Holes in health care

Low wages defeat many Southwest Coloradans’ efforts to find proper care

The safety net of health-care services in La Plata County has big holes.

Area residents are going without critical mental-health, substance-abuse, dental and primary care because of a lack of services, providers or access. Local health agencies, including Mercy Regional Medical Center, San Juan Basin Health Department and Axis Health System, are trying to close the gaps, but without something comprehensive, it could be just a patchwork solution.

Behavioral health describes the connection between our behaviors and our health and well-being. It can cover a lot of things, but many health professionals use it to describe people who have a mental illness and a substance-abuse problem, or have a mental-health and a physical health problem.

Southern Ute Community Action Programs Inc. has a program, Peaceful Spirit, that treats many residents with a co-occurring diagnosis of mental illness and substance abuse, Executive Director Eileen Wasserbach says.

“It’s sort of a chicken-and-egg thing. It’s really hard to tell which came first,” Wasserbach said. “Best research tells us that just treating addiction doesn’t always effectively address other behavioral health issues.”

SUCAP is a nonprofit organization that mostly serves the Ignacio area, but it operates some programs across La Plata County. Peaceful Spirit has several inpatient and outpatient programs for youths, adults and families. It’s the only residential substance-abuse treatment facility in the area. It doesn’t take insurance and costs $6,800 for the six-week program for non-Native Americans. It’s free for Southern Ute Indian Tribe members who live in the area. Other Native Americans may use the service for a fee.

Residents who need serious substance-abuse counseling most likely aren’t making the big bucks to afford this expensive treatment. Inpatient centers that may take health insurance for substance-abuse treatment often are far from family and friends in cities such as Farmington, Grand Junction, Colorado Springs and Denver.

Colorado has two state hospitals for inpatient mental-health treatment: one in Pueblo and one at Fort Logan, southwest of Denver. The Colorado Mental Health Institute at Pueblo is the state’s largest public psychiatric hospital. It charges fees on a sliding scale and accepts Medicare and Medicaid. Axis offers acute and emergency mental-health services. It also operates a detox treatment center on Three Springs Boulevard.

The lack of mental-health and substance-abuse inpatient services also puts pressure on the criminal justice system.

Todd Risberg, district attorney for the 6th Judicial District, which covers Archuleta, La Plata and San Juan counties, said people sometimes sit in jail for several months waiting for a bed to become available at a facility elsewhere. The wait lists are lengthy, and there are at least a couple of drug court defendants who currently can’t get a bed until October.

“It’s unreasonable, and a lot of the problem is we don’t have anywhere to send them locally,” Risberg said. “The criminal justice system ends up dealing with a lot of mental-health issues that I don’t think properly belong in the criminal justice system.”

Probation pays for some expenses for people in the court system, and there are nonprofit agencies that provide treatment services.

The other side of sending people away for treatment is having services available for when they come back. If they come back and have no place to live, Risberg said they can get a motel voucher.

“Aftercare is another severe need in this community,” he said. “You send someone up for treatment, and they learned this skill and they’re doing well, and they come back and they’re right back where they started with the same people they were using drugs with, and that’s just not the right way to do it.”

Many residents in Durango work part-time, low-wage jobs without health insurance. The new La Plata Integrated Healthcare, operated by Axis, on East Third Avenue offers behavioral-health and primary-care services. It takes Medicaid and Medicare, and uses a sliding-fee schedule for low-income residents without insurance.

“It’s an awful lot cheaper to deal with mental-health issues by giving people a stable place to live and treatment rather than put them in jail or put them in prison or send them to a hospital somewhere,” Risberg said.

Another hole in our health-care net is the unmet need for affordable dental and primary-care services.

The La Plata Integrated Healthcare Clinic, which opened in January, plans to offer dental services in about two years, according to minutes of the Citizens Health Advisory Council.

The advisory council, a group that supports community health by helping agencies collaborate, has formed an oral-health coalition with San Juan Basin Health. The health department pinpointed the need for adult dental care in a 2012 health-care assessment.

Many community members hope the Affordable Care Act will give area residents help with dental coverage. In 2010, 28 percent of Colorado adults earning less than $15,000 had lost all of their natural teeth, compared with 4 percent of Colorado adults with $50,000 or more a year in household income, according to a May presentation by San Juan Basin Health and the advisory council.

Health department Executive Director Liane Jollon said the community is gradually improving access to health care. However, that doesn’t mean everyone can use what’s available. Providers in primary care and dental care are in short supply historically for uninsured residents, she said.

In La Plata County, just six out of 31 dentists accept Medicaid, translating into two full-time providers and one part-time provider. Medicaid expansion for adults started in April, and it is expected to expand further this month, but there are no new dental providers for the estimated 800 Medicaid adults.

“We’ve increased our adults without dependent children population that can use Medicaid, so part of Medicaid expansion has now created a pay source for adults,” Jollon said.

Dental disease affects 30 to 50 percent of all low-income children and up to 70 percent of Native American children. In SUCAP’s Head Start program, kids brush after breakfast and lunch, Wasserbach said.

The health department was awarded a grant to increase its dental services for the next two years. The department also does immunizations and family planning.

“We do some components of primary care and some components of oral care,” Jollon said.

Mercy Regional Medical Center is adding more primary-care providers to its Mercy Family Medicine practice because demand is outstripping supply. Mercy is adding five more health-care providers in the next five months. A provider doesn’t necessarily mean a doctor. It can also mean a physician assistant or nurse practitioner.

A balanced ratio for a provider is 1,800 to 2,200 patients a year, McConnell said. They were seeing 50 to 75 percent more patients than that.

“It just makes it hard for us to provide the level of access that, really, patients need,” said Will McConnell, vice president of operations and outreach strategy for Mercy. “We’re one of the few locations that actually takes Medicare patients.”

Part of the practice recently was moved to the Horse Gulch Health Campus at East Eighth Avenue and Third Street. Mercy has a family practice at the hospital on Three Springs Boulevard and a clinic in Bayfield.

“The desire really is to have primary care accessible within a 10- to 15-minute drive of the majority of patients in and around Durango,” McConnell said. “If you can’t access primary-care services, you’re more likely to not have your diabetes managed or not have your congestive heart failure managed or to not seek medical care until you’re in a position that needs a trip to the emergency department or hospital admission.”


The illustration that accompanies this story is not meant as a commentary on the insurance company or the health benefit administrator named in the illustration .

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