The future of healthcare in Louisiana is in a state of flux as the first phases of an over $800 million package of healthcare cuts sweep the state after Congress removed Hurricane Katrina-related healthcare subsidies in July.
Last month, $152 million in cuts were levied against LSU-run public hospitals alone and the New Orleans metro area saw the closure of its only mental health facility when Southeast Louisiana Hospital in Mandeville was shuttered.
These cuts alone have led to an estimated 1,500 lost jobs as well as numerous in-patient beds lost.
The cuts have led some legislators to call for a special session to allow more input from those outside of the governorís office – a move local legislators, Rep. Greg Miller and Sen. Gary Smith, said is unlikely.
Although there will not be direct cuts in healthcare in St. Charles Parish, local healthcare providers expect indirect effects on the parishís healthcare service.
James Comeaux, chief operating officer of St. Charles Community Health Center, said cuts at the LSU and Charity hospitals in New Orleans will likely lead to a strain in healthcare centers in surrounding areas, including St. Charles Parish.
"Those folks will be coming and looking for other safety net providers, which community health centers are, and then we will see an influx of new patients.," Comeaux said. "Although we are not getting any additional funds to be able to take care of those additional patients."
Comeauxís fear is that the community health centers will fill to capacity and have to turn patients away.
"Then youíll have patients who wonít be able to access care so what that will do then is drive those patients to the emergency room for care," Comeaux said.
Fred Martinez, CEO of St. Charles Parish Hospital, said contrary to initial reports the cuts will not have a direct impact on rural hospitals like St. Charles.
"The rural hospitals have been exempted from most of the cuts and we are classified as a rural hospital right now," Martinez said.
However, like Comeaux, Martinez said he would not be surprised to see the number of patients seeking care in the parishís emergency room go up.
"Unfortunately, when people donít have coverage the emergency rooms are the only place they can go. By federal law you do have to take on people when they walk into an emergency room," Martinez said. "Thatís the only setting where that is the case."
Both Comeaux and Martinez said although care given to patients in emergency situations will help them stabilize, it really does not provide a long-term solution to those with chronic health conditions.
"An emergency room is a great place to go get care. But if you are going because your blood pressure is really high they will stabilize your blood pressure before they let you leave," Comeaux said. "They are not going to give you blood pressure medications and information on how to prevent your blood pressure from going back up."
Similarly, Martinez said he had a recent conversation with a patient who has repeatedly been admitted to the parishís hospital emergency room because he does not have access to other healthcare options.
"The emergency room is really the safety net for all of health care and when a patient doesnít have a regular physician to go to they are going to come to the emergency room," Martinez said. "If they have a chronic problem they are going to come over and over and over again. If they canít access a regular primary care physician then they are just going to keep coming to the emergency room."
That dynamic drives up healthcare costs as well as taking up resources that could be better used elsewhere.
Martinez said the hospital already experiences a surge in emergency room admissions when the community health centers are closed for holidays.
"They were closed on Columbus Day last week and it caused such an overflow into the emergency room they just about doubled the volume," Martinez said. "If the community health centers do reach capacity and they canít accept any more patients then it would impact our emergency room."
Although a rise in emergency room care has not yet been seen, impacts are already being felt in the mental healthcare units of both institutions.
Comeaux said the closure of Southeast Louisiana Hospital is just the latest in cutbacks to mental healthcare in the area.
"Weíve actually seen an increase in psychiatric patients and for patients for behavioral health and mental health services as those cuts have been happening over the past year or two," Comeaux said. "We have seen patients looking to us for mental health care so we have seen an increase around that."
Martinez said his hospital mental health ward is already at capacity almost 100 percent of the time.
"Closing the hospital in Mandeville is just going to put more and more pressure on everybody, as it is we are full in our units," Martinez said. "As soon as we can get a patient out we have someone waiting to come in and we have them lined up in the emergency room much like the other hospitals do."
Both Martinez and Comeaux said because funds for public healthcare are not dedicated and are more easily eliminated, that does not mean the costs both in dollar amounts and in quality of life go away.
"Cuts in healthcare are usually the easy target for politicians to go after," Comeaux said. "Itís a place that they are easily able to cut. The problem is that it really moves the cost onto a lot of other groups - free health clinics, community health centers, the emergency room and a whole bunch of other places that really arenít necessarily the best care for people."