Gov. Bobby’s ill-fated, self-serving decision to opt out of a Medicaid expansion for Louisiana is beginning to pay off in an ever-expanding crisis in medical care for the indigent population of Louisiana—on at least two fronts.
An occasional admission of error could go far in establishing a politician’s credibility but it is downright exasperating when this governor is so blind, so stubborn, so obnoxious, so obstinate, so pig-headed, and so disconnected that he cannot bring himself to cross Grover Norquist, the American Legislative Exchange Council, or the tea party—even when his decision endangers the health and even the lives of more than a quarter of a million of his constituents.
http://www.latimes.com/business/hiltzik/la-fi-mh-more-evidence-medicaid-20141027-column.html
Of course it was only a matter of time before the chickens would come home to roost but Gov. Bobby, Timmy Teepell, Kristy Nichols, et al, figured they would long gone and on their way to the White House before the fecal matter hit the oscillating air circulation device.
They were wrong and now they’re covered with the metaphoric filth of their own making with no one to blame but themselves.
The details of the latest developments are so horrific as to defy logic but tragically, they are true.
When Gov. Bobby decided to privatize the state’s charity hospital system (which, by the way, accounts for most of the state employee cuts he loves to crow about on Faux News, in his op-ed pieces, and speeches to his right-wing zealot faithful), he closed Earl K. Long Medical Center (EKL) in Baton Rouge.
That, of course, forced many low-income residents in the northern part of East Baton Rouge Parish to go to Baton Rouge General’s Mid-City medical center for emergency room treatments.
The only problem with that was Gov. Bobby had entered into a cooperative endeavor agreement with Our Lady of the Lake (OLOL) in south Baton Rouge. Consequently, OLOL was—and is—one of only two facilities in East Baton Rouge Parish receiving payments from the state. The other is Woman’s Hospital. Neither of the Baton Rouge General facilities (Mid-City and Bluebonnet), Ochsner Medical Center, nor Lane Memorial in Zachary received a dime from the state.
Because of that, Baton Rouge General recently announced that its Mid-City facility would cease operating its emergency room, effective March 31, because of the financial strain placed on it by the overflow from EKL.
When Gov. Bobby announced the cooperative endeavor agreement with OLOL in January of 2010, he was quite specific in saying the agreement to pay OLOL something on the order of $34 million ($14 million as per the agreement, plus the $24 million already appropriated for the LSU Medical Center which previously had trained its residents at EKL; some estimates put the state’s payments as high as $100 million) would “improve and expand access to health care services for the poor and enhance graduate medical education for Louisiana’s doctors, nurses and health care professionals.” (Emphasis ours.) http://dhh.louisiana.gov/index.cfm/newsroom/detail/88
Moreover, the cooperative endeavor agreement with OLOL says on pages 7 and 8:
- WHEREAS, LSU is obligated by Louisiana law to provide free or reduced cost care to certain patients who qualify for such care;
- WHEREAS, the State’s purpose of this initiative, which is recognized by OLOL and LSU, is to provide Medicaid recipients with integrated, coordinated care, management of chronic disease, improvement in access to preventive and diagnostic services for children and adults, improve recipient satisfaction with access to care and the care experience and provide the State with improved budget predictability;
- WHEREAS, in the interest of advancing the State’s goal of improving integration and coordination of health care services for the low-income populations, and recognizing the opportunity presented by the integration of outpatient and community-based services provided by LSU, inpatient and outpatient services provided by OLOL, and a payment mechanism being made available by DHH (Department of Health and Hospitals) that integrates all services through a prepaid model, the State, OLOL, and LSU intend to participate as a coordinated care network within Medicaid as proposed by DHH;
- WHEREAS, in order to successfully meet their respective purposes, OLOL, LSU, and the State intend to enter into this public/private collaborative whereby certain residency positions in the LSU GME (Graduate Medical Education) programs and patient care services will be relocated to the OLOL campus. (Emphasis ours.)
Click here to read the CEA.
But wait. Could there be a loophole in that agreement?
Apparently OLOL thinks so.
LouisianaVoice has learned that OLOL is taking the position that its only obligation under terms of the now infamous cooperative endeavor agreement is for residency training of LSU medical students. Apparently care for the indigent is off the (examination) table.
That should come as no surprise. After all, OLOL had already dug in its heels and had begun refusing to take indigent transfers from Baton Rouge General Mid-City’s emergency room if they were not already in the LSU system—and some, apparently, who were.
Woman’s also is refusing to take indigent patients.
Of course, it was also to the state’s advantage that OLOL and Woman’s not treat indigent patients or accept indigent transfers from Baton Rouge General because as long as those patients never see the inside of the OLOL emergency room or Woman’s treatment center, the state does not have to pay for their treatment (as in the decision to lower health insurance premium rates for state employees—not so much to help the employees as to lower the state’s premium share which in the long run only resulted in the depletion of Group Benefit’s $500 million reserve fund. Are we seeing a pattern here?).
All of which raises the obvious question: could all this be by design?
Obviously, no one would admit to any conspiracy.
But how could OLOL refuse indigent patients if it is the only facility in East Baton Rouge Parish receiving payments from the state for treating indigent patients?
Good question and the answer to that goes a long way in the decision by Baton Rouge General to shut down its Mid-City emergency room, leaving indigent patients with no apparent place to go for emergency treatment—in flagrant violation of clause in the agreement that says the state is “obligated by Louisiana law to provide free or reduced cost care to certain patients who qualify for such care.” (Emphasis ours.)
Sometimes those WHEREASes can come back to bite you.
LouisianaVoice also has learned that Gov. Bobby’s latest round of budget cuts may have figured in the decision by Children’s Hospital in New Orleans to delay taking over operations of the state’s new billion-dollar University Medical Center New Orleans (UMCNO) from May 15 to at least August. http://www.umcno.org/about-us
Gov. Bobby’s budget cuts, necessitated mainly by his squirrely fiscal policies, leaves all of the LSU hospitals across the state woefully short of the funding needed to keep them open under the various agreements the state has entered into with private hospitals for their management. http://theadvocate.com/news/11751470-123/state-hospital-operators-say-jindal
In the case of UMCNO, built to replace the old Big Charity that was destroyed by Hurricane Katrina, the state is coming up $88 million short of needed funding, according to Children’s CEO Gregory Feirn.
“If the state does not restore the funding, then the state is deciding not to allow for care for the people of New Orleans, deciding not to open their state-of-the-art facility that is nearly finished and striking a crippling blow to medical education in Louisiana,” he said in a prepared written statement.
Strong words indeed, but then Gov. Bobby long ago, with his decision to opt out of the Medicaid expansion, made that decision.
Rep. Walt Leger (D-New Orleans), House Speaker Pro Tem, was especially critical of Gov. Bobby. “The budget is in such a mess,” he said. “We keep hearing from (Commissioner of Administration) Kristy Nichols that they are in negotiations to work matters out.
“We expect to operate a world-class facility that we invested a billion dollars in but now we learn that the date for Children’s Hospital to take it over has been pushed back,” he said.
State Treasurer John Kennedy, appearing on a New Orleans radio talk show, said the news concerned him. “Feirn is a very able administrator and I think they’ll be able to manage that facility better than the state could. We’ve invested and we’ve got to make that facility work. We do not have a choice,” he said. http://www.wwl.com/Garland-Is-the-University-Medical-Center-ready-to-/10773584?pid=461170
Louisiana Voice 
I’m shocked that more Louisiana residents aren’t here, screaming from the mountain top, er, from the top of the duck blind…
Sounds like Frank Underwood to me!
The chickens are indeed coming home to roost.
LSU Interim Hospital (or Interim LSU Hospital) is the facility on Perdido Street, the former Hotel Dieu Hospital. It was meant to be the temporary home of the medical center after Big Charity was closed and until the new UMCNO is opened. After the Daughters of Charity turned it over to the state (or whatever they did) the name was changed from Hotel Dieu to University Hospital.
Exactly one year ago a physician friend told me with tears in his eyes that “The Lake” was turning away indigent patients who had no means, no insurance and were not on Medicaid. These patients made up the largest group in his practice, and they had received world class care at Earl K. Long before jindal closed it and sent the indigent to OLOL, he told me. This very wealthy, very conservative doctor told me that our charity hospital system of care and teaching had been the envy of the medical education community in the 49 other states, and it had been destroyed overnight. The jindal people had lied he said, because the uninsured poor were not being seen at The Lake – “they are sending my patients home to die.”
piyush: Matthew 25:36-40
We have sacrificed our state’s historic health care system at the altar erected by Grover Norquist and the tea party.
Say what you will about Huey Long, but at least sick people got taken care of. Now, we can only say rich people got taken care of. How Christian is that?
Yes, dp, brought to us by that super-Christian, piyush jindal, who truly worships only at the altar of grover norquist.
Norquist is an interesting character. Google is a wonderful thing – research shows him to be a not-so-secret Muslim – destroying government from within with his anti-tax policies that cause governments to collapse – like Louisiana, Kansas, Wisconsin….
This is an outrage. I don’t understand how can they send people away, morally or legally? OLOL is in violation of Federal Law, specifically the EMTALA Act of 1986 which forbids any hospital that accepts Medicare dollars from turning away ER patients….regardless of ability to pay or citizenship status. A class action of these indigent patients being turned away needs to be formed & a federal lawsuit filed.
Unfortunately, EMTALA doesn’t force OLOL to accept ER transfers from Baton Rouge General’s ER unless the patient requires a higher level of care than what could be provided by BRG. If the patient’s condition met these requirements, OLOL could still refuse the transfer if their inpatient beds were “full” or they did not provide the services needed by the patient. However, if a patient leaves the BRG ER without any urging of the BRG ER Staff, then shows up at OLOL ER, that patient becomes the responsibility of OLOL. Another caveat of EMTALA Rules is that a hospital’s ER is required to evaluate all patients presenting to their ER, however if, after the patient is evaluated and determined to be in a “Non-Emergent” condition, the ER can legally discharge the patient from the ER without treatment. This rarely occurs because the ER Physician on duty would not care to put his license at risk in order to save the hospital a few bucks. If a patient feels a hospital’s ER has violated the EMTALA Rules, he should call Frank Opelka M.D. at 225-342-9001. He is the Chief of Staff at DHH and is very competent. I’m sure he would be glad to direct you on how to make an official complaint.
Please understand, my earlier comment did not pertain to emergency room care. ER care is not being questioned. The difference is that EKL Hospital provided long-term, comprehensive care for disease and disease management, surgery, maternity and childbirth services, etc. – complete, needed hospital care and primary medical care and management, for the indigent and uninsured. This is the sort of life-saving medical care that is being denied to those who cannot pay and who have no insurance, or for GOD’s SAKE, Medicaid coverage.
Shame on jindal, nichols, kliebert, etc. They will have to answer to a much higher power than grover norquist.
I’m struck by “we have let this happen..”etc. Where are the votes coming from for t baggers and bj supporters? Here’s an anecdote. My 8th grader attends a relatively large middle school outside of one of our smaller cities ( because our zoned school is falling) and she asked me last week, ” Why does everybody (even minority kids) hate Obama”? Redundantly I point out that the poorest, least educated and least tolerant voters put “they” in office. They are the overwhelming votes as opposed to just selfish/ cynical wealthy folks. We expect this ideology of course from humanitarians like Charles Koch, Gingrich, etc. Not meaning to sound insensitive but using peoples fear and hatred to make them vote against their own best interest, wow that’s marketing!
I served as an election worker in the last two statewide votes. I can tell you from my personal observations that those elections were decided, at least in my polling place, by elderly, mostly obese white folks in generally poor health who voted against their own economic interest for the sole purpose of “taking back their country.”
Gov. Jingle was not on the ballot, but had he been, he could have carried the day.
Thanks for another much-needed piece of journalism that we are not getting from the major journals in the state.
What Jindal is doing is so shameful that it speaks very, very ill of a citizenship that lets him and his henchmen get away with actions that literally send poor people to their graves.
Jindal should no longer be considered an honorable person by everyone, not just his critics. He has abdicated all respect due his office. Shaming him off the stage is about the only tool left in the toolbox of decent folks, unless there are criminal charges in the works we don’t know about. Jindal himself is beyond shame, but shame on any entities that do not treat him as the pariah that he is. He should never be invited to speak at civic or church groups without loud vocal protest. In my opinion, Jindal is the new David Duke, i.e. someone way beyond the pale of decency. Let’s treat him that way.
Big Charity was NOT destroyed by the N. O. flooding when the levees failed. There was a decision made by the powers that be to not reopen the Hospital and persue the new facility.
Indeed. And that decision was made by Governor Kathleen Blanco, under the urging of LSU and Jerry Jones, then the head of the Office of Facility Planning and Control. Big Charity was rather ready to reopen one month after Katrina thanks to the efforts of its workers and the U.S. military under the command of Task Force Katrina Commander Lt. Gen. Russel Honore.
Tom’s article substantiates many reports I have been hearing, that people that would have otherwise qualified for medical indigent free care under state law are not receiving it at OLOL. I list the law below as reference:
R.S. 46:6 ADMISSION CRITERIA TO STATE-SUPPORTED CHARITY HOSPITALS:
http://www.legis.la.gov/Legis/Law.aspx?d=100969
For people to access this care, one’s income needs to be up to 200% of the federal poverty level judged byy family size. This level is referenced by R.S. 17:1519.1(12) DEFINITIONS:
http://www.legis.la.gov/Legis/Law.aspx?d=79870
The key here is for people so disposed is to register in advance with OLOL through one of its affiliated clinics (must be an LSU / OLOL designated site). Also — while any hospital public, ‘non-profit’ or private must treat people needing emergency care, PAYING for the care will also be required (unless one manages to qualify at OLOL under or any other LSU Board state hospital (even if privatized).
Alas, transfers from BR General will not fall under this designation for indigent care. That said, anyone hearing of charity care being denied to patients within the OLOL / LSU system per se — please post here and/or get in touch with me directly (as then we may via the above referenced statutes have the ability to enact legal recourse).
K. Brad Ott
bradott@bellsouth.net
I’m intrigued by the sheer number of folk who are now equating Jindal with David Duke. Back when I served on the Auctioneer Licensing Board, I told Rev. Freddie Phillips (the only African American auctioneer in LA’s history and who also served on the board) that, if David Duke had been elected governor and he had appointees who did things like members of the board had done (vote NOT to send Rev. Phillips as a representative to the NAA convention and OPENLY say to his face that the reason for doing so was that they felt he would be an “embarrassment”), the news media would have been all over it relaying his appointees demonstrated his true racist nature. For some reason, however, Jindal got a double-standard in that regard (perhaps because he is a minority, I honestly don’t know why) and it was perfectly fine for his appointees to conduct themselves in such an atrocious and inexcusable manner and the news media (until I met Tom) didn’t seem to give two flying flips about it.
As most LA Voice readers are aware, I have sued the LALB on several occasions, most especially for BLATANT violations of the open meetings law, etc. For those who would care to read it, I am going to copy and paste an excerpt from an opposition memorandum I filed on November 2, 2011 in 19th JDC (right after Jindal was re-elected and was “flying high”). I filed in in response to assertions that the LALB members made it its filing which indicated to the judge that Gov. Jindal fired me because of an “inability to get along with colleagues.” Here’s the excerpt:
———————————————————————–
Petitioner Most Certainly WAS “Fired” By Gov. Bobby Jindal
Defendant references in the Memorandum of the Special Motion to Strike that Petitioner was “fired by Gov. Jindal” due to an inability to cooperate with colleagues. On that point, Defendant is 100% correct! Petitioner was in fact “fired” by Gov. Bobby Jindal, and Petitioner wears that firing as a badge of honor! Also, Petitioner was aware long before this “firing” took place that he was “making too many waves” about rampant corruption within the LALB and the inexcusable treatment to which Rev. Freddie Phillips, the first and only African American auctioneer in Louisiana’s history, was being subjected……Prior to his termination on September 10, 2010, Petitioner sent an email to Gov. Jindal’s head of Boards and Commissions, Ms. Sarah Olcott. Included in that email is the following quote:
“Let me be blunt: If the choice is having to be ‘molded’ into the ‘good ‘ole boy’ network and engage in illegal and unethical practices to remain an LALB Member vs. being told by Gov. Jindal that I’m no longer desired as a Board Member, then that’s not a Governor for whom I wish to serve anyway!”…….
Petitioner will merely relay that, absolutely, he WAS “fired” by Gov. Jindal, and he is proud of that fact!
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Being honest, I never would have dreamed that I would end up being vindicated to the degree that I have in Jindal’s true character being exposed, and I can only relay that the Jindal/Duke comparison I think is right on target, but David Duke could have NEVER gotten away with what this guy has been able to do. I’m at a loss for why Jindal has been able to pull this off, but I am also thoroughly embarrassed and ashamed to have had ANY role whatsoever in his administration (even if it was a low-level board appointment in the early months of his first term before anyone really knew just what a charlatan he would turn out to be).
Thanks, Tom, for exposing the truth and for this forum we all have to shed light on a despicable administration that, thank God, has less than a year left in its tenure.
People are associating Jindal with Duke because the shoe fits. At least Duke never attained the power that Jindal has, and was never able to implement whatever he had in mind. Unfortunately, Jindal has had the power to enact his destructive agenda.
Just this week I received an invitation to a meeting to discuss how to use the now vacant EKL Hospital. If it is repurposed we will never be able to undo Jindal’s destruction. And if AG Caldwell had any ethics or chutzpa he would be suing OLOL to enforce the contract wherein they were to provide indigent services.
When I read that people who supported Jindal didn’t really know his true colors I’m reminded how stupid and short sighted voters are. Third World Jindal’s character was evident when as DHH Secretary he closed Greenwell Springs Hospital “to balance the budget”. (A feat he certainly hasn’t done since.) His tactics then were so damaging to Foster’s reelection prospects that Jindal was shipped off to the Bush administration, then used that “service” as credentials.
Just think about the damage TWJ’s successor will unleash if a moderate/populist governor is not elected. SINNER-TOR Vitter is poised (and paid) to enrich his donors (as Jindal does) while destroying more Louisiana lives.
Just when I thought this sh*t couldn’t get any worse. It’s worse. The hospitals that were actually closed (EKL and HPL) will cost millions to re-open due to fire code upgrades not to mention requirements from The Joint Commission. It would be cheaper to level the two buildings and rebuild. In the case of Pineville, there is a hospital out at the old England AFB that could be used.
As for Vitter, he is simply a hypocrite. I remember meeting him in Pineville when he was running for senator. He did all the “mom, apple pie, flag waving” crap. Then he gets caught frequenting a whorehouse. Of course, it’s ok because “Jesus forgave him”. Screw that. Man is not meant to be forgiven for all of his sins, and even if he was, he still has to face the consequences of his actions.
Sure his wife forgave him. She’s hanging on to one hell of a meal ticket.
My only two questions are this: (A) Will his opponents bring all of this out in the election campaign? (this should be brought up and he should be held accountable – ideally made to resign his Senator’s seat) and (B) Did he prefer Huggies, Pampers, Pull-ups, or cloth?
Yes Alicia I was short sighted. The Governor is without doubt a very educated man. I kept thinking he had a bigger and better plan not yet released (NOT). I am reminded of another Governor who became President. Jimmy Carter always counted on the math but could never relate it to real lives. The people of Louisiana are not numbers they are people in dire need. This Governor however will never rise from the ashes.
Far as I can see Jindal isn’t in ashes yet, though the thought of him as dust appeals. If the Tea Party wing nuts Jindal plays to can elect the likes of Bill Cassidy and replace a Senator who has delivered so much to this state we’re not too safe.
Jindal systematically and deliberately reduced revenue available to the treasury so he could excuse closing and privatizing every agency in sight to “prevent” deficits aka balance the budget. How’d that work out for ya, Bobby?
In education alone he has demanded (and received from feckless legislators) laws that horribly reduce state income while enriching the affluent.
In Jindal’s first year a law passed granting a tax exemption of $5000 for families whose children were in private or parochial schools. Additional new tax breaks now allow a credit of $5000 per each child in private, parochial or home school. And now ANY LA individual or corporation may donate UNLIMITED DOLLARS in “scholarships” to private and parochial schools and receive a (bottom line) tax credit. AND they will receive a 95% kickback from the state treasury. The 5% difference is paid to (Jindal approved) entities to “oversee” the process.
As for healthcare, we will never replace our once-admired and necessary public health system with a Republican (certainly not the Sinner-tor) as Gov.
Take a look at Representative John Bel Edwards (D, Amite) who has dared to oppose Jindal on his education, healthcare and other debacles.
Jindal wields his veto weapon on ANY legislation won by ANY of his opponents. That’s waaaaaay too much power and subverts the 3 branch power sharing structure Constitution framers envisioned.