Home   News   Schools   Sports   Biz   Opinion   Health   Scitech  Arts   Dining   Movies   Outdoors   Weather   Comics   Archives  NM Jobs Cars Real Estate

          Front Page  sage

Sunday, November 2, 2003

Five Women Moving Mountains in Santa Fe

By Susan Stiger
Of the Journal
    COVER STORY: This summer, the lieutenant governor, three cabinet secretaries and one secretary-designate were a force as they toured the state. By talking to real folks like you and your neighbor, they formed a plan to overhaul the services that dictate the quality of our lives.
    Shortly after Bill Richardson became governor, five women set about to overhaul the state's health and human services system.
    Rarely has there been a situation so ripe for a metaphor.
    Here are a few. It's a little bit like:
   

Doing a 180 in a battleship during a high wind.
   

Throwing all the chess, Parcheesi and Monopoly pieces off the game board so you can just play Life.
   

Cleaning out an old warehouse to decide what to keep, what to fix, what to throw out and what to move elsewhere.
    Call in the earth movers.
   
Power of five
    For those who have become inured to government titles, health and human services covers just about anything you might require, suffer through, fight against or succumb to between the womb and the grave. We're talking not just about the Health and Human Services departments, but about Children, Youth and Families, and Aging and Long-Term Care.
    And we're talking about your life— challenging, ever-changing, buzzing along. And state government— divisions, departments, rules, limits, holes, overlaps, cracks, patches and enough acronyms for a bowl of alphabet soup— a big gray hierarchy more daunting than Harry Potter's trek through the Third Task maze in "Harry Potter and the Goblet of Fire."
    This is where you meet the five women running the earth movers: Lt. Gov. Diane Denish; Secretary of Health Patricia Montoya; Secretary of Human Services Pamela Hyde; Secretary of Children, Youth and Families Mary-Dale Bolson; and Secretary-designate Michelle Lujan Grisham of the Aging and Long-Term Care Department, which is poised to become a cabinet-level agency during the legislative session in January.
    And this is where they insist on credit for the man who set this in motion, Richardson.
    "I think his mandate was, 'Make government work. You all need to work together, get the most out of every dollar,' '' recalls Hyde.
   
On the road
    Time for you to work out your own metaphor.
    Here's the nutshell: The three cabinet secretaries and Grisham, who combined, oversee more than 5,500 people and $3.382 billion, are fed up with New Mexico's ranking at the bottom of all those quality-of-life and availability-of-care lists we read about. They've been told, in no uncertain terms, to fix it. Fix the systems that handle the problems so that ultimately, the problems will shrink.
    On the agenda is a list of issues and programs so long it wouldn't leave room for the rest of this story. Among them: Medicare, health insurance, domestic violence, senior care, mental health care, mobile health care, juvenile crime and justice, immunization, family support, child care, home visitation, family intervention, child support enforcement, food stamps, programs vs. prison and so on.
    "So on" meaning: teen pregnancy, truancy, home meal delivery, prescription-drug benefits, drug and alcohol addiction, homelessness, social-worker burnout. And much more.
    Their first step, in true Richardson tradition: Get out there and chat up the folks in the trenches. So, back in May, Denish, Hyde, Montoya, Bolson and Grisham took to the road like a rock band, hitting 21 cities across New Mexico in what they called the Health and Human Services Spring and Summer Tour. They held 28 town hall meetings in those 21 cities, inviting anybody who works in any facet of health and human services, as well as local officials, clergy, townspeople, and of course, any bewildered citizens who need help and just keep circling the maze. Anywhere from 50 to 200 people showed up in Lordsburg, Gallup, Raton, Las Vegas, Santa Fe, Albuquerque, Grants, Silver City, Clovis, Portales, Deming, Ruidoso, Glorieta, Shiprock, Las Cruces, Taos, Española, Farmington, Roswell, T or C. and Window Rock, Ariz.
    Now, bring in the synthesizers. Richardson asked a task force of "stake holders"— health care industry people, advocates for populations and users of the health care system— to pore over proposals and town hall feedback and come up with a game plan, including money ideas— like rearranging funding or seeking more grants. Look to the 30- and 60-day Legislative sessions for the first big signs of change, says Denish.
   
Nips and tucks
    For as bureaucratic an undertaking as this process was, its human side emerged early.
    Imagine you live in Lordsburg, population 6,000 or so, closest fair-sized city Silver City. The lieutenant governor, three cabinet secretaries and a secretary-designate show up to ask how things are going around town and can they help. What is this— reality TV?
    "I haven't gone to one place where at least one person hasn't cried," says Bolson, of CYFD. "They've never seen one cabinet secretary, let alone four and then the lieutenant governor has been with us as much as she could."
    The reaching out, the brainstorming, the overhaul add up to an unprecedented bulldozing of walls, boundaries and protocol on the part of state government. (Departments of tourism and economic development launched similar tours.)
    One of the phrases you're likely to hear around the offices of the secretaries is "tearing down the silos."
    Say you run a domestic violence program. You work hard, stay on top of the problem, maintain your funding, look for more, try to justify your spending against your success.
    In the meantime, another program is launched. Maybe it has to do with homeless women or violent juveniles or pregnant teens. And with increasing frequency, its causes and effects overlap yours. You have your own work to do, so you stay focused on your world— which has now become your silo.
    Then along come the Fab Five, on their earth movers, and they say, whoa. If you and you and you put your heads together, you can provide more comprehensive services to families, giving them one door to knock on instead of three, maybe one form to fill out, continuity of care and— this is the kicker— we can spend one chunk of money on domestic violence instead of three and still offer the same services. You can all stop competing for the same money.
    And so they went, nipping and tucking their way through programs and services, asking employees to shake off their fears and shoot for innovation.
   
Community action
    From town to town, the issues varied, with the undercurrent of poverty running through each, and domestic violence everywhere.
    "Well, this is all fine and good," said a man in Deming, "but I want to know what you're going to do for the working people, because I don't qualify for Medicaid, but I can't afford health insurance."
    Always, always, there was somebody worried about the cost of prescription drugs, says Grisham, of Aging and Long-Term Care. "At least one or two or three people come who are desperate."
    In Ruidoso, they heard about the need for transportation to services. "You might be able to pay for a dentist, but if you can't get a dentist, what's the point?" says Hyde, of Human Services.
    In the Northwest, it's Indian Health Services. In rural areas, meth labs and not only a lack of services, but no way to get to the ones in the next town— if there are any in the next town.
    "In many areas, people have to drive for hours to get to a 30-minute (counseling) session," says Montoya, of the Department of Health.
    But the tour wasn't just one unmet need after another. Some towns were already kicking up brainstorms and pooling resources.
    Raton needed a dialysis unit because patients had to travel to Colorado for treatment.
    "They came together and through some community fund-raising, and a radio show, they asked for donations and collected $20,000 in a Valentine's Day promotion," says Secretary of Health Montoya.
    Farmington needed a child psychiatrist.
    "So they went out as a community," says Bolson, "figured out how many days a week they needed somebody, found one who would fly in for those two days a week, asked how much money would it cost, went to the (managed care associations) and said, 'Here's how much money we need you to pay this person.' They figured it out."
    Portales needed transportation.
    "What they did was get together and ignore all our rules," says Bolson. Aging and Long-Term Care had vans. School districts had buses. "They asked, how can we share these vans so they not only serve the population they need to be serving, but help everybody?" says Bolson. "They did it."
   
It won't cost you
    OK, time to talk about money. You're wondering about your taxes, aren't you?
    At this stage of change, the women's message remains, "Not to worry."
    The idea isn't to raise taxes; the idea is to move existing money around. Cut waste, cut redundancy, stretch every dollar. And eye federal funds like the wolf at granny's bedside. Put money in the right place, they say, and federal money is available to match it.
    Here's an example.
    At one town hall meeting, CYFD's Bolson was talking about children's behavioral health and a $50,000 experiment in telemedicine to get services to smaller communities by providing telephone access to doctors and nurses in other communities.
    "And Pam (Hyde) said, 'Stop, I think I can do a match.' And sure enough, we can do a Medicaid match," says Bolson.
    Thanks to matching federal money, the state's $50,000 has grown into a $200,000 investment in telemedicine across the state.
   
Preventive care
    The women hope to have eight years— a second term for Richardson— to move the mountains. Their priorities are the problems with the greatest potential to cause more.
    For instance, "there's almost no aspect of (Medicaid) we don't have under review or under change," says Hyde. "Every change affects something else."
    At CYFD, Bolson wants to put the horse back in front of the cart. To her, that means supporting families early, assuming they're open to services before damage is done— before domestic violence escalates or a kid joins a gang.
    "We can serve a young person with fairly high needs for about $15,000 a year in juvenile justice. It costs $50,000 a year to lock them up," Bolson says.
    In Grisham and Montoya's view, New Mexico isn't a particularly good place to grow old and it's not the best place if you need emotional help.
    Grisham would like to be able say to the aging:
    "They can age in place, they're not going to have to leave their home unless they want to, between their resources and my on-their-behalf resources, I can support them to stay home and live with dignity and independence."
    As for mental health care, the first issue is: It's sparse. Many smaller cities and towns have nothing in the way of treatment or therapy. "We don't have community crisis teams. We don't have the providers," says Montoya.
   
Crossing paths
    Bolson, Hyde, Montoya and Grisham were relative strangers when they came together. A couple of them had crossed paths before, but their styles and agendas were largely unknown to each other. Now they're friends, people who admire each other and mention each other's names when they could be talking about themselves.
    Denish is largely credited with pushing for these cabinet secretaries. (Grisham was already in place as a director; Richardson campaigned on upgrading Aging and Long-Term Care to a cabinet.)
    "I call them the four fabulous women," says Denish.
    CYFD's Bolson emanates an agreeable mixture of power and warmth. A mother of three grown children, she reflects on her years as a single mom— with one child diabetic— to remember what it feels like to need— help, respite, a net.
    "I want to say to people, 'I made it. I know it can be done. You are the catalyst. The community is there to help you and you need to use us in that process.' ''
    Grisham grew up with a highly disabled sister who had developed a malignant brain tumor by the time she was 18 months old. The results were mental retardation, developmental disabilities and blindness.
    Grisham, herself an ongoing explosion of can-do, watched her mother step forward to fill that child's needs and honor her dignity.
    "My mom was a voracious advocate," Grisham recalls. "That taught me you can always get it done."
   
Female power
    What if this team of five were all men, or three men and two women? Dare we claim some of this innovation for our gender? We who are credited as the more collaborative, cooperative, relational sex?
    Hyde, of Human Services, is most moderate in her response. "I don't think it has to do with the gender of the person. I think it has to do with the philosophy of the person. And the guy who started all this was Gov. Richardson. But I think there is some truth to the female way."
    These women didn't get to be cabinet secretaries— or a lieutenant governor— by slamming men. They'll say: There are women who operate more competitively; there are men who prefer collaboration.
    But, says Bolson, "I think (gender) is a big piece of it, because women tend to process and men tend to aim for goals. We're also dealing with women who grew up in a male culture, so we are all very goal-oriented. But we all have the processing piece; we are willing to do the process to get to the goals."
    Says Montoya, "It's about relationships."
    MICHELLE LUJAN GRISHAM
    Secretary-designate of the Department of Aging and Long-Term Care
    "Fate," she says, and it's an uncharacteristic one-word answer. The question is: "Why the elderly?" With a science background and a law degree, she saw her future as "a very rich, technically sound lawyer, maybe in patent or copyright."
    But it was 1987 and finding a job wasn't easy. She owed the State Bar of New Mexico a mandatory $275 fee and as a young mother of two with no job, "it might as well have been $275,000."
    She called the State Bar, and let fly a piece of her mind that was kindly interpreted as "passion." It seems there was an opening in a legal services program for the elderly. "Six months later, I was running that program, and I loved it."
    In 1991, then-Gov. Bruce King appointed her director of what is now Aging and Long-Term Care.
    PATRICIA MONTOYA
    Secretary of Department of Health
    From the time she was a little girl, Patricia Montoya wanted to be a nurse.
    "I saw them as being caring, helping people," she says. "My role models for nursing were the nurses in the hospitals hanging IVs."
    She did have occasion to witness them. Her mother suffered from tuberculosis, problems with her reproductive system and cirrhosis of the liver, as a result of untreated hepatitis. She died when Montoya was 17.
    With experience as a staff nurse, a school nurse and an emergency room nurse, Montoya started to see how the work of the City Council, the New Mexico Legislature and the U.S. Congress affected what she did.
    Time to learn about management and policy, which ultimately landed her the appointment of Commissioner for Children, Youth and Families during the Clinton administration, then New Mexico Secretary of Health during the Richardson administration.
    Back when she was hanging IVs, she never saw it coming.
    MARY-DALE BOLSON
    Secretary of the Department of Children, Youth and Families
    Everybody calls her Dale. But when she signs a document, she signs it Mary-Dale Bolson. "It's my legal name and I want everyone to know it's a woman."
    During her 11 years in New Mexico, she's served as principal of New Futures and as superintendent of education for the Juvenile Justice Division at CYFD. A mother of three grown children and a grandmother of four, she's known the trials of single motherhood and the luxury of getting a doctorate once her children were grown.
    "I've always said the people who are the better teachers are the people who are parents as well."
    PAMELA HYDE
    Secretary of the Department of Human Services
    Hyde's upbringing in a strongly religious Southern Baptist family planted a seed: She wanted to become a preacher. But women couldn't do that. So she decided to become a lawyer instead. And women could barely do that. But Hyde broke ground. She is considered the first female law clerk in Missouri. Her law degree in hand, her heart set on helping people, she started in legal services and made her way to health policy.
    Today, she's a driven mix of informal and hands-on.
    "I'm one of the first to try to visit field offices and be seen and listen," says Hyde. "Anybody can call me and I'll talk. I'm not aloof, but I'm not a social Chatty Cathy."
    DIANE DENISH
    Lieutenant governor
    Denish was a youngster in Hobbs when she got it: Other people didn't have what she had.
    "I think it's always been about equal access for me," says Denish, former chair of the Democratic Party, "because I have been so fortunate to have resources— whether financial or my education."
    She felt it as a divorced mother of three— it was hard, but she knew where to go for help. How must it be for women who don't?
    She arrived for her SAGE Magazine interview having just settled her father in an Alzheimer's facility. He has since died. It was hard watching her father fail, she said, and it was hard maneuvering the maze of services.
    "And I have all these resources at my disposal."