October 13, 2015

Chowder check

Observer Courtesy Photo

Observer Courtesy Photo

Williston Police Officer Travis Trybulski, who organizes the annual Williston Chowder Challenge, presents a $6,000 check to Board Member Cathy Michaels for the Williston Community Food Shelf. The Chowder Challenge, held last week, benefits the food shelf and the Williston Police Officers Association. More than 800 people attended the event, sampling chowders from 18 local restaurants and organizations and selecting their favorites.

Individuals also have a role in efficient health care

By Dr. David M. Coddaire

The topic of health care reform has been prominent in the Vermont news in recent years. The Vermont Medical Society, which is comprised of about 1,200 of the state’s medical doctors, has been working actively to make our health care system work better, more efficiently and at lower cost for our patients.

However, our politicians and policymakers are struggling to attain meaningful reform. Such a goal will require the cooperation of not only policymakers, insurance companies and various health care providers, but the efforts of all individuals.

Health care spending in Vermont compares very favorably with other states in the U.S., as does health insurance coverage rates. But we must do better.

All Vermonters should have health insurance coverage and we need to control costs. As a family physician and president of the Vermont Medical Society, I have a number of suggestions for the patients who are consumers of health care, which is essentially all of us.

Find a primary care physician or nurse practitioner that you trust and who is part of a 24/7 coverage network. Make that office your base of operations for health care needs. Accessible primary care is well documented to be less expensive than fragmented medical care.

Emergency room care is wonderful for emergencies, but terribly expensive for routine or convenience care. People have more tests and scans when evaluated in ERs. A call to your primary provider can help you decide whether the ER is the proper place to go.

Do not hesitate to question whether a test, scan or surgical procedure is absolutely necessary for you. Doctors typically try to use the technique of “shared-decision making” with patients in making such recommendations, but sometimes we need a nudge.

Take responsibility for your own prevention efforts. As a society, we tolerate too much violence on the highways (speed, distracted and impaired driving) as well as in our families. Regular exercise, attention to our nutrition and caution with our use of alcohol, drugs and tobacco can save us from illness, as well as preserve our health care dollars.

Understand your insurance coverage (this is a challenge). Ultimately, the cost of our health insurance premiums affects our paychecks as well as our taxes. Insurance companies are beginning to educate us about the cost of care. Too many people have huge deductibles, which can interfere with accessing necessary care.

I have written a long prescription that is not necessarily easy to implement, but thank you for considering it. Please regard my suggestions not only personally, but in whatever role you have in society whether you are an employer, consumer, policy maker or advocate.

David Coddaire, M.D., is president of the Vermont Medical Society and a family physician at the Morrisville Family Health Center. He also serves as the executive medical director of Community Health Services of Lamoille Valley and is a clinical associate professor at the University of Vermont College of Medicine.

Sharing fall’s bounty

Adams' Orchard_011  03Oct15Observer photos by Al Frey

Association of Operating Room Nurses member Darcy Renzulli picks apples Saturday at Adams Apple Orchard in Williston for the ‘Pick for your Neighbor’ program. Members of the Northern Vermont chapter of AORN picked five large bags of apples for the program, which benefits the Vermont Food Bank.

During apple harvest season, individuals, civic groups and companies are encouraged to visit a participating orchard to pick and purchase extra apples for donation to the Vermont Foodbank.

For more photos, visit the Web Extras section at www.willistonobserver.com.

In Chittenden County, 300 patients on opiate treatment waitlist

By Morgan True

For Vermont Digger

In his 2014 State of the State address, Gov. Peter Shumlin pledged to get more opiate addicts into treatment, but as the state attempts to address the growing crisis, demand for services is still dramatically outpacing the capacity of local providers in Chittenden County.

There are nearly 300 people on the “active” waiting list for medication-assisted treatment at the Chittenden Clinic, despite a doubling of the number of patients the clinic serves, according to Bob Bick, Howard Center CEO. In 2014, the clinic treated 441 patients; today 894 patients receive treatment for opiate addiction at the clinic. More than half of the patients are injection heroin users.

“It’s not going away,” Bick said of the opiate crisis.

Vermont has seen a 250 percent increase in people receiving heroin treatment since 2000, with the greatest percentage increase, nearly 40 percent, in just the past year, according to state officials and treatment providers.

The Chittenden Clinic, which is run by the Howard Center, serves patients in Chittenden, Franklin and Addison counties. The Howard Center is one of 11 designated social service agencies in Vermont supported by state contracts.

People on the active list have been triaged based on need, have checked in with clinic staff in the last month and could start treatment tomorrow. The “inactive” waiting list numbers greater than 800, though some patients may have found help elsewhere, Bick said.

The Howard Center’s needle exchange still sees roughly 40 new people each month looking for clean needles to shoot heroin with, he said. Federal law requires that pregnant women and injection drug users be given priority for treatment slots, but some IV users are still waiting months for treatment.

For addicts using prescription opiates or just snorting dope, the wait can be “interminable,” Bick said.

While there are other options, medication assisted treatment is widely recognized as an effective way for people to combat addiction. Patients are randomly drug tested and 90 percent stay clean of other drugs while in treatment, Bick said.

Courts clog waitlist

Shumlin recently lauded reforms to the state’s criminal justice system at a campaign stop with Hillary Clinton. The governor told a crowd in Laconia, N.H. that Vermont gets addicts who have been arrested for nonviolent crimes into treatment.

“We brought in third-party assessors who got folks when they were busted, when they were down, when they were most likely to move into treatment,” he told the crowd.

That’s how the system is supposed to work, but that’s not the reality, according to substance abuse providers.

The criminal justice reforms Shumlin is talking about started largely in Chittenden County. Since 2003, Chittenden County has operated a Treatment Court that allows drug-addicted defendants to get help. Those who complete the program typically get their charges reduced or dismissed.

In 2010, Chittenden County began the Rapid Intervention Community Court for low-level offenders with addiction or mental health issues, which allows them to avoid charges altogether if they complete the program.

There are a “slew” of people from those diversionary court programs who can’t enter treatment at the Chittenden Clinic in a timely fashion because of the bottleneck for services, Bick said.

Many people released from prison should receive treatment at the clinic, but they land on the waiting list because the clinic is over capacity.

“It’s not just folks coming out of corrections, it’s people coming through the courts generally,” he said.

Not enough doctors

The Chittenden Clinic is a treatment “hub,” one of seven in the state and physician’s practices and health centers where doctors prescribe maintenance drugs are the “spokes” in the state’s opiate treatment model.

Spoke providers give addicts the opioid derivative buprenorphine, which delivers enough opioids to prevent someone from getting dope sick, but not enough to feel a high. Unlike methadone, doctors can prescribe buprenorphine from their offices and patients who are ready can take it without supervision.

It allows people to lead more normal lives, without the daily trips to the clinic for methadone, but heroin users taking relatively large doses need to step down with methadone first.

Both Subutex and Suboxone drugs contain the opioid buprenorphine, but Suboxone, unlike Subutex, contains naloxone, an opiate antagonist that further deadens any high addicts might experience. In another form, naloxone nasal injectors, commonly referred to by the brand name Narcan, are effective in reversing opiate overdoses.

Subutex, because it doesn’t contain the opiate antagonist, is sometimes diverted for use by addicts who are not receiving treatment. Though tamper resistant, providers say addicts are still able to shoot the drug, which sells on the street for $50 per 8 milligram pill.

According to Hal Cohen, the secretary of the Agency of Human Services, a shortage of spoke providers is contributing to the backlog. There are a “relatively low” number of buprenorphine prescribers in Chittenden County, Cohen said. As a result, they’ve hit a “saturation point” with the Chittenden Clinic’s ability to meet demand in the region, he said.

“We also need to improve our capacity to transition people who are stabilized out of treatment to appropriate aftercare,” Cohen said.

The clinic is only able to add 9 to 10 patients per month, Bick said. At the same time, there are 50 to 70 patients at the clinic who have progressed in recovery to where they could be treated with buprenorphine at a doctor’s office, he said.

In the month of August, Medicaid claims data shows 17 doctors in Chittenden County wrote at least one buprenorphine prescription for a total of 356 prescriptions, according to figures from the state.

The majority of Chittenden Clinic patients are on Medicaid, the low-income health coverage program, Bick said. In the past year, the number of uninsured patients at the clinic was cut in half, from 14 percent to 7 percent, largely due to Medicaid’s expanded eligibility under the Affordable Care Act.

Federal law sets an initial cap of 30 patients for doctors who complete a course to prescribe buprenorphine. After several months, that cap increases to 100.

Cohen said his agency is working with the University of Vermont Medical Center, the state’s largest hospital and community health providers to create additional capacity. UVM Medical Center currently has 14 doctors certified to prescribe buprenorphine, according to a spokesman.

Recently, Bick and other stakeholders, including the Chittenden County State’s Attorney’s Office and the UVM Medical Center sent a letter to Vermont’s congressional delegation encouraging them to support S.2645. The bill would increase the number of patients doctors could prescribe buprenorphine to and would also allow physicians assistants and some nurses to prescribe maintenance drugs as well, thereby increasing capacity.

Though diversion is a concern with some maintenance drugs, providers said addicts who currently buy it on the street would be less likely to do so if they had a doctor who could prescribe it to them.

Waiting lists eliminated elsewhere

Dr. Deb Richter, an addiction medicine doctor in central Vermont, works with a medication assisted treatment team coordinated by Vermont’s Blueprint for Health, a care management program designed to reduce costs and improve people’s health.

Case workers track down her patients’ urine tests and help make sure people get their daily meds. That frees Richter up to provide counseling and other support services to her patients and allows her to see more of them.

BAART Behavioral Health Services, which operates for-profit methadone clinics in Berlin, St. Johnsbury and Newport, has eliminated its patient waiting list by partnering with the Blueprint, Cohen said. “That’s a remarkable accomplishment and a good example of what can be done with a consolidation of resources,” Cohen added.

Richter said there are other innovative approaches the state could adopt, such as telemedicine — or treatment assisted by video conferencing. While she would prefer to meet with patients in person, she and other doctors prescribing buprenorphine could serve many more patients if counseling sessions could happen via video conference.

“Some of our patients have to travel as many as two or three hours every day to get their meds or meet with us and then we expect them to have jobs, too?” Richter said.

Recovery is tremendously difficult and often takes people multiple tries. Richter has patients in Chittenden County and it’s difficult to see patients drop out of treatment and then have to go back onto waiting lists, she said.

But as tough as the recovery process is, Richter said many of her patients give her great optimism. A man who was using and dealing heroin just a year ago is now clean and has a job. He recently bought a car and is making his child support payments, according to Richter.

If providers in the state are given the right capacity and tools, Richter said she believes waiting lists like the one at the Chittenden Clinic could be dramatically reduced in six months to a year.

United Way honors local volunteers

Observer Courtesy photo Dick and Sharon NIchols stand with Verna Parker (center), to whom they give rides to the grocery store as part of their work with Cathedral Square

Observer Courtesy photo
Dick and Sharon NIchols stand with Verna Parker (center), to whom they give rides to the grocery store as part of their work with Cathedral Square

Observer staff report

United Way of Chittenden County honored 48 local volunteers during the fifth annual Building Block Awards ceremony at the LIVE UNITED Breakfast, held Sept. 28 at the Flynn Center For The Performing Arts.

Williston residents honored included Dick and Sharon Nichols for their volunteer work with Cathedral Square and Sarah Simmons for her service as part of the Vermont Action Team of Planned Parenthood of Northern New England.

“This event is our opportunity to recognize the precious gifts of time and caring that advocates and volunteers offer our community. Volunteerism and advocacy leverage the gifts of resources from our donors and are critical elements of the work that we do. Time is a precious gift,” said Director of Community Impact Amy Carmola.

Walkers hope to spread ‘awareness and inclusion’

Observer file photo The annual Buddy Walk is set for Oct. 11, beginning in Burlington’s Battery Park. The walk is intended to spread awareness and inclusion, helping Vermonters understand that those with Down syndrome are productive members of the community.

Observer file photo
The annual Buddy Walk is set for Oct. 11, beginning in Burlington’s Battery Park. The walk is intended to spread awareness and inclusion, helping Vermonters understand that those with Down syndrome are productive members of the community.

By Stephanie Choate

Observer staff

Locals are preparing to take to the streets of Burlington to raise awareness of and funds for people with Down syndrome and their families.

The sixth annual Champlain Valley Buddy Walk is set for Sunday, Oct. 11 at Battery Park. More than 200 people are expected to attend the event, one of more than 250 walks drawing nearly 300,000 Americans across the country this fall.

Williston resident Joe McNamara helped bring the Buddy Walk to the area six years ago, and has walked every year with his two daughters.

“The theme of the walk is awareness and inclusion,” he said. “To bring awareness to Down syndrome and for kids and adults to understand what Down syndrome is all about and that kids and adults with Down syndrome are just like everybody else.”

His daughter Caroline McNamara, 14 and a freshman at Champlain Valley Union High, has Down syndrome. McNamara said she looks forward to the event every year.

“She sees it as sort of a parade up Church Street for her,” he said. “It’s amazing how much happiness and joy anyone with Down syndrome seems to have, and you feel that when you do this walk. We all walk together and it’s really their day… It’s just a great, great day.”

Williston resident Michelle Gagne, whose 13-year-old daughter, Angelina, has Down syndrome, also walks nearly every year with her family.

“What we’re trying to do is raise awareness that our family members with Down syndrome can be productive members of the community and are just as important as everyone else in the community,” she said. “It puts faces to that as we walk through town.”

She added that it also gives her 16-year-old daughter, Elizabeth, a chance to spend time with friends who also have a sibling with Down syndrome.

Elizabeth Gagne added that the walk “lets people know that Down syndrome is not a disease.”

Willistonian Linda Scott, whose 19-year-old daughter, Emily, has Down syndrome, also pointed to raising awareness and inclusion of those with the syndrome—echoing others’ remarks that they are like everyone else—but also said the walk provides a connection among the participating families.

“It’s a way also for us parents to have a connection with other folks, and our kids get long lasting relationships from it as well,” she said.

The festivities kick off with a welcome and opening remarks at 12:30 p.m., followed by the walk at 1 p.m. The route will go through the downtown business district and up Church Street before returning to the park by 2 p.m. Those who have a family member with Down syndrome or who know a person with Down syndrome or want simply to support their friends and neighbors are welcome to join the Buddy Walk.

“What we hope participants will take away from this is that people with Down syndrome don’t have special needs, they have the same needs as everyone else,” said Champlain Valley Down Syndrome Group President Lisa DeNatale in a press release. “We all need a good education, to have access to good health care, to get a meaningful job, and to make life-long friends.”

Registration is $8 if prepaid online ($10 for day-of registration) per person ages 10 and over, with $40 maximum per family. To register, visit, cvdsg.org/buddy-walk-2015/

The walk is organized by the Champlain Valley Down Syndrome Group. The group’s mission is to “provide information, resources and support to individuals with Down syndrome and their families, and to promote awareness and inclusion in our communities of people with Down syndrome to help them achieve their full potential,” according to its website.

Gagne works with the group as a first-call parent, speaking with parents who have just received a pre-natal or post-natal diagnosis.

“They can connect with families who have already walked a few miles in those moccasins,” she said. “It lets them know that they are not alone, and it’s not a death sentence.”

Between walkers and observers, McNamara said the group hopes to spread understanding.

“Hopefully, they can take the message of awareness and inclusion back to their own worlds and if they ever encounter somebody with Down syndrome, they hire them or become friends with them or just treat them like anybody else,” McNamara said.

For more information, contact Tim McQuiston at 355-4206. To learn more about the Buddy Walk, visit www.facebook.com/ChamplainValleyDownSyndromeGroup or www.buddywalk.org.

Town eyes housing trust

By Stephanie Choate

Observer staff

The town is forming a new task force to examine the possibility of establishing a trust fund to promote affordable housing development in Williston.

During its Oct. 5 meeting, the board approved a charge for the task force, which would likely be made up of members from the task force formed in 2012 to look into methods to spur affordable housing.

Williston has long sought to encourage affordable housing in town, but the recent economic climate has frustrated hopes of developing it easily. Despite a task force that spent a year studying the issue, the Selectboard still identified the lack of affordable housing as the biggest issue facing the town during its annual retreat in June.

The Affordable Housing Task Force recommended that the town establish a housing trust fund in its February 2014 report.

“A housing trust fund can provide a mechanism for the Town to accumulate and manage financial assistance for developers and homeowners and renters to keep housing perpetually affordable,” the report states. “The Task Force recommends that the Town of Williston establish a Williston Housing Trust Fund, to function in collaboration with the Champlain Housing Trust.”

Housing is considered affordable when it costs 30 percent or less of the household’s income. According to the 2014 housing report, more than a third of Williston homeowners spend more than 30 percent, and 8 percent spend more than 50 percent.

The Housing Trust Fund Task Force would need to determine the level of funding needed, how the funds should be disbursed, who decides on fund distribution, what possible revenue sources could be considered and whether there should be an income targeted, among other things.

The task force would be established and its members identified by December. It would make recommendations to the Selectboard by November of 2016. That way, if the board decides to create the fund, it would have time to work it into its municipal budget.

South Burlington recently established a Housing Trust Fund, placing $50,000 in the fund for fiscal year 2016 and setting up a committee to monitor it.

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