One Year Later, New Orleans Health Care System Still in Limbo

NEW ORLEANS, Aug. 29 -- A year after Katrina's winds and surging waters destroyed much of this city, New Orleans' health care system is still at sea.

From the standpoint of physicians, nurses, hospitals, and public health, the first anniversary of Katrina's dreadful blow is at best a depressing reminder of how much more must be still done before even a semblance of normality returns.

For tens of thousands of patients -- no one will ever really know how many -- the concept of preventive medicine is a thing of the past. For the relatively few physicians who remain, acute care is often the best they can offer. For major chronic care, this city is no longer a haven.

The storm shut down all but three of the city's major hospitals. Physicians and administrators find themselves still adrift, wondering how best to revive a broken system, wondering where to even start.

They are short on everything except for the apparent inertia of local, state, and federal governments.

Areas of the city that remained largely dry during the hurricane, including the French Quarter and riverfront shops and restaurants familiar to most tourists, are thriving again. Mardi Gras carried on bravely, and the city is anticipating another bit of normality in October, when the American College of Emergency Physicians holds its annual meeting in the restored Ernest N. Morial Convention Center.

But just a stone's throw from Jackson Square, where President George W. Bush stood before the camera lights and promised to restore this blighted city, whole neighborhoods of houses destroyed or rendered uninhabitable in the Katrina flood remain empty, signs of lives upended, dreams deferred, hopes crushed.

"In New Orleans East where we practiced since 1970, it's like a wasteland out there," said Donald Palmisano, M.D., J.D., a clinical professor of surgery and clinical professor of medical jurisprudence at Tulane University School of Medicine.

"The flood went right through these homes, and even if you see an office building standing, there's no phone service there," he added. "If some crazy evil terrorist came and blew the levees tomorrow, I'm not sure that we're any better off than we were a year ago in communications."

A doctor who rode out the storm by running improvised clinics first in hotels and later in the hellish conditions of the convention center, agreed that the contrast is stark.

"When you're talking about the area known affectionately as 'the sliver by the river,' the area that didn't get flooded because it's on the highest ground, it's very easy to lull yourself into the sense of getting back to normal, because commerce is happening here, and so much of the commerce has now been concentrated," said Greg Henderson, M.D., director of anatomical pathology at the Ochsner Clinic in New Orleans.

"But all you have to do is cross five blocks beyond St. Charles Avenue and its like leaving the Green Zone -- it's just a disaster area, and it's very disheartening," Dr. Henderson said.

He likens health care in New Orleans today to a patient who barely survived a catastrophic accident: "The patient is now alive in the ICU on life support, but things sure as hell aren't much better yet, and unless there's someone who can come in and take some steps to help the patient get better, it's going to slowly die," he added.

Last August, Dr. Henderson, a New Orleans native who had just returned to the city after a 20-year hiatus, spent 11 days ministering to the needs of people left behind in Katrina's wake, first in makeshift clinics (supplied by raids on local pharmacies) in the Ritz-Carlton and Sheraton hotels, and later in the Convention Center, where he was the only doctor available to the estimated 15,000 people gathered there.

Although a pathologist by training and long unaccustomed to hands-on care of live patients, Dr. Henderson made the best of what he had to offer, aided by a police officer and a volunteer amateur medical corps.

They hung on there for three grueling days until the cavalry arrived, in the form of supplies and volunteers trucked in from around the country in response to an e-mail sent by Dr. Henderson from the Ritz-Carlton in the moments before it lost power.

The images and sounds of the chaos, despair, and squalor at the convention center and Louisiana Superdome, and the heartbreaking helicopter shots of people stranded on rooftops or wading neck-deep through foul waters, burned themselves into the memories of people around the world.

The scenes were emblematic of the failure of systems at all levels, and for the New Orleans medical community in particular they served as painful reminders of a fragmented, inequitable system of care.

Then

On Sunday, Aug. 28, 2005, while most of New Orleans headed for high ground as Hurricane Katrina roared toward this city, the staff at Tulane University Hospital, anticipating flooding, also moved the emergency department to higher ground -- the second floor. Not enough. Not nearly enough.

By day's end Tuesday, Aug. 30, the 1,000-bed hospital was evacuating all patients and staffers. "Everyone," said hospital vice-president Karen Troyer-Carawy.

A 200-foot long breach in the 17th Street Canal levee near Lake Pontchartrain sent water pouring onto the streets, spilling miles in all directions, inundating at least 80% of the city, and causing water at the hospital on Tulane Avenue to rise at least as high as the top of the first story.

Some of the infants in the neonatal intensive care unit were transferred to Lafayette Women's Hospital in Lafayette, La. Other patients were transported to hospitals in Alexandria, La., Houston, Pensacola, Fla., and Nashville.

The 424-bed Charity Hospital, the city's main trauma center, also on Tulane Avenue, and the nearby Memorial Medical Center (339 beds) on Napoleon Avenue, were also drowning.

At Memorial, hospital staff, patients, and families waited for rescue that was far too long in coming. Three days after Katrina had passed over the city, more than 1,000 people remained trapped in the stifling confines of the hospital. And when privately arranged help finally did arrive, patients on stretchers were carried down multiple flights of stairs and passed through a hole punched into a wall to await evacuation from a helipad on the roof of a hospital garage.

Louisiana Attorney General Charles Foti has alleged that during the tumultuous events, a Memorial staff physician and two nurses used a combination of morphine and Versed to euthanize critically ill patients in a privately operated ICU within the hospital.

Katrina also shuttered the 350 bed Methodist Hospital in New Orleans, and the 138 bed Chalmette Medical Center in Chalmette, St. Bernard Parish, a few miles east of the French Quarter.

Several miles west of downtown New Orleans, in Jefferson Paris, the storm took out River Oaks Hospital, a 126-bed psychiatric facility. Nearby, at the Ochsner Clinic Foundation on Jefferson Highway, many of the phone lines were down, the hospital was running on emergency power, and pieces of the roof were lying scattered on the ground. But for the most part, the hospital was spared the brunt of the storm, said Warner Thomas, president and chief operating officer.

Now

Only three acute-care hospitals in the area -- Ochsner, East Jefferson General Hospital in Metairie (443 beds), and the West Jefferson Medical Center in Marreo (350 beds) -- have never closed since the storm, according to the Louisiana Hospital Association.

In downtown New Orleans, Children's Hospital, the Touro Infirmary, and Tulane Infirmary are operational, as are six other psychiatric, rehabilitation or long-term care facilities.

"Touro Infirmary was the only hospital that was not significantly affected by the storm," said Jay Shames, M.D., a pulmonologist with a practice at Touro. "I guess we were closed for about a month, and are functioning at a pretty high level. There are a lot of physicians at Touro now who lost their practices in another part of town."

The 354-bed Veterans Affairs Medical Center, which serves veterans from 23 surrounding parishes is currently offering outpatient services again, but New Orleans veterans who need inpatient care have to travel to Pineville, La., Arkansas, Mississippi or Texas to find it.

In Jefferson Parish, Louisiana State University, which had set up an improvised emergency room in the Convention Center, is now running its trauma center, with 40 critical care beds, out of the Elmwood Hospital, which LSU is leasing from the Ochsner Clinic Foundation.

Tulane's medical school, which shifted operations to Baylor College of Medicine in Houston, reopened in July, and Louisiana State University Health Sciences Center is up and running again as well. LSU is running a combined emergency department and dental clinic in the former Lord & Taylor department store near the Superdome, and the state-run University Hospital is slated to reopen in November.

But there are still no acute care hospitals open in nearby St. Bernard or Plaquemine parishes.

Help Wanted

In addition to slicing the number of hospital beds to about a third of what is currently needed, Katrina also leveled the homes of thousands of doctors, nurses, technicians, orderlies, housekeepers, kitchen workers, physical plant operators, and others who keep a modern hospital alive and breathing.

"A shortage of nursers and support personnel is head-and-shoulders our worst problem," said Normam McSwain, M.D., professor of surgery at Tulane. "There's no place for them to live."

Medical personnel are caught in a Catch-22, Dr. Palmisano said. Some have started new lives in other cities, while others, who want to return and rebuild their homes, aren't sure whether they'll be able to.

"They can't get insurance," he said "and meanwhile, other states are saying 'Hey, we need an emergency room physician, we need a cardiac surgeon,' and so they're moving out. Some well known doctors are just moving to other states and they're not coming back."

Related Katrina Coverage:

• New Orleans Now -- Few Doctors in the HouseA Multimedia Special Report
  This special report from Zach Wise, a MedPageToday contributing photographer, presents the sights and sounds of New Orleans medicine a year after Hurricane Katrina.