MONDAY, May 8, 2006 (HealthDay News) -- Dr. Floyd Buras remembers the day the mayor of New Orleans finally let him visit his office on the corner of Robert E. Lee Boulevard and Franklin Avenue, a full two weeks after Hurricane Katrina had landed.
The building had been sitting in 12 feet of water for more than 14 days. Everything was destroyed, including medical records that now resembled piles of wet toilet paper.
A few weeks later, those same columns of medical records had hardened like papier mache, forcing Buras, a pediatrician, to hire a concrete removal service to heave it all out.
But even more damaging, Buras said, his patients were gone.
"We drew from the areas most severely affected by the storm. The patients left, and they haven't come back," he said. "If you talk about a medical practice being people, doctor-patient relationships, that was destroyed."
Buras, who started his practice in the late 1970s, is now trying to begin again, with 800 patient charts instead of 15,000. He and his partner have relocated to two rooms at Children's Hospital and are renting office space from a computer training school upstairs. "They had the same issue, no people to train," said Buras, who is president of the Louisiana State Medical Society. "It's mutually beneficial. They get some revenue from unused space, and we have a place to call home."
The most exceptional aspect of Buras's story is that it is not exceptional. Thanks to Katrina and the ensuing floods, New Orleans' health-care system has largely disappeared.
"You've got a city where the whole health-care system was destroyed," Buras said.
According to Susan D'Antoni, executive director of Orleans Parish Medical Society, Orleans and St. Bernard parishes, which were hardest hit, have gone from having nine hospitals to three. The metropolitan area has lost half its hospital beds and 40 percent of its physicians. St. Bernard Parish went from 75 doctors to three.
For all practical purposes, the network of charity hospitals for indigent patients is gone. Yet the number of uninsured has increased threefold to fivefold, thanks to a swelling of people who lost their jobs (and benefits), and an incoming temporary labor force desperately needed to rebuild the city.
"One of the major issues is that so much of our population is uninsured or underinsured because people lost jobs, and there's a major influx of immigrant workers," said Dr. Ruth Berggren, an associate professor in the section of adult infectious diseases at Tulane University Health Sciences Center in New Orleans.
And the nature of the work this temporary labor force is doing -- cleaning debris and fixing roofs -- means more injuries and more heart attacks, problems for which the decimated health-care system is unprepared.
For Buras, rebuilding a practice is going to occur despite the odds. Buras does not qualify for government help. The insurance company has stated it won't insure the building again unless it is raised 12 feet. That will cost $100,000 out of Buras's own pocket. "It may not be worth the effort," he said.
Buras, who is 56, plans to stay in New Orleans. Many younger doctors, facing mortgage payments, school loans and tuition for their own children, have left.
"Ten years from now, when I'm ready to retire, there's not going to be anybody here to take my place," Buras said.
But Buras and others also see an opportunity in this vacuum, an opportunity to truly start again.
"Rather than trying to rebuild Charity Hospital and refund all government programs, why don't we just create an insurance program and take all the money and buy everybody an insurance program?" Buras said. "We'd love to see things redone, and we could do it easily. We wouldn't have to get rid of the old. It's already gone."
"This gets at a larger issue that affects the system of health-care delivery across the U.S.," Berggren added. "Right now, our system allows us to reward the health-care system when people are sick. We need to turn that upside down, so money flows when people are out of the hospital because that ultimately will be cheaper."
As one medical professional stated, "How often do you get a clean slate?"
More information
The Louisiana State Medical Society has more on the health-care crisis in New Orleans.
