Hospital closing taking early toll
New Orleans — Valerie Cooper’s son has been in and out of so many hospitals, clinics and group homes that it’s hard for her to keep track.
Now with Southeast Louisiana Hospital closing, Cooper, who lives in Algiers, has been told that her son, 29-year-old Yonique Gould, will soon be moved to Central Louisiana State Hospital in Pineville.
“Everywhere he’s been, they shut down,” Cooper said.
Diagnosed with bipolar disorder and schizophrenia about eight years ago, Gould hasn’t been able to find treatment that can enable him to function safely on his own, Cooper said.
Before he went to Southeast, he was doing well enough to be set up in an independent living situation on the West Bank, Cooper said. But then he had an “outburst,” and Cooper had to go through the process she knows all too well: getting her son committed.
“I just want to know he’s safe,” Cooper said.
She’s witnessed too often what happens when he is not taking his medications, she said. He’s not safe and is prone to violent eruptions.
Cooper stays away when the police take her son into custody. If she’s there, she said, Gould gets very angry with her — and blames her.
When he’s taking his medication, Cooper said, he does well. But then when he’s feeling good, she said, he feels like he doesn’t need the medication. Once off, the downward spiral begins again. That’s not unique to Gould. Every time patients like him go off and on their medication, their illness gets worse, said Dr. Janet Bradley, a psychiatrist at Southeast.
He seemed to be doing the best while the was at Charity Hospital, his mother said. Then Hurricane Katrina hit.
Gould is crafty, Cooper said, and is good at fooling doctors and social workers into thinking he is taking his medication. That element of noncompliance is what makes it essential for patients like Gould to have access to quality inpatient services, said Cecile Tebo, a licensed clinical social worker who spent 10 years with the New Orleans Police Department crisis unit.
Kathy Kliebert, deputy secretary of the state Department of Health and Hospitals, says the state’s plan to consolidate mental health care facilities will not reduce capacity, access to care or quality of care.
According to Kliebert, if the same care provided by the state can be provided by private facilities at a lower cost to taxpayers, then “It doesn’t make sense in the long run.” The state, she said, has been making efforts to increase mental health services. The point of consolidation is “saving money for the state and sustaining services for the future,” she said.
The state pays more than $800 a day per patient at Southeast, while the public Medicaid rate paid to private care providers will be just $581 per day per patient, she said.
But many at Southeast disagree with the changes, as evident in the frequent meetings, rallies, and protests held over the past month.
On Monday, Gould called his mother. He knew something about the move, she said, and wanted the phone number for the apartment he had last lived in before being evicted.
Cooper tried to tell him that someone else lives there now and he could not return to that apartment. He hung up the phone in anger, leaving Cooper uncertain and confused about where her son would be placed. Cooper was not notified about where her son was going until Wednesday.
Cooper said she couldn’t believe it when she first heard Southeast would be closing. “They’ve closed everything,” she said. “There’s really nothing here. Where are they going to go? Mentally ill people really need help. It’s not their fault. They need more compassion.”
Cooper, who works a 2 a.m. to 10 a.m. shift as a pit tracking clerk at Harrah’s Casino, said she would put her son in a private hospital if she had the means.
“Mandeville is far enough,” she said. Typically, Cooper only visits when Gould calls and asks for her to bring something — magazines, cigarettes, food. Even then, Gould usually just takes what she brings and tells her she can leave. “He sees it as, ‘If not for you I wouldn’t be here — you called the police,’ ” Cooper said.
Cooper said she misses little things about her son, like how she used to call him, “dude,” and then he would call her “dudette.” And when he would tell her that he loves her.
When he was younger, she said, Gould loved basketball and playing video games. He also is very good with computers and pursued a career in the IT field for a short time at SUNO and Delgado.
In many ways, Bradley said, her patients are “just like you or I.” They love to watch Saints game, go on outings and to restaurants.
It can happen to anyone, she said. “It’s a thin line,” she said, “and a devastating disease.
Cooper said she worries about Gould being in new surroundings. “He’s not going to want to be there,” she said.
Kliebert said that transportation has been arranged for families living in New Orleans and on the north shore to visit their relatives both at Central in Pineville and at Eastern Louisiana Mental Health System in Jackson. From New Orleans, the drive to Pineville is close to four hours each way.
Bradley said for many of the patients, especially those with paranoia, it takes a long time to get comfortable with the staff.
“I feel a lot of trepidation about the move,” said Bradley, who said her views do not reflect those of the hospital. For many of the long-term patients, she said, Southeast has become home. Bradley said she was very concerned that the move will break the trust that had been established and will further traumatize patients.
Bradley estimated that more than 50 percent of the patients at Southeast are from the north shore or the metro New Orleans area. Most of her patients have family that visit regularly and are an active part of their loved one’s treatment, she said. She has talked to tearful family members in recent days who are worried they won’t be able to visit due to time and financial constraints.
If they have to consolidate, Bradley said she doesn’t understand why Southeast would be the target of the closure. In 2009, Bradley said the Joint Commission called Southeast a “pocket of excellence in an otherwise troubled mental health system.” In addition, she noted, it is a location that is the most accessible to the state’s highest population centers.
Bradley said that in her experience working at several other hospitals, Southeast is the most progressive with its treatment methods. Now, she said, her patients are going to “move further from their communities, further from their families,” Bradley said, which will likely result in longer stays and institutionalization. Without doubt, Bradley said “it will have a negative impact to their recovery.”
Bradley also said she fully expects to see further reductions in long term beds at the other two hospitals, part of what she views as a “systematic reduction of psychiatric services in the state.”
“They just end up treating them in jail — which is so inhumane,” Bradley said.
Tebo worries that Pineville “is next on the chopping block.”
“It’s a huge public safety concern,” Tebo said. “Our police officers are being asked to be psychiatric technicians, and our jails are being asked to be the leading mental health hospitals in the region.”
One of the issues with schizophrenia, Bradley said, is that patients are prone to lose jobs, become homeless and thus get marginalized and ignored until a major event occurs. In 2008, police Officer Nicola Cotton was fatally shot by a paranoid schizophrenic man. Additional beds were opened in response, Bradley said, but the increases did not even last a year. It was a bandage on a much deeper problem, she said.
“I don’t think it was his fault,” said Tebo, of the man who killed Cotton. “It’s the fault of a severely broken mental health system.”
Cooper and Gould’s story, Tebo said, is multiplied “1,000 times over.”
For patients who might move to private beds on the north shore and in the New Orleans area, Kliebert said there have been conversations with individual providers who have expressed interest. Those providers have until Monday to respond, and Kliebert said she expects to get responses.
The hospital bed relocations to private providers are expected to be completed by Dec. 31. But the specific private/public partnerships have yet to be identified.
Bradley said she’s skeptical about the public-private partnership being sought to balance the closure of Southeast. Most of her patients take about a year to adequately stabilize.
“There’s no profit in keeping patients as long as they need to be kept, she said. “But we have an obligation as a society to do that.”
Bradley is concerned that in the private facilities, when the money runs out, the patients will be discharged. “People aren’t numbers,” she said, “They aren’t better in three days or 10 days.”
Tebo said in the past she has seen private hospitals open beds, but then a short while later close them. “They weren’t sustainable because the Medicaid rates are so low,” she said
Mental illness in the New Orleans ares are at an “epidemic proportion,” Tebo said, but inpatient medical care is not responding adequately to ever increasing needs. Inpatient, residential care and outpatient care have to work in harmony, she said.
Instead, Tebo said, what she sees happening is the “severe fragmentation of the health care system to the degree that people are not going to be able to live with mental illness.”
“I cannot fathom the lack of humanity in all this,” Bradley said. “If this were cancer or diabetes or another chronic illness, these people would not be treated this way. It’s not right.”