Courtesy of Human Services Department
For much of the COVID-19 pandemic, Dr. David Scrase led both the Health and Human Services departments.
On Feb. 24, Dr. David Scrase will end his time as Human Services secretary for the State of New Mexico, a position he has held since 2019. For the better part of the last two years, Scrase, 70, also served as secretary for the Health Department. A board-certified internist and geriatrician, Scrase previously worked as interim division chief for general internal medicine and the chief of geriatrics at the University of New Mexico, where he also was a professor of internal medicine and geriatrics at the School of Medicine. SFR caught up with him right before his final week on the job at the state. The following interview has been edited for concision and clarity.
SFR: About year ago, you said you were having a good time running HSD and DOH. Did anything change?
David Scrase: Well, I got a year older. I don’t know if it was adrenaline or what, but I didn’t fully realize what a challenge it was to run two departments until I stopped running DOH. I went back to just HSD and I thought, ‘This is pretty manageable. I can do this.’ But it was even to the point where I just realized what a toll it had taken on my whole body doing both. I was already thinking—and I had talked to the governor last summer—about retiring the first half of this year. It’s been a great honor to serve the public and serve New Mexicans. It’s been the capstone of my career. But at the same time, I only have so many days left—I’ll go get the number. (Note: During a preamble to the interview, Scrase discussed his interest in the demographics of aging in New Mexico, and mentioned that he tracks the number of days he has left to live—a figure he calculates based on the combined average age his parents lived; at the time of the interview, he said he had 6,378 days left based on that number. He also “for fun” keeps track of how many days he has left should he live to be 100, which was 10,698.) So, I only have so many days, and I have neglected, probably, my family and my kids and my grandkids for almost a whole career. I’ve been increasingly looking forward to spending more time with them and being more involved in their lives, grandkids in particular…and traveling more.
But you’ll still be practicing medicine?
I plan on being back [at the University of New Mexico] about one quarter time…I’ll see my own patients about half that time; I’ll supervise residents…and I’m sure other duties as assigned in terms of geriatrics and helping out with the program. I’m looking forward to that, too. I love taking care of patients. And I feel as though they need more of my time as well, [though] I did see patients all throughout the pandemic.
Do you consider your role steering the COVID-19 pandemic your most important work?
No, actually not. When I applied to be a cabinet secretary, in the interview, the governor and I talked about both [DOH and HSD]. I was attracted to HSD because of the ability to change health care. We’ve brought an additional $2.5 billion into health care in New Mexico [through Medicaid] since 2019. Another problem I sought to try to solve is that New Mexico has the highest percentage of Medicaid members as a percent of population of any state in the country…and raising the Medicaid rates has made a significant difference [in expanding the number of providers]. In behavioral health, we doubled [the number of visits]. Everything we’ve done to strengthen and put together a solid behavioral health community…is super important. And it’s long-lasting. COVID was long…and it was one of those things where I was able to make really important and meaningful contributions—at least to me—in a relatively short period of time. But I don’t think that will be as sustained in some ways as the efforts in Medicaid, behavioral health and other things that we’ve done.
At the end of January, HSD announced it was canceling the Medicaid procurement process in light of your and Medicaid Director Nicole Comeaux’s departures so new leadership could ‘assess the design of the procurement.’ Can you speak to what’s happening there?
I think the emergence of the desire to have a health care authority in the state that consolidates purchasing is a factor that makes a difference. I’m not as sure Nicole and my departures are the driving forces for canceling the procurement. I do want to go on record as saying the team at Medicaid that did the procurement did an amazing job…[and] their recommendations were solid…but they may not have completely conformed to…the future vision of where we want to go with health care in the state. We may have a lot more information from the legislative session about what sorts of major health care policy [and] frameworks will be introduced and passed and signed by the governor.
As you note, Gov. Michelle Lujan Grisham recently announced legislation—Senate Bill 16—that would transform HSD into the Health Care Authority Department with a stated purpose of ‘establishing a single, unified department responsible for health care purchasing, regulation and policy.’ Do you support this move?
I think anything we can do to streamline the purchasing of health care in the state is worth doing, particularly in a state like New Mexico.
You’ve taken questions on long COVID throughout the pandemic. Can you speak as both a physician and public policy overseer about what comes next?
The federal government lay down $1.1 billion [in December 2020] and a lot of that research is underway. I think we’re facing a couple more years of just research about what exactly long COVID is. I have a couple patients with long COVID…it’s very devastating. One is a therapist who can’t do therapy anymore with people because her memory isn’t sufficient to track the conversations. So first, defining the disease—which I have been talking about for two years: What is it? What are the criteria? And then we have to understand what the physiologic basis of it is. Is it like Lyme disease where you get chronic symptoms? Or is it like another virus, like Epstein-Barr? Is it like something else? Until then, we won’t really be able to do much in the way of focused treatments. So it’s: ‘What is it? Why is it? And then how do we treat it?’ I think we’re in the middle of the, ‘what is it’ phase. You can do random trials and just throw medicines at it but, traditionally in the history of medicine, those are never as effective as understanding the etiology of the disease and then targeting that—like we’re doing much more in oncology now.
Any advice for your successors?
Number one is to make sure every single decision you make is based on your certainty that it will benefit low-income people in New Mexico. Two is to use the financial resources that we have to always drive improvements in quality of care and access to care. Three would be to serve the people of New Mexico with energy, intelligence, imagination and love. The predominant one for me was really love. I just love the work. I love the opportunity to take all these resources and bring them to people in their hour of real need in their lives.
