City full of patients, devoid of doctors

Eight months after Katrina, care for the poor and sick is difficult to find

Katrina's Aftermath / New Orleans

May 14, 2006|By DAVID KOHN | DAVID KOHN,SUN REPORTER

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."

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