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New Orleans Health Care System Still Recovering

April 24, 2007 at 12:00 AM EDT
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SUSAN DENTZER, NewsHour Health Correspondent: Before Hurricane Katrina, the only emergency trauma center in New Orleans was here, at now shuttered Charity Hospital.

INSPECTOR: One of the concerns that we have is that there’s pervasive mold.

SUSAN DENTZER: After the hurricane, the trauma center was moved here to MASH tents inside the city’s convention center. There, emergency Physician Peter Deblieux performed triage.

DR. PETER DEBLIEUX, Dir., LSU Emergency Medicine Services: We’ve had a whole slew of major trauma, including knife wounds to the neck.

SUSAN DENTZER: Two stops later, including a stint in a closed department store downtown, the trauma center is now in new, temporary quarters again. They’re at the city’s old University Hospital, which was also flooded and shuttered after the storm.

DON SMITHBURG, CEO, LSU Health Care Services Division: Well, this is the new trauma center.

SUSAN DENTZER: Just before the trauma center reopened, Don Smithburg, who heads Louisiana State University’s Health Sciences Division, showed us the freshly renovated space.

DON SMITHBURG: We basically were starting from scratch. With the exception of the piers and the foundation and the studs, everything is brand new. And FEMA actually has funded that so that we can provide first-class trauma care.

Struggling to provide a safety net

SUSAN DENTZER: The trauma center's long road from the old Charity Hospital to here at the officially named LSU Interim Hospital exemplifies the long, slow recovery of the greater New Orleans health care system. The recovery has been characterized by a few hard-won improvements like this but has mostly left the overall system in a full-blown state of crisis.

Sean Reilly is a board member of the Louisiana Recovery Authority, which leads post-hurricane planning efforts at the local and state level.

SEAN REILLY, Louisiana Recovery Authority: What we're talking about here is people, American citizens who have lost a safety net. And we are struggling to put it under them anew.

SUSAN DENTZER: No one really knows how many people who need that safety net are living in New Orleans or the metro area. What is known is that six out of 11 acute care hospitals in the city are still closed and fewer than a third of the area's health care professionals have returned in the now 19 months since the hurricane hit.

Dr. Jim Aiken, medical director of LSU's trauma unit, says getting more providers back has been a tough sell.

DR. JIM AIKEN, Director, LSU Trauma Unit: I'm very aware of some of the other problems we have, housing, education, a crime rate that certainly has gotten national attention. These are all issues that we know every practitioner deliberates before he comes back.

Treating uninsured patients

SUSAN DENTZER: Meanwhile, among other New Orleans' residents who are back, thousands are jobless without health insurance and often in need of medical care.

DOCTOR: Have you been feeling weak?

DEBBIE WEBRE, Patient: Not really.

SUSAN DENTZER: That's why the Interim LSU Hospital has been a godsend to Debbie Webre. She ran a dog grooming business but hasn't worked in more than a year. She suffers from a debilitating intestinal condition called Crohn's. It's a costly preexisting condition that has prevented her from being able to buy health insurance.

DEBBIE WEBRE: Crohn's is like having ulcers in your intestines. That's the easiest way to describe it. And they just sometimes will get out of remission, swell up, bust, causes blood.

SUSAN DENTZER: Webre told us that, in a period leading up to Katrina, she had not been experiencing these symptoms, but after the storm, she thinks, stress brought about a reversal.

DEBBIE WEBRE: I had at least five feet of water in my home. The home shifted from the foundation, had to tear it down, and probably all the stress and the not knowing probably added to it.

SUSAN DENTZER: Not knowing...

DEBBIE WEBRE: Not knowing what was going on in the city, what's going on with your home, your business, your friends.

SUSAN DENTZER: To top it off, Webre now carries $65,000 in unpayable debts from her last hospital stay for Crohn's disease. Now she's being treated at no cost to her at the Interim Hospital.

DOCTOR: All right, so here's what we're going to do. We're going to start an I.V. We're going to give you some fluid, because we think you're somewhat dehydrated.

SUSAN DENTZER: Webre's doctor, emergency physician Tracy LeGros, told us that the ranks of uninsured were actually growing in New Orleans, overflowing the E.R. at the Interim Hospital and elsewhere.

DR. TRACY LEGROS, Emergency Services Specialist: It is a full-blown catastrophe. I could not imagine a worse scenario right now in the city. We have the people that never got back on their feet and still don't have health insurance. All of the contract labor that has come in to help us to try rebuild this city, they're young and healthy but they fall off buildings and have construction-type accidents. So the number of people that require our care has just gone through the roof.

SUSAN DENTZER: Before Hurricane Katrina, almost all the city's uninsured were cared for by state-funded Charity Hospital and its network of clinics. But with Charity still closed and likely never to reopen, the area's other private hospitals have had to step in to provide care.

Louisiana Recovery Authority board member Reilly told us the hospitals had incurred large losses from treating thousands of uninsured patients.

SEAN REILLY: They can only do that for so long. Now, the federal government has helped. We've probably been allocated a little over $100 million. And the LRA has helped prioritize that and get it out to the community hospitals.

Federal funding for hospitals

SUSAN DENTZER: Recently, Health and Human Services Secretary Michael Leavitt was in New Orleans to discuss the federal government's latest ideas for covering the uninsured. One key approach would redirect some federal dollars that now go to Louisiana's hospitals to support care of the uninsured. Instead, those funds would be used to enroll 319,000 uninsured adults in private health coverage.

MIKE LEAVITT, Health and Human Services Secretary: If they have insurance, they'll have access to a medical home; they'll have access to preventive care. They wouldn't have the long waits that they currently experience, and we believe that the quality would be better.

SUSAN DENTZER: But Reilly told us state officials estimate the package would fall about $1 billion short over a five-year period and leave several hundred thousand people, many of them seriously ill, without health insurance.

SEAN REILLY: I think there is a disconnect on the resources necessary to make the new model a reality in Louisiana. And I think the American people, if they knew more, and thought deeply about it, they would say, "You know what? I think the federal government ought to do more, and I don't mind my taxpayer dollars going to that problem."

SUSAN DENTZER: But a spokeswoman for Health and Human Services Secretary Leavitt told us more federal money would not be forthcoming, at least from the Bush administration. She said any other remaining uninsured could still be dealt with through other arrangements now under discussion with the state.

SUSAN DENTZER: The other large remaining challenge is replacing Charity Hospital. The latest plan to do that is to build a roughly $900 million medical center. It would be jointly run by LSU and the Veterans Administration, whose local hospital was also severely damaged by the flood.

DON SMITHBURG: We really see the new medical center as a signature project for the recovery of New Orleans. It will be a major university teaching hospital, a major research institution that will continue to fulfill the Charity mission that we have fulfilled for decades.

SUSAN DENTZER: The target date for opening the new facility is 2011. But Smithburg told us the Federal Emergency Management Agency is only now conducting its fourth round of evaluations to determine what it will pay toward the project. State lawmakers, meanwhile, are bickering over the state's share.

Meanwhile, Dr. W is now out of the MASH tents and working in the Interim Hospital's emergency room. We asked him if he thought he'd be around when the new medical center opened and what he'd think on that day.

PETER DEBLIEUX: I'll think to myself, "What a long road." That's what I will think to myself. And I'll think to myself, if we don't have a stronger political voice, this kind of behavior will continue.

SUSAN DENTZER: The new trauma center at the Interim Hospital officially opened just after Mardi Gras.