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Eight Months After Katrina, Care for the Poor and Sick is Difficult to Find

Posted on: Sunday, 14 May 2006, 06:05 CDT

By David Kohn

NEW ORLEANS -- Charity Hospital has taken care of Leo Young for longer than he can remember. When his mother gave birth to him 48 years ago, it was at Charity. When he fell off monkey bars, its doctors put a cast on his broken arm. When he was hit by a car during a rainstorm, they repaired his shattered leg.

"Some people have a personal doctor - Charity was my personal doctor," says Young, a house painter who has never had health insurance.

But the hospital, with its decades-long mission to treat those unable to afford medical care, is no longer an option. Damaged in the flood after Hurricane Katrina, the hospital was closed.

So when Young became seriously ill, he joined thousands of other New Orleans residents struggling to get help from a medical system that remains devastated eight months after the storm.

Among the problems:

-- Only a quarter of the city's doctors have returned since the disaster, and specialists are particularly scarce.

-- More than half of the city's hospitals remain closed. Most of those that have reopened function at greatly reduced capacity as they grapple with the crushing demand for care. The burden is spilling over to suburban hospitals and the few area clinics that have reopened.

-- About 40 percent of the region's residents have no medical insurance, double the pre-Katrina rate. This is largely because tens of thousands of people have lost jobs that included insurance.

-- The federal government has provided relatively little help for rebuilding damaged medical buildings or enticing doctors to stay.

"A lot of people are slipping through the safety net," says Dr. Robert Boucher, a researcher at the Johns Hopkins University Bloomberg School of Public Health, who recently completed a study for the Federal Emergency Management Agency looking at how Katrina has affected health care in the region.

"Charity was the poor people's hospital," Boucher said. "Now these people have no place to go. Here we are ... months after the storm, and these people aren't getting seen."

With thousands facing significant hurdles in getting medical care, "there's no way that some people are not dying" as a result, said Dr. Karen DeSalvo, chief of general internal medicine at the Tulane University School of Medicine. Since the storm, she estimates, heart attack cases have increased about 25 percent, a rise she attributes mostly to patients getting little or no care after early signs of heart trouble.

Although the city's population stands at about 200,000 - compared with almost 500,000 before Katrina - experts agree that medical services are recovering at a slow pace.

The storm and subsequent flooding from levee breaks severely damaged nearly every hospital in New Orleans. Of the city's nine hospitals, five remain closed, and those that are open face a cluster of problems: ruined buildings and equipment, staff shortages and prolonged financial burdens.

Before Katrina, the city's hospitals and clinics had a total of 2,300 beds. There are now fewer than 500, according to a recent report by the U.S. Government Accountability Office.

Outpatient clinics have also suffered. A year ago, 90 clinics were operating in the city, mostly serving low-income patients and those without insurance. Today fewer than a quarter of those are open, many functioning with decreased staff for limited hours.

Compounding the basic infrastructure problems is the shortage of doctors. Only about 1,200 of the 4,500 physicians working in the city before the storm have returned, Boucher says.

"The system is totally disrupted," says Hopkins sociologist Gerry Anderson, who also worked on the FEMA study. "We don't even know where the doctors are. No one knows. If you want to know where your doctor is, you can't find out."

The state and local governments have had to make drastic cutbacks to health services since the storm - New Orleans cut almost three-quarters of its health department staff, while Louisiana State University laid off almost 200 doctors - and they have no money to rebuild the health care system.

Depending on the estimate, Louisiana has received between $10 billion and $30 billion for disaster aid, levee repair and home reconstruction. But relatively little help has arrived for rebuilding the health care system. The U.S. Department of Health and Human Services has given the state $100 million for medical and health programs, and $383 million to reimburse hospitals and doctors for the treatment of uninsured patients.Meanwhile, the area's hospitals continue to be inundated with uninsured patients. John Matessino, chief executive officer of the Louisiana Hospital Association, says the money "will not come close to covering the costs that hospitals and doctors have incurred."

So far, he says, the federal government has provided almost no help for long-term needs, such as repairing buildings and luring doctors back.

"People are talking about all these billions for aid," Matessino says. "There haven't been any billions for health care, I'll tell you that."

A medical void For almost 70 years, the region's poor depended on Charity Hospital. The imposing, 20-story Art Deco structure was built by supporters of populist political boss Huey P. Long, then funded and run by the state.

The flooding after the storm swamped Charity's first floor and basement, and the building was evacuated. State health officials decided to close and rebuild Charity rather than repair it, a process that will likely take five to seven years. Critics say the hospital did not sustain enough damage to be closed, and they accuse the state of using the hurricane as an excuse to leverage federal help to pay for a new facility.

In March, Louisiana converted a vacant downtown department store into an emergency room staffed by Charity doctors. But it treats only a fraction of the patients who received care at Charity.

Officials at Louisiana State, which runs Charity, say the facility was not only obsolete but posed a safety hazard because of flood damage.

"We had to err on the side of caution. It was a risk to reopen," said Rod West, chairman of the Louisiana State University System's Board of Supervisors.

But all agree that the closing left a huge void in the area's medical infrastructure.

"So much was lost with the loss of Charity Hospital," says Dr. Fred Cerise, the secretary of Louisiana's Department Of Health And Hospitals. "Most of what went on there was chronic disease care - hundreds of thousands of clinic visits a year. That's gone."

Even before the hurricane, medical care in New Orleans, and the state, faced serious problems. For years, Louisiana has ranked at or near the bottom in many measures of health care quality and efficiency. But since the hurricane, health care has significantly deteriorated, especially for the poor.

And many, like Leo Young, are confronting a health crisis.

Last fall Young began to feel sick. He was exhausted and had no appetite. With Charity closed, he knew of no place to turn for affordable treatment. Afraid of racking up huge medical bills and unsure of his options, he tried to ignore the symptoms even as they worsened. His long dreadlocks turned gray, and he dropped 100 pounds from his 6-foot, 5-inch frame.

Young endured months of pain and discomfort as he became increasingly ill. Finally, in late March, he could stand it no longer and went to the emergency room at the Tulane University Hospital and Clinic. By law, any patient - insured or not - who goes to an emergency room with a life-threatening problem is entitled to medical care.

Young was diagnosed with a hyperactive thyroid, a condition that can be fatal if untreated. The enlarged gland was pressing against his esophagus; one internist told Young she didn't know how he could swallow.

He is taking medicines to decrease thyroid hormone levels and slow his heart rate; relatives are helping pay for the prescriptions, which cost more than $100 a month. Young has no idea how he will pay for lab tests, which will likely cost thousands of dollars.

He says that he knows others in similar circumstances. "Several of my friends are gonna have enormous bills," he says.

To help bridge the gap, a few small clinics are offering free or inexpensive treatment. Housed in a modest brick building near downtown, St. Thomas Health Clinic has cared for more than 60 poor and uninsured patients daily since Katrina.

"If we're seeing more indigent patients than any other clinic in the city, that's really bad news, because there's a helluva lot more than 60 people who need to be seen who either don't have insurance or don't have a doctor," said Dr. Don Erwin, director of the clinic. A tall, imposing man inclined to candor, Erwin provides a grim assessment of the state of medical care in this city.

Source: The Baltimore Sun, Maryland

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