New Orleans Health Care System Struggles to Rebuild
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SUSAN DENTZER: This could be a MASH unit from a remote battlefield. But in reality this is urgent health care as it looks now in New Orleans. Operating in tents in the New Orleans Convention Center, doctors and nurses from the city’s shuttered Charity Hospital care for patients like LaVernia Black.
HEALTH CARE WORKER: Do the headaches come first before you black out or you black out and then you develop the headaches?
PATIENT: The headaches first and then I pass out.
SUSAN DENTZER: Dr. Peter DeBlieux directs the effort.
DR. PETER DEBLIEUX: What did we see last month — seven heart attacks, three strokes and two pregnant patients. And we’ve had a whole slew of major trauma, including knife wounds to the neck, and we simply put ourselves up in a convention center, almost no signage, and already last month we saw 4,700 people within these facilities.
HEALTH CARE WORKER: Turn your chin against my hand.
SUSAN DENTZER: But for obvious reasons, care delivered in tents can’t be all that sophisticated. Black, who doctors feared had heart trouble and bleeding in her brain, had to be transported to a fully equipped hospital outside of New Orleans.
DR. PETER DEBLIEUX (examining patient): Let me give a listen to your lungs, okay?
SUSAN DENTZER: DeBlieux and his colleagues are dismayed by the compromised state of care.
DR. PETER DEBLIEUX: The message has to be that it’s inadequate. It’s not appropriate. We are caring for patients in a tent. It’s understandable a month out — might be understandable two to three months out. And here it is six months operating within a tent system to deliver care to our patients. They deserve appropriate health care: Not health care within tents; not health care within a fragmented, broken system.
SUSAN DENTZER: This is the reason for those tents at the convention center: The mostly empty carcass of Charity Hospital.
DON SMITHBURG: All of what we’re about to walk through was just about completely under water.
SUSAN DENTZER: Closed since the post-Katrina flooding, it’s unlikely to open ever again.
DON SMITHBURG: One of the concerns that we have is that there’s pervasive mold.
SUSAN DENTZER: Don Smithburg recently showed us the basement which flooded after the storm. Smithburg heads Louisiana State University’s Health Sciences Division which oversees Charity.
DON SMITHBURG: We had really a huge heat wave after the hurricanes and the floods. So the mold just was spawned throughout the building in ducts that go up 21 stories.
SUSAN DENTZER: Until four days after Katrina hit New Orleans when many patients had to be evacuated from the roof by helicopter, Charity was the second oldest continuously operating hospital in the U.S. Both the hospital and a network of 16 clinics, it was New Orleans’ main source of health care for uninsured patients, caring for 90 percent of the city’s indigent.
DON SMITHBURG: This is where so much of the serious trauma took place and was cared for and treated.
SUSAN DENTZER: For years Charity also had the city’s only top or so-called level-one trauma center for treating severely injured patients.
DON SMITHBURG: To have a level-one trauma center means that you have around-the-clock, living in the building trauma surgeons, general surgeons, plastic surgeons, oral, maxillofacial surgeons, orthopedic surgeons as well as radiologists and neurosurgeons among others who are available at a moment’s notice.
SUSAN DENTZER: Dr. DeBlieux says the loss of the trauma center has huge consequences.
DR. PETER DEBLIEUX: Pre-Katrina level-one trauma center at charity hospital, you get in a car accident, you’re involved in a major fall, you have a stab wound or a gunshot wound, we have the capacity to have you in an operating room within minutes.
Flip side. That’s now shut down. Should any of those things befall you and you need a level-one trauma center, you’re going to a local area hospital that, if everything goes smoothly, you’re in an operating room in 60 minutes. It might be 90 minutes or 120 minutes. The difference in whether I get you to an operating room in ten minutes versus 120 minutes are a number of lives saved — huge impact.
SUSAN DENTZER: Even before Katrina, plans were in the works to replace Charity’s nearly 70-year-old buildings with a brand new structure at a cost of around $600 million.
SPOKESMAN: You can see all these mechanical systems here that are just obviously they’ve failed.
SUSAN DENTZER: Now the damaged buildings are the subject of a dispute between the LSU Health System and the Federal Emergency Management Agency, or FEMA.
SPOKESMAN: Again this was all completely underwater.
SUSAN DENTZER: LSU says its consulting engineers have estimated that restoring the hospital to pre-Katrina condition could cost at least $250 million. It wants to collect that much from FEMA, then use the proceeds toward building a modern new hospital.
SPOKESMAN: You can see how compromised the building is and how it’s caving in here.
SUSAN DENTZER: But FEMA’s offered $23 million, which FEMA’s outside engineering firm says will cover flood damage to the basement. FEMA says that’s all it can offer by law.
SPOKESMAN: How we could ever repair these systems, these 1938-39 systems with modern-day systems in this building is beyond us.
SUSAN DENTZER: As discussions with FEMA drag on, locals have even taken to raising pointed questions about Charity’s future as in this sign from a recent Mardi Gras parade.
HEALTH CARE WORKER: — having chest pain?
SUSAN DENTZER: Meanwhile what’s left of the health care system has little choice but to cope.
HEALTH CARE WORKER: Did he give him something for his pain. He was complaining of pain.
SUSAN DENTZER: Of 16 hospitals in the metropolitan area before Katrina, fewer than half are now open.
HEALTH CARE WORKER: I’m going to listen to your heart and lungs for a while.
SUSAN DENTZER: Brent Becnel is an emergency room nurse in New Orleans. It’s one of just three hospitals now open within the city limits.
BRENT BECNEL: At times it’s very, very scary to not know what’s going to come through the door because historically since Charity was open, all of your bad, bad injuries and your medical — just bad injuries, gunshot wounds, stabbings, things of that sort all went to Charity. Now they’re coming to you.
SUSAN DENTZER: What’s more, with only a third of the doctors who were here before Katrina, now back in the area, many patients are getting at best sporadic care.
HEALTH CARE WORKER: What do you think delayed your treatment? What was the cause of maybe you not going to see a doctor before?
PATIENT: I looked for them. You can’t find them. There weren’t any available.
SUSAN DENTZER: Herman Darby is typical. He has diabetes and recently sought care in Touro’s emergency room. The post Katrina flooding destroyed his home and along with it the special support shoes he wears.
HERMAN DARBY: All that was washed away so I went and bought a cheap pair of shoes that was too tight.
SUSAN DENTZER: Touro doctors determined Darby’s tight shoes caused a corn which became infected and resulted in gang green.
HEALTH CARE WORKER: So it’s your pinky toe on your left foot.
SUSAN DENTZER: At least one of his toes would have to be amputated.
HEALTH CARE WORKER: We’re going to keep you in the hospital. Let us know if you see any drainage or anything from your foot that is abnormal for you.
SUSAN DENTZER: New Orleans’ broken health care system clearly has to be rebuilt but the question is how. No one wants what was here before in Louisiana — probably the highest cost, lowest quality health system in the country.
The goal now is a much more efficient system that focuses on keeping people healthy. And that’s a tall order.
Dr. Fred Cerise is the secretary of Louisiana’s State Department of Health and Hospitals.
DR. FRED CERISE: We tend to pay for episodes of sickness no to maintain wellness. So I think as you look at rebuilding in the city, there will be a large effort at stepping back and thinking, okay, what do we want this to look like five years, ten years from now?
DR. KAREN DE SALVO: This is what we’ve cobbled together in one of the examining rooms in the clinic.