Print
Category: Front Page News Front Page News
Published: 26 June 2022 26 June 2022

This one addresses the fourth presentation at the work session by Dr. Teresa Arizaga reporting on Tu Casa and fifth presentation by Dr. Twana Sparks and Adrienne Dare on medical aid in dying.

[This is the fourth in a series of articles on the Grant County Commission meetings.]

By Mary Alice Murphy

In the fourth presentation at the Grant County Commission work session on June 21, 2022, Dr. Teresa Arizaga, Hidalgo Medical Services chief mental health officer, spoke about Tu Casa and its mental health and substance abuse treatment services.

She began by noting that HMS Chief Executive Officer Dan Otero will talk about HMS at a future commission meeting.

"Tu Casa enhances our HMS services," Arizaga said. "At HMS we continue to offer psychiatric consultation, psychiatric medication management, mental health and substance use treatment and assessments, individual and group therapy, crisis intervention, care coordination, comprehensive community support services (CCSS), psycho-social rehabilitation (PSR), peer support services, a 24/7 crisis line, and medicated-assisted therapy, which we continue to grow within HMS and the community, including working with our Detention Center."

She said that each provider that comes into HMS, whether medical or psychiatric, "we encourage them to get waivers, so they can prescribe suboxone, as well. (Editor's Note: it is used to treat opioid addiction)."

Arizaga said one way the program at HMS and Tu Casa is growing is through its multi-systemic therapy program, which is the family therapy that goes into homes to treat families and adolescents who are at risk, either through substance use or at risk of being taken from the home.

"We continue to work with the state and with the county looking to see what our CTC (crisis triage center) will look like as we move forward," Arizaga said. "HMS is involved in a monthly meeting with the state. That has been beneficial, because in the beginning the regulations were very strict on what it had to look like, and it was just not sustainable in our rural area. It has even been difficult in some of the urban areas, such as Dona Ana County. We're looking at different models, which might include a partnership with an emergency room or not having to be open 24/7 and just opening up when we need to. We will be able to use some of the staff we already have for these services. Really at Tu Casa specifically we offer all the services, just not 24/7. We are also continuing to work on a mobile crisis response work group that just started at the state level, so HMS has a voice there as well."

She referred to the 988 stakeholders group. The service for 988 will go live next month to connect people in behavioral health crisis to help for them. "We are working on what we will do when people use the 988 line. We recognize not everything will be in place to start with, and it will evolve over the next year, but a lot of planning has gone on."

Arizaga said a very important part of the HMS family residency program is that "we bring them into rotations at Tu Casa, so they are more comfortable with behavioral health issues. Having the residency program integrated is beneficial. A lot of times in rural and frontier areas, having psychiatric services is rare, so it's good to have family physicians learning about this, since they are the likely ones to have to treat the behavioral health issues."

"HMS is a part of our New Mexico Internship Consortium," she said. "This program started last year. They are psychology interns with the first cohort graduating this year. There are three sites. We are one and Shiprock and Las Vegas are the others. We work together to be a part of educating future psychologists. Hopefully, we will get some of them here. Right now, for someone with a referral for any age, it can take up to a year for them to see someone. HMS is developing a psychology division, which will have the full spectrum of services from the psychiatric to the psychological and therapists, and peer support services. This will be a chance to collaborate with schools, the high schools and the university. We are in the process of contracting a psychologist to oversee this program."

District 4 Commissioner Billy Billings asked how many people have been treated at Tu Casa.

Arizaga said she wished she had the number, but she does know that over the past couple years, the numbers have increased, especially for new patients never seen before with behavioral health needs.

Billings said he wanted to thank her for what she does, because it's helpful and productive, "as I know families who have participated in the program. It has had a great benefit.

District 3 Commissioner Alicia Edwards, who serves on the Tu Casa Advisory Board, also thanked Arizaga for the "amazing progress you're making at HMS. I'm participating in the 988 work group along with Dr. Arizaga and Dan Otero, and I really think implementation is an opportunity to put us over the hump to get things done because of regulatory and payment challenges. It will wake up the state decision-makers about rural health."

Arizaga said she believes the implementation of the 988 number will be a game-changer to help people get more complete care.

"Yes, our goal is still to have 24/7," she said in reply to a question from District 5 Commissioner and Vice Chair Harry Browne, who was chairing the meeting. "One of our goals is looking at the possibility of mobile crisis response, which would be 24/7, not just with HMS, but within the community. It's too big a lift for one agency, but it's something we're working toward as well."

Edwards said the 24/7 crisis triage center is part of the 988 piece. "it will boost all the things the state is having to do around the barriers to 24/7 service. I think it will be the opportunity for Tu Casa to reopen as 24/7."

Arizaga agreed and said over the past year, "we've worked with the Sheriff's Officem which has been extremely helpful, as well as with the Detention Center and other agencies."

The next presentation came from Dr. Twana Sparks, now semi-retired ear, nose and throat surgeon for 30 years. "What I would like to talk about here is that yesterday was the one-year anniversary of Medical Aid in Dying and its becoming legal. It's outstanding. There are 11 states that provide physician-assisted dying. New Mexico has become the leader in streamlining the process. We have had 105 ingestions that cause death in terminal patients in New Mexico, which shows the need. We had one in Grant County and have three more requests. We do not use the term, medically assisted suicide. I think for the first time in history, we are able to predict when a person will die. The way it has been explained to me is that if a person says: 'I'm going to commit suicide,' that is choosing between life and death. People in hospice are told they have less than six months to live, maybe three, maybe a week. They are choosing not between life and death but between death tomorrow to death in two weeks, and those two weeks may be horribly burdening with suffering. The term is medical aid in dying. You are likely to hear MAID if you follow the topic. I want to emphasize that no one, ever, if they are a patient in hospice, in no way, is required or encouraged to use the service. It is an option for them, and they should be informed. I personally do not favor it or promote it or encourage it or discourage it. I just want people to know it is legal option in New Mexico. No doctor is required to participate; no nurse is required to participate. I have informed all doctors in the three-county area that they are required to refer a patient who asks for this. That's the New Mexico law. When I did that, I found out that like the medical marijuana laws and pregnancy termination laws that no federal money may be used for this. This means for HMS that those doctors are not allowed to even refer. The law has been changed for pregnancy termination, so that a doctor at HMS can refer someone. Dan Otero is seeking to change the legal language for when people say to their doctor that they want to learn about medical aid in dying, so they can say: 'Here is the number to call.' It's not a major issue, because almost everyone that comes to medical aid in dying is in hospice. Most have been told they have less than six months to live, many from cancer, and others from neurodegenerative illnesses, such as ALS. I would like to educate you, commissioners, because you also serve as the hospital board, and it may become an issue there. Advanced directives are not enough. There are three requirements. One is the person has been declared by two physicians or one nurse practitioner or physician assistant and a physician that they have less than six months to live. The second is: 'Are you decisionally capable? Can you tell me your disease? Can you tell me how you feel? Can you say, yes, I want to wake up this morning, but not tomorrow morning?' The third requirement is for the patient to show an affirmative action that the patient is willing to participate. 'Can you pick up the glass to drink it? Can you push the syringe that would introduce the medications into your gastro-intestinal tube in your stomach or rectally? Can you make a decision on a date, and can you help with the intake of the five medications that will be ingested?'

She said surveys have been done to learn how people are coming to accepting this. "We found that 65 percent of Hispanics are in favor of legalizing this. 70 percent of African-Americans and Asian-Americans are in favor. 80 percent of Caucasian-Americans are in favor. So more than two thirds of the population is in favor. This is not legal in any facilities at this point. It is not legal in hospitals or nursing homes. The disadvantage is that a person must be discharged. There are homeless people on hospice; there are nursing home patients that have no place to go. An agency that supports this practice can rent a hotel room for a person to die in. People can offer a place in their home for people to die. There is an organization called A Place to Die. Haven and Ambercare, our hospice providers, cannot obstruct or encourage medical aid in dying, but they can say it is an option. A nurse may not be in the room for ingestion. The physician who wrote the referral will be in the room, along with family members. The person makes their ingestion and the nurse may return. They are likely to fall asleep within five minutes and die within two hours. The body is taken by the funeral home or whatever arrangements have been made. We have worked through every possibility if a person wants a peaceful death."

She introduced Adrienne Dare, who was instrumental in getting the legislation passed and had personal experience with her mother choosing this in Oregon.

Dare said she has been passionate about this for 20 years. "My mother, who was dying of cancer, used medical aid in dying in Oregon. That's when I became passionate about this issue. For the past 10 years, I've been very involved with this whole process. I've seen a growing acceptance. I know clinicians are reluctant to do this, because they have not experienced it before. Once they see how successful it is, they come on board."

She gave an example of a physician in California who performed medical aid in dying. He had trouble getting patients, but once people saw how successful it was, hospices, except for religious ones, came on board. Another physician in New Jersey saw people make the decisions by talking to their families or priests. Once they get the prescriptions, they feel they have control. About 35 percent do not take the medications, but they are comforted and feel they have control. It's been available in Oregon for 25 years.

In 2014, a 29-year-old woman, Britney, with a brain tumor, in California moved her family to Oregon to take medical aid in dying.

"We've been working on this since 1995," Dare said.

Sparks handed information out to the commissioners. Billings asked if it was for information or whether there is more to come from the Legislature.

"This is part of our educational outreach," Dare said. "After the legislation passed, we created a non-profit, End of Life Options New Mexico."

Browne said they had mentioned the New Mexico law could be a model for other states, but "it strikes me that two things are not as progressive as they could be. One is the necessity of two physicians or a physician and a lower-level practitioner to say the person has less than six months to live. There could be other times when a person might want to choose this, for example if they are in chronic pain. Will there be efforts to expand New Mexico's law?"

"Our law is pretty consistent with other laws in the country," Dare said. "We require that the person be able to self-administer. In Canada, for instance, they allow medical aid in dying, but basically, they allow euthanasia, with the doctor doing it rather than it being self-administered. One of the bills we tried to pass, we started out with a more lenient process, but we had to change it to six months to get it to pass. Hopefully, it will evolve."

Browne noted that the group is also working on a Spanish language version of the outreach pamphlet.

The next article will address a presentation from the county financial counsel, Mark Valenzuela on the potential issuance of a general obligation bond to be decided at the General Election.