Alaska Blog III- Mental Health Treatment in Remote Alaska
Imagine you are a woman with two small children living in a remote Alaskan village of 300 people. Winters are harsh, long and dark. You love your husband, but he is often abusive physically and psychologically.
The combination of hardships and some personal tendencies have caused you to turn to alcohol. You are beginning to suffer bouts of depression. Talking with others about the feelings of suicide has become frequent in your head, but you dare not say anything to those around you. Where do you turn? Getting to a doctor requires an hour by plane or eight hours by ferry.
While I was in Juneau, Alaska this week, I took a short walk from the offices of Southeast Alaska Regional Health Consortium (SEARHC) to a small mental health annex for a private conversation with a patient whose personal circumstances were not identical to what I just posed, but close enough. We talked alone for 20 minutes. She was candid about her situation, and I will honor her privacy by not changing the facts and not mentioning anything about where she lives.
Our conversation took place over a new videoconferencing system that is being extended into villages across Alaska. I have used videoconferencing equipment many times before. This was arranged in a way that made the interaction seem quite natural. The video was close up and we could see one another’s eyes and facial expressions. I finished the encounter feeling like I knew her personally. Granted, it is less than ideal but it is a huge step forward.
SEARHC behavioral health providers Rand West, Clinic II Director, and Carolyn Lemmon, Acting Director of Community Family Services Program, talk with Secretary Leavitt over a videoconferencing system.
This patient told me one thing that I think is particularly significant. She said, “In a small village like where I live, it is impossible to talk with anybody without others knowing your problems. Being able to do that this way, gives me the comfort I need to feel safe.”
The mental health problems of remote communities are unique and intense. The videoconferencing system is a great tool. We can find ways of using this technology to provide assistance in underserved areas.
Posted on August 1, 2008 in Mental Health
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Secretary Leavitt:
Great to read about your visit to SEARHC and your first-hand account of the great job they are doing meeting the needs of the rural communities there. You were right on when you pointed out that technology can be used to provide assistance in underserved areas.
My organization, ABC Coding Solutions, worked with Alaska Medicaid providing billing and procedure codes (www.ABCcodes.com) for behavioral health services delivered by para-professionals in Alaska's remote areas. ABC codes were successfully used in over a million and a half electronic transactions by Alaska Medicaid.
Health delivery solutions including using para-professionals (Community Family Service Workers, etc.), along with ABC codes for billing for care provided have been proven to lower costs and improve health.
I encourage you to visit our websites at www.ABCcodes.com and www.ZipClaims.com for more information. If you would like further documentation of the Alaska project using ABC codes, I would be happy to provide it to you.
Expanded use of ABC coding technology and utilization of para-professionals can go a long way in improving access to care for those in need of critical health care services in Alaska and elsewhere.
Posted by: Michael Mullen | August 04, 2008 at 07:43 PMUnrelated to your post: Please clarify your agency's attempts to classify contraception as abortions. Why do you choose to consider a preventive measure as a termination? It is not. Do the work to research the effects of contraception. They do not terminate pregnancies--they prevent it! In making your policy change, you are aiming to punish women who ARE being responsible. You are also punishing women like me, who have to use contraception to regulate irregular, painful periods.
Much like Ms. Dickson, I encourage you to tap the vast wealth of knowledge within the NIH and its sub-agencies to learn the actual mechanism of fertilization and the mechanism of contraception. Please don't change policy just to satisfy uneducated fringes!
Posted by: Emily Singletary | August 06, 2008 at 07:20 AMThis is unrelated to the topic, but I am outraged at this secret plan to radically change family planning funding rules. The Bush administration's proposed rule would severely threaten women's health care. Please reconsider.
Posted by: Marilyn | August 06, 2008 at 07:27 AMImagine you are a woman with two small children living in a remote Alaskan village of 300 people. Winters are harsh, long and dark. You love your husband, but he is often abusive physically and psychologically.
Now imagine you're that woman and suddenly find yourself pregnant once again, unwillingly, because HHS and the current administration have taken unreasonable and non-scientific measures to ensure that a woman will have difficulty in finding viable birth control. Pregnancy is not something to be taken lightly and it should be a matter of choice. An unwanted pregnancy can compound mental health issues.
Please address this issue. If the government is going to take action, you should at least be willing to explain the stance and allow a dialog to begin between you and the citizens for whom you work. We should all have a say in this matter.
Posted by: Alison | August 06, 2008 at 08:03 AMSecretary Leavitt - it concerns me greatly that there is a proposed rule change that would redefine the most common and effective forms of birth control as abortion. As secretary of the Department of Health and Human Services, I would hope that you could explain to the Bush Administration how wrong this new rule would be for our country. This new rule could cause many women in our country to go unprotected for STDs and unwanted pregnancies. It is not the job of the government to impose restrictions on the health care choices for anyone - our government is supposed to help and protect us, not limit our choices. As an American, a concerned citizen, a woman and a registered voter, I urge you to speak out against this proposed rule and the ramifications that it could have on our country.
If this is yet another empty promise/ploy by the Bush Administration to gain support for the Republican Party in the November elections, then please just be honest with the rest of America. We deserve to know the truth and put faith in our leaders to be honest with us. These types of political mind games only hinder our country from learning how to work together so that we can have a government that works hard to make sure we have rules that benefit each of us and gives everyone their own choices to make. Every person's situation is different from the next and they need to be able to make the best decision for themselves and their families.
Please explain your thoughts on the Bush Administration's proposed rule change. America needs to hear an honest answer on how you view the new proposal.
Thank you.
Posted by: Jeannette Brown | August 06, 2008 at 08:31 AMOh hey Scott, it's great that you seem to be taking such an interest in womens' lives and safety. I applaud you for that. However, your proposed plan that would define all forms of birth control as "abortion" makes me wonder if you really like women at all. There is no scientific basis behind your theory other than "morals" or "religion" and I like my science and pills without that, thanks. Please keep in mind that if your proposal passes, it will be a huge disadvantage to every woman in the country -- many will no longer be able to afford contraception if their insurances choose to stop subsidizing it, and some, if they can afford it, will not be able to pick up their prescription because there happens to be a self righteous pharmacist working behind the counter. I would like to hear you comment about this, please share your logic and enlighten the rest of us.
Posted by: Jennifer | August 06, 2008 at 09:47 AMI agree with Katharine Dickson. Regardless of the absurdity of classifying contraception as abortion (you'd think that in this age of information people would be better informed), refusing to answer someone's question is just childish. Please do us all a favor and grow a set of testicles and do the right thing.
Posted by: Bart Robello | August 06, 2008 at 10:07 AMDear Secretary Leavitt:
I would appreciate clarification of the HHS policy that the 98 percent of Americans who use contraception at some point in their lives are terminating rather than preventing pregnancy. I am sure you understand that such a policy would harm women in the US. As a woman who has relied on contaceptive technology my whole adult life, I would like to know how this issue is going to be shaped in your department.
thank you
Katherine E. Kelly
Posted by: Katherine Kelly | August 06, 2008 at 10:34 AM[edit]
I am very happy to hear of the wonderful work you are doing regarding mental health in remote areas of our country. Everyone deserves to have the help they need, when they need it. This help should not be confined to mental health alone. Contraception is a critical key component in the lives of millions of women, and in no way should be classified as abortion. I would love to hear from you on how this conclusion was reached. Thank you.
Posted by: Amanda | August 06, 2008 at 10:49 AMI also would like a comment from you concerning the subject of classifying contraception as abortion. Why would elected officials (mostly men) think women don't need choices? Why would you assume you can decide what I can do with my body? I am a Grandmother of 5 & Mother of 2, and can't for the life of me understand why you guys don't have anything better to do than worry about my body. Maybe the economy, or child abuse, or how to help people in your community? How on earth can contraception be in the same category as abortion? Actually - neither of them is YOUR business where I'm concerned.
Posted by: Susan | August 06, 2008 at 11:28 AMI await an answer on this issue.
Thanks.
So I'm guessing condoms will eventually be banned since they prevent sperm from entering the vaginal canal...at least according to your logic.
Posted by: Adina | August 06, 2008 at 11:51 AMSecretary Leavitt,
Again, my comment is a little unrelated as well, but I would like you to comment on the proposed regulation that would classify contraception as abortion. 98% of women use contraception at some point in their lives, meaning that millions of women are currently using contraception right now. This proposed regulation would put additional barriers up and prevent women from obtaining birth control, a basic health need that is already difficult to obtain.
I agree with Katharine above, there is absolutely no scientific way to prove that an egg has been fertilized before implantation. According to this regulation, should we therefore assume that all women are carrying a fertilized egg, until we can verify it? She would prosecute women for the fertilized eggs that are naturally lost before they have a chance to implant? Also, if birth control is considered an abortifacient, then what about other things women do to put themselves at risk for miscarriage? Should those be illegal too?
Not only am I against this unscientific and blatantly political regulation, but I have written my congressmen and urged them to oppose it as well. Considering this is something that affects me every day, I urge you to comment on this issue as soon as possible.
Thanks,
Posted by: Jessica | August 06, 2008 at 12:35 PMJessica Seales
Student
I appreciate this opportunity to comment on maintaining health care professionals "right of conscience". I believe that the American public wants their MD's to be ethical and act consistent with those beliefs. When the government forces health care professionals to do anything in violation of their ethics one begins down a slippery slope no telling where it will end.
Posted by: Laurel Downs, MD | August 11, 2008 at 07:25 PMRe the "morning after pill" if the result is eliminating a life no matter how soon in the pregnancy it is rightfully an abortion.
I,too am concerned that birth control will be classified as abortion and I think you should answer the question. Don't we have a right as Americans to have transparancy and truth in government? Even though I am 50 yrs. old I still take birth control pills to control migraine headaches. While I don't think anyone is really in favor of forcing doctors to perform abortions neither should you be in favor of forcing your ideology on the majority of Americans who do not agree with you! Please reconsider and tell the truth.
Posted by: Tamara | August 11, 2008 at 10:08 PMPlease support proposed new HHS regulations protecting my conscience rights as a physician and professional ethical decision-making:
1. HHS regulations are needed to apply existing law: Beginning with the 1973 Church amendment , which broadly protects religious expression in the workplace, and continuing through the more recent Weldon amendment, which forbids federal funding of discrimination against abortion objectors, Congress has expressed the will of the American people in protecting conscience rights. HHS regulations are needed to finally translate existing law into practice in healthcare.
2. Many healthcare professionals and patients view fertilization as the beginning of human life . The new draft regulations define abortion as "any of the various procedures—including the prescription, dispensing, and administration of any drug or the performance of any procedure or any other action—that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation." The new regulations simply recognize the view that life begins at fertilization as a valid point of conscientious concern.
3. Persons of faith are being pressured to compromise conscientious convictions in healthcare. Note that over 40 percent of doctors surveyed say they have experienced such pressure.
4. Ethical codes protect patients: A healthcare professional is by definition one who professes adherence to a code of ethics. These ethical codes (Hippocratic Oath, Scriptures, others) are designed to protect patients. When professionals do not or are not allowed to follow ethical codes, patients are vulnerable to both the whims of the healthcare individual and to political/ideological pressure on the medical system. That’s exactly what opponents of these regs want to do—apply pressure/coercion to the medical community as a way to enforce their own political views.
5. Patients have other options: Patients almost always have other options to access controversial procedures and prescriptions—often simply by accessing the Internet, Yellow Pages, or organizations. Possibly the only situation in which time might be considered critical would be so-called emergency contraception. If any cases actually exist when patients cannot locate other options, these are extremely rare and do not justify coercing the entire medical profession to violate longstanding ethical codes. There are often competing interests that must be weighed in policy decisions, and the First Amendment rights of professionals far outweigh the asserted “right” of someone to get contraception.
6. Faith-based professionals care for the poor: Attempting to force faith-based medical professionals and institutions to provide immoral services will only force them to shut down. Since faith-based healthcare entities care for the underserved, this would only eliminate medical care options for the poor.
7. Patients choose like-minded physicians – anyone who has chosen an obstetrician or hospital because that individual or institution does not do abortions understands the importance of being able to choose healthcare professionals based on the professionals’ moral codes and convictions.
Posted by: S. Warner, MD | August 11, 2008 at 10:19 PMDear Secretary Leavitt,
Thanks you for your support of the Right of Conscience. People should not be forced to do something which violates their conscience.
This does not prevent patients from going to someone who will do what they want. This is the patients right
Posted by: Jim Greeley | August 12, 2008 at 08:28 AMI just wanted to thank the secratary for standing up for doctor's and nurses rights, their right not to do something they wish not to. That is want living in a free society is all about. a gov. cannot force someone to do something that goes against their faith, religion and convictions.
Posted by: CHARLIE | August 12, 2008 at 10:04 AMDear Sir,
When I was in medical school trying to decide on a specialty, I wasn't sure of my position on abortion, but I was afraid that there would be pressure by my superiors in the training program to participate in performing them, if that was part of the training at my university. In Medicine (as probably in all occupations), everyone is expected to pull his/her weight. I did not feel morally comfortable with that situation. I was interested in going into oncology, but didn't know if I wanted to do serve pediatric patients, adults or women in Gynecologic Oncology. I ruled out the latter, because of this issue, as I would have to go through OB-GYN training before I could subspecialize in Gyn-Onc. One of the doctors who was a resident while I was a med student, and also a person of faith, went on to a faculty position to teach OB to family practice residents at the same major university. She subsequently quit medicine entirely to stay home with her children. I suspect this concern was part of her decision.
Posted by: S.E. Patton MD PhD | August 12, 2008 at 04:46 PMI also feel that the desire of some to empower patients to force their doctors to give them what they want, rather than what is medically good for them, is a slippery slope. For example, there are lots of narcotic-addicted patients who would like to force their doctors to prescribe their drug of choice. In that case, it would be not just a moral, but a legal catch-22 for the doctor.
Apparently, there is a primary care provider shortage in this country, felt especially acutely in the underserved rural areas that seem undesirable to all but the most altruistic doctors. It seems that these are likely to be the ones who would have conscience issues that if not protected would discourage them from wanting to practice in such settings. Particularly, the suggestion by the National OB-GYN organization that their members locate nearby someone who didn't have the same conscientious objection to abortion or else do it themselves. This approach is very likely to decimate the ranks of doctors willing to serve in isolated areas, as there is no way a conscientious objector would run the risk of being forced to do something they considered to be murder.
I read the above articles on your visit to Alaska and issues concerning birth control and abortion. First, I would like to say that it is my belief that abortion and reproductive services should be available to all women. I am pro-choice, and I do not understand why anyone would be against birth control and reproductive freedom.
I grew up in a household with several older siblings. My parents are Catholic, and I attended Catholic schools. All of my ex-childhood friends and teenage friends were also Catholic.
I have a brother, who is only a few years older than myself, by whom I was raped, molested, and abused by growing up. I was also raped by atleast 2 other men during childhood, but have been unable to prove my case to the police. As a small child, I was the victim of child pornography. I was diagnosed with paranoid schizophrenia at the age of 29. I am now on disability with the federal government.
As a teenager, my friends were aware of the abuse I had experienced. However, the Catholic Church teaches that abortion is wrong no matter what the circumstances. No matter what the circumstances???! Back in the time of Jesus, there was no such thing as abortion. It did not exist, nor did contraception. I believe in moving forward, not dwelling in the past as the bible teaches. Besides, I am not a Catholic, I am an Atheist and the United States Constitution does not discriminate based upon religion, race, ethnicity, sex, sexual orientation, age, disability, etc.
It is my belief that new technologies are making our world a better place to live. Stem cell research can help scientists discover a cure for cancer, or AIDS, etc. One hundred years ago, and still today in parts of Alaska for example, new technologies could help save lives. Do we not want to continue furthering medicine and science? Are some American's only concerned about what teleconferencing, ipods, cable television, cellular phones, computers, and video games can do for their social and business life? Are some American's that selfish that they cannot recognize that medical and reproductive advances in science are just as important. Maybe the anti-choicer's should try to give up their ipod, their computer, their cable television, or even their vehicles. It should be every American's freedom to have access to reproductive rights. Or do the conservative's wish to be stuck in the past forever?
No one is forcing a conservative anti-choice supporter to purchase birth control or have an abortion. They have the right to choose as they wish, and therefore so should a pro-choice supporter have that same right to choose.
Also, how many innocent women, who have chosen to have an abortion, will be labeled as "murderers" by the anti-choice supporters? Many of these women are victims of abuse, rape victims, incest victims, innocent teens or just young women trying to make a better life for themselves. What happens to a woman like myself, who has paranoid schizophrenia due to rape, incest, and childhood trauma? Do you think that it is just to label me as a "murderer" simply because I am pro-choice and I exercise my right to choose? My mental scars will never go away, and I will be on medication the rest of my life. How lucky was I, not to have been murdered by one of my abusers? How many other people have been murdered by these same sex offenders? Personally, I will feel a whole lot safer once all of my sexual abusers have been put in prison. Shouldn't that be what we all want?
Posted by: Linda | August 12, 2008 at 07:19 PMThank you for being an outspoken advoacate for those in the medical profession who are trying to fulfill their commitment to the health profession asa well as their patients in obedience to their conscience. Praise God for granting you wisdom and courage.
Posted by: Michael A. Momont | August 12, 2008 at 07:55 PMI am currently a student in the OB/GYN setting and I get to see so many transvaginal ultrasounds where a woman is 5-7 weeks along...a time when many women first are finding out their pregnant. There is already a little baby you can see inside the gestational sac and you can see the heart beating!! It is a miracle of life and forcing healthcare PROVIDERS to take life would be absolutely horrible.
Posted by: Jennifer Zamora | August 12, 2008 at 11:49 PMDear Secretary Leavitt,
Thank you for your support of the Right of Conscience and for your efforts to protect the rights of health professionals like myself. I make decisions of conscience as I care for patients everyday... whether it be to give a certain medication or not, whether to admit to the hospital or not, whether to bring certain family members into the discussion and care of a patient or not. Everyday, every decision I make requires wisdom and discernment. Everyday, I make decisions in my patients' best interests, to the best of my ability. It is impossible to separate out my conscience from my practice of medicine. I don't always choose to do what my patients want, but I choose what I believe to be best for them. If they disagree with me, they are free to choose another doctor. Every shift in the Emergency Room where I work, I have at least one patient who will ask me for a narcotics prescriptions for a condition for which I deem inappropriate, and I will decline that prescription request, because I do not believe it is wise for me to support the patient's lifestyle of substance abuse. I can't do or prescribe something to a patient if I truly believe it is harmful for them. I must be allowed to make that decision for the better care of my patients. Just because I have been trained to do a particular procedure or use a particular medication, doesn't mean I should do those things in all cases or simply beacuse a patient requests them. I am trained to weigh the risks and the benefits and provide the best possible care to the patients. I also have made a solemn vow to "Do no harm". To provide these services,to provide the best medical care possible, I must draw upon my judgment, wisdom, experience and conscience. To deny my conscience would make me a poorer doctor.
Posted by: Suzanne Ross Snyder, MD | August 13, 2008 at 12:16 PMDear Secretary Leavitt:
I also appreciate your strong defense of conscience rights. I believe this allows healthcare professionals a chance to actually live up to the part of the Hippocratic Oath about "Never do deliberate harm to anyone for anyone else's interest."
Right of conscience laws to protect the physician (and other health care workers) are critically important to safeguard the trust between patient and doctor. Does a patient REALLY want a physician who will violate his integrity upon request from the patient? If I as a physician will do what I believe is wrong (medically or ethically) because the patient askes me to, how can my patient be sure that I will not do what I believe is wrong if the insurance company asks me to.
Patients and doctors do not always agree on what should be done; but the patient should always be able to trust that the physician is acting in accordance with his conscience. We must have safeguards so that physicians (and others) are not penalized for being persons of integrity.
Thanks for your integrity and insights,
Posted by: Marian Matthews | August 13, 2008 at 03:37 PMMarian Matthews
Thank you for this forum. I have read some very interesting comments both for and against abortion. However, as I understand this situation, that is not the question. The subject is actually whether someone should be forced to do something against his or her will. Whether we like it or not, abortion is legal in this country, and not mandatory, like it is in some other countries. I think most every one would agree that forcing a person to have an abortion is a terrible injustice, and a breech of basic human rights. This is the reason that we have had such harsh words with China lately. Why would forcing a doctor to perform an abortion be any different?
It would be different if a physician were working for a company, ie. "Abortions Are Us" for example, and the physician decided to take a stand and not do abortions while employed. That company could, and probably should, fire the physician, because his refusal to do his job goes against the company's policy. However, when a physician is a private contractor, living in a free society, he or she must decide exactly what type of practice he or she will have, and what aspects of that practice he or she will do. For instance, not every dermatologist will do cosmetic laser treatments, even though the treatment is on the skin. Likewise, not every gynecologist will treat cancer. The reasons for their choices are varied, from not being fully trained in that procedure, not enjoying that procedure, believing that the procedure holds too much liability, or opining that the procedure is unpleasant, unpalatable or generally disgusting. Therefore, if an OB/GYN or family practitioner does not want to do an abortion for any reason, including that of conscience, he or she should not be forced to do that procedure. After all, we are still living in a free society ... I think.
I have just made my argument without any references to religion for a purpose. That purpose being to show that America is still considered the land of the free, and unless we are willing to give up that freedom for everyone, we shouldn't expect to deny that freedom on only one. You have the freedom to accept that argument or not.
Thank you,
Charles D. Thompson, MD, FACOG
Posted by: Charles D. Thompson, MD | August 13, 2008 at 05:40 PMObstetrics, Gynecology, and Infertility
Abilene, TX
CONTRACEPTION IS NOT ABORTION! Contraception is legal (for that matter, so is abortion, as much as the christian right tries to presume otherwise). Isn't it anti-American in a supposed democracy to force your own views onto others? The very notion that pharmacists can refuse to dispense physician prescribed medications at their whim is appalling to me.
Posted by: Lizabeth Lyles | August 14, 2008 at 04:18 AMIf pharmacists find they are unable to fulfill that aspect of their job, maybe they're ill-suited to the profession. No one is asking for the pharmacist's personal opinion or moral pretexts, simply that they do the job they went to school for (and were hired to do. This is also costing their employer money refusing to fill legal prescriptions.). Their beliefs are just that, their own beliefs, these should not be forced on to others, especially those in vulnerable positions.
I don't drink or smoke, & think both of those are nasty addictions that are exceedingly harmful, contribute to hundreds of thousands of deaths, raise my insurance premiums due to others medical expenses, etc, etc. Since I'm morally opposed to them personally, if I work at 7-11, I therefor have the right to refuse to sell them to customers because it violates my ethos? When I was a waitress my boss would have fired me immediately if I forced my tee-totalling opinions onto the clientele. I'm also opposed to hunting, but working at Walmart one is not given a choice on whether to sell the guns and ammunition in the sporting department. It's part of the job. I'm sure you understand my point. My opinion is my opinion, yours is yours, the pharmacists are entitled to theirs. Privately. It should not interfere with the physician & patient's directives.
Thanks for your time..
Lizabeth Lyles
First- a comment on this blog. Is it necessary for mental health facilities in a small community? I always thought of mental health facilities as being necessary in a city where emotional networks were..nt. The woman mentioned above surely has relatives nearby in a remote villiage of 300. Perhaps a 'community center' would be more appropriate so that she could work on her network! Ok and about the contraception thing. I'll bet 80% of avid anti-abortionists in America use some form of birth control. If there was a serious chance of a threat to 'birth control', I think the drug companies who provide them will squelch that real quick.
http://www.newenglandbee.com
Posted by: michelle | August 14, 2008 at 03:50 PM