The Scientific Laboratory, New Mexico’s sole public health laboratory, moved into a new $86 million building in mid September, where it will share space with Office of the Medical Investigator and the Department of Agriculture Veterinary Diagnostics Services, according to a news release the health agency issued.

“The opening of our new public health, environmental and toxicology testing laboratory marks the culmination of an 11-year effort that places New Mexico at the forefront of the nation,” David Mills, director of the Scientific Laboratory, was quoted as saying in the news release.

In addition to ensuring New Mexico’s water, air and milk are safe from chemical hazards, the lab’s scientists test for infectious diseases like flu and plague, perform drug testing for DWIs and autopsies, and test food associated in food-borne outbreaks, the news release said.

According to the agency, the new building provides a safer environment for the Scientific Laboratory’s scientists “to work with deadly biological and chemical agents, such as rabies, anthrax and tuberculosis,” because  the building “has the proper ventilation and electrical needs for new technology and for work with dangerous chemical hazards.”

The new building also will expand the science lab’s capacity for developing “new molecular diagnostics for emerging infectious diseases.”

The new building more than doubles the space the three agencies had when housed on the University of New Mexico campus, the agency said.

“The space and features in our new laboratory will enable New Mexico to continue providing cutting edge science that protects the health and safety of New Mexicans,” the state’s health secretary Alfredo Vigil, MD, was quoted as saying in the release. “When new diseases like H1N1 influenza emerge, we will be better prepared to perform the necessary testing to help us control the spread of diseases.”

Repealing the law through the Legislature is unlikely

Collecting enough votes among state lawmakers to overturn the law is a long shot. The New Mexico State Senate approved the 2007 bill by a vote of 32- 3. And although state Sen. Vernon Asbill, R-Carlsbad, one of those three “no” votes, said Monday he’d vote for repeal, he also said it didn’t seem likely to happen.

There’s been no dramatic shift in lawmakers opinions on the medical marijuana program and there probably won’t be, “unless there is some large-scale abuse—and that hasn’t been reported,” Asbill said.

The bill passed the New Mexico House of Representatives by a smaller margin, a vote of  36-31, but changing a few votes in the House wouldn’t do the trick either: Repealing a law requires approval from both the House and Senate.

Sen. Rod Adair, R-Roswell, offered a possible explanation why a repeal would prove difficult.

“Our law was drafted very differently than in California,” said Adair, who was among a broad spectrum of bipartisan supporters of the legislation.

Unlike California, which is generally seen as much more lenient, Adair noted, New Mexico’s law is much more strict, licensing marijuana producers only after they clear several hurdles.

Repeal is possible—though unlikely—through voter referendum

An even rockier path for overturning a state law than the legislative route is through a voter referendum. But the last time New Mexico voters successfully repealed a law using a referendum was in the 1930s, according to the Legislative Council Service. Referendums in the 1950s and 1960s failed.

Talk of a voter referendum is moot anyway. Opponents missed the narrow window allowed by the state constitution. In order to repeal the law by referendum, petitions should have been filed prior to the general election immediately following the legislative session during which the law passed; in other words, in 2008.

The governor could tighten program regulations

If elected governor, Martinez could appoint a secretary of health hostile to the program, officials said. Because governors control executive branch agencies, the state’s chief executive could direct an agency to make regulations so strict that they effectively stop a program’s day-to-day operations. The Martinez didn’t answer our questions about whether she might choose such an option if elected governor.

But gutting a program to the point where producers couldn’t grow plants and patients couldn’t buy from them could pose its own challenges, one medical marijuana advocate said.

“It would really be an abuse of an agency’s authority to thwart the law by regulating medical marijuana away,” said Tamar Todd, staff attorney of the Drug Policy Alliance. “That might be subject to a legal challenge.”

“The New Mexico Department of Health has really embraced the problem and tried to work with people,” Todd said. “I don’t know if the governor would have the power to come in and change it.”

New Mexico’s program, intentionally strict, has grown slowly

New Mexico’s law is considered among the most restrictive of the 14 states that have medical marijuana programs. New Mexico licenses marijuana dispensaries, but only after they clear several hurdles.

The state Department of Health then regulates how the cannabis is distributed to patients, but only after they present doctor-certified documents proving they suffer from one of several qualifying illnesses.

So far, the state has licensed 11 nonprofits to produce and distribute the cannabis to 2,250 active patients, according to Deborah Busemeyer, spokeswoman for the New Mexico Department of Health.

Roughly 1,022 of those patients are licensed to grow cannabis, but only for themselves. “They cannot distribute and sell it,” Busemeyer said.

Because the program relies on “available resources,” meaning it doesn’t benefit from a dedicated stream of revenue, cost-saving measures aimed at shutting down the program also would hurt other programs at the Department of Health, already the target of deep cuts over the past two years.

The state health agency announced some proposals it  hopes will make the medical marijuana program more financially self-sufficient.

Candidates for governor disagree on medical marijuana

Martinez has not said exactly how she might repeal the program, or if a repeal proved unworkable, what measures she might take to reduce or scale back the program. Martinez’s campaign didn’t respond to those questions from The Independent on Monday.

But Martinez reiterated her opposition to The Daily Lobo last week.

“I do not support distributing marijuana for any purposes, which is in violation of federal law,” Martinez told University of New Mexico’s student paper. “There are many other treatments for patients in need that do not break federal law.”

Her rival, Democratic Lt. Gov. Diane Denish, approves of the law, telling the Daily Lobo that “No one with a chronically painful or terminal illness should be denied a treatment option that has been clinically proven to reduce pain and suffering.”

The website won’t break down the infection rate by facility. That comes in July 2011, when the state will begin to post such data on several infections, meaning the public could compare how careful — or careless — hospitals and medical centers are in preventing — or allowing — sometimes deadly infections.

The catch: hospitals won’t have to share the data if they don’t want to on certain types of infections.

Unlike some states, including Colorado, New Mexico has no law requiring hospitals to publicly report rates of hospital-acquired infections even as the state is looking to expand the number of infections it tracks. And while a new federal rule issued recently requires hospitals to report to the federal government, the mandate only applies to one type of commonly contracted infection at hospitals and medical centers.

So the only data appearing on the state’s public portal once it is up and running will come from facilities volunteering the information, a state official said Tuesday.

“They would have to pass a law” to require hospitals to share that information, said Deborah Busemeyer, a spokeswoman for the New Mexico Department of Health.

Busemeyer, the health agency spokeswoman, pointed to the increase in hospitals and medical facilities voluntarily releasing the data to the state as evidence that hospitals and medical centers would continue to share the information.

“There’s been a lot of interest,” Busemeyer said. “We started with six hospitals. Now we’re up to 25.”

According to the website of the New Mexico Hospital Association, there are more than 40 hospitals and medical centers in the state.

One state lawmaker believes that New Mexico should be lauded for the progress it has made, but it isn’t where it should be in making such information public.

“I’m pleased that they’re moving forward and working with more consultants and epidemiologists to improve the quality of health care,” said Sen. Dede Feldman, D-Albuquerque. “But they have a ways to go in figuring out to report the information to the public in a usable manner.”

The state’s evolving program

The soon-to-be state website is an outgrowth of New Mexico’s move toward greater transparency regarding hospital-acquired infections, a problem receiving increasing public scrutiny across the nation.

In 2008, the state started tracking an infection that patients developed during stays at hospital intensive care units (ICUs). Nineteen incidents of central line–associated hospital infections in the ICUs were reported at six New Mexico hospitals from July 1, 2008, to May 31, 2009, according to a 2009 state report. A central line is similar to an IV. The rate of infection was lower than the national rate, according to a report last year. But it wasn’t clear where the incidents took place.

Since the initial pilot study more hospitals have joined the state’s voluntary program, Busemeyer said, with 17 hospitals reporting the number of central-line bloodstream infections patients contracted in ICU wards. Meanwhile, 25 facilities report on how many health care workers are vaccinated for influenza.

And in November participating hospitals will begin reporting two more infections: central-line-associated hospital infections outside of hospital ICUs  and clostridium difficile, a colon infection.

In addition, New Mexico has hired several staff to help run its new infection program, including two epidemiologists, a nurse, a program manager and several contractors, using more than $1 million in federal stimulus dollars, Busemeyer said.

The federal government is doing its part to require disclosure. In January a new federal rule will require 47 hospitals in New Mexico to report central line-associated infections to authorities in Washington. That information will wind up on the U.S. Department of Health and Human Services’s publicly accessible Hospital Compare web site, the state health department said Wednesday.

Hospitals that don’t report the infection data required potentially could lose some federal funding.

“New Mexico hospitals welcome the requirement,” Jeff Dye, president and CEO of the New Mexico Hospital Association, was quoted as saying in a  news release issued by the New Mexico health department Wednesday. ” Many have already built the reporting structure and those that have participated in the state pilot project have outperformed national averages.”

But the state’s decision to rely on voluntary reporting of infections despite a recommendation in a 2009 Healthcare-Associated Infections Advisory Committee report to mandate such disclosure potentially means that hospitals don’t have to notify the state of certain infections if they don’t want to. For example, clostridium difficile, the colon infection that participating hospitals will begin to report voluntarily in November.

Moving toward transparency

The move to tamp down on hospital infections has dovetailed with a national movement for medical facilities to become more transparent about the quality of care they provide patients.

The movement got much of its impetus from a 1999 Institute of Medicine (IOM) report “To Err is Human,” which estimated that up to 98,000 deaths and hundreds of thousands of injuries occur annually in the U.S. because of medical errors and infections.

In 2006, just two conditions caused by hospital-acquired infections in the U.S. (sepsis and pneumonia), were responsible for nearly 50,000 deaths and cost more than $8 billion to treat, according to a February report in the Archives of Internal Medicine.

Hospital-acquired infections have garnered so much public attention the new federal health care reform law addresses the issue.

One of the provisions in the law will require more public reporting of medical errors, including hospital-acquired infections, according to the Consumers Union, which publishes the magazine Consumer Reports.

Beginning in 2014, the U.S. Health and Human Services Department will report, on its Hospital website, each hospital’s record for medical errors and infections involving Medicare patients, the consumers organization found during a review of the new law.

The federal law also attempts to encourage better patient outcomes through incentives and restrictions, the consumers organization says.

Beginning in October 2012 non-rural acute care hospitals that beat federal performance standards for at least five measures, including certain hospital-acquired infections, will receive higher Medicare payments, the organization found in its review of the law. Medicare is a federal health insurance program for individuals over the age of 65 and individuals under 65 with certain disabilities.

Two years later in 2014, the federal government will reduce Medicare payments by one percent for those hospitals with the highest rates of medical harm as measured by “hospital-acquired conditions,” the Consumers Union reports.

Those include certain preventable infections and medical errors, such as serious bedsores, catheter-associated urinary tract infections and certain types of falls and trauma, the organization reports.

Childhood obesity is a growing epidemic nationwide that is blamed for a steady uptick in youth-onset diabetes and that can lead to chronic illnesses in adulthood, according to researchers.

Thanks to various reports, New Mexico knows that nearly 30 percent of its high school students and a quarter of 2- to 5-year-olds enrolled in a government program are overweight or obese. But the state Department of Health plans to fill in data gaps this fall when it begins to collect the body mass index levels for kindergarteners and third graders at 50 elementary schools, with an expectation of expanding the program to 50 new schools each year.

While quick to praise  the state’s plan this week, local officials, advocates and parents said this week they already know it’s a problem and they’re anxious for more help now.

“A lot more work needs to be done,” Cheryl Lucero, the incoming president of the Albuquerque’s Zia Elementary Parents Teachers Association, said of New Mexico’s efforts.

For starters, New Mexico doesn’t supplement federal funding for the U.S. Department of Agriculture School Meal program with its own dollars, as other states do. The extra funding could help schools buy more fresh fruit and vegetables for school meals, said Jennie McCary, wellness manager at Albuquerque Public Schools.

New Mexico also could throw its support behind the Farm to School initiative, a program that gives preference to local growers to get fresh produce into schools, advocates say. It’s an idea that’s being pushed by the New Mexico Food and Agriculture Policy Council.

Sugary beverages could be taxed to dissuade their consumption, said Erin Marshall, executive director of the New Mexico Healthier Weight Council. State lawmakers should expect to see that idea pushed during the 2011 legislative session. The council and other advocates plan to press that issue after the proposal surfaced but failed during this year’s legislative session.

Changes at the local level also could help, advocates say.

“It could be as simple as leaving gates unlocked” at school playgrounds so neighborhood children can play there during weekends and get more exercise, Marshall said.

“Other schools have community gardens,” she added. “Some schools have opened their facilities basketball courts – for children.”

Marshall’s group already is working to start a clearinghouse of sorts of “better practices” that will feature ideas from school districts and communities that have adopted healthful ideas to help foster greater communication among New Mexico’s communities.

“If Moriarty is doing something that works for them, would it work out in Magdalena?” Marshall asked.

Childhood obesity can lead to expensive health problems in adulthood

Childhood obesity is a large issue with a rising public profile, advocates and officials say.

The health risks associated with it are immense. Obesity at a young age can lead to the onset of diabetes during youth. And numerous government reports say obese and overweight children are likelier to suffer from chronic diseases such as heart disease, certain cancers and diabetes as adults, adding to the costs of health care.

As in the rest of the nation, childhood obesity rates appear to be growing in New Mexico.

The obesity rate for New Mexico’s children ages 2 to 5 years who participate in the Women Infants Children government program increased by nearly 30 percent from 2000 to 2007, going from 9 percent to 12.7 percent, according to a July 2009 state report titled Healthy Kids Healthy New Mexico.

Expanded waistlines are in greater evidence among older children too. In 2007 24.4 percent New Mexico’s high school students were overweight or obese, according to the same report. Two years later, the portion of high school students who were overweight or obese had increased to nearly 30 percent, according to a 2009 state Department of Health report titled Youth Resiliency and Risk Survey.

McCary of Albuquerque Public Schools confirms a similar finding among students in the state’s largest school district.

“We’re matching national numbers,” she said of the 25,000 Albuquerque Public School students whose body-mass index has been collected by the state’s largest school district in recent years.

Tough times for tackling childhood obesity

The state’s push to gauge the size of the problem comes at a time when budget pressures have cut deeply into health spending, rendering proposals like extra state dollars to help pay for school meals a tough sell to state lawmakers.

Funding for 33 county and community health councils and five Tribal Health Councils around the state has been slashed, a big hit to battling childhood obesity.

The councils “coordinate different agencies, organizations, in a community or county, that are addressing health needs at the local level,” Marshall said. “They are critical for addressing obesity.”

Mary Jo Quintana, for one, says the state needs to set its priorities and tackling childhood obesity should  be high up on its list.

A school parent with two children at Sunset View Elementary in Albuquerque, Quintana, like Lucero, sits on the Albuquerque Public Schools’ Physical Activity and Nutrition Advisory Committee.

“What they keep saying as we meet is it’s more than obesity,” Quintana said. “This also affects the graduation rates. There’s a strong tie in. It’s all connected. If we can get healthier children we can come up with better test results.”

Still, Quintana is thankful to see the state moving on the issue, even if it’s to get a better sense of how prevalent childhood obesity is.

“The state getting involved will help us,” Quintana said. ”We’re trying to move a mountain and they are helping us move that mountain faster. They are providing a lot of support.”

Unlike some states, including Colorado, New Mexico has no law requiring hospitals to publicly report rates of hospital-acquired infections, despite the recommendations of a 2009 Healthcare-Associated Infections Advisory Committee report.

The lack of public disclosure, supporters of such openness say, means that New Mexicans don’t have a way to measure the quality of care they receive at the state’s medical facilities.

The authors of the 2009 report recommended that such reporting be required in the future, even counseling New Mexico officials to look to other states for guidance on how to write legislation to accomplish that.

But so far there hasn’t been an all-out push to require such public disclosure even as other states are moving in that direction.

Nineteen incidents of hospital infections associated with a central line (similar to an IV), were recorded at six New Mexico hospitals from July 1 2008 to May 31, 2009, according to a 2009 state report. Those are infections that patients didn’t have when they came into the hospital.

We know about the 19 incidents because six hospitals– three from Albuquerque and one each from Alamogordo, Las Cruces and Farmington — volunteered the information to the Department of Health as part of a pilot program.

The rate of so-called central line-associated hospital infections at the six participating hospitals was lower than national rate, the report says. But it wasn’t clear where the incidents took place. The incidents were reported in the aggregate, and not assigned to the facility where they happened. Such infections are dangerous and can lead to death in some cases, the 69-page report notes.

Even supporters of public disclosure of such infection rates acknowledge they’d have a big fight on their hands if a big push came to require hospitals to share such data with the public.

“I would support opening this up to the public, but do you want you to spend your time having a fight with them about reporting this to the public or work with them on improving best practices?”  Sen. Dede Feldman, D-Albuquerque, told The Independent. Feldman sponsored legislation that created the advisory committee that created last year’s report.

“With no money, I think the answer is clear. I am working with them but we need to find out how far they are going on this important measure of health care quality,” Feldman said.

Federal funding helps expand monitoring

Since New Mexico’s 11-month pilot program, 15 New Mexico hospitals, up from the original six, are expected to share data on central line-associated hospital infections this year, thanks to an infusion of $1.5 million in federal stimulus dollars.

The federal money has allowed health officials to expand monitoring central line-associated bloodstream infections beyond adult Intensive Care Units to pediatric ICUs at the 15 participating hospitals, Dr. Joan Baumbach said via e-mail Tuesday.

Baumbauch is an epidemiologist and is the infectious disease epidemiology bureau chief for the state health agency.

The data on infection rates during the 2008-2009 pilot program came from only adult ICUs at the six hospitals.

The federal money also may prompt New Mexico to add another category to its hospital-reporting regimen. Participating hospitals now report two events: the central line-associated bloodstream infections; and the number of health care workers who are vaccinated against influenza.

About 55 percent of health care workers at the six participating hospitals during the pilot program got flu shots, important for reducing the possibility that patients will get the flu at the hospital.

Approximately 36,000 deaths and over 200,000 hospitalizations occur annually in the United States from influenza and influenza-related causes, according to the report.

The question, along whether this data should be required to be publicly reported, is what happens to New Mexico’s program once the federal money runs out at the end of calendar year 2011.

“I don’t know if we have any money to do this,” Feldman said of state funding.

A spokeswoman for the state health agency said Tuesday that the department would do its best to continue the program.

“We are committed to trying to prevent health care associated infections, and we’ll continue the program as best we can when we no longer have federal funds,” said agency spokeswoman Deborah Busemeyer.

National movement pushes hospitals to become more transparent

The move to tamp down on hospital infections has dovetailed with a national movement for medical facilities to become more transparent about the quality of care they provide patients.

The movement got much of its impetus from a 1999 Institute of Medicine (IOM) report “To Err is Human,” which estimated that up to 98,000 deaths and hundreds of thousands of injuries occur annually in the U.S. because of medical errors and infections.

Meanwhile, early results from hospitals with active surveillance programs, including at Veterans Administration facilities, have shown marked reductions in different types of infections – the invasive MRSA infections. That heightened surveillance is accompanied by a campaign to improve medical practices, including checklists that exhort health care professionals to wash hands more often and disinfect the patient’s skin before attaching a central line to a patient.

Beyond improving quality of care, such reductions in infection rates lower medical costs, patient advocates and others have insisted. Some medical researchers estimate that hospital-acquired infections add billions of dollars a year to health care costs because it lengthens patients’ time in ICUs.

With all that in mind, some states have begun to require public disclosure of everything from “adverse events” at hospitals – where people get sick or die due to medical errors — to hospital-acquired infections and vaccination rates.

Consumer Reports recently released a list of the best and worst performing hospitals as measured by the number of central line-associated hospital infections in their ICUs from 10 states that disclose such data, including Colorado.

Colorado is one of the states the authors of the 2009 New Mexico report pointed to as having a potential model for future legislation requiring public reporting of hospital infection rates.

Colorado requires hospitals and their units, as well as ambulatory surgery centers and dialysis treatment centers, to report “health facility-acquired infections data as a condition of their state licensure,” the 2009 report noted.

Tennessee also was another state held up as a potential model for New Mexico. That state requires facilities with so many inpatients or outpatients to join the National Healthcare Safety Network, which reports health care-associated infection rates from 2,200 hospitals across the country.

New Mexico makes progress in reducing hospital infections

Before New Mexico’s 11-month pilot reporting program, no New Mexico hospital had enrolled in the national health care safety network, the report noted.

There was also a drop in the number of central line-associated bloodstream infections from the first six months of the pilot at the six hospitals – 13 – compared to six events over the final five months of the pilot program.

The authors noted:

“While not statistically significant, the apparent decrease in CLABSI events did prompt discussion among the pilot hospitals. Several questions were posed to determine if any quality initiatives had been instituted or changed during the 11 months of data collection that could account for a decline.”

Five of the six hospitals that participated in the pilot reported that they had changed policies and increased educational in-services during the pilot program to reduce central line-associated bloodstream infections, noted the report.

But the state Department of Health said Monday it is legally required to pay the plaintiff fees. And Peter Simonson of the American Civil Liberties Union of New Mexico said if Adair’s bills pass and become law, it would put the state in further legal trouble.

“If he (Sen. Adair) wants to avoid attorneys’ fees he’s got a strange way of going about it,” Simonson said.

At a press conference on Tuesday Adair, backed with supporters, said he would introduce a bill that would cut the nearly $5 million a year New Mexico is paying out in the Jackson vs. Ft. Stanton lawsuit.

Adair says lawyers on the other side of the suit are using the courts to draw out the case, and collecting the fees that go with it.  “This is a colossal waste of money for the benefit of a few. If you take 100 voters I would say 91 or even more would say this is a scam,” Adair said.

He said when the lawsuit began it addressed real issues with the care the state was offering to the developmentally disabled. But since then the state has complied with the issue originally raised and the case should have been over long ago.

A pair of bills, Senate Bill 173 and 174 would simply cut the money the Department of Health (DOH) pays in the case. And to boot it would take that money and give it to DOH to boost the developmental disabilities waiver program. The waiting list for the DOH program includes over 4,000 people and DOH has said the program needs more money before they can take on any more.

Adair was quick to point out that New Mexico gets three dollars for every one dollar it spends in the program. So the $5 million would actually mean $20 million for DOH.

A spokeswoman for DOH says the state still has some ground to cover to fulfill the requirements set forth in Jackson v. Fort Stanton. So it will continue to pay the bills for the case.

“We would love to devote all of our funds to getting people the services we need,” spokeswoman Deborah Busmeyer said. “We are committed to meeting all of the goals outlined in the agreement during this administration.”

The ACLU  isn’t a party in the Jackson v. Ft. Stanton case but Simonson said the bills were misguided.

“Senator Adair is trying to twist the truth of these suits,” Simonson said, pointing out that the courts are the only recourse for citizens to bring concerns about the state.

Adair is hopeful passage of his bill will be the push forward the case needs to bring it to some resolution.  The question of whether or not he gets to find out is now up to the Legislature.

“The magnitude of hires after the freeze of unqualified people who are fast-tracked into training for financial positions is problematic and is creating morale issues,” Beffort said.

A Department of Health spokeswoman said Friday afternoon that most of the people Beffort was talking about were doctors, nurses and other medical professionals hired to care for patients. Those positions are exempted from the hiring freeze, said spokeswoman Deborah Busemeyer.

Some of 90 people hired also went toward beefing up the state’s fight with the swine flu. Busemeyer said the H1N1 virus has “required us to hire temporary folks to help us with vaccination efforts.”

Secretary of Health Alfredo Vigil

Although it has been praised for its innovative structure, New Mexico’s medical marijuana program, which debuted this year, has also been criticized for not providing enough of the drug to meet demand and for allowing high costs that could be prohibitive for some patients. The state’s first licensed nonprofit provider, The Santa Fe Institute of Natural Medicine, had its first crop ready to sell to patients in August — two and a half years after the state law was passed. It promptly sold out of its $11-$14 a gram product.

But after the New Mexico Department of Health approved four new producers last week, Secretary Alfredo Vigil told The Independent the difficulties of the program aren’t all that unique, if taken in the broader context of health care. The state’s program has a unique design and unique legal problems, but it faces the same barriers of provision and access as other health care services.

Pointing to the fact that New Mexico is the fourth largest state [see correction below] by geography, with a large rural and poor population, Vigil explained, “There are all kinds of services that aren’t adequately penetrated in all parts of the state, like behavioral health or trauma care, for instance. There are parts of the state that aren’t served like we want them to be served.”

In this respect, he said, the debate over access to medical marijuana is in line with the national debate over health care access in general.

Most of the state’s medical marijuana patients are in northern counties, which is why none of the four additional providers he approved this week are located in the southern portion of the state, he said, stressing that the program is in a developmental stage.

“The way the program is today is not the way it will always be,” he said. “We’re trying to develop a sustainable system.”

“It’s not the kind of thing where you pull a program out of a box and it works perfectly. It’s a program that’s never been developed before that has interesting legal dilemmas.”

Legal context unlike any other

Despite the fact that 13 states now allow the use of medical marijuana, it is still classified as a Schedule One drug by the federal government. That means that, according to the feds, it has no accepted medical use and can’t be prescribed by a doctor as medicine.

So technically, New Mexico’s program is in direct violation of federal law. Or, depending on how you view it, it’s blazing a path toward acceptance of marijuana as a valid medicine.

“The federal system is beginning to give some thought to striking a long range balance between federal policy and state policies,” Vigil said. “There are enough states that have gone down this road now that it seems the federal government will have to look at how to bridge the difference. We want to work in tandem with that [as we develop the program] so that everything is good and right.”

Each state has a different set of rules for how it allows its citizens to access marijuana. New Mexico’s approach is a trailblazer in that the law calls for the creation of a state-licensed production and distribution system. But rather than actually produce the drug itself, the state Department of Health licenses and regulates non-profit organizations or patients themselves as producers.

Vigil said safety issues require his agency to be very careful about how the program develops, which is one reason it may seem slow to the general public.

“Marijuana is a major source of income to major criminal elements,” Vigil said, “and in California they are beginning to see serious issues of violence and safety as the Mexican cartels begin to see the medical industry as a competitor, as encroaching on their territory. We don’t want to ever see anything like this in New Mexico, which is the reason for our confidentiality provision [in which the names and locations of non-profits and patients are not given to the public].”

Plus, because marijuana is used by many as a recreational drug, too much of it in circulation at any given time might lead to it being sold on the black market. But again, this doesn’t make medical marijuana unique, Vigil said.

“We already have a significant problem with diverted prescription medicine,” he said. “Kids swipe grandma’s medicine because they think it will make them high. We can’t totally protect against this, but we don’t want to create that problem with excess product which will certainly get diverted.”

Pricing too high?

One critique of the state’s medical marijuana program is that the initial crop was available for sale at black market prices. If more of the drug was made available, it might cost less, critics say.

But Vigil said this isn’t necessarily true. The experience in California hasn’t shown that readily available medicinal marijuana is priced lower than the drug available on the black market, he said. There are a lot of other factors involved in pricing of medical marijuana from non-profit producers, he explained, including overhead and salaries.

“As far as I know,” he said, “the Department of Health doesn’t have a spigot it can turn on to lower the price. This is what the national conversation about health care reform is about. Many can’t afford health care. And in the context of a revolutionary and new program, a lower price isn’t likely to happen in the short term.”

As he made these comments, Vigil stressed that everyone involved in developing the medical marijuana program cares deeply about patient care. While some may be interested in medical marijuana because it might eventually lead to the legalization of marijuana in general, he and his fellow workers are involved because they are interested in alleviating human suffering, he said.

“The main thing about this is that its an attempt to be responsive to an experience that people have with their chronic or terminal condition,” he explained. “This is about human suffering and improving the quality of life for that small group of people who haven’t gotten relief from other interventions. It’s not a panacea that works for everyone — it’s a medicine like any other medicine.”

*Correction: Our apologies to the state of Montana. New Mexico is actually the fifth largest state by land mass.

“This is good news for New Mexico, and I encourage people who are at higher risk for developing serious complications from the flu to get vaccinated,” Health Secretary Alfredo Vigil, MD, said in a release.  “Getting the H1N1 vaccine is a safe and effective way to protect yourself and your family from the disease.  I also encourage all New Mexicans to get a seasonal flu shot.”

Seven New Mexicans have died this year from the H1N1 virus, more commonly known as the Swine flu.

Nasal flu vaccine can only be given to persons 2 to 49 years of age who are not pregnant and do not have chronic health conditions, the agency said.

A H1N1 vaccine in the shot form will arrive later. The first groups the Department of Health is advising to get vaccinated in the shot form are pregnant women, household members/caretakers of infants less than 6 months old, children 6 to 59 months of age, children 5 to18 years with certain chronic health conditions that increase their risk of complications from flu, and healthcare workers and emergency medical service personnel with direct patient care.

The Department of Health expects to receive additional allocations of vaccine each week and estimates New Mexico will receive 1.2 million doses by the end of January 2010.  After the demand has been met in the first priority group, vaccinations will be provided to other people in the original priority groups.

The complete priority group the Department of Health is advising to get the H1N1 vaccination is:

Pregnant women

People who live with or care for children younger than 6 months old

Children and young adults age 6 months through 24 years

Health care workers and emergency medical services personnel

People age 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza

In addition to the H1N1 vaccine, the agency is encouraging New Mexicans to get seasonal flu vaccines. The agency already has started shipping seasonal flu vaccine to public health offices, the Department’s long-term care facilities and private providers statewide, according to the press release. New Mexicans should contact their health care providers to receive flu vaccine. The Department’s public health offices provide seasonal flu vaccine to people who are at high risk for serious illness and people who have no health insurance.

The Department is advising the following high risk groups get vaccinated against seasonal flu:

Residents of long-term care facilities

Persons ages 2-64 years with chronic health conditions, such as asthma or other breathing problems, kidney disease, heart disease, diabetes, muscle or nerve disorders that can lead to breathing or swallowing problems, and children on long-term aspirin therapy.
Children age 6 months up to their 19th birthday
Persons ages 50 years and older

Pregnant women

Health care workers who provide direct patient care

Household contacts and out-of-home caregivers of children up to age 5, or anyone at increased risk of flu complications

For information about scheduled flu shot clinics, call Nurse Advice New Mexico toll-free at 866-681-5872 or go online to www.nmivc.org/cliniclist.php. Public health offices are listed in the phonebook’s blue pages under state government. Contact information for public health offices is also listed at www.nmhealth.org.

An image of the H1N1 influenza virus

A 5-year-old girl from Rio Rancho and a Roosevelt County infant are the latest New Mexicans to have died from the H1N1 virus, the state Health Department announced Thursday evening.

Parents of students enrolled at Rio Rancho schools were notified Thursday night of the child’s death by an automated calling system.The Albuquerque Journal identified the Rio Rancho girl as Trinity “Trin” Olivares, 5, who died Monday evening.

Her death came just a day after complaining of nausea, the girl’s mother, Danelle Olivares, 31, told Journal reporter Olivier Uttyebrouck. “Trinity began feeling ill Sunday night and stayed home from school Monday as her nausea and vomiting became more severe, Olivares said. The girl’s parents took her to a hospital Monday afternoon, about three hours before her death,” Uttyebrouck wrote.

The Roosevelt County infant, a female, died this week of the virus, according to the Department of Health.

The two deaths bring to seven the number of New Mexicans who have died from the H1N1 virus, commonly referred to as “swine flu.”

“Our sympathies go out to the families who are dealing with the loss of their children,” Health Secretary Alfredo Vigil, MD, said in a press release. “These tragic events should remind all New Mexicans that flu can be a serious and sometimes deadly disease.”

Influenza can cause serious complications and even death in people who are otherwise healthy, Vigil said.

The state health secretary went on to encourage New Mexicans to “wash their hands frequently and cover their mouth and nose when sneezing and coughing” to minimize the spread of the disease.

“Stay home and keep your kids home when they’re sick for 24 hours after the fever is gone,” Vigil added.

He also encouraged New Mexicans to “get vaccinated against seasonal flu, and if you’re in a high risk group, get vaccinated against H1N1 when the vaccine is available.”

The Department of Health expects to receive the first shipment of H1N1 vaccine in mid-October, the release said.

The Department of Health is advising those who should receive the vaccine first are “pregnant women, household members/caretakers of infants less than 6 months old, children 6 to 59 months of age, children 5 to 18 years with certain chronic health conditions that increase their risk of complications, and healthcare workers and emergency medical service personnel with direct patient care.”

The Department also advised individuals in high risk groups to get vaccinated immediately against seasonal flu. The high risk groups are:

Residents of long-term care facilities

Persons ages 2-64 years with chronic health conditions, such as asthma or other breathing problems, kidney disease, heart disease, diabetes, muscle or nerve disorders that can lead to breathing or swallowing problems, and children on long-term aspirin therapy.

Children age 6 months up to their 19^th birthday

Persons ages 50 years and older

Pregnant women

Healthcare workers who provide direct patient care

Household contacts and out-of-home caregivers of children up to age 5, or anyone at increased risk of flu complications

The Department of Health started shipping seasonal flu vaccine to public health offices, the Department’s long-term care facilities and private providers statewide this week, according to the news release.

New Mexicans should contact their health care providers to receive flu vaccine. The Department’s public health offices provide seasonal flu vaccine to people who are at high risk for serious illness and people who have no health insurance.

The death of the two children this week by the H1N1 virus fits into a larger national picture of a virus that is spreading rapidly across the nation, the New York Times reported Thursday.

Meanwhile, Dr. Anne Schuchat, director of immunization and respiratory disease at the federal Centers for Disease Control and Prevention, told reporters on Thursday that there was “significant flu activity in virtually all states. Most states do have quite a lot of disease right now, and that’s unusual for this time of year,” according to a transcript provided by the CDC of Schuchat’s briefing.

In addition to Trinity Olivares and the Roosevelt County infant, five other New Mexicans have died of H1N1 virus this year, the state health agency said:

The other five deaths are as follows: a 45-year-old female from Sierra County with end stage liver disease, a 52-year-old female from Bernalillo County with chronic pulmonary disease, a 48-year-old female from McKinley County with asthma and diabetes, a 21-year-old female from Los Alamos County without chronic medical conditions, and a 58-year-old male from Bernalillo County with chronic conditions that put him at risk for serious complications from the flu.

For information about scheduled flu shot clinics, call Nurse Advice New Mexico toll-free at 866-681-5872 or go online to www.nmivc.org/cliniclist.php.

Public health offices are listed in the phonebook’s blue pages under state government. Contact information for public health offices is also listed at www.nmhealth.org.

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