County's fund for emergency health care is stretched thin, doctor warns

March 15, 1994|By Jackie Powder | Jackie Powder,Sun Staff Writer

Dr. Janet Neslen has a ready response to those who don't believe there's a health care crisis in the country.

The county health officer might mention that 500,000 Marylanders don't have health insurance or that some elderly people have to choose between paying for medicine or buying food.

But Dr. Neslen says one of the most striking examples of the inadequacy of the country's health care system is the health department's shrinking emergency-care fund.

The fund was set up three years ago to provide medical care to uninsured Carroll residents in cases of pain or acute infection.

Emergency fund money paid for medical treatment for 62 people in its first year, and 161 patients in the second year, an increase of almost 160 percent.

Since July, the fund has been used to pay for $13,000 worth of emergency medical care for 280 county residents -- already a 74 percent increase over last year's caseload.

Most emergency fund cases are referred to pediatricians, primary-care physicians and dentists, and there is a $250-per-patient limit for use of the fund. The health department receives seven to 11 calls daily with requests for emergency care.

The numbers alarm Dr. Neslen, who says the future of the fund is in doubt.

"We helped 281 people get the care they needed, so you look at it and it's been worth it," she said. "But there's serious problems attached to it, if there's no way to sustain the fund."

With the demand on fund resources comes an accompanying demand for the time of health department nurses who must do financial screenings and locate health providers for emergency fund cases.

"It's very labor-intensive to do this program," Dr. Neslen said.

For some years, the health department had set aside money for emergency care. Three years ago, at Dr. Neslen's request, the county budgeted a $4,000 annual contribution for emergency health care.

Last year, the fund received a one-time $30,000 grant. Dr. Neslen said the money was originally budgeted for another health department program that never got off the ground.

"The reason it [the fund] was set up was out of our desperation," she said.

A case this month made it clear, Dr. Neslen said, that the level of desperation has intensified.

The health department received a call about a 14-month-old with pneumonia who needed immediate care. The case qualified for the emergency fund, and health department nurses began calling local pediatricians. None of the physicians would treat the child, who finally had to be taken to the emergency room at Carroll County General Hospital.

"That's the only time we had to resort to the emergency room [for an emergency fund case], and the costs skyrocketed," Dr. Neslen said.

A typical emergency room visit -- including the hospital's charge and the physician's bill -- could range from $240 to $298, said Gill Chamblin, a spokeswoman for Carroll County General.

The inability to find a local doctor to treat the baby was especially troubling to Dr. Neslen, because 49 percent of the physicians in the county are primary-care providers, a higher percentage than in other jurisdictions in the state.

Although some local doctors have simply refused to take emergency cases from the health department, in most instances the doctors are overwhelmed with insurance paperwork or their own Medicaid patients, Dr. Neslen said. "Doctors are crushed with the number of things they're being asked to do at discount or for nothing," Dr. Neslen said.

The health department has about $30,000 remaining in its emergency fund and has already spent its yearly allotment from the county. If demand continues at the current pace, Dr. Neslen fears the money won't last much longer.

"Our approach is to spend the money while we have it; but if health care reform doesn't bring better access [to medical care], we recognize that the county doesn't have the kind of funds it used to," she said.

Originally, county health officials envisioned that most of the fund expenditures would be for emergency care for children, but that has become the exception.

"We're seeing a far greater number of young adults and adults not getting any primary care; they're just beyond the edges of being eligible for medical assistance," said Donna Hopkins, the health department's director of nursing.

Most young children are covered for outpatient, routine well and sick care under a variety of state or federal programs, Ms. Hopkins said.

But to be eligible for a medical assistance card, the monthly income of a family of four with teen-age children cannot exceed $467, said David Ensor, assistant director of the county's Department of Social Services.

Although the emergency fund can be used to treat an acute medical problem, extra money is not available for follow-up.

When the emergency fund began three years ago, Dr. Neslen had hoped that state and federal health reform would eliminate the need for it.

With the future of health reform in question, Dr. Neslen says it's time to evaluate whether an emergency fund is the best way to spend public health dollars.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.