A group of reporters from Kaiser Health News and the Capitol News Service have taken a hard look at a situation that most people in the Baltimore region intuitively grasp but have ceased to question.
Namely, that a city with world-renowned health care institutions can’t seem to prevent many of its poorest residents from getting really sick.
The project shines a light on barriers to medical care through story-telling and statistics:
• A leg injury from a car crash that turns into a chronic bone infection and five hospital visits due to a lack of follow-up care.
• People living on so little that a $15 co-pay is a struggle.
• A woman whose mass transit journey to get a blood pressure cuff and other needed medical supplies takes 5½ hours – one way.
• And a hospital, Bon Secours, so mistrusted by neighborhood residents that it is referred to as “Bon Se-Killer.”
The Two Baltimores
The project was reported by Kaiser Health News and students from the University of Maryland’s Merrill College of Journalism who staff the Capitol News Service. It was kicked off this week by the series opener, “In Freddie Gray’s Baltimore, the Best Medical Care is Nearby, but Elusive.”
“As with so much else, there are two Baltimores when it comes to health. One population is well off and gets the best results from elite institutions on the city’s west and east sides, the University of Maryland Medical Center and the Johns Hopkins Hospital,” writes Kaiser’s Jay Hancock.
“The other is a poor minority that gets far less, even as it uses hospital services at higher-than-average rates,” Hancock observes, noting one telling indicator, that “the typical Sandtown resident lives a decade less than the average American.”
The project was based on months of reporting mostly in Sandtown-Winchester, the neighborhood where 25-year-old Gray lived before he died in police custody last April, touching off days of protest culminating in rioting.
The series paints a bleak picture of a health care system that struggles, but often fails, to keep the poorest and most vulnerable citizens in Baltimore healthy. Among the findings:
• People are in poor health. Sandtown’s zip code had the city’s second-highest rate of diabetes-related hospital admissions and the second-highest rate of psychiatric cases. In 2013, it had the highest rate of babies born underweight.
• The physical environment is unhealthy. Liquor stores abound in poor neighborhoods. Lead paint in rental houses still cripples the development of many children. Basic amenities, from supermarkets to recreational facilities, are few and of poor quality.
• It can take months to qualify for Medicaid. Limited administrative resources, bureaucratic hurdles for the previously incarcerated and fear of legal consequences are among the reasons cited.
• Lack of follow-up care. This was the most glaring failing, particularly at Bon Secours, the hospital that serves Harlem Park, Sandtown and other especially poor neighborhoods. The institution had the highest readmission rate of any hospital in the state in 2014.
The report finds failings at all levels of the health care delivery system.
“A home-oxygen company wouldn’t serve a discharged lung patient because he had a $27 balance,” one source tells the reporters. “A hospital directed two home-health companies to teach a patient how to deal with a new colostomy bag; neither showed up.”
Spokesmen are quoted from Bon Secours and the UM Medical Center saying they are working to cut down on re-admissions by providing the kind of follow-up specifically needed by the poor patients they serve.
One feature of the series is its multi-media approach to telling the story of race, income and health disparities in Baltimore, such as this video.
As the car-mounted camera moves “from leafy Roland Park to nearly treeless Sandtown” a running indicator ticks down median income and life expectancy.