On Life Support
New Orleans's against-the-odds struggle to care for the infirm
"Solace." And while revenue is down, costs are up--way up. The biggest expense is staff. With housing scarce and expensive, hospitals are paying premium wages for janitors, accountants, and kitchen workers. West Jefferson Medical Center, just across the Mississippi River in Marrero, is serving 20 percent more inpatients and 18 percent more outpatients than it did a year ago, with the same number of full-time staff. The hospital has had to hire travel nurses at double the cost of a staff nurse. "If we had more nurses," says Gary Muller, the hospital's CEO, "we could open more beds."
Tulane Hospital reopened its downtown building in February with about 60 of its 235 pre-Katrina beds. The hospital's organ-transplant program is back up and running. But space is tight. Says CEO Jim Montgomery: "We're having a real problem with patients stacking up in the ER waiting for beds."
The shortage of beds means not only long ER waits (box, Page 58) but also less room for other patients. "There's a challenge every day of not having beds open for elective surgery," says Mark Peters, CEO of East Jefferson General Hospital, a public nonprofit in New Orleans. But, he adds, "it's very difficult to think about adding beds if you're just going to lose more money."
The cash crisis has been exacerbated by Louisiana's unique method of providing indigent care. In other states, both public and private hospitals receive federal and state funds to help cover the cost of caring for the uninsured. But in Louisiana, almost all the $761 million flows to a state-run, 10-hospital system administered by Louisiana State University Healthcare Services Division. "Big Charity," which has been providing medical care to all comers since 1736, was the system's flagship. With 150,000 ER visits and 300,000 clinic visits a year, Charity drew patients from throughout the state, a critical source of care in a region where just over half the adults were insured through work. At least it was.
Today, most of the hospital's thousands of employees are scattered. Ben DeBoisblanc, for example, who ran Charity's intensive care units, is picking up shift work at other hospitals and living in his SUV. Big Charity and its sister hospital, University, are dark and empty, the only signs of life security guards watching TV and staff members who return to salvage medical equipment. Since September, the ER staff has wandered the ruined city like medical gypsies: to tents in a parking lot at the convention center; to the USS Comfort; to a parking lot near University Hospital; then inside the convention center, and, since March, in the defunct Lord & Taylor. Bare sheetrock covers the bottom 2 feet of the pink walls, marking the reach of Katrina's floodwaters. The 30 beds in the ER tent serve about 4,500 patients a month, about one third of its former volume. It's a patchwork operation; most lab tests have to be sent an hour away to Houma, and once patients are diagnosed, there are few options for follow-up in the city. The lack of a hospital, says ER physician Keith van Meter, has produced an odd form of medicine. Doctors, for example, order CT scans because they can't get blood tests and invent other workarounds. With no end in sight, frustration builds. "The joy of seeing patients is the only solace we have to comfort us."
advertisement
