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New Orleans' Health-Care System Still in Tatters

A year after Katrina, city and region lack doctors, facilities, experts say

FRIDAY, Aug. 25, 2006 (HealthDay News) -- One year after Hurricane Katrina pummeled the Gulf Coast, the health-care systems that serve New Orleans and the surrounding areas are still fighting to get back on their feet.

The effort is halting. The region's biggest city continues to suffer from a dire shortage of health-care professionals and hospital beds, and the few hospitals that have stayed open are hemorrhaging money.

"This is a system that is stretched to the limit and beyond," said Dr. Richard Weisler, adjunct professor of psychiatry at the University of North Carolina at Chapel Hill.

Weisler recently co-authored a report in the Journal of the American Medical Association outlining the current mental health care system in New Orleans.

Katrina and its aftermath has "been described as the nation's greatest national catastrophe, but it's our country's greatest manmade catastrophe," added Dr. Patrick Quinlan, chief executive officer of Ochsner Health System. "If the levees had not failed, we wouldn't be having this conversation. It's an acknowledged federal failure."

Ochsner is one of the nation's largest non-university-based teaching institutions and the largest private employer in the state of Louisiana. It runs two acute-care hospitals and 25 health centers throughout Southeast Louisiana. Its New Orleans hospital was the only fully functional hospital to remain open throughout Katrina. Two other hospitals were partially open.

Quinlan is one of many who accuse the government of not doing enough to rebuild New Orleans' shattered health-care system after the disaster.

In the hurricane's aftermath, "We were consumed in trying to compensate for the consequences of federal failure," he said. Since then, "We have received no federal help, while supporting full [staff] employment and opening our doors to everyone."

Hurricane Katrina and a second storm, Rita, displaced some 2.5 million residents and killed at least 1,800 along the U.S. Gulf Coast. New Orleans was the hardest hit, when floodwaters from breached levees overwhelmed the city.

Weisler's JAMA article -- which he co-wrote with help from colleagues at Louisiana State University (LSU) -- estimates that only 140 of 617 primary-care physicians have since returned to practice in New Orleans. In Jefferson and Orleans parishes, about 40 percent of Blue Cross and Blue Shield doctors are back in business, said Gery Barry, president and chief executive officer of Blue Cross and Blue Shield of Louisiana. A report from the Louisiana Healthcare Redesign Collaborative puts the population down 35 percent since Katrina.

The poor have been hit especially hard, since just 100 doctors along the Gulf Coast area are now participating in the Medicaid program, compared to 400 before Katrina hit, according to Weisler's article.

Moreover, only 22 of the pre-Katrina total of 196 psychiatrists continue to practice in New Orleans, while the number of psychiatric hospital beds has been sharply reduced. As of June 14, there were only two psychiatric beds within a 25-mile radius of New Orleans, according to the JAMA article.

The emergency medical system also appears to be in shambles. More than half (52 percent) of emergency physicians responding to a recent survey reported little to no progress in the recovery of the emergency care system in their communities. Ninety-three percent said the shortage of beds is at least 25 percent below what is needed and 30 percent said the shortage is 50 percent below what is needed. Virtually all (96 percent) said their emergency departments were experiencing staffing shortages in areas such as nursing.

"Right now, the beds are very tight and we are concerned about the loss of health-care professionals continuing as we speak," Quinlan said. "This is in part due to very slow response on major issues such as levees and housing. The federal response has been very slow."

"There really has been a mass exodus," added Weisler, who is also adjunct associate professor of psychiatry at Duke University Medical Center. According to a report in the Jan. 18 issue of JAMA, LSU laid off 127 physicians in early December. A week later, Tulane University School of Medicine laid off 180 clinical faculty members. At present, the radiology department at LSU has been eliminated, with X-rays, CT scans and MRIs now performed at outside clinics.

To Quinlan, however, the real injustice is what is happening to those facilities that have stayed open against all odds. In particular, he pointed to Medicare reimbursement rates that have stayed the same even in the face of vastly increased labor costs.

"We have sustained and continued to sustain losses doing the right thing for the community and for our employees, taking all comers in the face of Medicare reimbursement that is out of sync with current reality," Quinlan said.

"There's all this care that's being provided without any funding," Weisler echoed. "It can't go on for long."

Ochsner's losses currently exceed $70 million, Quinlan said.

Other officials on the ground in New Orleans are more optimistic, pointing to a burst of new clinics, for instance. "They're functioning in a safety-net fashion," said Dr. Fred Cerise, secretary of the Louisiana Department of Health and Hospitals. "They've done a remarkable job of putting the pieces together, but there are still some gaps in the delivery system. It's a mixed bag."

In particular, Cerise said, Medicaid and uninsured populations have been affected by the disappearance of Charity Hospital. More clinics coming on line and a change in the Medicaid reimbursement system should help offset that turmoil, however.

"We have an opportunity to have things come back in a more organized fashion," Cerise said. "I think we'll put up a better system than we had before. It's just a matter of getting through a painful period."

More information

For a report on post-Katrina recovery, head to the American Red Cross.

SOURCES: Patrick Quinlan, M.D., CEO, Ochsner Health System, New Orleans; Richard Weisler, M.D., adjunct professor, psychiatry, University of North Carolina at Chapel Hill and adjunct associate professor, psychiatry, Duke University Medical Center, Durham, N.C.; Fred Cerise, M.D., secretary, Louisiana Department of Health and Hospitals, Baton Rouge; Gery Barry, president and CEO, Blue Cross and Blue Shield of Louisiana; Louisiana Healthcare Redesign Collaborative Region 1 profile; Jan. 18 and Aug. 2, 2006, Journal of the American Medical Association
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