Photo: Ryan Welch, Beuamont Enterprise / The Enterprise
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Carissa Robertson was born in St. Mary Hospital, her family relied on it while she was growing up and she has been to its emergency room in times of need.
“It’s a place that people trusted and you knew the people there,” she said. “If you were born in the ’80s or ’90s in Port Arthur, you’ve probably been there a lot.”
But Christus Southeast Texas Health System, which acquired St. Mary 20 years ago, has decided to shut it down, citing declining use and changing demographics in the area. The predominantly lower-income, often-uninsured patients who rely on the hospital must find a new provider as of mid-July. The health system recommends its Mid-County outpatient clinic, which is about a 14 minute drive away.
The looming closure raises the question of access in a community where 3 in 10 residents live in poverty and one-third of the population does not have health insurance.
“It really was devastating news,” says Linda Solis, credential coordinator at the Gulf Coast Health Center, also in Port Arthur. “I think it is really going to hurt the people that were relying on St. Mary because they had nowhere else to turn.”
The top local public health officer acknowledged after last week’s announcement that there could be short-term consequences and even some initial distrust to overcome, though he does not foresee a severe problem in the long run.
“Anytime a service like that is discontinued in the community, it leaves a period where the patient has to adapt to new circumstances and that will happen here,” said Dr. Cecil Walkes, who has led the Jefferson County Health Authority for decades. “There will be a learning period for those used to going to St. Mary, but our units down there look after people right now.”
The county has a clinic for indigent patients and the Port Arthur health department also provides services. Walkes said the county could have a mobile health clinic making stops in the community around St. Mary as soon as mid-July, thanks to grants.
Solis expects Gulf Coast Health, which accepts patients with insurance but focuses on the uninsured or under-insured, also will see many of the former St. Mary patients. The clinic provides services regardless of a person’s ability to pay or citizenship status. It also takes referrals from St. Mary’s emergency room.
Robertson, who was getting a checkup at the clinic last week, said she still uses the St. Mary emergency room on occasion. She also has a friend who takes her son there for care.
Christus is encouraging such patients to try its Mid-County outpatient center, which also has a 24-hour emergency room. It says it will provide free transportation for patients for the first 30 days after St. Mary closes.
The health system says St. Mary was underused, with fewer than 7,000 admissions between 2013 and 2014 and 56,600 ER visits during the same period.
Port Arthur’s westside residents aren’t the first group in the region to lose a major medical facility — Baptist Hospitals of Southeast Texas closed the emergency room at its Orange facility in early 2017 — but they will no longer have close access to emergency services from a nonprofit hospital.
In Texas, 72% of the uncompensated care for vulnerable communities is performed by nonprofit and public providers like Christus, and the rate of care provided has increased in the last several years. Between 2007 and 2016 the dollar amount of uncompensated care increased by 124% for acute-care hospitals, according to data reported to the state.
Christus reported it contributed $88 million worth of charity care in Port Arthur since 2015.
The health system said patients can receive quality care at its Mid-County outpatient facility, which was built three years ago.
State data shows outpatient visits have gradually increased over the past 10 years. But days spent in the hospital have stayed the same and emergency room visits have slightly increased.
Systems like Christus, founded as an extension of the Catholic Church’s health mission, still provide most charity care. But they, too, are affected by the federal aid programs most of their low-income patients rely on.
In a 2017 survey from consulting firm Deloitte, 85% of the 20 CEOs from some of the largest U.S. health care systems said declining Medicaid reimbursements and volatile politics around the program’s funding were their top financial concern.
An American Hospital Association study from 2015 showed Medicaid reimbursement fell short of actual market costs for care by $16.2 billion. Three years later, the shortfall had grown by $2 billion.
Medicaid accounted for 25% of emergency room payments for Christus Southeast Texas in 2017; Medicare made up another 17%.
Meanwhile, a growing number of Texans are putting off medical care due to cost, data from the Texas Behavioral Risk Factor Surveillance System show. In the health region that contains Jefferson County, almost 22% of people surveyed said they avoided seeing a doctor because of money issues. That rate is almost 6% higher for African-American and Hispanic people in the same area.
The emergency room is often the first place patients go for health care — a trend that providers would like to reverse.
Carl Dahlquist, a certified community health worker there, hopes the loss of St. Mary will encourage more people who had used its ER for nonemergency health care to find a place for checkups and more routine issues. Solis was there with her daughter, Elena, 7, who had stepped on an earring and had a small cut. She put on a brave face as nurse practitioner Karlie Nelson checked it out.
“There could be issues for people with real emergencies, yes, but I hope people start coming to us for their primary care needs,” Dahlquist said. “That’s what we are here for. We don’t turn anyone away.”
Correction: A previous version of this story incorrectly detailed the distance between Christus Southeast Texas Outpatient Clinic Mid County and St. Mary Hospital. It is 5 miles away, or a 14 minute drive.