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 V.20 No.22 | June 2 - 8, 2011 

Miss Diagnosis

The Miracle of Treatment

Medicaid axes inpatient program for drug-addicted mothers

Imagine you’re a nurse for newborns and looking after two little bundles of joy. Cute, huh? But you notice something amiss with one of the little bundles. It starts with a fine, jittery tremor. Soon the bundle is flailing her limbs around and crying with the saddest high-pitched mewl you’ve ever heard. “I think this baby is withdrawing,” you exclaim to your co-workers.

The baby’s heart races like a hummingbird’s. Since she’s on the small side to begin with, the decision is made to transfer her to the newborn intensive care unit. But without a reliable prenatal history, the medical team has to begin its treatment plan based on an educated guess. Later, the team confirms that the mother had an undiagnosed and untreated substance abuse disorder.

How much progress can a woman battling addiction make if she’s returning to the streets or to a violent partner every evening?

Jump forward two years. Our little bundle is now a toddler with some significant developmental delays. Her mother’s substance abuse problem has only worsened, and she lost custody of the baby. In fact, nobody knows where mom is.

This problem is real in New Mexico. And the state's only residential substance abuse treatment clinic for pregnant women, Casita de Milagros, will be closing on July 1. This clinic provides prenatal care and treatment to pregnant women who use drugs or alcohol. After July 1, women will still be able to receive outpatient services. But Medicaid funding for round-the-clock, inpatient treatment has been cut.

During my time as a mother-baby nurse, I cared for many Milagro patients. I also cared for substance-abusing mothers whose addictions remained untreated.

Cut back to the nursery. Now let’s take a closer look at the other little bundle of joy. She’s swaddled and sleeping soundly in her bassinet. This baby’s mother received regular prenatal care and personalized substance abuse treatment through Milagro. She carried her pregnancy a couple weeks longer than the untreated mother. This lessened the risk of premature complications.

You’re hunched over your paperwork at the desk, but your head pops up when the bundle starts stirring in her bassinet. You know the full prenatal history behind that baby, since the mother began regular care with Milagro early in pregnancy.

Because the mom was treated with methadone for her addiction, you’re on the alert for signs of methadone withdrawal in the baby. If the baby displays any of these signs, you’ll start a treatment plan that’s already in place. The team was able to develop this plan knowing that the baby hasn’t been exposed to any other drugs. This is because the baby’s mother agreed to regular drug screening as part of Milagro’s program.

Let’s jump again to two years later. We find our other little bundle is now a healthy toddler in the middle of a physical therapy session. Milagro referred this kid to a childhood development program called Focus when she was born, knowing that this child is at risk for developmental delays. This allowed our bundle’s physical development delay to be identified and treated early on.

This toddler lives with her mother, who has remained sober since leaving Casita de Milagros. One of the program’s partners, Reflejos Familiares, helped this mother obtain basic needs to get back on her feet. Home visits from another partner program called Vision taught this mother about creating a safe environment. Regular family practice follow-up visits for both mom and baby have kept the chain of care intact.

Of course, not all Milagro families experience the success illustrated above. But some do, and many others experience more modest successes. These aren’t always obvious. For instance, if treatment helps an expectant mother cut back from daily to weekly drug use, how do you quantify the harm that the baby avoids? The difficulty with recognizing these outcomes means that the good work done by Milagro can sometimes go unseen by the general public. As a nurse, though, I witnessed these successes time and time again.

Dr. Andrew Hsi, a University of New Mexico pediatrician, helped establish and name Milagro. He cites the waiting list for inpatient treatment as evidence of need. Ideally, the program would be expanding to meet this need. Instead, Hsi says that the closing of Casita de Milagros could create major gaps in the care of chemically dependent women and their children.

Although women will still be able to access outpatient care, many high-risk mothers require more intensive inpatient treatment. How much progress can a woman battling addiction make if she’s returning to the streets or to a violent partner every evening? Hsi predicts that moms and babies will have more difficulty following the chain of care if one major link is missing.

So how did this necessary program fall through the cracks? According to UNM spokesperson Sam Giammo, Medicaid funds Milagro. The money comes through OptumHealth, a firm that manages behavioral health Medicaid dollars in New Mexico. For 2011, Optum is capping budgets for services like Milagro in order to avoid overspending.

Things aren’t looking any better for 2012 because UNM is projected to receive less than $100,000 for all programs like Milagro. The program may be eligible for less than $60,000 of it. However, Giammo says that in past years, Milagro has received $350,000 to $450,000 in Medicaid funding. Obviously, a program with a budget in the hundreds of thousands of dollars can’t survive on $60,000. Giammo says that UNM Hospital has discussed this discrepancy with Optum and with the state, but there don’t seem to be any changes on the horizon.

At this point, Hsi feels that concern from the public might be the only way to save Casita de Milagros. The cuts highlight a larger issue of how health care dollars from limited public funds are distributed. Hsi asks, “How do you make that rationing decision in a meaningful way?”

Casita de Milagro’s closing demonstrates how vulnerable people, such as drug-addicted pregnant women and their babies, are losing out in the tug-of-funds game. For each new life brought into this world by a mother battling addiction, the consequences could be devastating.

Despite its brilliant name, this column is not intended to prevent, diagnose or treat herpes. Or any other diseases, for that matter.

Whitny Doyle is a family nurse practitioner.

The opinions expressed are solely those of the author.
Public Comments (5)
  • As always....  [ Thu Jun 2 2011 2:49 PM ]

    Another well-balanced and expressed instalment from my favourite Nurse from the Block. Albuquerque is blessed to have you working in the trenches!

    Last edited [6/2/11 2:56 PM]
  • Thank you  [ Thu Jun 2 2011 5:56 PM ]

    Thank you for writing this article. Although this program has been around for nearly 20 years, it is relatively unknown. Most people will probably be appalled to know that there is such a need for a program for pregnant women with substance abuse issues. This program has helped so many women and babies, and in doing so has helped our society. I hope the program lives up to it's name 'Casita de Milagros','Little house of miracles', and has a miracle occur to allow it to continue its good work.

    Last edited [6/2/11 5:57 PM]
  • Consider the greater context of this sad tragedy at hand...  [ Thu Jun 2 2011 6:50 PM ]

    Unfortunately, I must say that the closing of this much needed program is only a reflection of the greater political juggernaut at hand. Since April, the plan to cut Medicare and Medicaid in order to deal with the huge deficit at hand is still much debated but also frighteningly possible. Let's not even consider one's political affiliation but consider the sad prospect of a country that is even willing to toy with the idea of cutting funding to much needed programs. The current argument is cutting frivolous spending in certain Medicare/Medicaid programs. However, Ms. Doyle pointed out an important aspect. It is difficult to measure outcome measures on programs that provide primary and secondary prevention. How does a program prove its relevance when it is intended to improve the quality of life of children born to substance abusing mothers? Who is willing to pay for a prospective longitudinal study of the effects of such programs on youth at risk? How dose such a program prove that its interventions helped a woman win the battle of addiction? Many could argue that there are multiple confounding variables and have reason to cut these programs. It is a sad day indeed when we find more reason to cut these programs, but no reason is needed to continue to wage war. Our society values who wins in Dancing with the Stars more than finding ways to develop collective efforts in helping families be healthy and productive. Sad indeed...

  • hopefully  [ Fri Jun 3 2011 12:47 PM ]

    UNMH will hopefully be able to keep this program going. One can only hope that if their daughter or sister or any other female family member in need of this program will still have a place to get the help needed. With all that UNMH offers, I would think they could come up with something to keep this open.

    Last edited [6/3/11 12:50 PM]
  • This program changed my life  [ Tue Jun 21 2011 8:07 PM ]

    I can't believe they cut the funds to this much need program. I graduated from the inpatient program Sept. 2009 and I have 2 and a 1/2 years sober and I owe it all to this program and the wonderful staff that work there. If this program had not of been avaliable to me I would not be sober and the great mother that I am today. It is a sad sad day when the government has money to give to help other countries but doesn't have money to help people right here in the united states. So many young women are addicted to drugs without this program they won't have a chance.

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