ELK CITY — At the end of May, Dr. Leland Dennis will retire from psychiatry, leaving Elk City and the surrounding area without a psychiatrist.
Oklahoma has some of the highest rates of mental illness in the nation. Throughout the state, especially in rural areas, Oklahoma lacks enough providers because psychiatrists serve mostly in and around the Oklahoma City and Tulsa metro areas. An estimated 70 percent of adults who need mental health treatment do not get it, according to the Oklahoma Department of Mental Health and Substance Abuse Services.
Dennis knows how badly he’s needed, but he also knows that he needs distance from medicine.
After many years in practice, Dennis, 56, has grown more comfortable asking patients about traumatic experiences that can impact families. But his own experience magnified the issue for him.
Havi Dennis was only 3 when she asked her parents to call Grandpa back from heaven.
“What do you mean ‘call him back?’” they asked her.
“I died and went to heaven, and Mom called me back,” she told them.
It was a story Dennis and his wife, Deborah, hadn’t yet heard from their daughter, an experience she had during an open heart surgery that almost ended her life.
Eight years later, Havi looked over her mother’s shoulder as she was being loaded into the ambulance and said, “I don’t want to stay.” She died later that day from an acute illness.
“For the longest time, we struggled because Deborah said it was very clear she wasn’t looking at her,” Leland Dennis said. “We initially thought Havi was saying she didn’t want to stay at the hospital, but I think, looking back ...she had a connection with Jesus, with God, and I think she looked over Deborah’s shoulder at Jesus and said ‘I don’t want to stay here on the Earth.’”
Frustration in medicine
Losing Havi isn’t the only reason Dennis plans to retire. His frustration continues to grow with the limitations he faces in providing medicine to his patients.
Dennis moved his practice from Oklahoma City to Elk City after being recruited by a physician leaving the area. He opened Rivers Edge Mental Health, in hopes of building a practice with a child psychologist and other mental health providers.
But that business concept failed. It was difficult to recruit doctors to the area, and patients’ insurance providers sometimes wouldn’t pay for care.
It also was difficult for patients to pay for the care themselves.
Dennis sees a high rate of poverty among his patients. Many are poor and cannot afford medications that could help better control their symptoms.
And even if they do have insurance, companies have restrictions on which drugs Dennis can prescribe.
For example, he might have to prescribe a drug he doesn’t believe will work first because that’s the drug the insurance company requires he try with the patient before they’re willing to pay for the drug that he thinks will work.
The patient could buy the drug that Dennis is more confident in — but it’s going to cost more, and there’s no absolute guarantee it would work either, he said.
“Often times, my patients have a choice — do I eat, or do I buy my medicine?”
When Dennis retires, his practice will close, and he will be replaced at the Elk City hospital by a “doctor on a stick,” his term for telemedicine.
He’s not enthusiastic about that change, but he is hopeful his impact will continue on through other providers.
While in Elk City, Dennis has formed a friendship with Dr. Craig Phelps, a primary care doctor.
Often times, patients who need mental health services seek out help from their primary care doctor, or at least show signs of needing help in their offices.
Dennis has helped Phelps learn more about reaching out to these patients. Phelps said he sees patients more than once a day who have some kind of mental health need, and he’s grown more comfortable asking them questions to help them realize that.
Phelps said many physicians — especially newer ones — are used to dealing with “pure disease, pure medical-type illness — ear infections, sore throats — as opposed to being willing or comfortable delving into more of the mental health issues that accompany these problems ...There are so many different areas that can be somewhat uncomfortable that I probably was not as willing to delve into at that point.”
On Aug. 3, 2010, Dennis made the 116-mile drive from his office in Elk City to Havi’s hospital bed in about an hour. He and his wife decided shortly after he arrived to turn off the life-giving machines.
Both parents are in medicine and knew her poor vital signs meant she was already gone. Havi was born with a congenital heart defect and had suffered through surgeries and long hospital stays.
Almost four years later, a colorful soccer ball bank sits on the shelf of Dennis’ office, among moving boxes. It reads “Happy Father’s Day, Love, Havi.” There’s still money inside.
Havi loved to bank and save money. For every dollar of her allowance, her parents asked that she save $2.
She would sell her parents popcorn and soda during family movie night to make a little extra money.
A few weeks before she died, the family was having a movie night. Havi was healthy again after about a six-month stay in the hospital.
Deborah Dennis turned to Havi as she sold them popcorn and asked, “Havi, when you were so sick in the hospital, did you go to heaven and see God again?”
“No, Mom,” she said. “Just Jesus.”