Thursday, April 13, 2006
The New England Journal of Medicine has a great article on post-Katrina health care in New Orleans. The article is entitled, "After the Storm - Health Care Infrastructure in Post-Katrina New Orleans, authored by Ruth E. Berggren, M.D., and Tyler J. Curiel, M.D., M.P.H. Here is a brief excerpt:
Although many citizens have yet to return, area hospitals are scrambling to meet local needs. The population of metropolitan New Orleans is approximately 24 percent smaller than before the hurricane, but only 15 of 22 area hospitals are open, with 2000 of the usual 4400 beds. According to data from the Times-Picayune, before the storm, New Orleans had only 3.03 hospital beds per 1000 population, as compared with the average of 3.26 per 1000 for U.S. cities; today, there are 1.99 per 1000. "The number one current problem is total hospital capacity," says Joseph Uddo, chief of general surgery at East Jefferson General Hospital in neighboring Jefferson Parish. "Emergency department patients can't move into the hospital because beds aren't available. We have no surge capacity."
Moreover, open hospitals must deliver ever greater amounts of uncompensated health care. Patrick Quinlan, chief executive officer (CEO) of the Ochsner Clinic Foundation, says uncompensated care in his facility has tripled since Katrina. "Many people have lost their jobs, and we have throngs of transient workers in town without health insurance," reports Les Hirsch, CEO of Touro Infirmary. Reimbursement for uncompensated care has yet to come, and, Hirsch notes, there is "a huge debate regarding how best to have uncompensated care dollars follow the patients, rather than following the hospitals."
Common themes at all facilities include complications in patients with untreated chronic diseases, particularly hypertension, diabetes, and AIDS (see box). "These people come in with extremely severe problems," notes Alfred Abaunza, chief medical officer of West Jefferson Medical Center. "Diabetics have been off their insulin for six months. They come to us in diabetic ketoacidosis."
Many believe that mortality has also increased substantially, although specifics are difficult to obtain — the Louisiana Department of Health is still struggling to complete the compilation of 2005 data. As a crude indicator, there were 25 percent more death notices in the Times-Picayune in January 2006 than there were in January 2005. Stress exacerbating underlying health problems is blamed for some deaths. Post-traumatic stress disorder and suicide remain tangible public health issues. There are insufficient numbers of mental health facilities and care providers to deal with the crisis.
The entire article is an eye-opening read into the many issues that face the medical community in New Orleans. It is available free at the NEJM website and there is an additional audio file containing an interview with the authors here. Thanks to JIm Tomasewski for the heads up on this website. [bm]