Louisiana’s rural health care anemic for minorities, poor, elderly

Karen Wyble kept a promise that she made to the mother of a young sickle cell patient when she testified Thursday before a legislative committee. The woman’s daughter had refused to go to a hospital emergency department to address her severe pain because of the treatment she had received previously.

“‘Mom, please just let me die at home. I don’t want to go back to the ED because they look at me like I’m here for drugs,’” the girl told her mother, according to Wyble, chair of the Louisiana Rural Health Association. 

Wyble used the story to illustrate the lack of accessible care for sickle cell patients in Louisiana. Citing figures from the Louisiana Department of Health, she said there are more than 100,000 sickle cell patients in the state – and zero public clinics that can care for them.   

“They’re labeled with the stigma of pain medication seekers,” Wyble said. “They’re desperate. They’re hurting.”

Louisiana’s high poverty rate, combined with critical shortages of providers in the public health sector, exacerbate chronic issues in a largely rural state. That’s according to the administrators who appeared Thursday before the House Health and Welfare Committee on National Rural Health Day, which is marked annually on the third Thursday in November.

Fifty out of Louisiana’s 64 parishes are at least 92% rural with a population of 1.2 million residents combined, the majority of whom are minorities, elderly and live in poverty, Wyble said.

State health figures show 73% of residents live in areas officially designated as having a shortage of healthcare providers. 

Wyble also chairs a newly created rural health disparities task force that will provide a report to the legislature next March 1 with policy suggestions to address what they deem urgent needs. 

Medicaid expansion doesn’t improve access 

Meadha Kulharni is the administrator of federally qualified health centers in Allen and Evangeline parishes. FQHCs are often the only facilities in a community that accept patients with Medicaid or who have no health insurance. Her husband, Dr. Upendra Kulkarni, is the only obstetrician/gynecologist in Mamou, she said.

More than 1 million people in Louisiana obtain health care coverage through Medicaid, most of them children under 18, according to the state health department.

Medicaid’s refusal to cover infertility treatments should be addressed, Kulkarni said. While acknowledging the entire cost – which she said averaged around $80,000 – is unlikely to be met, Kulkarni said any assistance would go a long way with the women seeking options such as in-vitro fertilization.

Roderick Campbell, CEO of Iberia Comprehensive Community Health Center, confirmed the impact of Louisiana’s Medicaid expansion. His organization operates FQHCs in six parishes.

Ten years ago, 55% of the patients seen at Iberia’s clinics were uninsured and only 20% were covered through Medicaid. The numbers have nearly flipped since then, with 55% of Iberia patients using Medicaid and just 10% uninsured.            

Inadequate mental health staffing is also affecting access, administrators told the panel. Kulkarni said the growing number of chemical dependency units around the state are able to pay mental health nurse practitioners more than they would make at public clinics like hers. 

Rep. Joe Stagni, R-Kenner, commended Gov. John Bel Edwards for expanding Medicaid coverage to more people in Louisiana – the first state in the Deep South to do so – but Stagni said the move has not improved access, especially to mental health providers.

“If you don’t take care of their problems early, they’re going to be catastrophic later in terms of the cost and to their families,” Stagni said.

Dentists hard to find

Health committee member Rep. Robby Carter, D-Amite, noted the scarcity of dentists at public health clinics. In St. Helena Parish, where Carter grew up, there is one dentist who is around 80 years old and about to retire, he said.

The administrators concurred, sharing their difficulties in finding dental care practitioners at their rural facilities. Campbell said he’s currently trying to recruit a dentist for the Iberia health center in Many. In the meantime, the dentist at his clinic in New Iberia travels to Many – a 184-mile trip one way – twice a month to see patients. 

Campbell said the “red tape” of accepting Medicaid patients also deters dentists from working in public health. Many in private practice only accept cash or private insurance, he added.

There are 39 federal qualified health centers in Louisiana with some 300 affiliated satellite clinics, according to numbers Campbell shared. While that would seem to provide adequate medical infrastructure, the staffing shortage in various health fields further limits access to care, he said.

To mark National Rural Health Day, state health officials touted its Rural Health Scholars Program. It matches students from Louisiana colleges and universities studying to be a physician assistant or nurse practitioner with healthcare facilities in health professional shortage areas. The first 17 scholars to take part in the program’s first year were placed at 14 sites around the state.