New Orleans Health System Recovery Is Slow : Only half of the 3,000 physicians who practiced in the area before the storm had returned by mid-2006.

The city–along with LSU and Tulane–is trying to convince the VA to rebuild on the campus.

Dr. Michael Kaiser, acting chief medical officer of the LSU Health Care Services Division, said at the field hearing that–before Katrina–the VA bought at least $3 million in services from LSU annually. Before Katrina, 75 Tulane physicians had joint VA-Tulane appointments, and 120 Tulane residents received training at the VA, said Dr. Alan Miller, interim senior vice president for health sciences at Tulane, at the hearing.

Currently, 40 Tulane doctors provide services and training at VA outpatient clinics, which represents $2.2 million in physician compensation, he said.

The private Ochsner Health System is vying to have the new VA hospital built across the street from its campus in Jefferson Parish.

At the field hearing, Dr. Patrick J. Quinlan, Ochsner's CEO, noted that the site “is above sea level and not located in a flood plain.”

Because the federal government has not agreed to fund a new campus, Gov. Kathleen Blanco signed an executive order allocating an immediate $74.5 million for land acquisition and planning. To come up with the additional $1.2 billion needed, the state will float a series of bonds.

And some stalwarts have not given up on reopening Charity. Last year, the state legislature approved a study by an independent team of investigators to see if the first three floors could be refurbished while a new medical campus is put together.

EDs Feel Ripple Effect

The lack of inpatient beds and mental health care, and the shortage of primary care sites are felt most acutely in the area's emergency departments.

Two years ago, the now-shuttered Charity Hospital received 120,000 to 200,000 ED visits a year. Granted, there are fewer people in the city now, but there are more now who come in the door sicker or in need of basic care, said Dr. Jim Aiken of the emergency medicine department at LSU.

“We do a lot of renewing prescriptions and checking blood pressures,” and other primary care types of interventions, he said in an interview.

The Interim Hospital sees about 3,500 patients a month. Although things have improved in the last year, the ED is admitting more patients than before the storm, and “we struggle every day with surge capacity,” said Dr. Aiken.

Diversion is not uncommon, but the hospitals in the area now at least have a new communications module that lets them track online what's happening at other facilities in the area.

The lack of adequate mental health care, combined with poststorm stress and anxiety, is having the biggest impact on the ED, said Dr. Aiken. It is not unusual for the hospital to be holding 15 psychiatric patients at its 31-bed ED, he said.

Charity also housed a crisis intervention unit where the police could take the mentally ill. With that unit gone, those with psychiatric needs have been spread out around the city.

Before Katrina, there were 578 psychiatric and detox beds in and around New Orleans; that number is now at 236, with only a small portion of them actually in downtown New Orleans, according to Dr. Cerise.

The deteriorated mental health system is “probably in my mind the most critical health care issue in this state since the storm,” said Dr. Aiken.

Even the LSU system in Baton Rouge has been affected, said Dr. William “Beau” Clark, president of the Louisiana chapter of the American College of Emergency Physicians.

Emergency rooms in that city have absorbed some of New Orleans' outflow, including psychiatric patients who end up boarding in Baton Rouge, he said.

A new medical center is planned on a 37-acre parcel a few blocks from Charity Hospital, said Mayor C. Ray Nagin. Jay Westcott/Elsevier Global Medical News

Grants Offered for Primary Care Help

The state of Louisiana and city of New Orleans are struggling to lure physicians–especially primary care doctors–dentists, mental health professionals, and nurses back to the city or at least to convince those who did come back to stay in the face of a new and bigger onslaught of uninsured patients and a patchwork system of care.

After Katrina, thousands of residents, many of them doctors and nurses, evacuated. A recent study, citing Louisiana State Board of Medical Examiners data, reported that the number of board-certified primary care physicians in New Orleans dropped from 2,645 in August 2005 to 1,913 in July 2006 (Disaster Med. Public Health Preparedness 2007;1:21-6).

In April 2006, the federal government declared the greater New Orleans area–encompassing Orleans, Jefferson, Plaquemines, and St. Bernard parishes–a health-professional shortage area.