LSU Receives New Orleans Press Club Honors
Baton Rouge (July
30, 2009) – The LSU Health Care Services Division (HCSD) Office of
Communications and Media Relations received multiple honors from the Press
Club of New Orleans in its 2009 annual journalism and public relations
In the category
for “Best TV PSA” for an agency or staff of five or fewer employees, HCSD
received the first place award for “LSU Behavioral Health.” This PSA highlights the comprehensive LSU
behavioral health services in greater New
also received third place for “LSU Trauma Center,”
which gives wide exposure to the preeminent services of the Level 1 Trauma
Center of the Interim
In the category
for “Best Electronic Newsletter,” HCSD received second place for “LSU Health
System,” the internal newsletter for HCSD employees. First place was not given in this category.
In the category
for “Best Public Relations Campaign” for an agency or staff of five or fewer
employees, HCSD received third place for “LSU Community Clinics.” The campaign featured the quality
outpatient health care services of LSU clinics in New Orleans.
The staff of the
LSU HCSD Office of Communications and Media Relations includes Marvin McGraw,
director; Michael Higgins, coordinator; Shawn Taylor, public information
officer 3; and Stephanie Aymond, administrative assistant.
with Interim LSU Public
relations, participated in the production of the PSAs. Korry Melton and
Kevin Barraco, with KSM Advertising, provided
production services, and Jere Hales served as
The LSU Health
System - Health Care Services Division is one of the largest public health
care delivery systems in the country.
It has over 35,000 inpatient admissions, nearly 196,000 inpatient
days, 515,500 outpatient clinic visits, 894,000 outpatient encounters, and
nearly 244,000 emergency department visits.
Each year nearly 500 residents and fellows from the LSU and Tulane
Schools of Medicine and Ochsner Health System and
2,200 nurses and allied health students from many colleges and universities
are trained in LSU facilities.
LSU is the largest
single provider of uncompensated inpatient care in Louisiana.
LSU HCSD hospitals have an economic impact of over $1.4 billion in
asset business activity, $568 million in personal earnings, and generate over
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It must be tough
being Dr. Fred Cerise.
It has always been
tough not to get jammed up when dealing with Charity Hospital of New Orleans.
For Cerise, however, it is especially difficult. When you attempt to skew the
facts, you’re going to get jammed.
Neglected in the
whole Charity Hospital
debacle is what happened merely a few blocks away at University Hospital.
Like Charity, the basement of University
Unlike Charity, the flooding was not limited to just the basement; the first
floor flooded as well.
Cerise, “the state relied on recommendations from building experts to make
the decision to keep Charity Hospital in New
Orleans shut after Hurricane Katrina.”
What he fails to
mention is that those recommendations were not exclusive to Charity Hospital.
The report the state relied upon also assessed University Hospital.
former CEO and executive vice president of LSU Health Care Services Division,
told the LSU Board of Supervisors in October 2005, “The Big Charity and University Hospital buildings were issued their
‘death warrant’ by Katrina and the cataclysmic floods it spawned,” (“Charity,
University hospitals ‘dangerous.’ ” Alexandria Daily
Town Talk, Oct. 6, 2005,
that both Charity and University hospitals were “unusable due to structural,
mechanical and environmental damage,” (“Money needed to keep Charity going.”
The Times-Picayune, Dec. 10, 2005, Page 7B), as he relied heavily upon the
report issued by Adams Management Services Corp., which stated: “Given the
dangerous nature of the facilities at this time, they should not be occupied
for any purpose, short-term or long-term, especially inpatient use.”
warned that “You can get mold out, you can get dirt out, but you can’t get
bacteria out,” (“FORCED TO CHANGE.” The Times-Picayune, Jan. 9, 2006, Page 1A).
Oddly, University Hospital reopened. And therein lies the proverbial “fly in the ointment.” All the claims
about Charity Hospital
not being “viable” due to mold, structural and other environmental problems
ring rather hollow as those very concerns existed at University Hospital.
Why has retired
U.S. Army Lt. Gen. Russel Honoré
come forward now?
It is anyone’s
As Cerise astutely
points out, four years have passed. Four years translates to an entire
graduating class emerging from LSU Medical College in New Orleans without
ever having stepped foot into anything more than an interim teaching
Sciences Center-New Orleans Chancellor Dr. Larry Hollier
testified before the Louisiana House Appropriations Committee in January
regarding increased difficulty in filling residency slots: This means that we
are not attractive to our best kids who are training in our medical schools.
Perhaps Honoré is the only man in Louisiana who truly comprehends exactly
what Dr. Hollier is talking about.
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Houma Today | 07.30.09
her image from the day she entered the state’s highest office, former Gov.
Kathleen Blanco suffered another blow to her credibility and Louisiana another
obstacle to getting money for a brand-spanking new state-owned hospital when
a widely-praised figure contradicted their claims about Hurricane Katrina
Perhaps the person
in any position of authority who came out of events leading up to and the
aftermath of the storm that struck the New Orleans area in 2005 was Russell Honore, then a lieutenant general in charge of the
military’s efforts at damage control in the days immediately after the storm
triggered the breaching of the city’s levees.
Although he had a
decorated military career, Honore maybe is best
known for popularizing the phrase in his initial days on this job “stuck on
stupid” that characterizes those who don’t see mistakes of the past and are
unwilling to move forward in new and positive ways.
recently probably was not appreciated by Blanco or by the Gov. Bobby Jindal Administration when he made comments about the
situation at New Orleans’
“Big Charity” hospital that formerly existed in Mid-City. During Katrina,
winds whipped the building and it flooded. Not long after, Blanco declared
the building a total loss and began to pursue nearly $500 million in federal
dollars to build a new facility as the federal Veterans Administration
proposed a hospital of their own adjacent to it. Jindal
scaled back Blanco’s palatial plans somewhat but still seeks a new building.
To date, the
federal government has not seen the matter exactly the way Blanco proclaimed
and Jindal endorsed. It has argued that the
building might not have been as bad off as Blanco claimed, and further
contends that some portion of the “damage” was caused by decades of neglect
and has proposed a figure of less than a third of that for which Blanco
Simultaneously, a wide spectrum of community interests have asserted that
the original hospital was not as badly damaged by the storm as Blanco claimed
and have pushed for scrapping the new facility in favor of rebuilding the
the issue as these groups try to build a case to get the federal government
to intervene through various to stop work on a new facility, now retired Honore said after the military thoroughly reconstituted
the place in a couple of weeks, Blanco ordered it not to be reopened and
indicated something else was going to happen. Others have confirmed the
medical readiness of the facility at the time, most notably most of its
medical staff. Instead, the state got the federal government to spend over
$100 million in direct costs to provide health care from temporary
facilities, and private providers an unknown amount, to take up the slack
since. Honore and others involved in the effort
have called Blanco’s action politically-motivated to get new facilities.
this, but she has a track record on the subject of Katrina that erodes her
credibility. From her confused explanations about inaction to grudging yet
incomplete release of documents transmitted during the crisis, on numerous
occasions she and her staff have contradicted themselves on issues connected
to Katrina. By contrast, Honore’s straight talking
made him a minor celebrity in the months he spent overseeing rebuilding.
So who would the
reasonable person believe? More importantly, who will the federal government
believe, for if it’s Honore, that erodes the
state’s case for more money even more. Which is yet another reason why this
effort should be abandoned and the almost-four years now unused existing
structure be refurbished to vase hundreds of millions of bucks.
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By MARSHA SHULER
Advocate Capitol News Bureau
A month into the
new state fiscal year, Louisiana’s
health agency has yet to propose where it would cut $240 million from the
program that provides care for the poor and uninsured.
leaves physicians, hospitals and other health-care providers on edge because
of the uncertainty of how they and their patients would be affected.
State health chief
Alan Levine said Thursday his agency didn’t know until the final days of the
legislative session how much money would be available to finance the Medicaid
health insurance program, which covers about one-fourth of the state’s
Levine said the
state Department of Health and Hospitals had to “go back to the drawing board
on the cuts since there were significant changes made during the legislative
“It takes time to
get input from different groups, develop policies behind the cuts, and then
draft the rules” to implement them, Levine said.
The proposed cuts
in the $6.28 billion program, which pays the public and private providers of
health care, should be published no later than next week, Levine said.
rules must go through an administrative approval process that includes
potential sign-off by lawmakers and the governor.
The effective date
would be Aug. 1, Levine said.
Health care for
children will be a top priority, he said.
“I’m planning to
exempt physician services to children under age 16 from cuts,” Levine said.
In areas where cuts
are imposed “the percentage will be a little bit deeper” because the
financial shortfall will have to be absorb in 11 months instead of 12 months,
the agency will end up midyear with a funding shortfall.
Association president John Matessino said hospital
executives want to know how much their cut is going to be because they have
budgets to develop.
budgets are based on the federal fiscal year which begins Oct. 1 and finance
people are looking for numbers, Matessino said.
Other hospitals are trying to do their strategic planning, he said.
“It’s driving them
crazy,” Matessino said.
Matessino said the association hopes to know more
after a meeting today between its representatives and state health agency
executives developing the plan.
director of the Louisiana Chapter of the American Academy
of Pediatrics, said the 700 pediatricians her group represents are in the
dark about how the cuts are going to be implemented.
“We don’t know how
a particular type of service is going to be paid,” Durbin said.
services to children are exempt from cuts “that would be fabulous. That’s the
first I’ve heard of that,” Durbin said. “I’m not sure how that would help the
target of cuts.”
Levine said his
agency has been talking with various health-care providers to get ideas on
could rush an across-the-board cut and publish a rule within a week of
session. But I don’t think it’s appropriate to do that as it would be the
easy way out,” Levine said. “I really want to be as thoughtful as we can be.”
A $40 million
budget cut in a $75 million program that covers costs associated with
hospitals providing expensive, specialized neonatal intensive care services
is very troublesome, Levine said. The state health agency originally proposed
a $70 million cut in the so-called outlier program.
Levine said the
state health agency may have identified a way to protect the handful of
hospitals that provide the services, particularly Children’s Hospital in New Orleans.
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New Orleans Emergency Medical Services fees will
by Bruce Eggler, The Times-Picayune
The cost of using New Orleans' emergency
medical services is going up.
The City Council
this month approved increases in the fees for some services requested by
Mayor Ray Nagin's administration.
The fee for
emergency transportation of an ill or injured person to a hospital or other
medical facility will jump from $600 to $746 for a patient requiring advanced
life support level 2 and from $475 to $515 for a patient getting level 1
The same fee
applies whether the service is provided by the city's EMS
staff and vehicles or, as sometimes is necessary, by private companies
working for the city.
The fee for first
aid service when no transportation is involved will rise from $100 to $150.
The fees for
several other services will not increase. For example, the cost of
non-emergency transportation inside or outside of Orleans Parish will remain
Dr. Jullette Saussy, director of
the city's EMS program, told the council
that the new fees will be at or below those charged in the rest of the
approved the raises 6-0.
In other actions
at its July 23 meeting, all by unanimous votes unless otherwise noted, the
-- Approved the
administration's request to refinance $15.2 million in outstanding federal
loans that the city made years ago to spur construction of the now-closed Jazzland and later Six Flags theme park in eastern New Orleans. The city
has been paying $1 million a year to supplement $1.4 million from Six Flags
to make the $2.4 million annual payment that has been due on the Section 108
loan of Community Development Block Grant money that was used to build the
Little-Wood, the city's economic development director, said the U.S.
Department of Housing and Urban Development recently notified the city of an
opportunity to significantly reduce the interest rate on the loan. The
refinancing could save the city $700,000 to $800,000 a year, she said.
-- Urged City
Attorney Penya Moses-Fields to file
friend-of-the-court briefs supporting "any and all litigation"
seeking to prevent closing of the New
Hospital. New Orleans lawyer
Willie Zanders recently filed a lawsuit seeking to
block the state from closing the Uptown mental health facility. The suit contends
the closing would deny legally protected rights of NOAH's
patients and employees. A local judge this week ordered the suit transferred
to a Baton Rouge
this year voted to give the hospital $14.2 million but Gov. Bobby Jindal vetoed the money and ordered NOAH closed. The
council's resolution, sponsored by President Arnie Fielkow, decried the "inherent injustice" of
closing the city's only facility for uninsured mental-health patients.
-- Approved paying
WBOK Radio $15,000 to run a weekly one-hour, "magazine-format"
program presenting information about the council's activities. Councilwoman
Cynthia Hedge-Morrell said the goal is to reach poor African-American
residents who do not have access to cable TV or the Internet and cannot watch
the council's meetings. WBOK has a predominantly black audience.
Head questioned the failure to perform a marketing analysis or issue a
request for proposals from other stations before Hedge-Morrell and others
decided to put the program on WBOK. The appropriation was approved 5-1, with
Head opposed and Shelley Midura absent.
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Gov. Bobby Jindal has gone on record opposing President Barack
Obama’s health-care plan because it isn’t transparent enough.
We’re all for
transparency, but we were surprised to see the governor criticizing someone
else for not practicing it.
shouldn’t have been surprised. This is a governor, after all, who has favored
one standard of transparency for members of the Legislature and other public
officials, but another, more secretive standard for himself.
In a recent Wall
Street Journal op-ed article on national health-care policy, Jindal notes the secretive way then-first lady Hillary
Clinton set about trying to change health-care policy in 1993 and 1994. The
governor correctly notes that Clinton’s
proposal failed “because it was concocted in secret without the guiding hand
of public consensus-building.”
In Jindal’s view, Obama is repeating these mistakes.
transparency at all levels of government. We would suggest, however, that the
best way for Jindal to champion transparency is by
embracing it himself.
With the Jindal administration’s support, the Legislature recently
passed legislation touted as a “transparency” bill that actually will shield
more state government records from public view.
Louisiana Department of Economic Development is steering $134 million in
incentives to a prospective car manufacturer for the Monroe area in a deal that’s been largely
shielded from public scrutiny. State economic development officials
deliberately avoided generating a paper trail for the deal, citing the
proprietary interests of the car company. In other words, to borrow the
governor’s turn of phrase, the deal “was concocted in secret without the
guiding hand of public consensus-building.”
This is clearly a
governor whose guiding philosophy is “Do as I say,
not as I do."
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The president has
put forward a plan to run yet another part of our lives. This time he has
proposed to have government run our health-care system, delving into the
highly personal decisions of choice of provider as well as quality of care.
His assurances that a government-run plan would strengthen our current system
while driving down costs are simply not the case.
claims that patients will be able to keep their choice of provider under his
plan. That is not reality. Independent analyses have concluded that millions
of Americans will lose their private coverage once a government-run plan is
introduced to the marketplace. Recently the president himself admitted that
there is nothing in his plan that would prevent employers from dropping the
health coverage they currently offer when faced with unfair competition from
a government-run plan. The president should level with the American people on
this crucial point.
promise that care will be strengthened under his plan is also misleading. As
more of the population is forced onto the government-run plan, bureaucrats in
will have no choice but to ration care and mandate what they consider “best
practices” to try to keep costs down.
president’s plan will do nothing to lower costs. It will actually drive costs
up. The initial price tag for the president’s plan is somewhere between $1
trillion and $2 trillion. The president and Democrats in Congress are
considering proposals that will substantially increase taxes on small
businesses and the middle class, and implement cuts to Medicare and Medicaid.
Everyone knows that interjecting government control has never led to lower
costs. Quite the opposite.
should carefully consider the implications of allowing the government to
control this very personal part of our lives. A government takeover of our
health-care system is the wrong answer.
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While I agree in
principle with Ms. Francine Blake’s letter on national health care, I felt it
was necessary to respond to her statement about how the government
(Department of Veterans Affairs) treats its veterans.
utilized the services of the local VA clinic and found it to be a modern,
clean and well-maintained facility. The staff and volunteers on the site are
respectful, competent and show a great deal of care for the veterans they
I know there has
been some deserved bad press about the VA in the past, and I’m sure there are
still some areas that need to be addressed, but the Baton Rouge clinic does not reflect her
concerns about poor quality health care.
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Albert Tydings M.D.-J.D.
The recent call to
arms for health care reform emanating from our politicians has oddly omitted
any acknowledgement of one of the prime reasons of the present health care
demise: the dire need for at least minimal tort reform to control the
contingency-fee personal injury attorneys that dominate our Legislature.
threat of medical malpractice litigation has resulted in increased
hospitalizations, expensive invasive exams, costly studies, procedures and,
ultimately, a steep rise in insurance premiums for all.
In New York City,
after a student of obstetrics spends 12 years on tedious and expensive
schooling, it is necessary for the graduate to spend $172,000 to obtain a
yearly malpractice premium to protect him in case he is sued by one of his
patients in case of an unfavorable result (which can happen whether there is
malpractice or not).
consequence is that qualified candidates are shunning the field of
obstetrics, while one-seventh of the present certified Fellows of Obstetrics
have quit practicing prematurely.
who may not attain optimal results and indigent patients who are perceived to
be highly litigious are being refused care.
explosion has great implications for all people needing medical care.
Obstetrical care in this country is generally excellent, but excellent care
does not guarantee against a poor result. All consumers must be aware of
As costs are now
astronomical and care is becoming unobtainable for many, the medical and
legal communities must be forced to participate in formulating a workable
plan that promotes quality medical care while preserving patient rights.
Health care reform
cannot take place without tort reform.
Albert Tydings M.D.-J.D.
Fellow of the American College
Attorney at law
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John A. Mmahat
In sponsoring the
meeting allowing President Obama to promote his health care legislation, the
AARP is choosing government control over the interests of the elderly.
So far, most of
the proposed funding is from reductions in the Medicare program. The
accompanying news article shows another $35 billion being taken from
Medicare hospital reimbursement, reduced Medicare provider reimbursement and
elimination of the Medicare Advantage program for the elderly, the total
reaches $350 billion. We are told not to worry; improved quality will make up
for this loss of quantum.
And, of course,
this takeover of our health care is really "reform."
The AARP is not only allowing this to happen to our elderly people, the group
is helping engineer it.
John A. Mmahat
[BACK TO TOP]
By William Johnson
Seven of the 10 candidates
for Saturday's District 40 state House of Representatives race came before
the voters this week for their first and only public forum.
presenting this as a closing argument," said forum organizer Donovan K.
Hudson with the St. Landry Chapter of the Louisiana Grassroots Lobby.
"Hopefully, this will give you an idea of who you want to represent you
in Baton Rouge."
On hand for the
forum were candidates George S. Bourgeois Jr., Bradford Jackson, Ronald Lavergne, Kelly J. Scott, Anthony James Soileau, "Reggie" Tatum and Ledricka
Guillory and Anna C. Simmons both sent their apologies but said they had
prior commitments they couldn't cancel.
Quincy Richard was a no-show without a stated reason.
The candidates on
hand for the forum drew lots to determine their speaking order, and each was
given 10 minutes to present their views.
First up was
Ronald Lavergne, a health-care worker from Sunset,
who stressed education and health care as his main objectives.
and health care are the legs our government runs on. If we continue to cut
these, then we'll have no legs at all," he said, commenting on the just
competed legislative session where these areas took most of the hits as
legislators struggled to close a $1 billion shortfall in the state budget.
Lavergne said he is "running on responsible
and common-sense government," but warned voters to trust first in
Next up was
Bradford Jackson, an Opelousas
businessman, who used much of his time to discuss his varied history from his
childhood in the military, his summers on the farm, his work in the oil patch
and his last 25 years as a computer service consultant.
He argued this
history has given him a unique insight into the lives of everyday people.
consultant, I have gone into every kind of business there is. I get to see
what they have to put up with — insurance, taxes, regulation, lots of
paperwork to a lot of agencies," Jackson
Soileau, a private investigator who lives in Washington, called for
expanding the state charity hospital system to allow anyone, regardless of
their income, to use the service.
To help pay for
such an expansion, he called for significant cuts among state workers.
"We have the
highest number of state employees per capita in the nation. A lot of them are
on the payroll just to keep politicians in office," Soileau
Soileau also called for choice in schools, saying
parents who send their children to private schools should get a 100 percent
Bourgeois, an Opelousas attorney, said
he has a proven record of working for the people of District 40 through
numerous civic and charitable activities and called on the people to do the
"I believe we
can address our problems by working together. We can establish common goals
for District 40 and then work together to achieve them," Bourgeois said.
He outlined a
detailed priority list for the district, focusing first on education, then
infrastructure, health care, the state budget and agriculture.
foremost is education. Educational opportunity equals economic
opportunity," Bourgeois said.
analytical chemist with Eli Lilly, said he is in the race to improve health
care for everyone.
health-care system is in a shambles. We have more than 43 million Americans
uninsured. Drug costs are skyrocketing. We need to do a better job of
supporting health care in this state. I think we can do a better job,"
said Scott, who lives in Opelousas.
Pointing out that
nobody has served a full term in District 40 for the past nine years, Scott
called the many special elections a waste of money and pledged if elected to
serve his full term.
He said he will
fight for agriculture, greater services to veterans and pledged to support efforts
to expand funding for T.H. Harris.
business community depends on those graduates," Scott said.
an Opelousas-based attorney, also pointed to a long history of public
"I saw the
need. I didn't wait. I did it myself," she said. "I feel it is my
duty and responsibility to give back to my community."
Johnson-Thierry promised to work for increased funding for teachers and
school support personnel, increased support for farmers and increased
programs for young people, she said helping one another is what everyone
should be involved in.
become a reserve policeman, a volunteer firefighter. Don't just go inside and
talk about problems, get involved," she said. "We all have to be
more involved in our communities."
Johnson-Thierry promised to be a service-oriented representative.
"I will be
accessible to you. If I can't help you, I will try to direct you to someone
who can," she said.
Tatum, a licensed
medical technician, business owner and current Opelousas alderman, was the last to address
the audience, and like several of the other candidates,
he outlined a long list of awards and distinguished public service.
He spoke of the
need for better educational opportunities, economic development and promised
to fight to protect health care from further cuts.
But mainly, Tatum
spoke of the need to work cooperatively with other area representatives and
"I will work
with all of them. I will have only one vote. Without their votes nothing can
be done,"he said. "I will work for you,
putting the needs of the people first. That is how I have always led my
[BACK TO TOP]
By Jeff Matthews
The Central Louisiana Ambulatory
was "ahead of the curve," according to one of the doctors who practices
there. To stay ahead of it, the center is converting to a hospital within the
Approval was given
Monday by the Alexandria Zoning Commission and construction work already has
begun on the Central
Hospital, which will
add inpatient surgical care to the outpatient services already offered at the
certain things we couldn't do at the surgical center," said Dr. Renick Webb, a practicing otolaryngologist at the
surgical center and chairman of Central
we're doing is providing the same good care as our outpatient, but extending
it a little longer. It really is the same thought process."
The project will
add 46,000 square feet to the center, making CLSH a total of 77,000 square
feet. Six operating rooms will be added, giving the hospital a total of 12.
Also added will be
24 inpatient beds and an imaging department comprised of MRI, CT, general
radiology and ultrasound.
expected to be finished by the second quarter of 2010, with the hospital
ready for occupancy early in the third quarter. Webb hopes for a
"seamless transition," with the outpatient center serving patients
as it has right up to the day it becomes a hospital.
within 12 months it should be up and running and serving patients on a
regular basis," said Stephanie Tarry, senior vice-president of business
development for Neuterra Healthcare, which is
partnering with local physicians on the project.
CLSH was conceived
to add services for surgical patients who need a short hospital stay to the
outpatient surgeries already performed at the center.
The hospital will
deal with surgical patients only, and will not have a surgical intensive care
unit. Though Webb said there will not be a maximum stay, patients who develop
complications or require longer-term hospital care will be transferred.
Tarry said the
average stay at CLSH is expected to be two-and-a-half days, and most
inpatient patients will be discharged within 72 hours.
"This is a
place where you can come in for surgery, you can spend the night and you can
go home," Webb said. "And hopefully, you can save some money."
such as this, they do have lower infection rates, they provide an easier time
for patients ... who really all they want is to have a short stay and return
to the comfort of their homes," Tarry said.
CLSH will have 37
doctors and a nurse-to-patient ratio of 1-to-4, which Renick
said is much better than larger hospitals.
Alexandria already has two hospitals -- Christus St. Frances Cabrini and Rapides Regional
-- both of which have recently expanded or are currently expanding. Huey P.
Long Medical Center is based in Pineville.
Webb said Rapides
and Cabrini declined to participate in the CLSH project, though Tarry said
"that door or window is always open."
Cabrini and Rapides did not comment for this story.
[BACK TO TOP]
wasn’t the only one talking about revamping the U.S. health-care system this
week. Prior to the president’s July 22 nationally televised address, health
care reform dominated the National Governors’ Association summer meeting in
Biloxi, Miss., where governors raised concerns that states would have to foot
the bill, as outlined in a letter to Capitol Hill. The new NGA chair, Vermont
Gov. Jim Douglas (R), has chosen health care as his year-long initiative.
Bobby Jindal (R), who did not attend the NGA
meeting in neighboring Gulfport,
made appearances on Fox and CNN, criticizing current health care
proposals moving through Congress that include a significant expansion in
Medicaid, the state-federal program that currently provides health insurance
for 60 million poor Americans.
During NGA’s summer meeting, Cindy Mann, director of the Center
on Medicaid and State Operations at the U.S. Department of Health and Human
Services, acknowledged that the relationship between states and her shop have
been a “bit rocky” and pledged to work with states “rather than get in your
way.” Mann said the Obama administration is eager for states to use newly
created “express lanes” that enroll uninsured children to a state’s
subsidized health care plan at the same time the children are signed up for
food stamps, school lunch plans or certain other benefits.
Health care and budget
issues also were themes at the National Conference of State Legislatures’
annual summit in Philadelphia
During the NCSL
conference, state legislators called on Congress and the Obama Administration
to fully fund the new Medicaid beneficiaries and services as outlined in
federal health care reform proposals. "We just can’t enroll more people
on Medicaid when we can’t pay for the ones we currently have," North
Carolina House Speaker Joe Hackney and NCSL president said in a statement.
Meanwhile, Connecticut pushed
ahead on health care, enacting a plan to cover uninsured residents. The
Democrat-controlled legislature overrode the veto of Republican Gov. M. Jodi Rell, whose approval rating has dropped to its lowest
level since becoming governor. Connecticut
joins only Massachusetts, Vermont,
with revamped health care systems. Elsewhere, despite the recession, at least
13 states have acted to insure more children this year.
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By Eric Pianin and Mary Agnes Carey
leadership's agreement with conservative Democrats on health care legislation
drew fire from state officials worried about increased Medicaid costs and
liberal lawmakers upset about a proposed reduction in subsidies for
low-income families to buy insurance.
The pact with the
Blue Dogs, announced Wednesday, would trim $20 billion from the bill's
10-year price tag by requiring states to cover 7 percent of the cost of
expanding Medicaid, the state-federal health program for the poor and
disabled. The current version of the bill calls for the federal government to
pay for the expansion indefinitely.
In addition, the
agreement would cut $100 billion by making insurance subsidies available to
families and individuals only after they spend 12 percent of their incomes on
premiums, up from 11 percent in the existing bill.
reductions were necessary to offset demands from the Blue Dogs that drove up
costs elsewhere in the legislation. For example, the agreement would exempt
many small businesses from having to provide health insurance to their
employees and would lay the groundwork for more-generous fees for hospitals
and doctors treating patients in any new government-created insurance
program. Conservative Democrats from largely rural areas of the South and Midwest said the changes were essential to protect
small businesses and providers in their districts.
officials immediately voiced displeasure about the Medicaid change. While
contributing seven percent to the expansion of Medicaid “doesn’t sound like a
lot…that’s money right now that every state would have difficulty coming up
with,” said Tony Keck, health policy adviser to Louisiana Gov. Bobby Jindal, a Republican. “What kind of long-term liability
does it create for the states?" Over the last eight to 10 years, Keck
said, the cost of Louisiana’s
Medicaid program has doubled.
Ann Kohler, director
of the National Association of State Medicaid Directors, said that
"states cannot afford any additional pressures on their budgets at this
governors, struggling with reduced tax revenues and expanded Medicaid
enrollment as part of the recession, have been cutting optional benefits for
enrollees, such as dental care for adults. Under the House legislation,
Medicaid would be expanded to famlies and
individuals with incomes up to 133 percent of the federal poverty level, or
about $29,400 for a family of four.
“All I can tell
you is that I hope that this health care reform doesn’t put an additional
burden on the states, because the last thing we can handle at this point is
another burden and another pressure,” Republican Gov. Arnold Schwarzenegger
of California said in a July 22 interview on ABC's Good Morning America. “We
don’t have any money for health care reform. I think ultimately it has to
come from the federal government.”
Governors Association did not return calls Thursday.
members of the Energy and Commerce Committee protested the reduced subsidies
in the bill and vowed to find alternative savings to offset the deal with the
Blue Dogs – an agreement that was essential to ending an impasse with the
conservatives that threatened to prevent committee action on the legislation
before the August recess.
Markey, D-Mass., a senior member of the committee, vowed to work with his
liberal colleagues “to minimize the impact on the poor.”
Rep. Lois Capps,
D-Calif., a former elementary school nurse and a
committee member active in health care issues, said the agreement with the
Blue Dogs “presents one more challenge to getting the bill passed in the best
possible way.” She added that “our task at this moment is to find more
Seemingly on the
defensive, House Speaker Nancy Pelosi, D-Calif.,
said of the Blue Dogs, “No, I don’t think there is any disproportionate
influence when members speak out in favor of their own constituents."
Commerce Committee Chairman Henry Waxman, D-Calif.,
said he and his staff would work with the Blue Dogs and other committee
members to find acceptable cuts in the bill that would cover the cost of the
agreement and also bring down the overall cost of the bill from the current
estimate of $1.04 trillion to less than $1 trillion.
committee staff estimates, the change in the method for reimbursuing
health care providers would add $75 billion to the cost of the bill, while
the expanded exemption for small businesses would cost an additional $30
billion. The Medicaid and subsidy changes would save $120 billion, according
Rep. Mike Ross,
D-Ark., a leader of the Blue Dogs who helped negotiate the deal, said that it
wasn’t clear how the committee would make additional cuts, in order to bring
down the overall cost of the bill to under $1 trillion.
He said a number
of proposals are under review, including reforms in the health care delivery
system and hospital purchasing practices, that might
save an additional $53 billion over the next decade. However, he said he has
left it to Waxman and the committee staff to figure out those savings.
“I know the math
doesn’t add up, but they’ve pledged us they will find the additional savings,”
Ross said in an interview. “They’re going to bend the cost curve.”
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New Orleans CityBusiness |
by The Associated
WASHINGTON — House
Democrats pushed ahead with a compromise health overhaul today over liberals'
complaints, intent on achieving tangible — if modest — success on President
Barack Obama's top domestic priority ahead of a monthlong
"We've got to
pass the bill. Not only do we have to, but we're going to," said Rep.
Henry Waxman, D-Calif., chairman of the Energy and
Commerce Committee, the last of three House committees to act on the sweeping
In the Senate,
which breaks for recess a week later than the House, talks on a bipartisan
compromise sputtered with mixed signals emerging from negotiators.
Grassley, R-Iowa, one of the six lawmakers involved in the talks, said they
had made "very good progress" that could lead to a bipartisan bill,
"but that'll never happen if Democrat leaders tell Republicans to take a
hike by forcing the committee to move on an all-Democrat bill."
already jettisoned plans for floor votes before the summer break, and
Democrats are now aiming just to get bills out of the final House and Senate
committees that have yet to act.
Even that much has
turned into a protracted struggle, but Democratic leaders said it had to
happen. Returning to their home districts with Obama's top issue in disarray
on Capitol Hill was not an option.
resumed work today, with the goal of finishing Friday, after a
week-and-a-half delay caused by objections from fiscally conservative
Democrats. That rebellion was quelled with an agreement Wednesday that would
protect more small businesses from a requirement to provide insurance to
their employees, and restructure a new public insurance plan so it could pay
higher rates to doctors and other providers, among other changes.
concessions Waxman made to the so-called Blue Dog Democrats infuriated House
liberals. They denounced the proposed new structure of the public plan, which
was originally designed to be based on Medicare rates. The new structure says
rates would be negotiated with providers as occurs now with private
companies, which could result in more expensive care.
agreement is not a step forward toward a good health care bill, but a large
step backwards," 53 Progressive Caucus members said in a letter to House
leaders today. "Any bill that does not provide, at a minimum, for a
public option with reimbursement rates based on Medicare rates — not
negotiated rates — is unacceptable."
At a news conference liberal lawmakers threatened to vote
against the bill if it comes to the floor without a stronger public plan.
Rep. Anthony Weiner, D-N.Y., an Energy and Commerce member, said liberals
probably had enough votes to block the Blue Dog deal in committee.
Some details of
the deal remained murky. As part of the agreement the Blue Dogs are insisting
they won't vote for a bill that costs more than $1 trillion over 10 years,
but that would require Democrats to make more cuts or raise more money. It
wasn't clear how much, or how it would be accomplished.
As Energy and
Commerce lawmakers worked methodically through piles of Republican and
Democratic amendments, Waxman's shaky majority was on display early, when the
committee voted 29-28 to defeat a Republican amendment to strengthen ID
requirements designed to prevent illegal immigrants from getting Medicaid
Pelosi of California
expressed confidence the committee would approve the bill, and said the full
House would follow suit in the fall. She also signaled flexibility on key
issues, saying that despite her own backing for abortion rights, she would
not allow the issue to torpedo legislation.
House Democrats with talking points to take back to their districts. The
headline — "Health Insurance Reform to Hold Insurance Companies
Accountable" — showcased Democrats' stepped-up efforts to cast insurance
companies as villains in the debate, as polls show a public increasingly wary
of the health care effort.
Leader John Boehner of Ohio
warned that Democrats who support the legislation are "likely to have a
very, very hot summer."
frenetic activity the overhaul has spurred in Washington, health interests have reported
spending $262 million lobbying in the first six months of 2009, more than any
other portion of the economy, according to the nonpartisan Center for
That was $23
million more than health-related companies and groups spent lobbying during
the first half of 2008.
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The New York Times | 07.30.09
By PAULINE W.
When I was in
training, I took care of a slender man in his 40s who had been admitted to
the hospital with worsening ascites, or fluid in
the belly. Pete (not his real name) had been struggling with end-stage liver
disease for close to a year but had always been able to control his ascites at home with a cocktail of diuretics prescribed
by his liver specialist.
however, Pete’s liver function deteriorated further, and by the time I met
him for the first time, his belly had become so swollen it pushed up against
his lungs and left him constantly struggling for breath. The skin over his
abdomen was stretched translucent, and even from as far as the doorway of his
hospital room I could see the vessels crisscrossing his belly like streets on
a city map.
While this was
Pete’s first experience with severe ascites, I had
cared for many other patients with the same problem. I knew what I had to do:
I had to place a needle into Pete’s belly and drain the fluid out, a
procedure called paracentesis.
But before I could
do so, I was legally and ethically obligated to get informed consent. I had
to offer Pete all the information he would need to make an independent
decision about my proposed plan. I had to explain the nature and expected
course of his ascites, as well as the risks and
benefits of a paracentesis, alternate treatments
and even the option of doing nothing at all.
“Have you ever had
a paracentesis?” I asked, pulling out a consent
form for Pete to sign.
“No,” he answered
between short labored breaths. “Does it hurt?”
I tried to
reassure him by explaining how I would numb him first. But as I began
describing the anesthetic, the bee sting prick of the needle and the
pressured sensation of medication infiltrating the flesh, I felt myself
slipping into a familiar spiel, the same one I had delivered to all the other
patients with intractable ascites. I pointed to the
quadrant on his belly where I would work, estimated the amount of fluid I
would pull out, then reeled off the standard catalog of complications for
Pete looked away
from me and stared at the consent form. Yet even as I watched his brows knit
together, his eyes widen then wince, I kept on talking. I had gone into my
inform consent mode — a tsunami of assorted descriptions and facts delivered
within a few minutes. If Pete had wanted me to pause and linger over
something, I never knew. He couldn’t get a word in edgewise.
“So,” I finally
asked him at the end of my monologue, “do you have any questions?” Even as
that sentence came out of my mouth, I knew what his answer would likely be.
Pete signed the
consent. But as he took the pen to paper, I couldn’t help noticing the tremor
in his hand and the pall that had suddenly descended upon the room and our
In the years since
taking care of Pete, I’d like to think that I have gotten better at the
process of informed consent. But every so often, despite what I believe are
my best efforts, I feel myself falling back on old familiar patterns, habits
I picked up not because someone taught me but because I never learned
anything else. Like most doctors, I bumbled through each
consent on my own, picking up certain phrases and dropping others
through a sometimes painful and often awkward process of trial and error.
This week I thought
about those experiences and my conversation with Pete after reading a study
about pediatric cancer patients, their parents and informed consent in the
current issue of Academic Medicine. Investigators at the Cleveland Clinic
found that after a single day-long training session, doctors were better at
eliciting questions and clarifying comments than doctors who had not been
trained. Moreover, when researchers later interviewed the parents, they found
that parents who had spoken with trained physicians were more likely to have
a better understanding of the consent itself.
“There has been so
much attention paid to the consent documents,” said Dr. Eric D. Kodish, senior author of the study and a professor of
pediatrics and chairman of bioethics at the Cleveland Clinic. “But the
documents are at best props in the theater of informed consent. It’s the
process itself that is really important.”
While studies on
informed consent have historically concentrated on the legal and ethical
implications, the work of Dr. Kodish and his
colleagues represents an emerging research focus that in many ways reflects
larger changes in the consent process itself. Those changes in turn reveal
how our ideal of the patient-doctor relationship has over time evolved.
Dr. Timothy M. Pawlik, the senior author of a recent review of informed
consent in surgery and an associate professor of surgery at Johns Hopkins
University School of Medicine in Baltimore,
noted that while medicine has traditionally been paternalistic, “there’s been
an incredible sea change among patients and doctors in the last 40 years. We
are treating patients as partners in the process, and our informed consent
For some types of
practice, such as a surgeon’s, informed consent may be the most important
opportunity to strengthen the patient-doctor relationship. “In surgery,” Dr. Pawlik said, “informed consent is almost a bedrock. We see a patient and may have only one or two
clinic appointments before moving on to an operation. The informed consent process
is the main opportunity for patients to participate in their care and to form
a relationship with you.” Conversations that are one-way, rushed or
paternalistic not only miss an opportunity but also undermine the
relationship. “And that is very difficult to rectify after an operation,” Dr.
Pawlik pointed out, “because it’s like water under
process by which most doctors learn how to obtain informed consent is usually
haphazard at best. Young doctors rarely have formal mentorship or the
opportunity to observe more experienced physicians doing the process well
before they begin to obtain consents on their own. “So often in medical
training,” Dr. Kodish said, “the fully trained
attending physician will say, ’Go consent that patient for an appendectomy.’
You do it, but you never get a chance to think about the choreography of
informed consent — how you make eye contact, sit down, build trust. The
belief that we can ‘see one, do one, teach one’ is not sufficient here.
Informed consent is about forging a partnership with the patient.”
is essential and requires what Dr. Martin F. McKneally,
a professor emeritus of surgery and bioethics at the University
of Toronto in Canada describes as a “leap to
trust.” Patients must feel they have a certain degree of trust in their
doctors before they can give consent, and that trust is built, in part, from
the kind of difficult conversations that can arise. “The process of informed
consent forces you to address things both parties don’t necessarily want to
address,” observed Dr. McKneally, who has studied
how both patients and surgeons negotiate informed consent. “It’s like making
out your will. People don’t want to do it, but it’s an important transaction
While Dr. McKneally encourages other providers on the health care
team to be involved in the informed consent process, the process ultimately
demands commitment and time from both patients and doctors. Dr. Pawlik suggests that patients try to be as well informed
as possible and unafraid to ask hard questions. Bringing an advocate, such as
a family member or friend, to meetings with doctors can help as well.
informed consent is “so inherent to what we do,” Dr. Pawlik
observed, “that we have to be careful not to take it for granted and just go
through the motions. There’s a lot of stress on the system — the amount of
time we are allotted in clinic, the number of items we need to process before
we proceed. Once in a while it’s worthwhile to pause and re-examine these
“What we do to
patients is enormous. Informed consent is an opportunity to invite patients
to participate in the decision-making process of care. It’s a long-term
investment for doctors and patients.”
discussion on the Well blog, “Asking Patients to Sign Consent Forms.”
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