| PostIndependent.com

Colorado stakeholder group outlines recommendations about when wolves could be killed

An advisory group working on Colorado’s wolf reintroduction process believes if wolves are actively attacking livestock, they can be killed by wildlife agents and, in some cases, livestock producers.

Initially, producers would need to obtain a permit to take a wolf that is attacking livestock, but when populations are large enough to be delisted — at least 150 wolves sustained for two years — no permit would be required.

“The vast majority of wolves that are anticipated to be on this landscape are not going to be involved in any type of conflict,” said Eric Odell, Colorado Parks and Wildlife’s species conservation program manager.  

The recommendations come from Stakeholder Advisory Group, one of two working groups helping the agency fulfill a 2020 ballot measure to reintroduce gray wolves in Colorado by the end of 2023. The stakeholder group lacks rulemaking authority, but recommendations will be incorporated in the final reintroduction plan that CPW expects to have finished by the end of the year.

Odell presented the group’s recommendations to the CPW Commission on July 22, noting that lethal management is one of many tools available and shouldn’t be considered a “first line of defense.”

“At a population scale, this type of management is not a threat to the long-term viability of the species,” Odell said. “Lethal control is not intended to be a long-term tool across both space and time. It is a short-term response to an immediate issue.”

Current recommendations for reintroduction suggest it will be carried out over three phases. Phase 1 would be when wolves are still considered “endangered” at the state level. Phase 2 is referred to as “threatened,” with this transition occurring after CPW documents at least 50 wolves for four years.

Phase 3 would correspond with de-listing wolves on a state level. This would happen if there are 150 wolves for two years, or at least 200 wolves. Odell said CPW views these thresholds as minimums, not population goals.

The group recommends that wolf education and nonlethal tactics to haze a wolf are preferred to lethal management in all phases.

Killing a wolf wouldn’t be allowed in a case where wolves are present but not attacking livestock. Noninjurious tactics like fladry, range riders and guard dogs as well as injurious tactics like rubber buckshot would be encouraged if needed.  

When wolves are caught in the act of attacking livestock, and nonlethal tactics have been tried, recommendations say state or federal officials could kill the wolf. In Phases 1 and 2, a producer could kill the wolf if they obtained a state permit and they provide evidence of an attack.

In Phase 3, the producer wouldn’t need a permit, but the case will still be investigated by CPW to ensure there was actually an attack.

If wolves are determined to be a chronic problem, state and federal officers can decide to kill the wolves regardless of the phase. In some cases a producer may obtain a permit to take a chronically depredating wolf, but the stakeholder group wanted CPW officials deciding whether a wolf has become that much of a problem, not producers.

“They intentionally did not make a recommendation to state that a particular number of depredations within a particular period of time would be classified as chronic; rather, evaluation of the entirety of the situation will inform CPW in making this determination,” Odell said.

Recommendations also consider what to do if the presence of wolves leads to a decline in ungulate — deer, elk, moose — populations in a particular area. The group agreed these wolves could be relocated, but they did not take a vote on whether they could be killed. The group made the same recommendation regarding wolf impacts on other species like sage grouse and Canada lynx.

In a parallel effort to the working groups, Reid Dewalt, CPW’s assistant director for aquatic, terrestrial and natural resources, said the U.S. Fish and Wildlife Service is starting the process to get CPW what is called a 10(j) ruling under the Endangered Species Act.

When voters initially passed the 2020 ballot measure, wolves were about to be delisted, after which management authority would go to CPW. But a court ruling in February relisted wolves and put the Fish and Wildlife Service back in charge. The 10(j) would designate Colorado’s wolves an “experimental population” and give CPW authority to manage them.

This will require an environmental review, which is currently under a 30-day review process. The Fish and Wildlife Service is holding several public meetings on the potential ruling, including one from 6-8 p.m. Thursday, Aug. 4, at Moffat County High School in Craig.

“If all goes according to plan, late fall of 2023 the record of decision and final rule will be published,” Dewalt said.

To reach Dylan Anderson, call 970-871-4247 or email danderson@SteamboatPilot.com.

Why the Forest Service did not take all the water rights when it acquired Sweetwater Lake, Colorado’s newest state park

SWEETWATER LAKE — When the U.S. Forest Service acquired Sweetwater Lake in 2021, the agency did not pick up all the water rights associated with the property that is slated for development as Colorado’s newest state park. 

The Conservation Fund, which acquired the property in 2020, retained water rights that did not transfer over when the conservation group sold the property to the Forest Service last year. 

That troubles Garfield County’s commissioners, who are demanding details of the complex deal that landed the private acres in federal hands and how the new state park will be managed. 

“The general concerns of Garfield County concern this entire transaction, both the money side of it as well as the planning and the agencies following their own procedures, rules and regulations,” commissioner Tom Jankovsky said earlier this week as the three-member board signed a letter sent to the Forest Service. 

The overlapping state and federal processes to develop the park have not gone smoothly. A longtime outfitter at the lake is struggling to bring old buildings up to federal standards, fearing her decades-old outfitting business could be lost. Locals wonder if the now state-managed federal lands will draw unsustainable crowds to the remote lake at the end of a dirt road in Garfield County. 

Read the full story via the Colorado Sun.

The Colorado Sun is a reader-supported news organization dedicated to covering the people, places and policies that matter in Colorado. Read more, sign up for free newsletters and subscribe at coloradosun.com.

Declining levels at Lake Powell increase risk to humpback chub downstream

As climate change continues to shrink the nation’s second-largest reservoir, water managers are scrambling to prevent the release of an invasive fish into the Grand Canyon.

Smallmouth bass, a voracious predator and popular game fish, have been introduced into reservoirs throughout the Colorado River basin, including Lake Powell. The looming problem now is that as lake levels drop to historically low levels, the invasive fish are likely to escape beyond Glen Canyon Dam, threatening endangered fish in the canyon, whose populations have rebounded in recent years.

Smallmouth bass are a warm-water-loving species, hanging out in the top part of the water column, which is warmed by the sun. Until recently, the intakes for turbines at Glen Canyon Dam had been lower in the water column, where colder temperatures kept the fish away. But as the lake level falls, the warmer water band containing the smallmouth bass is sinking closer to the intakes, making it more likely that they will pass through the dam to the river below.

This invasive smallmouth bass is eating a native flannelmouth sucker. The smallmouth bass is a predation threat because they can eat fish up to half their own length and become fish-eaters when they are only a few inches long.| Photo by Melissa Trammel

Warmer water below the dam also means a more ideal environment for the bass, which thrive in temperatures above 61 degrees Fahrenheit (16 degrees Celsius).

“With the levels we are expecting to get to this coming year, water temperatures are going to be warmer than they’ve been in 52 years in the Grand Canyon,” said Charles Yackulic, a research statistician with the U.S. Geological Survey’s Grand Canyon Monitoring and Research Center.

The research center has been modeling the likelihood that smallmouth bass will become established below the dam under different scenarios and providing that information to decision-makers and water managers.

The confluence of the Colorado and Little Colorado rivers in the Grand Canyon, shown here in a September 2020 aerial photo from Ecoflight, represents an area where the humpback chub has rebounded in the last decade. That progress is now threatened by declining water levels in Lake Powell, which could lead to non-native smallmouth bass becoming established in the canyon.| Jane Pargiter/Ecoflight

Jack Schmidt, a Colorado River researcher at Utah State University and former director of the research center, co-wrote — along with Yackulic and others — a March 2021 paper that sounded the alarm that future warming is likely to disproportionately benefit nonnative fish species to the detriment of native species. The problem from which all others stem, including the changing fish communities, and the reason Powell is so low in the first place is the climate-change-driven, supply-demand imbalance, Schmidt said.

“If we are going to continue to load the atmosphere with carbon such that the atmosphere warms and the runoff in the Colorado River keeps getting lower and if we are going to keep consuming water … then you can only play this game of staving off the inevitable for so long before it’s game over,” he said.

Threat to humpback chub

Although the trout fishery and other native fish around Lees Ferry would also be hurt by the bass, the biggest risk would be to the fish listed under the Endangered Species Act (ESA), including the humpback chub.

“The biggest concern for a lot of stakeholders is how it could affect humpback chub and razorback sucker,” Yackulic said. “Over 90% of humpback chub are found in the Grand Canyon reach, and they have been doing really well over the last 10 years.”

So well in fact that in 2021 the U.S. Fish and Wildlife Service down-listed humpback chub’s status from endangered to threatened, a decision based partly on the thriving populations in the Grand Canyon. The down-listing means the chub still retains some ESA protections, but it is no longer at immediate risk of extinction.

This humpback chub was found in Havasu Canyon. The fish, which was recently downlisted from endangered to threatened status, is at risk from non-native predators like the smallmouth bass.| Amy Martin Photography

Scientists think that smallmouth bass are responsible for decimating humpback chub populations in the upper basin — for example, near Echo Park, at the confluence of the Green and Yampa rivers.

“We are very concerned that if they get into the Grand Canyon, they could have a similar impact on the humpback chub and, through predation and competition, could jeopardize that new listing of being threatened,” said Melissa Trammel, a fisheries biologist with the National Parks Service. “Our efforts to try to restore that species in the canyon would definitely be impacted.”

‘No low-hanging fruit to prevent this’

This graphic shows the levels needed in Lake Powell to maintain hydropower production. As levels decline, it becomes more likely that smallmouth bass will pass through the dam and threaten populations of native fish downstream.| U.S. Bureau of Reclamation

The Glen Canyon Dam Adaptive Management Program has formed a technical work group subcommittee to address the problem. Several ideas have been floated: installing a bubble curtain that could keep fish away from the dam intakes; electro-fishing and removal of smallmouth bass below the dam; selective withdrawal devices that allow dam operators to pull from different parts of the water column; or releasing colder water from the deeper jet tubes once a week to make the temperatures below the dam inhospitable to the invasive fish. This, however, would mean bypassing the turbines that make hydropower.

Clarence Fullard, acting program manager for the Bureau of Reclamation’s Glen Canyon Dam Adaptive Management Program, said they are considering all options to prevent smallmouth bass from becoming established, but there is still a lot of uncertainty about a way forward.

“There’s really no low-hanging fruit to prevent this,” he said. “The scale of Glen Canyon Dam and Lake Powell make it hard to come up with solutions. We don’t know what we could do operationally.”

One thing that has seen some success on the Green River below Flaming Gorge Dam is something called a flow spike. A carefully timed, short, high-flow release from the reservoir can knock the fish off their nests and wash their eggs downstream. According to Trammel, this tactic has reduced the reproduction of smallmouth bass in that area by about 30%.

And because of the planned releases this year from Flaming Gorge under the Drought Response Operations Plan (DROA), this spike flow is scheduled again for later this month.

“The extra water being released from Flaming Gorge to go down to Powell is actually being reshaped to help endangered fishes in the upper basin,” Trammel said. “We would not have had that experimental flow this year without the DROA.”

For now, members of the technical work group are creating a strategic plan, a draft of which will be released in August. Scientists will continue monitoring in places where the smallmouth bass are likely to try to establish. Each year for the past decade, Yackulic said, monitoring efforts have caught up to three smallmouth bass who made it through the turbines and ended up below the dam.

“The thing about fish is for every one you catch, there’s probably quite a few you don’t catch,” he said.

Still, scientists don’t think the fish have become established enough yet for there to be a reproducing population below the dam. But time is of the essence.

Although the invasive-fish issue may get overshadowed by the crush of bad news surrounding the Colorado River — record-low reservoir levels, shortages, emergency federal actions, potential loss of hydropower — scientists say there is still an urgent need to act on it.

“The long-term cost of trying to control that species maybe doesn’t feel as urgent as losing hydropower at Glen Canyon Dam, but once they are established, it is almost impossible to get rid of them,” Trammel said. “There’s no agency in the world that says, ‘I wish I had waited a little longer to try and control this invasive species.’”

This infographic shows how as Lake Powell water levels decline, warm water containing smallmouth bass gets closer to intakes delivering water through the Glen Canyon Dam to the Grand Canyon downstream.| U.S. Geological Survey
 

But any operational changes to combat an invasion of smallmouth bass in the Grand Canyon are likely to be just a stopgap measure.

“We should never forget that the fundamental problem is much bigger than how to operate Glen Canyon Dam; it’s about the balance between watershed runoff and consumptive use,” Schmidt said. “And until we get consumptive use matching the available supply, we are always going to be flirting with disaster. We can only hold off these changes for so long before we lose the battle.”

Aspen Journalism covers water and rivers in collaboration with the Glenwood Springs Post Independent and other Swift publications. For more, go to http://www.aspenjournalism.org.

Thousands of Colorado patients put in peril due to risky prescribing of psych medicine

Gene Estes looks out over the mountains his son, Shayn Estes, loved as he has a smoke outside his Crested Butte condo Thursday, May 5, 2022. Gene found his son dead Oct. 17, 2020, from an overdose and believes benzodiazepines are responsible.
Christian Murdock / The Denver Gazette

Gene Estes implored his son, Shayn, to go to the emergency room that day, fearful he was having another reaction to his psychiatric medication. Shayn was forgetful, dropping things throughout the day, combative and disoriented during simple conversations.

“I wanted him to see any doctor available,” Estes said.

Gene was worried the dosage was off again. But Shayn, 33, brushed off his father’s concerns as an overreaction. He jumped out of the car after the two argued at the post office and took off walking the six blocks to his Crested Butte apartment.

That was the last time the father would see his son alive. He found Shayn the next morning, on Oct. 17, 2020, dead in his bed, lying on the top of the sheets, still clothed.

Nearly six months after Shayn’s death, a psychiatrist at Mind Springs Health, the community mental health center that runs West Springs Hospital, the Grand Junction psychiatric hospital where Shayn sought psychiatric care, filed a complaint with a state oversight contractor alleging potentially fatal prescribing of benzodiazepines at West Springs and potential harm to patients like Shayn.

An investigation into those claims by the state contractor, Rocky Mountain Health Plans, would eventually force the resignation of Dr. Thomas Newton, another psychiatrist at West Springs. Newton resigned in May 2021 after an investigation found he engaged in “aberrant prescribing” of benzodiazepines — the same drug he had prescribed Shayn Estes. It’s a drug the father now suspects caused his son to fatally overdose while sleeping, though he has no definitive answer.

“If Hippocrates could be found, he’s probably rolling around in his grave,” he said, referring to the ancient Greek physician credited with the Hippocratic Oath, which is still voiced today: “First, do no harm.”

‘A broken system’

The heavy reliance on benzodiazepines at Mind Springs has been alarmingly common in Colorado, with state reports identifying thousands of patients as at potential lethal risk because of unsafe prescribing practices, an investigation by The Gazette has found. Known as “benzos,” the anti-anxiety drugs include trade names like Klonopin, Valium, Xanax, Ativan and others, and they are soaring in popularity.

Even as state officials are seeking to rein in the use of benzodiazepines, prescriptions for the drugs nearly doubled over the past two years during a time when the COVID-19 pandemic battered psyches, said Dr. Robert Valuck, executive director of the Colorado Consortium for Prescription Drug Abuse Prevention, housed at the University of Colorado Anschutz Medical Campus.

“These are now the most commonly prescribed controlled substances in Colorado,” Valuck said.

Medicare prescribing data show that 98 practitioners in Colorado had a single year in which they had a higher volume of prescribing benzodiazepines than Newton in the years between 2013 and 2019. Of those, 1 in 5 had their medical license sanctioned by the Colorado Medical Board, and the board cited nearly a dozen specifically for risky benzodiazepine prescribing.

The Gazette also found heavy prescribing of benzodiazepines to Colorado nursing home residents, despite benzodiazepines putting the elderly at increased risk of disorientation, falls and broken bones. One doctor who worked for one of the top prescribers of benzodiazepines to nursing home residents in Colorado said he saw nursing homes he worked with use the drug to cover up staffing shortages and to inappropriately sedate restless residents.

“It’s a broken system,” said Dr. Hugh Batty, now retired and living in Sheridan, Wyoming, referring to what he termed excessive reliance on benzodiazepines he said he saw in nursing homes in Colorado.

Doctors who heavily prescribe benzodiazepines say the benefits outweigh the risks. The drugs are popular, because they quickly quell severe panic attacks and help with seizures and insomnia. But studies have found them to be addictive and disorienting, especially in the elderly, who are at increased risk of falls and fractures when they take them. Benzodiazepines also increase the risks of overdose when taken with opioids, alcohol or other drugs that can suppress breathing.

The U.S. Food and Drug Administration has placed a black-box warning, the most serious label from the agency, on benzodiazepines. The warning cautions that benzodiazepines significantly increase overdose risk when combined with opioids, and that they can also lead to physical dependence, addiction and misuse.

Benzos were among the 10 drugs found in the body of Foo Fighters drummer Taylor Hawkins, who died in March in a Bogota, Colombia, hotel room.

A 2013 study by the Centers for Disease Control and Prevention found that benzodiazepines were involved in about one-third of the fatal narcotic overdoses nationwide in 2010.

“Typically, where you run into challenges is when you combine anything else that can depress the central nervous system, like opioids or alcohol, with benzodiazepines,” said Dr. Christopher Jones, who co-authored the CDC study and is the acting director of the agency’s National Center for Injury Prevention and Control.

Another 2019 CDC study found benzodiazepines were involved in about a quarter of overdose deaths due to kratom, an herbal extract that is unregulated and requires no prescription that can also suppress breathing.

Despite the risks, state officials have found widespread reckless prescribing of benzodiazepines by Colorado doctors.

The Colorado State Auditor’s office reported last year that in 2018 and 2019 nearly 13,000 prescribers in the state prescribed a benzodiazepine to a patient already prescribed an opioid from a different prescriber. Nearly 18,000 prescribers ordered an opioid for a patient with a benzodiazepine prescription from a different prescriber in those years, the audit found.

The audit also found that during those years, the 20 prescribers who created the most prescribing volume for such dangerous drug combinations in Colorado allowed nearly 3,000 patients to obtain more than 13,000 concurrent prescriptions of benzodiazepines and opioids.

The Colorado Department of Health Care Policy and Financing, which runs the state’s Medicaid program, reported to federal regulators that it similarly found benzodiazepines were “widely prescribed” in 2018 with other drugs in Colorado, despite evidence that shows doing so is a major risk that leads to “increased central nervous system depression and respiratory depression.”

Valuck, the executive director for the Colorado Consortium for Prescription Drug Abuse Prevention, said recent data show Colorado prescribers are doing a better job of ensuring opioids and benzodiazepines aren’t prescribed in tandem. So far this year, about 6% of patients in Colorado were co-prescribed opioids and benzodiazepines, down from 14% two years ago, Valuck said.

“People who are writing opioid prescriptions are changing,” he said. “The co-prescribing is starting to drop this year.”

A father mourns

Newton heavily prescribed the benzodiazepine alprazolam, which goes by the trade name Xanax, for Shayn Estes, according to prescriptions provided by Shayn’s father, Gene, and reviewed by The Gazette. Gene Estes blames the benzodiazepines for the death.

“The prescriptions he was on left him pretty strung out,” Gene Estes said. “I would put it to the medication.”

Shayn Estes’ autopsy concluded that he probably died from an accidental overdose of kratom, though benzodiazepines prescribed by Newton were also among the drugs found in his body. The autopsy also stated that bottles of prescribed opioids, along with other medications for anxiety and depression, were found in Shayn Estes’ apartment, where the father found his son’s body.

Shayn struggled with epilepsy, which caused him to have seizures, and attention deficit hyperactivity disorder. He was in and out of West Springs Hospital in Grand Junction, where Newton treated him, according to his father.

Gene Estes and his son, Shayn Estes, pose outside Crested Butte shortly before Shayn’s death. Gene found his son dead Oct. 17, 2020, from an overdose and believes benzodiazepines are responsible. Shayn grew up close to his father after his mother died from breast cancer when he was 7.
Christian Murdock / The Denver Gazette

Shayn had struggled with his psychiatric medications before, Gene Estes said. Once, four months before Shayn fatally overdosed, an air ambulance had to take Shayn to St. Mary’s Medical Center because he was having trouble breathing, the father said. That time, doctors warned that Shayn was on double the normal dosage, according to the father.

Newton and officials with Mind Springs did not respond to requests for an interview. Mind Springs officials in response to earlier articles said in written statements that they have put in place a 17-point corrective action guide demanded by Rocky Mountain Health Plans that will limit and put new oversight over the prescribing for Mind Springs patients. RMHP is the private company that the state’s Medicaid program contracts to oversee Medicaid benefits on the Western Slope.

Gene, now 81, was 45 when Shayn was born. Shayn’s mother died when Shayn was 7. Gene and Shayn Estes were close and saw each other daily.

“He was virtually my only life, particularly from the time his mother died,” Gene Estes said.

Shayn, who took up photography at age 14, turned down a scholarship to study photography at the Savannah College of Art and Design in South Carolina that he was offered after winning second place in a local art contest. Gene Estes remembers Shayn saying he couldn’t take the scholarship because it would mean he would have to leave the mountains of Colorado, which he climbed and hiked every chance he got.

“He was on top of every single mountain in the valley at least once,” the father said. “There’s no place I can go from Crested Butte to Grand Junction that there aren’t memories along the way.”

He still hasn’t had the emotional strength to go through the more than 6,000 photos, many of them of scenic wilderness, that Shayn had taken. A high school friend of Shayn’s put all the photos on a thumb drive and left it for Gene so he could look at his son’s work when he is ready.

“I haven’t gone through them because of the emotion,” Gene said. “I’m getting to where I can. I’m getting to a point where I can start thinking about doing it.”

‘Holy Trinity’ prescribed to addict

Heavy prescribers of benzodiazepines sanctioned by the state medical board include Dr. Andrew Ho, who practiced internal medicine in south Denver. He prescribed what addicts on the street call the “Holy Trinity,” a dangerous combination of muscle relaxants, opioids and benzodiazepines, court documents show. Although the combination is in high demand on the streets, it carries potent dangers, because it depresses the central nervous system and breathing.

One patient told investigators Ho repeatedly prescribed the “Holy Trinity” drug combination to her at a time when she was addicted and “popping pills like candy.” Even after pharmacists warned Ho to stop the dangerous prescribing, he continued to do so, court documents state.

Ho was sentenced in January 2020 to five years of probation after he pleaded guilty in U.S. District Court to one count of prescribing without a legitimate medical reason in a plea agreement that resulted in the dismissal of 20 other criminal charges.

Ho remains licensed as a doctor, though he’s currently barred from prescribing and has been ordered by the Colorado Medical Board to take classes on proper prescribing practices before he can resume giving out prescriptions.

Ho, who did not return messages seeking comment, claimed in court documents that he was naïve and that “it was easier to prescribe medications than to engage in the difficult discussions that could result from conducting the necessary investigation to root out these issues.” Prosecutors argued Ho’s “rationalizations underscore the casual recklessness of the defendant’s serious crime.”

Another facility in Colorado with heavy benzodiazepine prescribing in the data, Springbok Health Inc., a substance abuse treatment center with clinics in Colorado Springs and Pueblo, and its owner, Mark Jankelow, last month agreed to pay between $125,000 to $335,492 to settle a whistleblower claim filed in U.S. District in Denver alleging health care fraud. The settlement, obtained by the U.S. Justice Department, settled allegations of fraudulent billing of Medicare and Medicaid for high-complexity and prolonged medical evaluation and management services never actually rendered. Jankelow did not return messages seeking comment.

When Congress in 2006 created Medicare’s drug program, called Part D, they decided not to pay for anti-anxiety medications like benzodiazepines. But lawmakers later reversed that payment policy in 2013 under pressure from patient groups and medical societies.

Medicare patients younger than 65 still can qualify for drug coverage due to a disability. Patients with disabilities made up about a quarter of Part D’s enrollees nationwide, but they use benzodiazepines disproportionately, according to studies.


The Gazette analyzed Medicare Part D prescribing data from 2013 through 2019 to identify who prescribed the drug heavily in Colorado during those years. The Medicare data represents only a portion of the prescribing in the state. The Gazette did not have access to data on prescriptions paid by Medicaid or private insurers.

Colorado’s heavy benzo prescribers include Dr. John Hardy, a Pueblo psychiatrist who specializes in child and adolescent treatment. He was among the top 10 prescribers of benzodiazepines in Colorado from 2013 through 2019, prescribing an amount that what would equate to providing more than 960 patients, each, a half year’s supply of the drugs. At a time when others in the top 10 have begun to cut back on their prescribing of benzodiazepines or kept their prescribing consistent, Hardy has increased his prescribing of the drug, the Medicare data show.

Drug companies paid Hardy nearly $900,000 from 2014 to 2020, records show. The drug company payments include consulting and speaking fees as well as travel, lodging and meals.

“I’ve been practicing for many years, and if you stay in the same place, you end up taking care of a lot of people,” Hardy said, denying that drug company pay shapes his prescribing decisions. “I’ve never spoken for a benzodiazepine company.”

Dr. Lora Shirar, a doctor who owns Golden-based Rocky Mountain Senior Care, which provides medical care to more than 650 nursing homes and assisted-living facilities in Colorado, had the highest peak-prescribing year for benzodiazepines in the state, according to the Medicare data. In 2016, she prescribed an amount equal to providing roughly 400 patients, each, a half a year’s supply of the drug, 45% more than the peak year for any other prescriber in Colorado, according to the federal data.

Shirar said she thinks the numbers are inflated, because they may include prescribing by other doctors who work for her business. Since 2016, benzodiazepine prescriptions from her dropped precipitously, down to what would equate to roughly eight patients, each, receiving a half year’s supply of the drug in 2019.

Four other doctors who worked for Rocky Mountain Senior Care had a higher peak year volume of prescribing than any peak year for West Springs’ Dr. Newton for the years analyzed.

The state medical board suspended the medical practice of one of them, Dr. Kurt Wever, in June 2018, when he worked for Rocky Mountain Senior Care, because it found aberrant and dangerous prescribing for four patients in 2011 through 2015.

Three of Wever’s patients — a 45-year-old female, a 48-year-old male and a 62-year-old female — had been taking opioids and benzodiazepines in tandem, documents show. Wever continued prescribing drugs after one patient overdosed and after allegations surfaced another patient was selling morphine, according to medical board documents.

The board also found that Wever didn’t taper drugs, evaluate “medication-induced” seizures in another patient or adequately investigate why another patient’s heart rate soared to 136 while on prescribed medications.

In July 2018, the board reinstated Wever’s license to practice medicine, concluding “that the public health, safety or welfare does not require emergency action at this time.”

Wever did not return telephone and email messages seeking comment. Wever’s prescribing issues occurred years before he worked for Rocky Mountain Senior Care, Shirar said, noting that the medical board had found no ongoing danger.

“When the reality of the case was fully disclosed and investigated, there was no concern,” she said.

Shirar said she and other doctors at her business take precautions when prescribing benzos for nursing home residents. She said there are monthly reviews in nursing homes to monitor prescribed medications.

“There is a check and balance,” she said. “And there is a balancing in the system where patients have rights and need to be engaged as long as possible. They have to have decision making. You can’t just stop everything. Sometimes you have to taper them off and get patient engagement. You have to respect their ability to make decisions.”

But Hugh Batty, who worked for Shirar’s business for two years, said he saw widespread misuse of benzodiazepines during his time in Colorado due to staffing shortages in nursing homes.

“It’s just a pervasive problem,” Batty said of the use of benzos he saw at the facilities where he worked. “The nursing home structure is broken. It’s one of the greatest liabilities we have in our society. People have just jumped in to make money.”

He said doctors like him and Shirar try to limit the use of benzodiazepines for nursing home residents, but nursing home administrators want them prescribed heavily because they don’t have enough employees to monitor residents. The benzos sedate residents and make them easier to control, Batty said. The nursing home administrators will fire doctors if they don’t go along, he said.

“The patients don’t have enough one-on-one care,” he said. “That’s the problem. In order to make ends meet and address the bottom line in a business model, they go short on staffing in nursing homes.”

“You put them on too many benzos, and they are more at risk of falling. It’s not the prudent practice of medicine,” he said.

“You get someone 85, and you give them Xanax — Christ almighty, unless you have someone on each side of them when they’re walking, they’re going to fall down,” Batty said

He added elderly nursing home residents are prone to broken bones if they fall. “And a broken hip at that age is essentially a death sentence,” he said.

State regulators try to limit use

The heavy use of benzodiazepines in Colorado has generated debate over whether state regulators are doing enough to rein in their use. An audit released by the Colorado State Auditor’s Office in 2021 recommended that state regulators and law enforcement be allowed access to prescribing data in Colorado to identify medical practitioners with aberrant prescribing of benzodiazepines.

Regulators in 37 states can access such prescribing data, according to the audit, and 22 other states allow law enforcement access. But Colorado doesn’t allow police to access the data without a subpoena, and regulators in the state can only obtain prescribing data after a complaint is filed against a prescriber.

The Colorado Department of Regulatory Agencies is still exploring whether easing access to the data could be a solution, though that’s unlikely to happen, given all the pushback from doctors and patients who fear intrusions on patient privacy, Valuck said.

The Legislature is also considering ways to encourage more doctors to use Colorado’s Prescription Drug Monitoring Program. State law requires prescribers to use the program to check a patient’s prescription history to ensure a patient isn’t taking other drugs, such as opioids, which enhance the risks of prescribing benzodiazepines. Despite that law, a 2021 audit from the Colorado State Auditor’s Office found that 18% of prescribers in Colorado aren’t even registered to use that program.

House Bill 22-1115, sponsored by Rep. Cathy Kipp, D-Fort Collins, and Matt Soper, R-Delta, requires the state to spend $2 million to reimburse doctors and pharmacists who integrate the PDMP prescribing check system with their electronic medical records. Supporters of the legislation, which passed the Legislature and is awaiting signature by Gov. Jared Polis, say ensuring prescribing history checks are done automatically would save time for practitioners who balk at doing the checks manually because they say doing so takes too much time.

In February 2021, Colorado’s Department of Health Care Policy and Financing required prior authorization from state officials before a medical practitioner can bill Medicaid for prescribing benzodiazepines in excess of 90 days for patients 65 years or older.

The agency in 2019 previously put in place prior authorization for Medicaid patients taking opioids long-term and receiving a new prescription for benzodiazepines and vice versa.

Legislation passed last year also requires licensing boards for medical practitioners in Colorado to create new rules limiting how many days a benzodiazepine can be prescribed to patients not already prescribed the drug, with exceptions allowed for patients with severe disorders and neurological conditions.

One patient’s fight

Even with the new laws and regulations, Colorado needs to do more to ensure benzodiazepines are properly prescribed, said one former chronic user of the drug who contends benzos diminished her health for years.

Terri Schreiber, who runs the Schreiber Research Group, an advocacy group seeking to limit benzodiazepine prescribing, said the state needs to make sure patients prescribed benzodiazepines are signing consent forms that warn them of the risks. She said the state also needs to do a better job of identifying heavy prescribers of the drug and educating them of the risks of heavy use.

Schreiber said she struggled with chronic back pain and severe insomnia that only became exacerbated when she sought out medical help more than 20 years ago. She was prescribed benzodiazepines in 2001. Then six years later, while still prescribed benzodiazepines, she received a new prescription for opioids. She took combinations of the drugs for a decade before realizing at age 54 that they were harming her health. The doctors who prescribed the drugs never warned her of the dangers, she said.

“I became disabled from the medication,” Schreiber said. “I had to use a walker. And I became bedridden. I said, ‘I’m too young for this. This cannot be my destiny.’”

An allergist and a pharmacist in 2016 helped her to taper the use of the drugs until she was able to eventually stop using them completely. She said she struggled with withdrawals for 18 months. She could only sleep two to four hours a night and struggled with heart palpitations and a sore throat.

Now, she’s gotten over those side effects and manages her pain through massage, diet, exercise and by practicing mindfulness. She said she no longer must use a walker and doesn’t languish long hours in bed.

“I’m very lucky,” she said. “Very lucky. The fact was that I didn’t know what was happening or how I was at such a high risk until the public figures started to die, and then I started asking questions.”

 

 

Colorado River connectivity channel gets go-ahead after environmental assessment

Windy Gap Reservoir and Dam as seen from the air and in its current state. In late June or early July, construction will begin on shrinking the dam and rerouting the Colorado River around it.

Ten years after plans for a diversion route for the Colorado River around Windy Gap Reservoir outside of Granby was finalized, the project is a go.

A consortium of state and commercial water entities announced on Monday that in late June or early July, construction crews will begin excavating dirt from land adjacent to U.S. Highway 40, to fill in part of the existing reservoir and dredge a new path for the Colorado River to flow around it.

This comes after The Natural Resources Conservation Service released a Finding of No Significant Impact (FONSI) drawn from its Environmental Assessment of the Colorado River Connectivity Channel. The decision paves the way for the construction, which will wrap up in 2023 and provide a new, mile-long public fishing access to the Colorado, said Kirk Klancke, president of the Colorado River Headwaters Chapter of Trout Unlimited.

Trout Unlimited is joined by the Natural Resources Conservation Service, the Northern Colorado Water Conservancy District Municipal Subdistrict, Grand County and the Upper Colorado River Alliance in creating the project.

Klancke told the Sky-Hi News that the project is a long time coming for the health of the Colorado, which has suffered since Windy Gap was constructed in the 1980s. It currently blocks fish and sediment passage upstream and downstream of the dam. It also holds water in a shallow reservoir, sometimes elevating stream temperatures downstream of the dam when water is released. And on windy days, soils from around the reservoir get stirred in the water and fill the river below the dam with sediments.

“This dam killed the Colorado River for miles,” said Klancke. “Sediment filled the interstitial spaces in the rocks below it. Sculpin (a small fish and food source for trout) disappeared. The giant stonefly (another main food source for trout) disappeared. And 38% of macro-invertebrates vanished, according to a study done by Colorado Parks and Wildlife. So from this dam all the way down to the Williams Fork Reservoir, the ecosystem has been crashing. They put a dam right in the middle of a mainstream, whereas today you can’t get a permit for a dam.”

The connectivity project will shrink and deepen the reservoir, which stores Upper Colorado and Fraser River water. Through the Colorado-Big Thompson water diversion project agreement, Northern owns rights to 220,000 acre-feet of water from the Colorado per year, which it pumps into Lake Granby, Shadow Mountain Reservoir, Grand Lake and through miles of underground tunnel to multiple cities on the Front Range.

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This concerns water entities like the Upper Colorado River Watershed Group, which has asked the agencies to do a water accounting in the Upper Colorado River Watershed to insure sufficient water exists before moving along with the project.

UCRWG President Andy Miller said that while the group doesn’t flat-out oppose the project, important questions it posed to the Colorado Division of Water Resources were never answered.

“We have requested during this process a full accounting detailing how current and projected (considering climate change) basin water flows balance with local, Front Range and downstream rights to this available water,” Miller said. “We can’t continue to make decisions like this one without having an accurate picture of the current state of the river.”

The Colorado Division of Water Resources administers water rights, represents Colorado in interstate water compact proceedings, monitors stream flow and water use, and approves construction and repair of dams. When the Sky-Hi reached out to the division’s State Engineer Kevin Rein, he emailed the following:

“The water right for this diversion is decreed by the water court. The question of water availability is addressed at the time of application to the water court.

Once the court awards a decree for this diversion, with a priority date, the Division of Water Resources will administer it within the prior appropriation system, just as we do with all water rights in Colorado. If the water right can divert without impacting water rights that are senior to it, and the diversion is consistent with all terms and conditions of the decree, they may divert. If not, the water right cannot divert.”

Klancke added, “If the water isn’t available, Northern doesn’t get to pump. But the water in the channel will always be there because that’s guaranteed in Senate Document 80 (passed on June 24, 1937, by the 75th Congress). Senate doc 80 created Lake Granby and Shadow Mountain Lake. Lake Granby has certain flows it has to release. Those flows have to be in this channel, because there’s guaranteed flows below the dam. They can’t take that water and dry the river up below this dam. It has to go through that channel and on down the river because it’s guaranteed in Congress.”

According to the Windy Gap FONSI, the Upper Colorado River Watershed Group’s first choice for dealing with the dam — complete removal — would cost $75 million, whereas the Connectivity Project will cost $27 million.

The bulk of those funds will from the Natural Resources Conservation Service. Another $1 million comes from Grand County’s Open Lands Rivers and Trails fund, and Klancke says Northern has already exceeded the amount it committed to pitch in — from an initial $2 million to $4 million.

Klancke adds that Northern — seen as a “water buffalo” by many Grand County residents, due to its interests in diverting water to the Front Range — has “gone over and above” in its support of the project.

Based on the Natural Resources Conservation Service’s environmental assessment, the project “will result in long-term beneficial impacts for environmental resources (i.e. soil, air, water, animals, plants, and human resources).” With the FONSI secured, the Natural Resources Conservation Service can now provide funds pledged toward the project construction, and may consider granting up to $9 million in additional funds still needed for the project.

Grand County’s Board of County Commissioners applauded the Natural Resources Conservation Service’s work in reaching its decision and acknowledged “the tremendous work of the project partners and individual champions.”

Whistleblowers say they falsified patient records at Mind Springs mental health centers

FINDING HELP

If you’re struggling, help is available on Colorado’s crisis hotline. Call 1-844-493-TALK (8255)

A troubled Western Slope mental health care center falsified assessments of its patients’ conditions for at least nine years in an effort to make its treatment programs seem more effective and to secure funding from the state, whistleblowers say.

The state overlooked what former workers describe as a long practice by the Grand Junction-based Mind Springs Health of intentionally writing bogus patient evaluations. The three departments tasked with regulating Colorado’s mental health safety net system failed to notice the allegedly falsified reports during a recent multi-agency audit of the center and over years of lax oversight.

“You’ve got to wonder how closely these so-called regulatory agencies are really looking,” says Sunny Sullivan, one of 29 current and former Mind Springs workers who have come forward to tell the Colorado News Collaborative (COLab) what they see as legal and ethical breaches.

Among the allegations, Sullivan and five other former workers say their supervisors had them and their colleagues fill out mental health assessments of patients they knew little or nothing about and hadn’t actually evaluated. The whistleblowers, who were not trained in behavioral health care and had no clinical licenses or experience at the time they worked for Mind Springs, say their bosses also told them to:

• Make up diagnoses for patients to justify treating them

• Diagnose certain patients with disorders they did not have in order to qualify them for costly, Medicaid-funded treatment they did not need

• Show progress among all patients they were assigned to assess — including those whose symptoms had not actually improved — because state funding for the center hinged partly on the success of its treatment

Sunny Sullivan, a former team leader in the admissions department of Mind Springs' psychiatric hospital, West Springs, blew the whistle on a long pattern of falsifying patient records. She says she has little faith in state agencies' willingness to meaningfully inspect and regulate the troubled Grand Junction-based community mental health center. (McKenzie Lange, Grand Junction Sentinel)

Mind Springs’ longtime CEO Sharon Raggio and two of its other top executives resigned following a Colorado News Collaborative investigation about access to and quality of the center’s care. Interim CEO Doug Pattison and the center’s spokeswoman had not returned multiple emails and phone calls over several months about these latest allegations before the deadline for this story.

The former workers’ accounts span from 2012 to 2021, suggesting that falsifying records wasn’t merely a one-off or an occasional mistake in a state where the law is silent about specifically who should complete those records and how. Rather, whistleblowers say this was an intentional practice of concocting patient information that gave state regulators and policymakers a distorted view of Mind Springs’ effectiveness and, most likely, resulted in the center reaping more public funding than it would have otherwise.

“I’m no legal expert, but I’m pretty sure what we were doing was fraud,” says former case manager Amy Jensen, who estimates she took part in doctoring at least 1,000 patient assessments between 2014 and 2018.

“I’ve wondered how long it could go on without anyone at the state bothering to do something about it.”

‘CCAR parties’

Mind Springs is one of 17 regional community mental health centers statewide that have long made up the core of Colorado’s safety-net system.

The center serves people in 10 Western Slope counties: Eagle, Garfield, Grand, Jackson, Mesa, Moffat, Pitkin, Rio Blanco, Routt and Summit. Its last financial disclosure, from 2019, shows it received $26 million annually to provide inpatient hospitalization, intensive outpatient treatment, outpatient psychiatric care, counseling and other forms of treatment for Medicaid recipients and indigent people under its exclusive contracts with the state.


Those contracts — and the contracts of the 16 other community mental health centers — will no longer be exclusive under a massive bill passed last week to reform Colorado’s safety net system. The law creates a new set of policies that will be carried out by a cabinet-level agency called the Behavioral Health Administration, which, upon its launch in July, will replace the state’s current Office of Behavioral Health within the Department of Human Services.

The Behavioral Health Office long has required the centers and other mental health care providers complete evaluations called Colorado Client Assessment Records, or CCARs for short, for each person receiving Medicaid or other publicly funded care. One CCAR must be filled out upon intake for treatment and another when treatment has ended. Care providers must submit additional CCARs for clients in long-term therapy and for psychiatric patients who are medicated or hospitalized long-term.

The eight-page evaluation asks, among other information, for the client’s diagnosis. It also poses 25 subjective questions meant to assess their current mental health status: their levels of depression or hope, their grasp on reality, and their ability to function without treatment, for example. The person filling out the questionnaire is supposed to interpret often complex and contradictory answers, synthesize them with what they know about the client’s current mental health status, and rank each on a severity scale from 1 through 9 — 1 meaning wellness and 9 indicating crisis.

Clients typically don’t see their CCARs. They’re mainly administrative records to help guide the state in paying providers for services through Medicaid and tax-funded grants.

From a policy perspective, the evaluations help state agencies track who’s getting state and federally funded mental health treatment and the extent to which it’s helping. The state also uses aggregated data from the reports to inform lawmakers about the efficacy of Colorado’s overall mental health safety-net system. The clarity of that picture depends on the accuracy — and truth — of the information providers like Mind Springs submit.

From a clinical standpoint, the mere mention of a CCAR form can trigger groans among psychiatrists, psychiatric nurses and other care practitioners who often complain the assessment and other mandatory state paperwork take too long to complete. Because the need for publicly funded mental health care services far exceeds the number of clinicians available, the people most familiar with patients’ cases and who are most qualified to assess them often are slow to fill out the reports. That leaves backlogs of CCARs that need to be completed and submitted to the state in order for a provider to get paid.

At Mind Springs, management passed at least some of its CCAR backlog to employees in its hospital admissions office and to other workers who lack the behavioral health care training and experience most experts say is needed to diagnose people with mental health challenges and assess their well-being. They also lacked access to direct communication with patients, which state policy requires of people doing CCARs.

Sunny Sullivan, a former team leader in the admissions department of Mind Springs' psychiatric hospital, West Springs, blew the whistle on a long pattern of falsifying patient records. She says she has little faith in state agencies' willingness to meaningfully inspect and regulate the troubled Grand Junction-based community mental health center. (McKenzie Lange, Grand Junction Sentinel)

By the time they were assigned to fill out a CCAR, whistleblowers say the patient usually was long gone from treatment or discharged from Mind Springs’ psychiatric hospital. And so they typically filled in clients’ diagnoses blindly, often guessing that they had conditions such as general anxiety disorder, major depressive disorder or schizoaffective disorder. Sullivan — then a team leader in the hospital admissions office — says her supervisor told her and her staff to write in “adjustment disorder” under the reasoning “that everyone has trouble adjusting to something, so nobody would be questioning that diagnosis.”

Mind Springs’ objective, as whistleblowers tell it, was speed, not accuracy.

“They said just put down your best guess, and fast,” says Sarah Mackie, who also worked in hospital admissions. “I had no sense of who these patients were. I had no clue how they would (have) answered these questions about themselves. And I had no idea what I was doing.”

“I had zero business — zero, zero, zero — diagnosing people,” adds Jennifer Hector, another former employee of the admissions office.

Each of the whistleblowers says she was encouraged to work on CCARs whenever she had downtime on a shift. Some were called in to work evenings or weekends to complete hundreds of the assessments in Mind Springs’ backlog. Supervisors referred to those occasions as “CCAR parties,” says Hector, who estimates she completed about 700 of the questionnaires in one year alone, 2015. “You just sat there, put your head down and did nothing but fill out those forms.”

The single mother of seven says she told her supervisors, “I don’t want to do this” and “I’m not comfortable … messing with the state of Colorado and funding.”

To her many objections, she says they had the same response:

“That I didn’t have a choice.”

Jensen, the former Mind Springs case manager, also struggled with signing her name to phony assessments of people she wasn’t even sure were still alive. She says supervisors assured her the assignment was legal and urged her to stop raising objections.

Amy Jensen is a former case worker at Mind Springs who estimates she took part in falsifying at least 1,000 patient assessments. (McKenzie Lange, Grand Junction Sentinel)

“They had us flat-out making stuff up, then came down on us for asking if it was legal or even ethical,” she says. “I felt like I was in the Twilight Zone. Like, am I nuts? Why does everybody think this is OK?”

Asked why she did not come forward about the falsified reports sooner, Jensen says she had no confidence in state regulators to do anything about it and says she feared that publicly acknowledging her own role in defrauding the state could damage her new career and license as a professional counselor.

Financial incentives

Four of the five whistleblowers say supervisors instructed them, when working on a client’s discharge evaluation, to answer all 25 questions about mental health symptoms at least one number lower in severity than the corresponding number on that client’s intake CCAR. Mind Springs’ goal, they say, was to document that clients had improved from its treatment, whether or not that was actually true.

“We’d ask can we go read their treatment plans or their charts, and they’d say no, just mark them better, just mark them a point or two lower on all the questions,” Hector says.

Mind Springs’ preoccupation with showing improvement sometimes caused tensions between employees and departments. Sullivan recalls terse emails from an inpatient nurse asking why a CCAR evaluation blindly filled out by a staffer Sullivan supervised did not mention the patient’s extreme psychosis.

“She was frustrated. She had a hard time showing he had improved because what was written didn’t reflect his real symptoms,” Sullivan says.

Mental health care records are protected under HIPAA, leading the state to refuse the Colorado News Collaborative’s requests for CCARs submitted by Mind Springs and for certain data gleaned from them. Without what likely would be a prolonged — and expensive — legal battle, there is little chance someone outside the system could ascertain how many of Mind Springs’ clients have been misdiagnosed, mistreated or treated unnecessarily because the center falsified their assessments.

“What this means to people who needed help really bothers me. I hate to think of how many people weren’t getting the right treatment because of that,” says Reggie Bicha, who ran the Human Services Department under former Gov. John Hickenlooper.


It was under Bicha’s leadership that the state started to hinge its exclusive contracts with community mental health centers partly on their performance. Bicha’s behavioral health staff worked with each center to set quality improvement goals it had to meet in order to receive its monthly reimbursements from the state and renew its annual contract.

In fiscal year 2016-2017, for example, “improvement of symptom severity” was one of Mind Springs main performance goals. The state was able to monitor progress only through CCAR data.

In fiscal year 2017-2018, Mind Springs stood to lose up to $257,000 in state funding if it failed to show that symptoms of its adult clients’ depression were becoming less severe in the first six months of treatment and that the severity of those symptoms eased by 50% within a year. CCARs were key in demonstrating — or at least purporting to demonstrate — progress.

Mind Springs’ contract in fiscal year 2019-2020 shows the Office of Behavioral Health had concerns about the accuracy of information the center was submitting to the state. The contract listed “successful data submission” — including more complete and accurate CCARs — as one of the key performance goals it had to meet that year. If Mind Springs didn’t hit that target, the state warned that its unearned performance payment dollars could have been distributed to other community mental health centers that were meeting their goals.

That threat didn’t materialize, says a state official who asked not to be named because her agency forbids employees from speaking to the news media. She noted the irony that regulators may have carried through with the threat had anybody in the Behavioral Health Office thought to look for falsifications and not just for omissions on Mind Springs’ CCARs.

The often cash-strapped center had other possible reasons to falsify client assessments, including a program that gave centers the opportunity to earn extra funding if they “exemplify(ied) extraordinary performance.” That statewide pot was small at first, at only $50,000 in fiscal year 2016-2017, but by fiscal year 2017-2018 had grown to $3.9 million.

As Bicha tells it, a program that had real potential of boosting Mind Springs’ cashflow may have backfired.

“The intention of our performance management was to understand problems, hold ourselves and our partners more accountable and to drive better results for the people of Colorado,” he says. “A system that has contractors gaming it flies in the face of all of those priorities.”

Whistleblowers point to other incentives at play.

Amy Jenson talks about her experience working at Mind Springs in her office in Grand Junction, Colo., on Thursday, May 5, 2022.

Jensen, for example, recalls being assigned to evaluate clients serving parole with a community corrections company that partnered with Mind Springs. She says two of her supervisors and one member of upper management instructed her to diagnose every one of those parolees with a substance abuse disorder, regardless of whether they had a history of substance abuse. The diagnosis ensured that each parolee would qualify for a costly, Medicaid-funded intensive outpatient program that brought in money for Mind Springs.

As a private nonprofit, Mind Springs is not required to disclose how much it made from its partnership with the company.

Oversight overlooked

The Colorado News Collaborative’s investigation into Colorado’s mental health safety net focused not just on troubles at Mind Springs, but also more broadly on state agencies’ longtime failure to regulate community mental health centers.

Shortly after those stories appeared in at least 30 partner news outlets statewide, Gov. Jared Polis’s administration announced the state was conducting a surprise audit of Mind Springs and touted that three state departments would be involved.

The Colorado Department of Public Health & Environment found “zero deficiencies,” its records show.

The Department of Human Services found Mind Springs failed to report 40% of “critical incidents” such as botched prescriptions, violence, injuries, patient escapes and staff wrongdoing within the required 24 hours, and to provide patients being released from its hospital with the proper paperwork for continued treatment. It also found a few data submission errors, but falsified client evaluation was not among them.

The Department of Health Care Policy and Financing — which controls the Medicaid funding that makes up most of community mental health centers’ budgets — announced Thursday that it found Mind Springs has been using various auditing methods and statistics that have allowed it to expand its government revenues without expanding its services. It also found a need for Mind Springs to simplify its complex corporate structure and to improve the quality of its care.

As part of the audit, nobody from the three state departments reached out to any of the 29 current and former Mind Springs workers who at that time started contacting the Colorado News Collaborative about a long list of legally and ethically questionable practices at the center. Those include:

• Mind Springs executives discouraging its staff from reporting “critical incidents”

• Several accounts of West Springs Hospital inappropriately housing teenage patients alongside adult patients with histories of sex offenses

• Allegations of on-site sexual activity and violence among and between Mind Springs staff members and clients

• And a pattern, which almost all the whistleblowers described, of Mind Springs prioritizing care for privately insured clients over the Medicaid recipients and indigent people the state and federal governments pay it to serve

The whistleblowers hold little faith in state audits.

Sunny Sullivan, a former team leader in the admissions department of Mind Springs' psychiatric hospital, West Springs, blew the whistle on a long pattern of falsifying patient records. She says she has little faith in state agencies' willingness to meaningfully inspect and regulate the troubled Grand Junction-based community mental health center. (McKenzie Lange, Grand Junction Sentinel)

“Mind Springs Health was audited all the time. We saw auditors in and out of that place, and they never seemed to see what we were seeing, or even ask us. It makes me wonder if they even took their jobs seriously or if they simply ignored possible issues of fraud,” Sullivan says.

For months this winter and spring, the Human Services Department downplayed the relevance of allegations about falsified CCARs, saying state law gives leeway in how mental health providers fill out state reports. A spokeswoman, who since has left the department, emailed in March that state policy “does not dictate the physical location in which CCARs must be filled out and in most cases does not specify who can fill out a CCAR.”

“OBH Rule does not require an assessment to be performed in person … or by a licensed individual,” Maria Livingston wrote an apparent attempt to justify Mind Springs’ approach to the evaluations. “OBH staff routinely review CCAR data in line with the CCAR Data Reporting Policy as part of regular licensed/designated-provider site visits and reviews. The review involves checking to see if CCAR data is incomplete or missing.”

She would not say whether the reviews also look for accuracy.

Medicaid officials at Colorado’s Department of Health Care Policy and Financing also had little interest in whistleblowers’ accounts of falsifying CCARs at Mind Springs when the Colorado News Collaborative asked about them in the winter. Although they rely on data from CCARs, they said, the assessments are the Behavioral Health Office’s responsibility.

But earlier this spring, Rocky Mountain Health Plans, the company the Department of Health Care Policy and Financing pays to manage Mind Springs’ Medicaid contract, responded to the Colorado News Collaborative’s account of whistleblowers’ allegations by launching an investigation into possible waste, fraud and abuse. The company’s contract with the department obligates it to investigate and report about those types of allegations.

It was only then that the Department of Health Care Policy and Financing triggered its own internal review and said it is taking the allegations “very seriously.”

Last week, the Human Services Department stopped downplaying whistleblowers’ accounts and said it, too, is now launching its own new investigation into the accuracy of Mind Springs’ CCARs, among other things.

Whistleblowers, though buoyed by news of the state’s sudden interest, are skeptical.

“I worry this is a disingenuous PR move,” says Jensen.

Adds Sullivan: “I hope this time they actually take their investigations seriously.”

This story is brought to you by COLab, the Colorado News Collaborative, a nonprofit coalition of more than 170 newsrooms across Colorado (including The Aspen Times) working together to better serve the public. Learn more at https://colabnews.co.

Tri-agency audit reveals problems with Mind Springs management

Mind Springs Health in Grand Junction in March 2022. An unprecedented audit by three state agencies released recently about Mind Springs found a number of issues with management issues.
McKenzie Lange /

A change in leadership and management structure should address troubling issues surrounding Mind Springs Health, according to an unprecedented audit by three state agencies of the Grand Junction-based mental health provider.

In an exclusive interview with The Grand Junction Daily Sentinel with the executive directors of the three agencies and several members of their staffs, which included an advance copy of the audit’s results, the chief recommendation to curing what ails Mind Springs is in addressing how it is managed.

Much of that is already in the works, in part, due to the resignation of its chief executive officer, Sharon Raggio, and executive vice president, Michelle Hoy, in January, when the tri-agency audit was started.

“It’s an audit that shines a light on what needs to be done, but the new leadership and the subsequent leadership, that’s going to make all the difference in the world,” said Kim Bimestefer, executive director of the Colorado Department of Health Care Policy and Financing, which commissioned the audit along with the departments of Public Health and Environment and Human Services.

“When we met with them (the Mind Springs board of directors) in January, we asked the recruiter for the CEO to be present at that meeting because they needed to know what to recruit,” Bimestefer added. “More of the same is not going to do it. We needed a new sheriff to come in to meet the needs of the community.”

A copy of the audit was presented to Doug Pattison early Thursday. Pattison has been Mind Springs’ CFO since 2019 before he took over as interim CEO in January. Results of the audit also was being presented to county commissioners and others in a conference call later that afternoon.

“I fully support this,” Pattison said. “We’re embracing change, and we’re going to work collaboratively with all the departments, and getting all the various measures in place, some of which will take longer than others.”

Doug Pattison

That will start with a new CEO. Pattison is one of three finalists for that job, with a final selection expected to come soon.

The audit was ordered by the three agencies after nearly 50 complaints, including one whistleblower report over medication management, were filed by county commissioners and community leaders in the 10 counties that Mind Springs serves, including Pitkin, Garfield and Mesa counties.

While officials in the three agencies and Rocky Mountain Health Plans, which is contracted by HCPF to coordinate care and handle behavioral health Medicaid claims that conducted the audit, first learned about issues with Mind Springs early last year, the mental health provider was the subject of a recent series of investigative articles by the Colorado News Collaborative, a nonprofit news organization that specializes in in-depth reporting.

In some of that reporting, Raggio was unresponsive to questions about issues surrounding Mind Springs, saying she didn’t want to litigate its problems in the media.

Sharon Raggio, former CEO of Mind Springs Health

The audit isn’t intended to point fingers at Raggio and other Mind Springs leaders, the executive directors said, but it was highly critical of how its management and its various boards are structured, some of which led to gaps in communication with its own staff and the communities it serves, and a general lack of transparency, particularly over its finances.

“The (Mind Springs Health) board structure is complex, lacks transparency, limits community engagement, excludes specific community board participation, has over-representation in other areas, and is not being leveraged to respond to community needs,” the audit reads.

That “incredibly complex” leadership structure has led to issues in providing needed mental and behavioral health services, for which Mind Springs is contracted with the state and several of the Western Slope counties, Patrick Gordon, chief executive officer at Rocky Mountain Health Plans, told the Sentinel.

“There are no fewer than seven legal entities executing Mind Springs’ various programs and functions, overseen by three distinct, somewhat overlapping boards,” Gordon said.

“That structure, we find, has contributed to sort of a disconnect between the community members who serve on the board and the feedback from the community that Mind Springs is organized to serve,” he added. “Suffice to say that corrective action in this area … would be that the board structure be simplified, to be organized to be much more representative of the community, there would be greater consideration of public input and transparency, greater focus on potential conflicts of interests and, frankly, a much greater focus on holding the senior executives and managers at Mind Springs accountable for their performance.”

The audit also found that, primarily because of those management issues, other problems were created, such as a high turnover rate among staff, patient risks over prescription practices and increasingly limited access to psychiatric and behavioral health services.

The audit released this week includes several recommendations and corrective actions that Mind Springs should do, including a better system for prescribing medications, reforming its management and board structure and being far more transparent with local communities.
Bryce Martin / Sky-Hi News archives

One of those involved a whistleblower complaint filed to Rocky Mountain Health Plans by one of Mind Springs’ physicians, who expressed serious concerns about medication management and a lack of peer review and treatment practices for patients.

“RMHP Quality of Care reviewers found that MSH outpatient and inpatient policies and procedures were deficient in describing quality processes specific to the oversight and implementation of quality programs,” the audit says. “MSH’s peer review oversight process was inconsistent. Some reviews met peer review standards, while others did not meet standards. There was no indication that deficient findings were reviewed or acted upon.”

The audit found that Mind Springs’ prescription practices were placing patients’ well-being at risk, in part, because some were being prescribed multiple controlled substances, such as stimulants and sedatives “at high doses.”

The audit includes several recommendations and corrective actions that Mind Springs should do to correct its issues, including creating a better system for prescribing medications, reforming its management and board structure, being far more transparent in its dealing with the state and local communities, and complying with new guidelines in its financial reporting.

The audit also recommends that the three agencies continue to monitor Mind Springs to ensure it complies with those recommendations and implements those corrective actions.

“This (Mind Springs) board was not touching the community,” Bimestefer said. “To guess whether it was intentional or unintentional is less relevant than we change it. I prefer to not let the past be about why, but let the future be how, and that the corrective action fixes the issue of, whether it was intentional or not, to do things less transparent than they could have done.”

CORE Act has an important meeting set for Tuesday

From left, Mike Greenwood, Sen. Michael Bennet and Craig Caulder tour Camp Hale in February 2020 to promote the Colorado Outdoor Recreation and Economy Act, which would designate the former World War II-era military training camp in Eagle County as the first-ever National Historic Landscape.
Chris Dillmann/Vail Daily archive

The Colorado Outdoor Recreation and Economy Act — better known as the CORE Act — has been more than a decade in the making. It might, just might, pass a crucial milestone this week.

The bill, which would protect more than 400,000 acres across the Colorado Rockies through a combination of new designated wilderness areas, recreation management and conservation areas, has passed four times through the U.S. House of Representatives. It has yet to pass muster with the U.S. Senate.

The bill this week is set for a committee hearing and possible vote by the Senate Committee on Energy and Natural Resources. Sen. John Hickenlooper is a member of that committee. Tuesday’s meeting is the farthest yet the bill has made it through the process. If the bill passes out of the committee, it will head to a floor vote. If the Senate passes the bill, it will head to the desk of President Joe Biden, who has said he will sign the bill into law.

Talking up the bill

A group of bill sponsors and supporters Monday held a virtual meeting to talk about the bill and its possible impacts.

Sen. Michael Bennet, who has championed the act for more than a decade, said the bill could be “one of the most meaningful” pieces of public lands legislation for Colorado in the past 25 years. Bennet noted that the bill has been built from the local level, and has support from Democrats, Republicans and independents. Supporters also include environmental, recreational and business interests, including, Bennet said, “an operating silver mine in Ouray County.”

The bill’s major Eagle County impact would be the creation of the nation’s first-ever “national historic landscape” at Camp Hale, where the 10th Mountain Division trained during World War II.

Pitkin County Commissioner Greg Poschman is the son of a 10th Mountain Division veteran. Poschman said the CORE Act could show those still alive from the unit’s first days that “we still have lessons to learn” from that generation.

Poschman said John Tripp, who will turn 103 this year, wants to see the bill passed, not only for the Camp Hale designation, but also for the future of the Thompson Divide.

The bill is a big deal for those in the Thompson Divide area, an alpine area comprising pieces of Pitkin, Gunnison and Garfield counties. That area has long been subject to pressures from drilling, mining, agricultural and environmental interests.

A ‘vitally’ important bill

Carbondale rancher Bill Fales said the bill is “vitally” important to the area, and can provide some certainty about the area’s future.

Bennet noted that the bill’s language could add roughly 19,000 acres to the Thompson Divide area, and could prevent opening a mine near Crested Butte. But, he added, the bill could also clear a path for a land exchange for the mine property.

More than half of the CORE Act involves land in Gunnison County. Gunnison County Commissioner Jonathan Houck said the bill’s language began in local coffee shops and elsewhere, and was driven by concerns about balancing recreation, industry and preservation.

San Miguel County Commissioner Hilary Cooper noted that the bill is more important in the wake of large increases in public land use.

While the bill has broad support in this region, Bennet said the lack of action at the federal level shows the “dysfunction” in the nation’s Capitol.

Bennet noted there are senators with “an ideological opposition” to putting new restrictions or modifying use on public lands.

But, Hickenlooper said, he doesn’t see anything “insolvable” about moving the bill along this time.

What’s a ‘markup meeting’?

A “markup” meeting is legislative shorthand for a meeting in which committee members offer amendments and other potential changes before voting on a bill.

Colorado Outdoor Recreation and Economy Act is set for a May 3 markup meeting with the Senate Committee on Energy & Natural Resources. The meeting is set for 8 a.m. Mountain time.

Half-mile avalanche shaves snow from Bald Mountain near Breckenridge

A speck of a skier perches above an avalanche at Bald Mountain Tuesday, April 26, 2022.
Colorado Avalanche Information Center/Courtesy photo

Avalanche season isn’t over yet.

A pair of skiers triggered a domino-effect of an avalanche Tuesday at Bald Mountain east of Breckenridge, estimated at half a mile wide and up to 10 feet deep, according to Colorado Avalanche Information Center officials.

An avalanche in wind-tossed snow unsettled two lower layers of snow, one after the other, resulting in a major avalanche. No one was caught or hurt by it.

According to the Colorado Avalanche Information Center’s report, the first skier triggered a 50-foot-wide windslab. The skier escaped to a predetermined safe zone. The windslab, in turn, triggered another slab 3 to 4 feet deep below.

When those slabs neared the bottom of the chute, the entire left side of the chute broke, sending a third slab of snow sliding to the bottom.

The two skiers estimated the fallen slabs to be as tall as 10 feet in some spots based on the crown left behind, which spanned nearly a half-mile.

The run was the skiers’ second of the day on Bald Mountain. They previously skied a more easterly face.

“We very much underestimated the potential for deep slab avalanches today,” the skiers wrote in the Colorado Avalanche Information Center report. “Our biggest takeaway was that this snowpack is nowhere near stable in a lot more places than one might expect.”

Colorado Avalanche Information Center director Ethan Greene called the event “uncommon.”

The two lower layers of snowpack had been mostly stable, Greene said. The Colorado Avalanche Information Center saw little activity in them across the region and considered them dormant, making the avalanche somewhat unusual.

Anna DeBattiste of Summit County Rescue Group said the two skiers reported the avalanche immediately after it was triggered, providing some colorful words in their description.

Expletives aside, DeBattiste they want to encourage people to make reports of any avalanches they witness, because it can relieve response teams, many of which are all-volunteer groups.

Storms last weekend dropped over a foot of snow in the Breckenridge area. High winds moving south and west carried snow up and over ridges and deposited snow on north-, northeast- and east-facing slopes, according to the Colorado Avalanche Information Center report.

Such winds will scour ridges, create cornices and deposit pillows of snow along slopes. Greene and the Colorado Avalanche Information Center encourage backcountry travelers to avoid wind-loaded features like cornices and pillows.

Likewise, Greene encourages anyone heading into avalanche territory to do so early in the day this time of year.

“The adage is: start early, end early,” he said.

With spring’s warm days and cold nights, it’s safest to venture out in the morning. Snow will soften as the sun and temperatures rise, and avalanche risk will increase as the day progresses. That soft snow will freeze again during the night, gluing the snowpack together and tending to remain firm through the morning, officials said.

While Summit County’s avalanche risk was assessed as low Friday evening, officials say this does not mean avalanches are impossible. The local forecast says the highest risk of avalanches will be on northeast-, north- and northwest-facing slopes, near and above treeline.

A storm is expected to impact the Rocky Mountains this weekend and deposit up to 8 inches at high elevations. Strong northwesterly winds are expected to accompany the snow, drifting into slabs that could crack and break beneath or above skiers, the avalanche center reports.

Any avalanches that do occur are forecasted to be “large” to “very large,” according to avalanche officials, much like the Bald Mountain slide this week.

In the 2021-22 season so far, Colorado Avalanche Information Center has reported almost 5,000 avalanches. Greene considered that normal, although he clarified not all avalanches are reported.

Deaths are the only exact count the center records. There have been six deaths from avalanches this season, down from last year’s 12. The 10-year Colorado average is six per season.

Witnesses can report an avalanche by calling non-emergency dispatch at 970-668-8600.

Backcountry travelers can check the Colorado avalanche forecast online at Avalanche.state.co.us/forecasts.

 

Colorado officials warn 2022 could be worst wildfire year in state history

Daffodils bloom from the charred remains of Pastor Bill Stephens' home in Superior, Colo., on Thursday, April 7, 2022. Stephens, the lead pastor at Ascent Community Church in neighboring Louisville, and his family are among more than two dozen families in the congregation who lost their homes in a wind-whipped wildfire Dec. 30, 2021. The wildfire northwest of Denver destroyed 1,084 homes, and Stephens' church was filled with smoke and ash. Stephens views the flowers as a sign of rebirth. (AP Photo/Thomas Peipert)

Colorado will pour an additional $20 million in federal funding into firefighting and prevention initiatives ahead of what officials say could be the worst wildfire season in the state’s history.

Above-average temperatures and below-average precipitation are predicted across the state through June, thrusting many parts of Colorado into more severe drought conditions and placing more of the state at risk, officials said during a presentation Friday on this year’s wildfire outlook.

Monsoonal moisture could bring reprieve to the Western Slope in June, but current forecasts predict extreme drought conditions for the Front Range through July, Mike Morgan, director of Colorado’s Division of Fire Prevention and Control said.

Ahead of what could be a devastating wildfire season, Colorado’s strategy to fight fires involves early detection and aggressive initial attack, Morgan said. The funding will help the state grow its firefighting fleet for the 2022 wildfire season and implement a statewide dispatch center.

Last year, 6,679 reported fires burned a total of 56,056 acres — marking an uptick from the average 5,507 fires reported per year in Colorado, Morgan said.

The state is expected to experience up to a fivefold increase in acres burned by wildfires by 2050, according to the Division of Fire Prevention and Control’s 2022 Wildfire Preparedness Plan.

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FILE - Smoke rises in a neighborhood of Boulder County that was destroyed by a wildfire as seen from a Colorado National Guard helicopter during a flyover by Gov. Jared Polis on Dec. 31, 2021. In Colorado and other states hit by natural disasters this year, the pandemic has injected extra uncertainty and created more obstacles for families trying to rebuild. (Hart Van Denburg/Colorado Public Radio via AP, Pool, Fil)