Downsizing may put New Orleans' two medical schools, Tulane University and Louisiana State University Health Sciences Center, on sounder financial footing than they were before the floods of Hurricane Katrina wiped out much of their infrastructure and dispersed their faculty, residents, and student bodies.
While closure of several hospitals and clinics affiliated with those schools is of concern now, Dr. Larry Hollier, chancellor of the LSU Health Sciences Center predicted that a new primary care system under consideration eventually could better serve the city's charity care needs. Louisiana had the second highest number of uninsured individuals in the nation in 2005. Access and payment issues, however, continue to be a concern in the interim.
In late February, the federal Government Accountability Office estimated that only 456 beds were open at three hospitals in the city, down from 2,269 before the storm. (See box.) Outside the city, about 1,528 beds out of a total 1,814 had reopened.
Just two of the city's nine hospitals are fully reopened. A third, Tulane University Hospital and Clinic, has opened 62 of its 237 beds. Before the storm, 90 clinics, including 70 that were operated by the state, provided care for the uninsured. Now just 10 are open, and most are operating at 50% or less capacity, according to the U.S. Government Accountability Office.
Hurricane Katrina accelerated a long-simmering debate about what to do with the city's two main charity care facilities—University and Charity hospitals, both owned by the state and operated by Louisiana State University. Charity Hospital is housed in a 21-story facility built in 1939, but has been in continuous operation since 1736. University Hospital was built in the 1960s.
Together they had 500 beds; Charity was the central service site for the uninsured, but was deteriorating before Katrina, said Dr. Larry Hollier, chancellor of the LSU Health Sciences Center, in an interview.
LSU has said that it will not reopen Charity, but that it will reopen University on a phased-in basis, with 100 beds in July, 200 by November, and 250 by January. An LSU-hired consultant estimated that it would take $117 million to repair University and $257 million to get Charity back in operation. However, the Federal Emergency Management Agency—which is slated to pay for the hospitals' recovery because they are in a federal disaster area—had much lower estimates: $12 million for University and $24 million for Charity, according to the GAO report.
Without Charity, Tulane University Hospital is seeing more uninsured patients these days—about 30% of its patient visits. “That's a huge increase” from before the hurricane, said Dr. Ronald Amedee, dean of graduate medical education at Tulane.
Dr. Hollier, his LSU colleagues, and state government officials are proposing to build a new hospital in conjunction with the Department of Veterans Affairs, which also lost its 206-bed facility.
“We need more third-party payers,” said Dr. Hollier in an interview, noting that Louisiana pays for most of the charity care in a state where 23% of the population is uninsured.
So far, Congress has approved $75 million in planning funds, and the Bush Administration set aside $600 million for new construction in the hurricane relief package. But the joint hospital plan still needs to be approved and fully funded by Congress. The soonest that could happen is the end of the year, Dr. Hollier said.
“Everybody understands the urgency of this to the city,” Dr. Hollier said. But under the new post-Katrina system, he added, “I think there will be better access for the uninsured.”
Under a plan being advanced by LSU, the state would open more primary care clinics around the city. But it's not yet clear who will pay for those clinics, Dr. Hollier said.
And with so many neighborhoods still sitting empty, no one knows where those clinics would be built or whether there will be anyone to serve in those areas.
With all seven of LSU's teaching hospitals initially out of commission, LSU moved its residents to hospitals outside the city and across the state, in particular to Baton Rouge. Some are now back at work in New Orleans. At Touro Infirmary, which is down to 250 beds (from 345), LSU now has 50 residents—a substantial increase from the 8 who served there before the storm.
Dr. Ronald Amedee, dean of graduate medical education at Tulane, said that before the storm, the school had 46 fully accredited programs and 521 residents and fellows in the city. With the evacuation and closures, most were transferred elsewhere.