Secondary care involves a specialist, such as a cardiologist, as well as advanced testing procedures, such as MRI. Before September, when Hurricane Ike hit the coast, almost all of the county’s secondary care services were provided by the medical branch. 

Tertiary care includes hospital care and super-specialists for advance treatments of illnesses. That also was provided almost exclusively by the medical branch before Hurricane Ike, Dr. Mark Guidry, the director of the county’s health district, said. 

The Galveston County Health District provides health care services to about 15,000 residents, the majority of whom are covered under Medicaid or Medicare. About 2 percent of the county’s patients qualify for indigent health care, Guidry said.  

By state law, indigent care must be paid for by the counties. To be classified as an indigent patient, the county resident must be classified at 21 percent of the federal poverty level. 

The federal poverty level for an individual is $10,830 a year in income and assets. For a family of four, it is $22,050.  

When the county assesses eligibility, a person’s or family’s assets — cars, savings, house — are factored in. 

“So if someone has a job at McDonald’s, then he is out of the (indigent health care) program,” the county’s director of community service, Curtiss Brown, said.  

Brown is the county’s point man on creating the new health care network for the indigent population. 

Guidry said while the county has been struggling to create the secondary care network, patients have gone without necessary medical attention or procedures. He classified the situation as “urgent” for two reasons. 

“The health conditions of these people are serious, often times life-threatening,” he said. 

The second reason is economic. Patients not receiving secondary care are instead going to emergency rooms — with Texas City’s Mainland Medical Center bearing most of the load — which is more expensive care. The bill for those emergency room visits goes to the county. 

“Specialty care is always less expensive than ER care,” Guidry said. 

Creating The Network 

Galveston County was part of a consortium that included Liberty, Montgomery, Chambers and Brazoria counties. The consortium had contracts with the medical branch to provide indigent health care. But after Hurricane Ike, the medical branch canceled all of its indigent health care contracts, Brown said. 

“They just stopped taking my patients,” he said. “They are not taking my patients today.” 

The county has tried to reach a new contract with the medical branch, but Brown said those talks have gone nowhere. 

“They are not even negotiating with us in a meaningful way,” he said. “I wish they would. I miss them.” 

So, three months ago when it was obvious a new agreement with the medical branch wasn’t going to happen, Brown started working to find doctors and clinics willing to become part of the county’s secondary and tertiary health care network for the indigent.

Creating the new network hasn’t been an easy task. Doctors have to be willing to take on indigent patients. In doing so, they agree to be paid at a rate similar to that used for Medicaid, which is 40 percent of what the medical care would normally be billed. 

“Before UTMB closed its doors on us, typically we would pay UTMB hospital, UTMB Family Medicine and Mainland Medical Center and maybe two or three other physicians,” Brown said. “Today we have many, many more patients going to other doctors and Mainland Medical Center.” 

13 Providers

To date, Brown has signed contracts with 13 doctors or clinics. Two more contracts are pending. That is well short of what is needed, he said. 

While there have been doctors who have agreed to fill the void left by the medical branch, in many cases they want to limit how many indigent patients they treat as not to hamper their private practice. 

Also, unlike the medical branch with its clinics on the island and mainland, the new network has doctors as far away as Clear Lake and Pasadena. 

The county won’t pay for transportation for the patients, which has proved to be an obstacle. 

Guidry said the No. 1 need for secondary care is orthopedics, followed by gastroenterology and then cardiology. 

The county is talking with the Harris County Hospital District, which has been receptive about providing hospital care, Brown said. 

In May, county commissioners approved a pilot program where residents living at 50 percent of the federal poverty level would be eligible for taxpayer-supported hospital and specialty care. That pilot program ends at the end of August. 

County commissioners have not signaled whether they are in favor of continuing that program with a possible vote on creating a hospital district looming in November.

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