Hackensack Meridian Health shows the benefits of telepsychiatry


Addressing the increasing need for behavioral health services is a nationwide challenge. With a shortage of physicians to address the growing need for care, a lack of providers who accept Medicaid, access issues due to transportation or office hour challenges, healthcare organizations are looking to technology to help bridge the gap.

“Without the utilization of telehealth, patients arriving at an emergency department often have long wait times before meeting with an available physician, creating a strain on social workers other members of the behavioral healthcare teams inside hospitals,” said Dr. Eric C. Alcera, network medical director/Hackensack Meridian Behavioral Health, chief medical officer at Preferred Behavioral Health Group, among other positions.

Expediting treatment time

“The implementation of a telepsychiatry program expedites the treatment time for a patient presenting in the emergency department in crisis,” he continued. “Utilizing a Chromebook HIPAA-compliant communications platform such as Zoom or Google Meets, team members can reach a Hackensack Meridian Health psychiatrist who can diagnose, prescribe provide recommendations on next steps for patients.”

The implementation of the telepsychiatry program has been a tremendous asset for the health system in getting patients in need of immediate behavioral health treatment access to a physician.

“Telepsychiatry has been an invaluable tool as we face an ever-growing behavioral health crisis.”

Dr. Eric C. Alcera, Hackensack Meridian Behavioral Healt

“As Hackensack Meridian Health continues to add additional psychiatrists to its network to increase the ability for patients to secure in-person appointments, telepsychiatry has been an invaluable tool as we face an ever-growing behavioral health crisis,” he noted.

When a patient presents to the emergency department in crisis, clinical behavioral healthcare teams immediately jump into action, treating stabilizing the patient if there are any medical needs before evaluating the patient to determine next steps behaviorally.

Calling the psychiatrist

“If it is decided that a patient needs further care beyond that of the social worker, the equipment is rolled to the bedside a licensed psychiatrist is called,” Alcera explained. “The psychiatrist, who is able to visually see interact with the patient, will then determine how best to proceed in their care treatment.”

Hackensack Meridian Health reports the program has been very successful. In the fourth quarter of 2019, there were 7,430 in-person psychiatry visits no telepsychiatry visits. By comparison, in the fourth quarter of 2020, there were 4,634 in-person psychiatry visits 5,221 telepsychiatry visits, accounting for 52.98% of visits.

In the fourth quarter of 2021, there were 4,024 in-person visits 6,726 telehealth visits, accounting for 62.57% of visits. And the numbers are continuing to grow, demonstrating the incredible need for impact of this program, Alcera said.

The FCC telehealth grant program awarded Hackensack Meridian Health, based in Edison, New Jersey, $973,055 for laptop computers, tablets, a telehealth platform remote monitoring equipment to provide behavioral health services in high-concentration COVID-19 hospitals, to ensure vulnerable elderly patients remain safe at home while receiving required medical treatment, to protect patients in skilled nursing facilities through consistent monitoring.

FCC funds for telehealth

“The FCC telehealth award funds have been used to implement the telepsychiatry program at our emergency departments to implement a remote patient monitoring system, called VitalConnect, which monitors patient vitals,” Alcera said.

“That program was rolled out at Hackensack Meridian Health nursing homes rehabilitation centers has been tremendously helpful, particularly throughout COVID,” he continued. “The amount of time it took to don doff PPE to get into patient rooms to check vitals meant patient care for another patient was impacted.”

By using the remote patch monitoring system, the nursing teams were able to have confidence in the stability of their patients – it helped to keep everyone safer, he added.

“The monitors are still used, particularly in the care of patients who may need to be monitored very closely, such as those recovering from open heart surgeries,” he concluded.

Twitter: @SiwickiHealthIT
Email the writer: [email protected]
Healthcare IT News is a HIMSS Media publication.





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Omicron BA.2 sub-variant now globally prevalent


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A sub-variant of the highly transmissible omicron version of coronavirus known as BA.2 is now dominant worldwide, prompting surges in many countries in Europe Asia raising concern over the potential for a new wave in the United States.

Below is a summary of what is known about BA.2.

LONG COVID SYMPTOMS MAY DEPEND ON THE VARIANT A PERSON CONTRACTED

MORE TRANSMISSIBLE

BA.2 now represents nearly 86% of all sequenced cases, according to the World Health Organization. It is even more transmissible than its highly contagious omicron siblings, BA.1 BA.1.1, however the evidence so far suggests that it is no more likely to cause severe disease.

As with the other variants in the omicron family, vaccines are less effective against BA.2 than against previous variants like alpha or the original strain of coronavirus, protection declines over time. However, according to UK Health Security Agency data, protection is restored by a booster jab, particularly for preventing hospitalization death. 

Policemen staff workers get tested for the coronavirus disease (COVID-19) at a makeshift nucleic acid testing centre inside barriers of an area under lockdown amid the coronavirus disease (COVID-19) pandemic, in Shanghai, China March 24, 2022.
( REUTERS/Aly Song)

GLOBAL PICTURE

The rise of BA.2 has been blamed for recent surges in China as well as record infections in European countries like Germany the UK. Yet some European countries are now seeing a slower uptick in new cases, or even a decline.

BA.2 has been called the “stealth variant” because it is slightly harder to track. A missing gene in BA.1 allowed it to be tracked by default through a common PCR test. BA.2 another sibling, BA.3, which is also increasing in prevalence but is currently at low levels, can only be found by genomic sequencing, which some countries do more of than others.

OMICRON SUB-VARIANT BA.2: HEALTH OFFICIALS CALL IT ‘VARIANT OF CONCERN’

REINFECTIONS

A key concern about BA.2 was whether it could re-infect people who had already had BA.1, particularly as a number of countries seemed to be experiencing “double peaks” in infection rates surprisingly close together. But data from both the UK Denmark have shown that while omicron can reinfect people who had other variants, such as delta, only a handful of BA.2 reinfections in people who had BA.1 have been found so far among tens of thousands of cases.

Scientists say a possible explanation for the recent rise in BA.2 could be that the global uptick happened at the same time that many countries lifted public health interventions.

“In some ways, it could just be that BA.2 was the variant that was circulating when all these people stopped wearing masks,” said Dr Andrew Pekosz, a virologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

As such, other U.S. experts such as Eric Topol, director of the Scripps Research Translational Institute in La Jolla, California, said it was “a little too early” to call whether the U.S. too would see a significant BA.2 wave.

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But whatever the reason for BA.2’s rise, scientists said it was a reminder that the virus continues to cause harm, particularly among unvaccinated, under-vaccinated vulnerable populations.

“It is still a huge public health problem it is going to continue to be,” said Mark Woolhouse, an epidemiologist at the University of Edinburgh.



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Permanent daylight saving time may be harmful to our health, experts say


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The United States Senate recently unanimously passed a bipartisan bill known as the Sunshine Protection Act to make daylight saving time (DST) permanent, but the move may be more harmful to our health, according to a recent Wall Street Journal report. 

“Of the three choices—permanent daylight saving time, permanent standard time or where we are now, which is switching between the two—I think permanent DST is the worst solution,” said Dr. Phyllis Zee, director of the Center for Circadian Sleep Medicine at Northwestern University Feinberg School of Medicine.

WHAT IS ALOPECIA? JADA PINKETT SMITH JOKE SPARKS INTEREST IN THE AUTOIMMUNE DISORDER 

Our circadian rhythm, otherwise known as our “internal clocks,” are connected to the sun, but that is more in sync with permanent standard time, said Dr. Muhammad Adeel Rishi, pulmonologist sleep physician at Indiana University. 

Identify your triggers. Triggers vary by individual, but they may include certain people, places, things, foods (caffeine is often a culprit), activities, times of the year, or times of day. 
(iStock)

So when we advance our clocks one hour ahead, our internal clocks don’t adapt to the time difference, so daylight saving time is like “permanent social jet lag,” per the report. 

The paper noted too much evening light has also been associated with an increased risk of diabetes, high blood pressure, cancer, but these studies don’t prove less light in the morning causes the chronic medical problems, only that the medical issues are linked to it.

“It is the position of the AASM [American Academy of Sleep Medicine], that the U.S. should eliminate seasonal time changes in favor of a national, fixed, year-round time,” according to a position paper of the professional sleep society.

“Current evidence best supports the adoption of year-round standard time, which aligns best with human circadian biology provides distinct benefits for public health safety.” 

Electric Time technician Dan LaMoore puts a clock honto a 1000-lb., 12-foot diameter clock constructed for a resort in Vietnam, Tuesday, March 9, 2021, in Medfield, Mass. 

Electric Time technician Dan LaMoore puts a clock honto a 1000-lb., 12-foot diameter clock constructed for a resort in Vietnam, Tuesday, March 9, 2021, in Medfield, Mass. 
(AP Photo/Elise Amendola)

But “springing forward” does have some advantages that people enjoy, in part because the summer spring evenings have more daylight, which are good for business for some people’s social calendar, according to the report.

“Day after day of eating at the wrong time, being active at the wrong time, sleeping at the wrong time, build up” can lead to long-term negative health consequences, says Dr. Erin Flynn-Evans, circadian researcher consultant to the AASM’s public safety committee.

A recent sleep study, which randomized 20 healthy people to sleep in dim light versus moderate lighting, showed a single night of light exposure increased insulin resistance the heart rates of the participants the following day compared to those who slept in an environment with dim light, according to the Proceedings of the National Academy of Sciences of the United States of America. 

LONG COVID SYMPTOMS MAY DEPEND ON THE VARIANT A PERSON CONTRACTED 

One of the biggest objections to permanent DST is because the winter sun rises later, schoolchildren often will be walking to school in the dark, the Journal noted.

For example in certain parts of Indiana where the sun doesn’t rise after 9 a.m., Rishi warned: “You’re basically putting these kids two hours off from their circadian biology.” 

UNITED STATES - MAY 26: Sen. Marco Rubio, R-Fla., walks to the Senate subway after a vote in the U.S. Capitol on Wednesday, May 26, 2021. 

UNITED STATES – MAY 26: Sen. Marco Rubio, R-Fla., walks to the Senate subway after a vote in the U.S. Capitol on Wednesday, May 26, 2021. 
(Photo by Bill Clark/CQ-Roll Call, Inc via Getty Images)

The United States government has been unsuccessful at least three times to make DST permanent, with the most recent attempt in 1974 when the country was on DST for one year before it went back to the status quo, per the Journal.

Congress adopted daylight saving time originally as a wartime measure, but the bill is now headed to the House of Representatives, they are being cautious on whether it will have enough support to pass, according to The Hill. 

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“Different members have articulated a different perspective. We’ll have to come to some consensus. We were unexpectedly sent this bill by the Senate. Now, we’re trying to absorb it,” Rep. Hakeem Jeffries (N.Y.), head of the House Democratic Caucus, told the Hill.



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At a Tennessee Crossroads, Two Pharmacies, a Monkey, Millions of Pills


CELINA, Tenn. — It was about 1 a.m. on April 19, 2016, when a burglary alarm sounded at Dale Hollow Pharmacy in Celina, a tiny town in the rolling, wooded hills near the Kentucky border.

Two cops responded. As their flashlights bobbed in the darkness, shining through the pharmacy windows, they spotted a sign of a break-in: pill bottles scattered on the floor.

The cops called the co-owner, Thomas Weir, who arrived within minutes let them in. But as quickly as their flashlights beamed behind the counter, Weir demanded the cops leave. He said he’d rather someone “steal everything” than let them finish their search, according to a police report body camera footage from the scene.

“Get out of there right now!” Weir shouted, as if shooing off a mischievous dog. “Get out of there!”

The cops argued with Weir as he escorted them out. They left the pharmacy more suspicious than when they’d arrived, triggering a probe in a small town engulfed in one of the most outsize concentrations of opioids in a pill-ravaged nation.

Nearly six years later, federal prosecutors have unveiled a rare criminal case alleging that Celina pharmacy owners intentionally courted opioid seekers by filling dangerous prescriptions that would have been rejected elsewhere. The pharmacies are accused of giving cash handouts to keep customers coming back, one allegedly distributed its own currency, “monkey bucks,” inspired by a pet monkey that was once a common sight behind the counter. Two pharmacists admitted in plea agreements they attracted large numbers of patients from “long distances” by ignoring red flags indicating pills were being misused or resold. In their wake, prosecutors say, these Celina pharmacies left a rash of addiction, overdoses, deaths, millions in wasted tax dollars.

“I hate that this is what put us on the map,” said Tifinee Roach, 38, a lifelong Celina resident who works in a salon not far from the pharmacies recounted years of unfamiliar cars unfamiliar people filling the parking lots. “I hate that this is what we’re going to be known for.”

Celina, an old logging town of 1,900 people about two hours northeast of Nashville, was primed for this drug trade: In the shadow of a dying hospital, four pharmacies sat within 1,000 feet of each other, at the crux of two highways, dispensing millions of opioid pills. Before long, that intersection had single-handedly turned Tennessee’s Clay County into one of the nation’s pound-for-pound leaders of opioid distribution. In 2017, Celina pharmacies filled nearly two opioid prescriptions for every Clay County resident — more than three times the national rate — according to the Centers for Disease Control Prevention.

Visitors once came to Celina to tour its historical courthouse or drop their lines for smallmouth bass in the famed fishing lake nearby. Now they came for pills.

Soon after Weir’s police encounter in 2016, the Drug Enforcement Administration set its sights on his two Celina pharmacies, three doors apart — Dale Hollow Pharmacy Xpress Pharmacy. Separately, investigators examined the clinic of Dr. Gilbert Ghearing, which sat directly between Dale Hollow Xpress leased office space to a third pharmacy in the same building, Anderson Hometown Pharmacy. Its owners operators have not been charged with any crime.

In December, a federal judge unsealed indictments against Weir the other owners of Dale Hollow Xpress pharmacies, Charles “Bobby” Oakley Pamela Spivey, alleging they profited from attracting filling dangerous unjustifiable opioid prescriptions. Charges were also filed against William Donaldson, the former pharmacist owner of Dale Hollow, previously convicted of drug dealing, who allegedly recruited most of the customers for the scheme.

The pharmacists at Dale Hollow Xpress, John Polston Michael Griffith, pleaded guilty to drug conspiracy health care fraud charges agreed to cooperate with law enforcement against the other suspects.

Ghearing was indicted on drug distribution charges for allegedly writing unjustifiable opioid prescriptions in a separate case in 2019. He pleaded not guilty, his case is expected to go to trial in September.

‘An American Tragedy’

The Celina indictment comes as pharmacies enter an era of new accountability for the opioid crisis. In November, a federal jury in Clevelruled pharmacies at CVS, Walgreens, Walmart could be held financially responsible for fueling the opioid crisis by recklessly distributing massive amounts of pain pills in two Ohio counties. The ruling — a first of its kind — is expected to reverberate through thousands of similar lawsuits filed nationwide.

Criminal prosecutions for such actions remain exceedingly rare. The Department of Justice in recent years increased prosecutions of doctors pain clinic staffers who overprescribed opioids but files far fewer charges against pharmacists, barely any against pharmacy owners, who are generally harder to hold directly responsible for prescriptions filled at their establishments.

In a review of about 1,000 news releases about legal enforcement actions taken by the Department of Health Human Services since 2019, KHN identified fewer than 10 similar cases involving pharmacists or pharmacy owners being criminally charged for filling opioid prescriptions. Among those few similar cases, none involved allegations of so many opioids flowing readily through such a small place.

The Celina case is also the first time the Department of Justice sought a restraining order preliminary injunction against pharmacies under the Controlled Substances Act, said David Boling, a spokesperson for the U.S. Attorney’s Office for the Middle District of Tennessee. DOJ used the civil filing to shut down Dale Hollow Xpress pharmacies quickly in 2019, allowing prosecutors more time to build a criminal case against the pharmacy owners.

Former U.S. Attorney Don Cochran, who oversaw much of the investigation, said the crisis in Celina was so severe it warranted a swift unique response.

Cochran said it once made sense for small pharmacies to be clustered in Celina, where a rural hospital served the surrounding area. But as the hospital shriveled toward closure, as have a dozen others in Tennessee, the competing pharmacies turned to opioids to sustain themselves got hooked on the profits, he said.

“It’s an American tragedy, I think the town was a victim in this,” Cochran said. “The salt-of-the-earth, blue-collar folks that lived there were victimized by these people in these pharmacies. I think they knew full well this was not a medical necessity. It was just a money-making cash machine for them.”

And much of that money came from taxpayers. In its court filings, DOJ argues the pharmacies sought out customers with Medicaid or Medicare coverage — or signed them up if they didn’t have it. To keep these customers coming back, the pharmacies covered their copays or paid cash kickbacks whenever they filled a prescription, prosecutors allege. The pharmacies collected more than $2.4 million from Medicare for opioids other controlled substances from 2012 to 2018, according to the court filings.

Prosecutors say the pharmacies also paid kickbacks to retain profitable customers with non-opioid prescriptions. In one case, Dale Hollow gave $100 “payouts” to a patient whenever they filled his prescription for mysoline, an anti-seizure drug, then used those prescriptions to collect more than $237,000 from Medicare, according to Polston’s plea agreement.

Attorneys for Weir, Oakley, Donaldson, Spivey, Polston, Griffith either declined to comment for this article or did not respond to requests for comment.

Ronald Chapman, an attorney for Ghearing, defended the doctor’s prescriptions, saying he’d done “the best he [could] with what was available” in a rural setting with no resources or expertise in pain management.

Chapman added that, while he does not represent the other Celina suspects, he had a theory as to why they drew the attention of federal law enforcement. As large corporate pharmacies made agreements with the federal government to be more stringent about opioid prescriptions, they filled fewer of them. Customers then turned to smaller pharmacies in rural areas to get their drugs, he said.

“I’m not sure if that’s what happened in this case, but I’ve seen it happen in many small towns in America. The only CVS down the street, or the only Rite Aid down the street, is cutting off every provider who prescribes opioids, leaving it to smaller pharmacies to do the work,” Chapman said.

Donaldson, reached briefly at his home in Celina on March 9, insisted the allegations levied against Dale Hollow Xpress could apply to many pharmacies in the region.

“It wasn’t just them,” Donaldson said.

The Monkey the Monkey Bucks

Long before it was called Dale Hollow Pharmacy, the blue-and-white building that moved millions of pills through Celina was Donaldson Pharmacy, Donaldson was behind the counter doling out pills.

Donaldson owned operated the pharmacy for decades as the eccentric son of one of the most prominent families in Celina, where a street, a park, many businesses bear his surname. Even now, despite Donaldson’s prior conviction for opioid crimes his new indictment, an advertisement for “Donaldson Pharmacy” hangs at the entrance of a nearby high school.

“Bill has always had a heart of gold, he would help anyone he could. I just think he let that, well …” said Pam Goad, a neighbor, trailing off. “He’s always had a heart of gold.”

According to interviews with about 20 Celina residents, including Clay County Sheriff Brandon Boone, Donaldson is also known to keep a menagerie of exotic animals, at one point including at least two giraffes, a monkey companion, “Carlos,” whom he dressed in clothing.

A paper sign on the door of Dale Hollow Pharmacy bars animals from the property. A former owner of the property, William Donaldson, once let his monkey frequent the pharmacy. The pharmacy is accused of later introducing “monkey bucks” to entice opioid-seeking customers.(Brett Kelman / KHN)

The monkey — a mainstay at Donaldson Pharmacy for years — both attracted deterred customers. Linda Nelson, who owns a nearby business, said Carlos once escaped the pharmacy and, during a scrap with a neighbor’s dogs, tore down her mailbox by snapping its wooden post in half.

But the monkey wasn’t the only reason Donaldson Pharmacy stood out.

According to a DEA opioid database published by The Washington Post, Donaldson Pharmacy distributed nearly 3 million oxycodone hydrocodone pills from 2006 to 2014, making it the nation’s 20th-highest per capita distributor during that period. It retained its ranking even though the pharmacy closed in 2011, when Donaldson was indicted for dispensing hydrocodone without a valid prescription.

Donaldson confessed to drug distribution was sentenced to 15 months in prison. The pharmacy’s name was changed to Dale Hollow ended up with Donaldson’s brother-in-law, Oakley. In 2014, Oakley sold 51% of the business to Weir, who also bought a majority stake of Xpress Pharmacy, three doors away, according to the DOJ’s civil complaint.

Under Weir’s leadership, these two pharmacies became an opioid hub with few equals, prosecutors say. From 2015 to 2018, Dale Hollow Xpress pharmacies were the fourth-11th-highest per capita opioid purchasers in the nation, according to the DOJ, citing internal DEA data.

Many of these prescriptions were for Subutex, an opioid that can be used to treat addiction but is itself prone to abuse. Unless the patient is pregnant or nursing or has a documented allergy, Tennessee law requires doctors instead to prescribe Suboxone, an alternative that is much harder to abuse.

But at the Celina pharmacies, prescriptions for Subutex outnumbered those for Suboxone by at least 4-to-1, prosecutors say. In their plea agreements, pharmacists from Dale Hollow Xpress described stores that thrived on the trade in Subutex, said Weir set “mandates” for how many Subutex prescriptions to fill instructed them to “never run out.”

Griffith, the head pharmacist at Xpress, said the pharmacy in 2015 created flyers specifically advertising Subutex, then delivered them on trays of cookies to practices throughout Tennessee, including some hours away. In the following two years, the amount of Subutex dispensed by Xpress increased by about eightyfold, according to his plea agreement.

Dale Hollow didn’t need flyers or cookies. It had Donaldson.

After getting out of prison in 2014, Donaldson was hired by the pharmacy he once owned, where he “recruited controlled” about 50% to 90% of customers, according to the indictment filed against him. The pharmacy also enticed customers by distributing a Monopoly-like currency called “monkey bucks” — an apparent callback to Carlos — that could be spent at the pharmacy like cash, the indictment states.

Prosecutors also allege that, from a desk inside Dale Hollow, Donaldson would sign customers up for Medicare or Medicaid, then use a vehicle provided by the pharmacy to drive them to a doctor’s office to get opioid prescriptions, then back to Dale Hollow where he’d offer to cover their copays himself if they kept their business at the pharmacy. Sometimes, he would text the Dale Hollow pharmacist with instructions to fill specific prescriptions, or just to fill more of them, according to federal court records.

“Y’all have got to get your numbers up. Fill fill,” Donaldson texted Polston in 2018, according to his plea agreement.

By then, however, all those prescriptions had drawn unwanted attention.

In August 2018, Dale Hollow Xpress pharmacies were raided by DEA agents, who brought with them Fox News’ Geraldo Rivera a television crew. Six months later, DOJ filed its civil complaint, persuading a federal judge to immediately close both pharmacies.

Today, Dale Hollow Pharmacy sits shuttered, as it has been for the past three years, a paper sign taped to the door says animals are not allowed inside by order of the DEA. The building that was once Xpress Pharmacy reopened this year as an unrelated pharmacy with a fresh coat of paint. Ghearing’s clinic Anderson Hometown Pharmacy are closed.

Most of Celina’s opioid prescriptions are gone, too. According to the latest available CDC data, Clay County reported about 32 opioid prescriptions per 100 residents in 2020 — one-sixth the rate of 2017’s.

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Colorado Doubles Down on Abortion Rights as Other States — And the High Court — Reconsider


With the Supreme Court expected to overturn or severely weaken its landmark Roe v. Wade decision, clinics in Colorado are preparing for an increase in the number of out-of-state residents seeking abortions, lawmakers are cementing abortion access protections in state law.

Colorado is one of the few states without any restrictions on when in pregnancy an abortion can occur is one of the few states in the region without a mandatory waiting period of up to 72 hours after required abortion counseling.

When the Supreme Court heard arguments in December on a Mississippi law that restricts access to abortion, questions from the new conservative majority appeared sympathetic to the notion that states should be allowed to decide their abortion policies. While legislatures in many Mountain West Great Plains states are working to dismantle abortion rights, Colorado lawmakers are reinforcing the state’s safeguards. If the justices overturn the 49-year-old decision that protects the right to an abortion, the expectation is that the demfor abortions in Colorado from people who live in those nearby states where abortion is being restricted will rise.

“We’re planning on it,” said Margie Andersohn, practice manager at Healthy Futures for Women, a clinic in the Denver area that is trying to hire more staffers recently purchased equipment that will enable it to perform abortions later than 20 weeks into pregnancy.

“We really do anticipate a lot more demover the summer, unfortunately,” said Dr. Rebecca Cohen, medical director of the Comprehensive Women’s Health Center in Denver, referring to the potential effect of the Supreme Court decision.

Andersohn said demat the Healthy Futures for Women clinic increased after Texas passed a law that bans most abortions after about six weeks of pregnancy offers a reward to people who successfully sue someone who provided an abortion or helped a patient get one. The Supreme Court refused to block the law in early challenges. (Idaho recently passed a similar law.) At the clinic, appointments are being scheduled several days in advance, instead of the clinic’s preferred 24- to 48-hour window.

“Women are flooding in from Texas,” she said.

At the Comprehensive Women’s Health Clinic, Texans make up a fifth of all patients on some days, appointments are backlogged for several weeks, according to Cohen. She said the out-of-state patients tend to be further along in pregnancy, either because they needed time to sort out their work travel logistics to get to a clinic with available appointments or because they encountered problems later in pregnancy that put their health or the fetus in danger, like their water breaking early.

“They can develop heavy bleeding, they can develop infection, there’s also a very high risk that the fetus won’t survive,” Cohen said. “The safest thing to do is to end the pregnancy, but they’re just not able to access that care in Texas.”

The Texas law permits abortions after six weeks when a pregnancy threatens the woman’s life or threatens a medical emergency.

The influx of out-of-staters coming to Colorado for abortions is creating a “domino effect,” pushing Colorado residents — especially in parts of the state with few clinics — to travel farther to find care, said Amanda Carlson, director of the Cobalt Abortion Fund. Cobalt helps people pay for travel, accommodations, child care while they are seeking an abortion in Colorado. In late 2021, a third of its recipients were Texans.

Some Colorado clinics are struggling to keep up with the rising demand. Cohen’s clinic has launched a telehealth program to accommodate people who are eligible for medication abortions but need to be physically in Colorado for their consultation when taking the medication. Health care worker shortages are making finding qualified staffers difficult, Cohen said.

The effects of the Texas law on Colorado may be just the beginning. Three of Colorado’s immediate neighbors are “certain or likely to attempt to ban abortion immediately” if Roe v. Wade is compromised, the Guttmacher Institute, a research organization that supports abortion rights, projects. A fourth, Kansas, will ask voters in August to decide whether to change its constitution so that abortion is no longer considered a fundamental right.

About 10,400 people received abortions in Colorado in 2020, about 13% of them came from out of state, according to the most recent data available from the Colorado health department.

Traveling to Colorado may become the best option for people seeking abortions from a wider range of states if Roe is struck down. Kari White, a researcher at the University of Texas-Austin, said the early part of the covid-19 pandemic offered a glimpse of how demwould look in a post-Roe nation, because states including Oklahoma, Louisiana, Texas temporarily prohibited abortion, deeming it a nonessential procedure.

During that time, most Texans who needed abortions traveled to New Mexico, Colorado, or Kansas, White said — patterns that could be a sign of what’s to come.

“Your ability to exercise your reproductive autonomy is going to be incredibly dependent on where you live,” White said.

White found that in the four months after Texas implemented its law in 2021, the number of Texans seeking abortions out of state was 5,500, compared with 500 during the same period in 2019. Nearly half went to Oklahoma, which is now advancing several anti-abortion bills modeled on the Texas bill. Some also went to Kansas — which provided half of all its abortions in 2019 to out-of-staters.

Colorado, with about 20 abortion clinics, offers much more access than Oklahoma, Kansas, New Mexico, each of which has about five. It would be one of the few states west of the Mississippi River that plans to protect abortion access in the event the Supreme Court overturns Roe v. Wade.

In that landscape, Colorado is viewed as “a safe state for abortion access reproductive health,” said Katherine Riley, policy director for the Colorado Organization for Latina Opportunity Reproductive Rights, or COLOR.

But Colorado state law doesn’t explicitly guarantee access to an abortion. Legislators in the Democratic-controlled General Assembly just passed a bill that establishes that every pregnant individual “has a fundamental right to continue a pregnancy give birth or to have an abortion.” Democratic Gov. Jared Polis has said he would sign it into law.

The bill does not include any funding for low-income women to get abortions, which abortion rights proponents say will continue to limit access. A constitutional amendment from the 1980s forbids public funding of abortion, that means low-income residents often are forced to pay out-of-pocket. Federal Medicaid funds also can’t be used to cover abortions. But Medicaid is a joint federal-state program, 16 states use their own Medicaid funds to cover the procedure.

Rep. Meg Froelich, a Democrat from Greenwood Village, Colorado, who is one of the bill’s sponsors, said the measure would prevent counties, municipalities, or any local entity from reversing abortion protections if Roe falls. “That was one of the main reasons why we felt it was really important to get this on the books,” Froelich said.

But COLOR’s Riley said the new Colorado bill is not enough to permanently protect abortion access, pointing to the strong opposition by Republican lawmakers. She sees the bill as a stopgap measure until 2024, when abortion-rights advocates hope to present Coloradans with a ballot measure that would enshrine access in the state constitution.

“This will hold us,” Froelich said of the bill. “We do feel like this carries us into 2024.”

Conservative lawmakers in states considering abortion bans have recognized that residents may look to states such as Colorado in the future. In Missouri, where a state law banning most abortions after eight weeks of pregnancy is being challenged in court, one legislator is trying to make it illegal to help a Missouri resident get an abortion, regardless of what state it occurs in.

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