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Restoring Charity

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Thousands of New Orleanians are devoted to -- and dependent upon -- this city's Charity Hospital. To most people, the state's public medical complex is known simply as "Charity" or "Big Charity," even though it's now partnered with University Hospital in an entity formally known as the Medical Center of Louisiana at New Orleans (MCLNO).

Within the past few months, state budget cuts forced MCLNO to cut $40 million in services ("Who's Caring," Oct. 7). Those cuts include the closure of W-16 -- Charity's walk-in clinic -- along with a busy diabetes clinic and one-third of the surgical suites at Charity and University hospitals. The results have been devastating.

Charity Hospital delivers half the babies born in New Orleans each year. It sees 500 patients a day, many of them uninsured. Two-thirds of the doctors who train in the state's Charity Hospital system ultimately practice in Louisiana. Earlier this month, the U.S. Census Bureau released data showing that nearly 15 percent of Americans are now uninsured, largely due to high unemployment rates and skyrocketing health costs. In Louisiana, more than 20 percent are insured -- one of the highest rates in the nation. Thus, Charity's importance cannot be overstated.

For uninsured patients, the options are few. Federal law requires hospitals to treat anyone who needs immediate care, regardless of ability to pay. But hospitals alone determine what constitutes an emergency. In calls to several local hospitals, Gambit Weekly found that most hospitals require an up-front deposit of up to $500 for non-emergencies. A typical staffer advised that uninsured patients walking in the door should be prepared to pay $300, and that it might be smarter to look elsewhere. "Charity is the free clinic of the city," she said.

Now, as a result of W-16's closure, MCLNO projects that each month more than 2,000 additional patients will be showing up in Charity's and University's emergency rooms. The state, which has seen success with its LaCHIP and LaMOMS programs, is looking at other ways to further reduce the numbers of uninsured. David Hood, secretary of the state Department of Health and Hospitals (DHH), says that DHH plans to request permission to use federal Medicaid funds to help low-income people pay the premiums for insurance at work.

Some states have tried this with mixed results, according to a new 50-state analysis by the Kaiser Family Foundation, which found high administrative costs, low enrollments and inconsistent health benefits. Based on this report, Louisiana should conduct a feasibility study before committing Medicaid funds to private insurance premiums. We might be better off enrolling more working people in the existing Medicaid program.

Legislatively, Charity seems to have fallen a few notches on the state's priorities ladder. For example, Louisiana stands a decent chance of receiving about $125 million in funding under the prescription drug bill, currently being discussed in a conference committee headed by Rep. Billy Tauzin. However, earlier this year, after receiving additional federal funds, the state opted to fund private institutions instead of undoing cuts to Charity's budget. Hood says lawmakers will again decide how to spend any "new" federal dollars. He expresses optimism that some of that money will go Charity, but there are no guarantees. We think lawmakers should make every effort to ensure Charity's recovery.

The state's budget crunch has brought Charity's role in the community -- and its future as an institution -- to the forefront of public debate. Hood would like to see MCLNO's capacity for patient care, medical care and research expanded into a national "center of excellence." That would require building what Charity spokesman Jerry Romig calls "a great new hospital for this city." The current building is legendary -- but outmoded and rundown.

Hood also predicts that "down the road, you are going to see more local involvement, more local control" in charting Charity's course. This should not entail simply shifting costs to the city or to the region. The state -- heavily aided by the feds -- is better equipped than local parishes to provide stable and consistent funding. Poorer parishes, after all, are the very places that need Charity-type care the most, but they can least afford to pay for it.

In response to the Charity cuts, the city has been looking for federal funds to hire more doctors and to accommodate more patients in the existing network of neighborhood and sliding-scale clinics. This is a good start. The city should also address the realities of its system -- specifically, that it can take months to get an appointment at some of those clinics, and the computers are not networked.

Expanding local clinics is a long-range project that doesn't address other cuts, such as those to the surgical suites. At a minimum, the state, the city and our federal representatives should work diligently to reopen W-16 and the surgical suites. The number of uninsured will rise further. People who are not healthy can't attend school, can't work, and can't participate in building our city. The vitality of New Orleans depends on the vitality of Charity Hospital.

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