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County works to fill indigent care gap
Published November 18, 2008
ANGLETON — Brazoria County’s $200,000 telemedicine contract with the University of Texas Medical Branch in Galveston for indigent health care doesn’t include extended care, but local officials are working out a way to provide complete coverage without sending patients to the medical facility devastated by Hurricane Ike.
The $16,719 monthly payment as part of the annual package approved by commissioners last week pays for telemedicine for residents considered indigent, or unable to pay, said Jim Wiginton, chief of the Brazoria County District Attorney’s Office civil division. But that doesn’t address the hospital’s lack of beds needed for patients who require care beyond outpatient treatment.
The Galveston medical branch had 600 beds available before Ike’s September landfall and now has 200, Wiginton said. Of those beds, 120 are dedicated to state jail use, leaving 80 to be used for indigent care from Brazoria, Fort Bend, Chambers, Jefferson and Galveston counties, Brazoria County Pct. 1 Commissioner Donald “Dude” Payne said.
“Eighty beds aren’t going to be enough,” Payne said. “Most counties in our area have the same scenario. It’s a big mess.”
In telemedicine, a UTMB doctor interviews a patient in front of a television camera with a nurse in the room with the patient. The doctor either makes a diagnosis and the patient is given a prescription or the doctor assesses more urgent care is needed, Wiginton said.
The majority of local doctors do not accept Medicaid, which pays substantially less per visit than the going rate. The few doctors who accept the amount are paid by the county, outside the Galveston contract. Inpatient care outside the telemedicine contract was paid separately before the hurricane, County Auditor Connie Garner said.
Since there are very few beds available at Galveston, patients are sent to Angleton Danbury Medical Center or Brazosport Regional Health System in Lake Jackson. Those hospitals are not part of the indigent care network but are helping, Wiginton said.
“If you’re acute, you go to the emergency room, but that’s a problem,” he said. “Last week, a dozen patients needed to see specialists. We just don’t have a network of providers set up yet.”
Such a network is in the planning stages, with a meeting scheduled for Friday to address the need, Brazoria County Health Director Leo O’Gorman said. Since the storm, patients with extended need are sent to a handful of private physicians who have agreed to provide care, O’Gorman said. Or, they go to local emergency rooms on their own.
“We’ve written letters to local doctors asking for their help,” O’Gorman said. “I think we’re going to get good cooperation and partnership. We’re just figuring out how to do it. Right now, they do have access to emergency rooms, so someone will take care of them. For the long term, we’re working out the details for a complete health care system.”
O’Gorman said he’s confident a plan will be advanced within the next week.
An increased number of emergency room visits at Angleton Danbury Medical Center has not been overwhelming, Director of Marketing and Public Relations Tonya Visor said.
There hasn’t been much of an increase at Brazosport Regional Health System, spokesman Scott Briner said.
Hospitals will be included in this week’s meeting to address the situation, O’Gorman said.
Brazoria County has about 100 indigent patients, Wiginton said. That number is low because areas that have hospital districts, such as Sweeny and Angleton, take indigent patients regardless of their ability to pay and because of the county’s definition of indigent. A patient in Brazoria County is considered unable to pay regular medical rates if they are 50 percent below the poverty level for the number of people in a household, Wiginton said.
The federal poverty level for a family of four is $21,200 per year.
The county has contracted with the Galveston medical branch for indigent care since the 1980s and hospital officials hope to continue that relationship, University spokesman John Koloen said.
“UTMB is continuing to work through the issues created by Hurricane Ike,” Koloen said. “We haven’t canceled any contracts for indigent care anywhere and are continuing to review what our capabilities are.”
Dr. George Brooks, who conducts the hospital’s telemedicine for Brazoria County, said he will continue doing so even if he has to make calls from home, Wiginton said.
About 3,800 employees are to be laid off from the medical branch due to losses caused by Ike, the University of Texas Board of Regents said in a press release. Ike caused almost $710 million in losses to the branch with about $100 million of the damage covered by insurance.
Some of the branch’s 85 buildings were inundated by up to 8 feet of water, with the hospital’s kitchen, blood bank and radiology departments destroyed. The hospital’s current expenses exceed revenues by almost $40 million per month.
John Lowman covers Brazoria County government for The Facts. Contact him at (979) 849-8581.
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