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In New Orleans, Clinic Caring for Underinsured Once Again

September 16, 2010 at 6:16 PM EDT
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Betty Ann Bowser reports from the Crescent City on one doctor's success in establishing clinics for the underinsured after Hurricane Katrina wiped out the city's main charity hospital.
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JIM LEHRER: Next: a story about health care for the working poor in New Orleans. Today’s census numbers show that private health care coverage is disappearing for many Americans. And, in Louisiana, doctors are dealing with the unique challenge of reshaping a health care system that was badly damaged. Health correspondent Betty Ann Bowser has our report.

The NewsHour Health Unit is a partnership with the Robert Wood Johnson Foundation.

BETTY ANN BOWSER: When flooding inundated New Orleans five years ago, patients from the city’s big public hospital had to be evacuated by boat, truck and helicopter. The water also wiped out Charity Hospital’s 70 years as the place where 90 percent of the city’s poor and uninsured went for medical care.

DR. KAREN DESALVO, vice dean for Community Affairs and Health Policy, Tulane University Medical School: We created health care in the wild. There was nothing.

BETTY ANN BOWSER: Dr. Karen DeSalvo was a clinic director at Charity five years ago, who saw potential in tragedy.

DR. KAREN DESALVO: We had a clean slate. And, you know, Katrina, the storm, the flooding was horrific, but it really was an opportunity for us to try something new and better for our patients. So, when we had that chance and could go out in neighborhoods and begin building from scratch, that is what we sought to do.

BETTY ANN BOWSER: In the months after Katrina, there was controversy that lingers even today about whether to rebuild Charity Hospital.

But the building’s infrastructure was so badly damaged, the cost to do that would have been prohibitive. So, its doors were closed forever. DeSalvo and her colleagues at the Tulane University Medical School’s outreach program stepped in to fill the void, starting with a makeshift clinic at a home for unwed mothers downtown.

She talked with the NewsHour in the winter of 2006.

DR. KAREN DESALVO: This is what we have cobbled together in our — in one of the examining rooms in the clinic. It’s not pretty, but it works. And it’s better than nothing.

BETTY ANN BOWSER: Today, with a $100 million grant from Washington, DeSalvo and her colleagues have built a network of 90 community health centers.

DR. KAREN DESALVO: For this amount of money, you learn to work within that budget, and it’s not expensive, and you get very creative very quickly.

BETTY ANN BOWSER: On a recent Saturday morning, we went to the clinic in New Orleans East. It serves a population of mainly Vietnamese, African-Americans, and Hispanics.

DR. KAREN DESALVO: We are measured and followed by the granting agency for how well we take care of patients, the quality of care, their…

BETTY ANN BOWSER: Not how many tests you do?

DR. KAREN DESALVO: Not how many tests.

BETTY ANN BOWSER: Like the other centers, the clinic is also a medical home.

DR. KAREN DESALVO: They don’t have to just come see the doctor. They can come see the social worker. They can come to the case manager. They can come in and see our community outreach coordinator, or we’re going to go out and find them. That doesn’t happen in the rest of health care, because it’s not paid for that way.

BETTY ANN BOWSER: The clinics serve many of the same people who used to go to Charity, where the E.R. alone treated 200,000 patients a year. Many were the working poor.

DR. KAREN DESALVO: We see a lot of people in the service industry, people who are working in hotels, restaurants, bars. We see artists. We see people who work for nonprofits. We see schoolteachers. We see staff who work in hospitals in the low end of the ladder there and cannot afford the health insurance that is offered.

BETTY ANN BOWSER: Forty-four-year-old Don Spencer has chronic lung problems from inhaling mold in the days after Katrina.

Have you missed Charity Hospital?

DON SPENCER, New Orleans: Oh, definitely, yes. Yes, I have definitely have.

BETTY ANN BOWSER: And what have you been doing for health care since the hospital closed?

DON SPENCER: Just basically feeling my way around.

BETTY ANN BOWSER: Recently, Spencer was hospitalized for a month with pneumonia. Now he gets outpatient care at the clinic near his home.

Where would you go if you didn’t come here?

DON SPENCER: I guess the only other place would be — really, I don’t know.

BETTY ANN BOWSER: You would have to go all the way downtown?

DON SPENCER: Yes.

BETTY ANN BOWSER: And would you..

DON SPENCER: Definitely.

BETTY ANN BOWSER: And would you be as good about keeping appointments if you had to do that?

DON SPENCER: No, not really.

BETTY ANN BOWSER: DeSalvo says the numbers are preliminary, but the clinics are having an impact on at least one segment of the population.

DR. KAREN DESALVO: I can tell you that, for the Medicaid population in the area, we have bent the curve, and fewer are going to the emergency room.

So, where there’s a health center near a hospital, and you look at that hospital’s data, you can see that there’s a decline in admissions for uninsured patients, and a flattening in the number of uninsured visits to the E.R., as opposed to rising, which is what you would expect as the populations come back.

BETTY ANN BOWSER: A study in this month’s “Health Affairs” journal says that’s not the case nationwide. Over a four-year-period, more one-quarter of visits for acute care or a new health problem were made to the emergency room, not to family doctors. One of the reasons cited for this is the shortage of primary care physicians. DeSalvo is trying to address that in the clinics by bringing in medical students.

DR. KAREN DESALVO: I have more doctors that want to come to work in my sites than I can hire, because I only have so much money, but we have recruited now 10 of our residents into being faculty members and delivering services in community. And we have more medical students and more residents that want to work in our community sites than we can accommodate.

BETTY ANN BOWSER: Carlin Hauck is a second-year medical student who wants to be a primary care doctor, because she thinks that’s where the action is.

CARLIN HAUCK, second-year student, Tulane University Medical School: What’s needed right now in America across the board is primary care. And maybe you won’t be making the money that the plastic surgeons are making, but I think it’s still — you can live a happy, full life without making, you know, as much money as some of the plastic surgeons or — or the surgeons or just the highest-paying specialties.

BETTY ANN BOWSER: DeSalvo says the way she and her colleagues are delivering care serves as a model for the nation.

DR. KAREN DESALVO: Indeed, our patients, in aggregate, are sicker than the average American and more socioeconomically disadvantaged. So, we have been able to demonstrate that you can take those principles that were designed for a private pay population and apply that to an uninsured population and a Medicaid population, and it will work.

BETTY ANN BOWSER: This month, DeSalvo’s federal grants runs out. But the state has stepped up to the plate with $30 million. Meanwhile, Charity Hospital will soon be torn down to make way for a new multimillion-dollar for-profit medical center.