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Health cuts a risk to women
County's budget woes leave many waiting for care

Friday, February 08, 2008
Chicago Tribune
by Judith Graham

In what doctors term an emerging health crisis, hundreds of women with abnormal Pap smears, unusual bleeding, pelvic masses and other worrisome symptoms are waiting for weeks or months to see gynecologists in the Cook County health system.

The longer women wait for care, gynecological experts warn, the more likely it is that untreated medical problems could worsen, exposing the women to severe pain, cancers that are harder to treat or even life-threatening emergencies.

Officials blamed the backlog on budget cuts and related staff reductions, and called on the Cook County Board to restore funding to the health system when it finalizes the 2008 budget at month's end.

Tyesha Franklin, 25, is among those caught in a nightmarish limbo.

The West Side resident learned in June that her Pap smear, performed at one of the county's community clinics in April, had come back positive. The result suggests possible cervical cancer, but Franklin hasn't been able to get an appointment at Stroger Hospital's gynecological clinic for evaluation and follow-up tests.

"It makes me feel uncomfortable and scared," Franklin said. "I really want to know what's wrong with me. I don't want cancer. I really need some help."

Only seven full-time general gynecologists remain at Stroger, down from 12 a year ago. Another gynecologist works part time, and seven positions are open. The hospital's once-bustling gynecological clinic is now open only two half-days each week. The rest of the time, the doctors deliver babies, care for inpatients or tend to emergencies.

At the end of January, 244 women with abnormal Pap smears and 733 women with pain, unusual bleeding or other symptoms were waiting for gynecological appointments at Stroger Hospital's outpatient clinics, said Dr. Enrique Martinez, chief medical officer for the county's ambulatory and community health network.

A year ago, waits just weren't an issue, he said.

"We're struggling because we don't have [enough] providers," Martinez said.

Of course, some of the waiting women may not have serious medical problems, but others are at risk of dangerous infections, twisted ovaries, pelvic inflammatory disease, fibroids, and conditions such as cervical, ovarian and endometrial cancer.

Martinez said doctors try to identify women with the worst symptoms and arrange for specialists to see them as quickly as possible. But scarce resources make timely intervention difficult, he said.

A county doctor told the story of one patient who had a positive Pap smear in September and just got word she could see a Stroger gynecologist in April. The physician asked not to be identified because she wasn't authorized to speak to a reporter. "It's outrageous, what's happening," she said.

'We need to add capacity'

Dr. Robert Simon, interim chief of the county's health services bureau, called the situation a crisis and said already overburdened medical units would deteriorate further without additional resources.

"We need to add capacity," Simon said.

Under Cook County Board PresidentTodd Stroger's proposed 2008 budget, the Bureau of Health Services would get $96.8 million more, fill 270 open jobs and hire 420 new employees, in part to reduce backlogs in specialty service areas, officials said.

Stroger told about 200 doctors and nurses at county-owned Provident Hospital on Thursday that he would not support further cuts to the county's health system after it took a hit of more than $87 million last year.

Stroger was making the case for additional taxes, but Commissioner Forrest Claypool (D-Chicago), a Stroger critic, noted the failure to bill patients for $250 million in services during 2006 and said new tax revenue is not the answer.

"The real solution to the problems of quality health care and the budget is putting professionals in charge of the health-care system," Claypool said.

Whatever the outcome of the budget battle, the need for gynecological services in the county remains enormous. More than 450,000 women in the Chicago area don't have health insurance, and many depend on county hospitals and clinics, according to a May 2007 report from the Chicago Foundation for Women.

At private hospitals, women don't encounter the delays that patients are experiencing at the county's publicly funded hospitals and clinics.

Dr. Charles Miller, a gynecologic specialist at Advocate Lutheran General Hospital, said patients with pelvic pain or unusual bleeding almost always are seen within 24 hours. "Let's face it: These can be signs of gynecologic emergencies which, if not treated, could do terrific damage," he said.

"These patients are suffering. My heart goes out to them," Miller said when told of the situation at Cook County.

Post-test visits crucial

At the University of Illinois at Chicago Medical Center, Dr. Yvonne Collins said women with abnormal Pap smears should be seen in no more than two to four weeks and have further tests to detect pre-cancerous or cancerous lesions. "You don't want a cancer to progress and you want to get in there right away and do surgery if it's detected," she said.

A dramatic falloff in primary care at Cook County is also contributing to women's health problems. With fewer primary-care doctors and nurses, it's harder for patients to get medical appointments of any kind, said Dr. Janice Benson, president of Stroger Hospital's medical staff.

After last year's budget cuts, 44 doctors, nurses and physician's assistants now provide basic medical services to the hundreds of thousands of patients who turn to the county's community and urgent-care clinics for routine medical care, Martinez reported. That's down from 101 medical providers in 2006.

Even though doctors and nurses are working longer hours, there were 100,000 fewer patient visits last year than in 2006, he said. The demand for basic medical care is at least twice or three times greater than the county's ability to provide it, he said.

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