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OPINION: Where Do We Go From Here?: OSU Medical School Plight Part of a Bigger Health Care Crisis

Posted on: Sunday, 7 May 2006, 12:05 CDT

By Janet Pearson, Tulsa World, Okla.

May 7--It's getting so you need a scorecard to keep track of Tulsa-area health-care developments.

While most are positive, the fact there are so many players heading in so many different directions is one of the problems this community faces in dealing with the health-care situation.

A proposed academic affiliation agreement between Oklahoma State University's College of Osteopathic Medicine and Ardent Health Services for training osteopathic residents provides an opportunity to look at the bigger picture. An exhaustive new report on the local health-care scene provides the means.

A deal cementing OSU's residency training program at Ardent's Tulsa Regional Medical Center would solve one problem.

But the Lewin Group's report, compiled during the last year for the Community Hospitals Authority, spells out in agonizing detail other serious challenges.

The Lewin analysts explain that most large communities deal with health-care challenges using one or more of the following: a public hospital; a comprehensive medical school; enhanced Medicaid funding for the indigent; a hospital focused on high-need patients, and a strong network of federally backed health centers.

"Tulsa lacks all five," noted the Lewin team.

Some of the findings, while not new, still come as a shock:

More than a third of Tulsa County residents are uninsured or underinsured; Tulsa's age-adjusted death rates are 21 percent higher than the national average; for some conditions, such as respiratory ailments, the death rates are as much as 34 percent higher.

Perhaps most disturbing: Oklahoma is the only state in the country whose death rates, adjusted for age, worsened during the 1990s.

People here are dying early because of the failure to deal with health issues. Even people of means sometimes have difficulty accessing appropriate care in a fragile, overburdened system.

There is widespread agreement OSU deserves help with its residency needs, but there also are strong arguments for other proposals, including several being developed by the University of Oklahoma College of Medicine at Tulsa.

Stabilizing the OSU residency program and expanding some initiatives by OU-Tulsa are among recommendations in the Lewin report.

The OSU/Ardent proposal requires a $40 million appropriation from the Legislature, to be used for capital improvements at the hospital.

The money would be used to improve the medical/surgery unit and operating room suites; the outpatient surgery center; and labor, delivery and pediatrics services. Some new equipment would be purchased and patient rooms renovated.

OSU leaders want their plan considered apart from any other university proposals, but OU officials say their needs should be high priorities as well.

Among them: paying off the local campus debt of $18.5 million; funding a new "superclinic" to improve health-care access for needy populations; expanding the university's fledgling school-based clinic program, and more funding for proposed cancer and diabetes treatment centers.

If OSU doesn't get an agreement on its residency program, the future of the medical school is clouded. OU officials argue the future of their efforts are also uncertain without additional state commitment.

But what of the future of the community's entire health-care system? The two medical schools are important and should be priorities. But they are pieces in a much larger mosaic -- one coming together with little if any cooperation and guidance.

"Our findings confirmed what is well known among Tulsa health-care stakeholders: Tulsa faces many challenges in its delivery, financing and organization that limit its ability to successfully meet the needs of safety-net populations," the Lewin Group concluded.

Among the major problems are the lack of sufficient, dedicated funding, and the lack of a central authority for coordinating and monitoring services.

Because access to appropriate care is so elusive here, about 75 percent of all care rendered in emergency rooms could (and should) take place in more appropriate, less costly settings, the report noted.

Access to care is so spotty and fragmented that in tens of thousands of cases, patients never get appropriate care, the report said.

The Lewin Group recommends pursuing legislation to give the local hospital authority more power to plan, obtain financing, implement programs, acquire real property and employ personnel. Such authorities have succeeded in other communities.

The report repeatedly points to the "critical need of coordinated, focused planning and effort," but also emphasizes there is no "quick fix."

"Communities with safety-net strategies in place have created their systems of care over 20 or more years. Thus, Tulsa requires a strategic road map that can be put in place and achieved over the 'long haul.'"

There can be little disagreement over the Lewin Group's solid and well-researched findings. The next question is:

What will Tulsa do about it?

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Janet Pearson 581-8328 janet.pearson@tulsaworld.com

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Copyright (c) 2006, Tulsa World, Okla.

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Source: Tulsa World

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