Monday, 09 March 2015 10:12
Jindal's Medicaid Extension refusal causing Louisiana healthcare disaster
Written by 

Jindal-campaignby Tom Aswell, Publisher of Louisiana Voice.com

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

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