Some have not given up on Charity. Last year, the state legislature approved a study to see if the first three floors could be refurbished while a new medical campus is put together.
EDs Feel Ripple Effect
Two years ago, the now-shuttered Charity Hospital ED received 120,000 to 200,000 visits annually. Fewer people are in the city now, but more are sicker or in need of basic care, said Dr. Jim Aiken of the emergency medicine department at LSU, in an interview. “We do a lot of renewing prescriptions and checking blood pressures,” and other primary care interventions. The Interim Hospital sees about 3,500 patients a month. Although things have improved in the last year, the ED admits more patients than before the storm. “We struggle every day with surge capacity,” he said.
Diversion is not uncommon, but the hospitals in the area now at least have a new communications module that lets them track online what's happening at other facilities in the area.
Lack of adequate mental health care, combined with poststorm stress and anxiety, is having the biggest impact on the ED, said Dr. Aiken. It is not unusual for the hospital to be holding 15 psychiatric patients at its 31-bed ED, he said.
Charity also housed a crisis intervention unit where the police could take the mentally ill. With that unit gone, those with psychiatric needs have been spread out.
Before Katrina, there were 578 psychiatric and detox beds in and around New Orleans; that number is now at 236, with only a small portion actually in downtown New Orleans, according to Dr. Cerise. The deteriorated mental health system is “probably the most critical health care issue in this state since the storm,” said Dr. Aiken.
Even the LSU system in Baton Rouge has been affected, said Dr. William “Beau” Clark, president of the Louisiana chapter of the American College of Emergency Physicians. Emergency rooms in that city have absorbed some of New Orleans' outflow, including psychiatric patients who end up boarding in Baton Rouge, he said.
Grants Aim to Recruit, Retain Primary Care Help After Katrina
For more information on the program and to download an application, visit
Louisiana and the city of New Orleans are struggling to lure physicians and nurses back to the city, and to convince those who have returned to stay despite many uninsured patients and a patchwork system of care.
In April 2006, the federal government declared the greater New Orleans area a health-professional shortage area, making it eligible for federal grants to retain or recruit health professionals, and gave rise to the Greater New Orleans Health Service Corps.
The Louisiana Department of Health and Hospitals, which oversees the Corps, has received $85 million for recruitment and retention, said Gayla Strahan, of the DHH's Bureau of Primary Care and Rural Health and manager of the Service Corps effort. Half goes for recruitment and half for retention.
When the state applied for federal health shortage funds, in mid-2006, there were 405 primary care physicians and 30 psychiatrists in the region, but just 76 primary care doctors and 6 psychiatrists took Medicaid or uninsured patients. Based on the region's then population (about 700,000) and Medicaid enrollment (about 135,000), the DHH determined there was a need for 48 more primary care physicians, 38 more dentists, 10 more psychiatrists, and 33 other mental health professionals (psychologists, licensed clinical social workers, and marriage and family therapists).
The goal is to retain 50 primary care physicians and recruit 48 more by September 2009, when the grant cycle ends, she said. For mental health, the goal is 24 retentions and 43 recruits; for dentists, it is 10 and 30, and for faculty, the aim is to keep 48 current positions and bring in 46 more, including 24 at the medical schools.
The Service Corps also earmarked just over $2 million to retain 5 specialists and bring in 15 more. The applicant has to show there is a dire need, for instance, if there's only one cardiologist who agrees to accept Medicaid.
Applicants must accept Medicare, Medicaid, and the uninsured; work at least 32 hours a week in clinical practice; and be licensed in Louisiana or agree to become licensed before starting. Participants, who have a 3-year obligation, can tailor their own package of incentives up to $110,000, which is paid up front as a lump sum. They can use it for salary, to repay loans, for malpractice premiums, and/or to buy health information technology. Mid-level providers are eligible up to $55,000, registered nurses and nurse faculty up to $40,000, and allied health professionals can receive up to $40,000.