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Patients of a Lesser God or Victims of an Unjust Bureaucracy? – Yoli Diaz

Did you know that if you are an uninsured resident of Doña Ana County (DAC) diagnosed with cancer that you will be denied an appointment and ultimately denied life-saving cancer treatment at Memorial Medical Cancer Center (MMC)?  Most folks that I ask this question answer, shockingly, “No!” Yet the residents that have experienced this devastating denial can substantiate this as their reality.  

While we govern with the notion of separation of church and state, God is still front and center in our everyday lives. “In God We Trust” is the official motto of the United States and is printed on our currency. The 1776 Declaration of Independence, the preamble of the NM constitution, and our pledge of allegiance (which opens every City or County public meeting) all mention God.    The words of JFK echo this recognition of a higher power in our deeds, “With a good conscience our only sure reward, with history the final judge of our deeds, let us go forth to lead the land we love, asking His blessing and His help, but knowing that here on earth God’s work must truly be our own.”  

Do our leaders embrace the words, “indivisible with liberty and justice for all” in their actions?  Regarding access to health care, I emphatically confirm that they do not currently and have not for almost 10 years to my knowledge. The depths of the problem for healthcare access may be unknown to some leaders and residents, as the Open Meetings Act prevents discussion of any subject if it is not put on an agenda for the county commissioners’ and city council members’ meetings. However, these leaders are the source for solutions to reduce the cruel, unbelievable inequities and disparities in health care access in DAC.

Once understood, the substantial inequities in health care access scream out to the common observer. In our DAC border region, racism, inequity, disparity, and discrimination are alive and well, while tackling access to health care inequities suffers silently on the sidelines waiting for attention. Health care is not a privilege reserved for the wealthy; it is a human need. No one human is superior to the other in terms of getting an illness, nor should one be superior in receiving treatment for such. 

Why does this matter?  Social determinants of health plus the demographics of DAC create issues that remain unaddressed.  The injustice begins at the top levels of the people who run our government and trickles down to the ground level of business and health care.  The public hospital’s old name was Memorial General Hospital and it opened in 1950.  It was the city’s only hospital, our public hospital. With city and county leaderships’ concerns for the looming crisis in 2003 after the well-financed private competitor, Mountain View Regional Medical Center opened – MMC was purported to be losing $1 million per month. The stability of the Las Cruces health care system was at risk. This resulted in our only public hospital, which operated from 1950 to 2004, to be leased to a private company. This history is critical to the provision of access to health care we experience today in DAC.

The most recent denial of access to health care at MMC I’ve presented to DAC leaders was for a disabled, indigent patient in the DAC Healthcare Assistance Program (CHAP) who was diagnosed with breast cancer.  Although my advocacy of needed access to health care has been ongoing for over two years now, including an October 2021 meeting with the county manager, director or Health and Human Services and the mayor, not much action has taken place today to improve the crisis. I see this advocacy as the right thing to do because the problem of preventing taxpaying DAC residents’ access to needed health care is atrocious, unjust, discriminatory, and inhumane. As the crisis is multi-faceted and convoluted, I can describe the root of the problem and injustice to our taxpaying residents. If you are a DAC resident, you purchase goods and services and pay property taxes through rent or home ownership; you are a taxpayer. The disenfranchised residents of DAC need County, City of Las Cruces and/or the State of New Mexico to make provisions/funding to help alleviate this crisis of neglect. I have provided viable solutions and a proposal to both county and city leaders that they can turn into a resolution which addresses the issue. 

New Mexico statutes in place state that the responsibility for indigent care falls to the counties within the state. Circumstances changed once the public hospital was leased for 40 years with the County/City as Lessors and a private entity as the Lessee. The County/City managers have a seat on the MMC board in order to provide oversight and accountability to lease compliance. The lessee was intended to maintain the status quo of the public hospital as the lease states, 

“Lessee will provide Expanded Care Services, as hereafter defined, for the sick and injured in Doña Ana County who seek treatment at the Hospital, regardless of the cost of that care, even if it exceeds Sole Community Provider Funds.”

“Lessee shall coordinate with the County on processes and mechanisms  to seek state matching funds for hospital indigent care…”

Clearly, these responsibilities have not been upheld or the problem with access to healthcare would not be an issue. Who is responsible for this lack of oversight and compliance with the lease’s contractual obligations? The County/City government and the lessee all signed the lease to enforce indigent care and the continuation of services.

The greater failure in this obligation, in my opinion, lies with the county leadership.  In addition to being a 50% lessor in the lease, they also have Health and Human Services Department that has not upheld its own mission “to improve the quality of life in DAC by identifying and addressing unmet health and human service needs.” The County has also failed in its responsibility of NM Statute 27-5-2. Indigent Hospital and County Health Care Act. The purpose of which is: to recognize that each individual county of this state is the responsible agency for ambulance transportation, hospital care or the provision of health care to indigent patients domiciled in that county, as determined by resolution of the board of county commissioners.

The City, along with the County, has failed to oversee compliance with the lease; however, the City did establish the Telshor Facility Fund from monies acquired for MMC lease. This fund grants funds to city nonprofit organizations that “support…continued well-being, safety or improvement to lives of sick, indigent or low-income people.”

I want to return to the most recent tragedy I have encountered on this issue – the disabled, breast cancer patient who has been abandoned by the county, despite being in the CHAP for years. I alerted the director of HHS, the county manager, and the county attorney that MMC denied this patient an appointment due to her having no insurance. The negligence occurred after the county updated their indigent healthcare resolution for cancer care on August 22, 2023. I requested an email response by October 4, 2023 and have yet to hear from the county manager or attorney. The director said they were working on a contract, but none has appeared.

These denials and delays in healthcare have grave consequences for this suffering patient, as cancer doesn’t wait for paperwork before it progresses. While this patient and others like her are left to feel like patients of a lesser God, they are really victims of poor policy enforcement and bureaucratic shortfalls. Time for change is overdue.   

Yolanda “Yoli” R. Diaz

Patient Advocate

Disruptor of the Status Quo

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