FARGO, N.D. - North Dakota is among the states leading the way in making sure stroke victims are getting the fastest and best treatment possible. Stroke is still one of the leading causes of death in the nation, but continues to slide down the rankings, and the American Heart Association credits North Dakota as part of that improvement.

That's because the state has 80 percent of its hospitals in what's called a Stroke Registry, and Beth Ashmore, senior director of ambulatory services with the Essentia Health organization, says that's the highest rate in the nation.

"All six of the tertiary hospitals in North Dakota, and 26 out of the 36 critical-access hospitals, actively share and participate in the Stroke Registry."

She says hospitals in the program are provided with proven treatment plans, and outcomes are tracked so they can continue to improve treatment for stroke victims.

Ashmore says support of the North Dakota Legislature for the stroke registry and task force has been critical to the program's success since it began in 2009.

She adds that one component of that success is giving hospitals treatment guidelines to improve the continuity and standards of care for stroke victims.

"And it also tracks the performance. Hospitals can then identify areas for process redesign and what needs to be worked on to continually improve the care."

Another focus is educating the public about the warning signs of a stroke. They include confusion or dizziness, trouble speaking or seeing, and sudden numbness in the face, arm or leg.

Ashmore says if you have these symptoms or see them in another person, call 911, because with a stroke, time is critical.

"It's really a blood vessel that's being blocked by a clot, so really, fast diagnosis and treatment can make the difference between returning to a life of independence with minimal side effects, versus one of disability."

Ashmore says it's important to note the time that symptoms begin, because a key clot-busting drug called TPA can only be administered generally in the first three or four hours after onset.

The other key focus of the Stroke Registry is to let people know there are many ways to reduce stroke risk.

"Manage and control your blood pressure. You really want to know your cholesterol numbers. Manage your diabetes. Stop smoking and avoid second-hand smoke. Be active for 30 minutes a day, and really eat healthy. Maintain a healthy weight, looking at aiming for a diet with less than a 1500 milligrams of sodium per day."

Nationally, stroke has dropped from third to fourth as the leading cause of death, while in North Dakota, it has dropped to sixth.

More information is at www.ndhealth.gov




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After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.