Wednesday, May 18, 2011

My testimony at the Public Hearing "Health and Access to Healthcare"

My testimony at the Public Hearing "Health and Access to Healthcare"
sponsored by the Georgia Commission on Women, Georgia State Capitol, 5/18/2011. [this is what I meant to say even if it is not what I actually said].

My name is Marilyn Ringstaff. I am a Certified Nurse-Midwife and I have lived and worked in Rome, GA for almost 25 years. I worked for about 10 years in a private practice, 10 years in public health and now run a non-profit women’s health clinic, Women of W.O.R.T.H., Inc. in Rome.

Nellie, I know you said to limit our comments to 5 minutes, but let me tell you right from the start that what I have to say cannot be condensed into 5 minutes. So, I’ve written out my comments and I will put them up on my blog at Of course, it won’t be verbatim, but will be close to what I want to say.

As I said, I have worked in women’s health care for almost 25 years in Georgia and I remain astounded at how bad our health care system is for preventive health care. Rome, GA is a town with the highest number of doctors per capita in Georgia, but our women cannot find affordable preventive health care. Health care is the number one industry in Rome, it is a billion dollar industry in a small Georgia town but still our women cannot even find a simple affordable Pap smear.

Both our private health care and public health systems are broken. I have been writing for years on the subject, in internal e-mails to Georgia public health and letters to the Editor, editorials, blogs, notes on Facebook, Twitter documenting the dire situation for our women. I have written to every state agency including the Governor’s office with ZERO response. I have written so much that I have an entire book ready to publish on the problems of women’s health care in Georgia.

There’s no money to be made in preventive health screening. We have a complete lack of concern for the lives and health of our women--unless there is a dollar to be made or a state job with zero accountability to hang on to. Remember Nellie when I got the e-mail about this meeting, I wrote you back and said more talk was a waste of time—who would listen? But here I am, hoping someone will listen. I have found that even those who call themselves ‘women’s advocates’ will not advocate about real or controversial problems and some who call themselves advocates are some of the worst care providers I have seen.

There likely is no response from public health because public health IS part of the problem. For years I have been telling Georgia public health leaders that our health departments in NW GA are not delivering mandated services. No one cares if it isn’t their job or their pot of money that is threatened. Neither health department nor health directors are accountable for the health of the people entrusted to their care. This is the state of the care within public health. When I served on the public health protocol committee- the mandate was removed that required a health director to be clinically active. So now, outdated physicians ‘supervise’ (from a distance) RN’s practicing under a protocol written by non-clinically active RN’s-and these nurses are providing the only health care available to Georgians who have the greatest health risk.

It is not just that some health departments are not patient friendly. I brought it to the attention of public health leaders that our local health department was egregiously wasting taxpayer funds and putting roadblocks into the paths of those who need the help the most. I told our nursing and health director about extreme mismanagement, poor patient care, billing errors, violations of federal mandates, no supervision and terrible customer service, to name a few problems. I told my health director that the problems were so severe that our Grand Jury should be called upon to investigate it. But, I was fired in 2008 for talking about the problems. Now they can’t fire me anymore and I’ve kept talking about it but still no one will listen. I have documented the sorry state of women’s health in Georgia for years and no one within the entire public health administration could be bothered to even comment.

Before I was fired, I ran the Teen Plus Center in Rome- a Center that likely had the lowest teen pregnancy rates in the state and we demonstrated a significant drop in our county’s chlamydia and gonorrhea rates. I saw 2,500 patients my last year there- now this pitiful excuse of a clinic saw 400 patients last year and likely is getting the same funding.

Our health department continues to refuse to see patients, based upon their inability to pay, by overcharging them and not telling patients that the fees may be scaled down if they can’t pay. The health departments in NW Georgia charge as much or more than private providers for a Pap smear appointment-and these are the patients most at risk for cervical cancer.

Our patients report that the health departments in NW Georgia routinely screen out the high-risk patients and refuse appointments for a Pap smear if they have an abnormal Pap or even a history of an abnormal Pap. The, if the woman’s Pap was not up to date, she was refused an appointment for birth control. Two of our health departments in District 1-1 required a woman to bring her medical records in for review before they would even schedule her appointment. We had our volunteers call and document that this was actually the practice. For those lucky enough to get into a H.D., birth control method choices are antiquated and limited.

Appointments at our local health department are impossible to obtain for women’s health care- yet they continue to receive the funding to provide the services. I have informed public health at the state level in both family planning and BCCP program that I have patient names and numbers or reported complaints should they care to investigate--they never have. 

I’m going to play you an actual patient interview from Saturday- a patient that has not had a Pap smear in 20 years. Tape played for the Commission-an audio file of a patient last Saturday who came to W.O.R.T.H. with a problem after she could not get an appointment for a women’s health check-up at the Floyd County Health Dept. and she tried for over a year (her last Pap was 20 years ago).  

ME:                 So, you called the health department?

Patient:            I called the health department. I would call them & they would say ‘you need to call back next month, we’re all booked up.’ They’d give me a date to call back & I would call back. Then they would tell me the same thing and they just kept doing it and doing it and it has been almost a year now & I still haven’t been able to even get them to write my name down for an appointment.

ME:                 Did you tell them that you were having a medical problem?

Patient:            Yes.  The thing about it is, I actually walked, cause every time I called them on the phone, I said maybe if I would go up there and make it a little personal they’ll do something. So I go up there & she takes me in the back I sit down and she’s asking me what’s wrong & I tell her the issues that I’m having & she writes me down like I’m going to get an appointment & then she tells me that she can’t see me.

The problems with our women obtaining cervical cancer screening is so disturbing that I have talked with both the American Cancer Society and the Georgia Cancer Coalition. Neither one of them will help with cancer prevention. The ACS offered us some brochures. On Friday the ACS will have a Relay for Life in Floyd County raising almost $100,000 **for the ACS** but not much to stay in Floyd County and none to prevent cancer.

We are an STD epidemic state and our uninsured patients cannot get an appointment at the health department for testing or treatment.  This is not a question of funding-it is a problem of (mis)management within public health. Two weeks ago I saw a young man at W.O.R.T.H. who tested positive for chlamydia. He said that his girlfriend tested positive in February and he went to the health department to get treated. This health department in Floyd County refused to treat him until he paid $140.00 up front.

The Georgia Commission on Women may not have a budget left, but you do still have a voice. My hope is that will do more than sit here and listen. Somebody needs to speak up for the women of Georgia. Thank You.

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