By Kristi Eaton for The Daily Yonder.
Broadcast version by Roz Brown for New Mexico News Connection for the Public News Service/Daily Yonder Collaboration

The man had died three years prior. His widow was seeking about $700 a month in benefits under the Black Lung Benefits Act, a federal law allocating money to miners who suffer from pneumoconiosis or black lung disease.

"We were discussing all the problems that the widow had gone through, and that hit home very hard to the people who participated in the program," said Dr. Akshay Sood who had launched Miners Health ECHO shortly after moving to New Mexico.

When Sood moved to New Mexico, he was quickly overwhelmed by patients, many of them former uranium miners who were suffering from radiation exposure and couldn't find a single physician who would accept their federal benefits card. Many of the patients came from Latin America or were from rural isolated communities. Some didn't speak English.

Miners Health ECHO is different from traditional telemedicine: Whereas telemedicine supports a one-to-one transactional visit between a patient and a physician, telementoring supports a community of learners.

While a number of the leading research universities with strong name recognition offer training in lung diseases, many are not congruent with the rural populations that need them most, Sood said.

"The best programs exist at Harvard, at Yale, at Seattle, at Emory," he said in an interview with the Daily Yonder. "The need is in places like New Mexico, Montana, Wyoming, Utah."

Some of the most well-intentioned researchers and academics working also don't quite understand what rural people really need, he added.

"When you work in rural communities, you realize that rural people have a shortage of resources, but they don't have a shortage of innovation," he said. "And they innovate with what they have, and they do a really, really good job at it. And homegrown solutions are incredible, and you have to learn from them."

And sometimes it's giving space to people who may otherwise be unable to have a voice. Miners, Sood said, often come from underrepresented and underresourced populations. They lack advanced degrees, and in New Mexico, more than 70% come from minority backgrounds, he said.

A typical program starts with an introduction and announcements, Sood said, which lasts about five to 10 minutes. An expert usually speaks for about 15 minutes, followed by questions and answers for 20 minutes. That is followed by a case discussion, which takes about 30 minutes. Finally, the case is summarized and notes are exchanged, with the program lasting about 75 minutes.

"There's geographic diversity," he said. "There's cognitive diversity, so it's relevant to all stakeholders. Otherwise, what happens is that the two stakeholders that take up a lot of a lot of verbal space are physicians and lawyers. And so we have to make sure that there's adequate space for other stakeholders to articulate their opinions."

Specialized medicine is often expensive, and is typically distributed in populated areas and close to more affluent populations, said Bobbi A. Gore, program manager with Black Lung & Outreach at Miners' Colfax Medical Center in Raton, N.M.

"Miners who need specialized services are often in rural and less affluent communities," Gore said in an email interview with the Daily Yonder. "Telemedicine overcomes this bias, and encourages distribution of specialized medicine to miners that would otherwise be unserved or underserved."

"These are real problems real people face," Sood said. "They're very few people who want to deal with the compensation system, because, typically, they're complicated. You don't get compensated for filling out all that paperwork... It's very clear that you can't help a miner with chronic disease without addressing the compensation benefits issues as well."

Kristi Eaton wrote this article for The Daily Yonder.

New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.

The California State Assembly is considering a bill to require schools to have a cardiac arrest response plan. Assembly Bill 2887 would make sure schools update their safety plans to include CPR training and an automatic external defibrillator or AED onsite.

Dr. Stephen Sanko, a professor of clinical emergency medicine at USC, and a founding member of the Cardiac Arrest Survivor Alliance, is a volunteer expert for the American Heart Association. He said having a plan in place is critical.

"The American Heart Association is promoting that schools have a cardiac arrest response plan. A written protocol for what to do in order to decrease the likelihood that if somebody collapses, that they die," he said.

Two years ago, 15-year-old Cash Hennessy collapsed on the football field due to a previously unknown heart defect. Two off-duty medics in the stands gave him CPR. The school brought out its AED - but it was useless, because the batteries were dead.

Hennessy said the experience was traumatic.

"I feel blessed that I had people there for me, that could give me C-P-R. But I think about if those people weren't there and that was another kid, who knows what would have happened? Because there wouldn't have been an AED to save them," he explained.

An AED walks people through the steps to deliver a life-saving shock to a person's heart until an ambulance arrives. Studies show that 70% of kids who suffer sudden cardiac arrest at school recover if an AED is deployed correctly - whereas the survival rate for kids and adults not in the hospital is less than 12%.