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New Mexico Residents Struggle to Navigate Health Care System in Crisis

October 15, 2008 at 6:25 PM EST
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In New Mexico, where a quarter of the residents do not have health insurance, rising poverty rates and a lack of medical facilities are straining the system and bringing health care to the forefront of this year's election.
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BETTY ANN BOWSER, NewsHour correspondent: Once a month, badly needed food and health care come to the small rural towns that dot the country roads of Chaves County.

In this part of the state, one-quarter of the people live below the federal government’s poverty line. They’ve been hit hard by rising food and gas prices. So when the Roadrunner food pantry hands out 50 pounds of groceries for $2, that’s an offer locals can’t refuse.

JANE BATSON, dean of health, Eastern New Mexico University: Did you go get your blood pressure checked?

BETTY ANN BOWSER: While people wait for food, Jane Batson works the line, looking for those with health care problems.

JANE BATSON: Have you got one?

NEW MEXICO RESIDENT: Oh, a doctor? No.

BETTY ANN BOWSER: As dean of health at Eastern New Mexico University Roswell, Batson is keenly aware that nearly one quarter of the people in New Mexico have no health insurance. That’s the second-highest percentage of any state in the nation.

Many of these people work for the small businesses that drive much of the economy of the state and whose owners can’t afford to offer health insurance.

So Batson, in conjunction with the food pantry, Blue Cross-Blue Shield, and several drug companies, runs this outreach program.

DOCTOR: OK, a little stick, one, two, three.

BETTY ANN BOWSER: It provides blood pressure checks, diabetes screening, and help for people like Sandra Beckley.

DOCTOR: Are you taking meds?

SANDRA BECKLEY: I just run out of them about a month ago. It’s really hard for me to breathe.

BETTY ANN BOWSER: Beckley has asthma, rheumatoid arthritis, four herniated discs, carpal tunnel syndrome, and no health insurance. She’s too disabled to work and can’t afford the drugs she needs to control her asthma.

SANDRA BECKLEY: There’s been several times this past month since I’ve ran out of my inhalers that I’ve seriously thought about calling 911 because I felt like I was just breathing through a straw.

DOCTOR: Are you having any mucous drainage?

SANDRA BECKLEY: Yes.

JANE BATSON: She’s really quite typical.

DOCTOR: How much water do you drink every day?

Needed care simply not available

Jane Batson
Eastern New Mexico University
The health professional shortage in New Mexico is acute. Primary care physicians are on call 24 hours a day, seven days a week in a small community. They may not have anybody who can substitute for them.

JANE BATSON: You're seeing what we see all the time. The university has a lot of outreach programs, and our intent is to try to just make a little dent or to at least provide some access to the health care system.

BETTY ANN BOWSER: That's what Beckley got that afternoon when she was examined by nurse practitioner Kari Hendra (ph). The exam was paid for by the outreach program.

DOCTOR: So we want to get you back on your medicines for sure.

BETTY ANN BOWSER: Tragically, two-and-a-half weeks after we interviewed Beckley, she died. The cause of death is still undermined.

But even if she had had insurance, Beckley lived in an area where health care of any kind is hard to come by.

More than half of all the people in New Mexico live in non-urban areas, many in small towns like Hagerman, population 1,200. Here, there are no big supermarkets. There's no pharmacy. There is one gas station. But Hagerman has no doctor.

Two years ago, Hagerman's only clinic shut down. Now, Mayor Cliff Waide says patients must drive 25 miles or more to the nearest urban emergency room.

CLIFF WAIDE, mayor of Hagerman, N.M.: If they're going to get treatment right away, it seems like that's about the only way to do it. The doctors in the area are so overloaded that it's six weeks to get an appointment.

BETTY ANN BOWSER: Six weeks?

MAYOR CLIFF WAIDE: A lot of times.

BETTY ANN BOWSER: And you're sick right now?

MAYOR CLIFF WAIDE: You're either cured or dead by the time you get in to see the doctor, if you don't do that.

BETTY ANN BOWSER: So, well, what do you do if you get sick?

MAYOR CLIFF WAIDE: Usually I just suffer.

BETTY ANN BOWSER: Hagerman is not unique. All over the state, there are towns whose economies are driven by small businesses like Piccolino's. Owner Carlos Tarango doesn't provide health insurance for his workers.

CARLOS TARANGO: I wish I could, but I cannot afford it.

BETTY ANN BOWSER: Jane Batson says towns like Hagerman also don't attract primary care physicians.

JANE BATSON: The health professional shortage in New Mexico is acute. Primary care physicians are on call 24 hours a day, seven days a week in a small community. They may not have anybody who can substitute for them.

Lack of funding causing deaths

BETTY ANN BOWSER: A hundred miles west of Hagerman is another area with an acute doctor shortage, the Mescalero Apache Indian Reservation. The only medical facility on the 460,000-acre reservation is this 13-bed hospital run by the federal government's Indian Health Service, or the IHS.

The Mescalero Apaches, and other Native American tribes, were promised health care through treaties with the federal government and by an act of Congress in 1921, but the IHS has been chronically underfunded by Washington for decades.

Just three doctors serve 4,000 Mescalero Apaches, and only the most basic medical conditions can be treated. Even though the Mescalero Apaches own this big resort and casino, the vast majority are unemployed.

CARLETON NAICHE-PALMER, president, Mescalero Apache Tribe: About three-quarters of the reservation is forest.

BETTY ANN BOWSER: Carleton Naiche-Palmer, president of the tribal council, says that means poor health outcomes.

CARLETON NAICHE-PALMER: Because of the lack of funding, we have people that are dying prematurely because of various diseases like diabetes.

BETTY ANN BOWSER: The New Mexico Department of Health says the state's 200,000 Native Americans have the highest rates of diabetes, pneumonia, and alcoholism of any other group in the state, and the highest death rate.

Some tribal members, like Ellis and Nina Tortilla, don't like to go the Indian Health Service, because they think the care is inadequate. Sixty-two-year-old Ellis Tortilla lives on Social Security disability payments and has no insurance. Still, he won't go to the IHS unless he's desperate.

Recently, Tortilla needed abdominal surgery. Since the IHS wasn't equipped to do the procedure, they referred him to an outside doctor. When they refer a patient to medical facilities off the reservation, the IHS is supposed to pay for that treatment.

Is this a bill for all those things that you had that were done?

NINA TORTILLA: Yes. Yes.

BETTY ANN BOWSER: What are you going to do about this bill? It's $10,750.

NINA TORTILLA: I'm going to take it back to IHS.

BETTY ANN BOWSER: To the Indian Health Service?

NINA TORTILLA: Yes, to the Indian Health Service.

Slow, inadequate, defunded service

Paul Ortega
Shaman
People get hurt at night more than they do in the daytime. They feel the pain. They feel that they can't go to the hospital because the hospital is closed. Sometimes they call a medicine man.

BETTY ANN BOWSER: Tortilla may have a long wait. The IHS ran out of money to pay for the medical treatment off the reservation in July. Until new funding comes from the federal government, they are paying only for cases they consider life-threatening.

Dr. Ulysses Velez (ph) is frustrated, too. He was recruited to work for the health service from Puerto Rico.

Do you feel like you have enough tools to work with here?

DOCTOR: Nope.

BETTY ANN BOWSER: Budget problems?

DOCTOR: Yep. We are working without money.

BETTY ANN BOWSER: With no funds?

DOCTOR: Without funds.

BETTY ANN BOWSER: The hospital closes at 10 p.m. After that, if there's an emergency, the closest ambulance is 20 miles away. If a tribal member suffers a stroke or a heart attack, President Naiche-Palmer says they're in trouble.

CARLETON NAICHE-PALMER: People, in many cases, just die because service is just too slow and far away.

BETTY ANN BOWSER: Some tribal members turn to Paul Ortega for care. He's a shaman, a medicine man.

PAUL ORTEGA: People get hurt at night more than they do in the daytime. They feel the pain. They feel that they can't go to the hospital because the hospital is closed.

BETTY ANN BOWSER: So what do you do? Where do you go?

PAUL ORTEGA: You don't go nowhere. Try to take care. You go see -- sometimes they call a medicine man. They'll call over here and want to know if I have anything, because so-and-so is hurting.

BETTY ANN BOWSER: Ironically, some of the Mescaleros and other uninsured New Mexicans might be eligible for Medicaid or other government assistance. Jane Batson says lack of knowledge and bureaucracy keep people away.

JANE BATSON: They've become discouraged about looking for access because they've been unable to find it. They may have been turned away. They're unfamiliar with the programs that are there, and so they really don't know what to do.

BETTY ANN BOWSER: Some officials, like Batson, would like to see universal coverage in New Mexico, but concede that, even if all the state's residents had health insurance, they would still have trouble getting access to health care.