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Luna County Health Status Assessment
Methodology and Results
Coordinated by the New Mexico Office of Border Health
Developed and Implemented April – July, 2007
by
Jacob Nevarez, MS, Environmental Epidemiologist,
NM Office of Border Health
and
Janet Flores, Dr.PH, Public Health Region 5 Epidemiologist,
NM Department of Health
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Health Needs Assessment Process
In April of 2007, The New Mexico Office of Border Health undertook the task of identifying and
addressing the health conditions and health care challenges facing the US/Mexico Border county
of Luna, New Mexico.
To this end, the OBH Environmental Epidemiologist enlisted the help of the Region 5 Public
Health Office Epidemiologist to methodically design the following framework for this study:
1. Interview key informants from local primary care clinics serving indigent and
underinsured clients, and collect information on prevalent health condition and health
services utilization by residents of Luna County.
2. Interview key informants from the sole provider of hospital inpatient and emergency
services in Luna County, and collect health condition and hospital utilization data on
Luna County uninsured or underinsured residents.
3. Interview key informants from the Luna County public health office, and collect client
service utilization data
4. Interview key informants from local behavioral health and relevant social service
agencies and collect health care condition and utilizations information that will contribute
to the Luna County health care profile
5. Collect from NM Department of Health, current infectious disease and vital statistics data
to contribute to a profile of Luna County health care profile.
6. Assess the degree to which the identified health care challenges for Luna County are
associated with US/Mexico port of entry located on its southern border.
7. Select Luna County health care challenges for solution planning
8. Work cooperatively with Mexican state public health entities in Chihuahua, Mexico to
develop strategies for solutions to the selected Luna County health care challenges
Activities:
Interviewed key informants from the Ben Archer Health Centers in Deming and Columbus.
Interviewed key informants from the Deming Health Center run by Presbyterian Health
Services, and subsidized by Luna County Indigent Funds
Interviewed key informants from the Local Public Health Office
Interviewed key informants from local offices of the Border Area Mental Health Agency,
New Mexico Income Support Division, Area Agency on Aging Senior Center
Interviewed key informants from Mimbres Memorial Medical Center
Interviewed Luna County Manager, Scott Vincent regarding sole community provider
funding and emergency transport services
Background
The southern border of Luna County, New Mexico lies along the US-Mexico International
Border, directly north of the Mexican municipality of Ascension, in the State of Chihuahua,
Mexico. Luna County is one of New Mexico’s three border counties, but it is the only New
Mexican County with a population center in close proximity to a Mexican population center.
The Luna County Village of Columbus, located at the US Port of Entry, is (distance) from its
Mexican counterpart of Puerto Palomas. The number of annual legal crossings at the
Palomas/Columbus port of Entry totaled 1,216,053 in 2003, or 3,332 per day.
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Demographics
In 2006 the population for Luna County was estimated to be 27, 205 (US Census Quickfacts), of
which 60% were of Hispanic origin. The 2000 US Census reported that nearly 20% of Luna
County’s population was foreign born, and nearly half of the Luna County population spoke a
language other than English at home.
As of 2005, only about 60% of Luna County’s population over the age of 25 were high school
graduates, and only 10% had earned a four-year college degree or higher.
Median household income for Luna County residents in 2004 was $22,888, approximately 65%
lower than median household income for New Mexico residents. The percent of Luna County
persons with incomes below poverty in 2004 was nearly 25%. Unemployment in Luna County
in 2004 was 15%, nearly 2.7 times that for New Mexico. Luna County unemployment in 2006
dropped to 10.6%, which was 2.5 times that for New Mexico.
Percentage of Unemployed Population
Luna County & NM 2004-2006
18
15.8
16
14 13.1
12 10.6
Percent
10 New Mexico
8 Luna County
5.8 5.3
6 4.2
4
2
0
2004 2005 2006
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Health Care Access
According to US Census for 2000-2001, approximately 67% of the Luna County total population
had health care insurance coverage. During the same period, approximately 31% of Luna
County children under the age of 18 had no health care coverage. From 2004 to 2006, the New
Mexico Human Services Department, Medical Assistance Program reported that 27% of the
2006 Luna County population was enrolled in the Medicaid Program, and amount that declined
more than 6% since 2004.
All Ages Medicaid, 2004-2006 ²¹
% of 2006 Population % change from % change from
Enrolled 2005 2004
New Mexico 20.73 -3.14 -4.04
Luna County 27.13 -5.54 -1.09
Source: New Mexico Health Policy Commission, 2007 Quick Facts, January, 2007
21 New Mexico Human Services Department, Medical Assistance, Reports, Eligibility Report – All Clients by County,
http://www.hsd.state.nm.us/mad/pdf_files/Reports/AllClientDistributionbyCo.pdf
Among Luna County children under the age of 21, 65.5% were enrolled in the Medicaid
Program in 2006, representing a decline of nearly 4% enrollment since 2004.
Medicaid Children Under Age 21 2004-2006 ²²
% of Total Medicaid % of Total Medicaid % of Total Medicaid
2006 Enrollment 2005 Enrollment 2004 Enrollment
New Mexico 63.87% 62.31% 64.04%
Luna County 65.52% 65.90% 67.88%
Source: New Mexico Health Policy Commission, 2007 Quick Facts, January, 2007
22 New Mexico Human Services Department, Medical Assistance, Reports, Eligibility Report – All Children by
County, http://www.hsd.state.nm.us/mad/pdf_files/Reports/AllChildDistributionbyCo.pdf
New Mexico Bureau of Vital Records and Health Statistics reported that for the period 2003-
2005 showed heart disease, cancer, accidental injuries, chronic lung disease, and cerebrovascular
disease (stoke) ranked as the first through fifth leading cause of death in Luna County.
Leading Causes of Death in Luna County 2003 2004 2005
Heart Disease 61 63 93
Cancer 63 44 61
Accidents 12 13 21
Chronic Lower Respiratory 13 10 16
Cerebrovascular 16 11 12
All Deaths in Luna County 241 240 280
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Among the top five leading causes of death in Luna County, there were increased deaths over
time due to heart disease, accidents, and chronic lung disease, and frequent underlying causes of
chronic heart and lung disease deaths were coronary heart disease, atherosclerosis, emphysema,
asthma, and bronchitis. The most frequent underlying cause of accidental deaths were motor
vehicle accidents.
Luna County Health Care Safety Net
Luna County Sites Delivering Primary Medical and Mental Health Services to the
Uninsured or Underinsured
The Luna County sites selected to participate in the local health care needs assessment process
were those identified as serving or assisting the uninsured or underinsured residents of the
County to receive health care. The sites included the following:
1. Ben Archer Health Centers in Deming and Columbus
2. The Deming Health Center (Presbyterian Medical Services)
3. The New Mexico Department of Health, Public Health Office in Deming
4. Mimbres Memorial Hospital in Deming
5. Border Area Mental Health Services in Deming
6. Columbus EMS and Ambulance Services
7. The Luna County Manager of the Indigent Care and Sole Community Provider Funds
8. International Customs Enforcement Office in El Paso
9. Luna County Senior Center
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Key Informant Interviews
Local health care and social service agencies involved in the planning and provision of primary
and preventive health and relevant social services to residents of Luna County were identified
and contacted; key informants from each agency were interviewed with a predetermined set of
interview questions designed by the study team. The questions were designed to elicit
information and data that would assist the study team to identify prevalent health care services
needs, health issues, and health care access barriers specific to Luna County and related to its
proximity to the US-Mexico border crossing. A copy of the interview questions can be found in
Appendix A.
Key agencies included those depicted in the graphic above:
Deming Health Center (Presbyterian Medical Services)
Ben Archer Health Centers (Deming & Columbus)
Local NMDOH Health Office (LHO) in Deming
Mimbres Memorial Hospital in Deming
Columbus EMS
Luna County Manager (Deming EMS, and Sole Community Provider fund manager)
Luna County Senior Center, Border Area Mental Health Agency, New Mexico Human
Services Department, Medical Assistance Program
ICE/Customs/Port authorities in El Paso
The Deming Health Center
Deming Health Center is managed by Presbyterian Medical Services, and financed, in part, by
federal funds as a qualified Primary Health Care clinic, and by Luna County sole community
provider funds, is located in the City of Deming. The clinic accepts uninsured or underinsured
Luna County residents, and charges them adjusted service fees, according to their incomes. This
Health Center serves about 30% of the uninsured/underinsured residents of Luna County. Health
Center clientele include 66% Hispanic and 33% non-Hispanic White.
Deming Health Center was unable to report the number of non-residents they serve, however a
majority of Health Center clients (91%) list their residence zip code as that for the City of
Deming, while only 6% list post office box zip codes. The Health Center’s billing system, while
not able to track the prevalent health conditions (like diabetes) of their clients, was only able to
generate categories of ICD-9 billing codes, which were too general to determine the burden of
disease or prevalent health conditions for Luna County clients.
At the time of the key informant interview, the clinic was operating with only one of two FTE
Nurse Practitioners and two medical assistants and no medical doctors. Although funded as a
primary care clinic, the Deming Health Center did not provide prenatal care services, so pregnant
clients were referred elsewhere. Underinsured and uninsured pregnant clients were referred to
the local public health office in Deming, a few doors down from the Deming Health Center.
Deming Health Center listed the following five top reasons for clinic visits: 20% were for well-
child checks; 16% were Diabetes related; 13% were for PAP tests; 13% were for hypertension;
and 12% were for childhood earaches.
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A previous obstacle for Deming Health Center underinsured and uninsured clients, was their
inability to purchase diabetes testing supplies or prescription drugs. Currently, Deming Health
Center participates in the State Diabetes program to provide glucose monitors and testing strips
to patients who cannot afford them. The Health Center also participates in prescription drug
discount programs offered by drug manufacturers for qualifying patients.
Some of the prevalent obstacles facing uninsured/underinsured Deming Health Center clients
include access barriers to diagnostic lab and radiology procedures, prescription drugs, and
behavior health services. Additionally, the underinsured and uninsured clients of Deming Health
Center face high rates of teen pregnancy, a lack of locally available specialty and sub-specialty
care, limited transportation to medical services in and out of the county, unemployment/seasonal
employment, and language barriers.
Lastly, In addition to the primary care services delivered at its’ Deming clinic facility,
Presbyterian Medical Services contracted to provide primary health care to inmates of the Luna
County Detention Center and to Deming Public School students at the future school based health
center.
Ben Archer Health Center
Ben Archer Health Center (BAHC) is a federally qualified health clinic (FQHC) operating two
locations in Luna County, Deming and Columbus. Each clinic site provides comprehensive
health care to include family planning, women’s health, chronic disease management, and well-
child check-ups. Radiology services mental health and dental services are available at the
Deming facility. BAHC provides transportation to and from clinic visits for their patients.
At the time of the key informant interviews with the Luna County Clinic Coordinator, the BAHC
Columbus facility was operating with one physician assistant and one nurse practitioner. BAHC
was in the process of hiring a new MD and a dentist and hygienist for the Columbus clinic. At
that time, the Columbus clinic staff was providing limited low risk prenatal care to Columbus
Village residents who were prohibited from traveling to Deming past the Border Checkpoint,
located on the only highway between Columbus and Deming.
Grant funding from the Con Alma Health Foundation enabled BAHC staff to provide home visits
to seniors diagnosed with diabetes, where one-on-one education on diabetes, cholesterol, blood
pressure, diet and exercise is conducted in Spanish and English.
BAHC also participates in several prescription drug discount programs that serve 85 clients in
Deming, and 31 clients in Columbus. At the time of the key informant interview BAHC was
adding two new dentists to its’ Deming dental staff of one dentist and one dental hygienist. With
a full complement of dental staff, BAHC will again be able to rotate dentists through the
Columbus clinic, and will be able to do more school-based dental health screening for children.
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At the time of the key informant interview, BAHC in Deming was embattled with city officials
to pave the access road and parking lot to its facility. Rainy conditions create access problems
for ambulatory and non-ambulatory clinic patients. The Luna County Manager committed to
paving the city road so patients/staff have access to the client during times of bad weather.
Many local doctors in Deming resent the fact that BAHC doctors are not required to take hospital
call for BAHC patients, increasing the hospital call burden on all local non-BAHC physicians.
This creates a liability for the doctors on-call, and many are not compensated for there inpatient
services to under/uninsured BAHC patients.
At the time of the key informant interview, the Luna County BAHC Payer Mix included: 43%
Self-Pay (uninsured); 24.7% Medicare/Medicaid; 12.6% Medicare; 11.3% Private Insurance; 7%
Medicaid.
The top five reasons for clinic visits at BAHC included: 9.3% hypertension; 4.9% diabetes;
4.3% Gyne exams; 3.5% Acute Upper Respiratory Infections; and 2.9% well-child check-ups.
The access barriers to health care in Luna County, as perceived by BAHC key informants
included: A lack of dental services in Columbus, transportation difficulties to specialty care
services outside of the BAHC system, language barriers, staffing shortages, and access to
prescription medications are major difficulties for the uninsured without documentation to
qualify for assistance. Additionally, BAHC clinical staff saw diabetes, hypertension, chronic
obstructive pulmonary disease (COPD), and sexually transmitted diseases as prevalent medical
problems for Luna County residents. BAHC clinical staff also saw a big need in Luna County
for accessible behavioral health treatment for depression and drug abuse, and for more
community services and activities for homebound senior residents of Columbus.
Border Area Mental Health Services (BAMHS):
Border Area Mental Health Services is an outpatient mental health service agency based in Silver
City, that provides clinical diagnostic assessments, outpatient mental health counseling, sexual
assault, psychiatric, and substance abuse recovery services for children, adolescents, and adults
in four counties in southern New Mexico: Catron, Grant, Hidalgo, and Luna.
In Luna County, the unduplicated BAMHS client caseload has grown 11% since 2003-04, from
859 to 955 clients. Hispanics have accounted for an annual average of 53% of BAMHS clients
in Luna County in since FY04. Sixty eight percent of the mental health diagnoses for children
up to age 18 seen at BAMHS in Luna County in FY06 included adjustment disorders, adjustment
disorders first diagnosed in childhood, and depression/other mood disorders. Sixty-eight
percent of the diagnoses for adult BAMHS clients seen in Luna County in FT06 were for
depression/ other mood disorders and substance related disorders.
Approximately 42% of all new Luna County child clients seeking services through BAMHS
were uninsured at enrollment, while 54% had Medicaid. Approximately 66% of all Luna County
adults seeking services through BAMHS were uninsured, 21% had Medicaid, and 6% had
Medicare.
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Local New Mexico Department of Health, Public Health Office:
The local health office (LHO) is funded by the New Mexico Department of Health, Public
Health Division, and is located in the county hub city of Deming. The clinical staff include one
nurse practitioner and one registered nurse. The array of services provided at this LPO includes
prenatal care, family planning, WIC, well-baby checks, sexually transmitted disease testing and
treatment, breast and cervical cancer screening follow-up and treatment, immunizations, TB
testing & treatment, syringe/needle exchange for diabetics and intravenous drug users, and
diagnoses and management of chronic diseases. Clinic services are provided on a sliding fee
basis, depending on income.
The prenatal care clinic serves about 100 clients per year, at an average of five clinic visits per
client. Most of the prenatal clients are uninsured/underinsured, undocumented, ineligible for
Medicaid assistance, and unable to afford to pay prenatal visit co-pays or full prenatal care costs
out-of-pocket. For this particular group, the LHO is their only option for prenatal care.
In addition to routine care for normal pregnancies, the LHO also receives funding from the
Office of Border Health, the NM High-Risk MCH Program for high-risk and specialty Ob-Gyn
services such ultrasounds, treatment for diabetic or drug-using mothers, and colposcopic services
for cervical cancer diagnosis.
The clinic staff reports a continuing high teen pregnancy rate, increasing cases of STDs,
including congenital syphilis, high numbers of binational Tuberculosis cases, Hepatitis-C cases,
and substance abuse. They see a real need in Luna County for sex education for parents and
teens to help them to communicate with each other about sexuality and prevention. The LHO
VAST survey frequently identifies methamphetamine use among clinic clients. Positive
Hepatitis-C clients are referred to the Las Cruces LHO for treatment, which is problematic for
those without transportation. Deming LHO could benefit from the ECHO project.
Deming LHO staff sees that the prevalent health care access barriers for Luna County residents
continue to be the largely seasonal agricultural workforce that is uninsured, underinsured, or
ineligible for Medicaid or Medicare assistance, and is too disadvantaged to pay for health care.
Transportation to medical care within and outside of Luna County is a major barrier for residents
of this rural community. Additionally, the trans-mobility of Luna County and Palomas residents
across the US/Mexico Border, contributes to the challenge of adequately treating sexual partners
of the rising number of Luna County STD cases, and of preventing congenital syphilis among
births in Luna County.
Columbus EMS
Columbus is a small village in Luna County, located within three miles of the US-Mexico
border, adjacent to the Mexican town of Palomas. The population of Columbus is approximately
2,000, 65-68% of which is Hispanic and the remainder non-Hispanic White. Palomas has a
population of 8,000-10,000 residents and nearly 400 Palomas children attend school in the US
County of Luna.
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New Mexico state law requires any ambulance service licensed to operate in the state to answer
every call for assistance. It is common for Palomas residents needing medical attention to
present at the port of entry crossing requesting emergency medical assistance. In all cases the
border authorities are instructed to call the Village of Columbus ambulance service. Emergent
cases originating at the port of entry are transported directly to Mimbres Memorial Hospital
Emergency Room. Almost all of these emergency cases are Mexican nationals without
documentation and without the means to pay for either their emergency transport or their hospital
services.
For the years 2005 and 2006, 54% and 60% of all Columbus Ambulance calls originated from
the port of entry, respectively, and the Village of Columbus is left to encumber the costs of
responding to all port of entry calls and transports.
2006 Columbus EMS Calls:
Call Location Number Cost
Columbus 136 $ 79,244
Luna County 51 $ 22,000
Out of County 29 $ 16,500
Port of Entry 282 $154,400
Total 498
Mimbres Memorial Hospital
Mimbres Memorial Hospital (MMH) is the only hospital facility in Luna County, located in the
City of Deming. The hospital is a 49 bed acute care facility that has operated in Luna County
since 1957. The 10-bed obstetrics unit of the hospital delivers over 300 babies a year. Its’
outpatient services include radiology, physical and respiratory therapy, and the pharmacy,
pathology lab, and ER operate 24 hours a day. The hospital’s medical staff provides expert care
in 18 medical specialties and service areas.
Mimbres Memorial Hospital, because of its’ proximity to the US-Mexico Port of Entry, serves a
high number of patients that are undocumented and are unable to pay for their services. The
hospitals’ patient payer mix averages about 61% Medicare/Medicaid insured, 25% private and
other insurance, and nearly 8.5% uninsured, resulting in an increase in write-offs and and cost-
shifting and price increases for other hospital services. Prices for hospital radiology services are
so steep that many local providers refer elsewhere for these services, often to out of county.
Radiologists if patients have transportation. The hospital suffers from a local reputation of being
the “Mexican Hospital” that provides inferior quality of care. The hospital unwritten policy of
requiring “upfront” payments for services has prompted insured patients to shop around for
elective hospital care.
Section 1011 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003,
provides for federal reimbursement funding emergency inpatient, outpatient, or ER care.
However, the program only pays a fraction of the hospital costs involved in providing such
services.
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To ensure the likelihood of receiving some, but not all reimbursement for its’ services to the
under/uninsured, the hospital contracts with an external accounting agency to determine patient
eligibility for public insurance, and to operate the hospital billing and collections departments.
According to the MMH management information system, which tracks hospital payer mix, 77%
of Section 1011 funds went to emergency hospitalization for pregnancy and laboring conditions
of Mexican women transported from the port of entry. There are many medical and social
advantages for Mexican nationals residing along the US-Mexico border to birth in the U.S, and
Section 1011 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003
actually facilitates this to occur. For MMH, the closest U.S. hospital facility to the
Palomas/Columbus Port of Entry, there is a serious financial burden to delivering infants of
undocumented Mexican women, because they generally do not pay for these services. Many
Mexican laboring women arrive without documentation of their having had timely prenatal care.
Mimbres Memorial Hospital obstetrical protocols require that all infants delivered to women
without documentation of adequate prenatal care must remain an extra 24 hours in the hospital
for lab testing and results for serious neonatal diseases, like congenital syphilis.
Possible strategies have been proposed on both sides of the US-Mexico border to reduce the
financial impact to MMH for uncompensated labor and deliver care to the undocumented. One
proposed suggestion is for the Palomas Public Health Clinic to issue each of their prenatal
patients current copies of their prenatal records that they can take with them to any hospital.
However, MMH officials say that this strategy will do nothing to change the current situation.
They say that Section 1011 reimbursement funds apply only to medically emergent situations,
and that a US-hospital delivery of a Mexican woman who arrives with her current prenatal
records will be perceived as a premeditated act rather than an emergent one, and negates Section
1011 reimbursement altogether. Another possible solution is to have Mexican Public Health
physicians triage laboring patients presenting at the port of entry to render a determination of
medical emergency justifying a emergency medical transport to Luna County.
In 2006, MMH wrote off $3.1 million in hospital service charges for Luna County medically
indigent residents, after reimbursements from the Luna County Indigent Fund. That same year,
MMH wrote off $1.1 million in hospital service charges for Mexican undocumented patients,
following Section 1011 reimbursement payments. In 2006 alone, MMH wrote off a total of $4.2
million in financial losses for services rendered to the indigent and undocumented, and in 2007 at
mid-year, the cumulative MMH financial losses amounted to $2.6 million.
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Mimbres Memorial Hospital Patient
Payer Mix
2006 2007
7.0% 21.5% 9.5% 20.0%
23.5% Medic a id 26.5% Medic a id
Medic a re Medic a re
Ins ura nc e Ins ura nc e
S elf P a y S elf P a y
48.0% 44.0%
Luna County Manager
A meeting with the Luna County Manager revealed that the County’s proximity to the US-
Mexico border has negatively affected not only the financial health of MMH, but also that of the
Village of Columbus. The Columbus Emergency Medical Services is considering ceasing its
response to US-Mexico Port of Entry calls, because these uncompensated emergency runs are
competing with the medical emergency needs of the Village of Columbus residents. Luna
County has provided Columbus with temporary funding to continue port of entry transports until
a long-term solution can be reached. A proposed solution is to have Elite Ambulance Company
(the group providing service for the City and County) deliver 24-hour ambulance services in
Columbus, seven days per week, at a cost of ~$12,000 per month, while the Village of Columbus
would gladly reconsider continuation of its ambulance services for an ongoing $12, 000 per
month subsidy.
The County Manager described several actions he took immediately after taking office related to
health care access in Luna County. At that time, he determined that 40% – 50% of the county
elected not to be covered by the county health insurance plan because of their portion of the
premiums and co-pay costs. The County assumed a greater proportion of health insurance
premium costs, making it more affordable, and then mandated that all county employees must
have insurance.
The health care coverage problems in Luna County go beyond County employees. High
unemployment rates, low median incomes, a seasonal agricultural work force, and lack of
mid/high paying jobs create access to health care problems for many residents. Unaffordable
health insurance, lack of transportation, lack of after hours non-emergent health services, and
cultural and language barriers impede Luna County residents from accessing health care daily.
The County Indigent Health Care Funds are completely expended each year on documented legal
Luna County residents, but are not available for care of undocumented residents.
The County Manager summed Luna County’s proximity to the US-Mexico border crossing as
contributing factor to the following health care challenges in Luna County:
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Patients seeking emergency medical services at the Palomas-Columbus port of entry
put a strain of the Luna County health care system,
Luna County Indigent health care funds are expended each year, and yet MMH is still
writing off huge amounts of debt,
High numbers of Luna County doctors are uncompensated for the hospital care they
provide to the undocumented at MMH which may also contribute to the high turnover
of physicians in Luna County,
Local health manpower shortages increase liability and staff burn-out among the
remaining medical providers in the county and,
Luna County may need to provide business or economic incentives to increase the
number of local employers providing affordable health insurance to their employees.
Deming Senior Center
The Deming Senior Center is located in the town of Deming. Here, Luna County seniors gather
for hot lunches and social and recreational activities. The Center provides local seniors with bus
transportation to the center or home-delivered nutritious meal services for homebound seniors.
The Center’s professional staff offers seniors personal assistance to apply for governmental
health coverage such as Medicare, Medicaid, home health nursing arrangements, senior housing,
and other senior benefits. The center operates daycare services for senior family members of
those who work full days, where seniors enjoy cooked meals, activities and companionship in a
safe and supervised environment.
Some of the health care concerns of the Deming Senior Center staff include the following:
Many local seniors and their younger family members are unaware that they may
qualify for public assistance and governmental health insurance programs.
Language cultural barriers keep people away from seeking timely health care
Poverty and lack of insurance keep people away from seeking timely health care
Too many Luna County seniors are discharged from MMH on Fridays, without
regard for the time it takes to arrange post-discharge home health nursing care and
nutrition services for a recuperating senior to survive the weekend alone.
The number of community residents unable to access health care services for
themselves and their family because they work part-time seasonal jobs, with no health
care benefits, and lack documentation to qualify for Medicare or Medicaid
Too many Luna County residents seeking government assistance get treated
discourteously by those whose job it is to help these people.
International Customs Enforcement (ICE)/Customs/Port Authorities in El Paso
An interview with the Director of the El Paso Federal International Customs Enforcement Office
(ICE) provided clarification of US border policies and procedures relevant to Section 1011 of the
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Medicare Prescription Drug, Improvement and Modernization Act of 2003. The purpose of ICE
is to prevent the entry of terrorists or weapons of mass effect into the US, and to prevent illegal
entry of contraband, illegal aliens or terrorist into the US. Approximately 2,000 miles of the
United States’ southern border with Mexico must be monitored and secured.
Contrary to myth, no US Port of Entry guard is authorized to refuse entry to anyone requesting
emergency medical care, nor are Port of Entry guards trained to determine a true medical
emergency. Instead, by law, US Border guards are mandated to call 911 for those requesting
emergency medical care, and to remain with the affected individual until medical assistance
arrives. The ICE Director clarified that Section 1011 of the Medicare Prescription Drug,
Improvement and Modernization Act of 2003 is a federal program to reimburse health care
facilities rendering emergency care to undocumented aliens presenting at US border crossings
that is independent of ICE. The Customs Enforcement Office has nothing to do with the
distribution of Section 1011 funds or the support of the program, but understands the financial
burden this program creates for the Luna County health care system. The ICE officer described
a failed attempt about five years ago to institute a triage/telemedicine site at the port in
Columbus. The program failed because of the liability issues involved, and because medical
staff were not willing to support the project.
Results of the Participatory Planning Workshop for the Luna County-
Palomas Bi-National Corridor:
In July, 2007 the NM Department of Health (NMDOH)/Office of Border Health (OBH) in
partnership with the Luna County Health Council and the Palomas-Columbus-Luna County Bi-
National Health Council, held a planning workshop to clarify the health care issues and barriers
identified in the preliminary Luna County health care needs assessment (key informant
interviews and selected health statistics) and to develop strategies to address these issues.
The results of the preliminary needs assessment of health care issues and barriers in Luna County
were formally presented by NMDOH and OBH staff to the Planning Workshop participants.
Presentations included the outcomes and conclusions of the community key informant
interviews, and selected county health conditions and vital statistics. Workgroups prioritized the
health issues presented, proposed appropriate interventions, identified agencies and organizations
responsible for such interventions, and proposed time frames for implementing such
interventions.
Luna County Health Status Presentations:
Diabetes
The New Mexico Department of Health Office, Diabetes Prevention & Control Program
presented data on the risk factors for diabetes, compared the medical costs for persons
with and without diabetes, and discussed the 2004 prevalence estimates for adult diabetes
in New Mexico Southern Border Counties.
Medical care costs to persons with diabetes are over five times those for persons without
diabetes. The percent estimates for Luna County adults with diabetes (9.5%) were
slightly below those for the United States (9.6%), and above those for New Mexico
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(9.2%). New Mexico adult diabetes estimates are believed to be gross underestimates at
best, because diabetes diagnoses require access to health services, and in 2004, 21% of
New Mexicans were uninsured.
Estimated Diabetes Prevalence
NM Border Counties, 2004
2004 Number of % of Adults
Population Adults with with Diabetes
Over Age of Diabetes
18
National 20.8 million* 9.6%*
State 1,426,028 131,195 9.2%
Dona Aña 134,593 13,192 9.8%
Hidalgo 4,259 406 9.5%
Luna 18,823 1,810 9.6%
Luna County Prenatal and Delivery Service Challenges
In 2005, there were 412 births to Luna County, a large decrease from 2004, when births
peaked in the county, and yet representing an 8% increase in birth numbers since the year
2000. The crude birth rate for Luna County (15.6 births per 1,000 population) was ninth
out of 33 counties in state, and the county fertility rate (82.1 births per 1,000 females 15-
44 years of age) was fourth out of 33 New Mexico counties.
NUMBERS of BIRTHS to LUNA COUNTY
FEMALES by RACE/ETHNICITY
2000 2001 2002 2003 2004 2005
All Births 381 400 402 392 429 412
White not
Hispanic 60 61 58 62 65 71
Hispanic 310 324 326 313 363 330
Black 5 8 11 10 0 7
Native
American 3 3 2 6 0 3
Other 3 4 5 1 1 1
Sources: New Mexico Selected Health Statistics 2001-2004 for Luna County, and NM Bureau of
Vital Records, 2001-2005 2
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15
Luna Co. & NM Crude Birth Rates
2000-2004
16.5
16.3
Births per 1000 population
16.0 15.7 15.7 NM Crude
15.5 Birth
Rates
15.5 15.2
15.2
15.0
15.0 14.9
14.8 14.8 14.9 Luna Co.
14.5 14.6 Crude
Birth
Rates
14.0
13.5
2000 2001 2002 2003 2004 2005
Sources : NM Vital Records & Health Statis tics , NCHS Population Es tim ates 2000-03, UNM
BBER, 2004
Of the 412 births to Luna County mothers in 2005, only 225 of these births (55%) took
place in Luna County. The remaining 187 births to Luna County mothers occurred
outside of the county. New Mexico Vital Records showed that 97 births to Luna County
residents occurred in Dona Ana County, 70 births occurred in Grant County, 11 occurred
in Bernalillo County, and nine birth locations were unknown. It is likely that the some of
the births in Grant and Bernalillo counties were high-risk births, but what about the
others? What reasons would mothers from Luna County have for birthing in neighboring
counties 53+ miles away?
Where Do Luna County Mothers Deliver?
Births to Luna County Resident Mothers
By Counties Where Births Occurred, 2001- 2005
70 62.4
57.8 59.4 59.2
60 54.6
Bernalillo
50
Dona Ana
Percent
40 Grant
30 23.6 23.5 Luna
22.4
19.7 19.1
17.0 Other
20 15.6 13.8
11.8 12.9
Unknow n
10 5.0 3.6
1.8 2.5 2.5 2.3 2.6 1.6 2.7 2.2
0
2001 2002 2003 2004 2005
5
In 2005, a total of 284 births occurred in Luna County; 225 of these births were to Luna
County mothers and the remaining were to mothers from other counties or from Mexico.
In fact, vital records indicate that nearly 84% of 2005 Luna County births were to New
Mexico residents, 15.5% were to Mexican residents, and 0.7% of the births were to
mothers whose county of residence was unknown (but likely Mexican).
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16
Mothers’
Luna Co. Births by Mothers’ State Residence
4
Many key informants felt that pregnancy, prenatal care, and birthing services were
significant issues in Luna County. It was generally felt that the undocumented and/or the
medically uninsured were more likely to get no or low levels prenatal care during
pregnancy. At the time of the needs assessment, NMDOH local health office (LHO) was
the only source for free or low-cost prenatal care in Luna County, and even though the
LHO offered walk-in prenatal care on Mondays, uninsured/undocumented low-income
women living outside the City of Deming without a reliable means of transportation,
inconsistently obtain regular prenatal care.
From 1995 to 2007, Luna County had 14 cases of congenital syphilis. Four mothers with
syphilis reported at least one prenatal care visit between their 5th – 7th month: One
mother was not screened for syphilis until delivery, and three mothers were screened too
late to prevent congenital transmission. Ten syphilitic mothers had no records of prenatal
care, although some reported having had some prenatal care in Mexico.
Approximately 77% of annual Section 1011 funded hospitalizations for July, 2006 – July,
2007 in Luna County were pregnancy related. Mexican mothers arriving at Mimbres
Memorial Hospital by EMS from the Port of Entry, usually make the trip alone, without
partner support or documentation of prenatal care. These mothers without documented
prenatal care must wait an additional 24 hours after delivery to collect their infants to
allow the hospital time to PKU screen their babies before they are discharged.
Most Mexican mothers will not pay for their hospital delivery services, but for those
arriving via emergency transport from the Port of Entry, Section 1011 funds will pay a
small portion of the hospital charges. However, most of the hospital charges will be
written off as financial losses, and the high uncompensated hospital care costs get shifted
to the insured and paying hospital patients.
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17
77% of Section 1011 Luna County
Hospitalizations are Pregnancy Related
Teen Pregnancies
Many of the key informants expressed concern about the numbers of teen pregnancies in
Luna County. While it is true that Luna County’s teen birth rate has consistently
exceeded that of New Mexico, vital records indicate that rates of teen births (to 15 – 19
year old girls) in Luna County have declined since 2004, and are currently at a rate below
2000 levels. An examination of age-specific teen birth trends in Luna County after 2003,
indicate that birth rates for 18 – 19 year old girls remain relatively high and are rising
despite a big drop after 2003, while birth rates for 15 – 17 year olds are declining.
Teen Birth Rates Luna County
2000 - 2006
110
102.4
98.8
Births/ 1000 females ages 15 - 19 yrs.
100
93.3
90 92.8
83.8 US
83.0
80 81.6
NM
70
Region
5
60
Luna
50
40
30
2000 2001 2002 2003 2004 2005 2006
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18
Luna County Teen Birth Rates by Age Groups
2000 - 2006
350
313.3
Births/1000 females aged 15-19 yrs.
300
Luna
250 15 - 19
196.8
200 182.1 181.1
Luna
150.4 18 - 19
150
147.7
133.7 102.4 98.8 92.8 Luna
100 93.3 83.8 81.6
83.0 63.5 15 - 17
64.6 58.4 50.6 54.2
50
47.5 49.6
0
2000 2001 2002 2003 2004 2005 2006
Sexually Transmissible Infections (STIs)
Key informants expressed concern about the increase in positively STI cases in Luna County and
the unique challenges they face in doing in case finding, treatment, follow-up for STIs. Key
informants indicated that because of fears of deportation among the large illegal/undocumented
Luna County resident population, STI client contact information is likely to be false, making
case finding difficult. The north and southbound mobility by Luna County residents across the
US-Mexico border at the Palomas/Columbus Port of Entry, makes STI case finding, treatment,
follow-up for STIs a challenge, particularly since New Mexico Public Health policy requires
treatment of New Mexican STI cases, but not of sex partners living in Mexico. When Mexican
sex partners of confirmed New Mexican STI cases remain untested or untreated for STIs, this
greatly increases the likelihood that treated New Mexican STI cases will be re-infected by their
untreated Mexican sex partners.
In Luna County, between 450 and 500 clients are tested for STIs per year. Most of Luna County
STI cases are reported from the Luna County Health Office, but STIs are also reported by MMH,
Ben Archer Health Center, Deming Women’s Health Center, Dr. Byrne, and other physicians. .
The Chlamydia positivity rate (the % of all clients testing positive for Chlamydia) has increased
from 5.7% in 2004 to 10% in 2005 and 2006. The Gonorrhea positivity rate has risen from less
than 1% in 2004 to 6% in 2005 and 2006. In the first six months of 2007, the NMDOH STI
Program reports a 2% positivity rate for Gonorrhea. Syphilis positivity rate plateaued at 6 cases
per year in 2003, 2005, and 2006. Cases of congenital syphilis were previously discussed in the
parental care section.
Other Communicable Diseases: Tuberculosis
Foreign-born Tuberculosis cases occurring among persons from Old Mexico continue to account
for the largest percentage (> 70% in 2006) of the foreign-born cases in the State of New Mexico.
The tansmobility across the US-Mexico border of TB infected and exposed persons poses unique
challenges for effective TB surveillance, treatment, and follow-up, and creates a potential threat
to the public’s health.
In 2005, the NMDOH INPHORM system for the Deming local health office documented 704 TB
visits, and in 2006, 576 TB visits were documented in Deming. TB services provided at the local
health office include the following: TB skin tests, reading positive and negative PPD tests,
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19
certification of TB clearance, active pulmonary TB diagnoses, direct observation of TB therapy,
latent TB infection diagnosis, and monitoring regular preventative TB therapy.
Not unlike STI case-finding, treatment, and follow-up, Tuberculosis cases among the
transmobile population of Luna County often requires cross-border contact investigations, for
which there are simply insufficient resources. In the meantime, both U.S. and Mexico deny that
TB is a real public health problem. To further complicate matters, are the new drug-resistant TB
strains showing up in New Mexico that may be associated with ineffective or incomplete TB
treatment, and may reflect real cultural barriers to preventive care and treatment compliance.
Results of the Section Reviews at the Luna County Health Planning
Workshop
In the afternoon of the July, 2007 Luna County Health Planning Workshop, participants were
assigned to one of ten workgroups that reflected the local health care challenges identified by the
Luna County health care needs assessment presentations during the morning session.
Workgroup participants were tasked to discuss the factors they perceived contributed to that
particular health care challenge, to propose possible solutions/interventions for the problem, and
to identify the agencies that would be responsible for these interventions.
The following were the factors discussed per workgroup section:
1. Substance Abuse/Mental Health
a. Lack of dreams/ h. Children bond to addicted
Hopelessness mothers
b. Inpatient services needed i. Stigma against seeking
c. Easy access to services help
d. Family History of mental j. Cultural Barriers
illness k. Denial (family)
e. High cost for services l. Inadequate bilingual
f. Domestic violence mental health workforce
g. Peer pressure
2. Emergency Services
a. Difficult to retain d. High demand at port of
qualified emergency entry for EMS
professionals e. Immigration influx
b. EMS $$ unfairly f. Low reimbursement rates
distributed for border transports
c. Few training
opportunities for
emergency professionals
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3. Diabetes
a. Community Involvement d. Professional
b. Secondary Prevention Development
c. Public Education and e. Policy Development
Awareness f. Planning, Surveillance &
Evaluation
4. Teen Pregnancy
a. Lack of hope f. Poverty
(hopelessness) g. Role of media
b. Social acceptance h. Substance abuse (ease of
c. Culture factors access)
d. Limited preventive i. Lack of education about
education due to school family planning and
board contraception
e. Peer pressure j. Lack of youth activities
5. Prenatal Care
a. Transportation h. Lack of alternative
b. Early Care prenatal care
c. Education i. Lack of state-federal
d. Legal status/want child to agencies
be U.S citizen j. Drugs are a crime/moms
e. Fear of closing border who use fear criminal
checks action
f. Hospital Liability k. Limited pre-natal care
g. No Insurance
6. Sexually Transmitted Diseases
a. Follow-up difficult d. New Mexico will treat all
b. Great deal of movement cases in the state but
back and forth across the cannot treat partners in
border Mexico
c. Address provided to e. Patients likely to be re-
Public Health may not be infected by untreated
real address; e.g., partner
provide address for f. Missed opportunities
friends, relatives
7. Developing and Attracting Health Professionals
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a. Low Pay d. Lack of reciprocity for
b. Rural Areas license
c. Compensation does not e. Bilingual professionals
equal to position f. Compensation/Salary
8. TB
a. Resources lacking (funding)
b. foreign-born cases
c. Drug resistance
d. Prevention
e. Education/training
f. Limited ability to treat binational cases to prevent re-infection and spread
9. Heart Disease and Stroke
a. Diet f. Education and prevention
b. Stress g. Costs of Medicines
c. Tobacco Use h. Genetic Factors
d. See Diabetes i. No screenings (early)
e. EMS Interventions j. Stress
10. Immunization and Infectious Disease
a. Clinics for adults e. Earlier Interventions
b. Cost barriers f. Cross-border
c. Publicity for services immunization sharing
d. Better Data
10. Access to Health Care
a. Transportation i. Low Pay
b. Wait to Appt- specialty care j. Rural Areas
c. Lack of Insurance k. $$ compensation not equal to
d. Community awareness of position
resources/ services l. Lack of reciprocity for
e. Collaboration among some clinical licensure
providers m. Inadequate bilingual medical
f. Lack of Education and professionals
awareness of Symptoms n. Lack of housing for medical
g. Legal status professionals
h. Provider's availability
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APPENDIX A
Luna County Health Status Assessment Key Informant Interview Questions
Key Informants:
Mimbres Memorial Hospital -Business Office Manager-Danielle Ortiz
NMDOH Deming PHO Clinical Staff- Velia Luna and Mary Jackson
Luna County Manager-Scott Vincent
Presbyterian Medical Services (Deming Health Center) - Bob Rayner
Ben Archer Health Centers in Deming and Columbus- Clinic Manager – Lupe
Morales and Clinic Staff
Emergency Medical Services for Deming and Columbus- Scott Vincent and Alan
Rosenberg
Border Area Mental Health Center – Katherine Ritterbush
Deming, Luna County Senior Center – Barbara Borden
ICE/Customs/Port authorities in El Paso
Interview Questions:
Services offered?
o Specialty
o Ancillary
Hours of Operation
Locations
Payer Mix
o Insurance Type
o Luna County Resident vs. non-resident
Top 5 medical conditions for which patients are served by agency
Prevalent problems and obstacles to health services delivery
o Perceived obstacles for patients
o Agency Obstacles/Concerns
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