Loretta Bobb, 51, woke up at 5 a.m., sweating and gasping for a breath. She stumbled outside her South Dallas home for fresh air. Bobb figured she was having a heart attack.
Emergency room physicians concluded she was suffering a stroke from untreated diabetes. She had no idea she had diabetes.
That was 11 months ago. She hasn’t seen a doctor since then.
Because of too many cases like Bobb’s, Baylor Health Care System is investing $15 million to address diabetes management with its Diabetes Health and Wellness Institute.
It opens Monday within the remodeled Juanita J. Craft Recreation Center.
“There’s a whole lot I don’t know,” Bobb said. “I think there are a lot of people in our neighborhoods that need this service.”
The center is in South Dallas, behind Fair Park, in the middle of the Frazier neighborhood, in the 75210 ZIP code, where residents are nearly three times more likely to die of diabetes than other county residents.
Baylor’s diabetes institute, with a $2 million investment from the city of Dallas, includes a full-time physician; a pharmacy with lower-priced medication; nutrition and healthy cooking classes; a farmer’s market with fresh fruits and vegetables; and exercise and weight training programs.
Their experiment pits money and a comprehensive wellness program up against poverty and unhealthy lifestyles. Diabetes costs the state $12.4 billion a year for treatment and in lost productivity, according to the Texas Department of state health services.
Baylor reasons that investing in diabetes prevention and management is cheaper than seeing those residents as emergency room patients at nearby Baylor University Medical Center.
Success would bolster the argument that hospitals can be leaders at bending the health care cost curve. Failure, however, would be a setback to a central logic behind the Obama administration’s health overhaul law, that hospitals can be held more accountable for the costs and care of their patients.
Low pay, high weight
Poverty complicates diabetes. Residents of the 75210 ZIP code on average earn $14,123 a year, according to data from the U.S. Internal Revenue Service. Within the Frazier neighborhood – bounded by Fitzhugh Avenue, Haskell Avenue, White Rock Creek, Scyene Road and Robert B. Cullum Boulevard – the average annual income is $9,000 a year.
Bobb said she can’t afford a doctor’s visit. At 5 feet 2 inches and 264 pounds, she is overweight, has high blood pressure, an under-active thyroid, no insurance and no job.
The single mother of six lives in the same house she grew up in, just off of Malcolm X Boulevard, bequeathed from her deceased mother.
She hasn’t made much of a dent in the medical bills racked up from the diabetes episode 11 months ago, and she’s unsure of the grand total.
“I don’t feel good about that,” Bobb said. “But my house is falling apart; I just don’t have the money.”
She’s first to accept blame for her “sugar” problem, her reference to diabetes.
“Some of it is eating habits,” Bobb said. “I’m kind of a mirror image of my mother now. It’s trickled down. She told me to be careful before she died.”
Now it’s trickled down further to Louis, her obese 11-year-old son. Bobb says students at Billy E. Dade Middle School pick on Louis, who stands a little taller than 4 feet with a 180-pound frame. Louis, who visits a juvenile obesity clinic, has to wear man-size pants, which Bobb hems at the cuffs.
“He doesn’t get enough exercise, which I blame myself for because I’m afraid to let him outside with his severe asthma,” Bobb said. “He’s a sweetheart, just a big ol’ teddy bear, but he’s just overweight.”
Helena Geter, 48, who lives in the Frazier Courts public housing project, used to weigh 360 pounds but now watches her weight after shedding 190 pounds over the past two years. She had a peach cobbler in the oven during a reporter’s interview but clarified it was for a friend’s birthday party. Geter, who has trouble walking, struggles to find affordable fresh food in her neighborhood.
“Money getting the food is the problem,” said Geter, whose income is $647 a month. “I try to eat a lot of fruit.”
On board
“For Baylor, there is no greater priority on any single program,” said Albert Black, who grew up in Frazier Courts and is now chairman-elect of Baylor Health Care System.
Black’s rise to the chairmanship of Baylor is a bit of serendipity for the Frazier community. He lived in the projects until age 14. He recalls summers of racing his bicycle with friends up Spring Avenue to Juanita Craft Park, then known as Wahoo Park.
He’s fond of the area. His wife is from there, too.
“The soil grew a good crop but hasn’t been tended to in recent years,” Black said.
The diabetes institute was his idea; other board members say they enthusiastically support it.
In March 2006, Baylor set up a task force to study Dallas’ southern sector to make health care more accessible.
Baylor set a $15 million budget and recruited acclaimed diabetes author and educator Donna Rice to spearhead the institute effort.
Rice, a former president of the American Association of Diabetes Educators, set up town hall meetings in the Frazier neighborhood to hear what residents wanted.
She hired from within the community. Some of her staff are black, including an on-site physician and exercise physiologist. The thinking is that nearby residents, 98 percent black, might feel more comfortable with folks who look like them.
Benefits
To be sure, skeptics of not-for-profit hospitals may question Baylor’s altruism. In exchange for their tax exemption and eligibility for favorable bond financing, not-for-profit hospitals are required to provide a so-called “community benefit,” which should be at least 5 percent of net patient revenue.
Baylor says it exceeds that, spending 20 percent of patient revenue on community benefit projects last year.
But not-for-profit hospital systems define community benefit differently. Some count employee wages as community benefit, arguably a competitive advantage over for-profit hospitals.
Baylor plans to count the salaries of Rice and her 16 employees as community benefit. Additionally, Rice is planning to hire one person from all 127 area churches to act as diabetes educators and promoters of the institute – also credited as community benefit.
Baylor uses the profits from its wealthier hospitals – in Carrollton, Frisco, McKinney and Plano, where most patients have private insurance – to fund community benefit projects.
If its South Dallas experiment succeeds at reducing costs and saving lives, Baylor CEO Joel Allison expects other hospital systems to follow its lead.
“Health care organizations need to expand their role in the community, and this initiative is one example,” Allison said. “Hospitals have not traditionally been in the business of providing cooking classes, farmers markets, treadmills and computer labs. But this new model of care represents the future.
“We are now working to improve the health of a community beyond the walls of the hospital.”
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