Chabert staff worry about community loss

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“I was born here, so I wanted my baby to be born here,” Tessie Lecompte said as she bottle fed 3-day-old Kali Rae Verdin from their room at the maternity and neonatal care floor of Leonard J. Chabert Medical Center.


Lecompte said she was glad to have her first child before March 2, when the public medical facility will stop providing maternity and newborn services n unless a $2.9 million miracle takes place.

Responding to a sweeping $29 million budget reduction by the LSU Health Care System, impacting seven charity hospitals with a total 645 job cuts and loss of critical services n translating to the elimination of 80 jobs, labor and delivery services, neonatal intensive care, which is often the life-saving department of the region’s youngest residents, and inpatient beds at Chabert alone n patients, employees, facility founders and even state legislators offered their comments.


Chabert had its order to cut costs and services, reduced from an original $4.5 million, because according to CEO Rhonda Green, “this facility has been fiscally responsible.”


During the fiscal year of 2008, available data revealed that Chabert generated $105.2 million. Of that total, $47.9 million was strictly charity in nature and uncompensated. More than $33.3 million came in by way of Medicaid. Medicare cases generated $10.7 million with Medicare cost reports listed at $1.1 million. Commercial private pay patients brought in more than $6 million, and self-generating revenue totaled $1.6 million.

All total, Chabert that year alone, according to the Louisiana Hospital Association, contributed in excess of $212 million to overall business activity for the region.


Yet, at the Houma facility that services Terrebonne, Lafourche, St. Mary and Assumption parishes, distress, frustration and even anger are the emotions expressed with what appears to be a countdown of 17 days before the state as a whole begins to feel an impact.


* Employees and Customers

Renee Almarad works on the maternity floor at Chabert. She is among the staff waiting to lose their jobs. In Almarad’s case, she was also expecting to give birth to her second child in April, with help from the people she works with and trusts.


Now, she has been forced to change doctors and find a new, unfamiliar hospital (St. Anne General Hospital in Raceland in this case) to address her and her unborn baby’s needs.


Almarad mostly cries when she talks about having her birthing plans changed while at the same time losing her job and being separated from a crew that cares for one another as much as any could.

With help from co-worker, friend and nurse practitioner Margaret Eschete, Alamard relayed how her pregnancy is considered high risk. In addition to having lost the staff and facility she was counting on, she found it difficult to find a doctor that would consider accepting her as a patient, because of possible complications.


“Her first child was born here,” Eschete said. “Chabert has been her life. This is her home.”


“I chose to deliver [at Chabert], because I feel the best care is here,” Alamard said through tears.

Presently, Chabert averages 30 births a month.


* Beyond Birthing


Neonatal ICU Registered Nurse Naomi Danos explained that being a Level 3 medical center means that Chabert has the technology, ventilators, heart monitoring equipment specifically designed for infants, a six-bed unit and trained staff that few hospitals in the area offer.

Terrebonne General Medical Center (which is not part of the LSU system) only recently advanced to that Level 3 designation for neonatal intensive care, but according to Danos and Eschete would be unable to handle the demand and do what two equally-equipped medical facilities could do in a worst-case situation.


“We even have this [equipment] where we can look at the baby’s heart and send [a live transmission] to a doctor in New Orleans and he can tell us what to do,” Eschete added. She noted the technology and hundreds of thousands of dollars in specialized high-tech tools that stand to be left unused after taxpayer dollars were spent to place them in Terrebonne Parish. “A lot of this is brand new.”


“We have some of the most up-to-date high tech equipment available in the area,” Nursery and Neonatal Care Supervisor Kelly Guidry said. “We even compare to New Orleans hospitals for what we offer our babies.”

The Chabert neonatal ICU staff includes not only those who work inside the hospital, but outside to train parents who have infants with special needs.


“We have certified car technicians,” Labor and Delivery Supervisor Tara Dargre said. “We provide parents of our premature babies with challenges with checks [outside the hospital]. We also go out in the public and hold car seat checkpoints with state police.”


* Comparative Examples

“With New Orleans [Interim Medical Center of Louisiana] labor and delivery also being closed, the Baton Rouge [Earl K. Long Medical Center] labor and delivery being closed, a woman delivering on an emergency room ramp at 30 weeks with no Medicaid or insurance and no transportation, would have a baby that would be transferred to Alexandria to be in an ICU.” Dargre said. “Hospitals like TGMC cannot refuse [the uninsured patient] if they are there, but they can refuse to accept a transfer.”


Guidry added to the complexities involved by confirming that in a region of multiple cultures, expectant mothers in south Louisiana might not speak English as a primary language. They may speak primarily, or exclusively, Spanish, French or Vietnamese. “They won’t understand when they come to the door and are told they cannot be accepted,” she said. “Where are they going to find someone that will find a way to communicate with them? They will show up on an emergency room ramp not understanding that language barrier.”


“[Without Chabert] you are going to have a lot of women not receiving prenatal care and just showing up at emergency rooms to deliver,” Guidry said. “That will increase traffic at emergency rooms.”

* Prenatal Prognosis


“Prenatal care is needed to increase infant mortality and the state of Louisiana is second lowest in the nation already [at 9.7 deaths per 1,000 births],” Dargre added. “Without having providers available for prenatal care, the increased wait time and appointment lag time will flood the market with patients seeking prenatal care. There will be unavailable appointments for those that cannot afford to pay.”


According to Chabert professionals, with the elimination of maternity and neonatal intensive care, uninsured and poor parents will no longer have a place to bring infants at risk because of major medical conditions or receive the care they need to bring healthy babies into the world. “What is going to happen to these sick babies?” registered nurse Anne Boughton asked. “The infant mortality rate is going to skyrocket.”

Chabert has been one of few facilities in the LSU Health Care System that offered parenting classes to young mothers, addressed teen pregnancy and attempted to educate the community.


The Chabert staff spends a lot of time teaching contemporary mothers how to be parents. “They are not prepared,” Dargre said. “Adolescent pregnancy is on the rise. It is the highest now than it has ever been. I would say 25 to 30 percent of our births are to adolescents. People under 18. Some of them are 14. Some of them are 13. We’ve had a 12-year-old. Where do they go? If your mamma didn’t teach you … these nurses are also serving as parents to a lot of these young mothers.”


Dargre fears that without the services Chabert provides, the youngest of mothers will have no place to turn. “I think we will see an increase in scenarios that we have seen where moms with no prenatal care and don’t come to the doctor and dispose of their babies,” she said. “If they have to choose to pay a $60 bill at a physician’s office or feeding existing children, they are going to be without prenatal care.”

Guidry said that comparably, births at Chabert are not as high as at other places, “but our volume of prenatal visits is in the hundreds.”

The neonatal supervisor said that an additional 500 prenatal cases per year would have to be taken on by other area hospitals. “That is a number we will not be able to absorb,” she said. “It is not so much the number of deliveries, but the care that makes sure mom is safe throughout her pregnancy that makes a difference.”

Guidry and Dargre said that with federal funding cuts, expectant mothers that have used Medicare and Medicaid to receive prenatal care up to delivery could be admitted to private hospitals that would then be taking money that would have otherwise gone to state-managed health care facilities. “So federal funding will be going to private hospitals,” Dargre said.

* Doctor Dilemma

Another group of professionals expecting to feel the impact of losing labor, delivery and neonatal care at Chabert are resident doctors that would not receive direct, real life experience in this field.

“With the labor and delivery closed down we won’t be able to rotate here for OB/GYN which is part of our education,” third-year medical student Kevin Leung said. “So we have to scramble and find a hospital that would accommodate for us, but there is such huge competition by other schools that it limits hospitals where we can do it.”

“As a resident, the impact of closing labor and delivery here at Chabert would impact the way we manage patients,” Dr. Sheena Pullman said. “In this setting it is different. The interaction you get with patients, taking ownership with the patients, is different than at a private hospital. This is where we learn how to work with patients and take on a technique of how you will do it in the future. Following patients from prenatal care up to delivery will be missed as part of the learning experience.”

“This is going to be a major change for us.” Dr. Bret Hemelt said regarding the resident doctors he supervises. “This is where they learn obstetrics. So we won’t have as many residents assigned here. Chabert has been the place where a resident was allowed to make decisions and basically get good experience at managing patients. That will be a big change.”

Chabert also provides training for nursing students, Acadian Ambulance Service and medical education resources for Fletcher Technical Community College and Nicholls State University. “We are a teaching institution,” Dargre said.

* Common Connections

Registered nurse Anne Boughton said the Chabert cuts mean all labor, delivery, nursery and neonatal care personnel will lose their jobs. In her case, because of seniority, she will be relocated to another department in the facility. “But it still is not right,” she said.

With a 2-to-1 patient to caregiver ratio, Chabert employees become close to mothers, babies and their families. It is an element staffers said is not possible at larger departments where personal attention is difficult to offer.

Guidry said the difficulty for members of the Chabert staff losing their jobs includes the fact that they experience little turnover and become close in personal relationships as well as professional associations. “I’ve been here 22 years,” she said. “There are a lot of people with well over 15 years and many with more than 10.”

With 25 labor and delivery employees and another 15 in the nursery, as well as 40 other Chabert staffers facing their final day of employment in familiar areas, none seem able to understand why the services they provide have to be eliminated at the expense of the community at large.

* Insider Insights

Dr. Irving Blatt is one of the founders of Chabert Medical Center. He contends the politics involved between Gov. Bobby Jindal’s office, the Department of Health and Hospitals and the LSU Health Care System is more involved than decision-makers inside the system are willing to admit.

“There has always been a crisis where the charity hospital system suddenly is without funding or is with diminished funding, and therefore services are going to be closed,” Blatt said. “Threats are made. Then they get some money and everybody lives happily ever after until the next crisis.”

State Rep. Joe Harrison (R-Napoleonville) has been critical of the state legislature as a whole regarding budgeting. He has been even more critical of the Jindal administration and how budgeting priorities are made.

“Government has become very good at throwing money at failures and taking away from those who are successful,” Harrison said on multiple occasions. He noted that Chabert is the only member hospital of the LSU Health Care system that has generated revenue. “Why should they have to suffer for that?”

“You cannot divorce the medical education system from medical practice,” Blatt said. “These people are suffering and they are suffering because of a lousy system. [Chabert’s] problems can be solved by getting out of the system. They are capable of generating funds and operating at a profit just like any district hospital.”

Blatt claimed that powers inside the LSU Health Care System would lock down information and threaten administrators with the loss of their jobs if they talk about conditions within the system. “Are you willing to have your house burned down?” the Louisiana State Medical Society Board of Governors member said regarding reactions some claim to have received when threatening to exposing of details on how the LSU Health Care System is operated.

Attempts to get comparative data directly from the LSU Health Care System were unsuccessful. Also, public access to online information has been blocked.

* Labor of Love

Guidry said that the concept of indigent care and stereotypes associated with them has been an issue battled by Chabert employees. “We service anyone,” she said. “We don’t pick and choose who we will serve. We have a neonatal transport team so we go to get babies at surrounding hospitals that don’t provide the level of care that we do here as a Level 3 ICU.”

“Labor and delivery isn’t just about labor and delivery,” Dargre said. “We treat each patient head to toe, not based on payer source. We treat body, mind and soul. We are still hoping the white horse will come in with $2.9 million and we can keep this facility open. We still are going to be hopeful.”

“We have been kind of a safety net hospital,” Hemelt said. “I’m not sure what is going to happen to those patients.”

“They took good care of me,” Lecompte said. “If I had another baby I would want him to be born here too. I don’t see why [the LSU System] would want to close them down. A lot of people got their own opinions, but I like it here.”

* Resource Resolve

“Right now, we are working with our patients to get them connected with doctors and other hospitals, but you need to remember that the ones that are able to find new care options add to the patient load of other hospitals,” Guidry said, adding that she fears the increased patient load at surrounding hospitals could impact the quality of care.

Although many of Chabert’s maternal and newborn patients do receive Medicaid, and approximately 10 to 20 percent are insured, the neonatal nurse contends many patients could fall through the cracks and not receive the prenatal care or delivery attention they need.

Chabert patients needing to transfer records to another medical provider can do so by going to LJCPatientNavigator@lsuhsc.edu or by calling (985) 873-2458.

Registered Nurse Naomi Danos examines an infant in the neonatal intensive care unit at Leonard J. Chabert Medical Center. MIKE NIXON