“Texas’ Other Death Penalty“

A few weeks ago, I did an article about mainstream medicine advocating for health insurance for everyone, and I mentioned that the New England Journal of Medicine (NEJM), one of the premiere US medical journals, did an editorial strongly advocating for health care for all.

While the NEJM stopped short of completely endorsing the Affordable Care Act (Obamacare), they were forceful in arguing for some form of total health care insurance. The NEJM is run by the Massachusetts Medical Society and the authors drew upon their experience with Massachusetts’ health care program.

Additionally, the American Medical Association (AMA), through its publication, Journal of the American Medical Association (JAMA), is not only supporting health insurance for all, it has started offering support services for doctors and patients in regards to this issue.  It has produced handouts for patients explaining the ACA, offers help to patients and doctors to access government information on affordable health care, and offers a patient advocacy site in which questions on the ACA (among other things) can be addressed.

Also, some medical professional societies are doing similar things with respect to accessing affordable health insurance.

Free health and dental clinic by Remote Area Medical during the week of August 19, 2009, Los Angeles, California. (spirit of america / Shutterstock.com)

Free health and dental clinic by Remote Area Medical during the week of August 19, 2009, Los Angeles, California. (spirit of america / Shutterstock.com)

Subsequently, I wrote a later story discussing another article from the NEJM, Dead Man Walking. It talked about problems with uninsured patients not getting desperately needed health care for serious medical conditions. And how, in some instances, they, and their physicians, were unable to do anything to access such care. The end result was, indeed, a dead man walking. And he didn’t walk for long before dying.

Today there is another example of why the alleged “safety net” that the poor, uninsured and underinsured are supposed to be able to make use of, has not only failed (and has been failing for years), but is now shrinking – virtually vanishing.

This article is written by an MD/PhD student in Texas, Rachel Pearson, and published in the Texas Observer. The title is “Texas’ Other Death Penalty.” It’s a simple, clearly written, and horrific description of the safety net failures, specifically in the Galveston, Texas area.

Texas is just one of the states that has refused to open up to Obamacare, and has refused federal funds to expand Medicaid. Local and state Republican officials are insisting that uninsured Texans (possibly 25% of the population) prefer to try to get into vanishing, overcrowded free clinics. Or they go to local emergency rooms, and later face staggering bills.

Or they do without care altogether.

The author of the article cites statistics that upwards of 9,000 Texans will die EACH YEAR as a result of the fantasy safety net that only conservatives seem to be able to see, but of course don’t have to actually access themselves. If they DID need to use it, there would be screams of outrage from the right wing.

Part of the reason is that local hospitals, in this case the University of Texas Medical Branch (UTMB), which used to provide free or low cost care to those who were desperate, is shutting off these services. UTMB used to be a state-supported “charity hospital.” But that has changed. And it’s not just that hospital, but others in the area, as well. Many hospitals, that used to offer some amount of free or lower cost care to the uninsured or underinsured, are providnig that service less and less. They’re feeling the economic squeeze and are cutting back as much as they can.

This isn’t just a recent development. In 2005, UTMB was providing charity care to the working poor, Medicaid, uninsured and underinsured. But only 77% of them qualified at that time for UTMB’s charity services. Already over 20% were being turned away. Shockingly, In 2011, UTMB WAS ONLY ACCEPTING NINE (9) PERCENT of patients sent to them for charity care. And there is no other hospital that is picking up those 91% that are turned away.

If UTMB shuts them out, where do they go? To places like St. Vincent’s, an overcrowded, undersupplied volunteer-staffed, marginal clinic that can only provide the MOST BASIC of care. And the availability of “band-aid” clinics, like St. Vincent’s, is so limited that some people have to take the day off from work and drive two hours each way, just to get there. Then they wait for hours to be seen in order to get a prescription for a necessary medication. Then they MIGHT be able to afford that prescription if it’s on a $4 prescription list somewhere. If not, tough luck. In essence, we’re permitting a large segment of our population to experience third-world medical treatment.

Free health and dental clinic by Remote Area Medical during the week of August 19, 2009, Los Angeles, California. (spirit of america / Shutterstock.com)

Free health and dental clinic by Remote Area Medical during the week of August 19, 2009, Los Angeles, California. (spirit of america / Shutterstock.com)

Here’s a bit from the story:

“There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.”

Beyond the terrible statistics are the human realities: People who need care, who try to access it to get help. Only to get either turned away, charged beyond their ability to pay, or, perhaps, being able to get care that was much less than they needed. The toll on the patients, the staff of St. Vincent’s, and even the hospitals that can no longer afford to treat these struggling citizens, is frightening. Rachel describes how some of her patients at St. Vincent’s have fared when they needed more care than St. Vincent’s could offer. It can almost be summed up like this:

She was told by one of the surgeons who taught her: “A physician never takes away hope.”

In my second year of medical school, I took a small-group course with a famously terrifying surgeon. He told us his moral motto: “A physician never takes away hope.”

I never figured out how that motto could guide doctors through a system where our patients are dying from treatable diseases. Part of my job, it seems, is precisely that: to sit down with patients and, as gently as possible, take away hope.

This story doesn’t have a happy ending. It’s not uplifting. No one experiences a miraculous cure and walks away smiling. They MIGHT have been able to experience that cure, if they could have accessed appropriate treatment, but that rarely happens.

Very sadly, this is not limited to just this area of Texas. Or the Midwest. It’s happening in many areas of the country. It’s happening right now, as you read this. Someone, uninsured, is sitting in pain, debating whether or not to go to a local ER or urgent care. Someone is hoping that the fever will go down so she won’t have to try to find that $4 needed to get her antibiotic prescription filled.

Please take a look at Rachel Pearson’s article. It’s a quick read that gives a different perspective to this problem. It will take you a few minutes to read through it, then a few more minutes to stop the tears. These things shouldn’t be happening to anyone in our America.
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Healthcare interview podcast with Rachel and a journalist familiar with this situation:

St. Vincent’s Clinic


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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