pointe primary care :: Article CreatorLouisiana Is In Need Of Primary Care Physicians, With 61 Of 64 Parishes Behind Recommendations
Primary care physicians are typically a patient's first point of contact within the health care system, and they provide critical preventive care, disease management and referrals to specialists, according to America's Health Rankings.
The Health Resources and Services Administration estimates that an additional 17,000 primary care providers are necessary to meet U.S. Health care needs — and the deficit is expected to grow to 48,000 physicians by 2034.
Catahoula, Grant and Tensas parishes only had one primary care physician for the entire parish in 2021, according to data from the American Medical Association.
Bienville, Cameron, Madison and St. Helena parishes only had two primary care physicians in 2021.
In contrast, the World Health Organization recommends one primary care physician per 1,000 people. The average ratio of doctors to patients in Louisiana is 1,441 people per physician.
While the more populated parishes in Louisiana had more primary care physicians, those doctors were grossly outnumbered in 2021:
East Baton Rouge Parish: 1,153 people per physician Orleans Parish: 895 people per physician Lafayette Parish: 929 people per physician Catahoula Parish: 8,805 people per physician Sabine Parish: 7,378 people per physician Although the doctor-to-patient ratios reflect that parish populations outnumber primary care physicians, not all residents are seeing or seeking general practitioners.
A Zoning Issue Could Delay Medical Care At Prevention Point
Patients at Prevention Point Philadelphia, a public health organization for people with addiction and the only brick-and-mortar syringe exchange in the city, could see delays in the medical care they receive there if a zoning change at the property is not resolved.
The issue is an application for a zoning exception that would allow more than one medical provider at a time to offer care at the organization's Kensington offices. It requires approval by the city zoning board.
The nonprofit offers a number of health services to clients with addiction, including HIV testing, primary care for HIV-positive patients, and treatment of the wounds caused by the animal tranquilizer xylazine, called tranq, which has contaminated most of the opioids sold illicitly in Philadelphia.
Prevention Point has been a controversial presence in its Kensington neighborhood since it opened there more than three decades ago. Some neighbors blame it for enabling drug use through its distribution of sterile syringes, a measure widely supported by public heath experts to prevent the spread of blood-borne illnesses.
Earlier this year, Mayor Cherelle L. Parker, who has pledged to curb open drug use and dealing in the neighborhood, cut nearly $1 million in Prevention Point's funding for syringes in her first budget. Experts have warned that her cuts could cause a spike in HIV cases. Parker has said such programs should be privately funded and emphasized her support for wide-ranging public health strategies to address the overdose epidemic.
Now, a neighborhood committee has voted against allowing Prevention Point to obtain a special zoning exception to become a "group medical office." That would formally allow the organization to host multiple medical providers who see patients simultaneously, as it has for years at its offices in a converted church on Kensington Avenue.
In March, the organization filed for an exception to continue offering this kind of care, said Cari Feiler Bender, Prevention Point's spokesperson.
If it's not granted, one medical provider at a time will still be able to provide care at Prevention Point. But that could create delays in care for patients, Bender said. Homelessness and addiction already make it difficult for many Prevention Point patients to access the regular medical care required for serious medical conditions like HIV and infected wounds caused by xylazine use.
"The community and the people who live there are of the utmost importance to us and we are committed to continuing to work with the community as a partner," Bender wrote in an email. "At the same time, the array of medical services provided at our main building is also a vital and necessary public good that [is] desperately needed in Kensington."
A city spokesperson said in an email it was "too early" to say whether the city has plans to expand medical services for people with addiction in Kensington to make up for those delays if the exception is not approved.
For now, health-care services offered at Prevention Point continue as usual, Bender said.
Continuing community conversations
At a community meeting this summer, a civic organization voted to oppose Prevention Point's request to update its permit, the Kensington Voice reported. The vote is nonbinding: The Zoning Board of Adjustment, which has final say in granting exceptions to the city's zoning laws, can take neighbors' opinions into consideration.
The pushback highlighted neighbors' fatigue over the opioid crisis that has led hundreds of people to use drugs openly in their neighborhood — and the deep skepticism among some about Prevention Point's presence in the community.
"I'm all for people getting help — this is an illness," said Roxy Rivera, who runs the civic association Somerset Neighbors for Better Living and voted against allowing the exception. "But where are the residents' rights? We're cleaning thousands of needles from our sidewalks, catching people defecating in between our cars, using actively in front of children going to school."
After years of open drug use in the area, Rivera said, some neighbors are skeptical that the neighborhood's many programs for people in addiction are working.
A 2019 study found that Prevention Point prevented more than 10,000 HIV cases over 10 years by distributing sterile syringes to people who inject drugs.
And the organization says it offers crucial services to people in addiction who might not seek care elsewhere. Bender said the group also conducts regular street cleanups and delivers groceries to neighbors monthly.
After neighbors voted against the zoning exception, Prevention Point opted to delay a scheduled zoning board hearing in order to hold another public meeting. That meeting has not yet been scheduled.
"Prevention Point wants to work with the community to be the best neighbor possible, listening to and addressing concerns to reach common ground," Bender wrote.
Scrutiny Of Buffalo VA Unlikely To End With Inspector General Report On Patient Care
The Department of Veterans Affairs is planning a disciplinary review and a thorough investigation of patient care referrals at the Buffalo VA Medical Center, and Congress may take a close look at what's going on at that facility, too.
Over 54 pages, the report paints a picture of a VA Western New York Healthcare System where local system administrators failed to address lengthy scheduling delays for patients with serious health conditions, even when staff repeatedly tried to alert leadership of how the lapses were affecting veterans.
In other words, Friday's devastating report about delays in care at the facility – which, in one case, amplified the suffering of a terminally ill cancer patient – will probably not be the last such report.
The report from the Department of Veterans Affairs Inspector General examined 42 cases in which patient care was delayed. Investigators found that in nine of those cases, the delays in referring patients to doctors outside the Buffalo VA Medical Center affected the patient's clinical status or condition.
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"The next step is a disciplinary report, for which the 60-day clock starts today," said Langworthy, a Republican who represents Buffalo suburbs and the Southern Tier and who first called attention to the problems at the local VA hospital in August.
The VA already took action in connection with the trouble at the Buffalo hospital, transferring Michael J. Swartz, executive director of the VA Western New York Healthcare System, and Dr. Philippe Jaoude, the system's chief of staff, to positions where they no longer deal with patients.
The VA did not respond to a follow-up question about whether Michael J. Swartz, executive director of the VA Western New York Healthcare System, or Chief of Staff Dr. Philippe Jaoude could return to those roles, pending the outcome of the investigation.
But Langworthy said he hopes the disciplinary review leads to a more thorough overhaul of the hospital's community care referral office. In those cases, the VA refers patients to medical providers outside its system.
Langworthy said he already knows what the results of the disciplinary review ought to be.
"This entire community care office needs to be cleaned out, and they need to have processes in place that are following the wishes of the physicians and the care providers," Langworthy said.
A blistering report released Friday cited numerous instances where veterans had to deal with lengthy scheduling delays at the Buffalo VA Medical Center before receiving care for critical conditions.
Libby March, Buffalo News
Elnahal, the top VA health official, is scheduled to travel to Buffalo on Monday to discuss the situation at the city's VA hospital. And in his conversation with Langworthy on Friday, the VA's top medical officer also vowed to continue studying the problems that, according to the inspector general, prompted undue suffering for several veterans.
"They're doing a two-full-year look-back on all patient outcomes to see if there's anything else," said Langworthy, who expressed confidence in Elnahal's sincerity about fixing the problems at the local hospital.
VA Press Secretary Terrence Hayes said that review of completed community care consults from 2022 through 2024 will determine if there were additional delays in care for patients.
"The network director has asked a team of VA community care experts to conduct a thorough review of the VA Western New York Healthcare System leadership and how they responded to concerns regarding delayed care," Hayes said. "The goal of this review is to evaluate how patient safety was prioritized and make recommendations for how to improve going forward."
Meanwhile, "all community care staff are being monitored to ensure that standardized procedures are followed, and if necessary, training is conducted to correct any issues," Hayes said.
While all that happens, Congress is likely to weigh in, too. Rep. Tim Kennedy, a Buffalo Democrat and member of the House Veterans Affairs Committee, said he will recommend that the panel investigate what happened at the Buffalo VA.
"The Department of Veterans Affairs has taken appropriate action in removing those leaders, but we have to continue to put the spotlight on the issues that have occurred there so they never have them again," Kennedy said. "And we have to come up with real solutions to resolving the problems that have been created at the Buffalo VA and across the country."
Rep. Claudia Tenney, a Republican whose district stretches from Niagara County to Watertown, agreed that Congress needs to pay close attention to the issue.
"It is clear that Congress must act to ensure that veterans have the freedom to seek care from providers in their community and prevent future bureaucratic failures like those that occurred at the Buffalo VA," Tenney said.
How community care works
Whether implemented by the VA or recommended by Congress, any reforms would aim to improve a system that, in theory, is geared toward helping veterans get access to timely care by allowing them to go outside the VA system at the VA's expense.
Veterans are only eligible for such "community care" when a VA facility is unable to provide an appointment within a certain amount of time, when specific services are not available in-house at a VA medical facility or when the drive time to a VA facility is more than 30 minutes for primary care or 60 minutes for specialty care.
For example, the Buffalo VA doesn't have neurosurgery, and the closest VA hospital that does is more than an hour away, so the VA would refer a patient to a community provider that has that specialty, explained Amy Clarke, associate director of National Nurses United at the Buffalo VA and a staff nurse.
The community care process starts by a VA provider placing a "community care consult" for the patient to get services from another provider.
Some of these consults require approval by a "delegated authority" to clinically review and determine whether the requested service is appropriate.
Once it is approved, community care employees are supposed to schedule appointments within seven days.
In its report, the inspector general found all 42 patient consults "significantly exceeded" the seven-day scheduling requirement. It took community care staff anywhere from a low of 21 days to a high of 285 days to schedule each of the 42 outside appointments. The average time for an appointment to be scheduled among those 42 cases was 128 days.
Clarke said National Nurses United, which represents more than 400 nurses at the Buffalo VA, has long been speaking up about the broken processes in the community care department. She also noted some of the issues come down to having "too many referrals and not enough staff and resources."
Asked if the union is hopeful that the report could lead to meaningful change, Clarke said she can't make that determination yet.
"There haven't been any major changes yet to show an improvement, so it's too soon for NNU to say we have a ton of optimism yet," she said.
The case of 'Patient A'
The inspector general's report cited one case involving a veteran it called "Patient A," someone in their mid-70s who was diagnosed in spring 2022 with esophageal cancer.
A scan two weeks later showed the veteran's cancer had spread to the liver and to the bones. Before long, the patient started chemo-immunotherapy.
In late 2022, by which point the patient had scans that showed bone destruction in the right hip, the oncologist entered a community care consult for radiation therapy.
While the consult was "flagged with urgency for expedited processing," it wasn't until 15 days later – and until after a community care nurse sent additional messages about the urgency of the request – that the chief of oncology approved Patient A's consult.
During an interview with the inspector general, the chief of oncology admitted the two-week delay, citing "human error." The oncology chief remembered being alerted to the consult, but said, "Somehow, I didn't do it."
In the case of Patient A, the radiation therapy appointment was never scheduled, let alone within seven days.
In early 2023, the patient suffered severe pain and had to use a walker. After another appointment, another oncology provider sent an email to community care leaders and staff.
"Pain is now affecting (Patient A's) mobility," the doctor wrote. "(Patient A) has not been contacted yet regarding scheduling. … I am hoping the priority of this radiation oncology referral can be escalated to help with this veteran's pain management."
Fifty-two days after the community care consult was entered – and 36 days after the chief of oncology approved the consult – Patient A was hospitalized to manage his pain.
Twelve days later – now 64 days after the consult was requested – Patient A was moved to hospice after an internal medicine doctor recommended "comfort care" at that stage.
Eleven days later, Patient A died, having never received radiation therapy.
While the inspector general noted Patient A had Stage 4 esophageal cancer, was late in the course of disease and had a poor prognosis, investigators believe radiation therapy could have improved the end of the veteran's life.
"Timely action by community care staff to oncology providers' repeated requests for radiation therapy would likely have decreased the level of pain and improved the quality of life in the patient's final months," the report said.
Jon Harris can be reached at 716-849-3482 or jharris@buffnews.Com. Follow him on Twitter at @ByJonHarris.
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