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Programming note: "American Morning" is live for the first Mardi Gras celebration since Katrina. Will it help the city recover? 6 a.m.-1 p.m. ET.

Health care difficulties in the Big Easy

Vital signs improving in New Orleans, but prognosis uncertain

By Neil Osterweil
MedPage Today Senior Associate Editor

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Louisiana State University Health Sciences Center is operating a M*A*S*H-like emergency room.

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(MedPage Today)external link -- Six months after its near death by drowning, the Crescent City is marking its resuscitation with Mardi Gras.

But even during this season of excess, a season that ends at midnight on Fat Tuesday, the city's medical community finds itself living on half rations -- short on beds, understaffed, overworked and underpaid.

There are signs of progress, to be sure: On Valentine's Day, Tulane University Hospital and Clinic reopened its downtown facility, including the emergency room closest to the French Quarter and the Mardi Gras parade route.

But the reopened hospital was not the same as it was when it was evacuated last summer as Hurricane Katrina surged ashore.

On August 28, the hospital had 235 licensed beds. Today, it has about a quarter of that number. It has 24 critical-care beds and 39 medical surgical beds. Before Katrina, the hospital had 2,600 employees; today fewer than half of that work there.

Tulane joins the Touro Infirmary and Children's hospitals as the only other downtown hospitals with fully functioning emergency departments, although Louisiana State University Health Sciences Center, whose University and Charity hospitals are still shuttered, is operating a kind of M*A*S*H unit emergency room out of the Ernest N. Morial Convention Center.

Tulane's medical school, which has been operating out of Baylor College of Medicine in Houston, Texas, is expected to reopen in July.

Staff shortages, crushing caseloads

A little farther afield in Jefferson Parish, the Ochsner Clinic Foundation Hospital, East Jefferson General Hospital and West Jefferson Medical Center emergency departments, all of which managed to remain dry and open during the hurricane, have been shouldering the burden of care.

"In terms of patient care, we've been bursting at the seams and are beyond pre-Katrina levels, whether we're talking about emergency services or inpatient services," said Dr. William Pinsky, executive vice president and chief of academic medicine at Ochsner.

The hospital has remodeled and reopened two new units to accommodate the additional patient volume, but staffing issues limit its ability to care for additional patients, Pinksy said. There just aren't enough nurses or support personnel to go around.

The problem has been particularly acute in the emergency department, said Dr. Joseph Guarisco, chairman of the department of emergency medicine at Ochsner.

"We have residents coming back into the city, the trailers are coming in, and the people are coming in, and the growth in the health care availability in the city was not keeping up with the demand from the residents coming back into the city," Guarisco said.

"The hospitals and the emergency departments that were open were really overwhelmed with patients, with long delays and ambulances waiting and unable to get into the emergency department."

The crushing caseload has eased somewhat with the opening of Tulane and the LSU emergency room, and with other facilities gradually coming back online, Guarisco said.

"During Mardi Gras, the ambulance transports triple to 300 or 400 a day -- huge. A lot of it is falls and minor injuries, and a lot of alcohol and drug-related issues -- people get drunk on the street and can't make it home, so they sleep it off in the emergency department," he said.

A large share of the blame for the burgeoning patient volume in local emergency rooms is that many patients have nowhere else to turn. Many community-based physicians either lost their private practices or homes in the storm, were put out of work when the hospital or clinic they worked in closed, or have fled the city.

Ochsner lost about 40 physicians in the aftermath of Katrina, although the hospital has managed to hire that number back and then some.

But according to the Orleans Parish Medical Society, there are an estimated 1,200 practicing physicians in the New Orleans metro area, down from about 4,500 in the days before Katrina. Some of those physicians pulled up stakes and won't be back, while others have yet to return, uncertain whether they'll be able to make a go of it.

About 1,200 of the pre-Katrina complement included house staff -- medical residents and post-doctoral fellows who are the foot soldiers of teaching hospital physician rosters.

At LSU's makeshift emergency room in the convention center, the problem is a lack of nurses, said Dr. James Aiken, from the faculty of emergency medicine at LSU. " We just don't have enough nurses," Aiken said.

Another critical ingredient in short supply is cash.

"Our uncompensated care of indigent patients has quadrupled," Pinksy said. "We're hoping that through the federal and state governments somebody will pay for some of that care so we don't totally drown in red ink."

Tulane official: 'We've overcome huge hurdles'

LSU's Medical Center of Louisiana at New Orleans, which included the Charity and University hospitals, is temporarily closed due to extensive damage from Hurricane Katrina, and it's not clear whether Charity, the city's chief resource for poor patients, will ever reopen.

The Veterans Affairs Medical Center also was forced to close, and while it's offering outpatient services again, New Orleans veterans who need inpatient care have to travel to Mississippi or Texas to find it.

Last week, LSU and the VA announced plans for a joint venture that could create two new teaching hospitals in the heart of the city. LSU also has proposed that the free clinics offered by Charity Hospital be replaced in the future by neighborhood clinics that bring health care to people where they live.

There's still a long way to go, acknowledged Dr. Paul Whelton, senior vice president for health sciences at Tulane Medical Center.

"Still, we're a lot further along than I would have predicted even a few months ago," Whelton said. "We already have our clinicians at work, we have all our researchers back in our labs, we have most of our residents back, and we'll have the residual number of residents and M.D. candidates back in July. We've overcome huge hurdles."

Guarisco said, "Lots of aspects of life in New Orleans, whether you're looking for a restaurant or dry cleaning or health care, it seems as if over time we're starting to see a return to normality in terms of the availability of everything you need in life, including health care.

"That's in the dry areas," he continued. "If you were in the areas that were flooded, nothing's happening. Nothing."

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