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The Closure of Southeast Louisiana Hospital 

Charles Maldonado on the politics and the human cost of closing southeast Louisiana's public mental hospital

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click to enlarge Pat Brister, president of St. Tammany Parish, 
praises Gov. Bobby Jindal, but is critical of the closure of Southeast Louisiana Hospital.
  • Pat Brister, president of St. Tammany Parish, praises Gov. Bobby Jindal, but is critical of the closure of Southeast Louisiana Hospital.

  Nevertheless, Brister adds, "I think it probably would be a good idea to try to call it. I have no reason not to call it, by any means."

The announcement of the cuts came from DHH Secretary Bruce Greenstein in July after Congress significantly reduced Medicaid reimbursements to the state last summer, leaving an $859 million hole in this year's budget.

  "I was totally and utterly shocked," says Dr. Avery Buras, a child psychologist at SELH. "I work on youth services. And we were actively hiring employees ... We had kids lined up to get in. So it was kind of shocking that we get this memo, this email saying the hospital was closing down. We didn't see it coming from anybody."

  There is no plan at the moment for the 82 other patients in the hospital — 32 short-term acute patients and 50 juveniles. They may stay there if DHH identifies an operator to take over the site. That's one idea that may come out of a recent DHH-issued request for information (RFI) from interested contractors. Another one would be to move them to one or more yet-to-be-identified partner(s) that run mental health facilities elsewhere.

  "That's what the RFI was for ... It's just to see who's interested, who has capacity, and then we'll start talking," DHH spokesperson Kliebert says. "Our intention is to work with the parish to see we can do to keep the facility operational as a health care facility."

Kliebert says the state hopes, in a best-case scenario, to split those remaining 82 beds between the south shore and the north shore.

  Nor is there a plan for the 64 addictive disorder beds that the Florida Parishes Human Services District runs on the hospital's grounds; or for the Louisiana Methodist Children's Home, which has 20 resident spaces there; or for the National Alliance on Mental Illness (NAMI) St. Tammany offices there.

  "There are two schools there. St. Tammany School Board has one, the Jumpstart program, and the other one is the school for the patients there. They have to go to school, too," Brister says. "Those type of services in addition to the addictive disorder services, the alcohol abuse services. There are many, many services that I'm hopeful we'll be able to keep."

  SELH provides 476 filled full-time jobs right now. Add contractors and the nonprofits that work on site, and the number is well over 500. DHH has offered some SELH employees the chance to work at one of the other two facilities.

  "We have currently more offers than people have accepted. So if someone wants one of those positions, and it's a position they qualify for, we will automatically give those positions to those individuals," Kliebert says.

  But accepting jobs at facilities located several hours away might be difficult if not impossible for some employees, says SELH psychiatrist Dr. Janet Bradley.

click to enlarge Southeast Louisiana Hospital employs 476 full-time workers, some of whom have been offered jobs elsewhere.
  • Southeast Louisiana Hospital employs 476 full-time workers, some of whom have been offered jobs elsewhere.

  "Some people, even when positions were offered, cannot afford to relocate a family of four to those remote locations," Bradley says. "Most of the direct clinical care staff want to stay until the end, until the last patient is gone. So they're really making a lot of personal sacrifices. They could be looking for jobs right now. By the time they do start looking for jobs, there may not be jobs left."

  Bradley and Buras helped found the Committee to Save Southeast Louisiana Hospital, along with a handful of staff members. Other supporters include Save Charity Hospital veterans Derrick Morrison and Brad Ott and Mandeville Mayor Donald Villere, the group's first major political supporter. Villere lets the group meet in City Council Chamber at Mandeville City Hall. State Treasurer John Kennedy gave a speech at the group's "speak out" last month, as did several state legislators, including Donahue. The event was packed. DHH did not send a representative.

  Community support — and the possibility of a special session — yields varying degrees of optimism among the group's members.

  Ott is dogged and thorough. A expert on state government, he makes the phone calls to Baton Rouge, tries to keep tabs on the possible special session signees and explains legislative procedure to the other group members. But he's been in similar fights before and lost. During a group meeting late last month, he ended an enthusiastic presentation on Richard's call for the session with this: "This is a rare event. It will be a momentous occasion, even if we don't win the thing."

  By contrast, psychiatrist Bradley's confidence appeared shaken only once, when she was asked what she plans to do if, as seems likely, the hospital does close or transitions to a much smaller private operation. Her face drops, and she admits she hasn't thought about it.

  Buras has. He says he will be open-minded about a private operator proposal. Unlike the long-term adult beds moving to Jackson and Pineville, the state wants to keep the juvenile beds near New Orleans, provided someone else runs them. If that doesn't work out, he has some prospects in Mississippi. Buras says he'll commute there from Louisiana until his son graduates from high school.

  "Then I'm getting out," he says.

Many in the group and among its sympathizers suspect that the cuts are less about fiscal pragmatism more about Jindal's political ambitions and ideology.

  "This proposal is supposed to be because we don't have enough money, and that's just not accurate, folks," Kennedy said at last month's speak-out. "I've read that Louisiana has as many as 19,000 consultant contracts. ... You want to save money? That's where you start."

  There are other areas where revenue could be mined.

  A July report by the Associated Press found the state only collected $198 million in corporate taxes last year, 12 percent of about $1.7 billion it could have collected — if not for the state's many corporate exemptions. An August Louisiana Budget Project analysis found that the state's film tax credits cost $231 million last year. And in September — two months after Greenstein said SELH would close and LSU hospitals would soon see another round of large cuts — the state announced a $130 million budget surplus for the fiscal year ending June 30.

click to enlarge cover_story-5.jpg

  "You would think $3.5 million wouldn't be that difficult to come up with out of it," Brister says. "I don't think it's just financial. It's a policy decision. I think if it were just financial, we'd be having more discussion on how to fill that gap."

  Along with SELH's closure, the federal Medicaid reduction led to $152 million in cuts — including 1,500 jobs and more than 100 inpatient beds — to LSU's hospital system, according to a plan developed by Dr. Frank Opelka, newly appointed head of the LSU Health Care Services Division. Opelka presented his plan to the LSU Board of Supervisors earlier this month. The board approved his plan unanimously and enthusiastically. Chairman Hank Danos said it will take the state's health system from "good to great."

  Not everyone agrees.

  Kliebert, the DHH spokesperson, says the administration does have an ideology when it comes to public health — but it's not what its critics believe.

  "We still do feel strongly that we have to be a safety net of services," Kliebert says, adding that DHH is moving long-term patients to other state facilities because state government is better equipped to care for them than private operators. "We try and always figure out, is this something we need to be doing as a state? Is this something the state needs to be providing? And clearly it is in the case of the intermediate care beds," she says — as opposed to the acute beds, which Kliebert says can be operated by private groups for less money and without a drop in quality.

  "We're doing it in a sustainable way, so that we can assure those services are sustained in the future. That's our only ideological investment in this. We want to make sure we have the ability to sustain mental health services in the future," she says.

  Hotard, whose daughter will be relocated because of the cuts, disagrees.

  "[Jindal]'s done nothing but close down everything that smacks of public health care," she says. "If it's public funding, we're not taking care of anybody."

Since finding out that she'd be moving again, Shelley Hotard has been guarded and less willing to speak to or even see her mother.

  "I made the drive down on Saturday, driving in a rainstorm, got there, and she would not come out of the unit to see me," Pat Hotard says.

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