Northern Kentucky Republican intends to file a bill that would add coercive control to Kentucky’s protective order legislation.?

Rep. Stephanie Dietz, R-Edgewood, presented a draft of her bill to the Interim Joint Committee on Judiciary Friday in Frankfort.?

“We’re all aware of the devastating effects of domestic violence on individuals, families and communities,” she said. “There is a significant gap in our current laws that we can address, and that is coercive control.”

Currently, someone in Kentucky can get a protective order if they’ve experienced physical violence or face immediate threat of physical violence. But some survivors face a more nuanced abuse, Dietz explained.?

“It involves a pattern of behavior aimed at undermining a victim’s autonomy and freedom,” she said of coercive control. “This can include manipulation, isolation, financial control and threats, none of which necessarily involve physical violence, but are equally devastating.”?

Coercive control is “consistent” and “repetitive” behavior in which one person exerts control over another through isolation, threats, surveillance, loss of financial freedom and medical access and more, explained Christy Burch, the CEO of the ION Center for violence prevention in Northern Kentucky.?

The ION Center provides free services, including emergency shelter, pet boarding and court advocacy to survivors of intimate partner violence in a 13-county area.?

Through “complete domination,” Burch explained, people in these situations can experience “a loss of total self.”?

Such control doesn’t always include physical violence, Burch said, though it can. People in these situations might lose access to money, not be allowed to drive or seek medical care and more, she said. They might be encouraged to quit their job, not hang out with their friends or be threatened with separation from their children.?

“Coercive control is utter control,” she told lawmakers. “We worked with (a) survivor who had three children. The kids were never allowed to play outside. Mom was not allowed to potty train kids. The abuser withheld soap, hygiene products, hygiene time, controlled food, controlled whether the children were allowed to school.”??

Allowing victims of coercive control to get protective orders, Burch said, would put Kentucky in line with eight other states that have coercive control language in their statutes. Another eight states, including Illinois, have similar language.?

Kentucky State University. (Kentucky Lantern photo by McKenna Horsley)

Kentucky’s Department of Public Health will now offer an internship program to Kentucky State University students who wish to get hands-on experience in the field while studying.?

Employees of the Department of Public Health (KDPH) will also get tuition assistance for continuing their education at Kentucky State University (KSU). Such employees can take five or fewer courses per academic year for free.?

KSU becomes the 10th postsecondary institution in the state to benefit from such a? partnership with KDPH, the Cabinet for Health and Family Services announced Thursday. The other institutions are Bellarmine University, Eastern Kentucky University, University of Kentucky, University of Louisville, Murray State University, Northern Kentucky University, University of Pikeville, Simmons College of Kentucky and Western Kentucky University.

KSU president Koffi Akakpo said in a statement the new partnership, which is effective immediately, will “benefit our students, the future of the public health workforce and the citizens of Kentucky.”?

KDPH says it’s hired nine full-time employees as a result of its Student Internship Program, which created 40 internships and hosted 107 students.?

“Public Health supports an easier path to a healthier life for all Kentuckians,” Dr. Steven Stack, Kentucky’s public health commissioner, said in a statement. “Those interested in entering the field can choose from a full spectrum of services, from newborn screenings and nutrition education to administering vaccines, medication programs and so much more. The professional development opportunities, provided through our programs, will help students find their niche in improving health outcomes for large populations.”

The Centers for Disease Control and Prevention found in 2022 that the COVID-19 pandemic “strained many essential frontline professionals, including public health workers.”?

From March 2020 to January 2022, the CDC said, most public health workers had a COVID-19 component to their job. At the time, the CDC said, “40% of the workforce intends to leave their jobs within the next 5 years.”?

A 2023 study published in the health policy journal Health Affairs examined those public health workforce trends before and during the COVID-19 pandemic.?

Researchers said then there is “critical urgency needed to address the shrinking state and local governmental public health workforce that has the potential to jeopardize the safety, security, and economic prosperity of the U.S.”?

That study concluded: “Given the likelihood of increasing outbreaks and future global pandemics, recruitment and retention must be prioritized, especially for younger staff, who represent the future of the public health workforce.”?

Sen. Shelley Funke Frommeyer wants the legislature to beomce "more diligent around proactive wellness. (LRC Public Information)

Sen. Shelley Funke Frommeyer filed paperwork Wednesday to start a new legislative caucus focused on holistic wellness.?

The Alexandria Republican, who has often touted Kentucky’s need for what she calls a “wellness revolution,” said she is hoping for approval by Senate President Robert Stivers and House Speaker David Osborne within a week.?

Funke Frommeyer wants the caucus to look at Medicaid spending, prior authorization, pharmaceutical issues and more, she told the Lantern.

She also wants to look at “some basics around daily activity and quality nutrition,” she said, as well as focus on environmental issues that contribute to overall health.?

“My goal with the wellness caucus is to get legislators together that see issues and maybe work more closely and collaboratively on how are those issues affecting wellness, and get more diligent around proactive wellness,” she said.?

Kentucky can and should, she said, make “radical, incremental changes” to improve health outcomes.?

Midwife Danielle Ray, right, discusses infant safety at the Tree of Life birth center with, from left, Senators Shelley Funke Frommeyer, Lindsey Tichenor and Adrienne Southworth. (Kentucky Lantern photo by Sarah Ladd)

JEFFERSONVILLE, Ind. — A group of Kentucky lawmakers visited a freestanding birth center in Indiana Thursday to learn about an issue that promises to come up again during the 2025 legislative session.??

Tree of Life, a freestanding birthing center in Jeffersonville — right across the Ohio River from Louisville — accepts only clients with low-risk pregnancies. It was founded by physicians and midwives with WomanCare, an obstetrician and gynecology group in Indiana.?

And more than half — 61% — of its total births last year were Kentuckians who traveled out of state for the care they can’t get in Kentucky, which has no freestanding birth centers.?

This comes as lawmakers have considered — for years — whether or not Kentucky would be served by lifting or modifying its certificate of need (CON) requirements for freestanding birth centers.?

What to know about the certificate of need debate in Kentucky

Advocates blame the state’s lack of freestanding birth centers on the certificate of need laws, which mandate a process that attempts to hold down health care costs by certifying that there is a need for a service, be that extra beds in a hospital, an extra MRI machine or a new facility altogether, like a freestanding birthing center.?

Sen. Shelley Funke Frommeyer, R-Alexandria, who invited her fellow lawmakers to the center for Thursday’s tour and fact finding mission, said she wanted her colleagues to see firsthand what they will vote on next year.?

She and House Majority Whip Jason Nemes, R-Louisville, — both staunch advocates for freestanding birth centers — told the Lantern they intend to again sponsor bills in 2025 to reform CON in a way that allows Kentucky to open freestanding birth centers.?

Birth, Funke Frommeyer said, “is a physiologically natural process, but when we’re in the committee room and you’re talking about it, immediately you come up with ‘it’s not safe,’” she said. “So, I wanted people to see what ‘safe’ looks like.”?

Other lawmakers who joined her and Nemes included Republican Senators Julie Raque Adams of Louisville, Lindsey Tichenor of Smithfield, Adrienne Southworth and John Schickel of Union as well as Rep. Rachel Roarx, D-Louisville and Rep. Dan Fister, R-Versailles.?

Mary Kathryn DeLodder of the Kentucky Birth Coalition, said she believes the tour gave good insight to people neutral on the birth center issue — and gave advocates more fuel.?

Nemes agreed.?

“Some people, in their mind, they don’t know what a birthing center is. And some people, when they think about it in their mind, it’s like, ‘is this just like a hotel room? How safe is this?’” he said. “So we wanted people to come here and say, ‘Look, these people are serious about making sure that the mom and the child are healthy, not just for the moment of birth — certainly that — but leading up to it and after it’.”?

Tree of Life has four rooms, eight midwives and three partnering physicians.?

As of 2022, there were more than 400 freestanding birth centers in 40 states and Washington D.C., according to the American Association of Birth Centers.?

Kentucky babies. Indiana born.?

Tree of Life is one of the out-of-state centers that’s delivered hundreds of Kentucky babies, born to mothers who travel for the care they cannot get in the commonwealth.?

And the number of Kentucky babies born to Tree of Life is on the rise.?

In 2023, 120 Kentucky residents gave birth at the center, making up for 61% of all births at Tree of Life.?

In 2022, 110 Kentuckians traveled to Tree of Life, an increase from 107 in 2021 and 71 in 2020.?

As of July 31, 69 Kentucky residents have delivered at Tree of Life in 2024, representing 57% of the births, according to center data.?

One of the Kentucky women who chose to deliver at Tree of Life — an hour drive from her Trimble County home — is Paige Thompson.?

She wanted midwifery care and didn’t want to give birth in a hospital. She also wanted to be the first woman in her family in many years to have a vaginal birth.?

When she delivered in 2022, she felt “very comfortable” at Tree of Life, which is right across the street from Clark Memorial Hospital, making for quick transfers if necessary.?

“If I birth here with a midwife, I can eat and drink whatever I want,” she explained. “I can move however I want. I can birth in whatever position feels right to me. I can birth in the tub — which I didn’t, but… it’s an option — and those are really big for me.”??

Tree of Life isn’t alone in delivering Kentucky babies. The Clarksville Midwifery practice in Tennessee delivers about 25-30 Kentucky babies every year.

This is a sticking point for Funke Frommeyer, who acknowledged Kentucky’s poor maternal health vital statistics.?

“I want Kentucky to show that we’re having many wonderful, healthy births,” she said. Since birth centers only work with low-risk pregnancies, their clients are often having the lowest intervention births. But if they travel to another state for that experience, she said, Kentucky doesn’t get statistical credit for them, meaning the state is “missing the opportunity” to show its “great, healthy births without all the trauma.”?

For Jessie Powell, a doula who lives in Meade County and comes with clients to Tree of Life, giving birth in that type of environment is all about comfort of the mother and informed consent, she said.?

“It’s hard, because birth is such an emotionally-driven situation,” she said. “It’s physically impossible when you’re in such an emotionally-driven situation to really be able to break down risks and benefits on your own and be able to take the whole picture into account.”?

Rebekah Shirrell, one of the center’s midwives who previously worked as a nurse for nearly 20 years, said she understands concerns around safety at birth centers. Every birth center experience is set up to handle an emergency, she said, and transfer to the hospital is quick if necessary.?

“Nobody wants a bad birth outcome, ever,” she said. “Nobody gets into (this) for that.”?

Vice presidential candidate Minnesota Gov. Tim Walz celebrates with his daughter Hope, son Gus and wife Gwen at Democratic National Convention on Wednesday, Aug. 21, in Chicago. The Walzes clarified this week that they didn’t use IVF but another kind of fertility treatment to grow their family. (Justin Sullivan/Getty Images)

The broader scope of fertility treatments entered the spotlight this week after Minnesota Gov. Tim Walz and his wife Gwen shared that they had children through a less commonly known procedure.

Since Vice President Kamala Harris selected Gov. Walz as her running mate, he has discussed his family’s fertility journey during speeches in Pennsylvania, Nebraska and mostly recently at the Democratic National Convention in Chicago, Illinois.

“It took Gwen and I years,” Walz said on Wednesday night. “But we had access to fertility treatments. And when our daughter was born, we named her Hope.”

This week, the Walzes clarified that they conceived via intrauterine insemination, not in vitro fertilization.

IUI involves injecting sperm into the uterus during or just before ovulation to increase the chances of fertilization and pregnancy.

“Our fertility journey was an incredibly personal and difficult experience. Like so many who have experienced these challenges, we kept it largely to ourselves at the time — not even sharing the details with our wonderful and close family,” Gwen Walz said in a statement provided to States Newsroom. “The only person who knew in detail what we were going through was our next door neighbor. She was a nurse and helped me with the shots I needed as part of the IUI process.”

During IVF, eggs and sperm are combined in a lab and an embryo is inserted into the uterus. IVF has been drawn into national reproductive rights debates for much of this year, and Walz has been talking about it on the campaign trail while discussing his family’s fertility journey.

U.S. Ohio Sen. J.D. Vance, the Republican vice presidential candidate, accused his opponent of lying about how he and his wife had children. In an Aug. 20 social media post, Vance said, “Today it came out that Tim Walz had lied about having a family via IVF. Who lies about something like that?” He also shared a clip of Walz talking about fertility care and families on Aug. 9.

In a statement, Harris-Walz campaign spokesperson Mia Ehrenberg said, “Governor Walz talks how normal people talk. He was using commonly understood shorthand for fertility treatments.”

Experts said that patients commonly get IUI and IVF confused or refer to them interchangeably, given that in vitro fertilization is more popular.

“There’s such a huge sort of alphabet soup that comes along with assisted reproduction,” said Kimberly Mutcherson, a professor at Rutgers University-Camden who specializes in reproductive justice, bioethics, and family and health law.

Dr. Kelly Acharya, a fertility physician and assistant professor of obstetrics and gynecology at Duke University, said patients’ partners are more likely to mix up the two treatments or rope related procedures into IVF.

“A lot of times in my line of work, I see people that are referring to other things, like egg freezing, they call that IVF, even though technically it’s not,” she said.

Both Acharya and Mutcherson said the main differences between IUI and IVF are where fertilization occurs, the price and effectiveness.

“Intrauterine insemination or IUI is basically less invasive. It’s typically less expensive, and it is often what is recommended as the first thing that somebody tries,” Acharya said. “When somebody has mild forms of infertility, like if there are mild differences in the semen analysis, or if somebody is young and they’re not quite sure why they’re not getting pregnant, then often a provider will recommend that they do IUI as a first step to help things along.”

IUI is performed during or near ovulation, and it typically takes 10 minutes and is a minor procedure, according to Acharya. The price of IUI varies, depending on insurance coverage, from a few hundred dollars to several thousand dollars.

Mutcherson noted that some people also confuse IUI with intracervical insemination, or ICI. During this method, the sperm is inserted into the cervix — the passageway to the uterus, according to the Carolina Fertility Institute.

Doctors often recommend ICI or IUI as a precursor to IVF, which Mutcherson said can cost $12,000 to $15,000 per cycle — or more with grading and genetic testing. During IVF, “fertilization happens outside of the body,” Acharya said.

IUI, the treatment the Walz family used to have children, is not under the same scrutiny as IVF, which has faced opposition from anti-abortion hardliners. “It sometimes is listed as being less controversial than IVF, because it’s just helping along the natural process of getting the sperm inside the uterus and then expecting fertilization to happen inside the body,” Acharya said.

But Mutcherson said that could also be attributed to the fact that it’s a less well-known procedure.

“I think the really big issue when it comes to something like artificial insemination is that it allows people to create families that a lot of these folks — unfortunately, in the Republican Party and folks who are evangelicals — don’t approve of: families with two moms, families with two dads, single women who are having children,” she said.

Price is a significant barrier to fertility care. Only 21 states require insurers to cover fertility procedures, Stateline reported. A successful birth via IVF can cost more than $60,000, according to a 2022 study published in Reproductive Biology and Endocrinology.

“It requires a lot more physically, emotionally and economically to be able to do IVF,” Mutcherson, who conceived via IUI, said.

IVF became a national reproductive rights issue in February after the Alabama Supreme Court likened frozen embryos to “unborn children” in a ruling. The plaintiffs were couples who sued for damages under an 1872 wrongful death of children law after their embryos were accidentally destroyed in a clinic four years ago, Alabama Reflector reported. Alabama’s fertility clinics temporarily closed after the ruling until Republican Gov. Kay Ivey signed legislation in March shielding providers from criminal and civil liabilities, the Reflector reported.

But there’s still uncertainty over whether embryos and fetuses in the state have legal “personhood” rights. Despite the new law, two fertility clinics in Alabama announced plans to close by the end of the year, though one denied the decision was related to the? ruling.

Since the Alabama ruling, polls have shown most Americans back IVF. A survey conducted by Pew in April found that 70% said IVF is a good thing, while 22% said they’re not sure, and 8% said it’s a bad thing. Awareness is growing, too: 42% of Americans said they or someone they know have had fertility treatments, according to a 2023 Pew poll.

Nationally, Republicans and Democrats condemned the Alabama Supreme Court’s ruling and filed bills seeking to protect IVF this spring, though all of them stalled in Congress. The Republican Party’s platform featured support for both IVF and the equal protections clause of the 14th Amendment, which conservative legal scholars argue can be used to solidify “fetal personhood” along with effectively banning abortion. And in June, the Southern Baptist Convention — the largest Protestant denomination in the U.S. — voted to condemn IVF, particularly the destruction or donation of embryos that are not implanted in the uterus.

“People who believe that life begins at conception, people who believe that an embryo is no different than a 5-year-old sitting in a kindergarten classroom, those are people who have really deep and abiding principles related to procedures like in vitro fertilization,” Mutcherson said.

The number of babies born in the U.S. using assisted reproductive technology has increased in recent years: 2.5% of newborns were conceived using fertility treatments in 2022, according to the American Society of Reproductive Medicine. That’s up from 2.3% in 2021, per federal data.

A rabid bat, the first this year, has been found in Louisville. (Getty Images)

LOUISVILLE — The Louisville health department says a bat found in the East End was positive for rabies, a rare but deadly viral disease.?

This is the first rabies case in Jefferson County this year, Ciara Warren, environmental health manager at the Louisville Metro Department of Public Health and Wellness (LMPHW), said Thursday.?

“It is quite rare, but it is always a possibility,” she said.

The bat, found in the 40207 ZIP Code on a homeowner’s porch, is now dead after euthanasia and testing. The homeowner covered the bat and called the health department, and she was not exposed to rabies.?

In 2023, Jefferson County had two rabies-positive bats, according to the health department. Previous year totals are:?

• 2019 – 4 bats?
• 2020 – 2 (1 bat, 1 dog)?
• 2021 – 7 bats?
• 2022 – 3 bats?

The health department does not know where the 2024 bat could have contracted rabies, Warren said. Rabies typically spreads through blood or saliva.?

How to stay safe if you come across a bat?

Health department staff said if you come across a bat, the safest thing is to assume the bat has rabies, and do not touch it.?

Instead, cover the bat with something, if possible. Then, call the health department at 502-574-6650 and ask for someone with the rabies prevention program for further help and instructions.??

“Bat teeth are very tiny, so most of the time, you do not know if you’ve been bitten or scratched by a bat,” Warren said. “Sometimes bats, if they do have rabies, and maybe are further along since they’ve contracted it, they might be showing some signs, maybe swooping kind of low, laying on the ground. They might look a little bit sick. You might think that they have rabies, but the safest thing to do is just avoid it, and do not touch any bat.”?

If someone is unsure of exposure, one should call their doctor immediately, said Dr. Kris Bryant, associate medical director at LMPHW and pediatric infectious disease specialist at Norton Children’s Hospital.?

“Rabies is a viral infection, and once the virus enters your body from the bite or a scratch of an animal or even just handling an infected animal, the virus travels to the brain and can cause severe inflammation,” Bryant said.?

Symptoms of rabies include confusion, agitation and coma.?

“Once you develop symptoms, there is no treatment for rabies,” Bryant said. “Once you develop symptoms, the infection is uniformly fatal. So the most important thing to do is to prevent exposures by not handling bats.”?

If someone suspects exposure but isn’t sure, they can seek post exposure prophylaxis, which in the case of rabies is a series of rabies vaccines and a dose of rabies immune globulin, Bryant said.?

They should call their doctor to discuss that treatment as soon as possible, Bryant said.?

Even though human rabies is rare, “once someone has symptoms, we don’t have effective treatments,” she said. “And so once someone is sick with rabies, they almost always die.”?

How to protect pets?

Since 2019, one dog has tested positive for rabies in Jefferson County.?

Ideally, all pets would be vaccinated against rabies ahead of time, Warren said. Either way, pet owners should call their veterinarian immediately to discuss options. There is no cure for pets, like humans, so all pets should stay up-to-date on their rabies vaccines.?

“They would most likely recommend a 10-day quarantine, which is just where you monitor your animal for 10 days to make sure they don’t develop any signs or signs or symptoms of rabies,” Warren said.?

Symptoms in a dog or cat include lethargy, foaming at mouth, stumbling and aggression.?

Kentucky’s non-doctor health care workforce is on the mend, though state hospitals still have thousands of unfilled positions.?(Warodom Changyencham/Getty Images)

Kentucky’s non-doctor health care workforce is on the mend, though state hospitals still have thousands of unfilled positions.?

That’s according to an August report released by the Kentucky Hospital Association that shows 12% of positions in the state’s hospitals were empty in 2023, with nurses being the most in-demand. The data comes from 94% of the state’s acute care hospitals that responded to an association survey.?

The report shows Kentucky hospitals had a nearly 17% vacancy rate for registered nurses (3,899 positions) last year. That’s down from 19% in 2022.?

This decrease “indicates to us that all the hard work that our hospitals are doing is starting to pay off,” Nancy Galvagni, the president of the Kentucky Hospital Association, told the Lantern. “Things are trending in the right direction.”?

However, the number of vacancies is still too high, she said.?

“We don’t want to have a false impression that there is no problem anymore,” she said. “There’s absolutely a problem with 16% — almost 4,000 — vacancies. That’s very concerning. This is still a critical issue.”?

Kentucky — and the nation — have a well-documented nursing shortage, which was exacerbated by COVID-19-induced burnout and an aging worker population.?

“We’ve been having a nursing crisis, really, since COVID, the pandemic, which caused a lot of nurses to either retire early; some new nurses decided they didn’t want to continue in nursing, or certainly at the bedside,” Galvagni said. “And our members have been working extremely hard to invest, through pay, through efforts to retain nurses, to improve the work environment.”?

Retention and recruitment?

About 11% of hospital registered nurses are nearing retirement, the report shows. About 15% of the state’s RNs are 55 years or older, putting them about a decade out from retirement.?

Appealing to young Kentuckians is key for the hospital association, Galvagni said.?

“The older baby boomers are pretty much very few in the workforce,” she said. “So, our hospitals are looking (at) how they can appeal to those younger workers.”?

Sometimes staff visit schools to show students what a career in medicine could look like, she said.?

They want “to make health care careers appealing to younger people and exciting, and (we’re) trying to get them to think about health care careers when they’re choosing a career for the future,” she said. “We have to get more people choosing to enter the health careers.”?

Hospitals are also working to increase pay and offer better benefits for the nurses in their employ.?

During the 2024 legislative session, lawmakers passed bills that Galvagni expects to improve retention and recruitment for Kentucky’s nursing workforce.?

Among those are House Bill 194, which made it a Class D felony to assault a health care worker.?

“Of course, that’s not the silver bullet, but it’s helpful,” Galvagni said. “Hopefully (it) acts as a deterrent, and because that is a concern … for our health care workers.”??

Lawmakers also passed House Bill 159, which decriminalized medical mistakes made by health care providers. Galvagni believes this new law can help recruit people to health professions in the state.

“I believe it sets Kentucky apart from even many other states that don’t have that law,” she said. “I think all of these bits and pieces help make a better environment in our state for health care workers.”?

Meanwhile, staffing shortages in any health facility can impact patients’ experience, Galvagni said, especially when it comes to speed of care.?

“If you’re coming to the emergency room, it could mean a longer wait to get seen,” Galvagni said. “It also might mean that hospitals can’t have all their beds open. … Hospitals have a lot of physical beds, but you can’t put patients in beds if there’s not enough staff. It could mean, if you’re having elective surgery, that it’s a longer way to get that scheduled.”??

Other key takeaways?

The report shows, for 2023:?

• Kentucky’s hospitals have 8,641 full time vacancies for a total workforce vacancy of 12%. That’s down from 15% in 2022.?
• Registered nurses, licensed practical nurses and nursing assistants are the most needed.?
• Kentucky’s hospitals have 3,899 unfilled registered nurse positions, 254 licensed practical nurse vacancies and 1,264 nursing assistant vacancies.??
• Among registered nurses, there are significant shortages for psychiatric (24% vacant), medical surgical (23% vacant) and critical care (19% vacant).
• Millennials (39%) and Generation Z (23%) together represent about 63% of the current RN workforce in Kentucky. These workers are 40 and younger.?
• Generation X (born between 1966 – 1980) represents 27% of the RN workforce in Kentucky.?
• Baby Boomers (57 and older) are 11% of the RN workforce in Kentucky.?

Centers for Disease Control and Prevention photo

The Northern Kentucky Health Department has issued a public health advisory after detecting an outbreak of Cryptosporidium, often shortened to Crypto, a fecal-borne intestinal parasite.

The advisory states that at least some of the cases were detected in connection with a local public pool. A representative from the Health Department confirmed that the pool in question was the Silverlake water park in Erlanger. About dozen cases have been confirmed and numerous probable cases have been identified.

“Crypto is a gastrointestinal illness caused by the Cryptosporidium parasite and causing symptoms such as watery diarrhea, abdominal cramps, low-grade fever, vomiting and nausea,” the advisory reads. “These conditions can lead to dehydration and similar concerns. However, an individual’s symptoms can vary and some may not show any symptoms. Young children and people immunologically suppressed are at increased risk for more severe illness. The incubation period for Crypto is from 2 to 10 days, with most developing symptoms in 7 days from time of exposure. In otherwise healthy individuals, symptoms usually subside within a couple of weeks with supportive care to treat the symptoms and avoid dehydration. Crypto can be shed (transmitted) for two weeks or more after symptoms subside.”

Infected animals and human carriers shed the parasite through their feces. Exposure to contaminated water, soil or food can lead to infection. The parasite is resistant to the chlorine treatments commonly used in public pools as well hand sanitizer and rubbing alcohol.

People with confirmed infections should avoid using public pools and similar facilities for two weeks after their symptoms subside as they can still transmit the parasite during that time. Babies who have not been potty trained should also refrain from swimming in public pools.

The health department stated that the outbreak could have started as far back as June. The number of detected cases is expected to grow.

Anyone with symptoms should contact their doctor immediately.

This story is republished from?LINK nky.

A pharmacy technician fills a container with pills to put into a drug dispensing machine for an automated line at a pharmacy in Midvale, Utah. As prescription drug prices continue to rise, states increasingly have been turning to lawsuits to fight the power of pharmacy benefit managers — the middlemen in the drug supply chain. (George Frey/Getty Images)

Last month, the Federal Trade Commission released a scathing report suggesting that pharmacy benefit managers, the middlemen in the drug supply chain known as PBMs, are “profiting by inflating drug costs and squeezing Main Street pharmacies.”

The FTC found that because of consolidation in the industry, the three largest PBMs now manage nearly 80% of all prescriptions filled in the United States. PBMs use that power, the agency concluded, to raise drug prices, control patients’ access to them, and steer people away from independent pharmacies and toward the pharmacies they own.

A week after the FTC released its report, Vermont filed a lawsuit against CVS, Evernorth Health Services (a subsidiary of insurance giant Cigna) and nearly two dozen affiliated entities, claiming they have “distorted the market to their benefit at the expense of Vermont patients” and the state. The PBMs, the suit claims, “are driving up drug prices and foreclosing patients’ access to life-sustaining treatments in order to increase their profits.”

Vermont was the first state to file a lawsuit specifically citing the FTC report, but it probably won’t be the last.

States increasingly have been turning to lawsuits against PBMs in their drive to lower prescription drug prices. They’ve done so partly because of the barriers they’ve faced in trying to address the problem through legislation, including fierce lobbying by PBMs and a federal law that prevents them from helping the two-thirds of Americans who get their health coverage through their employers and so-called self-funded plans.

In taking their fight to courthouses, states also are turning the tables on corporations that have used lawsuits to block legislative attempts at regulation.

“Pharmaceutical companies themselves have a scorched-earth policy towards any legislative or regulatory changes. In other words, the industry will throw every claim it can think of at the states to try to block implementation of the law,” said Robin Feldman, a professor at UC Law San Francisco and an expert on pharmaceutical law.

State legislators and policymakers “have decided that if [their laws] are going to end up in court, perhaps they might have their own claims to bring,” Feldman told Stateline.

In the past couple of years, Arizona, Hawaii, Indiana, Kentucky, Ohio and Utah have sued PBMs, and complaints from dozens of states and municipalities across the country have been consolidated into multidistrict litigation in New Jersey.

And in June, 32 state attorneys general and five pharmacist trade groups joined a lawsuit in support of an Oklahoma law that would place tough new regulations on PBMs — but which the companies have blocked in court.

Illinois Democratic state Sen. Laura Fine, who serves on the Health and Human Services Committee and has pushed for new regulations on health care companies, said she has been frustrated by the limitations of legislation.

“I’m glad that we have attorneys general who will take on these issues and these causes on behalf of the people in our state,” Fine told Stateline. “I think it’s an important tool in the toolbox for everyone to know that if we cannot accomplish what needs to get done, we have our attorneys general behind us to make sure that they can be out there to protect the consumer.”

Major players

As intermediaries in the drug supply chain, PBMs determine which drugs are available under a person’s insurance plan, set copayments and decide how much pharmacies must pay to acquire drugs.

The PBMs argue that they use their bargaining power to negotiate lower drug prices for consumers and pharmacists. They blame drug manufacturers — often known as Big Pharma — for prices that are higher in the United States than anywhere else.

Greg Lopes, vice president of public affairs and communications for the Pharmaceutical Care Management Association, a trade association representing PBMs, wrote in an email to Stateline that “any notion that PBMs are increasing prescription drug costs is patently false.”

“Employers choose to hire PBMs because they have a proven track record of lowering drug costs for health plan sponsors, which translates to lower premiums and lower out-of-pocket costs for patients,” Lopes wrote. “PBMs protect the ability of employers to offer quality health coverage by serving as the only check against Big Pharma’s unlimited pricing power.”

David Winthrop, vice president of external affairs at CVS Health, which owns the PBM CVS Caremark, said the company “is proud of the work we do to make medicine more affordable for American businesses, unions and patients.”

“Any policies that would limit PBM negotiating tools would instead serve as a handout to the pharmaceutical industry, leaving those who pay for prescription drugs at the mercy of the prices drugmakers set,” Winthrop said.

The Federal Trade Commission sees the problem differently.

It notes in its report that CVS Caremark is among the three major players that dominate the PBM landscape, along with Express Scripts and Optum Rx. Express Scripts is a subsidiary of Cigna, and Optum Rx is owned by UnitedHealth. Together, the FTC asserts, the three companies use their supremacy to “wield enormous power and influence over patients’ access to drugs and the prices they pay.”

“This can have dire consequences for Americans, with nearly three in ten surveyed Americans reporting rationing or even skipping doses of their prescribed medicines due to high costs,” the FTC report states.

The agency also notes that PBMs harm independent pharmacies, “who struggle to navigate contractual terms imposed by PBMs that they find confusing, unfair, arbitrary, and harmful to their businesses.” Between 2013 and 2022, the report states, about 10% of independent retail pharmacies in rural America closed.

“Health plans and PBMs are often just trying to protect the status quo as it remains today, for obvious reasons, because the environment has benefited them significantly,” said Antonio Ciaccia, CEO of 46brooklyn Research, a nonprofit that studies drug pricing data.

Daniel Aaron, an associate professor at the S.J. Quinney College of Law at the University of Utah who specializes in health care policy, pointed out that pursuing litigation allows states to sidestep PBMs’ lobbying power in legislatures.

Aaron argued that legislation and litigation can work in tandem.

“Lawsuits can actually help form policy,” Aaron said in an interview. “And because these lawsuits attract a lot of attention and capture the public interest and expose a lot of documents, they can actually buttress policymaking and attract even more public attention.”

He also noted that by taking on unpopular defendants, state attorneys general can raise their political profiles — and many of them aspire to be governors.

Ben Widlanski, the co-lead attorney in a lawsuit involving insulin prices, agreed that lawsuits are valuable because they shine a light on companies’ conduct in a way that state and federal regulators have been unable to do.

“Because there’s not a lot of oversight and because the government agencies responsible for it have not really been doing their jobs for a very long time, the only immediate response that has any chance of making a difference is litigation,” said Widlanski, a partner at Florida-based Kozyak Tropin & Throckmorton.

In suing large corporations, state attorneys general often hire outside law firms on a contingency fee basis.

The limits of litigation

Aaron said successful lawsuits “can hold parties accountable, at least in theory, for illegal conduct and for causing harm. It can increase the cost of engaging in illegal conduct by making that conduct more expensive.”

But Ron Howrigon, a former Cigna executive, cautioned that using litigation to rein in deep-pocketed corporations isn’t as effective as enacting strong laws — however difficult that might be. Howrigon said many large health corporations consider expensive legal settlements to be merely the cost of doing business.

“I don’t think they’re really necessarily worried that the individual litigation is something that’s going to shut it down,” said Howrigon, who is now president and CEO of Fulcrum Strategies, a firm specializing in insurance contracts. “As a friend of mine put it, it’s putting ‘Band-Aids on bullet wounds.’”

What health care corporations are really scared of, Howrigon said, are sweeping policy changes.

“If I’m an insurance company, I’d much rather pay millions of dollars in fines than have a new law that I have to comply with going forward,” he said. “So, I’m not going to say that lawsuits don’t have any impact. But they don’t have nearly the impact as what legislative change would have.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: [email protected]. Follow Stateline on Facebook and X.

Abortion fund directors nationwide have been raising the alarm for months about declining donations and their struggles to meet the needs of those seeking help with the financial burdens of finding abortion care, especially those who live in one of?22 states?with near-total bans or severely restrictive abortion laws. (Photo by Scott Olson/Getty Images)

Advocates for abortion access say compounding crises of abortion bans, rising economic costs and systemic health care issues are beginning to cause significant funding challenges and potential disruptions to reproductive care of all kinds.

Several people described it as a “perfect storm” of problems with the U.S. health care system, particularly post-pandemic, and the rise of abortion bans and other reproductive care restrictions in the wake of the Dobbs v. Jackson Women’s Health Organization decision in June 2022. Many individuals must now travel hundreds or thousands of miles to seek abortion care, and the consolidation of demand at a smaller number of clinics is increasing wait times, which means pregnancies progress to a more advanced stage and the costs balloon further. According to leaders of Planned Parenthood affiliates and abortion funds, there simply aren’t enough dollars right now to support the need at any level. A recent report from #WeCount showed the number of abortions nationwide started to increase in 2017 and has continued to increase post-Dobbs, with more than 102,000 abortions in January alone.

Abortion fund directors nationwide have been raising the alarm for months about declining donation revenue and their struggles to meet the needs of those seeking help with the financial burdens of finding abortion care, especially those who live in one of 22 states with near-total bans or severely restrictive abortion laws. That includes every state in the Southeast.

Planned Parenthood of Northern New England announced at the beginning of the month a projected funding shortfall of about $8.6 million over the next three years, and Planned Parenthood of Greater New York announced just a few days later that it would pause abortion care at or beyond 20 weeks because of financial struggles that began earlier this year. The National Abortion Federation runs America’s largest financial assistance program for abortion patients and said that just in the first half of this year it has partially funded more than 60,000 people’s abortions — a total of around $6 million per month — but has now had to reduce patient grants from 50% of the cost of care to 30%.

Even in areas with new abortion restrictions, such as Florida, donations have declined significantly. Stephanie Loraine Pi?eiro, executive director of Florida Access Network, said during a June press conference that the month after the Dobbs decision ended federal abortion rights, the fund received $200,000 in individual donations — but after the state supreme court decision in April 2024 reduced the state’s abortion ban from 15 gestational weeks to six weeks, the fund received just $40,000 in donations.

“That is a stark difference, and it has everything to do with donors feeling burnt out,” Loraine Pi?eiro said.

States with abortion access face hostile political winds?

Planned Parenthood Federation of America told States Newsroom it is meeting its fundraising goals, but the organization’s local health centers and regional affiliates are struggling to provide care in the current climate.

Nicole Clegg, interim CEO of Planned Parenthood of Northern New England, told States Newsroom the affiliate has always been under-resourced and under-reimbursed for the care it provides, which includes birth control, testing for sexually transmitted diseases and routine gynecological care in addition to abortion services. But now that the region, which includes Maine, Vermont and New Hampshire, is taking on more patients from states with abortion bans, it is reaching a tipping point.

“The services we provide are just not valued by the insurance industry, or Medicaid and Medicare — they have always been poorly reimbursed,” Clegg said. “Once costs really started to skyrocket, the margin we were operating with disappeared.”

According to an analysis of health care spending and costs by KFF, health spending tripled between the year 2000 and 2022, from $1.4 trillion to $4.5 trillion. The pandemic accelerated that spending, but the analysis also said the aging population of the U.S., rising rates of chronic conditions, inflation, and expansions of insurance coverage have also driven up costs.

A bill that would have provided nearly $3.4 million to Maine’s family planning centers got caught in legislative wrangling that affected many appropriations bills at the end of the session.

In New Hampshire, which allows abortions until 24 weeks of pregnancy, the affiliate had nearly secured a multi-year grant of more than $2 million total, with the support of Republican Gov. Chris Sununu. However, Clegg said that when the grant went before an executive council for final approval in 2023, the members struck it down, saying they didn’t want taxpayer dollars to fund abortions. Both led to the projected $8.6 million shortfall over the next three years.

“The executive council has become increasingly hostile to Planned Parenthood,” Clegg said.

Planned Parenthood Great Northwest, which includes northwestern states as well as Hawaii, Alaska, Indiana and Kentucky, also said it is facing financial challenges that put access to care at risk. Lisa Humes-Schulz, vice president of policy and communications for Planned Parenthood Alliance Advocates, said in a statement that the affiliate is facing the same health care cost challenges, an underfunded federal family planning program, workforce shortages and rising labor costs. Great Northwest includes Idaho, where there is a near-total abortion ban and which was at the center of a recent U.S. Supreme Court case over whether emergency room physicians could be prosecuted under the state law for providing an abortion in the case of a medical emergency. The affiliate’s clinics in Washington have seen an influx of patients from Idaho as a result of the abortion ban over the past two years, including some emergency patients that were airlifted out of Idaho.

“Unlike other safety net providers, we are trying to navigate these business challenges on top of the unprecedented political attacks focused on providers of abortion care and gender-affirming care,” Humes-Schulz said.

For Planned Parenthood of Greater New York, financial struggles have already prompted a change in care. After the state legislature failed to increase Medicaid reimbursement rates for medication abortion, the affiliate said it implemented executive pay cuts, consolidated job functions and closed small health centers to make up deficits. More than half of the patients that visit Planned Parenthood centers rely on Medicaid.

But it took another step in temporarily stopping abortions at 20 or more weeks starting Sept. 3 because it can’t afford to cover the vendor costs for anesthesia. Only one Planned Parenthood location in New York City will offer deep sedation and abortions at 20 or more weeks for now.

‘Unprecedented is not even the word anymore’

The struggles also extend to organizations that provide more basic infrastructure for abortion clinics, such as the Abortion Care Network, which started a campaign called Keep Our Clinics to raise funds for independent abortion clinics. Independent clinics make up 55% of abortion providers, according to the network, while Planned Parenthood comprises 41%, and the remaining 4% occur at physicians’ offices and hospitals. The vast majority of clinics offering abortion care after 22 weeks — about 86% — are also independent.

Erin Grant, co-executive director of the Abortion Care Network, told States Newsroom the organization’s mission is to provide grant funding for independent clinics to support infrastructure needs — such as supplies, equipment, building repair, security, and litigation support — rather than patient care. The network has supported 32 clinics, and gave out $700,000 to providers in recent months.

But for the network too, donations are down by one-third. The full amount of donations to the Keep Our Clinics campaign goes to clinic members, and the organization granted nearly $5 million to clinics in 2022, but only $3.4 million in 2023. The requests for support did not go down during that time, but donations did.

Grant said it’s important to support the infrastructure of independent abortion clinics because once they close, it is extremely difficult to work through the bureaucratic process again to reopen them. In areas with newly instituted six-week abortion bans, such as Florida, Iowa and South Carolina, more clinics have closed their doors.

“We are in times where ‘unprecedented’ is not even the word anymore, and there is so much happening that calls for our attention. … There’s a need in this moment for us to hold multiple crises across communities,” Grant said. “… This isn’t something we get to say we did as an immediate need, because there’s decades of work ahead to build the actual infrastructure to have health care access, let alone abortion access in this country.”

During a June press call, several leaders of state abortion funds discussed funding struggles. Oriaku Njoku, executive director of the National Network of Abortion Funds, said the funds provided more than $36 million in abortion funding and $10 million in logistical support in 2023.

“This is not the same movement that it was five years ago, let alone 50 years ago, and yet we’re still operating and funding as if it were the same issue as it was before,” Njoku said.

There are nine clinics in Ohio, where voters affirmed their desire to keep access to abortion in 2023, but it is surrounded by three states with near-total bans — Indiana, Kentucky and West Virginia. Lexis Dotson-Dufault, executive director of the Abortion Fund of Ohio, said during the press conference that her organization averaged about 100 patients per month in 2022, but now it averages more than 500.

“While abortion funds have a huge increase in need, we are not seeing a huge increase in money coming in to support this need,” Dotson-Dufault said.

National Abortion Federation: Without cutbacks, funding would run out by fall?

Planned Parenthood Federation of America, the national organization, did not directly address whether it would provide more support to the affiliates facing significant financial troubles.

“While issues around funding are a concern, it is important to note that the reproductive health care ecosystem is straining under the weight of the post-Dobbs crisis,” a Planned Parenthood spokesperson said in a statement. “PPFA is working to support affiliates as they take action to adapt and continue to provide care.”

The organization’s comments came a few days after 41 abortion funds from around the country signed on to an op-ed in The Nation saying there is a disconnect between the most visible national reproductive rights organizations, like Planned Parenthood and the National Abortion Federation, and grassroots groups working to directly support those who need care. The op-ed called out the National Abortion Federation for cutting back its financial assistance program in July, from 50% of the cost of seeking care to 30%. Signers included the Abortion Fund of Ohio and the Florida Access Network.

Brittany Fonteno, CEO and president of the National Abortion Federation, called the change an “incredibly heartbreaking and difficult” decision that had to be made despite an “incredible and generous budget” that is the largest it has ever been. She said that in the first half of this year, NAF was funding at $6 million per month for abortion care, and then upwards of $200,000 per month in patient assistance funds to help with associated travel costs. These patient assistance funds are completely funded by foundation and individual donors, Fonteno said, noting that individual donations dropped nearly 40% in 2023 from the previous year after the Dobbs decision leaked.

In 2023, NAF said it funded 106,865 people with an average amount of $519 per patient. So far in 2024, the hotline has funded 66,330 people at an average of $541 per patient.

“We’re truly in a public health emergency right now, and unfortunately, we just can’t keep pace with the patient need,” Fonteno told States Newsroom. “We had to make this decision in order to make sure that we could stretch our funds and make sure that we could help as many people as possible for the rest of this year. If we hadn’t made this decision, then we would have run out of funding in the fall.”

The changes include no longer making exceptions for those in later stages of pregnancy who face higher costs — sometimes as much as $10,000, Fonteno said — because the procedure costs more or they have to travel further to find a clinic that can provide it. That “exception budget,” which was also used for patients facing extreme circumstances like intimate partner violence, will not exist for the remainder of the year, according to Fonteno.

“Of course, we’re working incredibly hard to try to fundraise, to try to get the word out and bring awareness to this issue. And if we’re able to fundraise, we may be able to consider increasing the funding that we’re able to do,” she said.

Presidential election matters, director says?

Clegg, interim CEO of Planned Parenthood of Northern New England, said the problems will only get exponentially worse if the presidential election in November breaks for Republicans over Democrats. Project 2025, the blueprint document produced by the Heritage Foundation for the next Republican presidential administration to follow, calls for the federal government to prohibit Planned Parenthood from receiving any Medicaid funds (for non-abortion reproductive health services; federal funding of abortion is currently prohibited) and issue guidance to states that says they are free to defund Planned Parenthood in their state Medicaid plans as well.

Instead, it calls for the funding to be redirected to “health centers that provide real health care for women.” The anti-abortion organizations involved in crafting the document, such as Susan B. Anthony Pro-Life America, often promote funding for crisis pregnancy centers, which counsel pregnant patients against abortion and are known to spread misinformation about the procedure. A recent analysis from reproductive rights advocacy group Equity Forward showed nearly $490 million was allocated in 23 state budgets over the past two years for crisis pregnancy centers, most of which were in the same states that restrict abortion access.

“It’s not just making sure the public understands that we need them to engage and partner with us to make sure we can keep providing the care; it’s also having them connect the dots to the November election and understand that who they vote for, who they put in office is going to determine our future,” Clegg said.

Hundreds of people rallied at the Alabama State House in Montgomery, Ala., in February in support of legislation to protect in vitro fertilization. Democrats are hoping that increased engagement on the issue of in vitro fertilization will translate into voter turnout at the polls in November. (Brian Lyman/Alabama Reflector)

Marilyn Gomez was sitting at her kitchen table in Charlotte, North Carolina, on Feb. 16 when news alerts and friends’ texts began pinging her phone: The all-Republican Alabama Supreme Court had ruled that frozen embryos created through in vitro fertilization were children under state law. That meant providers could be held liable for discarding them, a common part of the IVF process.

As Alabama clinics began suspending IVF services and public outrage mounted, politicians on both sides scrambled to distance themselves.

In Gomez’s quiet kitchen, it all felt deeply personal.

“I remember thinking, this is the only way I was able to become a mother,” Gomez told Stateline. She and her husband went through years of fertility treatments and multiple rounds of IVF before the birth of their daughter in 2016. Without freezing her embryos and going through IVF, she said, “I would not be a mom. My 8-year-old would not be here.”

Gomez owns a small business, called Infertile Tees, where she designs and sells shirts and accessories aimed at people experiencing infertility. Less than two hours after hearing about the Alabama court ruling, Gomez, who describes her political views as Democratic-leaning, had created a new set of T-shirt designs featuring the slogan “Protect IVF.”

In the wake of the Alabama ruling, potential threats to IVF access have become an election-year issue, pushing many political novices toward involvement and activism. Reproductive rights groups say they’ve seen unprecedented interest in protecting IVF access, and Democrats hope it will motivate voters in the swing states that will decide the election, including North Carolina.

At least 19 states — either through state law, criminal statutes or case law — have declared that fetuses at some stage of pregnancy are people, according to a 2023 report by Pregnancy Justice, a nonprofit that conducts research and advocates for the rights of pregnant people, including the right to abortion. Such statutes could, in theory, be used to restrict or ban IVF by classifying the destruction of embryos as causing the death of a child. The Alabama high court cited so-called fetal personhood language in the state constitution when it issued its decision.

North Carolina isn’t one of those 19 states, but conservatives there have been testing the waters.

A bill proposed last year by three Republican state representatives would have banned abortion from the moment of fertilization, and last year an appeals court judge terminated a woman’s parental rights for conduct during her pregnancy because “life begins at conception,” though the opinion was later withdrawn.

Michigan, Pennsylvania and Wisconsin, all swing states, do have laws that include references to “unborn children.” And in Georgia, another contested state, the state’s abortion ban defines a person as “any human being including an unborn child.”

Democrats are eager to highlight the issue. The newly minted Democratic vice presidential candidate, Minnesota Gov. Tim Walz, has been outspoken about the seven years of fertility treatments he and his wife, Gwen, went through before conceiving.

“This is very personal for my wife and I,” Walz told a crowd in Eau Claire, Wisconsin, last week. “I remember each night praying that the call was going to come, and it was going to be good news. The phone would ring, tenseness in my stomach, and then the agony when you heard the treatments hadn’t worked.”

Republicans say the idea that IVF is under threat is overblown, and dismiss Democratic warnings as scare tactics.

“There is no concerted Republican, conservative, pro-life effort mounting against IVF,” said Cole Muzio, executive director of Frontline Policy Action, a Georgia organization that lobbies for abortion restrictions and other conservative policies.

“I think this is something the left largely has tried to use as a wedge issue, but I don’t think most people are buying it as something that’s a real threat,” he said.

But Muzio acknowledged that some anti-abortion advocates have asked his organization to talk more publicly about IVF. And he predicted that eventually, more conservative lawmakers will turn their attention to the issue.

“Long term, we believe in the value of human life, and that’s my concern with IVF, that it results in the discarding of human life,” he said. “Now that Roe has been overturned and we’re able to have legislative conversations and think about where life begins, it’s an important conversation to have.”

Following public backlash over the Alabama court decision, lawmakers in a dozen states, including Alabama, introduced bills to protect IVF, according to the Guttmacher Institute, a research organization that supports abortion rights.

But so far, only Alabama has enacted a law. In March, Alabama’s Republican-majority legislature hastily passed a measure shielding IVF providers from criminal and civil liability. The only other bill that gained traction was one in Louisiana, where both legislative chambers approved it. However, it was scuttled in May after the state’s powerful anti-abortion lobby opposed the removal of fetal personhood language that would have left IVF providers open to criminal prosecution and civil lawsuits.

Far-reach consequences

For many people, the IVF issue illustrates how fetal personhood laws can have consequences far beyond abortion. And it has energized them.

The National Infertility Association, which goes by the name Resolve, has held a national advocacy day annually for more than two decades. This year, after the Alabama Supreme Court decision, more than a thousand people attended the event virtually, twice the number that attended last year, said Barbara Collura, CEO of Resolve.

“We ended up with our largest advocacy day ever,” she said. “More than half of the people attending were brand new to the event. We feel very much that what happened in Alabama motivated people to figure out a way for themselves to get involved.”

In North Carolina, Gomez sold out her “Protect IVF” T-shirts within 24 hours. She launched a new batch a week later, and sold out again. Since then, she’s continued selling new “Protect IVF” designs, donating a portion of her proceeds to Resolve.

Before getting involved in IVF advocacy, Gomez said she barely paid attention to politics. Now, she’s been active in supporting pro-IVF legislation and contacting her state lawmakers. And she often fields Instagram messages from customers in other states who are scared, she said, and want to know what they can do.

“People are saying to me they didn’t know IVF was on the line, that they were surprised it wasn’t protected in every state,” said Gomez, who sends them links to sites where they can learn more about the state of IVF access where they live. “Customers are saying their parents and grandparents are having these conversations in their social circles, saying they wouldn’t be grandparents without IVF.”

She added: “I think we forget how much power we have. Regardless of what happens with the presidency, we have so much control over what happens in our state.”

‘New territory’

Less than two weeks after the Alabama court decision, Jamie and Dontez Heard stood at one end of a long hallway on the fourth floor of the Alabama State House, staring nervously at all the doors of state lawmakers’ offices. They considered turning around and going back home.

“It was intimidating, and it was scary, not knowing what to say, thinking, ‘I’m going to stumble over my words,’” Jamie said. “What if I say the wrong thing? Neither one of us has ever been in any type of advocacy role, so this was new territory.”

The couple had driven down to Montgomery that morning from their home in Birmingham, anxious but determined to defend their chance at having another baby by convincing their legislators to save in vitro fertilization.

The court decision had landed just two days after the couple met with a specialist in Birmingham to begin a new round of IVF. They’d conceived their son, Legend, now 2, through IVF in 2022 after years of struggling through infertility. They’d hoped to add another child to their family this year.

“It was devastating,” said Jamie. “We didn’t understand what it meant for us and our family.” But a few days after the ruling, she saw a social media post that her fertility clinic had shared about a gathering of IVF families and supporters at the state Capitol.

“I knew then that we needed to be there,” she said. “We couldn’t afford to sit on the couch and wait and see how this plays out.”

Since speaking to Alabama lawmakers, Heard has testified before Congress and traveled to other states to advocate for federal and state laws that would protect access to IVF.

Next door in the battleground state of Georgia, one of the biggest reproductive justice advocacy organizations in the Southeast recently launched its first-ever Black (in)Fertility Awareness Week. SisterSong, which is focused on reproductive rights for women of color, hosted a panel, documentary screening, online discussions and a raffle of $40,000 in fertility services for Black Georgia families.

Leah Jones, director of maternal health and birth equity at SisterSong, said the new initiative had been in the works for a while, but the Alabama ruling highlighted for people how IVF access is connected to other reproductive health issues, from preconception through pregnancy to postpartum.

“What we realized when we started this conversation around infertility in Black communities and listening to their stories, these are the same people talking about maternal health, abortion, mental health, birth justice,” said Jones. “Once you make the connection that this is part of an attack on overall bodily autonomy, I think that’s when it clicks for people.”

Even in Minnesota

As Minnesota’s governor, Walz in 2023 signed a law confirming the right to abortion and other reproductive health care in Minnesota.

And yet Minnesotans like Miraya Gran felt the shockwaves from the Alabama court decision. Gran and her husband struggled for years with infertility before finally conceiving their daughter Isla, now 3, through IVF.

Gran advocates for a Minnesota law that would require health insurers to cover fertility treatments.

“We saw some great momentum after the Alabama decision,” said Gran. “It didn’t really matter which political party you were a part of. If you believed in access to IVF, you joined our group.”

Gran said she considers Minnesota a “safe state” for IVF access and other reproductive rights, at least for now. “But we look to our neighbors in Iowa, where they introduced some personhood bills recently. It’s terrifying. It’s too close to home.”

Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. Contact Editor Scott S. Greenberger for questions: [email protected]. Follow Stateline on Facebook and X.

Psychologist and Eastern State Chief Administrative Officer Lindsay Jasinski celebrates with emergency psychiatrist and Eastern State Chief Medical Officer Andrew Cooley at the July ribbon cutting for EmPATH. (UK Photo)

This story mentions suicide and mental health. If you or someone you know is contemplating suicide, please call or text the Suicide Prevention Lifeline at 988.?

Kentucky’s first psychiatric emergency unit cared for more than 150 people in its first 10 days of operation — more than half of whom were dealing with suicidality.

The EmPATH (which stands for Emergency Psychiatric Assessment, Treatment and Healing) unit is on Eastern State Hospital’s campus in Lexington, but is serving a wide-ranging population, with patients traveling from as far as Danville, Ashland and Somerset. It opened July 30, the first of its kind in Kentucky.?

There are 30 EmPATH units in the country, which have open floor plans, as opposed to individual rooms. People who seek care during mental health crises can walk around, hang out on a patio for fresh air and even talk to peer support specialists who have histories of mental health issues and can relate to patients.?

“??They can move … to an area that has sunshine and they can see outdoors, but it allows them to sort of choose their space, whatever works for them, to help decompress whatever that behavioral health crisis was,” Eastern State Chief Administrative Officer and psychologist Lindsey Jasinski said.?

Kentucky’s EmPATH unit, funded by the University of Kentucky,? is about 11,000 square feet, has a 12-person capacity and only sees patients 18 and older.?

Anyone who is experiencing a mental health crisis that is impacting their day-to-day functioning can seek help at the unit at 1354 Bull Lea Road in Lexington.?

How does the EmPATH unit work?

As soon as a patient comes into EmPATH, they’re seen “nearly immediately,” Jasinski said. The facility takes insurance, but will treat people whether or not they have it. If that is the case, Jasinski said, the unit works with that patient to develop a sliding scale payment plan based on their ability to pay, which means they won’t face a flat rate.?

The unit has three peer support specialists — employees who have histories of mental health issues and are specially certified to speak peer-to-peer with patients — who are available seven days a week from 10 a.m. to 10 p.m.?

These specialists greet patients as soon as they walk in the door. They may ask a new patient if they need food or water, sunshine or air. They are also trained in de-escalation.?

“The key part of what they provide in this environment, and this is sort of central to all of what EmPATH does, is they provide hope that things can be different,” Jasinski explained. “And I think that is a very, very powerful message for someone to leave with, not only the medications they need, not only the therapy they need, but a sense of hope that things can be different.”??

As soon as they arrive, patients receive a pillow, blanket and a recliner, which they can move around the unit as they see fit.?

Patients can stay up to 23 hours in the unit, after which they either go home or are transferred to inpatient care or substance use recovery treatment.?

If there is immediate risk the patient will hurt themselves or someone else, staff can involuntarily hold them. But that is rare, said Marc Woods, who’s worked at Eastern State Hospital for more than 30 years and is its chief nursing officer.

“Safety first,” emphasized Dr. Andrew Cooley, a UK HealthCare psychiatrist and chief medical officer for Eastern State Hospital. “We are going to protect someone who can’t protect themselves. And if that requires further inpatient admission, then that’s what we would have to do. That’s when it would convert from a voluntary process to involuntary.”?

But most — Woods estimated about 90% — of the unit’s patients go home after visiting the unit.?

In its first week and a half of operation, patients were a mix of walk-ins and outside referrals.?

Decreasing mental health stigmas?

Stigma around mental health in general and around mental health hospitalization is improving, Woods said, but it’s still present.?

“We’ve had a couple of families and patients even come in … saying that they’ve really avoided seeking help because they don’t want to go to the (emergency department), or, they’re embarrassed by having to go to the ED,” Woods said. “And they’ve come to us, they’ve expressed they were happy to have a place to come where they felt like they didn’t have to be embarrassed by some of the things they had going on in their lives.”?

Stigma is perpetuated, Jasinski said, when people and media link mental illness with violence.?

But: “Our folks with mental illness that we see are much more likely to be victims of violence than perpetrators of violence,” she said.?

She and the other EmPATH staff are keen to break through stigma around mental illnesses. They will measure success in this effort, they said, by making sure people are coming and getting help from the unit and when they see the number of deaths by suicide decrease. In 2022, at least 823 Kentuckians died by suicide, according to the Centers for Disease Control and Prevention. The suicide prevention lifeline is 988.?

“If we can treat behavioral health emergencies just like any other need, we can reduce stigma around that, and this allows folks to get very timely, effective intervention and stabilization for behavioral health crisis in a specialized setting for them,” Jasinski said.?

Part of de-stigmatizing mental health is to decriminalize it, she said, which is a goal the staff is working toward.??

“Historically, within the mental health system, there’s been a lot of involvement of law enforcement,” Jasinski said. “There’s some criminalization that has happened with mental illness. What would be great is if law enforcement never had to touch these folks.”?

Easing strain for physical health emergency rooms?

A key part of Kentucky’s EmPATH unit is to treat mental illnesses in the state and lower stigma around that care. But it also “makes an impact on the entire ecosystem,” Cooley said.?

“With this design, patients that have mental illnesses are not congesting routine emergency rooms, where … they would wait commonly for hours and hours,” he said.?

And traditional emergency rooms aren’t trauma-informed and calming places, Jasinski said.?

“If you are anxious or overwhelmed, it is not a place that’s going to make you feel less anxious,” she said. “Typically, it’s very loud. There’s a lot going on.”?

Medical providers are also going to prioritize patients with gunshot wounds or heart attacks, Woods said. At EmPATH, though, staff have a singular focus on treating the mind.?

“This is a low bar type of entry,” Cooley said. Staff will medically screen anyone who walks through the door. “In the past, emergency services — or urgency services — had high bars, and the threshold was way too high: ‘You’re too sick’ or ‘you’re not sick enough.’”?

He added: “We’re not saying no to anybody who walks in the door.”?

Even if the unit is at capacity, Jasinski said,?we would still see patients, medically screen them, and then decide the best place for them to be.”

They could also be transferred to a nearby hospital unit, if need be, she said. “Our goal is to treat every patient we can possibly serve.”

The hope for expansion?

Not yet two weeks in, “What we’ve learned is that we’re going to be busy, and we have been busy already,” Jasinski said.?

But she and others are already looking to support organizations around the state that want to open similar units.?

“We don’t want this to be the only EmPATH,” she said. “There needs to be many, many more of these.”??

Chan Kemper with her daughters, Tavi and Mika. (Photo provided)

This story discusses postpartum depression and suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988.?

Before having children, Chan Kemper pictured how the experience would go.?

“I was determined to have the hippiest, dippiest, crunchy, earth goddess pregnancies and deliveries that I could have,” said Kemper, 43.?

The attorney, who is from the Virgin Islands and now lives in Louisville, researched “the crap out of pregnancy” and her baby, she said. “I didn’t do that much research about after.”??

She had a fairly smooth experience with her first baby, Tavi, whom she had at 37. In fact, she said, it was “so fine” that she and her husband decided to have another baby right away.?

After having her second child, Mika, at 39, “it was just immediately different,” said Kemper, who was then diagnosed with postpartum depression (PPD).?

Her blood pressure spiked and she could not breastfeed. She cried nonstop — to the point of dehydration. Prozac didn’t help what Kemper described as a “profound sense of sadness.” She feared her baby would die, a fear that escalated when Mika had to be hospitalized with a severe urinary tract infection.?

Eventually, “I just thought to myself, ‘I don’t want to be here,’” she recalled. “And I meant like, ‘I don’t want to be here on this Earth.’ And I had never felt like that in my life, ever.”?

Kentucky therapists who treat postpartum and perinatal depression said people who have it can often experience suicidal ideation — which needs to be addressed immediately. People with PPD also often experience headaches, irritability, trouble sleeping, anxiety, depression, low self esteem, visceral feelings of panic, trouble connecting with their baby and more.?

Societal stigma and cultural shame can compound these symptoms, therapists say, making it a debilitating illness.?

The illness can affect anyone, therapists say, but is more likely to affect people of color and those with a history of trauma, anxiety and/or depression.?

What is postpartum depression??

Rebecca Kerr, a Bowling Green therapist who specializes in PPD, said it falls under the umbrella of perinatal mood and anxiety disorders (PMADs) and is “very common.”?

PPD “doesn’t necessarily discriminate,” said Kerr. “Really, anyone could experience postpartum depression, but there are populations that may be more vulnerable. So, if you have a personal history of depression, anxiety, OCD (obsessive compulsive disorder), anything like that, you may be more prone to experiencing it.”

Wesley Belknap-Greene, a Richmond therapist, said it’s important to distinguish between PPD and the “baby blues.”?

Baby blues can mimic some of the symptoms of PPD — but they don’t last past two weeks and come on because of hormone shifts following delivery.?

“A lot of people, probably especially around here, who have experienced actual true postpartum depression have systematically, continuously been told ‘oh, it’s just the baby blues,’” said Belknap-Greene. “Whether that’s a thing with rural America, Appalachia, … mental health has not been talked about in this country historically.”?

Baby blues is an “emotional disruption” for sure, she explained. But “perinatal depression, or postpartum depression, is this? debilitating, very difficult, deep, dark depression that makes it difficult for the mother to be able to provide care to herself, let alone her baby.”??

The film industry has added stigma, Belknap-Greene said, by depicting PPD as a condition in which a mother wants to kill her baby. While it can take that form, she said, it’s “very rare.”?

Chan Kemper’s story?

In addition to feeling like she didn’t want to live anymore after giving birth to her second child, Kemper recalls feeling guilty for feeling that way.?

“I had … access … to a lot of things, and I still felt alone,” she said. “As a Black woman, I felt even more like I’m supposed to be strong, and I wasn’t. I wasn’t strong at all.”?

Even her cat, Cosmo, whom she described as “the worst cat ever,” was “distressed by my distress.”

Kemper’s blood pressure spikes turned out to be panic attacks — and she feels her race was a factor in those symptoms being dismissed. She went to the hospital when she “felt like I was having a heart attack” with “insanely high” blood pressure and sat waiting for care.?

“I think there would have been more concern or care if I had not been a Black woman,” said Kemper, who is also Jewish. “I’m … larger, I’m tall, and I feel like it’s like, ‘oh, she’s strong, she’s fine.’ And it’s like, ‘no. I deserve, and I need, help.’”??

But, she said, lack of mental health care for new mothers is an equal opportunity offender “across the board.”?

Kemper got into therapy and on the right dosage of medication, and is doing “so much better” but “I’m still crawling my way out of this.”?

She would like to see classes focused on PPD, just as there are birth classes, as well as more public health education about PPD.?

“There’s so many red flags,” she said. “We don’t talk about it. … I think it’s so important to talk about things that are stigmatized.”??

She predicts fewer new mothers would be surprised by the symptoms if more people — and health organizations — talked about PPD publicly.

“I had no clue that this could ever happen to me,” Kemper said. “I did not in a million years think that there were signs that I should have been looking out for or having my partner look out for.”?

Kemper isn’t alone. Other Kentucky mothers who spoke to the Lantern about their PPD experiences described feelings of loneliness and depression exacerbated by shame and guilt that took them by surprise.?

Proctor and Luntzel?

Vashti Proctor, one of those mothers, found out she was pregnant — unplanned — in March 2021. COVID-19 was everywhere and racial justice protests were ongoing following the police killing of Breonna Taylor in Louisville.?

Proctor, who lives in Louisville, said she considered abortion, which was legal at that time in Kentucky.?

“I was literally scared out of my mind to think that I’m gonna enter a Black child, a Black baby, into this world when a Black woman was just shot and killed … in her home,” Proctor said. “That was very, very scary for me.”??

With support from her family, she decided against abortion and gave birth to Aaliyah in December 2021. At her four-week checkup, she got on Zoloft to help with her PPD symptoms.?

The stressors compounded quickly. Proctor, who had to work, couldn’t find child care — much less affordable child care — for the baby. So, she took her to work with her until she found an opening — which remains her second highest bill behind only rent.? She nursed on demand while not being able to sleep at night.?

The first person in her friend group to have a baby, the then-28-year-old had entered a new chapter of life her friends couldn’t relate to. The COVID-19 pandemic also kept her from a social life. Therapy was too expensive. There was a national formula shortage.?

All this made her feel “really heavy” and “very overwhelmed,” she said. Having more accessible child care would have helped her in her transition to motherhood, she said.?

It would also be helpful if there were more medical providers who look like her, she said. A 2020 study from the Proceedings of the National Academy of Sciences found that Black babies were twice as likely to survive when their doctor was also Black.?

Autumn Luntzel of Bowling Green had a slightly different experience. She felt immense guilt when she had her son in late 2019 and the depression, numbness, anxiety and sadness hit her.?

“I’m never going to be a better mom,” she remembers thinking. “My husband’s never going to divorce me so I need to just end it all so (my son) can have a better mom.”?

Reid, her son, was happy and healthy. Her husband was “very hands on.” Her career thrived.?

But Luntzel, the daughter of Bangladesh immigrants, felt tremendous pressure to be perfect, she said.?

“My whole personality is my parents — specifically my dad — sacrificing everything to have the life that I have,” she said.?

So, she thought, “here I am being sad and I shouldn’t be.”?

In February 2021, Luntzel attempted to end her life: “I truly believed that Reid, my son, needed a better mom because I couldn’t be a good mom to him because of the way that I was feeling.”

Her husband found her after that attempt, and helped her get into an intensive six-month therapy program, where she began taking medication. She no longer lives with suicidality and advocates for mental health in her community.?

What policies could help combat PPD in Kentucky??

PPD doesn’t have much space in The Diagnostic and Statistical Manual of Mental Illnesses (DSM) — a paragraph compared to pages for other conditions, Belknap-Greene said.? More research and space for the condition is much needed, she added.?

Kentucky also needs a universal, paid parental leave, she said. That would put it in line with 13 states and Washington D.C. that provide paid family and medical leave.??

“If mom and dad — or mom and mom, dad and dad, whatever that nuclear family looks like — if there’s not that opportunity to provide secure attachment, we’re looking at a whole host of other issues for the baby,” said Belknap-Greene.?

Research published in the National Library of Medicine in 2023 backs up the importance of leave, saying that “paid, longer maternity leave is associated with less postpartum depression.”?

During the 2024 legislative session, a bill that would have given teachers 20 days of maternity leave died. Another bill to give state workers with at least a year on the job up to four weeks of paid leave made it through the Senate but failed to advance in the House.?

There is bipartisan appetite in Congress to pass paid parental leave, with bipartisan and bicameral working groups working on solutions. Members’ legislative framework for such solutions includes having public-private partnerships and cross-state program harmony.?????

Meanwhile, Kentucky therapists and mothers who spoke to the Lantern agreed: screening mothers earlier would be a huge step toward combating postpartum depression and anxiety early.?

“We should start screening moms before they deliver,” said Kerr. But certainly, screening them as they are leaving the hospital after delivery would help as well.?

“If it were up to me, that would be a thing that had to be discussed before discharge,” Belknap-Greene said. And: “A follow up appointment for mom needs to be done much sooner than the two-week checkup for the baby.”?

Because she spent so much time internalizing her PPD symptoms, Luntzel said having OB-GYNs better trained to spot those symptoms early would have helped her. She’d also like to see mental health professionals give on-site consultations with new moms at hospitals after delivery.?

Mental health services like therapy should generally be more accessible as well, she said. The Lantern previously reported Kentuckians are more likely to pay out of pocket for mental health services than medical services.?

“Mental health, in general, I think, needs to be discussed more because our brains are so complex, and yet we treat it like it’s just this one being and that’s just not it,” Luntzel said. “I don’t think it’s okay to treat it like that.”?

People with symptoms of long COVID attend a Senate Committee on Health, Education, Labor and Pensions hearing on long COVID in January. A group of senators is now urging the Social Security Administration to grant greater access to disability payments for people with long COVID symptoms. (Photo by Drew Angerer/Getty Images)

Seven U.S. senators have called on the Social Security Administration to make it easier for people with long COVID to access disability benefits, actions that disability rights advocates and patients say are desperately needed.

In a letter released Monday, they said the agency should make the process more transparent, track and publish data on long COVID applications, and consider expanding the listing of impairments the SSA considers in applications for benefits. The letter was signed by Sens. Tim Kaine (D-VA), Ed Markey (D-MA), and Tammy Duckworth (D-IL), Bernie Sanders (I-VT), Tina Smith (D-MN), Angus King (I-ME), and Richard Blumenthal (D-CT).

“In some situations, these symptoms can be debilitating and prevent an individual from being able to work, take care of their family, manage their household, or participate in social activities,” the senators wrote to SSA Commissioner Martin O’Malley.

Long COVID is a chronic health condition, which often includes fatigue, brain fog, and shortness of breath, following a COVID-19 infection. About three in 10 American adults have had long COVID at some point?according to KFF’s April analysis of long COVID data. About 17 million people had it in March 2024. In 2021, the U.S. Department of Health and Human Services released guidance on long COVID as a disability under the Americans with Disabilities Act.

Kaine has been outspoken about his own experience with long COVID and Sanders introduced legislation this month to provide $1 billion in funding each year for 10 years to support long COVID research by the National Institutes of Health.

Lisa McCorkell, co-founder of the Patient Led Research Collaborative, a group of long COVID patients and patients with associated illnesses, told States Newsroom, “Creating a ruling or listing would be a huge improvement — having that specific guidance for how to document long COVID, its related diagnoses, and its associated impairment would assist physicians who may not be as knowledgeable about long COVID.”

The SSA administers disability benefits through Social Security Disability Insurance and Supplemental Security Income programs. The former program requires past employment payment into Social Security. The latter one does not have those restrictions and is based on financial need but to receive benefits, applicants have to prove they qualify as having a disability. The average monthly disability benefit for Social Security Disability Insurance is $1,538.

Long COVID’s economic cost

Researchers and economists are still trying to understand the full impact of COVID-19 infections and long COVID on the workforce. A 2023 study estimated that COVID-19 brought down the labor force by 500,000 people and that the average loss of labor is equivalent to $9,000 in earnings. More than 25% of people with long COVID said their condition had an impact on their employment or work hours, according to a 2022 Minneapolis Fed paper.

Long COVID is not going to go away, particularly as government protections on the federal, state, and local level to reduce the spread of COVID are “severely lacking,” said Marissa Ditkowsky, who serves as the disability economic justice counsel at the National Partnership for Women & Families, an organization focused on health, economic justice, and reproductive rights for women and families.

“While COVID continues to be a reality, we know that COVID disproportionately impacts women, disabled folks, and people of color, and the folks who are most impacted already have issues with access to appropriate health care, access to employment, and access to equitable wages,” said Ditkowsky, who has long COVID herself. “A lot of folks might be working in low-wage jobs where they’re in the service industry and constantly out there and more likely to contract COVID. It starts not just with the programs for how to deal with folks with long COVID, but how to prevent people from getting long COVID.”

In the meantime, she said people with long COVID, as well as other people with disabilities, would benefit from the changes senators are advocating, such as restoring the treating physician rule, which was repealed in 2017. The rule allowed the agency to give greater weight to medical evidence from a physician who treated a patient for years compared to, say, a doctor who examines a patient once.

“Giving your own doctor the weight [they] deserve is huge,” Ditkowsky said.

Mia Ives-Rublee, senior director of the disability justice initiative at the Center for American Progress, a liberal think tank, said there is an opportunity for the Biden administration or the next administration to revamp how the agency administers disability benefits. She said that given the aging population, there is more reason than ever for the agency to make significant improvements to the application process. Advocates for people with disabilities say it’s also imperative to boost funding for the agency.

“Not only are we seeing an increase in disability in younger folks, but we’re also looking at the big boomer generation getting older … We’re going to see a huge pressure on the [SSA] and we need to see real changes and funding and think of ways to manage the wide variety of experiences that people have in order to deal with differences in applying for these benefits,” she said.

Carole Johnson, the administrator of the Health Resources and Services Administration. (Kentucky Lantern photo by Sarah Ladd)

LOUISVILLE — Carole Johnson, the administrator of the Health Resources and Services Administration for the Biden administration, was in Louisville Thursday to discuss ways Kentucky can improve maternal health outcomes.?

After moderating a roundtable on the topic, Johnson discussed maternal health issues facing Kentucky with the Lantern. The conversation has been edited for length and clarity.?

Kentucky Lantern: Maternal health issues are very complicated, very intersectional, but in your work, do you ever see there is one domino issue, if you will, that, if you can tackle that, other things sort of fall into place??

Carole Johnson: It is a lifespan issue. That’s why we really think about it as: We have to support women of reproductive age in the community. We have to make the clinical setting as high quality and ready for complications as possible. We have to have a system that gets people connected to prenatal care as quickly as possible, and then postnatal.?

We have to make sure that — new parenting is hard — that people get the supports that they need, and that we’re tackling things like maternal depression. So, we really think about it as that continuum.?

I think sometimes with health policy problems, we tend to think about, ‘well, what happens inside the four walls of the clinic?’ And this is not one of those issues. This is an issue that’s about that, but it’s also about all the other ways that we make sure that pregnant women and new moms are healthy.?

KL: I know Kentucky is not alone in this, but in Kentucky, we see a lot of our statistics around maternal health impact Black women and other women of color more than white women. Does racism play a role in driving that fact? And if so, how do you tackle racism with policy??

CJ: What we know is what the data tells us, which is that Black and Indigenous women are dying at two to three times the rate of white women, and those disparities persist even when you control for things like education or income or the like. So there are systemic issues here that we have to address, but part of it is obviously about access … and being heard in the healthcare system.?

What we hear repeatedly when we do these roundtable sessions around the country is about women’s voices not being heard. Women know when something’s wrong or know when they need something, and their voices are not always heard.?

It matters that we center this work around women’s experiences, and that’s why we’re doing things like investing in community-based doulas so that women have an advocate and a voice in the healthcare system, particularly when they’re pregnant, when … all their energy should be about making sure they’re managing their own health, not about trying to fight for the access and services they need.?

That’s why we’re investing in more midwives. That’s why we’re investing in more (obstetricians) who come from the communities that we want them to serve in. That’s why we’re really focused on what does access look like? And access that isn’t just about checking a box on a map, but that actually is a trusted community provider that will listen to and support women’s needs.

KL: For the past few years, we’ve had a bipartisan debate in Kentucky on whether or not we should clear the path to have freestanding birth centers. Do those tend to help statistics around maternal mortality??

CJ: Sometimes the scope of services in freestanding birth centers can raise different levels of debate.?

Where there are freestanding birth centers that are able to manage less higher complexity deliveries, in a place where there’s a maternal health desert, … those are the kinds of things that we have to be thinking about.?

There are far too many counties in this country where access to maternal health services means getting on the road and driving for a very long time and and often ending up in the emergency room in a community hospital that may not have the preparedness and all the strategies that are necessary to have the healthiest deliveries.?

KL: Some of our debate revolves around the concern that rural hospitals could lose income as a result of people choosing to go to another facility. Do you see that as a problem, generally?

CJ: I actually think rural hospitals can be creative about thinking about what kind of partnerships in the community they can have. So I don’t know that it has to be an either or question if we can think about the kind of partnerships that would make it possible for rural hospitals to be part of that solution too.?

KL: We heard a lot today about mental health and substance use disorders. How key is it to talk about mental health when we talk about maternal mortality??

CJ: Mental health and substance use disorders are the leading cause of maternal mortality, and the data clearly shows about 80% of maternal deaths are preventable. That is a call to action for all of us around addressing maternal mental health and substance use disorders.?

It is heartbreaking, the stigma that still exists around these issues. A lot of times, when women are pregnant, … they think they have to be super women. We need to make sure that there’s a low barrier to entry to getting support and services for mental health and substance use disorders.?

We’re actually fighting right now in D.C. to make mental health and substance use disorder required services in our primary care settings, because that’s what we need to do. We need to make it part of the equation. We don’t want to be in a place where someone’s ready for help and raises their hand and what they get is a referral (to) ‘go call these numbers and see if you can find someone.’

KL: A key part of Kentucky’s Momnibus bill that became law this year is that the state made pregnancy a qualifying condition for insurance coverage in Kentucky. How important is it to have that insurance and to get that prenatal care??

CJ: We in the Biden Harris administration, one of our proudest accomplishments is getting health insurance to more people.?

It’s vital that we do that and we do everything possible so that people have coverage. We also need to make sure that there’s a place you can use that insurance card and we need to make sure that’s a high quality place that you can use that insurance card.

Coverage is critical, but it’s not sufficient. We need more.?

HRSA Roundtable in Louisville (Kentucky Lantern photo by Sarah Ladd)

LOUISVILLE — Maternal health is complicated, and reducing mortality around birth takes a comprehensive approach, advocates from across Kentucky said at a Thursday roundtable moderated by Carole Johnson, the administrator of the Health Resources and Services Administration for the Biden administration.

During the roundtable, which took place at the Marriott Hotel in downtown Louisville, Johnson said Kentucky is now eligible for more than $8 million in federal funding through the Maternal, Infant, and Early Childhood Home Visiting program. Kentucky’s version of this is called HANDS (Health Access Nurturing Development Services), which is a voluntary service that offers parenting guidance to new or expecting parents.?

“We are thrilled to be here,” Johnson said to a room full of parents, medical providers and other maternal health advocates. “We’re thrilled to put these resources on the table but we know that what it takes to actually execute on them is all the work that happens by all of you around this room.”?

She also praised Rep. Kim Moser, R-Taylor Mill, who spearheaded Kentucky’s move to pass a maternal health “Momnibus” bill during the 2024 legislative session and was present Thursday.?

Momnibus, which made pregnancy a qualifying event for insurance coverage in Kentucky, among other things, was? “a big bill. It was a big lift,” said Moser, who chairs the House Health Services Committee. “I’m excited to see how it gets implemented.”?

What is working for maternal health in Kentucky??

Kentucky has dismal maternal mortality rates, which is worse for women of color than white women.?

The 2023 March of Dimes report showed the state once again had high maternal mortality, which was worse for Black Kentuckians. The state has a maternal mortality rate of 38.4 deaths per 100,000 live births, higher than the national rate of 23.5 deaths per 100,000 live births.

A 2023 state report on maternal mortality also showed substance use disorder contributed to nearly 60% of all maternal deaths. Most maternal deaths in Kentucky — 88% — are preventable, that report from the Cabinet for Health and Family Services said.

Advocates around the table Thursday said improving maternal health has to involve a comprehensive approach that looks at physical and mental health as well as social determinants of health, like reliable transportation, safe housing and clean water, among other things. Several shared the work they’re doing to meet those needs.?

Bethany Wilson, who is in long term recovery and now works at the University of Kentucky to treat substance use disorder during and after pregnancy, said shame, lack of transportation and lack of education were all barriers she faced when pregnant.?

“While in addiction, I was, of course, unengaged in the healthcare system altogether, despite having serious medical conditions,” she said. “But when I learned about my pregnancy, so many emotions came — just embarrassment, fear, guilt, sadness.”?

Now she shares her story and information about resources with UK patients to promote harm reduction and health education.?

“Word of mouth is a huge piece,” she said. “The word-of-mouth patients that have engaged in our program will tell other people in their community through them knowing that it’s a safe place to come.”?

Capric Walker, who heads the University of Louisville’s 550 Clinic to provide care for HIV-positive people in seven counties, including Jefferson, said she focuses heavily on educating patients that HIV is “no longer a death sentence.”?

HIV can pass to a fetus during pregnancy and birth, though treatment can lower the chances of that happening, according to the American College of Obstetricians and Gynecologists.

“We do a lot of education for them to help them understand what their full options are because mental health and depression and substance use are real concerns for many of them,” Walker said. “Our populations really have high instances of depression because of the history and the stigma around this diagnosis.”?

Her program’s retention among patients after delivery is around 90%, she said.?

Where are the gaps??

Kentucky needs more resources for first-time fathers, said Lance Newman, who works with Black Birth Justice in Louisville to offer just such support in a program he’s still developing.?

“We talk about maternal health, and we don’t really speak about how important the father is,” he said. “Fathers need job placement help, they need that workforce help. They need that substance abuse help. They need a lot of advocacy.”??

The National Institute for Children’s Health Quality backs that up, saying fathers’ positive involvement throughout pregnancy and beyond can have a positive health impact on mother and baby.?

Josh Hawkins, a Louisville father, said he needed mental health and job resources when his daughter was born and believes other fathers need support too.??

“We can … certainly help with maternal and infant mortality rates and alleviate some of that as well,” he said. “We want to be involved, too. We really do.”?

Kentucky’s non-doctor health care workforce is on the mend, though state hospitals still have thousands of unfilled positions.?(Warodom Changyencham/Getty Images)

Both the overall number of abortions and the use of telehealth abortion care continue to increase in the United States, according to the latest #WeCount report released Wednesday.

Telehealth made up 20% of all abortion care in the first three months of 2024, and the monthly total of abortions exceeded 100,000 for the first time since the group began tracking abortion data in 2022.

#WeCount is a collaborative group of researchers who collect national abortion data from clinics every month and is a project of the Society of Family Planning, a membership organization focused on abortion and contraception science. Dr. Alison Norris, co-chair of the group, said the data captures about 80% of abortion clinics nationwide. Using that data, the group makes estimates to account for clinics that do not provide reports.

From January to March 2024, there were about 19,700 telehealth abortions per month, according to the report. The states with the biggest jumps in the average number of abortions per month compared with the first three months of 2023 include New York, California, Virginia, Kansas and Pennsylvania. Kansas saw 59% more telehealth abortions and 29% more in-person abortions each month.

Norris said the use of telehealth has continued to grow, particularly now that five states — New York, Massachusetts, Washington, Vermont and Colorado — specifically shield those who provide telehealth abortions from legal ramifications if they work with patients from states with abortion restrictions. Maine will become the sixth state when its shield law takes effect on Friday. Fourteen states in the U.S. have a near-total ban on abortion.

“There was already a move toward telehealth (during the COVID pandemic), but I think it was accelerated by the need,” Norris said.

Telehealth abortions provided by clinicians in states with shield laws averaged 9,200 per month from January to March 2024, according to the report. That’s an increase of about 1,200 per month from the last report that showed data from October to December 2023.

In the nine months from July 2023 to March 2024, over 65,000 people in states with near-total or six-week bans and states with telehealth restrictions have accessed medication abortion provided under shield laws.

But the vast majority of abortions still take place in person, Norris said, in part because medication abortion can only be prescribed via telehealth through 10 weeks’ gestation, and because some people just prefer to be seen in person.

The overall number of abortions per month has grown as well, with a high of 102,350 in January. The average over the first three months of 2024 was 98,990 — the highest monthly number during the last quarter of 2023 was 91,470.

Norris said the data shows the number of abortions began to rise nationally in 2017, and while it’s hard to pinpoint the cause, there are new factors that could be contributing. Some people who needed an abortion before the Dobbs decision in 2022 could get them once states passed legislation to remove barriers. And for those who faced financial issues obtaining an abortion, she said, there is more awareness of abortion funds and other sources of support.

“There’s a lot more information in the ecosystem, there’s better resources on the internet, and there’s potentially been a destigmatization of abortion, given how much it’s in the media and being talked about by politicians,” Norris said.

Although she views it as a positive that many people who live in states with near-total bans or six-week bans are able to access abortion via telehealth, she said it’s still an unfair situation.

“Those bans and those restrictions are not evidence-based in terms of public health science, and the fact that thousands and thousands of people don’t have access to ordinary and safe health care that’s time-sensitive just because of the state where they live, it is an injustice that I hope people keep their eyes on,” Norris said. “It’s important that people maintain the will to keep advocating for access for all people in the U.S., no matter where they live.”

Dr. Mark Barns of UofL recommends taking a COVID-19 booster and flu shot together this fall. (Photo by Scott Olson/Getty Images)

LOUISVILLE — COVID-19 is “alive and well” in Kentucky, cautions infectious disease expert Dr. Mark Burns, as hospitalizations for the virus rise and students and teachers head back to school.

Kentucky’s Cabinet for Health and Family Services data shows an uptick in emergency department visits and hospitalizations from COVID-19 as of Aug. 1.?

In July there were 438 hospitalizations for the virus in Kentucky up from 292 hospitalizations in July of 2023.

Also in July 2023, there were 736 emergency room visits for COVID-19, up to 1,704 last month.?

This comes as the virus is on the rise in Kentucky, among 35 other states, according to the Centers for Disease Control and Prevention. Much of the country, especially the South and Midwest, is seeing increased numbers of the COVID-19 virus ahead of the new school year and holiday season.??

“It is out there,” Burns told reporters Monday. “But the good news is, of course, you still have protection from the vaccines.”?

The CDC recommends everyone six months and older get vaccinated against COVID-19. A new vaccine booster is expected this fall, possibly in September, as an update to the fall 2023 shot.?

“We’re hoping that everybody will take it along with the influenza vaccine — or the flu shot,” said Burns, who is an associate professor at the University of Louisville and a medical doctor with UofL Health. “It is safe to take them both at the same time. We’re in a place now where we’re going to try to make it more of a yearly vaccine as opposed to every three, four or five months.”?

As children head back to school, Burns said, they should be diligent about hand washing, covering coughs and general good hygiene that can reduce the spread of COVID-19 and other respiratory illnesses.?

And if a person feels sick, they should stay home to lower the risk of spreading the virus to others, he said.?

“If they’re contagious, then they will spread it on,” he said. “So we’re asking people who are ill to stay home.”

This story has been updated to correct an error in an earlier version about the rate of increase in hospitalizations for COVID-19.

Elizabeth Ha created the privacy-minded menstrual tracking app Monthly last year, after failing to find an option that felt safe enough to her following the Dobbs decision. (Courtesy of Elizabeth Ha)

After the Supreme Court overturned the constitutional right to abortion in 2022 and abortion was banned in the state of Tennessee, Dr. Danielle Kelvas quit using an app that tracked her menstrual cycle.

“It frightened me … I actually got frightened because it tracked me for like, a week,” Kelvas said of the Oura Ring feature Cycle Insights. “And I thought, where’s this information going?”

Immediately following the Dobbs V. Jackson Supreme Court decision which struck down the constitutional right to abortion, data privacy experts cautioned to take a closer look at menstrual cycle tracking apps. Information logged into these apps, or tracked via wearable devices like a Fitbit or an Oura Ring, have the potential to be used in prosecuting those who seek abortions in states which criminalize it.

Kelvas, a former emergency room physician, is a big fan of her Oura Ring. She researched the device — which gives insight to users about their biometric data like heart rate and sleep quality — thoroughly before buying it.

When the company rolled out its menstrual tracking feature, called Cycle Insights, she was excited to try it. But when she started reading more into the terms of agreement, she couldn’t find clear cut information about how the data was stored, how secure it was, or if it was encrypted.

States Newsroom reached out to Oura for clarification on its privacy policy for Cycle Insights, but the request for comment was not returned.

Kelvas, 34, lives in Chattanooga, Tennessee, where abortion is banned, with only the exception of preventing death for the expectant person. The law, a trigger ban that went into effect in August 2022, also makes obtaining or performing an abortion a criminal offense.

“So I deleted it,” Kelvas said of the app.

Opal Pandya is in the same boat. The 25-year old Philadelphian deleted the app Flo, after reading case studies about data releases to external third parties. She also took note when she started suddenly getting targeted ads on Instagram for products that would help soothe period symptoms she’d just logged in Flo.

“I realized my data was flowing across multiple platforms,” she said.

She didn’t feel comfortable with that, and didn’t have the time to figure out who had access to that data. The final straw was learning that third-party data could be available to states in prosecuting abortions banned under their laws.

Pandya also opted out of her Apple Watch’s cycle tracking after trying it for a while, and has stopped wearing it to bed, as it tracks ovulation cycles via temperature at night while sleeping.

Healthcare privacy has always been something Pandya’s been wary of, she said, and while there’s benefits of tracking menstrual information, the Dobbs decision showed her there could be “serious consequences” of that data being vulnerable.

“I have always been sensitive about my health information and understand there’s a strong distrust of the medical system as a whole,” Pandya said. “And overturning Roe v. Wade did nothing but solidify and spread that distrust, especially among minority women.”

Kelvas, who now owns a medical writing service and is a consultant for software company IT Medical, is acutely aware of those delicacies of navigating menstrual tracking.

As a physician, she said she can’t emphasize enough how important it is that people have access to cycle tracking. It’s one of the few tools people have to be in more control of family planning and their reproductive health, as some states attack access to birth control.

But her experience in health care IT has highlighted how easy it is for sensitive data to go unprotected. Many people think all healthcare information is protected under the federal privacy law, known as HIPAA. But menstrual cycle tracking apps, along with other healthcare technologies, like texting platforms that patients can use with doctors, are not.

In highly restrictive states, Kelvas said it’s challenging to navigate your reproductive rights — “It doesn’t really matter what we do, we’re always in trouble,” she said.

“For a lot of women, suddenly becoming pregnant means that they are illegal,” Kelvas said. “And what do you do after that? You know, for a lot of people, the reality is that they just don’t own their uterus anymore.”

What data is up for grabs?

There haven’t been any cases where a menstrual tracking app’s data has been subpoenaed yet, but that’s probably due to the slow speed of which cases proceed through the court system, said Jake Laperruque, deputy director of the Center for Democracy and Technology’s Security and Surveillance Project. There have been few cases of electronic data of any form being subpoenaed yet, but via their terms and conditions, many companies leave themselves vulnerable to having to hand data over to prosecutors or courts.

Laperruque warned that the data that could be used to prosecute abortion cases could be more far-reaching than just what’s logged in a period tracking app.

“There are a lot of really innocuous seeming data in healthcare — location information, communications, metadata patterns and even information you don’t know you’re generating,”

Laperruque said.

If social media apps have access to your location, for example, prosecutors could timestamp your visit at an abortion provider’s office through the location data of any number of apps.

“Data collected by apps, wearables, could potentially now be used by law enforcement or even private individuals, seeking to sue or target people for exercising reproductive choice and seeking out information or care around abortion,” he said.

Digital footprints have been used in prosecuting reproductive cases even before the Dobbs decision.

In 2018, a woman in Mississippi was charged with second-degree murder after she gave birth to a stillborn baby at home. Part of the prosecution’s case noted that she had researched how to terminate a pregnancy in the past.

Last year, a teenager in Nebraska was convicted for terminating a pregnancy after prosecutors subpoenaed Facebook messages between her and her mother.

How to assess data privacy

For now, most of the responsibility to protect a user’s data falls on the user themselves, said Andrew Crawford, a healthcare privacy-focused senior counsel with the Center for Democracy and Technology.

“It really is incumbent on users to do their homework,” Crawford said. “And unfortunately, sometimes that means reading really dense privacy policies and looking for keywords.”

The terms and conditions of an app or a wearable device need to spell out what data it’s collecting, what it does with that data and who else may have access. An app may automatically seek access to things like your contacts, your geolocation, or photos, but you may not have to give it those full permissions. Period tracking apps often share information with data brokers, advertisers or third parties that are hard to track.

Users should also pay attention to how an app treats the data it gets. A keyword to look for is “encryption,” or data that’s changed into a secret code that can only be unlocked with a unique digital key.

Data that’s stored locally on your device also tends to be safer than data that’s stored in a cloud, Crawford said. It would be a lot harder for law enforcement to access encrypted data stored only on your device rather than if they can subpoena a company for it.

There’s always risk as long as data is logged somewhere, Laperruque said.

“But police are only going to be able to search your phone if they hand you a warrant and seize the phone,” he said.

Most wearable devices that collect biometric data have some encryption aspect. Apple’s privacy policy says that when your device is locked, all your health and fitness data that’s on the device and synced to iCloud is encrypted.

“This means that when you use the Cycle Tracking feature and have enabled two-factor authentication, your health data synced to iCloud is encrypted end-to-end and Apple does not have the key to decrypt the data and therefore cannot read it,” the company said.

Fitbit and Oura Ring say they use encryption measures, too. All three companies say that they have to comply with subpoena requests by law enforcement agencies.

The cost of your data

App developer Elizabeth Ha, 27, of Los Angeles, built cycle tracking app Monthly in response to the Dobbs v. Jackson decision. All of the health data inputted into the app is stored privately on your device, and doesn’t enter a database. You can delete your app (and subsequently, your data) at any time, and Monthly does not make your data available to anyone but the user.

Ha had been a long-time user of one period tracker app, but the Dobbs decision and the attention that data privacy was getting at the time, forced her to take a harder look at where she was logging her information.

“Once your data gets sent to these data warehouses, it’s like a little bit of a black box,” she said.

She feels pretty secure about her reproductive rights in California, but you never know what’s going to happen or who else might need a more secure option, she said of Monthly, which released on the app store late last year.

The field of mobile apps is so new, developing in the last decade or so, she said, and it evolves so quickly. The reason so many period trackers are free is that they’re built by larger companies that can collect and sell your data, Ha said.

“For them to be a business, a lot of the business is selling the data,” she said.

Many Americans are waiting for a comprehensive, federal data privacy overhaul. The American Privacy Rights Act was proposed in congress in May, which would require covered entities to be transparent about how they use consumer data and give consumers the right to access, correct, delete, and export their data, as well as opt out of targeted advertising and data transfers.

It would also mandate that a covered entity could not collect or transfer to a third party biometric data “without the individual’s affirmative express consent.”

For now, those who wish to keep data related to their reproductive health safe, should be vigilant about the terms and conditions of the devices and the platforms they use.

“It just kind of speaks to the importance of both the surveillance and consumer data side of upgrading the laws,” Laperruque said. “We have to be more protective.”

Vice President Kamala Harris speaks in Greensboro, North Carolina, July 11, 2024. (Sean Rayford/Getty Images)

When Kamala Harris was California’s top prosecutor, she was concerned that mergers among hospitals, physician groups, and health insurers could thwart competition and lead to higher prices for patients. If she wins the presidency in November, she’ll have a wide range of options to blunt monopolistic behavior nationwide.

The Democratic vice president could influence the Federal Trade Commission and instruct the departments of Justice and Health and Human Services to prioritize enforcement of antitrust laws and channel resources accordingly. Already, the Biden administration has taken an aggressive stance against mergers and acquisitions. In his first year in office, President Joe Biden issued an executive order intended to intensify antitrust enforcement across multiple industries, including health care.

Under Biden, the FTC and DOJ have fought more mergers than they have in decades, often targeting health care deals.

“What Harris could do is set the tone that she is going to continue this laser focus on competition and health care prices,” said Katie Gudiksen, a senior health policy researcher at University of California College of the Law, San Francisco.

The Harris campaign didn’t respond to a request for comment.

For decades, the health industry has undergone consolidation despite government efforts to maintain competition. When health systems expand, adding hospitals and doctor practices to their portfolios, they often gain a large enough share of regional health care resources to command higher prices from insurers. That results in higher premiums and other health care costs for consumers and employers, according to numerous studies.

Health insurers have also consolidated in recent decades, leaving only a handful controlling most markets.

Health care analysts say it’s possible for Harris to slow the momentum of consolidation by blocking future mergers that could lead to higher prices and lower-quality care. But many of them agree the consolidation that has already taken place is an inescapable feature of the U.S. health care landscape.

“It’s hard to unscramble the eggs,” said Bob Town, an economics professor at the University of Texas.

There were nearly 1,600 hospital mergers in the U.S. from 1998 to 2017 and 428 hospital and health system mergers from 2018 to 2023, according to a KFF study. The percentage of community hospitals that belong to a larger health system rose from 53 in 2005 to 68 in 2022. And in another sign of market concentration, as of January, well over three-quarters of the nation’s physicians were employed by hospitals or corporations, according to a report produced by Avalere Health.

Despite former President Donald Trump’s hostility to regulation as a candidate, his administration was active on antitrust efforts — though it did allow one of the largest health care mergers in U.S. history, between drugstore chain CVS Health and the insurer Aetna. Overall, Trump’s Justice Department was more aggressive on mergers than past Republican administrations.

Harris, as California’s attorney general from 2011 to 2017, jump-started health care investigations and enforcement.

“She pushed back against anticompetitive pricing,” said Rob Bonta, California’s current attorney general, who is a Democrat.

One of Harris’ most impactful decisions was a 2012 investigation into whether consolidation among hospitals and physician practices gave health systems the clout to demand higher prices. That probe bore fruit six years later after Harris’ successor, Xavier Becerra, filed a landmark lawsuit against Sutter Health, the giant Northern California hospital operator, for anticompetitive behavior. Sutter settled with the state for $575 million.

In 2014, Harris was among 16 state attorneys general who joined the FTC in a lawsuit to dismantle a merger between one of Idaho’s largest hospital chains and its biggest physician group. In 2016, Harris joined the U.S. Department of Justice and 11 other states in a successful lawsuit to block a proposed $48.3 billion merger between two of the nation’s largest health insurers, Cigna and Anthem.

Attempts to give the state attorney general the power to nix or impose conditions on a wide range of health care mergers have been fiercely, and successfully, opposed by California’s hospital industry. Most recently, the hospital industry persuaded state lawmakers to exempt for-profit hospitals from pending legislation that would subject private equity-backed health care transactions to review by the attorney general.

A spokesperson for the California Hospital Association declined to comment.

As attorney general of California, Harris’ work was eased by the state’s deep-blue political hue. Were she to be elected president, she could face a less hospitable political environment, especially if Republicans control one or both houses of Congress. In addition, she could face opposition from powerful health care lobbyists.

Though it often gets a bad rap, consolidation in health care also confers benefits. Many doctors choose to join large organizations because it relieves them of the administrative headaches and financial burdens of running their own practices. And being absorbed into a large health system can be a lifeline for financially troubled hospitals.

Still, a major reason health systems choose to expand through acquisition is to accumulate market clout so they can match consolidation among insurers and bargain with them for higher payments. It’s an understandable reaction to the financial pressures hospitals are under, said James Robinson, a professor of health economics at the University of California-Berkeley.

Robinson noted that hospitals are required to treat anyone who shows up at the emergency room, including uninsured people. Many hospitals have a large number of patients on Medicaid, which pays poorly. And in California, they face a series of regulatory requirements, including seismic retrofitting and nurse staffing minimums, that are expensive. “How are they going to pay for that?” Robinson said.

At the federal level, any effort to blunt anticompetitive mergers would depend in part on how aggressive the FTC is in pursuing the most egregious cases. FTC Chair Lina Khan has made the FTC more proactive in this regard.

Last year, the FTC and DOJ jointly issued new merger guidelines, which suggested the federal government would scrutinize deals more closely and take a broader view of which ones violate antitrust laws. In September, the FTC filed a lawsuit against an anesthesiology group and its private equity backer, alleging they had engaged in anticompetitive practices in Texas to drive up prices.

In January, the agency sued to stop a $320 million hospital acquisition in North Carolina.

Still, many transactions don’t come to the attention of the FTC because their value is below its $119.5 million reporting threshold. And even if it heard about more deals, “it is very underresourced and needing to be very selective in which mergers they challenge,” said Paul Ginsburg, a professor of the practice of health policy at the University of Southern California’s Sol Price School of Public Policy.

Khan’s term ends in September 2024, and Harris, if elected, could try to reappoint her, though her ability to do so may depend on which party controls the Senate.

Harris could also promote regulations that discourage monopolistic behaviors such as all-or-nothing contracting, in which large health systems refuse to do business with insurance companies unless they agree to include all their facilities in their networks, whether needed or not. That behavior was one of the core allegations in the Sutter case.

She could also seek policies at the Department of Health and Human Services, which runs Medicare and Medicaid, that encourage competition.

Bonta, California’s current attorney general, said that, while there are bad mergers, there are also good ones. “We approve them all the time,” he said. “And we approve them with conditions that address cost and that address access and that address quality.”

He expects Harris to bring similar concerns to the presidency if she wins.

This story is republished from?KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Addiction Recovery Care, Kentucky's largest provider of drug and alcohol treatment, has offices and other facilities in Louisa, photographed June 27, 2024. (Kentucky Lantern photo by Matthew Mueller)

Kentucky’s largest provider of addiction treatment services, Addiction Recovery Care, or ARC, is the subject of an? FBI investigation into possible health care fraud, according to a July 30 post on a website of the federal agency’s Louisville office.

ARC, which is funded almost entirely through Kentucky’s Medicaid program, has not been charged with any crime but the agency is asking people with information to fill out an online form “if you believe you were victimized by ARC or have information relevant to this investigation.”

ARC, a for-profit company based in Louisa, and whose CEO and affiliates have emerged as prolific political donors in recent years, said in a statement from spokesman Kyle Collier that it is cooperating with the FBI.

“We have recently learned that there is a federal investigation into ARC,” the statement said. “As we all know, healthcare is one of the most highly regulated fields in the country, and addiction treatment is among the most highly scrutinized healthcare services. ARC is a trailblazer in the field of addiction services. We are confident in our program and in the services we offer. We, and our legal counsel, are cooperating fully in the investigation.”

Collier directed further inquiries to ARC’s chief legal officer, Jessica Burke, who provided a similar statement.

ARC has developed a reputation for aggressive expansion since it was launched by Tim Robinson, a Lawrence County lawyer who founded the company with a single halfway house for alcohol treatment in 2010. Fueled by the availability of new Medicaid funds for substance use disorder treatment since 2014 under the Affordable Care Act, ARC operates some 1,800 treatment beds in 24 counties and reaches hundreds more clients through outpatient services, the Kentucky Lantern reported in July.

Recovery CEO gives big to support Democrat Beshear and a host of Republicans

Last year, ARC took in $130 million in Medicaid funds, the government health plan which gets most of its money from the federal government, making it by far the state’s largest provider of substance use services.

Robinson and? his wife, Lelia, own ARC and some related entities which provide them with an annual income of $533,400, according to a 2022 tax filing of a related non-profit company, Odyssey Inc.

The company has been singled out for praise by politicians including Kentucky Gov. Andy Beshear, who spoke at an ARC ribbon cutting for a new ARC facility in March.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said.

He also praised Robinson, ARC’s founder, in his State of the Commonwealth speech in January.

“With us today,” Beshear said, “is Tim Robinson, founder and CEO of ARC, an essential partner in our fight against addiction. … I’m proud to say we now have more treatment beds per capita than any other state in the country.”

From mid-2021 through the end of 2023 Robinson, his corporations and employees gave at least $252,500 to political committees supporting Beshear, according to reporter Tom Loftus’ analysis in the Kentucky Lantern of campaign finance records.?

The donations to Democrat Beshear were a shift in the giving pattern for Robinson, a lifelong and loyal Republican. He also gave big to?Beshear’s opponent in the 2019 governor’s race, Republican incumbent Gov. Matt Bevin.

The Lantern’s analysis shows that — including money contributed to Beshear committees — Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew.

He also has donated to Kentucky Republican lawmakers including some who wrote recent letters on ARC’s behalf, asking that rate cuts proposed to ARC and other addiction providers be suspended until further study.

Kentucky lawyer climbed out of alcoholism, launched a recovery boom

The rate cuts of 15% to20% proposed by three of the six private insurance companies that process state Medicaid claims became public this week at a legislative hearing. ARC and another provider told lawmakers that such cuts would devastate Kentucky’s efforts to turn the tide of addiction to drugs and alcohol.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for?Addiction Recovery Care, or ARC, told a legislative committee Tuesday. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

Six national insurance companies known as managed care organizations, or MCOs, handle the majority of the state’s $16 billion a year Medicaid business. Under contracts with the state, they are paid a fixed rate per member to cover the cost of care.

Brown, the ARC official, told lawmakers this is no time to cut payments for addiction services, citing some indicators of success.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state’s latest?annual?overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

In a statement released after the hearing on the cuts, the Kentucky Association of Health Plans, which represents the MCOs, said its members?“are proud to work collaboratively with quality, trustworthy?providers of behavioral health and substance use disorder treatment” and access to those services is “top of mind” to ensure those in need receive care.

“Health plans strive for the best networks possible and are encouraged by the state to prioritize plan member outcomes and value-based care,” it said.

The FBI posting on the website seeking information on ARC does not provide further information about the nature of the investigation,

A spokeswoman did not immediately respond to a request for comment.

A questionnaire people are asked to fill out includes several questions including whether they have been or are a patient at ARC and if so, what services were received. It also asks whether the person responding has ever made a complaint before about ARC and if so, to whom.

Speaking in Bowling Green against Kentucky's abortion laws, Dr. Janet Wygal said: “No physician should be forced to wait until someone becomes sick enough to intervene with basic necessary health care because the government says so.” (Getty Images)

Kentucky Reproductive Freedom Fund members, who in June announced a pro-abortion access messaging campaign, gathered at the Warren County Courthouse in Bowling Green Thursday to say their campaign has reached 1.8 million people through digital ads.?

Ona Marshall, who founded KRFF and co-owned one of Kentucky’s last two abortion clinics, also criticized Kentucky’s lack of avenues for citizens to put abortion access on the ballot.?

“We could follow the lead of other states that are moving to protect reproductive rights,” she said. “These are states that have citizen-led ballot initiatives to protect abortion access in their state constitutions. But that choice isn’t possible in Kentucky.”?

Nevada, Colorado, South Dakota, Florida and Maryland will have abortion-related questions on the ballot this November, States Newsroom has reported. Others are working to qualify and follow suit, including Arizona, Montana, Missouri and Arkansas. Kentucky is one of 24 states that do not allow citizen-led ballot initiatives.?

Thursday’s event came two years after a judge reinstated Kentucky’s abortion ban — after a brief injunction following the fall of Roe V. Wade and subsequent trigger law.?

“Kentucky is in a health care crisis, and our choices to reverse this dire situation are being limited by lawmakers,” Marshall said. “Our freedom in Kentucky is not being protected, our freedom is being denied. Our lawmakers can repeal the abortion bans and restore our freedom.” Marshall co-owned Louisville’s EMW Surgical Center, which provided abortions Louisville’s but closed when the abortion ban took effect..?

After the U.S. Supreme Court overturned Roe v. Wade, which had guaranteed the constitutional right to abortion, in 2022, a “trigger law” went into effect in Kentucky that banned abortions. Another law bans abortions after six weeks. Doctors have previously said many people don’t know they’re pregnant at the six-week mark.?

Later that year, Kentucky voters rejected an anti-abortion amendment that would have stated there is no right to an abortion in Kentucky’s Constitution. Only the legislature has the power to put constitutional amendments on the ballot in Kentucky.

Kentucky does not have abortion exceptions for rape or incest, though both Republican and Democratic lawmakers have filed unsuccessful bills to change that in recent years.?

Kentucky has an exception in cases where the life of the pregnant person is at risk. Dr. Janet Wygal, an OB-GYN who spoke alongside Marshall Thursday, said that’s not enough.?

“No physician should be forced to wait until someone becomes sick enough to intervene with basic necessary health care because the government says so,” said Wygal. “These laws create an environment of fear and uncertainty, not only for doctors and their patients seeking abortion care, but also for those needing the full spectrum of reproductive health care, including IVF (in vitro fertilization), contraception and cancer screenings.”?

Canoeing the Green River is one of Mammoth Cave National Park's many above ground attractions. (National Park Service)

Mammoth Cave National Park is famous for what’s below the ground, featuring the world’s longest explored cave system with hundreds of miles of passages and a unique ecosystem of fish, insects, worms and crustaceans. But it’s what’s happening in the air above the cave system that has Kentucky environmentalists concerned.?

Mammoth Cave is one of the country’s haziest national parks, says a national group dedicated to conserving the parks. Environmental groups say a Kentucky plan being drafted for controlling the air pollution that causes haze falls short — criticisms state officials largely refute.

Haze is tiny, airborne particulate matter that can obscure outdoor visibility. It can be created from natural sources such as wildfires but largely comes from man-made sources, such as emissions from motor vehicles and power plants. This pollution can impact people’s health by aggravating asthma, reducing lung function and leading to heart problems. It can also negatively impact wildlife.

“We’re seeing more of these haze pollutants depositing into the soil and the water and impacting wildlife, because they eat a lot of things that are in the soil and in the water,” said Natalie Levine, the senior manager for clean air and climate programs at the National Parks Conservation Association (NPCA), the group that analyzed haze pollution in national parks.?

According to the NPCA, the large majority of that haze drifting into national parks is man-made. And at Mammoth Cave, more than 70% of pollution contributing to haze is coming from electricity generation — specifically coal-fired power plants.?

Smokestack emissions from coal-fired power plants contain toxic gasses sulfur dioxide and nitrogen dioxide, which can react with water and other atmospheric gasses to become acid rain that acidifies water and soil and harms the wildlife that rely on them. Excess nitrogen and sulfur from these gasses can be deposited into the soil and water through acid rain or by settling onto surfaces through the air, potentially killing and inhibiting the growth of trees and other plants.?

“We are concerned about our national parks. We’re concerned about their biodiversity. We’re concerned about hazy skies and giving people the best outdoor experience possible. But we’re really talking about the health of the communities as well,” said Julia Finch, the director of the Sierra Club’s Kentucky chapter.

A spokesperson for Kentucky’s environmental protection cabinet, however, says its efforts to reduce haze “are significantly reducing emissions”? and that air quality around the national park is better than national standards.?

John Mura, a spokesperson for the Kentucky Energy and Environment Cabinet that houses the Division for Air Quality, in a statement said the state is committed to working with federal agencies “and other interested parties to ensure the cleanest air quality possible for our citizens by understanding and addressing the emission sources that are contributing to visibility issues at Mammoth Cave National Park.”?

Slow improvements in haze

Haze protections for national parks date back to the establishment of the Clean Air Act in the 1960s and the additions and amendments added to it over the decades,?

In 1999, the U.S. Environmental Protection Agency (EPA), empowered through the Clean Air Act, issued new regulations requiring states to develop regional plans to reduce haze in national parks and control the pollution sources contributing to it. Such regional plans, for example, could require coal-fired power plants to install smokestack scrubbers or controls to filter out sulfur dioxide and nitrogen dioxide emissions. The long-term goal of the plans is to return national parks to their original natural visibility by 2064.?

But there have been a number of delays in getting states to submit these plans, Kentucky included. The EPA required the first version of these plans to be submitted by the end of 2007; Kentucky did, but 37 states did not. Progress reports on how states are meeting goals set in their haze plans are due every five years, and new versions of the regional haze plans are due every 10 years.?

The EPA set another deadline for states to submit their second version of regional haze plans in July 2021, a deadline that Kentucky and 14 other states did not meet. Kentucky is now trying to submit a new draft haze plan for the EPA to consider by a new deadline of Sept. 29 under the potential threat the EPA could step in and create its own haze plan for Kentucky.?

State officials say Kentucky’s first regional plan has decreased the state’s sulfur dioxide emissions by 310,047 tons since 2008, and that air quality at the park is better than national standards.?

Data from the National Park Service (NPS) does show visibility and the impacts of acid rain and ozone at the park have improved in a little over a decade since the state’s first haze plan was submitted, though acid rain and ozone are still impacting wildlife and human health.?

Median visibility at the park only reached a “fair” classification as of 2021 after having “poor” visibility since 2009, according to NPS data. The amount of sulfur and nitrogen deposited into the park’s soil and water every year through acid rain and the air has decreased, though sulfur levels have decreased much more significantly than nitrogen levels.?

The levels of ozone, a reactive gas largely created from emissions from power plants and cars that can harm human health, have also decreased since 2009. Ozone impacts to vegetation in the park are rated at a “good” level but remain as only “fair” for human health, according to the NPS.?

Environmentalists say more should be done

Even with that progress, environmental groups including the Kentucky Chapter of the Sierra Club and the Kentucky Resources Council, say the updated haze plan Kentucky is considering doesn’t do nearly enough to reduce air pollution impacting the park through haze and acid rain.??

These environmental groups say only two coal-fired power plants — the Tennessee Valley Authority’s Shawnee Fossil Plant in McCracken County and the Big Rivers Electric Corporation’s D.B. Wilson Generating Station — were analyzed by the state as potential sources of haze pollution in the draft plan when over a dozen more pollution sources including other power plants and industry are also contributing to the haze.?

Among the two power plants analyzed, these groups say, the state decided to not require any additional emissions controls to reduce nitrogen dioxide and sulfur dioxide emissions from the plants. The groups say state officials also only accounted for controlling sulfur dioxide emissions and not nitrogen dioxide emissions, which also can create haze.?

“In the excluded list were five coal plants and nine other industrial facilities, including those with aluminum and metal smelter operations, oil and gas operations, and lime and cement operations,” said Audrey Ernstberger, a lobbyist with the Kentucky Resources Council at a public hearing on the draft haze plan last month.

Ernstberger said the result, according to KRC’s analysis, is that more than 82,000 tons of haze pollution will still be released under the draft plan.?

In Kentucky’s draft plan, state officials write that because the electric utility Big Rivers Electric Corp. had installed a device in November 2022 to control sulfur dioxide at its Wilson coal-fired power plant, a deeper analysis into potential emissions controls wasn’t needed.?

Officials also write that the emission levels of nitrogen dioxide coming from the Wilson and Shawnee plants didn’t exceed “screening thresholds” in the state’s modeling, so officials “did not perform any reasonable progress analyses” for nitrogen dioxide emissions.?

For the Shawnee Fossil Plant, Mura said the state worked with the Tennessee Valley Authority to modify its state air permit to limit sulfur dioxide from the plant to 8,208 tons per year starting in 2028. State officials chose that limit following a deeper “four-factor” analysis conducted into potential emission controls for the coal-fired plant.?

When asked by the Lantern why the state chose only the Wilson and Shawnee plants to analyze for haze pollution, Mura said the state used modeling to determine the plants were “significantly impacting Mammoth Cave National Park and that limiting SO2 emissions at these facilities would have the greatest impact in improving visibility in the region.”?

If Kentucky meets the September deadline for submitting a haze plan, the EPA could approve the plan as is, ask the state to make revisions or step in and make its own plan. A federal judge last month signed a consent decree directing the EPA to speed up action on haze plans submitted by 32 other states.?

Hilary Lambert, a former Lexington resident who led a New York-based water protection nonprofit, said at the July public hearing she owns a cabin in Green County less than 50 miles east of Mammoth Cave National Park. She echoed what she wrote in a Louisville Courier-Journal column saying the state needs to do more to curb pollution and ensure compliance with state and federal regulations.?

“It's the state's own, the commonwealth's only big national park, and it's a jewel for people to visit,” Lambert said at the hearing. “Please get up to date and bring a number of businesses into compliance with the law to clean up the air for everybody.”

Addiction Recovery Care and its owner Tim Robinson have rebuilt a block in downtown Louisa into a coffee shop, commercial kitchen, community theater and an event space. (Kentucky Lantern photo by Matthew Mueller)

FRANKFORT — The state’s largest provider of drug and alcohol treatment is warning that looming cuts in Medicaid reimbursement to some providers could damage efforts to curb addiction that has engulfed Kentucky — just as the state is showing improvements.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for Addiction Recovery Care, or ARC, told a legislative committee Tuesday. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

A handful of companies that provide substance use disorder treatment, including ARC,? have been notified they face cuts of 15% to 20% from some private insurers that handle most Medicaid claims, Brown told the committee.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state’s latest?annual overdose report, released in June,?shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

Brown was joined by Deron Bibb, chief financial officer for Stepworks, a recovery program based in Elizabethtown, and ARC executive John Wilson, also executive director of the Kentucky Association of Independent Recovery Organizations, speaking to the interim joint Health Services Committee about the cuts.

“This will likely result in higher overdose rates, higher recidivism, more crime and incarceration,” Bibb said. “We need to understand the full scope and impact of these cuts.”

The cuts have been announced by three of the six managed care organizations, or MCOs, private insurance companies that handle claims for most of the state’s $16 billion-a-year Medicaid program, Brown said.?

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Under their contracts with the state, the MCOs generally have authority to set rates they pay providers. The state pays MCOs a fixed amount per member to cover Medicaid costs.

One company also has begun notifying patients it will no longer cover addiction services at ARC effective Sept. 30, Brown said.

He did not identify the MCOs that have announced cuts and declined to do so after the hearing, saying ARC and other companies are still attempting to negotiate with them.

Sen. Stephen Meredith, R-Leitchfield and co-chairman of the health committee, said Tuesday the lawmakers likely would seek more testimony on the subject, including from the MCOs.

“I know there’s two sides to every story,” he said.

Wellcare, with 420,000 members, is the largest of the six MCOs followed by Passport by Molina, Aetna, Anthem, Humana and United HealthCare. Together they oversee payment of Medicaid claims for about 1.4 million Kentuckians.

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Wilson said the recovery organization he represents wants to make sure lawmakers are aware of the situation and already has asked them to voice concerns.

“There’s going to be real world consequences and I think it’s important to let legislators know what’s taking place,” he said.

Some defenders benefitted from owner’s largesse

Several lawmakers have signed letters urging that the MCOs suspend any cuts to substance use treatment until the General Assembly can further review the matter. They include some in key leadership positions and some who have benefited from campaign donations from ARC founder and owner Tim Robinson and his employees.

ARC, a for-profit company based in Louisa, has emerged as the state’s largest and fastest growing provider of addiction services, financed largely by Medicaid, the government health plan with the majority of funds from the federal government. Growth took off after 2014 when substance use treatment was included in the Medicaid expansion authorized by the Affordable Care Act.

The Lantern reported the company took in about $130 million last year in Medicaid funds and was by far the largest recipient of the about $1.2 billion the state spent on substance use treatment.

The company and Robinson also have become among Kentucky’s major political donors with more than $500,000 in contributions over the last decade — with funds divided among Republican causes and those of Gov. Andy Beshear, a Democrat, the Lantern reported earlier this month, citing campaign finance and other public records.

Sen. Phillip Wheeler, R-Pikeville, who has received $19,900 in contributions from Robinson, his wife Lelia and ARC employees since 2016, on July 9 sent a letter to Kentucky Medicaid Commissioner Lisa Lee urging the cuts for addiction services be suspended “until the legislature fully understands the reasons behind them.”

“Kentucky has made great progress in tackling the addiction crisis that has touched so many of our constituents, neighbors, colleagues, friends and family members,” Wheeler said.?

Cutting reimbursement now “could negatively affect some of our most vulnerable citizens and prevent us from seeing these positive trends continue,” his letter said.

A similar letter addressed to “to whom it may concern” was signed by Rep. Patrick Flannery, R-Olive Hill, who has received about $17,000 in campaign contributions from Robinson and ARC employees.

Another letter was signed jointly by Senate President Robert Stivers, R-Manchester, House Speaker David Osborne, R- Prospect, Rep. Kimberly Moser, R-Taylor Mill and Meredith. Moser and Meredith are co-chairs of the joint Health Services Committee which heard from ARC and other treatment officials Tuesday.

Republican supermajorities control the Kentucky House and Senate.

Robinson has given $10,000 to the Kentucky House Republican Caucus, and $15,000 to the Kentucky Senate Republican Caucus in the last four years.

Robinson also has given other contributions to campaigns of Republican state legislators in the past decade including $4,100 to Moser and $2,000 to Osborne.

From 2021 through 2023, ARC companies and employees gave about $252,000 to a political committee supporting Beshear, whom Robinson, a Republican, has said he admires and would like to see run for president.

Bibb, Stepworks’ chief financial officer, gave $500 to Flannery in December 2023 and $2,500 to the Kentucky House Republican Caucus in October 2022, according to Kentucky Registry of Election Finance records.

Not asking for more money, just no cuts, says company official

Brown said that one concern of the MCOs is the cost of treatment, in particular long-term treatment for addiction.

ARC understands concerns about costs, but experience shows people with addiction benefit the most from long-term services, Brown told the committee.

“It is not just about surviving from their addiction but thriving in their communities,” he said. “Long-term treatment is vital.”

Without quality treatment, costs to the state will rise elsewhere, Bibb said.

“These costs will not go away,” Bibb said. “They simply will shift back to the emergency room, the judicial system, foster care, homelessness.”

ARC is willing to work with the MCOs and the state to ensure it is using money efficiently and effectively, Brown said after the hearing.

“Everybody’s got to be good stewards,” he said. “We’re committed to helping provide a solution.”

Brown and Wilson said representatives of treatment providers plan to meet with MCOs and state officials in coming weeks to try to resolve their differences.

“We’re not asking for more money,” Brown said. “We’re asking for no cuts.”

Wheeler, in an interview, said he appreciates the support of Robinson, a longtime friend since college together at the University of Kentucky, but that’s not why he sent the letter.

Rather he’s concerned about the impact of cuts of up to 20% on ARC’s services, which he said have helped many people in the region including a brother who benefited from its treatment program.

Also, he said, ARC is a major employer in the area where jobs have been scarce and also trains its clients for jobs.

This story has been updated with a statement from the Kentucky Association of Health Plans.

Kentucky Auditor Allison Ball, center, spoke to lawmakers on July 30 about access to computerized records of child and elder abuse cases. Ombudsman Jonathan Grate is at left and Alexander Magera, general counsel in the auditor's office, is at right. (Kentucky Lantern photo by Sarah Ladd)

FRANKFORT — Kentucky’s Cabinet for Health and Family Services and the state auditor’s office said Tuesday they are open to entering a memorandum of understanding to ensure the office of the ombudsman has the access it needs to a computer system that stores information about abuse and neglect cases.?

The two parties are still hashing out the language of such an agreement, though.?

This comes after some back-and-forth between the cabinet and state Auditor Allison Ball, whose office now oversees the ombudsman. That move happened on July 1 thanks to a new law enacted last? year by the legislature — Senate Bill 48 — that moved the office from the cabinet to the Auditor of Public Accounts.?

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The ombudsman, whose job it is to investigate and resolve complaints about cabinet agencies including protective services for children and elderly Kentuckians,, can’t do that job without access to iTWIST, (the Workers Information System), Ball testified before the Interim Joint Committee on Families and Children.?

“I don’t think that there’s any issue about, any disagreement about, whether or not … we need the access,” she said. “It’s totally clear, we need the access. But right now, we’re being prevented from the access.”??

The database includes suspected child or elderly abuse and neglect case reports, investigations and findings records and other medically sensitive information.?

The cabinet believes access to the computer system iTWIST is limited by state law to cabinet social service officials under Kentucky Revised Statute 620.050, with some exceptions for certain parties within the cabinet, law enforcement and prosecutors, outside medical or social service officials and the parent or guardian of the child in question, the Lantern has reported.?

The state auditor’s office believes the ombudsman is covered under that statute.?

Eric Friedlander, Cabinet for Health and Family Services secretary, said SB 48, which reorganized several government operations, “was a big bill” and that all of its provisions have been carried with resoling access to the database being the only remaining stumbing block.?

“Everything has been done and completed — we have one issue,” he said. “And this is where we have a disagreement, but we will continue to try to work through it.”??

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The auditor wants to make sure no language in a memorandum of understanding limits her access to the court system should she need it, she said.?

“We’re not trying to shut off their avenue to any court,” said Wesley Duke, the cabinet’s general counsel.?

Meanwhile, Ball said confidentiality is important to her and the new ombudsman, Jonathan Grate.?