AS SOUTHEAST LOUISIANA HOSPITAL PREPARES TO CLOSE, SOME OF GOV. BOBBY JINDAL'S SUPPORTERS ARE SPEAKING OUT AGAINST THE PLAN. MEANWHILE, FAMILY MEMBERS OF PEOPLE IN LOUISIANA'S PUBLIC MENTAL HEALTH SYSTEM BRACE FOR ANOTHER CHANGE.
"The merger will not affect the capacity of the New Orleans region ... "
— Then-Department of Health and Hospitals (DHH) Secretary Alan Levine in a 2009 letter to The Times-Picayune on the plan to close New Orleans Adolescent Hospital (NOAH) and transfer patients to Southeast Louisiana Hospital (SELH) in Mandeville.
"This is the right thing to do to ensure that the people of Louisiana have a sustainable behavioral health care system for the future."
— DHH Secretary Bruce Greenstein in an August statement on the plan to close SELH and transfer patients to state facilities in Jackson and Pineville
"Two years, they're going to close Pineville. Listen to what I'm telling you."
— A protester at a rally against the closure of SELH
FOUR PEOPLE, INCLUDING ME, STAND AROUND IN THE DARK on a semi-rural highway just outside the gates of Southeast Louisiana Hospital (SELH) in Mandeville. It's 5:55 a.m. on an early October morning, and we've come to watch a charter bus make a right turn. Seventy-five percent of us are employed by local press outlets, so the right turn is actually kind of a media event. The right turn is scheduled for 6 a.m., but nearly an hour goes by before we finally see headlights on Pelican Drive, the hospital campus' main thoroughfare. Then the bus approaches, pauses and pulls onto Highway 190. The whole thing lasts about 20 seconds.
The Bus Turning Right, we discover, is as visually gripping as a bus turning right. That it happens to be the first physical step in the dismantling of metropolitan New Orleans' last public psychiatric hospital is what makes it significant.
For Pat Hotard, the image of the bus leaving would have been too much to handle. Aboard the bus that early morning is Hotard's daughter, 32-year-old Shelley Hotard, a schizophrenic who has been living at SELH since 2010. Interviewed a few days after the move, Hotard says she couldn't bring herself to make the drive down from Baton Rouge to see it.
"I was just so emotional that day, it was better that I not," she says.
The bus is headed for Central Louisiana State Hospital in Pineville (aka "Central"), a three-and-a-half hour drive away. Twenty-three women who've been receiving long-term psychiatric care — also called intermediate care — at SELH left the hospital on Oct. 2, four days before the hospital would mark its 60th anniversary.
Sixteen more patients were planed on another bus the next Tuesday, Oct. 9, this time bound for Jackson, La., and the Eastern Louisiana Mental Health System (aka "East"), two hours away. Another bus will arrive the Tuesday after that, and so on until the end of the month, when the state plans to permanently cease all long-term inpatient care at SELH.
The facility's 94 long-term adult patients will go to Pineville and Jackson, while its 50 youth patients and 32-patient short-term acute capacity patients will be sent to as-yet-unidentified private providers.
The Louisiana Department of Health and Hospitals (DHH) is in very early talks with private providers. One possible outcome of those talks may be privately run mental health services on the SELH site, albeit much more limited and without any adult long-term care.
As of now, Gov. Bobby Jindal's administration plans to close the hospital entirely by the beginning of 2013, less than four years after it closed New Orleans Adolescent Hospital and transferred its patients to SELH — promising the adolescent NOAH patients and their families that care would be provided at SELH.
The latest changes will yield significant savings for the state, right after it was hit with a major cut to federal Medicaid payments, says Louisiana Department of Health and Hospitals (DHH) Deputy Secretary Kathy Kliebert.
"At Southeast, it costs us about $826 a day per individual. That's an average of the population," Kliebert says. "In the private sector we can, for the acute beds we're transitioning, we can basically buy those for at most $580 a day. In addition, our cost at East is under $500 a day. At Central, it's a little over $600 a day." Kliebert says the standard Medicaid rate for a public provider is $580 a day.
East is cheaper because it's much larger, with more than 500 total beds. And Central doesn't take juvenile patients, who push costs up, Kliebert says. Total savings are expected to reach $1.6 million this year, including $555,000 from the state general fund, and $3.5 million every year thereafter.
"A savings of $3.5 million in the state general fund is a significant savings. And remember that we're not losing any services in this. We are able to assure the same level of services provided, the same number of inpatient beds, and produce a significant savings," Kliebert says.
Jindal has long said he wants to "right-size" the state's public health system, reduce total inpatient beds and transfer services to private providers — all of which, he says, can be achieved without reducing the quality of service.
"Part of our long-term strategy is being sure that people can be served in their homes and their community," Kliebert says. "Over 30 percent additional funding has been added to our community-based services."
This argument has come up repeatedly in the past year, as the administration has stripped funding from the remnants of the state's Charity Hospital system, which is run by Louisiana State University (LSU). This month, the seven LSU hospitals in south Louisiana took a $152 million hit. Residents were assured that services would be continued through "partnerships" with private providers — though, for the most part, state officials have not even identified LSU's prospective partners.
A Southern Media and Opinion Research poll released earlier this month shows Jindal's approval rating at 51 percent — down 13 points from last year and down even more from his sky-high approval ratings of four years ago. Sixty-eight percent of respondents said Jindal has cut the operating budget enough; 89 percent said they were concerned about the LSU health cuts; and 80 percent believed state residents would lose access to service as a result of the cuts to health care.
Even some of Jindal's supporters in government are complaining about the cuts. Rep. Jerome "Dee" Richard, I-Thibodaux, has taken the extraordinary step of calling for a special emergency legislative session next month to revisit cuts and proposed privatizations to health and correctional facilities.
"Since our adjournment in June, there has been almost a billion dollars in reductions to the state budget without any input from the Legislature," Richard wrote in a letter announcing his intention to call for the session. "I believe it is time for us, as legislators, to aggressively reinsert ourselves into the budget process by using the constitutional rights given to us. We should not have to relinquish our legislative duties to the administration once we pass the budget at the end of regular session in times like this."
St. Tammany Parish President Pat Brister, a longtime Jindal supporter, says that while she still backs the governor overall — she calls him "brilliant" — she doesn't like how he handled SELH.
"It was done without notice to any leadership or any of his legislative delegation here. I think that was unfortunate and should not have been done that way," Brister says. "I have watched his political career since he first went to work for Gov. [Mike] Foster. I know he's quite bright. And I think he really does live by his convictions. I just disagree with this part of what he's doing. I won't say that it has changed my opinion on the person he is. I just disagree with him."
Asked about the special session, Brister says she doesn't think it will be effective since it's unlikely to get much support outside of south Louisiana. (Or, for that matter, maybe even in south Louisiana: Senate President John Alario, R-Westwego, House Speaker Chuck Kleckley, R-Lake Charles, and Sen. Jack Donahue, R-Mandeville, have all come out against the proposed session.) Moreover, Brister says, there's no chance of passing any budget bill with enough votes to override a certain Jindal veto.