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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.

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.

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

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.
 

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