Medical services at Borrego Springs Clinic are facing a crisis with the termination of full-time, licensed medical providers: Jan Jones, long time family nurse practitioner, and sole psychologist Pam McEvoy. Adding to the clinic’s problems, resident medical doctor, James Huot has not been at work for months without explanation, or confirmation of a return date.

Psychologist Pam McEvoy has been treating patients with emotional and mental health disease through therapy and referrals to psychiatrists on a full-time basis since 2007. Dr. McEvoy initiated Borrego Health’s behavior health programs at the Borrego Springs clinic.

She was notified on April 21, by a brief phone call from Anna Navarro, Chief of Borrego Community Health Foundation Department of Human Resources. According to Dr. McEvoy’s account, she was just preparing for her 1 p.m. round of patient contacts, when she received the call.

“The first words were: ‘You’re terminated, as of Friday, April 23.’”

“I was stunned and hurt. There were no forewarnings, no explanations, no severance pays, no job evaluations, nothing. No one’s talking, even when requesting additional information on follow-up calls from me. Nobody will say why I was fired or talk to me about it.”

Previously in a confusing conversation, Dr. McEvoy was told to “farm out long-term patients, anyone with six to eight weeks into therapy, to other mental health providers in the community.

That surprised me for a number of reasons, including the fact there are no other mental health professionals in Borrego Springs.

According to Dr McEvoy, adding insult to injury, some patients and staff at the clinic were told she retired.

“I’m still reeling in shock, my treatment was unprofessional, cruel and inhumane,” she said.

Jan Jones, Borrego Springs clinic’s resident family nurse practitioner, was likewise terminated by a call from Navarro, and told her “last check would be in the mail.” Ironically, Jones received her call April 23, while trying to console her colleague, Dr. McEvoy, at the clinic.

Jones was hired in 2006, and has been the primary source of interaction with patients with chronic diseases, providing prescriptions and medical plans, as well as non-life-threatening emergency interventions. She also made medical rounds at the Borrego Health assisted living complex in Borrego Springs.

According to Jones, when she asked about her patients, she was told, she would be “replaced with rotating nurse practitioners and assistant nurses from other clinics.”

Neither, Jones, the clinic’s website, or receptionist could clarify if the rotating nurse practitioners from other Borrego Health clinics would have regularly scheduled days to be seen in the clinic, or whether a visit requires a prescheduled appointment. Doctors, according to the clinic’s website, and receptionist, can be reached by phone or Telehealth.

The clinic is not doing right by the community. Most other Borrego Health clinics, like clinics in Escondido, La Mesa and El cajon, have other medical options, with hospitals, as well as private and public providers in their community. They also have less elderly, fewer families with incomes at or below the poverty line. Many are trying to survive on seasonal wages, which have dried up.

There are people living in Borrego that can’t afford insurance, don’t drive, own cars or computers, or are even computer literate. There are also language barriers. These are the people the clinic is paid to serve. They need trusted medical providers, who are on site, available to treat them, when they need them, at least 40 hours a week. Another problem is many specialists, like pediatricians, only come once, or twice a month, and we are expected to stand in for them.

Revolving nurses and doctors by phone or video, don’t know the community, people, let alone a patient’s history. Plus, medical professionals, rotating into Borrego, may bring the virus into the community.

“I live in Borrego, love this community, and providing health care was my way of giving back. I enjoyed working at the clinic. It’s been my life,” Jones said. “Borrego medical advertises they have heart.”

When a community survey of the clinic was completed in 2015, the comments were notably negative with regard to the care and availability of competent doctors. There was one positive that ran throughout the poll. That positive was Jones, who was referred to by many as “Dr. Jones.” The family nurse practitioner was credited with being a “doctor” and considered to be the best practitioner by respondents.

Jones is not sure what she will be doing, while Dr. McEvoy, worries that her clients, who were told she retired, may believe she abandoned them. Dr. McEvoy is planning to continue her practice as a private provider.

An added complication for the clinic is that in California, while nurse practitioners can diagnose, treat, and prepare health management plans, they can only prescribe prescriptions in collaboration with a medical doctor. The absence of Dr. Huot compounds the clinic’s problems, not to mention, the concern patients may have about having an unknown doctor supervising their prescriptions.

In an unsigned official statement from the Borrego Community Health Foundation, in apparent response to community concerns about the changes at the Borrego Springs Clinic, the termination of full time medical professionals and ‘dramatic shift’ in the way is primary care is delivered” was explained, as the result of the “rapidly escalating COVID-19 public health emergency,” and financial strain. “One third of the work forces, according to the statement, “were impacted by reduced hours, temporary furloughs, or layoffs.”

In a 2018 990 filing, Borrego Health Foundation boasted having $236 million in revenue and $67 million in assets, with 1,392 employees. When the Borrego Sun asked Borrego Health administration about layoffs, pay reductions and furloughs at other clinics and at the administration/management level, the leadership team refused to respond other than the statement.

The response to the COVID-19 public health emergency was sent to Borrego organizations one week after the Borrego Sun began asking questions of the Borrego Health Foundation. When asked about the availability of COVID-19 tests, a worker (unwilling to give a name) at the clinic, advised that a Borrego Health doctor would have to make a diagnosis and decision on testing.

The statement goes on to ensure that “a licensed medical provider is on site everyday,” and patients are able to meet their medical needs via telephone or Telehealth. And that Borrego Health, “in this unprecedented time of crisis, is committed to ensuring the needs of Borrego Valley are met.”

However, callers to the Borrego Sun expressed concern about the absence of licensed health professionals on site when they visited, or called. Many stated, “the clinic was empty except for non-medical staff.”

One comment was, “Lots of cars in staff parking, no medical people.”

Linda Haddock, former Borrego Springs Chamber of Commerce Executive Director, like many others, expressed dismay about the surprising dismissals of Jones and Dr. McEvoy.

“For as long as I have lived here, since 2008, I have never heard anything but praise for Jan and Dr. Pam. No matter what criticisms were leveled at Borrego Health, there’s never been any negative criticism of these two caring women,” Haddock said.

“They will be missed, and missed more than ever at this critical time. People are afraid. They’re losing their income and loved ones to the virus. In times of fear, we need people we can trust, especially when it comes to our health. I’m worried we don’t have that trust right now.”

Among the criteria Governor Gavin Newsom announced for resuming delayed and necessary medical procedures and visits to clinics is that health systems be prepared to handle any surge in patients.

Is the Borrego Springs clinic prepared?