Heath Haussamen/New Mexico In Depth
The Arizona company that took over a long-time Las Cruces health services provider this weekend shut down its in-house pharmacy Tuesday afternoon after discovering it didn’t have a license to operate it.
The pharmacy shutdown left some patients without a service they were used to receiving.
La Frontera replaced Southwest Counseling Center, which operated an in-house pharmacy to dispense medication. Its clients include people who suffer from mental illness, are recovering from drug and alcohol addictions, and some who have suicidal or aggressive tendencies.
La Frontera applied for a state license hours after shutting the in-house pharmacy down, CEO Dan Ranieri said. And Matt Kennicott, spokesman for the state’s Human Services Department, said the state will issue an emergency license quickly and La Frontera’s pharmacy will reopen Wednesday.
Earlier this month, Gov. Susana Martinez promised the state was “not going to leave people without services” as it forced the transition to La Frontera by freezing Southwest Counseling’s Medicaid funding. For a time on Tuesday, however, patients were going without prescriptions being filled at the clinic.
La Frontera and state officials disagreed with Southwest Counseling Center officials on Tuesday over how severe a disruption Tuesday’s shutdown caused.
Ranieri characterized the disruption as “more of an issue of convenience than anything else,” saying patients should be able to fill prescriptions at “just about any pharmacy.” But Roque Garcia, who was Southwest Counseling’s CEO, said it’s critical that the clinic have its own pharmacy.
Some clients are homeless or have transportation issues and can’t easily get to another pharmacy, he said. Some may not take prescribed medications, overdose, or sell the medication on the street. For those clients, Garcia said, “the staff has to be there when (medications) are administered,” and having an on-site pharmacy makes that easier.
In addition, medication cost and availability are concerns, said Krista Scorsone, who was a psychiatric mental health nurse practitioner at Southwest Counseling. Some of the medications Southwest Counseling kept in its pharmacy, such as injectable antipsychotic drugs, aren’t readily available at other pharmacies, she said. While other pharmacies can special order such drugs, the cost is higher than the discounted rate Southwest Counseling obtained, Scorsone said.
Scorsone said she worries about the client who might be schizophrenic but, with medication, has a job, a family, and functions fine. She asked, “What happens to you, your job, and your family” without daily access to needed medication?
Scorsone hasn’t yet signed on with La Frontera, saying she’s not sure the new clinic is “going to be what’s best for my patients.”
“Patients like these cannot go without medication,” Garcia said. “… These are the most vulnerable, the ones that really need the medication.”
Ranieri said it takes more work to prescribe and monitor drug use without an on-site pharmacy, but his staff will make it happen. Dispensing fewer doses at a time, making clients come in every day to receive medications on site, or visiting them daily at their homes are possibilities he mentioned.
“People are not falling through the cracks,” he said.
‘Are we going to be perfect? Absolutely not’
The Martinez administration forced the transition after an audit recently flagged Southwest Counseling and 14 other New Mexico health organizations for problems including overbilling and possible fraud. The administration suspended payments to most of the providers even though federal regulations give the state flexibility in deciding whether to freeze funds.
Southwest Counseling was the first provider to give the state notice that it could not operate without the funding, and La Frontera took over Sunday. Ranieri said he first spoke with Southwest Counseling Center about taking over last Tuesday. The transition took place over a five-day period.
Ranieri and the state were touting a smooth transition on Monday. Kennicott told New Mexico In Depth that La Frontera had hired 95 percent of Southwest Counseling’s 120 employees. Ranieri also sounded cautiously positive.
“I hold my breath when I say this, but things have gone fairly smoothly so far,” he said Monday.
Ranieri told NMID last week there would be problems, but that La Frontera had taken over two companies before in Arizona. But Ranieri admitted he had never faced such a speedy transition.
“Obviously, you would like to have more time, but you adjust,” he said. “… Are we going to be perfect? Absolutely not.”
La Frontera’s pharmacy was open and dispensing medication to clients Monday and part of Tuesday because staff assumed it had a license, Ranieri said. When he learned around noon Tuesday that it was operating without a license, Ranieri said he shut down the pharmacy.
By the end of the work day on Tuesday, La Frontera had filed its license application. Kennicott initially told NMID the pharmacy would not shut down, saying the state would issue an emergency license this week. When told by NMID the pharmacy had already shut down, he said late Tuesday afternoon that it would reopen Wednesday morning.
Minutes later, Ranieri said he hadn’t been told by the state that the pharmacy could reopen Wednesday.