Pre-Katrina Healthcare Woes Resume

Tami McMahon, a nurse, wept on her way back to Seattle. She was thinking about the place she left behind: the splintered neighborhood of east Biloxi, where she volunteered at a free medical clinic after Hurricane Katrina.

McMahon, 33, was going home because state health officials said the emergency clinic was no longer necessary. Local doctors were eager to channel patients back to their practices, and hospitals were up and running. McMahon didn’t see it that way.

“They are sick down there,” she said. “They are very sick, and they have not been cared for for years.”

The tension between healthcare providers in Biloxi illustrates a question facing Gulf Coast communities after Katrina: In populations that have been needy for decades, when does the period of emergency care end?

Local providers are the first to acknowledge that there are gaps in healthcare that long predated the hurricane. Louisiana and Mississippi routinely rank last among all 50 states in measurements such as infant mortality and early death.

In Katrina’s aftermath, one public health expert said, outsiders are coming face to face with the region’s entrenched problems.

“The primary-care system before the storm was terrible. That’s not the fault of any one individual,” said Thomas Farley, chairman of the Department of Community Health Sciences at Tulane University School of Public Health.

Disaster workers, he said, “go in to deal with acute problems, and they uncover chronic problems. They can’t figure out how to get out ethically.”

East Biloxi, a poor neighborhood of single-family houses, underwent a transformation this fall. Before the storm, parts of the neighborhood were so drug-ridden that police and judges in Harrison County used to refer to them as the “red zone.”

Katrina reduced the neighborhood to stretches of rubble. But it was also teeming with volunteers, many of them college-educated and from other parts of the country. Among the services that took shape in the heart of east Biloxi was free medical care.

“All you had to do was fill out a form, take a seat and you were next,” said Alberta Paige, 83.

Late in October, a free clinic at Yankie Stadium in Biloxi shut its doors at the request of state health officers. The clinic’s rotating staff -- including two doctors and five nurses -- were seeing an average of 100 patients a day, said Sue Dillon, a Colorado physician who worked there.

It came as a shock to Lawonda Galloway, who showed up for a prenatal checkup to discover the clinic had closed. Galloway, 24, was five months pregnant and having dizzy spells.

“We needed the clinic here,” she said. “I didn’t think they would be here forever, but I thought they were going to be here longer.”

Free care needed to be phased out if permanent systems were to return, said Steve Delahousey, disaster medical officer for Harrison County. By late October, the hospitals along the coast were all functioning, and so was Coastal Family Health Center, a nonprofit network of community health centers that offers care on a sliding-scale fee basis.

Physicians were eager to return to Biloxi and restart their practices, Delahousey said, but found that many patients were receiving their care in free clinics. Moreover, he said, health authorities were concerned about oversight and licensing in the volunteer-staffed clinics that sprang up after the storm.

Free clinics were “not intended to be a long-term solution,” he said. “We have to keep in mind that if local practitioners do not have patients, they will leave. Some already have. If hospitals don’t have patients, they will shut down.”

For decades, poor or uninsured people in east Biloxi have received primary-care services in the cinderblock building run by Coastal Family Health.

But Coastal Family Health cannot offer obstetrics services because there are so few specialists in the state, and even fewer who accept Medicaid, said Lee Gentry, the company’s clinic administrator. Most pregnant women get no prenatal care, and go to the emergency room if they have problems, he said.

“The official answer is you just have to do the best you can,” he said.

Last year, the clinic laid off its psychiatrist because Medicaid would not reimburse it for such services. At least 1,000 psychiatric patients were left stranded, unable to get prescriptions renewed, sometimes waiting three months for an evaluation, Gentry said. They, too, resorted to emergency room visits.

Katrina has magnified chronic funding problems, said Joe Dawsey, director of Coastal Family Health Center. Dawsey said Coastal Family Health had received no payment for more than 15,000 emergency visits after the storm, and had a two-year backlog of unpaid Medicaid reimbursements amounting to as much as $902,000.

With no revenue coming in, Dawsey was forced to borrow from next year’s federal funding to make his December payroll. Dawsey said there was a 30% chance that the network would not be able to continue to function in the area.

Biloxi City Councilman Bill Stallworth, who represents much of east Biloxi, said many of his constituents had never received consistent primary healthcare, relying instead on emergency room visits. Volunteers may have been shocked, but “here, it’s just par for the course,” he said.

“If you’ve been in that situation for so long ... you see that things are broken, [but] you just have the tendency to walk past them after a while,” he said.

Doctors and nurses who had volunteered along the Gulf Coast continue to compare notes on their experience. Dillon, the Colorado physician, recently visited lawmakers in Washington, including Mississippi Sen. Trent Lott, to complain about the deficit of care in Biloxi.

“It scares us -- those of us who were there,” she said. “We are fearful for those folks. I don’t know what they are going to do.”

Weeks after the free clinic closed, Galloway had still not received the prenatal vitamins she wanted. She tried going to Coastal Health, which cannot treat pregnant women; they referred her to a state health department office, which placed her on a waiting list for care.

Eager to see a doctor, she went to the emergency room at Biloxi Regional Medical Center, which made her a follow-up appointment with an obstetrician. When she called about that appointment she was told it would cost more than $100. So she didn’t bother.