When Autumn Nelson decided she was ready to seek treatment for her alcoholism, she knew she had to act fast.

“When someone with an addiction says, ‘I need help,’ we’re begging,” she said. “We want it.”

Nelson, who lives on the Blackfeet Reservation, knew she might have to leave home to get the help she needed. Crystal Creek Lodge provides inpatient and outpatient treatment on the reservation, but community members say the place is almost always at capacity. Journey to Recovery, another facility on the reservation, provides outpatient services primarily focused on supporting individuals after they return from inpatient treatment. And sometimes, it can be helpful for people struggling with addiction to leave their environment and disconnect from people in their circles who may be using.

So when Journey to Recovery gave Nelson the contact information for a treatment center in Arizona, Nelson was hopeful. She was ready to get clean. Little did she know she’d soon be caught up in a national scandal.

Phoenix House Recovery, a treatment center in Arizona, paid for Nelson’s plane ticket to Arizona, and Nelson was eager for a fresh start. Her father died of cancer three years ago, and just before his death, her younger brother died in a car accident.

“That really set my alcoholism off,” she said. “I kind of just stepped out of reality for a while.”

But Phoenix House Recovery wasn’t what Nelson had imagined. She has a background in health care and had been to other treatment centers in the past, and as time went on, she grew suspicious about how the facility was run.

“I started asking questions,” Nelson said. “Like, ‘Where’s the 12-step plan? Why isn’t that in our daily agenda? Why aren’t we learning about triggers, external and internal? Where is our life skills training? Why aren’t we building resumés? Why is there one therapist for 30 patients?’ I asked the clients and staff, and they kicked me out the next day.”

Out on the streets in 100-plus degree weather, Nelson had to find somewhere to go. She looked into other sober living homes but grew concerned when she was offered alcohol and drugs at one of them. She didn’t know who she could trust.

“I was scared,” she said. “I’m thousands of miles away from my family and my home. I was freaking out. I was hysterical.”

While Nelson ultimately made it home to the Blackfeet Reservation, her experience in Arizona is not uncommon.

What happened to her has happened to thousands of other Native Americans in Arizona amid a widespread Medicaid fraud scheme, where treatment centers billed the state thousands of dollars per patient for services that were not actually provided. Indigenous people from Montana, Arizona, New Mexico and South Dakota were recruited to get treatment at these fraudulent facilities, and experts estimate that at least 100 Native Americans from Montana are tangled in the scam.

The scheme defrauded Arizona taxpayers, and at these fraudulent sober living homes, some clients were given drugs and alcohol. Others were told to get on food stamps. And some people seeking treatment were paid to recruit more Native Americans to these facilities. As the fraudulent treatment centers have shuttered amid a government crackdown, Montana tribes and grassroots advocates are scrambling to get their relatives home. But because these facilities changed clients’ state of residency to Arizona for billing purposes, it’s even harder for tribes and families in Montana to locate their loved ones.

What exactly is happening in Arizona?

Arizona officials have called it “a stunning failure of government.”

In a widespread scam, treatment facilities in Arizona billed for nonexistent services, and the money was paid through the Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid program. The scam targeted Native Americans because a loophole in AHCCCS’s American Indian Health Program allowed individuals to pose as a treatment facility.

Reva Stewart, who launched the campaign #StolenPeopleStolenBenefits to raise awareness of the fraud, said experts have traced the origins of the scam to the pandemic.

“They targeted Native Americans because the American Indian Health Plan would pay for everything they documented,” she explained. “Once these places found out they could get something like $1,700 per day per person, you saw them popping up everywhere. With that money, one home can make $2 million in two weeks. I even saw a YouTube video on how to open a sober living home in 15 minutes.”

The Arizona Mirror reported that AHCCCS was billed $53.5 million under the outpatient behavioral health clinic code in 2019. In 2020, it more than doubled to $132.6 million, and by 2022 it exploded to $668 million.

The FBI, which is investigating the fraud, is seeking to contact victims of the scam. The agency said in some cases, organizers pick up addicts at popular gathering places; sometimes individuals are given alcohol during transport; and clients are told to obtain food stamps during their time in treatment even though their enrollment brings funding to the home. The FBI investigation has resulted in at least 45 indictments by the office of the Arizona Attorney General, and at least $75 million has been seized.

Arizona Gov. Katie Hobbs in May announced, according to The Associated Press, that the homes defrauded the state of hundreds of millions of dollars. AHCCCS has since suspended payments to hundreds of providers in the state.

As these homes have closed, Native American residents are left on the streets of Arizona in temperatures nearing 115 degrees. Some people have been reported missing, and others have turned up dead.

‘I blame them’

Mona Bear Medicine, Blackfeet, said when her 25-year-old son RayDel Calf Looking went to Phoenix for treatment, she had high hopes for him.

Calf Looking completed a longer treatment program, lasting 60 or 90 days, and Bear Medicine said he was doing well. There are many highly regarded treatment facilities in Arizona that have effective programs and competent staff, and plenty of Montana tribal members speak highly of them.

“He sent a selfie over Christmas, and he looked really healthy,” Bear Medicine said of her son. “He looked good. And I could tell he was doing good for himself.”

Bear Medicine said her son started drinking in high school, but she didn’t realize he was doing drugs until about five years ago. Calf Looking was gay, and Bear Medicine said he struggled to come out and faced adversity when people he loved didn’t accept him.

“I think that was the reason he got into drugs,” she said. “He didn’t know how to come out. He was teased for it, and it hurt him. He started doing different drugs, and it got worse and worse, and he got into meth. It was hard for me to realize the extent of it, and I didn’t realize how hard it was going to be on my family.”

Calf Looking completed the long-term program, and then went to a sober-living home in Arizona, called Calm Integrated Healthcare. Bear Medicine said, “That’s when the problems started.”

In February, Bear Medicine hadn’t heard from her son in a while, and she was worried. She and her sister flew down to Arizona and found Calf Looking, who had walked out of the home and appeared to be intoxicated.

“He was disappointed in himself for relapsing,” Bear Medicine recalled.

Bear Medicine took her son back to Calm Integrated Healthcare and almost immediately got a bad feeling about the place. She said her son was clearly intoxicated, and the staff at Calm Integrated said it was fine for him to stay with Bear Medicine at her motel for a few days.

“It was so shady,” Bear Medicine said. “When she said RayDel could stay with us, I asked, ‘What does he need to do? Does he need to go to class?’ And she just said, ‘No, he doesn’t need to do anything.’ When I drove away, I said to RayDel, ‘I’m so confused. I thought sober living was sober.’ And he said, ‘They don’t care as long as they get your money.’”

When Calf Looking stayed with Bear Medicine at the motel, he kept drinking, and after Bear Medicine left, she knew he was still drinking, even though he’d returned to the sober-living home.

In late March, Calf Looking’s cousin, Vandree Old Person, was found dead on the Blackfeet Reservation, and Calf Looking, who was supposed to fly home to be a pallbearer, was taking the death hard. Again, Bear Medicine didn’t hear from him, and again, she was worried.

One day in April, Bear Medicine got a call from a detective.

“When she called, I thought, ‘What did he do now?’” Bear Medicine recalled. “I said, ‘Is he in jail? Is he hurt?’ And she said, ‘No.’ Then she asked me, ‘Is anyone with you?’ and that’s when it started clicking. I said, ‘Oh my God. Is he dead?’ And she said, ‘Yes.’”

The detective told Bear Medicine that her son broke into a house while intoxicated and the homeowner, fearing for his life, shot Calf Looking as he walked up the stairs of his home. Bear Medicine said her son was shot in the back, which she finds incongruous with the detective’s recounting. And she still hasn’t received an autopsy. She was told the FBI is investigating her son’s case, but months later, she still hasn’t heard from the federal agency.

Calm Integrated Healthcare has told Bear Medicine that her son walked out of their facility and was not under their care at the time he was killed, but Bear Medicine maintains that the sober-living home had a part in his death.

“I do think the center was responsible for his death,” she said. “They took the money but still let him drink. He was really trying. He really did try, but it was so easy for him to have a free place to stay that allowed him to drink. I blame them. I really blame them.”

AHCCCS payments to Calm Integrated Healthcare were suspended on May 15 — about a month after Calf Looking was killed.

‘It’s systemic’

Just as with Autumn Nelson, Journey to Recovery in Browning connected Josh Racine to a treatment center in Arizona. A spokesperson for Journey to Recovery was not available for comment.

Racine, Blackfeet, flew out to Sunrise Native Recovery, an alcohol and drug treatment center in Scottsdale, in March. About a month later, he was on the streets.

Laura McGee, Racine’s sister, didn’t know where he was or what happened, but she was determined to find him. She called Sunrise Native Recovery, but they were no help. She called the hospitals in the area, but no luck there, either. Racine would occasionally ask her to send him food at the treatment center — something McGee thought was odd — so she scoured previous food orders to try and nail down a timeline of his disappearance. She scrutinized past texts with her brother to pinpoint a location, but her efforts felt futile.

“I was panicking because I knew what had happened to RayDel,” she said. “It was a feeling I can’t even describe. We lost our mother suddenly, and seven months later, our stepdad, who primarily raised Josh, died. And then our grandmother died, and our first cousin died of an overdose. So Josh is already an addict and now he’s out on the streets dealing with sudden death.”

As McGee did more research, she learned about the hundreds of other sober-living homes in Arizona that had been shut down. It became clear that the problem was bigger than just her and her brother, so she approached the Blackfeet Tribal Business Council.

“I told council, ‘I need help,’” she recalled. “’You sent him there through a program on this reservation. I need help getting him back.’”

The council ultimately paid for a few of McGee’s family members to fly to Arizona, and they successfully brought Racine home, but McGee’s work was not done. Upon her brother’s return, she began to piece together the broken system.

Through conversations with her brother, McGee said she learned that Sunrise charged AHCCCS at least $117,000 in one month for services related to Racine — services that Racine himself said he did not receive.

“That was for one month for one person,” McGee said. “So imagine doing that for 20 or 80 people in a facility. It adds up.”

Racine told McGee that the centers would give clients $50 a week to live on, and he was reportedly told by Sunrise that if he recruited other Native Americans, they would reward him with $100.

“It’s systemic,” McGee said. “There weren’t protocols, and people were being taken advantage of.”

McGee said people struggling with addiction are a particularly vulnerable population, which worked to the scheme’s advantage.

“These are addicts who have lost the trust of their families,” she said. “So when they say, ‘This treatment center isn’t good. They’re putting me out on the street,’ families weren’t believing them. These people knew that and used it against them.”

That’s exactly what happened to Wendy Bremner. Her daughter Brooke Running Crane, Blackfeet, also went to Sunrise, and Running Crane was also suspicious of the facility. She told her mother she wasn’t comfortable at Sunrise and was scared to be there. But Bremner didn’t know what to do.

“I didn’t want to be an enabler,” she said. “I don’t know if what she’s telling me is true. I don’t want to interfere with treatment.”

Later, Running Crane’s anxiety about Sunrise rose to a breaking point, and she was hospitalized for a panic attack. Sunrise told Bremner that her daughter could not return to the facility, and as far as Bremner could tell, her daughter was going to be discharged from the hospital on to the streets.

Bremner called Sunrise over and over again until they finally agreed to help transfer Running Crane to another facility. Running Crane’s new facility is a good one, but Bremner said she doesn’t know what would’ve happened to her daughter if she hadn’t intervened.

“It was really scary,” she said. “She didn’t have anywhere to go, and I was just calling people saying, ‘You can’t just throw my daughter out.’”

Bremner said her daughter ended up at Sunrise because she’d heard of several people in Browning who’d gone there. And when Running Crane expressed that she wanted to receive treatment, Bremner said the treatment facilities in Arizona “felt like a miracle.”

“Families are desperate to get their people help when they say, ‘I want to go to treatment,’” she said. “It’s very rare, so at that moment, you really want to get them in somewhere while they’re ready to go. It’s so hard to get treatment here, and sending her far away is scary, but we wanted her to get help.”

AHCCCS payments to Sunrise Native Wellness were suspended on July 21 — almost two months after Racine went missing and five months after Running Crane’s panic attack.

Tribes take action

After the Blackfeet Council helped get Racine home, it quickly became clear that its work wasn’t done.

As McGee became more vocal on Facebook, more and more families reached out saying their loved ones were missing or stuck at treatment centers in Arizona. McGee continued to present her findings to the tribal government, and eventually, the council came out with a formalized plan of action.

Councilman Lyle Rutherford directed facilities on the reservation, including Journey to Recovery, not to send clients to treatment centers in Arizona. The tribe has worked with McGee and other advocates to bring at least 10 members home. And on Tuesday, the council issued a public health state of emergency “for Blackfeet tribal members affected by the humanitarian crisis arising from shuttered fraudulent behavioral health treatment facilities in Arizona.”

The council on Thursday instituted a ban prohibiting the solicitation of individuals on the reservation to attend fraudulent treatment facilities in Arizona and established civil penalties for individuals or entities that violate the ban at $5,000 for the first offense, $10,000 for the second offense and permanent expulsion from the reservation on the third offense.

The council also pledged to continue to help members who were displaced and said it created a task force to identify displaced individuals.

Councilwoman Shelly Hall said the emergency declaration helps bring awareness to the crisis and could allow the tribe to allocate more money toward its resolution.

“I believe there are about eight or 10 more Blackfeet down there,” Hall said. “This is important because these are our members. If they’re in any kind of trouble, we want to help them. We’ve heard horror stories of people who are on the streets in this heat.”

McGee said she also urged Gov. Greg Gianforte’s office to issue a public service announcement on the matter but was told that his office needed more information on the subject. She also reached out to members of Montana’s congressional delegation, and Sen. Jon Tester sent a letter to the Centers for Medicare and Medicaid Services, urging the group to “immediately investigate this matter further and provide a detailed report of their findings.”

The Billings Area Indian Health Service has asked Montana tribes to let the agency know how many citizens have been impacted, and other tribes in Montana have also taken action.

Josie Fisher, Northern Cheyenne, was at a different treatment facility in Arizona and didn’t feel safe. She said a staff member made inappropriate sexual comments to her, and she wrote on Facebook that she wanted to leave.

Fisher got connected with advocates through Facebook, and the Northern Cheyenne Tribe paid for her plane ticket home.

“I’m so thankful to be home,” she said. “I’m at peace now. When I was there, I was just in survival mode.”

Northern Cheyenne Councilwoman Melissa Lonebear said as of Aug. 1, the tribe had helped three members get home from Arizona and added that the council is working with the tribal health department to develop a plan to get more people home.

She said part of the issue is that there is no treatment center on the Northern Cheyenne Reservation.

“The way the system is set up is if someone hits rock bottom and they want treatment, they will do an assessment at the Northern Cheyenne Recovery Center and then get referred to an outpatient 10-day program,” she said. “After 10 days, there’s a chance a bed will open in Billings or Butte, but that person may have to just return home. And because we don’t have sober living homes here, people come back and return to the same environment.”

Lonebear is hopeful that the tribe will be able to help people return home from Arizona, but acknowledged the council will have to overcome significant barriers in doing so. To be eligible for AHCCCS, treatment centers had clients change their residency address to Arizona, so it’s hard for tribal councils in Montana to know how many of their members are there. And tribes have noted that even when someone returns home, it can take time to change their residency back to Montana and re-enroll them in Medicaid.

“I just posted on Facebook asking, ‘How many Cheyenne members do we have in Arizona?’” Lonebear said. “I’m getting names from families, and it’s hard. It’s hard to reach people because there’s no way to communicate if that person doesn’t have a phone. This is a lot bigger than we know.”

Fisher’s boyfriend was at the same facility in Arizona, but it wasn’t as easy for him to get home. Jacinto Brien is Crow, and he tried reaching out to his tribe, just as Fisher had. But he had no luck.

“I tried reaching my tribe on the phone, but I couldn’t get ahold of anyone,” he said. “And because I’m Crow, the Northern Cheyenne Tribe couldn’t help.”

Reva Stewart, of the #StolenPeopleStolenBenefits campaign, ultimately fundraised to help get Brien home. Her GoFundMe has raised more than $8,000 to help Native Americans caught in the scam.

“I’m really grateful,” Brien said of Stewart’s efforts. “I’d just say, for any tribe that’s willing to help, please answer your phones. People need your help. This is important.”

Resources

If you or a loved one is at an Arizona treatment center or was at an Arizona treatment center and wants to come home, here are some resources:

• Call your tribe. See if they can help bring you or a loved one home.
• The Billings Area Indian Health Service is asking each tribe to let the agency know how many members have been impacted. Send relevant information to Jennifer.Lamere@ihs.gov and Steven.Williamson2@ihs.gov or call 406-247-7248.
• For an updated list on which Arizona treatment centers have been suspended, visit azahcccs.gov/Fraud/Providers/actions.html.
• To either verify or report an existing treatment center, visit verifyandreport.org.
• If you suspect Medicaid fraud or a health violation, call the Montana Department of Public Health and Human Services’ fraud hotline at 800-201-6308.
• If you would like to file a report to add to the ongoing FBI investigation into Arizona treatment centers, visit forms.fbi.gov/phoenixgrouphomes.
• Advocates Reva Stewart and Laura McGee can be reached on Facebook.

This article was first published in the Missoulian. 

The post Sober living fraud scheme targeted Montana tribal citizens appeared first on Buffalo’s Fire.

Editor’s Note: This article first appeared in Keep It Rural, an email newsletter from the Daily Yonder. Like what you see here? Join the mailing list and receive more like this in your inbox each week.

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Christopher Nolan’s biopic of Robert Oppenheimer, “father of the atomic bomb,” opened recently and the internet exploded with praise and #Barbenheimer jokes (the Barbie movie premiered on the same day and the contrast between the two made for some excellent memes). 

While I’ve certainly spent my fair share of time indulging in these memes, one aspect of “Oppenheimer” that’s been largely overlooked are the real-life impacts of the Manhattan Project, the lab Oppenheimer led that developed the atomic bomb. 

Oppenheimer’s work took him to Los Alamos, New Mexico, where the world’s first nuclear weapon was developed and eventually tested in the Alamogordo Bombing Range, also known as the Jornada del Muerto desert, 210 miles south of Los Alamos. One hundred more tests were conducted between 1945 and 1962 in New Mexico and Nevada, according to Princeton University research. 

The fallout of these tests in rural communities near and far has been felt ever since.

The bomb was developed by the United States, with support from Canada and the United Kingdom, during World War II in response to threats that Germany was developing their own nuclear weapons. Atomic bombs were dropped over Hiroshima and Nagasaki, Japan, in August of 1945, killing an estimated 110,000 to 210,000 people, most of them civilians. 

As the United States developed its nuclear weapons technology, scientists chose remote areas in Nevada and New Mexico to drop test bombs under the assumption that nothing was out there. Of course, this wasn’t true: the desert is home to thousands of plant and animal species that have built remarkable adaptations to the extreme temperatures — high and low — this biome is known to bring. But not everyone recognizes the value of the desert, which is why it’s been the site of not just nuclear bomb testing but radioactive waste storage proposals and aircraft boneyards.

The desert is home to people, too. “Downwinders” is the term used to describe people exposed to radioactive contamination from nuclear fallout. The health effects are deadly: 19 types of cancer are listed as compensable under the Radioactive Exposure Compensation Act that provides financial support to people who were exposed to nuclear fallout. The law has awarded more than $2.5 billion to nuclear workers and downwinders near the Nevada test site in the south of the state (crowds used to flock to the Las Vegas strip to view the mushroom clouds that formed from the dropped bombs). 

But New Mexicans were left out of much of this funding, even though Los Alamos was where the first atomic test bomb — called the Trinity Test — was dropped. This test is the main plot of the new Oppenheimer movie. 

According to reporting from Source New Mexico, “despite the government’s continued description of the Jornada del Muerto test site as ‘isolated,’ and ‘remote’ in archives, tens of thousands of people lived within 50 miles of the first nuclear blast. These people, and their descendants were marked by diseases without family histories [that might predispose them] – including leukemia and other cancers.”

The Tularosa Basin Downwinders Consortium is a group of New Mexicans who claim they were exposed to nuclear fallout from the Trinity Test and suffered from illness and death afterward. Some downwinders were as close as 12 miles to the drop, according to the group. 

The Radioactive Exposure Compensation Act has never provided this group compensation. And new research shows the Trinity Test’s nuclear fallout may have reached even farther than New Mexico, to 46 states and Mexico and Canada. 

These are the details “Oppenheimer” leaves out, making it a painful watch for people still suffering from the Trinity Test aftermath.

The post ‘Oppenheimer’ Discourse Leaves Out Downwind Communities appeared first on The Daily Yonder.

The Montana State Hospital in Warm Springs, the state’s only public adult psychiatric facility, is continuing to see high staff vacancies, budget deficits, and shortfalls in health and safety standards more than a year after losing federal accreditation following investigations into patient deaths and injuries.

In a virtual public meeting Tuesday with the hospital’s governing board — composed of top administrators from the Department of Public Health and Human Services and the Warm Springs facility — staff and consultants delivered presentations about safety trends and plans for improvement while touting encouraging changes at the state-run facility. 

The state health department has said that the oversight from the recently created governing board and focus on improving conditions at the facility is part of the Gianforte administration’s commitment to regaining the hospital’s federal certification from the Centers for Medicare and Medicaid. One of the consultants hired by the state to help oversee hospital operations described that effort in a written report on Tuesday as a multi-year “rigorous journey,” an assessment echoed by members of the group during the hour-long meeting.

The hospital is currently operating at roughly 80% capacity, with about 216 patients residing there, including the geriatric-psychiatry Spratt unit and a forensic wing for evaluating and treating criminal defendants. The hospital’s forensic unit was the only part of the facility with a wait-list. It is licensed for 54 beds, but has operated at a consistently lower census since last year. As of June, it was occupied by 46 people with 70 people across the state waiting for admission that month.

There have been 159 patient falls — one of the key indicators of patient safety that federal investigators flagged in 2022 — recorded across all parts of the facility so far this year. The highest frequency of falls — an average monthly rate of 12.1 per 1,000 patient days — has occurred in the Spratt unit. Staff told the governing board on Tuesday that falls are being tracked and reported more accurately across the facility and are down on the geriatric unit by roughly 25% compared to last year. 

The hospital also reported failing to meet its goal of zero chemical restraints used on patients in the main hospital and geriatric wing. Chemical restraints — defined by the federal Centers for Medicaid and Medicare as “any drug used for discipline or convenience and not required to treat medical symptoms” — were most commonly employed in the main hospital, where the intervention was reported at an average rate of 8.85 instances per 1,000 patient days in 2023. The practice was less common in the Spratt unit, while the hospital’s forensic unit reported zero instances of chemical restraint this year.

A 2022 clinical resource document created by the American Psychiatric Association said that using medication to treat a patient’s agitation should be voluntary and that medication should “never [be] used as a ‘chemical restraint,’” but noted that the term is poorly defined and misunderstood. Involuntary medications, the publication says, “should be used as a last resort for situations that present as acutely dangerous.”

A spokesperson for the health department did not respond before deadline to questions about how the hospital defines “chemical restraints” and what counts as an “occurrence.” 

Bernie Franks-Ongoy, director of the federally designated oversight group Disability Rights Montana, said Thursday that while eliminating the use of chemical restraints entirely should be a priority, defining and documenting the misuse of medication is often complicated.

“It is difficult to know exactly what the numbers represent without knowing precisely how the term ‘chemical restraint’ is defined under current hospital policies and what the reporting requirements are,” Franks-Ongoy said. “It would be good to know, for example, how many occurrences of chemical restraint were the result of genuine patient safety concerns and how many were based on staff convenience.”

The rate of patient seclusion also exceeded goals in different parts of the facility, sometimes significantly. In the main hospital, hours spent in seclusion per 1,000 patient hours ranged from 16.68 in January to 1.81 in May, far exceeding the goal rate of less than .36 hours.

In the forensic unit, rates of seclusion also varied widely, recorded at .05 hours per 1,000 patient hours in March to 24.73 hours in May. In the Spratt unit, rates of recorded seclusion were much less common and consistently below the hospital’s goal.

The hospital’s quality improvement metrics did not include how many of its patients have died this year. A health department spokesperson did not respond to multiple questions from Montana Free Press about patient deaths before deadline. 

Safety issues resulting in serious injuries continue to occur, officials said Tuesday, with a total of 10 recorded between the main hospital and the Spratt unit so far this year, compared to 14 in the prior year. 

One patient recently ingested a “toxic cleaning agent” brought into the facility by a contractor, interim hospital administrator David Culberson said. The patient was transferred to another facility for a higher level of care and later returned to the psychiatric hospital. That patient has since been discharged, Culberson said, and the hospital has implemented five new safety protocols to more closely monitor contractors entering the facility in the future.

The hospital reported a 37% employee vacancy rate in June, down from 45% last summer. After a hiring surge in January, February and March of this year resulting in a net gain of 39 employees, the hospital reported losing nine staff members in May and June. 

The highest vacancy rates are among registered nurses, with an 82% vacancy rate, and clinical therapists, whose vacancy rate was 72%, according to the hospital’s latest finance and human resources report. 

With high rates of contract staff and traveling professionals continuing to work at the facility, the hospital’s director of nursing, Jocelyn Peterson, told the governing board that Warm Springs is working to extend the length of traveler contracts to 26 weeks instead of 13 weeks to increase training opportunities for short-term workers.

“This way we can give them a couple more weeks of actual training and speak to some of those areas of safety, and things to look for, and kind of give them a better idea of what the facility is like and how important it is to treat our patients and make sure that they’re safe,” Peterson said. 

Culberson also told the board that the hospital is working hard to respond to the passage of House Bill 29, which will restrict the admission of patients with a primary diagnosis of Alzheimer’s, dementia or traumatic brain injury to the Montana State Hospital beginning in 2025.

“That’s a good portion of the folks in [the] Spratt [unit] right now. And we will not only have to turn down admissions, but we will have to discharge everybody with those three diagnoses,” Culberson said. “So it’s a big project we’ve started here with the help of [contractor Alvarez & Marsal] and then the care team in Spratt.”

As of June, the hospital reported overspending its annual budget significantly, with about $93 million in expenses versus its stated budget of $48.9 million, a trend that has continued from 2022. Of the listed expenses, the finance report said roughly $3.9 million was spent on the cost of traveling staff in June, a figure that has fluctuated month-to-month.

The hospital was given nearly $16 million in additional funds by the 2023 Legislature to make facility repairs and upgrades to help regain federal certification. 

Out of that total budget for capital projects, the hospital’s Tuesday report outlined specific uses for $5.9 million, including repairing the HVAC system, replacing fire doors, and other safety and medical upgrades. The report said the remaining $10 million in legislative appropriations will be set aside as “contingency for unanticipated repair projects impacting recertification.”

The group did not receive any public testimony during the designated public comment period. It is slated to meet again in the fall.

The post Montana State Hospital tallies high rates of falls, chemical restraints and staff vacancies appeared first on Montana Free Press.

By Jennifer Fernandez

More North Carolina babies are being born with syphilis, and state health officials are urging women to get tested before they give birth to help catch the sexually transmitted illness early.

In December, North Carolina Department of Health and Human Services issued a public health alert on the rise of syphilis in women and children.

Reported cases among women rose 538 percent between 2012 and 2021, DHHS said in that alert. During that same time period, there was an associated 4,100 percent increase in babies born with congenital syphilis.

Health officials say a rise in riskier sexual behaviors, especially among younger adults, coupled with a drop in overall concern or awareness about sexually transmitted infections, has led to increases in STIs such as syphilis. Syphilis is a bacterial infection transmitted by sexual contact.

They also stress that syphilis is treatable. The earlier the infection is addressed, the better — especially for babies.

“Congenital syphilis can have long-lasting effects on a child’s health and development,” said Matt Jenkins, HIV/STD director for Mecklenburg County Public Health.

Newborns at risk

Sexually transmitted infections had all been rising for several years, even before the COVID-19 pandemic led people to delay or skip testing and treatment, according to the Centers for Disease Control and Prevention.

While it isn’t seen with as much frequency as other STIs, such as chlamydia and gonorrhea, syphilis more often leads to severe health issues or death when passed on to a baby.

Easily transmittable, syphilis presents initially as sores in the genital area and later as a rough, red rash, according to the CDC. Later stages can have no symptoms, but left untreated, syphilis can cause damage to the brain, heart and other organs.

A newborn may not show any signs of infection but can develop serious problems within a few weeks — or even years — if not treated. Likely health issues include developmental delays, hearing loss, vision problems, bone abnormalities and neurological issues, among others.

In pregnant people, syphilis can lead to premature birth, low birth weight, stillbirth or a newborn’s death shortly after birth.

Mecklenburg County accounted for 12 of the state’s 55 cases of congenital syphilis last year, Jenkins said. Through June this year, seven cases have been reported in the county, he said.

Kimberly Newton, a family medicine doctor and OB-GYN with Cone Health who also serves as medical director for Alamance County, didn’t have exact numbers for Alamance or Guilford counties, where she works.

She did say she has seen more cases in recent years.

CDC statistics show that men account for most syphilis cases, with the majority of those cases among gay men, bisexual men and other men who have sex with men.

However, the number of cases in women and newborns has been rising in recent years — a worrying trend, health officials say. 

“The good news is that sexually transmitted infections are preventable,” said Evelyn Foust, chief of NCDHHS Division of Public Health’s Communicable Disease Branch, in a statement in April during STI Awareness Month. “We need to empower ourselves to learn about them, how to talk about them, when to test for them and where to go for care and treatment.”

Barriers to care

A variety of factors put pregnant people at risk of contracting syphilis, according to the CDC. They include having sex for compensation, with multiple partners or while using drugs; getting late or no prenatal care; using methamphetamine or heroin; being incarcerated (or having an incarcerated partner); and having unstable housing or being homeless.

Lack of knowledge about STIs may also be playing a role, Newton said. She said generations of people have now had only abstinence-only or non-comprehensive sex ed classes in the state’s public schools, so they may not have complete information about how these infections get passed around and how to protect themselves.

Multiple screenings are important if there is a chance a mother may have contracted syphilis during the pregnancy. One of the hardest conversations is having to tell someone who previously tested negative that they are now positive during their pregnancy, Newton said.

“The most common question is, ‘Is my baby going to be OK?’ with any prenatal diagnosis,” she said. “With congenital syphilis, it’s really hard to know until your baby is born. And that is really hard (to share) as a practitioner and really hard to hear as a family.”

There are several reasons women may be delaying a syphilis test while pregnant, Jenkins said. 

It could be lack of knowledge about the importance of early prenatal care, limited access to health care services, financial constraints, fear, stigma associated with seeking care, or even logistical challenges in scheduling appointments, he said in an email to NC Health News. 

Newton added that even in areas where there are plenty of providers, access may still be limited if they are not accepting new patients. And she agreed that financial constraints often delay care.

“The economic reality of all of our patients is when you have your prenatal visit, you basically have to take a half day off work,” she said. “And for an hourly worker, that is huge.”

Historically marginalized communities may be more hesitant to get care because of bad experiences with health care among members of their communities, Newton said. 

“If you are a transgender man walking into an OB-GYN office, it might not feel the most welcoming,” she said.

Language can be another barrier, Newton said.

“How do you explain how bacteria work when people have never even heard the word in their language?” she asked.

Newton said people may want to just blame the patient for not getting care earlier, but there are usually barriers keeping them away.

“There is no patient that I have ever met that is positive for syphilis that was volitionally trying not to get care,” she said. 

Jenkins said addressing the many barriers and promoting early and consistent prenatal care is “crucial in preventing congenital syphilis.”

With the General Assembly approving Medicaid expansion, more people will be covered for routine testing and treatment, including STIs, once the policy goes into effect.

Missed opportunities

In 2021, 43 percent of congenital syphilis mothers in North Carolina had little or no prenatal care before delivery, DHHS reported. 

Earlier care would have allowed for earlier detection and treatment for both mother and baby.

However, a national study released that same year showed that some newborns are going home without being diagnosed with syphilis, despite testing protocols.

The overall number of congenital syphilis cases in the country increased from 462 to 1,306 between 2014 and 2018, according to the study published in Pediatrics, the journal of the American Academy of Pediatrics.

The authors found reports of 67 children with symptoms of congenital syphilis a month after their birth during that four-year span. 

As the number of congenital syphilis cases in the country is higher than it has been in more than 20 years, “many pediatric providers may be evaluating and treating infants with [congenital syphilis] for the first time in their careers and should be prepared to do so,” the authors wrote.

Among their recommendations, the authors said pediatric providers should review maternal records and confirm maternal syphilis status, advocate for maternal testing at delivery, and consider a congenital syphilis diagnosis regardless of maternal history.

Funding cut

While cases of STIs rise across the country, funding to stem that growth is decreasing. During the pandemic, Congress funneled more than $1 billion into strengthening the public health workforce over a five-year period. In June, as part of a debt limit deal to avoid defaulting on U.S. obligations, lawmakers clawed back $400 million of that health funding, even as the Biden administration had recently issued a multi-agency plan to combat rising STI rates.

The money had been used to hire 3,000 disease intervention specialists — public health workers who do contact tracing, investigate disease outbreaks and connect people to testing and treatment services.

Newton didn’t have an exact number on the local impact of those cuts. But she said a systematic defunding of public health over the past three decades has trickled down to local health departments, which are indirectly funded by these federal programs.

Yet, as public health departments, they’re mandated to provide the care, even when they do not have the staffing or other resources, she said. 

David C. Harvey, executive director of the National Coalition of STD Directors, called the funding cut a “devastating blow to the fight against rising STI rates” and pledged to fight to get the funding back.

“This will be an uphill battle,” he said in a statement, “but it’s a battle the nation needs us to fight.”

The post Delayed testing, limited access to care, and lack of sexual health literacy contribute to rise in syphilis cases in newborns, health officials say appeared first on North Carolina Health News.

U.S. Census numbers show that higher rates of rural Americans have a disability than urban Americans. 

In 2021, nearly 15% of rural residents reported having a disability, compared to 12.6% of urban people, according to the U.S. Census. 

“It really doesn’t surprise me,” said Dan Kessler, interim executive director of  Association of Programs for Rural Independent Living, also known as APRIL. “When you look at rural areas, in terms of disability, there are many factors. I think one of those could very well be just access to health care…. Looking at primary care, where you may see a physician for a number of issues, for example, your diabetes or, or some other condition, which, if left untreated, could very well result in someone acquiring a long term disability.”

Kessler added that the digital divide also impacts access to medical care. 

According to the Census numbers, in 2021, the South had the nation’s highest rates of disability at 13.8%. That was followed by the Midwest (13.1%), the Northeast (12.3%), and the West (12.1%).

“A lot of people age into a disability,”  Mary WIllard, director of Training and Technical Assistance at APRIL told the Daily Yonder. “We talk about disability, it is really from that birth to dirt kind of a spectrum. And so I would say aging into disability, it’s a big thing in rural areas that’s been happening.”

She added that the surveys have also changed how they ask the questions, which may impact numbers. 

“We’re starting to see a bigger breadth of people now disclosing on the Census, as well. So that’s … some of it’s just semantics, I think, disclosing I have a disability versus I might have difficulty walking,” Willard said. 

Kessler told the Daily Yonder housing is another factor. “If you have affordable, accessible, safe housing, that can have a direct impact on your health care and your well being,” he said. 

WIllard added that in many rural areas, the housing stock is older, making it harder to retrofit for people, especially with the increased costs for building materials associated with the pandemic. 

Direct care workers also may not get paid for the travel time from rural client to rural client, making it less financially feasible, she added.

Still, there are positives, Willard said. 

“I think rural America, especially post pandemic, has become more appealing to people with disabilities, especially if you’re immunocompromised,” she said. 

Willard also mentioned the program AgrAbility, which works to enhance the quality of life for farmers, ranchers, and other agricultural workers with disabilities.

“I think more programs like that are helping people with disabilities to really live the rural agricultural life that they want to,” she said. 

The post Census: Rural Americans Have Higher Rates of Disabilities Than Urban Dwellers appeared first on The Daily Yonder.

BLACKWELL — A Blackwell Public Schools teacher quit her job in May after she said she received conflicting information from administrators and was “forced out” of her classroom when she tried to take maternity leave. But the district said it was simply following its policies, a claim that highlights the significance of a new state law […]

The post ‘Frustrated as hell’: Blackwell teacher quits after trying to take maternity leave appeared first on NonDoc.

THE PLAINS, Ohio — After operating for decades, the Rite Aid location in The Plains closed this summer. The closure has left residents without a local pharmacy and increased the distance between many neighboring communities and the nearest pharmacy option.

“This decision has been sprung on everyone (in) the Plains who used that pharmacy, completely without regard to how this would affect people who can’t easily travel to the next closest pharmacies in Athens or Nelsonville,” said The Plains resident Sam Jones in a Facebook message. 

Jones has primarily used the Rite Aid pharmacy in The Plains since 1998.

Rite Aid press office representatives said, “A decision to close a store is one we take very seriously and is based on a variety of factors—not just one—including business strategy, lease and rent considerations, local business conditions and viability, and store performance. 

“We review every neighborhood to ensure our customers will have access to health services, be it at Rite Aid or a nearby pharmacy, and we work to seamlessly transfer their prescriptions so there is no disruption of services. We also strive to transfer associates to other Rite Aid locations where possible.”

Press office representatives declined to provide more detailed information about The Plains closure.

Since 1998, the site of the former Rite Aid at 93 N. Plains Road has been owned by a Buffalo, New York-based company with the same address as national property management corporation Benderson Development. Company representatives did not respond to requests for comment.

The nearest pharmacies to the former Rite Aid include the Shrivers Pharmacy location on West Union Street 4.1 miles away and the CVS locations on East State Street and Court Street in Athens, each about five miles away. Existing Rite Aid prescriptions were automatically transferred to CVS, according to the store’s voicemail. 

In addition to The Plains, the closure will also impact neighboring communities such as Chauncey and Millfield, which also lack a local pharmacy option. 

“Late at night if a kid spiked a fever or needed allergy medicine I could run [to the Rite Aid] instead of Athens,” said The Plains resident Josie Dupler. “I used Rite Aid to get my flu shot every year, it was just convenient.”

For residents without reliable transportation, the increased distance to a pharmacy creates an added barrier to accessing healthcare.

Shrivers offers free prescription delivery. However, delivery is not an option for emergencies and some prescriptions. 

In such cases, as The Plains resident Kit Seida said, those options “may as well be on the moon when you don’t drive.”

“No one wants to spend an hour on the bus when they’re sick just to go pick up something like cold and flu meds or an anti-diarrheal,” Seida said.

In addition to concerns regarding convenience and emergency pharmacy access, many residents expressed concern about losing the comfort of a local establishment.

The Plains resident Sue Estes has used the pharmacy for 25 years and will miss the comfort of a local store with familiar faces. 

“The pharmacists always made me feel very comfortable when getting immunizations there and they always answered … questions I had regarding immunizations and medications with exceptional knowledge and patience,” Estes said. “It’s so sad that Rite Aid is no longer here.”

For Tammy Conner Hogsett, whose husband worked at Rite Aid in the late ‘80s and early ‘90s, the store “was not just another store, it was an opportunity creator for myself and my family.” 

For others, the store’s disappearance is a troubling sign about the trajectory of their community.

“To lose Rite Aid feels disheartening,” Seida said. “Because all too often, all I hear is how The Plains has gone downhill, or how it isn’t what it used to be, or that it’s slowly ‘getting worse’. And the loss of an essential business, like the pharmacy, feels like proof-positive of those assertions.”

However, Seida added, “I — and plenty of others — are racking our brains to keep those assertions from being truth.”

The post The Plains loses its pharmacy appeared first on Athens County Independent.