Medical considerations thrown into disarray

Katrina's Wake

September 18, 2005|By Julie Bell and Matthew Hay Brown | Julie Bell and Matthew Hay Brown,SUN STAFF

The hurricane that scattered patients and their doctors in the Gulf Coast, leaving both homeless and up to thousands of miles apart, also has left them in medical limbo.

Evacuated diabetics hunt down insulin in their adopted hometowns. Cancer patients fret about where to go to continue the care that might save their lives. Physicians wonder if they should even think about returning to damaged homes and destroyed clinics when their patients are gone.

And people scheduled for surgery at now-closed New Orleans hospitals search for others to perform operations that in some cases are desperately needed.

Myrtis Bannister was supposed to have had bypass surgery at a hospital in New Orleans on Thursday. The day found the 64-year-old eating lunch with her two daughters at a Houston shelter instead.

"I'm going to have to find a doctor to do it because I could have a heart attack and die," she said.

Three weeks after Hurricane Katrina hit, only three of the New Orleans area's 20 hospitals are open. The government has turned a fourth, Kindred Hospital, into an emergency medicine triage area and a place for federal, state and local officials to plan their next steps.

Experts there are discussing where to open public and community health clinics, how to help hospitals pay dispersed employees so they won't quit before patients return, and when to let residents move back.

"If you wait too long, not only will providers not be back, their patients won't be back," Dr. Jimmy Guidry, Louisiana's state health officer, said about keeping New Orleans residents out.

Meanwhile, on the Gulf Coast and in the hundreds of places to which evacuees have moved, officials, patients and doctors improvise, coping the best they can with health care interrupted.

William Gomila, a Laplace, La., pharmacist faced with a Katrina-inspired shortage of drugs for his elderly customers, avoided the law enforcement roadblocks that had halted his store's deliveries by taking back roads to meet a supplier.

Dr. Donald J. Palmisano, a former American Medical Association president who has lived in three places in Baton Rouge since the hurricane shut down his New Orleans East surgery practice, busied himself ordering BlackBerry pagers and walkie-talkies. He plans to deliver them to doctors where phone service is down.

And in Jefferson Parish, La., Dr. Elizabeth "Lisa" Fronc, a University of Maryland assistant professor of pediatrics who usually works at Baltimore Washington Medical Center in Glen Burnie, led a volunteer team of doctors, nurses, pharmacists and technicians running a community health clinic whose regular staff has been displaced by the storm.

Institutions are improvising, as well. The National Institutes of Health, for example, is running a consultation hot line that Katrina-affected patients and physicians can call for expert medical advice. Among the dozens it has helped: a Louisiana teenager with cystic fibrosis whose lung transplant had been scheduled in New Orleans. He is being helped by doctors in Houston.

Despite such efforts, experts acknowledge that interrupted care has likely led to injuries and deaths - and might lead to more - never to be recorded in any official count.

"I think there were probably some deaths," said Dr. Thomas Kirsch, a Johns Hopkins University assistant professor of emergency medicine who led an American Red Cross team of physicians into Louisiana after the storm. "They came sweeping out of the disaster with none of their medications and little understanding of what they were taking."

In Houston, shelter doctors saw arriving patients who needed dialysis immediately, whose blood pressures were dangerously high or who were moving into diabetic shock. In at least one case, a woman had nearly lapsed into a coma.

Isaac Polk Jr., 67, a retired New Orleans truck driver who has diabetes, said that by the time he arrived in Houston, he was shaking and sweating.

"That tells me when I need them," he said of the unspecified pills he takes. He was able to get more medicine at the Reliant Arena's shelter clinic, and he is now staying in a section of the shelter reserved for elderly and special-needs patients.

Such destabilizing episodes can have negative, long-term consequences, physicians say. Even some patients in the shelter say they aren't getting what they need.

Joan Maker, 50, an evacuee who has cerebral palsy, asthma and arthritis, is staying in Houston's Reliant shelter after leaving her flooded New Orleans home. There, she lives in the section for evacuees who are elderly and who have special needs.

"They told me I'm doing pretty good," she said. But she said she had yet to get the inhaler she had requested.

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