What's the Whole Story Behind Louisiana's Medicaid Expansion for the Dead?

I've read the legislative auditor's report and various articles on Louisiana compensating private industry insurers for Medicaid services rendered to dead people; and the more I read, the more unanswered questions I have.

In this article, Kathy Kleibert blamed it on Social Security records.

Department of Health and Hospitals Secretary Kathy Kliebert said Monday that the problem occurred because DHH was relying on “a very sloppy database in Social Security” to determine who should be enrolled in the managed care plans. Most of the cases involved older adults with disabilities qualifying for Medicaid through the Social Security system, she said.

“In the future we are going to be using our vital records database,” she said, referring to the state’s registry of birth and death records.
http://theadvocate.com/home/7492510-125/auditor-state-pays-health-coverage

This Town Talk article implies the state relied on data from the DHH vital statistics office.  http://www.thetowntalk.com/viewart/20131104/NEWS01/131104017/Audit-Louisiana-DHH-paid-1-9M-Medicaid-dead-people

The legislative auditor definitely used DHH Vital Stats data to conduct the audit, but why would he use that method if the state uses/used Social Security info? http://app1.lla.la.gov/PublicReports.nsf/5BBFA4B0591132DB86257C14004DD0C4/$FILE/00035F69.pdf

Also, wouldn't Kleibert's response suggest that all of those people kept receiving federal and/or state SSI payments after they died?

I understand using a different methodology to audit payment errors.  That makes sense, but why wouldn't the state legislative auditor also use the same methodology as a means for comparison to lend more validity to his findings?

Or did the auditor intentionally employ a methodology that provides a safety escape hatch for DHH?

Jindal: No need to expand Medicaid since Obamacare will be effective

There you have it, folks.  Gov. Jindal finally gives a legitimate reason for why he won't expand Medicaid eligibility.  You see, contrary to all of his previous arguments against healthcare reform, the Governor argues that Obamacare WILL be effective in reducing the number of uninsured Americans.  See Argument #4 in this article:

Without expanding Medicaid, and once eligible people are enrolled into healthcare exchanges set up by the federal government, there will be less than six percent of Louisianians without health insurance. That's why the state is focused on implementing public-private partnerships with charity hospitals across the state to expand access.

http://www.businessreport.com/article/20130422/BUSINESSREPORT02/130429997#ixzz2RpBwwhJF

For Mitt Romney's Health Plan, Look to Gov. Jindal

Want to know how Mitt Romney would fix America's healthcare problem?  Just look to how Gov. Bobby Jindal is reforming healthcare in Louisiana: by eliminating it.  If you think I am kidding, look at the Governor's travel schedule.  Louisianians already know that Jindal spends more time with Romney and raising money for him than he does at the state capitol.  Who else would Romney look to for advice other than the Republican-proclaimed healthcare guru?

Every time Jindal and his band of suck-up, "whatever you say, boss" state healthcare administrators have reassured us they are only cutting healthcare costs without sacrificing services, it has turned out to be a boldface lie.  Each time, they and Jindal have known exactly what the plan was all along, then proceeded to tell the public the exact opposite.  

It all started with mental health. Three years ago, the state's Medical Director clearly stated their intent to eliminate inpatient psych services for youths.   Remember New Orleans Adolescent Hospital? Remember how all those beds in New Orleans were moved to the northshore?  Isn't it convenient how NOAH was sold earlier this year just before the state decided publicly announced that Southeast Louisiana Hospital was closing and that those "psych beds" would be relocated back to the southshore?  I put "psych beds" in quotes because even though the state has already moved the patients out of Southeast Louisiana Hospital, it has yet to even identify where those "beds" will ultimately physically exist, which means they don't exist. And they likely never will.  Just like those more abundant outpatient services to replace the shuttered hospital units don't exist -- and in many cases never did. 

Using the loss of federal Medicaid funding as an excuse for decimating the LSU system is, in my estimation, Jindal and Greenstein being less than totally honest, to put it charitably.  The trip down that road has been underway since last summer when Jindal single-handedly and against the will of the legislature, and therefore that of the people, CHOSE to eliminate about $24 million in federal healthcare funds when he CHOSE to veto the renewal of the 4-cent cigarette tax.  The trip continued with the privatization of Medicaid with his brainchild the Bayou Health Program and with giving control of mental health services to the private insurer Magellan which slashed reimbursement rates to providers 30-40% before Jindal even learned of the federal Medicaid funding cuts, which of course led to even deeper cuts.

The latest outcry, which will of course be ignored by Jindal, is against his cuts to the LSU system that stand to cripple the training of future doctors.  Even his handpicked henchmen on LSU's Board of Supervisors weren't aware of the extent of Jindal's destructive plans:

"The shortage came as a surprise to members of the LSU Board of Supervisors, who recently approved a plan to cut $150 million out of operations of seven LSU hospitals in south Louisiana." -The Advocate 10/29/2012

Oh wait. Except they were lying about not knowing.  An article from six days earlier titled, "Medical Plan Caught Up in Cuts to LSU," noted:

"...the LSU budget cuts could jeopardize training programs’ accreditations and standards, threatening medical education in Louisiana and chasing away medical students needed to treat patients in a state that already has issues about access to health care and doctor shortages in rural areas.  LSU leaders and the governor’s health secretary, Bruce Greenstein, say they’re keeping all of that in mind and have graduate medical education at the forefront of their planning." -The Advocate, 10/23/2012

How are you surprised to learn of something you promised a week ago to keep in the forefront of your mind?  Seems to me that Jindal and his yes-men are lying about saving medical education too.  Why would they if they're getting rid of the places those doctors would practice?  

So if you're down with that, then by all means, cast your vote for Romney and roll out the welcome mat for incoming Secretary of the U.S. Department of Health and Human Services & new Cabinet member Gov. Bobby Jindal.

I Am So Not Gellin', Magellan!

Louisiana completely privatized mental health services on March 1, 2012.  The behavioral health insurance company Magellan is now the gatekeeper to pretty much ALL mental health services paid for by the state.  

True, there appear to be some advantages.  Services heretofore unavailable to LA Medicaid recipients, such as group therapy and reimbursement for meeting with your child's therapist without the child having to be present, are now available. 

Other than that, it's been HELL.  Where do I even begin?

1. Provider reimbursement rates have been SLASHED by about 30%.  Imagine finding out    

on March 5th that your salary would be cut by 30% -- beginning March 1st.  Yes, March 1st of the same year.  Uncle Bobby Jindal decided to privatize healthcare, or so he says, because the private sector provides the same or better services for lower costs without all the bureaucratic overhead and logjams.  What he didn't mention is that in his kingdom, he would let the private sector insurance company pay psychiatrists and therapists 30% less for services provided to its Medicaid customers than it pays the very same psychiatrists and therapists to see its non-Medicaid customers. 

2.  As of yesterday, zero of my clinic's claims appear to have been processed, so we have no feedback regarding whether Magellan is the type of insurer that will regularly deny 15%, 30% or whatever% of our claims (i.e., payment for services already provided).  You would think the lauded private sector would understand that to keep a business from going under you need to be able to project your revenue.

3. As reported yesterday by Gambit, Clinical Advisor still doesn't work.  

Clinical Advisor is an online records management system intended to streamline inter-clinic communications and the mechanism through which clinics submit Medicaid claims. It's not working. As a result, providers — many of which, like the Guidance Center, serve Medicaid clients — haven't been able to submit Medicaid claims. What's more, they say, the newly formed Louisiana Behavioral Health Partnership (LBHP) between the state and the private contractor is denying certain types of claims that used to be paid. [Gambit, 3/20/2012]

4. Forget about Magellan paying for your child to undergo a formal psychological evaluation.  They are denying ANY test that in ANY way could POSSIBLY be used to diagnose learning or educational problems even if the test has other uses, AND even if the psychologist states s/he wants to use that test for one of its other uses.  Magellan reasons that the federal government already provides that service.  In reality, the federal government mandates that school districts evaluate any child 0-21 years of age suspected of having a learning or emotional disability.   They just don't provide the schools with all the funding needed to accomplish that.  

5. Our insurance specialist has spent most of her time on hold when calling Magellan, one time for 30 minutes before the call was simply disconnected.  I emailed a question to the provider account plastered all over their website and on DHH's site -- 8 days ago.  Still no response, not even a form reply stating they have received my email.

6. We have heard that Magellan is requiring inpatient psychiatric providers to obtain daily authorization for hospitalized patients, a process that colleagues say is taking about 2 hours/day.  This despite what is written on page 15 of their 21-page FAQ document for providers [updated 2/24/2012]:

Q: For our inpatient unit, I was requesting authorizations practically every day, for different patients. I would get multiple authorizations of two days or three days or four days. If a patient comes in to this short-term unit, am I going to have to get an authorization every day?

A: You do not have to obtain an authorization every day, but the authorizations will be for short periods of time. We want to be sure first of all that the person still clinically needs the inpatient level of care and could not be safely returned to services in their community. Secondly, we want to have a discussion at every review about the discharge plan. Discharge planning, in our view, begins at the time of admission. We want to make sure that members have a well-established plan for aftercare services in place when they are discharged. So we are going to be reviewing every two to three days depending on the status of the person’s clinical condition and the plan for discharge.

And those are just the things I care to write about right now. 

Jindal Will Sell New Orleans Adolescent Hospital

Gov. Jindal's current budget depends on the sale of New Orleans Adolescent Hospital (NOAH). 

In the spending plan for the LSU public hospitals, $35 million is tied to the sale of the New Orleans Adolescent Hospital, which hasn't yet been sold. [Alexandria Town Talk, 3/12/2012]

The state acquired the property through a Dec. 16, 1981 transfer agreement from the federal government. That deal specified that the property would used for "general health care" services for 30 years, a period that expires in December 2011. [Times-Picayune, 4/7/2010]

You remember NOAH.  

That's the safe place we used to have for our suicidal and homicidal kids before we routinely shipped them off to Shreveport. 

Is LA Medicaid Putting Fat Cats' Profits over Patient Health?

No, I don't mean the so-called "fat cat" doctors that people who aren't doctors think get rich off Medicaid payments.  I mean pharmaceutical companies.

I learned today that Medicaid patients need prior authorization for generic ADHD medications.  Name-brand (i.e., more expensive than generic) ADHD medications are on the current Louisiana Medicaid Preferred Drug List, but generic versions of those same medications are not.  This means that LA Medicaid will pay, no questions asked, for Adderall XR, Focalin, Focalin XR, and Concerta; but physicians must submit Prior Authorization forms for the less expensive generic forms of these medications.

That means that providers who prescribe these drugs to Medicaid patients must fill out additional paperwork, and may even have to call the state medicaid office, to justify why the state should pay for the CHEAPER  generic version.    

As if that isn't problematic enough, there is a shortage of stimulant medications used to treat ADHD, and many pharmacies only have generic versions.  They couldn't get the name-brand versions of the drugs if they wanted to.

I find this policy interesting, considering Governor Jindal's push to save healthcare dollars by privatizing Medicaid and his constant hootin' and hollerin' about how much Louisiana pays to fund Medicaid. 

Levine Admits Republicans Don't Know Much About Health Care

This is from today's Times-Picayune, page A-6:

"The shortest book in the world is, 'Republicans that I've known and met that know a lot about health care,' " Levine said. "And so there's been a lot of candidates for governor or state legislators from various states who reach out and call and ask, 'What are some of the basics? What are some of the real hot issues from a health policy standpoint?' " [T-P, 7-18-2010]

I guess that explains why Congressional Republicans weren't able to come up with sensible remedies to our nation's health care problems, and why the ones they keep insisting on proposing are often...well...shitty.

The T-P article also offered some insight as to why Levine has overseen the decimation of mental health care services in Louisiana. It seems he might not have known what the hell was going on down here because, like his bossman Bobby, he's been too busy traveling the country instead of doing the job we've paid him six figures to do here at home.

"LA Health and Hospitals Secretary Alan Levine...has been busy doling out policy advice to Republican political candidates around the country,"

"In recent weeks he's written a health care "white paper" for the Republican Governors Association, addressed Republican U.S. House members about the effects of the new health care law on the states, and spent a day in California recently with policy advisers to Meg Whitman, the former eBay CEO who is running for chief executive of the Golden State." and said he hopes to continue doing so through the 2012 presidential cycle." [T-P, 7-18-2010]

So cut the guy some slack, y'all! He didn't KNOW that our children's psychological well-being was in the terlet. How was he to know? He wasn't even here! So lay off of him, people!

The upshot for Alan is that he has used all of these connections he's been busy cultivating to land a posh private sector job back home in Florida, now that he's done fucking the good people of Louisiana over. Way to go, Al! Best Wishes!

Why Is Jindal Taking Our Money?

I just read two news reports that share an interesting common thread. The first story involves the dissolution of the Louisiana Recovery Authority, formed after Katrina to guide the state in its expenditure of federal recovery dollars:

HB1173 would have required legislative approval of proposals and contracts for the use of more than $50,000 in recovery dollars while HB1175 would have allowed parishes to seek alternative uses for allocated recovery funds. Under opposition from the Jindal administration, neither bill won final passage.[Louisiana New Link].

With the dissolution of the LRA, the Jindal administration essentially is allowed to write a blank check on the remaining funds"[2theadvocate.com]

The second story is about how Jindal wants to hold on to the money the state has gotten from BP and prefers that the affected coastal parishes go obtain any money BP owes them on their own.:

Gov. Bobby Jindal unleashed his veto pen late Friday, nixing lawmakers’ attempt to direct $24.9 million to parishes and small towns affected by the oil leak...In his veto message, Jindal said BP should pay the municipalities directly for the impact of the April 20 rig explosion in the Gulf of Mexico.

Left unnoted in Jindal’s veto message was the fact that the money legislators wanted to give to the municipalities comes from a fund fattened by a grant from BP. The Jindal administration wants state agencies to have use of the money. “If it’s acceptable use for state government, then why isn’t acceptable for local governments?” said state Rep. Sam Jones, D-Franklin, who co-sponsored the amendment that would have diverted much of the BP money in the state’s Oil Spill Contingency Fund to help 11 coastal parishes and the towns of Lafitte and Grand Isle. [2theadvocate.com]

Now Learn the Reverse Jindal Two-Step

In my previous post, I taught y'all how to do the Jindal Two-Step. Now I'm going to show you the Reverse Jindal Two-Step. You may recall that in the simple Jindal Two-Step you do something THEN you claim you're not doing that exact same thing. The Reverse Jindal Two-Step is merely the same thing except backwards:

1) DON'T do something (or say you're not going to do that thing):

Governor Jindal said: Unlike Alabama, California, Florida, Georgia, Maine, Maryland, Massachusetts, Missouri, and New Mexico, which all assumed in their budgets that FMAP aid would be extended for their states - this budget does not anticipate federal relief for FMAP, out of an abundance of caution. [nwlanews.com, 2/15/2010]

2) Then do that thing you told the world you would not do:

By relying on a federal bailout to solve the 2010-11 budget deficit, Jindal is courting potential opposition from legislators who might be leery of using that money until Congress has acted. [T-P, 4/17/2010]

As you can see, you'll add flair and pizazz to the first part of this dance move if you also criticize others for doing something that you'll turn right around and do yourself. Try out these moves at your next Fais Do Do. It'll be a hit! Let me know how it works out.

Learn the Jindal Two-Step

Here's how you do the Jindal Double-Talkin' Two-Step:
1) Do something:

[LA Education Superintendent Paul Pastorek said:] “While the governor’s proposed budget does not dedicate state funding to support teacher stipends... [2theadvocate.com, 3/7/2010]

2) Then claim you're not doing the very thing you're doing:

...our Nationally Board Certified Teachers will receive their annual $5,000 stipend through their local school districts.”[2theadvocate.com, 3/7/2010]

To sum up, Jindal and Pastorek would have us believe that even though the Governor hasn't included money for teachers' stipends in his budget like he did last time, he's not the one cutting teachers' stipends because the local school districts have these surpluses they can use to pay the bonus stipends. Unfortunately, the local school districts beg to disagree:

Local school board officials counter that without the traditional annual cost-of-living bump, Jindal’s proposed standstill MFP saddles them with increases in a variety of costs such as health care and retirement... John Dilworth [Superintendent of the East Baton Rouge Parish School System] wrote a letter to The Advocate’s editor Thursday challenging the validity of Pastorek’s numbers. He says declines in revenues, such as sales taxes from which the public schools receive much of their money, are being offset by the surplus. Dilworth does not commit to paying the stipends. [2theadvocate.com, 3/7/2010]

If this song-and-dance seem familiar to you, it may be because you remember that Gov. Jindal dispatched his minions to try and pass the same okee-doke routine over on us when they closed NOAH and cut inpatient psych services while claiming that they weren't cutting services at all.

Jindal, OMH Decimating Outpatient Psych Services Too

Remember back when Gov. Jindal, DHH Secretary Alan Levine, and top OMH officials assured us that by closing New Orleans Adolescent Hospital (NOAH) they were freeing up $14 million to "improve much-needed outpatient services"? I can't help but assume that money never made it down to the outpatient clinics I work at everyday because no one in Baton Rouge wants to even pay for us to have voicemail, and it's not because they're paying to lease clinic space after removing us from the space we had at NOAH. The lease at our cramped new digs is $0 where, incidentally, they have consolidated so many employees that the power goes out 3-5 times a day from the now overloaded circuits. Try faxing in a prescription authorization to pharmacies when the power goes out whenever you hit "Send," or when that telephone/fax line periodically goes dead. When I receive a call, I have to walk down the hall because we can't transfer calls to each other despite being in the same building; and while I'm on the phone, no one else can call. OK, actually that's not true. People can still call us but that call goes immediately to a voicemail system that no one from here to Baton Rouge can tell us how to access. All we can do is hope none of those are urgent, which is a fantasy since we serve very ill, troubled youths. Actual assistance or a simple acknowledgment of these problems from OMH are also fantasies much of the time.

We serve the same number of clients even though we have fewer therapists. They left because they were fed up with this sort of foolishness, but they won't be replaced because of Jindal's hiring freeze even though the state has already budgeted for those positions just like they budgeted for all that money closing NOAH was supposed to free up.

Working at a place where your co-workers, even some of the ones making close to six figures, openly discuss finding a new job and share job leads with one another can be nerve-racking. That sort of stress will complicate any job but especially when your job is helping others deal with their own constant psychological stress.

A story about continuing cuts to healthcare in Louisiana is, interestingly, posted to a web page titled Accidents & Disasters. I fear we'll being seeing more of those in the near future. Not just the spectacular, front-page headline kind, but also the excruciating, painful type of tragedy that slowly and quietly ruins families' lives. If you need an example, think of the economic and social ruin left in the wake of an Orleans Parish school system starved of basic necessities. Talk to anyone now in the position of trying to provide state-funded services within LA's Office of Mental Health(OMH). Ask them how employee morale is these days. I should know. I am one of them.

LA Legislators Think About Doing Something

From the Baton Rouge Advocate:

Legislative leaders are expressing concern about the cuts to health-care programs in the governor’s $24.2 billion proposed state operating budget.

However, members of House and Senate budget committees said they do not have an alternative spending plan for the fiscal year that starts July 1.

Senate President Joel Chaisson II, D-Destrehan, said there still is time for legislators to develop their own agenda. [Advocate, 2-18-2010]

Umm, yeah, y'all might want to get crackin' on that.

Gov. Jindal DOES Care

I've always been pretty tough on Genius Boy Bobby, but maybe I was wrong about him. I cynically assumed the surprise announcement on Monday that he was giving state employees off on New Year's Eve had something to do with budget cuts (a la Nagin's 4-day work week proposal); however, I see now that his decision was completely driven out of concern for us.

He knew how difficult it would have been to work today anyway after being up all night worried sick about whether we're one of the hundreds who won't have a job by the end of next week.

The Tebo on CNN. Gotta Lurve the TEBO!!

Mr. Transparency

Jindal spokesman Kyle Plotkin said the governor's office encouraged lawmakers to reject the session by returning their ballots, mailed out July 17, but did not say what form that effort took or how involved Jindal was in the process.

That's our Governor...Mr. Transparency!

Louisiana To Cure Severe Psychological Disorders

Dr. Richard Dalton, medical director for the state Office of Mental Health, cited planned expansion of the clinical staffs of the outpatient clinics and new treatment programs. "Our goal is to get our community services to the point so we can in the next two years discontinue the hospitalization of children, " he said. "That's not a fiscal goal. That's a clinical goal."

A clinical goal I bet the American Psychiatric Association would be tickled pink to hear and probably jealous they didn't think of that first!

I've said it before, but I'll say it again. After all, if state officials can keep repeating the same senseless shit, then surely the rest of us can keep responding with some good old common horse sense. I too wish we didn't need hospitals for either physical or psychiatric illness. Really, who WANTS to be hospitalized? (OK, there are a few people who like being hospitalized but that is, ironically, a psychiatric disorder.) Hell, I've been trying this new "optimism" thing lately, so I'm even willing to believe that we can discontinue psychiatric hospitalizations in two years. Still, wouldn't it be prudent to have the hospital as a backup option until we have more success with the all-outpatient, all-the-time thing?

Employees who provide NOAH outpatient services will transfer to two new clinics expected to open in August: one in Mid-City at 3801 Canal St., the other in Algiers at a location the state has yet to secure.

Or at least have the outpatient services in place before closing the hospital?

In Reality, which is apparently nowhere near Baton Rouge geographically nor metaphorically, some human illnesses simply cannot be treated on an outpatient basis; but Dr. Dalton would have us believe that in 2 years, we will be able to drag a suicidal teenager down from the Crescent City Connection, give him or her a ride home and one of those nice, pretty business cards with an appointment date/time on the back, and sleep comfortably for the next night or two until we get a chance to see them in the clinic -- or whenever their parents are able to bring them by.

La dee dah...whenever is fine!

While we're at it, let's just go back to having all women deliver their babies at home and scheduling surgeries between haircuts at the barbershop! Who the fuck needs hospitals anymore? They're so antiquated.

What Exactly Are Levine & Jindal Up To?

Everybody and his mama from New Orleans has made it abundantly clear to Baton Rouge that the New Orleans Adolescent Hospital NEEDS to remain open IN NEW ORLEANS, and the legislature even put money back into the budget to keep NOAH open. Then, right after the legislature adjourned, nola.com posts a story that ends with this little tidbit:

The health care restorations include 67 positions at the New Orleans Adolescent Hospital, the Uptown mental hospital that Jindal had proposed to close in a cost-saving measure. But Health and Hospitals Secretary Alan Levine said he will ask Jindal to veto that language, as the money for NOAH would be taken from dollars that are targeted for outpatient mental-health services in the New Orleans area.

True to Times-Picayune form, they run a story that leaves more questions than it answers. How much money is being taken from which programs to keep NOAH open? If Jindal vetoes the language, does the legislation still call for transferring NOAH's beds to Mandeville or is there now no such provision, which would mean we're losing 35 psych beds -- period -- to hell with just relocating them?

Then again, maybe it really doesn't matter because Levine and Jindal have insisted on closing NOAH for months, New Orleans and her citizens and our pleas and evidence to support our need to maintain NOAH's services be damned. Our money is better spent on rescuing private golf courses.

Spin, Lie, or Fraud?

With Jindal's administration continuing to distort reality and turn truth on its head to convince us to support its misplaced priorities, the latest directives from the governor's office can be aptly described by all of the words in the above title. Their latest attempt to convince us that closing N.O. Adolescent Hospital (NOAH) does not amount to a reduction in services took the form of an editorial yesterday in the Times-Picayune written by DHH Secretary Alan Levine.

It is one of the most dishonest opinion pieces I have ever read.

Levine tries to convince us that because the state spent millions expanding community health care services in N.O. that there is no longer as much of a need for inpatient psychiatric hospitalization (which strikes me as a point DHH wouldn't have to keep pushing if they really felt they were not REDUCING services in the N.O. area -- but that's just my crazy, bizarre opinion). True, assertive mental health services were expanded last year under Nicola's Law, according to this T-P article which also points out that there are little data to support the supposition that such services reduce the need for psychiatric hospitalization.

Such services are partly granted through various "waivers" which provide services like home health care aides who help families care for developmentally delayed individuals and those with severe behavioral and emotional problems. Something Levine conspicuously failed to mention, as he touted the hundreds of children and adults now served by last year's increase in mental health funding, is that there are many more on the waiting lists for these services. One family in our clinic has been waiting 5 years for their waiver (a VERY common wait time), yet DHH is cutting the meager funding for the waivers they provide (see page 14 of linked-to document) while simultaneously rejecting stimulus money to save healthcare from budget cuts. Another thing he left out, when saying "fewer than 15% of the referrals from the mental health Emergency Room at University Hospital are referred to NOAH," was the number of referrals that actually refers to. Also, that percentage has probably plummeted since the state already quietly closed an adult psychiatric unit housed at NOAH 2 months ago.

But back to the issue at hand: NOAH. Secretary Levine's reasoning that NOAH can be safely "moved" (DHH's euphemism) because there are more outpatient services now defies not only logic but also common sense for the same reason that having a primary physician in no way means one will never need hospitalization. Family physicians can no more treat heart attacks, strokes, and traumatic brain injury in their offices than can mental health providers treat psychiatric emergencies on comfortable office couches.

Levine insists: "Our proposal does not reduce the number of mental health beds." He forgot to add in New Orleans at the end of that sentence because when you add those 3 words to this new DHH mantra, it translates into: There will be ZERO publicly funded inpatient psychiatric hospital beds for children and adolescents by the time we get through screwing New Orleans, who by the way did not vote for Gov. Jindal...not that our decisions have anything to do with that fact. If you're a master of subtlety and reading between the lines, you might have picked up the slightly different meaning those 3 little words add.

Yup, I can spin with the best of 'em!

As for fraud, I am sad to say that Secretary Levine has intentionally tried to deceive us when he said: "less than 35 percent of the children treated at NOAH are even from New Orleans." There really is no excuse for trying to slide this piece of misleading info into the mix when just a few weeks ago Arnie Fielkow and Shelly Midura exposed DHH Deputy Secretary Sybil Richard for attempting the same act of deceipt at a city council Subcommittee on Mental Health meeting on March 27. Yes, 35% come from Orleans Parish, followed by another 40% or so from Jefferson Parish. I'm willing to bet the ones that also come from St. Bernard, Plaquemines, St. Charles, St. John the Baptist, Terrebonne, and Lafourche also would not appreciate an even longer drive than they already have to see their hospitalized children.

Honestly, I do not know why the state is putting the entire southshore in such dire straits. I'd ask them, but I doubt they'd tell me the truth anyway.

Are Jindal and Levine Lying About NOAH?

According to a March 24, 2008, LA Department of Health & Hospitals press release, precisely one year ago, Governor Jindal acknowledged a dire mental health crisis in New Orleans:

Jindal said, "The broken pieces in our mental healthcare system affect every Louisianian, but the problem is especially acute in New Orleans. New Orleans officials estimate that the annual suicide rate has more than tripled since Hurricane Katrina...and the World Health Organization estimates that tens of thousands of people in the storm-affect region today have a serious mental illness. We must take a comprehensive approach to address this crisis -- one that incorporates the needs of patients, law enforcement, and the community as a whole."

Said DHH Secretary Levine in the same March 24, 2008 press release:

"The combined impact of these bills and the Governor’s budget represents a sweeping transformation of our mental health system," said Levine. "The mental health system has been neglected, and while it won’t be fixed overnight, this is the kind of commitment one would expect of a reform-minded Governor."

A February 15, 2008, DHH press release announced: "NOAH key to easing mental health crisis in New Orleans," and included this tidbit: “The occupancy rate at NOAH was 96 percent in 2007. These beds are almost always full. Opening up 20 new beds is critical to providing mental health services in the city because it will help to reduce waiting time for patients who require hospitalization.” Yet, just last week, Dr. Levine insisted that there is no dire need for psychiatric beds in New Orleans:

"I keep hearing, 'Where are we going to take these people?' " Levine said. "But the numbers we're seeing, the demand doesn't appear."

And in DHH's own words: "NOAH was the first public mental health inpatient facility to re-open after Katrina within New Orleans and remains at the forefront of providing these vital services to a population in great need. Prior to NOAH’s re-opening, people with mental illnesses were either not treated, were seen and discharged from hospital emergency rooms or were transferred to hospitals elsewhere in the state."

Yet, at the N.O. City Council Mental Health Subcommittee meeting on March 27, 2009, DHH Deputy Secretary Sybil Richard had the audacity to tell us that the proposal to move NOAH across the lake was something that would have been done anyway in the interest of patient care and was a decision not borne of Jindal's desire to rid the budget of anything non-revenue producing (i.e., services for a parish of Democrats who never have and never will donate to his campaign coffers.)

Dear Gov. Jindal, Do The Right Thing

Dear Governor Jindal,

I was so pleased to hear that you understand and are concerned about the link between dropping out of school and ending up in prison, and that you would like to address these problems.

Every year 14,000 high school students drop out of school. Every year we lock up about 14,000 people in our prisons. I don't think that's a coincidence. -Gov. Bobby Jindal on his initiatives to reduce Louisiana's dropout and recidivism rates. [Times Picayune, 1/4/09, p. A-13]

I was not so pleased to read on the very same newspaper page your plans to stave off a projected $341 million budget shortfall by delaying the opening of a mental health crisis center in New Orleans and by canceling plans to add 6 inpatient beds to the N.O. Adolescent Hospital. You should be aware that a recent study shows that children in LA impacted by Hurricane Katrina currently suffer from physical and mental health problems at rates double that of homeless children in New York City.

NY Times 12/5/08:
...41 percent under age 4 had iron-deficiency anemia -- twice the rate for children in New York City's homeless shelters. Anemia, often attributable to poor nutrition, is associated with developmental problems and academic underachievement.

More than half of those ages 6 to 11 had a behavior or learning problem, yet in the East Baton Rouge School District children can wait for as long as two years to be tested for learning disabilities.

...many of the children of Hurricane Katrina are behind in school, acting out and suffering from extraordinarily high rates of illness and mental health problems. Their parents, many still anxious or depressed themselves, are struggling to keep the lights on and the refrigerator stocked.

Governor, these are the children most likely to not finish high school and then end up in jail, and these are the very children that your budget cuts will hurt most. I think that the Obama administration and Congress would be hard-pressed to hand over $450 million for a new Charity hospital to a state that won't even spend $4.25 million to address the dire needs of its own citizens, needs which should have been addressed 3 years ago now.

Show us that you care about your citizens. Let us know whether a man of God would choose $385,040 in pay raises for 6 Cabinet members already making six figures a year over thousands of families who have nowhere else but you to turn to for survival. Six psychiatric inpatient beds at NOAH will cost $250,000.

Governor Jindal, do the right thing this time.