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Losing Patients

Working people who fill Charity Hospital's emergency room now routinely wait up to 12 hours for care. If the city lands a federal grant later this month, those patients could visit expanded city clinics.



The big hubbub came midway through Vernon Griffin's 10-hour wait on Monday.

He was sitting with about 20 other people in Charity Hospital's Fast Track (non-emergency) waiting room. A local woman who gave only her first name, Lavette, recalls the scene. "One man was lying on the floor and another one had chest pains. We saw the doctors and the nurses going backwards and forwards, backwards and forwards. But they weren't calling any names -- they had called only two names in two hours."

One patient stopped a nurse and asked why it was taking so long. The nurse used the word "ignorant" in her answer, and other patients -- furious -- began to defend him in loud, heated voices. Then a half-dozen hospital police arrived and escorted some patients out. One woman who left called a television station, and soon a TV reporter showed up.

"It was a big ol' argument," says one woman. Hospital staff say that the tension is high right now. Griffin has seen, in previous visits, patients taking their hostility out on nurses. But he thought the comment went one step too far. "We're not ignorant, we just want to know," says Griffin, a diabetic who had been experiencing blurry vision but had run out of insulin and couldn't afford the test strips for his sugar-testing machine. (Charity got the machines donated but patients still have to pay for the costly strips.)

Wait times here are more than double what they were just last year, before the state cut $40 million from the budgets for Charity and University Hospital, which are formally combined into one entity known as the Medical Center of Louisiana at New Orleans (MCLNO).

In September 2003, those budget cuts shut down surgical suites, inpatient beds and a busy diabetes clinic. The cuts also forced the closure of the walk-in clinic called W-16, named for its room number in the hospital's west wing. W-16 alone saw 40,000 patients each year, and its closure was disastrous for the emergency room.

The diabetes clinic's nurse practitioners and five out of 12 of W-16's doctors were shuffled to other clinics. But in the emergency room, waits skyrocketed. Waits that once took three to four hours before the cuts climbed to 16 to 24 hours, according to Dr. Myra Kleinpeter, who oversees all of the hospital's outpatient clinics. Waiting times have since stabilized, but they're still lengthy, between eight and 12 hours for a non-emergency.

Lavette had accompanied her companion, whose leg injury has been keeping him off the job. But the two of them left after a six-hour wait. They joined a growing rank of "deserters" -- patients who leave before they're seen by doctors. Before the budget cuts, about 1 in 25 deserted. Today the desertion rate is triple that, about 3 in 25, says Kleinpeter.

Some deserters will simply go without care or will return to wait another day. Others will find care elsewhere. "It's clogged up emergency departments all over town, because when people get tired of waiting here, they go to another emergency department," Kleinpeter says.

That can mean big bills. On a recent morning, Corey, a young man with his arm in a sling, says that his visit to another hospital cost him $800. Most private hospitals do have some sort of indigent fund, but unless he's able to tap into that, he'll be paying on this bill for a few years, he says. So he and his girlfriend Niya plan to sit here all day if they have to, waiting for Charity's doctors to check on his damaged tendons and ligaments.

It's not only locals who turn to Charity. Becky and Jason Riggs drove all the way from Chauvin, because the charity hospital in Houma doesn't have the equipment to deal with Becky's kidney stones. "I've never been here before," says Becky, a hairdresser who says that they had private insurance until recently, when Jason was laid off.

Being without insurance gives you a whole different mindset about health care, says Jason. "Before we never worried about how much the bills cost," he says, because insurance covered it. Now, on top of all their other bills, they just couldn't handle an unforeseen medical expense.

In a typical Charity Hospital waiting room, 80 percent are working people, most of whom work low-wage jobs and can't afford health insurance premiums, according to hospital data. The number of Americans without insurance reached the highest level on record in 2003, according to U.S. Census data released in August.

Nationwide, one in six people lack health insurance. In Louisiana, only about one in 10 children are uninsured, thanks mostly to the state's Medicaid-LaCHIP program. But one in four of the state's adults, aged 19 to 64, lack insurance, a topic that the Governor's Health Care Reform Panel will tackle in their next meeting, scheduled for New Orleans in December.

For the most part, it's adults who occupy the seats in Charity's waiting room, and they generally know what to expect. "You know when you're going to Charity that you're going to wait -- it wasn't a shock to me," says Becky Riggs, who spent 10 hours at Charity on Monday and then returned on Tuesday to spend five more hours in the urology department.

Lavette says that they plan to return to Charity this week. "I know that they have good doctors here -- the best," says Lavette. "But if you go there, you probably should bring breakfast, lunch, and dinner, because the waits are getting worse and worse."

"In the city of New Orleans, we're the sickest of the sick," says Dr. Kevin Stephens, director of the city's health department. "We have the worst numbers in the country." He lists off grim statistics -- the worst death rate for diabetes in the country, the highest rate of amputations because of diabetes, and the highest rate of sexually transmitted diseases.

New Orleans has, for a long time, had a shortage of primary-care providers, he says. Then W-16 closed, and the city had a true crisis on its hands.

Stephens, an obstetrician who also has a law degree, is a speedy talker who quickly glides from one topic to another, from the city's clinics to its need for better playgrounds and more healthy diets, the last of which prompts him to stock big bowls of fresh fruit for his employees.

Next to a bowl of ripe pears sits a map of the city. Stephens shows the location of 11 clinics run by the New Orleans Health Department. Some of them are school-based clinics; most of the rest focus on child and well-baby care. "If you're male and you're 40, there's almost nowhere you can go," says Stephens.

After W-16 closed, the Greater New Orleans Community Data Center took the list of patient ZIP codes and sorted them by neighborhood. The areas with the highest use are shaded dark red. Dark-red blocks make an arc all the way through the center of town, from the Lower Ninth Ward to Central City.

ZIP code 70117 had the highest total number -- 4,495 -- of W-16 visits. So it's no coincidence that the health department has proposed expanding a clinic in that area, at the Katherine Benson Health Center on North Claiborne Avenue. In June, the city submitted a 200-page grant to the Health Resources and Services Administration, part of the U.S. Department of Health and Human Services.

The grants are extremely difficult to get. But the city will know within the next two weeks whether it'll receive $650,000 each year for the next three years.

With that money, the city would be able to provide primary care to all low-income people (including adults) through a new "federally qualified health center," which must treat anyone who walks in the door regardless of income. The center would include three sites -- an expanded version of the Benson Health Center and two existing school-based health centers -- at George Washington Carver and Booker T. Washington high schools.

This would be the city's second federally qualified health center. There should be many more. "In the city of Boston, there are 26," says Stephens.

The center, if approved, would be another step in a larger effort to provide primary care in neighborhoods rather than providing it at one big place such as Charity and University hospitals, says MCLNO medical director Cathi Fontenot.

Last week in the Charity waiting room, Charles Crawford, a 51-year-old construction worker who was hurt on the job and is now waiting for disability, sat and talked with his daughter Voncilla Crawford. Voncilla was born at Charity Hospital and is studying to be a pharmacist. She looks at her dad and recalls a recent nine-hour visit here. "A few months back, he had an emergency and we sat in here for hours until he was getting ready to pass out."

"I don't like the wait," she says, which is why she would rather pay $25 to see a private doctor. But she doesn't have any chronic conditions that require expensive medication -- unlike her dad, who was recently diagnosed with diabetes.

Many of the people in this waiting room, she guesses, are dealing with chronic conditions like diabetes, asthma and hypertension. Today they felt bad enough to end up here. But, as she's learned in school, what these patients need, more than anything, is regular care, she says. "Then they probably wouldn't end up here at all."

After W-16 closed, the Greater New Orleans Community Data Center sorted the list of patient ZIP codes by neighborhood. Dark-red blocks marking the highest-use areas make an arc through the center of town, from the Lower Ninth Ward to Central City.
  • After W-16 closed, the Greater New Orleans Community Data Center sorted the list of patient ZIP codes by neighborhood. Dark-red blocks marking the highest-use areas make an arc through the center of town, from the Lower Ninth Ward to Central City.

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