The Bitterest Pill

Andre Billeaud, left, and his son, Giacomo, at UMC’s Pediatric Clinic

As one doctor in training put it regarding impending cuts at UMC, ‘These patients are going to die. There’s no way to sugar coat it.’ By Heather Miller

photos by Robin May

Tammy Villalobos began a nursing career at University Medical Center more than a quarter of a century ago, long before the hospital formed its Pediatrics Clinic that today treats more than 6,000 children a year for the most serious and complex of illnesses.

“Before these clinics were formed, when these children got here they were on their death beds,” recalls Villalobos, now the RN supervisor for UMC Pediatrics.

By March 5, the decades of advancements in UMC’s delivery of medical services could be a closed chapter in health care history, as UMC staffers face dire mid-year state budget cuts that threaten the most critical of health care services offered by Lafayette’s only charity hospital.

News of impending layoffs reached UMC employees Jan. 14 when the LSU Health System announced that it will be forced to slash $29 million from its budget. It’s been widely reported that the mid-year budget deficit will impact seven LSU system hospitals statewide and could mean the loss of 80-100 employees at UMC as well as the hospital’s ENT clinic, labor and delivery department, neonatal ICU unit, ophthalmology department and pediatric clinic.

“Once all these clinics were formed, it prevented these serious illnesses,” Villalobos warns. “They’re talking about budget cuts, but this will be much more expensive in the end. We’re going back 20-30 years with our health care.”

At the heart of these cuts are UMC programs that largely defy the charity hospital stigma, cost-efficient specialty medical services that offer a “one-stop shop” for ailing children and preventive and follow-up care to thousands of the region’s poor and uninsured residents every year. But the med school residents, doctors and nurses who walk the aging hallways of UMC also spend their days treating patients from every end of the socioeconomic spectrum, an undisputable fact to which Andre Billeaud of Lafayette can attest.

“My family is fortunate to have private health insurance coverage that enables us to travel the nation for the best specialty care available for our son’s conditions,” Billeaud says in an open letter he sent to The Independent (and is reprinted in full on the facing page). “We chose UMC’s Pediatric Clinic because it is the best primary care that money can buy for his unique needs, including heart disease, asthma, epilepsy, stroke, feeding tube dependency, developmental delays and attention deficit disorder. It is the single best source of primary care and care coordination for children with attention and behavior disorders, developmental delays or disabilities and other chronic illnesses and disabling conditions in the region, bar none.”

UMC Hospital Administrator Larry Dorsey is trying to formulate a plan to shift pediatric patients to the family medicine division, but nothing has been finalized and it’s not clear yet whether every child will fit into the formula.

“We don’t have much time to get this together. None of this is our choice,” says Dorsey. “We’re trying to do the best we can with what we have, trying to accommodate every patient the way we have in the past. I’m just not certain at this point that it’s going to be possible. I’m hoping we won’t have to do this and the funding will be restored. But that’s wishful thinking on my part.”

State Sen. Fred Mills, R-Parks, says he expects to see the final draft of the plan before it’s presented to the LSU System Board of Supervisors on Feb. 3. The Acadiana legislative delegation is working to combine “creative” local funding sources with possible restoration of some money, while also reaching out to private physicians to see who — if anyone — will step in to fill the void.

The monetary hit to UMC would be two-fold, Mills explains, because the hospital not only cares for patients the private sector here can’t help, but it also serves as a training center for more than 70 future doctors a year.

“We all understand that as physicians finish their residencies in the areas where they live and go to school; that’s where they’re more likely to make their home,” Mills says.

For fourth-year resident D’Antoni Dennis, however, professional training is a distant second to what’s truly at stake.
“We can always supplement our education,” says Dennis, who rotates between LSU System hospitals in Baton Rouge, New Orleans and Lafayette. “The focus of closing these UMC programs is not the residencies or our training. It’s the patient care. Those are the guys who are going to suffer the most.”

A few corridors down from pediatrics is the home of UMC’s ENT Clinic, where Dennis joins fellow LSU Medical School residents like Neelima Tammareddi and Kevin Taheri in tending to more than 300 head and neck cancer patients every month. That’s in addition to the countless other chronic, non-urgent ENT patients who visit the clinic regularly and the handful of facial fractures and traumas they surgically mend every week. If the clinic closes as planned, the students fear the worst.

“We already see many of these patients at a very advanced stage,” says Tammareddi, a third-year resident. “A lot of these are blue collar people just down on their luck. Many of them work but don’t have a high enough paying job. Sure there are some who don’t have jobs and don’t take care of themselves as much as we’d like, but many of them, especially in the community here in Lafayette, are patients who are making that effort and still struggling. Many of them are elderly or have poor social support systems. To be blunt, if you take away this resource, these patients are going to die. There’s no way to sugar coat it.”

The potential program eliminations will force patients from Acadiana and as far away as Deridder, Lake Charles and Fort Polk to travel to the state’s larger charity hospitals in Baton Rouge or New Orleans, Dorsey says. A large percentage of those patients are without adequate transportation.

“It will be a problem,” Dorsey says. “Eliminating this care and trying to meet this budget cut, we’re trying to figure both out at the same time. It’s not easy.”

The short-sighted budget cuts represent a clear “quality-of-life issue,” one that could trickle down to the entire community — including the affluent and privately insured, says Taheri.

“Our next available appointment for non-urgent care is late March or April,” says ENT Clinic RN Supervisor Patience Jordan. “With referrals we get from New Iberia, Alexandria, Lake Charles, trying to get these patients to New Orleans or Baton Rouge is impossible. We have 300 cancer patients on surveillance right now. They see us monthly. Where are they going to go? Who’s going to absorb them? Many of these patients, whether they have money or not, they don’t even know what’s coming. You’re going to shut down a service that takes care of hundreds of patients and you’re not going to give them a place to go or any warning.”

Even if it were financially viable for private physicians to take in a substantial population of UMC’s Medicaid patients, Tammareddi notes that “private patients are going to eventually have problems.”

“These patients have complicated, very time-consuming issues,” she says. “If they have to get admitted to the hospital, then that hospital is going to lose money and other patients are going to suffer. No matter how much people in the private sector may want to help, I’m just not sure that they can.”

A recent Weekly Credit Outlook from Moody’s Investor Services concurs. According to the report, the statewide gutting of LSU’s hospital system could specifically impact Our Lady of Lourdes and Lafayette General Medical Center, not to mention seven other private hospitals around the state.

“With these changes, many Medicaid-dependent, uninsured patients that formerly used services provided through LSU’s public hospital system are likely to seek care at non-governmental facilities, including private not-for-profit (NFP) hospitals,” the report says. “Adding new indigent patients is a credit negative for the private NFP hospitals ... Hence, it will have a negative impact on hospitals’ profitability and debt service coverage.”

The more than 900 employees at UMC have all received notice of impending layoffs, though no one knows yet where the pink slips will land next month. Dorsey says the layoffs will span beyond the specialty clinics in danger of closure. Every department, he says, will likely take a blow.

“The scenario is that everything is unknown,” says Donna Broussard, a child development specialist/patient care coordinator for UMC’s Pediatric Clinic. “We don’t have concrete info on any of this. We have a very short window of time to assist our patients if this happens. My whole career we’ve worked toward having a one-stop shop for patients, reducing the fragmentation of care, providing for more cost-effective care. When they come to UMC they can see the doctor, the occupational therapist and the other departments they need all in one locale. It means a lot to families who rely on these services.”

UMC Pediatric Clinic is irreplaceable

Recent news reports are alarming to me as the parent of a child with complex medical needs. UMC’s Pediatric Clinic is a vital resource that our community cannot afford to lose. It is the only nationally recognized Patient-Centered Medical Home for Louisiana’s pediatric patients west of the Mississippi.  Directed by one of only three board-certified developmental/behavioral pediatricians in the state, it is the single best source of primary care and care coordination for children with attention and behavior disorders, developmental delays or disabilities and other chronic illnesses and disabling conditions in the region, bar none.

My family is fortunate to have private health insurance coverage that enables us to travel the nation for the best specialty care available for our son’s conditions. We chose UMC’s Pediatric Clinic because it is the best primary care that money can buy for his unique needs, including heart disease, asthma, epilepsy, stroke, feeding tube dependency, developmental delays and attention deficit disorder.

Sadly, health care coverage remains a privilege in this country. We recognize our privilege and the precarious position that we and all parents are in trying to provide health care coverage for our children. We are deeply grateful that UMC is equally accessible to all children with complex medical needs, including HIV, sickle cell anemia, autism and diabetes, regardless of their families’ ability to pay.  After all, there, but for the grace of God, go I – or you.

Even for those children with ordinary health care needs, UMC Pediatric Clinic plays a critical role. Its pediatric residency program trains upcoming doctors in model medical home practices while providing routine exposure to and familiarity with exceptionalities that are more likely to go undiagnosed or be mistreated in a generalist setting by these future, locally grown pediatricians. With exit exam scores ranking the highest in the state, UMC’s pediatric residency program provides Acadiana with a richness unparalleled in other communities of its size and geographic distance from the major medical centers, since the vast majority of doctors trained here remain here.

Simply put, UMC’s Pediatric Clinic is an irreplaceable asset that we must preserve through this difficult economic time.

Andre Billeaud, Lafayette

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