New Orleans Hospitals in Serious Condition, 11 Months Post-Katrina
You go to the drugstore to refill a prescription and learn the doctor's left town. You spend an extra week in pain because disk surgery isn't an emergency. You're admitted to a hospital, but the rooms are full, so you spend days in ER.
That's what it's like in New Orleans today if you need health care. The system is in serious condition, 11 months after Hurricane Katrina.
And it could get worse.
Within the next two to three months, "all the hospitals" will be considering cutting services, said Dr. Mark Peters, board chairman of the Metropolitan Hospital Council of New Orleans.
The medical community also suffered a blow last week when a doctor and two nurses were arrested on suspicion of murder, accused of giving four patients - stranded in the hideous conditions at flooded Memorial Medical Center - lethal doses of morphine and a sedative.
Since the chaotic days after the storm and the subsequent flooding, hundreds of doctors have fled the city, says Gery Barry, chief executive for Blue Cross and Blue Shield of Louisiana, one of the state's largest insurers.
"About three-quarters of the physicians who'd been practicing in the New Orleans area are no longer submitting claims to us," he said.
Some doctors returned, but like the neurologist treating Janette Trembus for Parkinson's disease, chose not to stay. Trembus's daughter, Marci Kraus, learned the doctor had left when she tried to refill a prescription in March. In the end, her mother's primary care doctor provided a temporary refill and helped find a new neurologist.
Two months later, a letter arrived saying the neurologist had moved to Florida.
Susan Dantoni, president of the Orleans Parish Medical Society, thinks the Blue Cross estimate overstates the situation. It may omit doctors who take Medicaid patients, not to mention those working at free clinics, she said. Dantoni believes at least half the area's 2,300 doctors are back.
That might seem enough because New Orleans has fewer than half the residents it had before the storm. The current estimate is roughly 220,000.
"The problem is, it's not a good mix. You may be back in Orleans Parish, but your doctor may not be," said Jack Finn, president of the hospital council.
In the four worst-hit parishes, 2 out of 5 hospital beds are out of circulation; in New Orleans itself, it's 2 out of 3.
Susan Seip's eye surgeon was back, but the laser needed to clear the milky haze from her vision was destroyed in the floods at Memorial Medical Center, which is still closed. Her doctor referred her to another ophthalmologist, whose laser was safe but in storage. She finally found another doctor with an accessible laser.
"I waited probably three months to have my procedure done," she said. "When I did get it done, it was 30 seconds an eye."
Any doctor who's back may be much farther away.
John Burr, who had a bone marrow transplant a few days before Katrina, now drives about 40 miles across Lake Pontchartrain instead of a few miles across town to see his doctor at Tulane Cancer Center. Not that he's complaining - he's delighted the office is that close, organized. "Seeing what we had been through, I was extremely impressed," he said.
Another problem: For whatever reason, more people are waiting to see a doctor until they can't wait any longer. Then they hit the emergency room. Like ERs everywhere, those in and around New Orleans were overloaded even before the storm. Now it's worse.
"The patients we're seeing are very sick," said Becky Gab, operations director for the emergency department at Tulane University Hospital and Clinic. About half the people who come to the hospital's ER end up admitted, up from 15 to 30 percent before the storm, she said.
"Before the storm, diabetics would come in with high blood sugars," said Brent Becnel, at the Touro ER. They were easily and quickly treatable. Now, when they come in, they're in much worse shape, needing ICU treatment to prevent a diabetic coma.
There's a shortage of paramedics and emergency medical technicians too. It's made worse when drivers wait hours for doctors to get to patients who aren't emergency cases but are too sick to be left in a waiting room.
The ambulance shortage is aggravated by a shortage of psychiatric beds. Only 80 remain of the 450 before the storm, said Dr. Jeffrey Rouse, a deputy psychiatric coroner who decides whether someone should be committed to a psychiatric hospital.
"We are now New York without Bellevue; Washington, D.C., without Saint Elizabeths, North Carolina without John Umstead," he said.
Acadian Ambulance officials say they take 8 to 13 psychiatric patients a week to a hospital four hours away.
Touro Infirmary's emergency room is seeing more than 25 psychiatric patients a week. Before the storm, it took about 16 hours to find a psychiatric bed in New Orleans. Now it's averaging two days, Becnel said. "We've had as many as six medically cleared patients waiting for psychiatric inpatient beds" in the ER, he said.
They're not the only people waiting a long time in ER. It happened to Leona Root, 81, who cracked a vertebra in a fall. It left her unable to move without pain.
The ambulance crew called the hospital, recalls her son, Richard Root. "They said, 'Oh, you're lucky. There's a room available.'"
But as morning stretched on to late afternoon and his mother was still on a gurney, Root asked when the room might be ready. "They said, 'Oh, well, it might be a day,'" Root said. It was two.
The shortage of doctors, nurses and even janitors, has wiped out many nursing homes and nearly eliminated other first steps out of the hospital: long-term acute care hospitals, rehabilitation centers and home health care.
"Those things just don't exist right now," said John Matessino, president and chief executive of the Louisiana Hospital Association.
"New Orleans is not an easy place to recruit health care professionals right now," he said. "There's nowhere for them to live. You can't recruit people to live in a FEMA trailer."
East Jefferson General Hospital, which is fully open, had to close two operating rooms. That means, for instance, that a neurosurgeon has trouble scheduling surgery for a patient with severe back pain.
On the one hand, the pain is not life-threatening," said Peters, the hospital council chairman and East Jefferson's CEO. "I don't say that cynically. They weren't going to die from the pain. On the other hand, that's miserable."
It's just as hard to find nonprofessionals such as nursing assistants, janitors, housekeepers and cooks in a city where signs in front of every Burger King offer up to $10 an hour. Hospitals are paying more than they did before the storm, but it's still hard to compete.
The bigger paychecks and longer stays are contributing to a money hemorrhage.
"Since the storm, everybody's losing money - anywhere between maybe a million dollars a month to about $9 million a month," said Finn of the Metropolitan Hospital Council.
Here's why: Medicare payments to hospitals are fixed, based on an average length of stay for a given condition or operation. The hospitals pay for every extra day.
They're also treating far more indigent and uninsured patients. The two state hospitals that had provided the bulk of care for such patients remain shuttered, and the federal money for their care has gone to other charity hospitals. And, though many of the area's poor have not returned, thousands of migrant workers have shown up for roof work and other rebuilding jobs.
"We at East Jeff have had our uninsured population triple, going from 3 percent to 9 percent," Peters said. The state has found a way to get some payment for their care, but it doesn't cover all the cost, he said.
U.S. Health and Human Services Secretary Mike Leavitt and other federal, state, hospital and health care groups have signed a plan for redesigning the state's health care. It sets goals for personal responsibility and accessible preventive care.
"There's been a lot of talk about redesigning the health care system, and certainly throughout the country and especially in Louisiana there's great room for improvement," Peters said.
He said all hospitals want to participate but added: "It's a whole lot easier to plan for the future if you don't have to worry about, 'Will you live till tomorrow?' That's been the missing link."
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On the Net:
General health care info: https://www.noladashboard.org/
Hospital stats: https://www.dhh.louisiana.gov/offices/page.asp?id112&detail5218
Metropolitan Hospital Council of New Orleans: https://www.sharecor.com/metro/
