Two years after Hurricane Katrina, the relatively few open health care facilities and diminished corps of physicians in New Orleans are struggling to serve the needs of a smaller, but just as needy, population. It's a picture that's changed little since this time last year.
Emergency rooms, in particular, bear 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). 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 roughly 3,000 physicians in the area before the storm have returned. In mid-2006, according to Blue Cross and Blue Shield, only half were back. The Louisiana State Board of Medical Examiners said from August 2005 to July 2006, the number of primary care physicians declined from 2,645 to 1,913.
The lack of access has hit hard. An analysis of death notices in the Times-Picayune by Dr. Kevin U. Stephens, Sr., director of the city health department, and associates, showed a 47% mortality increase in the first half of 2006—to 91/100,000, versus 62/100,000 in 2002-2004 (Disaster Med. Public Health Preparedness 2007;1:15-20). The authors studied death notices because of vast gaps in state and city data.
Primary Clinics to Be Medical Homes
In an interview, Dr. Frederick P. Cerise, secretary of the Louisiana Department of Health and Hospitals, said 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 next 3 years as part of a $161 million allocation aimed at improving health care in the area.
The clinics are eagerly awaiting that money, said Dr. Karen DeSalvo, executive director of Tulane University Community Health Center at Covenant House, in an interview. The money will give “a chance to expand upon what's been developing—multiple neighborhood clinics that are turning into medical homes,” said Dr. DeSalvo, also chief of general internal medicine and geriatrics at the university and special assistant to its president for health policy. Dr. DeSalvo that though primary care is improving (the 18 clinics see about 900 patients daily), too many still seek routine care in EDs. “We're trying to find those patients in the ER and get them into our system.”
Inpatient Capacity Still Down
Currently, in New Orleans proper, five hospitals are open; and five more are 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 recently added a 20-bed detox unit (only 5 were staffed at press time), and is in the midst of adding 33 inpatient mental health beds elsewhere in the city, plus 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 parcel that the city 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 campus would include 30 public, private, and nonprofit organizations. The state has put aside $38 million for a cancer research institute at the site. The city—along with LSU and Tulane—is trying to convince the VA to rebuild on the campus.
Before Katrina, 75 Tulane physicians had joint VA-Tulane appointments, and 120 Tulane residents received training at the VA, said Dr. Alan Miller, interim senior vice president for health sciences at Tulane, at the hearing. Currently, 40 Tulane doctors provide services and training at VA outpatient clinics, which represents $2.2 million in physician compensation, he said.
The private Ochsner Health System is vying to have the new VA hospital built across the street from its Jefferson Parish campus. At the hearing, Dr. Patrick J. Quinlan, Ochsner's CEO, noted the site “is above sea level and not located in a flood plain.” In the end, however, the VA decided to stay in downtown New Orleans. It has not decided yet whether it will rebuild on the existing shuttered 34-acre site or join together with Charity and University on a new parcel of land. Because the federal government has not agreed to fund a new campus for Charity and University, Gov. Kathleen Blanco signed an executive order allocating an immediate $74.5 million for land acquisition and planning. To come up with the additional $1.2 billion needed, the state will issue a series of bonds.