Bobby Jindal: the gift that keeps on giving.
It’s bad enough that colleges and universities are facing the threat of temporary closures, cancellation of summer school, and loss of accreditation. But coupled with the bad news on higher education is an equally grim outlook for health care.
A sample of the legacy left us by Jindal’s hospital privatizations and closures:
In Baton Rouge, the closure of Earl K. Long (EKL) Medical Center had a ripple effect on the low income residents of North Baton Rouge. The emergency room patient care shifted onto Baton Rouge General Regional Medical Center Mid-City became such a money loser that it closed its emergency room on March 31, 2015. That moved emergency room care 30 minutes further away to Our Lady of the Lake (OLOL) Medical Center, located in largely white South Baton Rouge. One emergency room doctor confided to the author that it was his feeling that Jindal wanted to create “a medical wasteland north of Government Street.” Government Street, which traverses Baton Rouge in an east-west direction is a roughly-defined dividing line between South and North Baton Rouge.
Mid-City was hemorrhaging $2 million a month through its emergency room because Jindal refused to expand Medicaid and rejected any idea of putting up state money to keep the facility open. With the closure of its emergency room, residents of North Baton Rouge, which is largely low-income black in its demographic makeup, had few medical choices. With Our Lady of the Lake so far away, the alternatives were two urgent care clinics operated by the partnership of LSU and Our Lady of the Lake. The clinics were located on North Foster Street and Airline Highway. The North Foster clinic has no onsite doctor and the main Airline High clinic has a doctor onsite only until 7:00 p.m.
The same emergency room doctor who related the “medical wasteland” story told of the tragic case of an elderly African-American couple. “I felt sick reading this report,” he said. He said it involved “an old black couple who were paying $40 per month on their existing medical bill” to another Baton Rouge hospital.
The report read said the decedent was found “supine on bedroom floor. His wife told EMT personnel that her husband had congestive heart failure and that fluid had been building up. He did not go to the emergency room because the couple owed money to the hospital. She said he had been short of breath through the night and when she awoke, he was not breathing. CPR and advanced cardiac life support were initiated but were terminated after no response. “If he had gone to the LSU urgent care center, likely as not, no doctor would have been on duty,” the ER doctor said.
The closure of EKL and the decision by Baton Rouge General Mid-City to close its ER necessarily imposed a heavier workload on OLOL which entered into a partnership with the state for treatment of Medicaid patients. That increased workload has understandably also produced greater pressure on doctors and staff which in turn has apparently led to lapses in quality of care.
Consider the following brief email thread:
“Please see the email below sent from one of vascular consultants to our Associate Chief Medical Officer Dr. (redacted). My purpose for forwarding this email to you is not to criticize anyone nor is (it) to elicit a string of email responses. The sole purpose is to make all of us aware of the perception some of our consultants and primary care teams have of us. Increasingly of late, I am getting this type of feedback, be it real or otherwise.
“Doctors, we must elevate our game to meet the expectations of all our physician colleagues. I know you guys are working hard, but I am asking each of you to pay attention to the finer details.
“As Dr. (redacted) aptly said to me last night, our physician colleagues are our customers; we need to put ourselves in their shoes, be their voice, the voice of our customer.
The email to which he referred read:
“I had a very irritating call last night from the ER. It bothers me that the environment around our hospital is deteriorating into a stereotypical dysfunctional training facility that we are all too familiar with and probably chose to go into private practice to avoid.
“I received a call at about 11:30 p.m. The answering service informed me who the call was about. When I called back a resident picked up and started telling me about ‘an endostent that had an endoleak with pain, transferred from Lake Charles.’ Knowing I was on city call, I figured I’d investigate this to expedite patient care. The resident told me they had already spoken to a doctor but it didn’t make sense when I couldn’t get the specifics I was asking for. At that point, I asked to speak to the attending whom (sic) was able to figure out they got the wrong guy. However, it’s a little disheartening that he didn’t readily know who the surgeon was they had spoken to that was assuming responsibility for the patient. He did mention ‘Dr. (redacted)” who is our resident (redacted)—but I’m not sure he knew it was a resident. It’s my feeling that in a patient potentially critical as this one—the attending should have his finger on the pulse a litter better than it appeared last night.
“After those 15 minutes I again informed the attending I was Dr. (redacted)…returning a page. At this point the attending gave me to ‘Dr (redacted), first year (emergency room) resident.’ The resident reports a consult on a patient with WBC (white blood cell) 19, blisters on cellulitic foot…When I ask asking info, it turns out the patient ‘has been on the board over 7 hours.’ When I ask to speak to attending who saw the patient—no longer working. At this point, I’m given back to the same attending who gave me to the first year resident he was covering. This attending was covering the resident, had taken sign-out, and expected the resident to call me and report but had never seen the patient. This reminds me of something I would get from the old ER at Mid-City, not what I would have received from OLOL in first 12 years of practice.
“I do realize we are a training facility but you and I both recognize that happens to a private practice service when run by residents. I’m sure the ER has exploded with new personal (sic) during this growth phase, but part of their responsibility is to know who the doctors are that routinely admit to this facility. To say the least, I was discouraged at the attending’s ‘finger on the pulse’ of what he was responsible for last night.
“This email is not to condemn any individual but to raise flags over the environment. Please forward to the appropriate people.”
(Sender’s name redacted)
Such is life in the aftermath of Bobby Jindal’s grand state hospital privatization scheme.