Baby is born on Interstate 65 in Louisville during traffic blockage for President Obama's motorcade; father, nurse tell story

Nurse and EMT worker and baby
Photo from Floyd Memorial
Hospital Facebook page

A baby boy was born along Interstate 65 April 2 in Louisville because the road was closed for President Barack Obama's motorcade and they couldn't get to the hospital.

Because he stayed in Washington to announce the nuclear deal with Iran, Obama was three hours late, putting him in Louisville right at the beginning of rush hour and causing a traffic nightmare.

MetroSafe told WAVE-TV it received a call at 5:25 p.m. saying a woman was in labor on I-65. And just before 6 p.m., the baby, an 8-pound, 9-ounce boy, Arley Keith Satterly, son of Jessica Brown and Zakk Satterley was born, WHAS reports. “We couldn't get nowhere, so I called 911,” Satterly said.

After Brown and Satterly realized that the baby was coming and they were in "traffic gridlock," Satterly began to ask the cars around them for help, Shalanna Taylor reports for WLKY-TV. “I started asking people in different cars if they knew anything about having a baby,” Satterly said.

One of them was a nurse, Tonia Vetter, Gill Corsey reports for WDRB-TV. "I told the dad, I said, 'I'm a high-risk nursery nurse at Floyd Memorial'," the hospital in New Albany, Ind., Vetter said. "It actually happened very, very quickly. ... I think she pushed one time and the head delivered, and then she pushed again and the baby was born." Other drivers provided a shoestring for the umbilical cord and a blanket to keep the baby warm, Corsey reports.

"I've attended a lot of deliveries, but I've never delivered a baby on my own, and I've certainly never delivered one in the middle of an interstate," Vetter said. "God was definitely watching over me, the baby, the mom, because she could have hemorrhaged. The baby could of had a cord or a shoulder or any number of complications could've happened."

An ambulance took Brown and Arley to the University of Louisville Hospital, where a spokesperson said the mom and baby were doing just fine and were in good condition.

As session nears end, bills on heroin, dating-violence orders, managed-care appeals and lawsuit review panels are hanging fire

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The General Assembly has sent Gov. Steve Beshear four health-related bills, and several more could reach his desk in the legislative session that ends Wednesday. Legislators will return briefly after 10 days to reconsider any bills Beshear vetoes; they could also pass more bills, but would not be able to override any vetoes.

Here are some of the health-related bills that were pending on Monday; bills with two readings are ready for floor action.

Heroin: tougher penalties and needle exchanges?

Both the Senate and the House have heroin bills and both remain in committee in the other chamber, but hope remains high in both chambers that a compromise can be reached so that a heroin bill will pass this session. Senate Bill 5 is sponsored by Sen. Christian McDaniel, R-Latonia; House Bill 213 is sponsored by Rep. John Tilley. The main differences are how traffickers would be punished and whether to start needle-exchange programs for addicts. The Senate's penalties are tougher and it has opposed needle exchanges, which advocates say prevent disease and death from dirty needles and can lead addicts to treatment.

Now the Senate is moving toward accepting needle exchanges, James Pilcher reports for The Cincinnati Enquirer. Rep. Dennis Keene, D-Wilder, and Sen. Wil Schroder, R-Wilder, said exchanges "are much more likely to be included than when the session started," Pilcher writes. Schroeder told him, "I think there is a real possibility that we could include needle exchanges and then get our tougher penalties." Pilcher reports, "The possible legislative position shift comes as health officials throughout the Tristate have expressed deep concerns about the spread of diseases that can be contracted using dirty needles."

Protective orders for dating violence

House Bill 8, sponsored by Rep. John Tilley, D-Hopkinsville, has received its second reading and is awaiting passage in the Senate. This bill would allow dating partners to petition for interpersonal protective orders if they have been the victim of domestic violence, sexual abuse or stalking. Such orders are now available only to those who are married, live together or have lived together, or an unmarried couple with a child in common.

Kentucky is the only state that offers no protection for such victims. Legislation to do that has stalled in the Senate in earlier sessions, but a Senate committee substitute addresses a key objection, by creating a new chapter in the statutes for the bill, separate from the existing domestic-violence chapter.

Advocates say domestic violence is a health issue not just because of the physical injuries it causes. They say victims are more likely to be depressed, have unplanned and premature pregnancies, go to fewer prenatal visits, and to miss more well-child visits with their children.

Prescription synchronization, managed-care appeals

Senate Bill 44, sponsored by Sen. Julie Raque Adams, R-Louisville, has had its second reading in the House. This bill would allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

House Majority Caucus Chair Johnny Bell, D-Glasgow, has filed a floor amendment on an unrelated issue, to create a state appeals process for health-care providers to appeal decisions of Medicaid managed-care companies. It is the same as or similar to Senate Bill 120, sponsored by Sen. Ralph Alvarado, which has given it a first reading without assigning it to a committee. The Cabinet for Health and Family Services opposes a state appeals process, saying it would have a conflict of interest (successful appeals would cost the state money) and providers have the courts available to them to resolve contractual issues. UPDATE: Bell withdrew his floor amendment to Senate Bill 44 March 9. 

Review panels for suits against health-care providers: Senate Bill 6, filed by Alvarado, remains in the House Judiciary Committee, but a discharge petition was filed March 4 to bring it to the floor, bypassing leaders of the House's Democratic majority. This bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court, but not legally binding. Opponents say that Kentucky already has laws to punish attorneys for filing frivolous cases and that this just adds another barrier for patients seeking justice.

Newborn screenings for fatal disease: Senate Bill 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, has had two readings. It would require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur. Treatment with stem cells from an umbilical cord blood transplant is sometimes successful it the infant is treated early enough. The cabinet opposes the bill, saying the screening will cost half a million dollars a year at a time when local health departments are suffering budget cuts.

Spina bifida: Senate Bill 159, sponsored by Sen. Julie Raque Adams, R-Louisville, is in the House and the three-day posting rule has been waived. This bill would require medical providers to supply written, up to date, accurate information to parents when their unborn child is diagnosed with spina bifida so parents can make informed decisions on treatment

Physician assistants: House Bill 258, sponsored by Rep. Denver Butler, D-Louisville, is awaiting Senate passage. This bill allows a physician to supervise up to four physician assistants at the same time, rather than two.

In-home care: House Bill 144, sponsored by Rep. Tom Burch, D-Louisville, is awaiting Senate passage. It would establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services. The daily cost would have to be less than the average daily nursing home payment allowed by Medicaid. The bill would also provide non-medical support services to the applicant as needed.

BILLS SENT TO THE GOVERNOR

Colorectal cancer screening: Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, received final passage in the House March 4. This bill requires that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The bill would apply to health plans issued or renewed on or after Jan. 1, 2016, if it becomes law. A similar measure, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, is awaiting passage in the Senate with a committee substitute by Sen. Julian Carroll, D-Frankfort, calling for a Medicaid savings study.

Medical order scope of  treatment (MOST) form: Senate Bill 77, sponsored by Sen. Tom Buford, R-Nicholasville, received final passage in the House March 3. This bill creates a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care. It is considered a physician's order, travels with the patient between health care facilities, and must be reviewed annually. The bill clearly defines the order of controlling documents for end-of-life care: the living will first, the MOST form second and the health-care surrogate, which is chosen by the patient and listed on the form, third. The MOST form is already used in 32 states.

Emergency care for strokes: Senate Bill 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, received final passage in the House March 4. The bill requires that a list of all acute stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky be posted to the cabinet's website and be made available to all emergency medical services providers, who are required to set their own internal protocols toward assessment, treatment and transport of stroke patients.

Funding for UK cancer research center: House Bill 298, sponsored by Rep. Rick Rand, D-Bedford, received final passage in the Senate March 4. This bill authorizes the state to appropriate $132.5 million, half of the cost, for construction of a new medical research center at the University of Kentucky. The university will raise money to cover the other half. The facility will target prevalent diseases in Kentucky, including cancer, diabetes and cardiovascular disease. The bill required a 60 percent vote in each chamber because it affects the state budget and the legislature is in a non-budget session; it passed the House 83-9 and the Senate 36-1 (Sen. John Schickel, R-Union).

Telemedicine helps reduce waits for mental-health patients in ER and provides better health-care access in schools

Health professionals have used telemedicine to help delay Alzheimer's disease and reduce hearing loss in Appalachia, especially among children. Now the new approach is helping students access health care, and mental-health patients to get faster medical attention in emergency rooms.

AMD Global Telemedicine has been establishing telemedicine systems in schools, which allow "providers to care for students on-site with few clinicians to support it," Katie Wike writes for Health IT Outcomes. So far "the Center for Rural Health Innovation in western North Carolina used the technology to support 14 school-based programs and provide care to 4,000 students.

The health-care provider can ask the questions during the exam, and "it doesn't assume the presenter knows the questions to ask," said CRHI Executive Director Amanda Martin. This approach allows one nurse practitioner to provide care to thousands of children. Some Kentucky schools are already using the telemedicine platform, Wike reports.

Sometimes when patients seek mental-health care in emergency rooms, no psychiatric services are available. In this case, hospitals often contact and wait for a provider to arrive or send written evaluations for review, Karla Paris writes for Health IT Outcomes. Now KentuckyOne Health has a telemedicine program that gives faster response times for those requesting mental-health care. For example, patients who visit Louisville's Ss. Mary & Elizabeth Hospital for mental-health care will be able to videoconference with professionals from Our Lady of Peace Hospital. "Patients can then be referred for admission at Our Lady of Peace, another outpatient program or care center," Paris reports.

Free-standing emergency departments could be the solution to keeping hospital services in rural areas

The tribulations of rural hospitals in Georgia, and the response, could signal a new direction for saving such facilities. Four rural hospitals in Georgia "have closed in the past two years, and several more either have closed or significantly reduced services since 2001," Bob Herman reports for Modern Healthcare. "Nationwide, more than two dozen rural hospitals have shut down since 2013. For people in rural areas, a closed hospital means they have to travel farther, sometimes hours, for care. And that could mean life or death in situations such as cardiac arrest, car accidents, workplace injuries and other emergencies."

Republican-led Georgia, where officials have refused to expand Medicaid under federal health reform, "has proposed a regulatory change that some observers think could help rural hospitals across the country," Herman writes. Republican Gov. Nathan Deal said in March that "financially struggling rural hospitals can offer fewer inpatient services and still keep their hospital licenses. In essence, they can convert into free-standing emergency departments that stabilize and transfer patients to bigger hospitals. Under Deal's proposal, these rural facilities also could offer other basic services such as labor and delivery."

Some people are critical of the idea. Brock Slabach, a senior vice president at the National Rural Health Association, "said the financial sustainability of free-standing rural EDs in Georgia as outlined by Deal would be low," Herman writes. Salbach told him, “Emergency departments would be nice for access, but that doesn't provide (insurance) coverage. These rural communities are still going to be having problems of paying for these services. We need to try to find a way to expand coverage to these poor populations in a way that's not going to be called Obamacare.”

There are somewhere between 400 to 500 EDs in the U.S., Herman writes. Most "are affiliated with a hospital or health system, serving as a feeder for patients needing inpatient care. The EDs usually are within 20 miles of a full-service hospital. More recently, for-profit ED companies have been building in affluent suburbs, targeting privately insured patients who see the EDs as more convenient than making an appointment with a primary-care physician."

The problem is that few are located in rural areas, Herman writes. For urgent-care centers and free-standing EDs to survive in underserved rural areas the “operating model will need to adapt,” said Alan Ayers, a vice president for Concentra, the urgent-care subsidiary of giant Louisville-based insurer Humana Inc. "They will have to use mid-level clinicians including physician assistants and nurse practitioners, reduce operating hours, and offer other high-volume services such as primary care and occupational medicine. That could help rural facilities offset the typically high fixed costs, Ayers said."

"Perhaps the most feasible solution for rural areas is a hybrid model, mixing lower-level emergency care with primary-care services," Herman writes. "An example is Carolinas HealthCare System Anson in Wadesboro, N.C., a town of 5,800. In 2012, Carolinas HealthCare System—a large system based in Charlotte, N.C., with $4.7 billion in annual revenue—decided to overhaul Anson Community Hospital, a Hill-Burton facility with 125 staffed acute-care and nursing beds."

"The system spent $20 million and downsized the hospital's inpatient capacity from 30 beds to 15," he writes. "The new facility, which opened in July, offers 24/7 emergency care in addition to the limited number of acute beds. Carolinas officials said Anson's major innovation and attraction is that it uses a patient-centered medical home model, offering residents access to primary-care providers with the help of a patient navigator." (Read more)