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Community Health cutting behavorial health services

STORY BY EILEEN KELLEY, (Week of November 1, 2012)
Photo: Miki Ashton: 'I cannot believe that they can do this.'

More than 370 mostly poor people receiving psychiatric care and another 67 people recovering from addiction to pain medications or other opiates are being phased out of the Treasure Coast Community Health system, told these services are being eliminated.

Vicki Soule, the chief executive officer of the non-profit health agency, said she was left with no other choice but to scale down the health system’s services to mentally ill and addicted patients because of high costs associated with their treatment.

The agency spent $710,000 last year caring for mentally ill and addicted patients. For years, the agency siphoned money from a federal grant to offset the high cost of care.

The problem is the agency wasn’t supposed to use any of the $2.07 million federal grant for such specialties, said Soule.

The agency is not dumping its psychiatric program for children.

Soule said her agency was told after a site visit in August that it could lose its federal grant if it continued to operate as it has been.

Soule said it’s just not possible to continue providing care for these patients. “It has been a very difficult time for us and our organization,” she said.

News of the changes does not sit well with many patients, and often leaves them to call other clinics in tears after getting the word either in a letter that their next visit would be their last or learning of the changes when they arrive at the clinic.

The Mental Health Association, which has problems of its own, has taken on some of TCCH’s patients but cannot take any more, said a man who answered the association’s phone last week.

Questions surfaced last month about the backgrounds of the MHA’s clinical director and a counselor who allegedly had inappropriate contact with a patient, raising questions about the level of care it provides.

One Treasure Coast patient said she is very worried about the future.

“I’m doing better than I ever have been. I just cannot believe this,” said Luanna Smoldt, 58, of Fellsmere, who suffers from post-traumatic stress disorder and attention deficient disorder.

Smoldt, who has no insurance, was paying the Treasure Coast clinic in Fellsmere between $20 and $40 a visit for her psychiatric care.

The doctors are paid much more.

Soule said it typically costs Treasure Coast on average about $163 per patient visit when all of the agency’s patients being seen for behavioral health issues are divided into the cost of providing these services.

In addition, the number of people seeking help for behavioral health has spiked.

Treasure Coast logged 3,262 visits for behavioral health care all of last year. As of Sept. 30, there had been 4,200 behavioral health visits by 940 patients.

Patients like Smoldt were given a list of other agencies that might be able to help them. Even with a sliding fee scale, the costs will be much higher at agencies accepting new patients for the same 30-minute doctor visit.

“I cannot afford to go anywhere else,” said a 35-year-old Sebastian woman.

Eleven years ago, the woman – whom Vero Beach 32963 agreed not to identify – had a complete mental breakdown. Twice in a matter of 24 hours, she tried to kill herself. The woman has bi-polar disorder.

Coming to grips with it and learning how to manage her life was a long and painful journey.

She lost custody of her child and her marriage fell apart. At one point in her treatment at a for-profit agency when she was working and had insurance, she was being prescribed $1,000 worth of drugs at a time. Now, she no longer has a job or insurance.

At the Fellsmere clinic, which has a steeply discounted pharmacy, her costs are about a 10th of that.

Until the news of losing the program, the woman said her future looked promising. She’s taking adult education classes, and has remarried.

“I’m happier than I have been in years,” she said.

She was recently turned away from the Fellsmere clinic with a prescription for three months of drugs to control her disorder.

“What was the doctor going to say? It’s not her fault. She did apologize but there is nothing she can do about it. It’s not her fault,” the woman said.

After she runs out, she said she’ll have no choice but to go off her medications as she lost her job a year ago, and her husband earns about only $350 a week.

“I won’t be able to afford another place,” the woman said. “I won’t be able to go so that is what it is basically going to come down to.”

Stopping the adult behavioral health program isn’t just having an impact on the patients.

There are doctors, too.

Dr. Edward Katz’s job with Treasure Coast is being phased out. He said he was recruited by the agency after he became board certified and fellowship trained in addiction medicine.

His 67 patients who are receiving Suboxone treatment for their opiate addictions are being let go.

About half of the patients he worked with at Treasure Coast had insurance, he said. His work was successful in large part because he was able to expand it by getting patients on a regimen of Suboxone – which is less addictive than methadone – and also arranging for them to work with counselors and psychiatrists to overcome their addictions.

Katz said he had no ill feelings toward Treasure Coast leadership but does feel badly for his patients.

“They looked at the numbers,” Katz said. “We saw the patients that nobody wants. Where are they going to go? We were helping sustain the community.”

Treasure Coast Community Health, which began as a lost-cost clinic helping the poor in Fellsmere in the early 1990s, was so successful reaching out and providing medical, dental and psychiatric help for the region’s poor that its growth and scope could be its undoing, Katz said.

So far this year, Treasure Coast has had 25,200 medical visits and 13,300 dental visits. Its budget is $10.5 million.

Katz said he hopes his patients will continue to get the care they need. “I don’t want them to be left naked,” he said.

The University of Florida Center for Psychiatry and Addiction Medicine also offers Suboxone treatment.

“We are helping them (TCCH) in any way we can,” said Juan Recinos, the clinic manager.

The practice’s prices, however, are much higher even at a steep discount – $80 for a 30-minute visit is the lowest fee for those on a sliding scale seeking psychiatric care. The group also does not take Medicaid.

“I cannot believe that they can do this,” said 55-year-old Miki Ashton of Sebastian who has been seeing a psychiatrist at Treasure Coast for two years.

For the past 15 years, Ashton has suffered from anxiety and insomnia. It was so bad that by the time she got home from work, she’d suffer a panic attack just at the thought of another sleepless night.

Now she has no health insurance and is trying to get by financially by selling coffee at farmer’s markets.

She recently received a letter from Treasure Coast urging her to seek out another psychiatrist to help her with her mental health needs.

“Of course I cannot go to a local psychiatrist as I have absolutely no health insurance at all and would not be able to afford even one visit. That means I have no one to write the prescriptions for my medications.”