On Life Support
New Orleans's against-the-odds struggle to care for the infirm
NEW ORLEANS--Peter DeBlieux always pictured himself working in a tent one day. It just "wasn't in this country." A veteran emergency-room physician, DeBlieux is inside a tent pitched in an abandoned Lord & Taylor store just a few blocks from where he once ran one of the busiest ERs in the United States. That would be New Orleans's Charity Hospital, but, thanks to Hurricane Katrina, DeBlieux can't go back there. The flood that followed Katrina knocked out Charity's electricity and water. Patients and staff spent five grueling days trapped in the hospital in 100-degree heat, rationing drinking water, and hand-squeezing "ambu" bags to keep ventilator patients alive.
That was the easy part, some now say. Seven months later, New Orleans's healthcare system is floundering, and the fact that the city's once biggest hospital exists in a 30-bed tent is just one of the most obvious symptoms. When Charity started offering emergency care in a military tent on the convention center parking lot last September, DeBlieux thought he'd be practicing medicine this way for a month, tops. "Seven months out? It's not OK," he says. "This is the United States of America. This is not a Third World country."
Before the storm, greater New Orleans had 16 acute-care hospitals. Now there are nine, with just 2,000 of the 4,000 beds the city used to have. A year ago, there were about 63 nursing homes. Today, there are 34. Ninety clinics provided safety-net care; now there are 19. No one knows how many doctors and nurses remain in the Crescent City; thousands fled because their houses were ruined or their children's schools closed. Charity had the region's only Level 1 trauma center; the closest now is in Shreveport, 350 miles away. "Healthcare here remains unacceptably primitive," two New Orleans physicians wrote in last week's New England Journal of Medicine. "Without rapid, coordinated, and effective help from government agencies, we fear that disproportionate human suffering and death will continue to plague greater New Orleans."
The Big Easy, in fact, is trapped in a cruel vise. While the number of institutions offering medical care has shrunk drastically, the number of people seeking help has not. There are now about 1 million people in the New Orleans area, compared with 1.3 million before Katrina, and more arrive every day. Some are residents returning home. Others are workers drawn by high pay for reconstruction work. The nine hospitals are swamped. "We're jammed to the gills, our census is higher than it was prior to the storm, and we've had to open more beds with many fewer RNs and support services," says Nancy Davis, chief nursing officer for the Ochsner Health System, one of three hospitals in New Orleans that stayed open through Katrina. ER visits at Ochsner are up 60 percent, and the hospital is delivering twice as many babies as it did a year ago.
In the perverse logic of this disaster, hospitals like Ochsner that are making heroic efforts to tend to the sick and injured are losing millions of dollars a month. Some of that is because uninsured patients who formerly went to Charity now go to Ochsner and the few other hospitals still open. Before the storm, just 3 percent of these hospitals' patients had no insurance (half the national average of 6 percent). Now they are seeing 9, 12, or 20 percent uninsured. The number of patients with private health insurance, the cash cow for hospitals, has dropped, since many people have lost their jobs. At the same time, patients are staying in hospitals longer because there are few nursing homes to discharge them to, or family members don't have a home where they can care for them.