Pa. lawmakers told of health care deserts
A mental health patient in an Eastern Pennsylvania emergency room recently wrapped a towel around the neck of a staffer and dragged the employee across the floor as ill patients watched, before he could be stopped.
The disturbing scenario was recounted by Tammy Torres, a hospital president, on Tuesday when Democratic lawmakers held a hearing on “health care deserts” in areas where hospitals have closed or where dysfunction within the health care system has produced bad consequences.
Sen. Katie Muth, D-Montgomery, said 33 hospitals have closed in Pennsylvania in the past 20 years — including 15 closures in the past five years — and Ms. Torres and Patrick Keenan of the Pennsylvania Health Access Network testified on aspects that need attention.
Ms. Torres, president of Lehigh Valley Hospital-Hazleton, said insurance reimbursements for mental health care are smaller and slower to arrive than those for physical care. That dynamic that has caused institutions that specialize in such care to close and force mental health patients who may be about to “escalate into crisis” to wait in traditional emergency rooms.
The recent scenario at her hospital, she said, resulted in an employee who “was left unconscious and had to go on disability.”
The hearing was held by the Democrats’ House and Senate policy committees, which plot goals around which to propose new laws. It was held at Lackawanna College in Scranton. Among other concerns, Ms. Torres or Mr. Keenan described:
• No increases for more than a decade in Medicaid supplemental payments tied to some maternity-related services, helping to cause hospital maternity units to close. A recent Post-Gazette report described a six-county area of northern Pennsylvania that was soon to be without maternity care.
• The need for scrutiny of the motivations of large corporations or health care nonprofits to take over other entities. Mr. Keenan said it has been shown that a hospital merger or change in ownership is “one of the best predictors” of the future closure of a hospital. “We need more transparency,” Mr. Keenan said.
• Ms. Torres said the state is expected to have 1,000 fewer primary care physicians than it needs within six years, and the “shortfall” of registered nurses could hit 20,000.
Specifically concerning nurses, Ms. Torres suggested that elimination of a language test required in Pennsylvania but not in some other states could encourage an influx of nurses from Spanish-speaking places outside the U.S.
Ms. Torres at one point said hospital mergers generally don’t affect the staff that provide direct care but tend to thin out “higher ranks” in the organizations.
She got pushback from state Rep. Jessica Benham, D-Allegheny.
“Certainly out in Allegheny County I hear quite a lot from folks, particularly nurses, who as they work alongside physicians are very concerned about whether or not there will be continuity of care,” Ms. Benham said. “And, the potential impact, as well, on contracts, or if there is a union, contract negotiations.”
Mr. Keenan said hospital consolidations often are touted as creators of access to high quality resources. What ends up happening, he said, is costs to patients go “through the roof.”
He said, “The fact is that more people are putting off care than ever before. They are delaying care. They are skipping their medications. They are not following up with diagnostic tests and procedures, because they simply can’t afford it.”