PAR report calls charity system inefficient, unfair

A draft of an upcoming report commissioned by a government watchdog group calls for major reform of the University-run state charity hospital system, including the privatization of a majority of the University's charity hospitals. An incomplete preliminary copy of the report, which was written by the Public Affairs Research Council of Louisiana, was first released Tuesday after The Daily Reveille made a public record request. The report characterizes the current charity system as "inefficient and unfair," stating it has failed to fulfill its dual mission to educate medical professionals and provide health care for the uninsured of Louisiana. "The charity hospital system has failed to provide ready access to medical services for the target population of more than 800,000 uninsured persons in Louisiana," according to the report. "Charity hospitals are ill-equipped to shoulder these responsibilities, lacking some of the most basic tools with which modern hospitals provide medical care. If the public and private sectors shared the burden of indigent care and medical education, true centers of excellence could develop to provide quality care and quality education." The charity hospital system was founded in 1735 in New Orleans. After assuming responsibility of several individual hospitals, the LSU System took full control of all state charity hospitals in 1997. It has retained control over the charity hospital system. The charity hospital system was severely crippled by hurricanes Rita and Katrina. Medical Center of Louisiana at New Orleans, Charity Hospital, was destroyed and five other charity hospitals were severely damaged. The PAR report, which was compiled by PAR health care analyst David Hood, who previously served as secretary of the State Health Department and is a longtime critic of the Charity hospital system, asserts medical care in the Charity system is outdated and lacks in technological advances. "Some of the tried and true advanced technology procedures, such as cardiac cauterization, angioplasty and heart bypass surgery, are still not offered in most Charity hospitals," according to the report. "Though advancements are in progress, the Charity hospitals lag behind the private hospitals in the range of services they can provide and the immediacy of care available." The report also recommends seven of the state's 10 Charity hospitals - W.O. Moss Regional in Lake Charles, University Medical Center in Lafayette, Leonard J. Chabert Medical Center in Houma, Bogalusa Medical Center, Lallie Kemp Medical Center in Independence, Huey P. Long Medical Center in Pineville and E.A. Conway Medical Center in Monroe - be gradually phased out of the state health care system and replaced by alternative care facilities. "Louisiana's system of care for the uninsured should be converted over time from the current network of 10 Charity hospitals, to a patient-centered, widely accessible and integrated structure composed of public and private hospitals, community-health clinics, rural health clinics, school-based health centers and primary care physicians and specialists," according to the report. The PAR report recommends the transformation of the remaining three Charity hospitals into "academic medical centers ... reaching out to a broader patient mix that includes more private insurance patients." "LSU hospitals in New Orleans and Baton Rouge should be established and operated as academic health centers under the jurisdiction of the LSU Health Sciences Center in New Orleans," according to the report. "Each hospital should strive to be a center of excellence for medical education, research and patient care." The report also advocates restructuring healthcare options for the uninsured to include a broader spectrum of private and public healthcare. "The safety net of care for the uninsured would be broadened to include private hospitals for acute care and clinics for primary care. Rules for funding care for the uninsured would be developed so that the dollars follow the patients to both public and private care providers," the report states. "Other budgetary changes would enable the state to capture additional federal funding for graduate medical education." The report comes in the midst of an ongoing debate over the use of hurricane recovery funds to rebuild the Big Charity Hospital in New Orleans. The state Legislature is expected to vote this week by mail on a bill that would appropriate $74 million for land and design of a new Charity hospital and $226 million later for the construction of the hospital pending further legislative approval of the business plan. The PAR report favors a smaller replacement facility focused primarily on medical training, research and specialized care instead of the large trauma center currently being proposed by the LSU System. "Careful design could yield an academic teaching hospital and trauma center that complements the existing medical facilities in the region with specialized care unavailable somewhere else while providing sufficient supply of primary care physicians to enable the development of a decentralized system of care for the uninsured," the report states. LSU System representatives would not comment but released the following statement to The Daily Reveille. LSU System President William Jenkins was unavailable to comment. "The report's recommendations would have us destroy rather than improve a working system upon which around a fifth of the population depends," according to the statement. "PAR advocates the massive closure or divestiture of Charity hospitals but without identifying a feasible means to fund and organize a viable alternative system to provide care to the uninsured. "Beyond the detrimental effects of the PAR recommendations on access through the LSU hospitals and clinics, the training programs of several medical schools that coexist in the safety net system will be disrupted and dislocated. That impact alone would be indescribably detrimental to Louisiana." System officials acknowledged the need for reform but said the PAR report does not suggest viable changes. "Change in the public health care system is both desirable and inevitable. It must be thought through, however," according to the statement. "The PAR report represents a continuation of the traditional tactic. Bash and denigrate the Charity system (whose patients have little political voice), reduce political and financial support for it, but come up with no workable alternative." The copy of the PAR report released by the University is a draft given to Jenkins for preliminary review before its official release by PAR later this month. University Spokesman Charles Zewe told The Associate Press that Jenkins had not wanted to release the report, but was forced to after LSU System Counsel advised they could not legally hold it under public record laws. "We had every intention of honoring the confidentiality and had honored the confidentiality of the draft. It is unfair to PAR to release the document before they are allowed to finish it," Zewe told AP. PAR President Jim Brandt did not return multiple calls and e-mails.

----- Contact Sarah Yokubaitis at syokubaitis@lsureveille.com