New Orleans' health care might never be the same

NEW ORLEANS -- The city's health system of public and private hospitals, clinics and individual medical practices is among the victims of Hurricane Katrina.

When the winds subsided and floodwaters stopped rising, just three of the city's 16 hospitals were still operating. Some that closed were so damaged they may never reopen, experts say. And no one knows yet how many private doctors offices and clinics were damaged and how severely.

"This is going to totally reconfigure the health care structure of New Orleans," says Joseph Dalovisio of the Ochsner Clinic Foundation, a specialist in infectious diseases. "I think there will be fewer hospitals. The population of the city will shrink in size. Some institutions will be weeded out, while others will grow."

Demand vs. services

Dalovisio says it's likely that at some ruined clinics and doctor's offices, patient medical records were lost or destroyed in the flooding. Ochsner has its records filed electronically, and the hospital, which had generators to provide electricity, backed up its medical record system right after the storm.

New Orleans has been deserted, except for thousands of emergency workers, both military and civilian. But last weekend, the first business owners were allowed back.

Because so many people fled the area, "right now we have more services than patients," Dalovisio says. Ochsner had 150 patients on Friday, down from its usual 400.

"The evacuation saved hundreds of thousands of lives," he says. But "after the smoke cleared, all the patients and physicians are elsewhere."

Now, he says, Ochsner directors are trying to balance needs with available staff at the main hospital and its 26 clinics in this region. "We have 8,000 employees scattered, and we're trying to bring them back."

Many of the hospital's employees have concerns beyond employment. "They're dealing with their own personal tragedies," Dalovisio says, including loss of homes or family members. Others are struggling to arrange schooling for their children and cope with insurance, property damage and other storm-related issues.

Ochsner, East Jefferson and West Jefferson Medical Centers, which combined serve 40% of the population, are up and running. Two hospitals near New Orleans, Northshore Hospital in Slidell, La., and St. Charles Parish Hospital in Luling, La., have reopened. Others are expected to open, at least partially, in the next few weeks.

But several, including the famous Charity Hospital in New Orleans, suffered such massive damage that their future is in question.

Donald Smithburg, CEO of LSU Health Care Services Division, which operates Charity and LSU's University Hospital, says both hospitals were damaged and are closed. For Charity's landmark building, which opened in 1939, "the storm was a death knell," he says. "For decades it has been recognized that Charity needs to be replaced. The building has needed upgrading, and the storm completely wrecked the electrical system."

Smithburg says it's too soon to say whether either hospital will ever be used again for medical care.

"It's highly unlikely Charity would be reusable without hundreds of millions of dollars in renovations," he says.

Despite the grim outlook for the historic institution, whose motto, "Where the unusual occurs and miracles happen," is engraved on a wall in the lobby, medical students and residents pitched in Friday to continue cleanup work that began immediately after the storm.

They tossed heaps of medical waste onto patient beds, wheeled them to stairways and carried them down 10 flights. It was dirty work that took place in the dark, in 90-degree heat.

"The thing we're worried about is that this is all in vain," says Marcia Glass, 29, a third-year medical resident at Tulane. "If they condemn this building and wait for FEMA money (to build a new hospital), where will the patients go?"

Planning for the future

As devastating as Katrina has been on the city's public health system, says Ochsner CEO Patrick Quinlan, the disaster presents a rare chance to create a new model of health care that could be a vast improvement on what was here before the storm.

Quinlan and other medical experts are meeting with Louisiana congressional representatives and other officials in Washington, D.C., today to support a plan to replace the patchwork of state and local clinics. They seek a system of coordinated neighborhood-based clinics, each providing the same basic, high-quality medical care, such as preventive care, dental and mental health services.

Records would be electronic, so when residents move, their new doctors would have their complete medical records.

These clinics, which should be "accessible and familiar" to people in communities, will provide better, more uniform care and will save money by keeping people healthier.

The idea has support among national and local health experts.

Dan Hawkins of the National Association of Community Health Centers says many health systems now are centered on hospitals. "The key difference between this and anything we see out there today is it would be grounded and centered in the community," he says, and would provide a wide range of services in one spot.

After a period of transition, Quinlan predicts, doctors and their patients will return to the city they love.

"People have such an affinity for this town," he says. "Given the scope of the problem, I think the repatriation will surprise everybody but the people of New Orleans."

Contributing: Julie Appleby

in McLean, Va.

To see more of USAToday.com, or to subscribe, go to http://www.usatoday.com

© Copyright 2004 USA TODAY, a division of Gannett Co. Inc.