SPECIAL REPORT: Children of Poverty
An unhealthy situation: Being poor and young
By Mark Sommer
Updated: 05/04/08 9:36 AM
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- In Western New York, 24,800 children are uninsured, 92,585 receive Medicaid, and 23,304 are insured by the state. Twice as many are treated in emergency rooms as the statewide average.
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Mae Bynum of University Heights chose treating her grandson’s wounded leg over healing his troubled mind. She couldn’t afford insurance co-pays for both.
Samantha Martinez, on Buffalo’s West Side, had to go to Rochester to get medical care for her daughter so she could be fitted with a prosthetic eye. Specialists who could have treated her in Buffalo wouldn’t accept Medicaid.
Over on the East Side, Terrence Gaiter’s 4-month-old baby girl died the day after a brief examination by a resident in a hospital emergency room. She was diagnosed as being dehydrated, given an IV and sent home.
Laini died the next day from endocarditis, an infection that attacked her heart; Gaither said his pediatrician told him she might have responded to treatment with an antibiotic if administered early enough.
Stories like these illustrate “a two-tier system” of health care, says Dr. Raul Vazquez, in which children of poverty and those near the poverty line are often treated unfavorably.
Unequal access to medical care strongly affects Buffalo, the nation’s second poorest big city, where nearly 43 percent of children — mostly black and Hispanic — are poor.
But it’s also a problem for all of Western New York, where 24,800 kids are uninsured, 92,585 receive Medicaid and 23,304 get state-subsidized Child Health Plus, according to the state Department of Health.
The problem of access is increasingly affecting the middle class, especially those whose incomes leave them underinsured. But it lands particularly hard on poor children, medical professionals say, because of their susceptibility to such chronic health maladies as asthma, diabetes, obesity, poor dental health, trauma, behavioral disorders, sexually transmitted diseases and exposure to lead paint.
“Health care for children in Buffalo is horrible, and it’s getting worse,” said Vazquez, a family doctor.
“The system is so overwhelmed. There are so many kids in a terrible situation,” said Heather Gennuso, director of St. Francis Cottage, a residential treatment facility for teenage girls administered by Baker Victory Services in Lackawanna.
The girls she sees have been traumatized by physical abuse, sexual abuse, neglect, exposure to violence, removal from their homes and failed adoptions.
“Every time I think I’ve seen the worst of the worst, something else comes along,” Gennuso said.
Gaining access to quality health care for the poor may be challenging, but some people say it’s there for those who seek it.
Conchetta Rigoli, a mother of two in South Buffalo, hasn’t had difficulty getting medical services through Medicaid for 4-year-old Evan, who has severe congestion and acid reflux problems.
“My son has been to the doctor at least 100 times since he was born and seen about four specialists, and I’ve never been billed,” Rigoli said.
Some doctors refuse to accept Medicaid, or Medicaid managed care, because those reimbursement rates are substantially lower than what private insurance companies pay.
“Given the current structure of Medicaid reimbursement, it is virtually impossible for someone with Medicaid to be seen by a private physician,” said Dr. Peter Winkelstein, chief of general pediatrics at Women and Children’s Hospital.
It’s even harder for someone without medical insurance.
Denied personal physicians, families often wind up in hospital emergency rooms for routine care. A 2007 survey found Western New York children used costly emergency room services at more than double the statewide rate.
Medical professionals say there are other barriers the poor face in getting medical care.
There is a lack of understanding about the importance of preventive care, such as regular doctor and dentist visits. Reasons include lack of education, cultural differences and language barriers.
Public transportation and work schedules often don’t coincide with doctor’s office hours, and more than 30 percent of Buffalo residents are without a car.
Transiency is another factor. Fifty percent of Buffalo residents have moved in the past five years. And neglect also can be a factor, because some parents do not make medical care for their children a priority.
Bad home environment
The state Department of Health doesn’t track chronic illnesses by income, but several studies identify glaring health issues afflicting poor children in Western New York.
A January 2007 report by the Harvard School of Public Health singled out Buffalo and Niagara Falls as being among the dozen worst home environments for black and Latino children.
The report found:
• Many babies begin life with low birth weight and preterm.
• They grow up in largely segregated neighborhoods, accompanied by poverty and a concentration of social ills. The 2000 U. S. Census placed Buffalo eighth on the list of most residentially segregated cities in the nation.
• The disparities in opportunities, including medical care, have “devastating consequences.”
A February 2008 report prepared for the Community Health Foundation of Western & Central New York highlighted several chronic diseases among children in poverty rising “at an alarming rate.”
“Asthma, diabetes and obesity are taking their toll, not only physically, but on the child’s capacity to learn and participate in important developmental activities,” the report said.
It found the number of local health providers willing and able to serve low-income populations, without regard to insurance status, was “limited and in some parts of the region, non-existent . . . People continue to seek routine and acute care through emergency rooms at record numbers.”
“The health care system, designed for the middle class, makes little accommodation for families from low-income or ethnic communities,” the report said.
Now there is yet another reason to be worried about poverty and its effects on children — brain damage.
The latest research on the subject was introduced in February at the American Association for the Advancement of Science. It suggests that experiencing poverty at an early age can produce unhealthy levels of stress in children, leading to impaired language development and memory.
The stress children in poverty live with contributes to behavioral problems, said Nathan Hare, who heads the Community Action Organization of Erie County.
“If the child is in an environment where a lot of disorder or disruptive behavior is going on, he or she learns how to process new information through a false lens,” Hare said. “It’s as if you had dark yellow glasses on all the time.
“After a while, you would think that is normal, especially if it is happening at the earliest time of your life.”
Blame put on parents
Last year, the State Legislature expanded state-subsidized Child Health Plus, allowing eligibility for 400,000 children not previously covered. It also simplified Medicaid enrollment, making it easier for those eligible to sign up.
Some people with limited financial means say they are satisfied with the medical services available to them.
“I’m at the poverty level, but there are enough services that there shouldn’t be any children in the inner city going without health care,” said Chanyl White, a mother of two who works full time. “The health care and resources are there.”
White puts the blame on the behavior of some parents.
“I have come upon people who do not keep their children’s regular appointments. It’s just neglect. In the inner city, [some people’s] focus isn’t even on the children,” said White, who lives on the East Side.
“I see kids in the early morning going to the corner store and getting their food for the day. Or kids who are outside until late on school nights.”
Women and Children’s Hospital last year served nearly 10,000 people on Medicaid, many of them poor children, at its hospital and two outpatient clinics.
The health centers fill a huge need for people with limited access to private doctors, said Winkelstein, the chief of general pediatrics.
Yet the federally supported Community Health Center of Buffalo, on the campus of Erie County Medical Center, is underused despite being located in a poor community. Set up to help the poor, it offers numerous services under one roof, from family doctors and pediatricians to psychologists and social workers.
“The frustration is that we have to do more outreach and educate the community about what primary care really is,” said LaVonne Ansari, the executive director. “Understanding the importance of health, and how to get the services you need is not as prevalent as people might think.”
Dr. Okoje Osehotua of the Community Health Center is also frustrated.
“Asthma prevalence in this region is very high, but we’re not seeing as many asthmatic kids. Why? Are a lot of them sitting in emergency rooms unnecessarily?”
‘Blindsided’ by bill
Allison Duwe realized how expensive a hospital stay can be after giving birth to Elijah.
Duwe, whose insurance through work covers only herself, was led to believe her only hospital expense would be a $500 co-pay. She felt “blind-sided” after being hit with a $1,200 hospital bill and $230 pediatrician charge.
“We are still trying to figure out how to pay those bills while trying to get coverage for the baby,” Duwe said. “My husband and I are struggling to navigate the system, and both of us consider ourselves to be pretty well-educated individuals.”
Duwe, executive director of the Coalition for Economic Justice, figured her work on health care issues gave her an advantage working around the health care system.
“Instead, I fell into the same difficulties and frustrations that confront so many of us these days,” Duwe said.
People like Mae Bynum, who works a full-time job earning minimum wage while raising grandson Jazz, 16, along with her son.
Jazz was shot in the leg last year, and Medicaid has covered most of his medical care. But Bynum has trouble paying the minimum $40 copay, which forced her to put a halt to nurse home visits to change the dressing on his wound.
She also, reluctantly, had to forego counseling for the teen, despite believing he needed it to learn “how to cope with society.”
“I prioritize about what’s most important, and that is the physical therapy. I don’t want him to be disabled. It’s impossible for me to pay these co-pays, and pay my bills,” Bynum said.
A state Department of Health study earlier this decade found Buffalo and Niagara Falls had the highest concentrations of elevated levels of lead outside New York City due to old houses.
Veronica Pruitt has painfully dealt with lead poisoning — her two children, Be’Shawn Evans, 16, and Amorette Pruitt-Sanders, 12, both were poisoned, she said, while living in an East Side house with exposed lead paint.
Be’Shawn “stays above water” in school, suggesting he doesn’t show obvious signs of lead poisoning, Pruitt said. He also suffers from bad bouts of asthma and migraine headaches.
Amorette “learns a little slower than other kids,” Pruitt said.
Samantha Martinez, a single mother of four, is frustrated by the limitations Medicaid places on medical care.
There was that trip to Rochester so her daughter, Gabriel Malbonado, 13, with severe cerebral palsy, could get a prosthetic eye after specialists in Buffalo would not take Medicaid.
There’s the prescription coverage that forces Gabriel to take a drug other than the one that has been effective in halting her chronic runny nose.
Martinez also tried for years to get insurance to pay for an expensive, adjustable bed with guard rails to protect Gabriel, who also has scoliosis.
“I get mad, but what can I do?”
