A broken system on the mend: 10 telling quotes from patients, healthcare providers in Baltimore

Baltimore is home to world-renowned medical institutions. Driven by the shift from fee-for-service to value-based care, the city's healthcare providers say they are trying harder than ever before to improve the health of lower-income residents of West Baltimore, according to NPR.

However, interviews with dozens of patients, physicians and local leaders reveal how numerous barriers between some of Baltimore's financially struggling residents and its hospitals still prevent patients from getting the kinds of medical care and support they need, according to the report. In fact, residents told reporters from Kaiser Health News and the University of Maryland's Merrill College of Journalism that they have little more confidence in the medical system designed to heal them than they do in the criminal justice system intended to protect them.

Here are 10 standout quotes from NPR's report, which details the barriers preventing many Baltimore residents from accessing vital healthcare services.

1. "They come in with a great service, but they don't have relationships with people in the community," Louis Wilson, senior pastor of New Song Community Church in Sandtown, Md., told NPR. "They want the people in the community to come in and respect them, but they don't respect the people in the community. It does not work. It just doesn't."

2. "When you walk into a hospital, it's like walking into a courtroom," said William Honablew Jr., who volunteers at LIGHT Health and Wellness, a nonprofit whose community services include helping those with HIV and other chronic illness navigate the system, according to the report. "You know who's in charge, and you know who's not."

3. "Why, in the midst of this extraordinary healthcare enterprise that is present in Baltimore, with all this expertise, are we sitting here on this side of Martin Luther King [Boulevard] and on the west side ... you have some of the most disappointing life expectancies that one could imagine?" said Jay Perman, MD, a pediatric gastroenterologist and president of University of Maryland. Dr. Perman was referring to the town of Sandtown, which has a life expectancy of just 69.7 years — the same life expectancy as in North Korea.

4. "The system is fragmented," said Debbie Rock, who has run LIGHT Health and Wellness on Sandtown's western edge since the 1990s, according to NPR. "I think that people need to go back and talk to each other. I think the doctors and the health insurance companies need to sit down and listen to each other."

5. "I change doctors like I change underwear," Eddie Reaves, 64, told NPR. He said he tries to find practices that charge copays under $12 or $15. His income is $1,170 a month. He added, "I must have seen a good total of about 10 doctors" in 2014.

6. "Didn't have no bills," Mr. Reaves said of Health Care for the Homeless, a nonprofit that delivers comprehensive medical care to the homeless regardless of their ability to pay. "Your medicine they helped pay for. They did a lot for you. You could get your teeth done and everything. It was just great, man." Mr. Reaves said that program provided him the best healthcare he ever received. Now he is on Medicare because of a disability. While he's applied to Medicaid twice for better benefits, he has never received the paperwork, according to the report.

7. "We've got a joke here, but it's a serious joke," said Robert Peace, who broke his pelvis in a 2004 car crash. After being treated at University of Maryland Medical Center, Mr. Peace developed a persistent bone infection, but received little follow-up care. The infection eventually required numerous surgeries and hospital readmissions. "If they ain't medicating, they're amputating or operating. But what's missing is the care. Primary care."

8. "As a profession, as an industry, we have not sufficiently appreciated, let alone done something about, the impact of social determinants" such as poverty, poor housing, lack of food choices and low education, Dr. Perman said, according to the report. "Guys like me and gals like me can easily say, 'I made the correct diagnosis. I wrote a proper prescription. I'm done.' What I say to my students is, if you think you're done — if 'done' means the patient is going to get better — you're fooling yourself."

9. "We want to bring the standard health in this neighborhood up to national standards," said Marcia Cort, MD, CMO of Baltimore-based Total Health Care, according to the report. "We don't want it to be the neighborhood and area [where] life expectancy is low and people are dying from preventable things." Still, she added, "Baltimore City is in a health crisis."

10. Distrust of the healthcare system is a growing problem that is handed down from generation to generation, according to Derrick DeWitt, pastor of First Mount Calvary Baptist Church in Baltimore. "It's a culture that has come about over time, because younger people have seen or feel like their parents and their grandparents didn't get the best medical treatment when they went to the hospital," said Mr. DeWitt, according to the report. "So they have this why-go attitude."

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