Two years after Hurricane Katrina's floodwaters submerged much of New Orleans, the city's relatively few open health care facilities and diminished corps of physicians are struggling to serve a smaller, but very needy, population.
It's a picture that's changed somebut not muchsince a year ago.
Emergency departments, in particular, are bearing the brunt of the broken system, as they are one resource that is nearly always available to the uninsured and those with little access to primary care.
It is thought that about 200,000 people now reside in the city, with another 400,000 in the three surrounding parishes (Jefferson, Plaquemines, and St. Bernard). In that region, there are some 101,000 uninsured residents and 147,000 Medicaid recipients, according to the Louisiana Department of Health and Hospitals (DHH).
It's still unclear how many of the approximately 3,000 physicians who practiced in the area before the storm have returned. In mid-2006, according to claims information from Blue Cross and Blue Shield, only half had come back. The Louisiana State Board of Medical Examiners said that from August 2005 to July 2006, the number of primary care physicians declined from 2,645 to 1,913.
The lack of access to care has hit hard. According to an analysis of death notices in the Times-Picayune by the Dr. Kevin U. Stephens Sr., director of the city health department, and colleagues, there was a 47% increase in the mortality rate in the first 6 months of 2006to 91/100,000, compared with 62/100,000 seen in 2002-2004 (Disaster Med. Public Health Preparedness 2007;1:15-20). The authors said that they studied death notices because of vast gaps in state and city data.
Primary Clinics to Be Medical Homes
According to Dr. Frederick P. Cerise, secretary of the Louisiana Department of Health and Hospitals, there are 26 primary health care sites in the New Orleans area, including federally qualified health centers, Tulane University and Louisiana State University outpatient clinics, and mobile and nonprofit clinics.
The sites will receive $100 million from the federal government over the next 3 years, said Dr. Cerise in an interview, as part of a $161 million allocation aimed at improving health care in the area.
The clinics are eagerly awaiting the shot in the arm, said Dr. Karen DeSalvo, executive director of Tulane University Community Health Center at Covenant House. The Tulane clinic is part of an 18-clinic alliance, the Partnership for Access to Healthcare (PATH).
The money is "going to give us a chance to expand upon what's been developingmultiple neighborhood clinics that are turning into medical homes," said Dr. DeSalvo, who also is chief of general internal medicine and geriatrics at the university and special assistant to its president for health policy.
All PATH clinics have agreed to uphold and advance the principles of a medical home, she said. The concept was developed by the American Academy of Pediatrics and is being promoted on a national level by the American College of Physicians and the American Academy of Family Physicians.
Dr. DeSalvo said that while she believes the primary care picture is vastly improving in the city, noting that the 18 clinics see about 900 patients a day, too many patients still seek routine care from the emergency departments. "We're trying to find those patients in the ER and get them into our system," she said.
Inpatient Capacity Still Down
Currently, in New Orleans proper, there are five hospitals open; five more are either abandoned or closed, according to the Louisiana Hospital Association.
Louisiana State University, Baton Rouge, is once again operating a level one trauma center in downtown New Orleans at the LSU Interim Hospital (formerly University Hospital).
The now-179-bed Interim Hospital and Tulane Hospital are all that's left of the Medical Center of Louisiana at New Orleans. Before Katrina, that campus also included Charity Hospital, a Veterans Affairs (VA) hospital, and medical office buildings. LSU was able to open Interim Hospital with $64 million in Federal Emergency Management Agency (FEMA) funds. It has recently added a 20-bed detox unit (only 5 were staffed as of press time) and is in the midst of adding 33 inpatient mental health beds elsewhere in the city, as well as a mental health unit in the emergency department.
LSU is one of the main backers of a huge new medical campus within a few blocks of Charity Hospital on a 37-acre partly undeveloped parcel that the city has said it will take.
According to testimony by Mayor C. Ray Nagin at a field hearing of the U.S. House Committee on Veterans' Affairs in early July, the new campus would include 30 public, private, and nonprofit organizations, including LSU, Tulane, Xavier University, Delgado Community College, the LSU and Tulane hospitals, medical offices, and biotechnology companies. The state has put aside $38 million to fund a cancer research institute at the site. The cityalong with LSU and Tulaneis trying to convince the VA to rebuild on the campus.