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November 27, 2014

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THE FUTURE OF NEVADA :

What’s at stake, for those who need and care

Thousands of Nevadans are feeling the effects of budget cuts, while bracing for the worst. Here are some of their stories.

THE PEDIATRIC PHYSICAL THERAPIST

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Physical therapist Edwin Suarez looks at a leg brace to make sure it is straight for a pediatric patient at his office in Las Vegas on Tuesday, Dec. 23, 2008. Suarez has expanded his practice from strictly pediatric to adult physical therapy because it is more lucrative, but he fears he cannot continue to see patients with Medicaid insurance because the reimbursement rate was reduced drastically in the last round of budget cuts.

Edwin Suarez earned a scholarship to study physical therapy at UNLV by agreeing to work with the region’s badly underserved child population for two years after earning his degree.

He was hooked immediately.

“You grow to love the kids. Emotionally, you get attached to them and their parents,” he said.

With the most recent round of state budget cuts, his Medicaid reimbursement rate for providing physical therapy was cut from $130.60 per session to $92.32. His practice has lost money every month since.

Even the children whose parents have good private insurance often must rely on Medicaid because private insurers cap the number of visits well below what is necessary for good treatment. Moreover, unlike adults, child patients require one-on-one care, not just because of temperament, but also because their disabilities are often neurological and quite profound. Without Suarez’s help, many of his patients will never learn to walk or be independent.

Suarez has seven employees, and before the Medicaid cut, he had taken out a line of credit against his house to begin work on a new facility, though that was before the budget cuts, so he wonders how viable his expansion plan is.

He and his wife, who helps him manage the practice, wonder if Nevada is the place to raise their 22-month-old daughter.

To stay solvent, Suarez says, he’ll have to consider phasing out pediatrics and treating only adults because treating children is losing him money.

In that case, parents will have few options.

Children’s Therapy Center would be one of them, but it closed one of its three clinics several months ago — even though there’s a waiting list — because the Medicaid cut meant it couldn’t afford to hire therapists, said Beth Ward, the centers’ pediatric group director.

She may have to close another clinic as losses mount.

Children who need more acute care are also in danger because Southern Nevada’s five pediatric orthopedic surgeons have stopped accepting new Medicaid referrals, Ward noted.

—JPC

THE PHYSICALLY HANDICAPPED CHILD

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Physical therapist Edwin Suarez works with Medicaid patient Maliylah Silva, who has been diagnosed with spinal muscular atrophy, at his office in Las Vegas Tuesday, Dec. 23, 2008. Silva needs regular therapy sessions for her degenerative condition, and Suarez fears he cannot continue to see patients with Medicaid insurance because the Medicaid reimbursement rate was reduced in the last round of budget cuts.

Ashley Silva works at Nordstrom’s Cafe, but with no insurance, she depends on Medicaid.

Her daughter Maliylah is a bright, happy girl, but as an infant didn’t kick or squirm as babies should. She was diagnosed with spinal muscular atrophy.

Maliylah has poor muscle tone and no control over her trunk. She can’t stand up or walk on her own, and because she’s is too weak to cough, she’s connected to a machine twice a day to have fluid shaken from her lungs. Pneumonia could kill her.

She sees Edwin Suarez for physical therapy three times a week, with an additional day of occupational therapy.

The condition is degenerative — without therapy, she will regress.

She can stand now, with help of a hip-knee-ankle orthotic, a brace fitted for almost her entire body.

Bathing is easier, her mom says, because she doesn’t fear her daughter drowning.

Suarez, who treats lots of kids with severe conditions, gives Maliylah cones that she throws into a basket, forcing her to stand, turn slightly and use coordination to get the cone in the basket. It’s painstaking and difficult work, but without it, Maliylah has no future to speak of.

Occasionally, during this work, she slowly falls, like a building imploding. Suarez catches her.

With last year’s Medicaid cuts, Suarez is losing money now, and he’s considering phasing out pediatrics. He’ll treat some patients at a loss, and but he can’t treat them all.

—JPC

THE SCHOOLTEACHER

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Kerri Soper, who teaches third grade at Bob Forbus Elementary School, puts more words on her word wall while readying the classroom for her students to return from track break Friday, Jan. 9, 2009. Soper struggles to pay her bills and says a 6% pay cut would be a financial burden.

Kerri Soper came here in 2006 for a teaching job, knowing the Clark County School District didn’t have the best reputation.

But the recent Marquette University grad from suburban Chicago wanted to teach, and jobs in the Midwest were hard to come by. Here, Soper would teach seventh grade English and, she hoped, broaden her horizons.

Even though she lived with two other teachers, her starting salary of about $35,000 required her to take a part-time job. Soper wasn’t alone.

Teachers in Clark County, the nation’s fifth-largest school district, are paid below the national average.

Moreover, Nevada ranks near the bottom of the list nationally when it comes to per-pupil funding, and Clark County has some of the largest classes in the country, particularly at its high schools.

Soper, 26, has since switched schools — now she teaches third grade — and quit the part-time job because of time demands. Many of her colleagues, she said, have had to provide their own copy paper and constantly dig into their own pockets to supplement meager art budgets. Making rent is a monthly struggle — and now the governor has proposed a 6 percent pay cut.

“We all live paycheck to paycheck and live very modestly,” Soper said. “I understand the budget needs to work for everyone, but I don’t think teachers can take any more hits.”

If her pay is cut, Soper said, she’ll seriously consider quitting. Many of her colleagues, she said, are having similar thoughts. Indeed, half of Clark County’s teachers leave the district within five years.

Nevada’s approach to education has been profoundly disappointing, she said.

“Where I come from education is the most important thing. It’s the foundation and the pathway to success,” Soper said. “Coming out here has been eye-opening. Education has always taken a back seat.”

—MJM

THE COLLEGE STUDENT

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April Seelig is a junior public relations major at UNLV who has been affected by the budget cuts with larger class sizes and less class offerings.

April Seelig, 20, wants to graduate from UNLV on time next year.

So the junior communications major is taking six classes this semester, worried that budget cuts will kill a required advertising course. And she’s upset that much of her instruction is happening online because the number of course offerings was cut recently and classes filled quickly.

“I’m really just sick of the whole situation,” she said. “I’m ready to get into the professional world and not have to worry about whether I’m going to graduate or not.”

Seelig, whose focus is public relations, saw the crunch coming. The university, she said, has cut classes and increased class sizes. Some of her media ethics classmates went without desks.

To satisfy her graduation schedule, Seelig was supposed to take “Advertising and the First Amendment.” But when that course instructor left UNLV, her only option for graduation was to take “The History of Journalism” instead.

As a public relations student, she said she feels cheated.

Still, Seelig counts herself lucky. Her parents enrolled in Nevada’s prepaid tuition plan years ago, so her tuition is paid. Many of her classmates, she said, are struggling to pay for classes because of rising student fees. Millennium Scholarship money isn’t stretching as far as it used to.

Moreover, state legislators raided the program last year to plug budget holes. The fund is almost broke.

—MJM

THE COLLEGE PROFESSOR

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Sondra Cosgrove, chairwoman of the CSN Faculty Senate, works on her online classes for the next semester in her office at the College of Southern Nevada's Charleston campus in Las Vegas on Wednesday, Jan. 7, 2009.

As chairwoman of the College of Southern Nevada’s faculty senate, Sondra Cosgrove is in the business of logging professors’ complaints, and these days there’s plenty to complain about.

With departmental budget cuts, things as fundamental as course syllabuses and classroom handouts are going extinct — at least in paper form. Printing costs have forced professors to post online, she said. More problematic are dwindling course offerings and ballooning class sizes.

Budget cuts, Cosgrove said, could not have come at a worse time. Because of the deepening recession, scores of Southern Nevadans are going back to school to learn new skills and buff their resumes. Enrollment was up 6 percent last semester and if the state cuts deeper, CSN may turn students away.

“We have always been the institution of last resort; no matter what, you can come here and we will help you,” Cosgrove said. “Now we’re going to have to tell a tremendous amount of students, ‘We can’t help you. We have no classes to put you in.’ ”

And it’s not just classes. Entire programs will be cut if the state goes through with another round of cuts, Cosgrove said.

Indeed, Executive Vice Chancellor Dan Klaich told the Board of Regents last month that cutting more than 14 percent from the budget would essentially dismantle Nevada’s higher education system.

Cosgrove has lived here for 22 years and says things have never been so dire. The dilemma, however, remains the same. “We all want to have these services,” she said, “but nobody wants to pay for them.”

—MJM

THE PAROLE AND PROBATION OFFICER

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Department of Public Safety Officer David Deuel, right, who is in the Gang Unit, visits the home of Travion Tyler, 19, who is on probation and house arrest, while on patrol in Las Vegas on Wednesday, Dec. 31, 2008. Though Deuel's caseload in manageable, many officers in the Department of Public Safety have almost twice the normal caseload, and monthly mileage restrictions that make it impossible to do any home visits.

Officer Dave Deuel considers himself one of the lucky ones.

State budget cuts haven’t touched the gang unit yet. As a state parole-and-probation officer dealing exclusively with gangs, Deuel conducts dozens of unannounced home visits and scheduled follow-up interviews every month. He has to keep his caseload manageable.

Deuel’s parolees and probationers are the most likely to be repeat offenders, in part because they’re constantly surrounded by gang members. Temptation, he says, is always around the next corner.

Take, for instance, the 30-year-old who got busted for “battery with substantial bodily harm.” One morning last month, Deuel banged on his door, waking him up, to search the house for drugs and weapons and to see whether he had a job, as ordered. The fellow told Deuel he had just gotten a job as a cook at KFC. Deuel congratulated him — and promptly told him to produce a pay stub by day’s end.

After a half dozen visits it’s clear the probationers need regular pressure, and Deuel’s caseload — about 35 or so — allows him to apply it.

Officer Andrew Davis isn’t so fortunate. A rookie officer in the “general supervision” unit, Davis oversees the gamut of offenders, from petty thieves to murderers, and his current caseload is 148 — more than double the division’s target ratio.

Budget cuts have frozen 60 open positions in Southern Nevada. And to save additional money, public safety officials have put their officers on a leash, ordering them to not drive more than 700 miles a month. That’s roughly 23 miles per day per officer.

“The most we can do is prioritize,” Davis said. “We try to keep our eyes on the worst of the worst.”

When the allotted miles run out, Davis resorts to meeting with parolees and probationers in his office. It’s not nearly as valuable as a home visit, he said. And it’s often worthless because many convicts don’t keep appointments, Davis added.

What will further budget cuts mean? “Less supervision, more crime.”

—MJM

THE PEDIATRIC ORTHOPEDIST

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Dr. David Stewart puts a cast on patient Makenna Millett, 3, during his office hours in Las Vegas on Friday, Jan. 2, 2009. Dr. Stewart is one of just five pediatric orthopedic surgeons in southern Nevada. Because of cuts in the reimbursement rates, he and his partners are no longer accepting Medicaid patients

Dr. David Stewart, one of only five pediatric orthopedists in Southern Nevada, said his group’s decision to stop taking new Medicaid referrals was tough because working with children is gratifying. “They’re the future our society,” he said. “It’s a way to make a difference.”

But he and his partners had no choice. The reimbursement for procedures was cut 41 percent. At the time, Medicaid patients made up one quarter of their practice, so they were bleeding money.

He and his colleagues still take Medicaid patients when they do their hospital shifts and continue to treat existing patients with ongoing problems.

Medicaid will now likely have to send children out of state for orthopedic care.

This environment turns off doctors who consider moving here, Stewart said: “We’ve talked about bringing on a fourth partner, but there’s no way we could attract a viable person.”

—JPC

THE DEVELOPMENTALLY DISABLED ADULT

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Christina Sablan, 26, and her mother Julie Olvera talk in Sablan's bedroom inside her apartment in Las Vegas on Wednesday, Dec. 31, 2008. Sablan, who had a viral infection in her brain as a baby and brain damage as a result, had little success in 12 group homes and on multiple medications. A year and a half ago she was given her own apartment, with supervised staff, and has flourished in that environment, says her mother, who communicated with her daughter through sign language and written notes.

Julie Olvera held back tears the first time she watched her 26-year-old daughter pull out the keys to her own apartment.

Olvera’s daughter, Christina, is nonverbal, the result of a viral infection in the brain while she was an infant, and the apartment was her 12th placement in 10 years. The group homes were a nightmare, she said. Staff did not understand Christina’s unique disability, Olvera said.

“She is very smart and alert, but she can’t express her feelings,” Olvera said.

That led to behavioral outbursts, and at one point, Christina was taking 15 medications. Olvera said staff at the last group home beat her daughter with a broom, leaving a gash on her head. In 2007, the state tried a different approach. It awarded Christina her own apartment — with 24-hour supervision.

“It was amazing,” Olvera said. “We had a whole new young lady.”

Six months later, the state, looking to cut costs, tried to take the apartment away.

With the help of a lawyer, Olvera fought and won. Now, with more cuts on the horizon, the prospect of losing the apartment — and entering another group home — is back. “Group homes do not work for her,” Olvera said. “It will be a total disaster, and they know it.”

—MJM

THE CHILD IN SPEECH THERAPY

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Cory Steelsmith, 11, plays a video game while waiting for his therapist at Henderson Speech Hearing and Language Center on Wednesday, Dec. 24, 2008. Cory has had three open heart surgeries, and during the first he suffered brain damage that affected his speech, motor skills and socialization. Henderson Speech, Hearing and Language Center's Elissa Mandel, a speech-language pathologist, is seeing Cory pro bono.

Medicaid owes Henderson Speech, Hearing & Language Center $50,000, money tied up in red tape, and with last year’s cut in the reimbursement rate, the clinic no longer accepts new Medicaid patients, director Elissa Mandel said.

Chele Steelsmith and her 11-year-old son, Cory, got their foot in the door. For other Nevadans, this could have devastating consequences.

Cory has had three open-heart surgeries, and during the first he suffered brain damage, affecting speech and motor skills and socialization, much like the disorders suffered by autistic children.

Cory’s father is lead show carpenter for “Mystere,” but even their good insurance doesn’t cover therapy, so Cory gets Medicaid.

They’ve been coming to Henderson Speech for 2 1/2 years, during which Cory has made great progress in learning how to express himself, Steelsmith said. He is less frustrated.

As Cory was getting therapy in another room at Henderson Speech, Steelsmith described watching her son begin to progress: “All of a sudden, these kids who never did puzzles before, they were doing puzzles! The difference once he got here, it’s amazing.”

—JPC

THE AUTISTIC CHILDREN

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Phil and Rachelle Reynolds watch an educational television program with their sons Sebastian, 4, and Eli, 2, before bedtime for the boys at their home in Henderson on Tuesday, Dec. 30, 2008. Both Sebastian and Eli have been diagnosed with autism and the Reynolds have struggled financially with their specialized care.

Rachelle and Phil Reynolds bring their boys Eli and Sebastian to JabberJaws for intensive speech therapy. The boys are autistic, but their parents fear that because the children are higher functioning than other autistic children, they’ll soon lose Medicaid coverage if the state cuts funding.

Rachelle promised Boston-native Phil in 2004 that they could give Sebastian the middle name “Fenway” if the Red Sox won the World Series. It seemed a safe bet at the time.

And so, Sebastian Fenway Reynolds it was.

Phil is a bartender at the Wynn and has the good Culinary Union insurance, but therapy for autism isn’t covered.

They drained their savings paying out of pocket for a while, and now they’re on Medicaid.

Rachelle has a simple hope for Sebastian, and she chokes up a little talking about it: “I just want him to be able to make his own choices that lead him to happiness.”

When the school district crafted his individualized education plan, “I was crying,” she said. “And I said, ‘I just want for him not to need me one day.’ ”

Without treatment, she fears Sebastian and Eli will regress, becoming more and more dependent on their parents, and eventually the state of Nevada.

—JPC

THE SPEECH THERAPIST

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Therapist Julie Cole, center, and mother Drew Belk, left, help 13-month-old Emma Belk learn to eat during feeding therapy at Cole's office in Las Vegas on Tuesday, Dec. 30, 2008. Belk, who has Medicaid insurance, has been in feeding therapy since November 2008 and has made a lot of progress, though Cole fears she may have to stop taking Medicaid patients because the reimbursement rate has been cut in Nevada.

Julie Cole came to Nevada from Michigan when University Medical Center offered her a job as a speech therapist, and then she set up a practice, JabberJaws, in 2004. She has two partners, an employee and 120 patients.

Cole works with children who often have severe disabilities, including trouble feeding and swallowing.

She works with babies, for instance, who aspirate, taking food or water into their lungs.

Many of her patients are autistic children who “don’t recognize their own mother as more important than that chair. When you move the child through the continuum,” she said, referring to a successful treatment process, “that is so rewarding.”

Two of every five of her patients are on Medicaid, and her reimbursements from Medicaid were cut 27 percent last year.

She comes in Saturdays to do clerical work, which includes Medicaid’s Byzantine process for reimbursement.

She won’t stop taking Medicaid patients, though: “I have a hard time doing that for ethical reasons — should I be making decisions about who gets care?”

To meet overhead, she’s considering cutting sessions to 30 minutes, which is not enough for many children.

Cole is baffled by the state’s cuts, which she argues will only lead to greater expense later. A child who cannot swallow or talk, she said, will be an adult who will require public assistance.

—JPC

THE PARENTS PAYING CASH

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Pierce Laurent, 5, gets a hug and kiss from his mother Robin after speech therapy at Henderson Speech Hearing and Language Center on Wednesday, Dec. 24, 2008. Pierce has been diagnosed with autism and the neurological disorder apraxia, and will need intensive daily therapy if he's ever to become independent, says his mother.

Robin Laurent is a tough advocate for her autistic son, Pierce.

Regardless, they’re no longer eligible for services he needs at Desert Regional Center, which has borne the brunt of state budget cuts.

“Children with autism have a window of early intervention. If you don’t capture language before age 6, you won’t get there,” she said.

Pierce is 5.

She and her husband have five degrees between them, but their out-of-pocket expenses are at least $18,000 per year for therapy and other costs, and they’re worried about the financial abyss.

“All of a sudden, we’re upside down. How did we wind up upside down?”

She has friends in the autistic community who have left Nevada for states that offer better services.

Pierce has to be rewarded for every little bit of progress, which is how he learns. His motivators are food first, and he’s a good little eater, and touching and tickling second. So as his therapist, Elissa Mandel, sits with him and he accomplishes a task like learning to say “Mama,” she rubs his arms and tickles him. He seems to really like it.

—JPC

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