Nagin to Jindal: Please reconsider proposed cuts to hospitals ...

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The following is a copy of a letter written by New Orleans Mayor Ray Nagin and sent to Governor Bobby Jindal. The letter was provided by the City of New Orleans.

The Honorable Bobby Jindal

Governor

P.O. Box 94004

Baton Rouge, LA 70804-9004

Dear Governor Jindal:

I am alarmed by the plans to make extensive cuts in the provision of public health care services in the City of New Orleans. You recently announced plans to close the New Orleans Adolescent Hospital (NOAH), which would require adults and children currently treated there to receive mental health inpatient services at Southeast Louisiana Hospital in Mandeville. Following this, your administration announced major cuts to the Louisiana State University Interim Hospital that would eliminate 300 jobs, cease providing dental services, and reduce cancer screenings. Individually, each of these cuts would hinder the recovery of our region, but combined they would mean major setbacks to the moderate progress that has been made in health care in New Orleans post Katrina.

These changes would have the greatest negative impact on our poorest citizens who are frequently underinsured or uninsured. They have few options for obtaining primary, emergency, or mental health services from other providers. Due to lack of insurance, they receive exorbitant bills they cannot afford if they do seek services in community hospitals.

The planned changes take the beds away from where they are most needed - in the center of the largest metropolitan region in the state and in the parish with the most damage to people's lives and property. As you are likely aware, successful inpatient mental health services are dependent upon the family support network. It would be a tremendous hardship for New Orleans region residents, who are still struggling to recover, to travel more than an hour for daily sessions. This would disproportionately affect our poorest residents who lack transportation and financial means for this travel. As a result, the success of these services would be greatly diminished.

The City of New Orleans has faced a significant health care crisis since Hurricane Katrina. Last year, your administration recognized this crisis and took a tremendous step in the right direction as it relates to mental health care when you announced your "Comprehensive Plan on Mental Health Care in New Orleans." You addressed the fact that the problem was especially acute in New Orleans where suicide rates have doubled after Katrina and the World Health Organization has acknowledged that large segments of the population experience serious mental health issues that traumatic losses bring on, such as depression. Untreated, mental illness poses a serious threat not just to the patient but to the community at large, which was made painfully clear again when New Orleans Police Officer Nicola Cotton died at the hands of a mental health patient in crisis. Our community was optimistic about your plans that involved putting back together the "broken pieces" of our health care system, and even adding more critically needed beds to the NOAH facilities.

NOAH has been operating with inadequate capacity to serve the community's needs since Hurricane Katrina. A promised increase of 10 additional beds in 2008, which would have brought the total to 55, never occurred. Instead, the State of Louisiana reduced the budget for NOAH in January 2009, which led to a cut in the number of beds at the facility from 45 to 35. Although NOAH is a key New Orleans facility for the indigent and uninsured, it is currently operating to capacity with no available beds.

The State has estimated that the consolidation of NOAH with Southeast Louisiana Hospital would result in annual savings of $9.1 million. The quoted cost-per-bed comparison used in that analysis can be misleading, however. The cost-per-bed goes down when the number of beds increases, because the overall cost to operate the facility remains approximately the same. Conversely, the cost-per-bed goes up when the number of beds is reduced, as happened at NOAH when the number of beds was reduced to 35 in 2009. Therefore, an analysis of savings based on the cost-per-bed between Southeast Louisiana Hospital, which has more beds, and NOAH, which has fewer beds, is not an accurate portrayal of the overall cost to operate the facilities nor of savings that could be incurred by combining them. If the number of beds was increased at NOAH, as had been promised, or if the facilities were consolidated at NOAH instead of Southeast Louisiana Hospital, the cost-per-bed at NOAH would go down. In addition, there is an in-kind contract with Children's Hospital to provide the needed medical services that adds significant value to keeping NOAH in New Orleans. Medical clearance is an expensive but necessary step prior to hospitalization. The added cost of these medical services if NOAH were closed should be accounted for in your calculations.

Despite our repeated requests, the staff at NOAH has been unable to provide us with data regarding its daily bed count and the origin of the patients served there. I would greatly appreciate your assistance to obtain this public information, which help us further evaluate the needs of our community.

Additionally, your administration spoke of opening community based mental health clinics on both east and west banks of the metropolitan area in concert with NOAH's closure. I would very much like to see your plan and the timeline associated with these clinic openings as well as the targeted population they would serve.

In closing, I thank you for your overall commitment to New Orleans and our recovery. We have worked creatively during the past 3 But we can accomplish this only if our citizens can receive the services they need to maintain their physical and mental health. I understand the need to make difficult decisions, as we have been forced to do the same during our own budget process. I also understand that there are severe limitations in the areas of the budget that you may cut, and I support your having more budgetary discretion to not sacrifice critical medical needs in times like these. I ask that you seriously reconsider these planned cuts, which would lead to greater suffering by the most disadvantaged residents of a city that has already experienced severe devastation.

C. Ray Nagin

Mayor



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