Five years after Hurricane Katrina work still to be done

Five years ago, Hurricane Katrina chased Keith C. Ferdinand, MD, from his native New Orleans.

The disaster, as much the fault of human error as nature’s fury, destroyed his home and Heartbeats Life Center, the cardiology clinic he founded with his wife Daphne Ferdinand, RN, PhD, in the city’s Ninth Ward. Ferdinand, who is currently adjunct clinical professor at the Morehouse School of Medicine and clinical professor in the cardiology division at Emory University, told Infectious Disease News that he still regularly visits New Orleans and plans to move back when his house is repaired. But Ferdinand will not rebuild the clinic, saying the financial and emotional costs of rebuilding are just too great.

“Many practitioners who had very well-developed practices in the Ninth Ward have not restarted their practices,” he said. “There are two major reasons for this: The depletion of patients who would serve as means of developing a major clinic and the questionable reimbursement for not only specialty care but also primary care.”

Progress is slow

Ferdinand expects to see great things happening in New Orleans and he said he is encouraged by the election of Mitch Landrieu as mayor last year, replacing Ray Nagin. However, he remains frustrated that New Orleans East — which sustained the most damage from the hurricane and subsequent flooding — is far from “back to normal” even as the downtown resort corridor looks as good or better than it did before the storm, and the Superdome has been fully repaired at a cost of $185 million.

Five years after Katrina made landfall on Aug. 29, 2005, medical care is largely absent from the east side of New Orleans, an area that includes the Ninth Ward. Charity Hospital, known locally as Big Charity, which was once the second largest hospital in the country and served most of the city’s poor, sustained serious flood damage and officials from Louisiana State University have announced the hospital will not reopen. Methodist Hospital, Lakeland Medical Center and Lindy Boggs Medical Center, all of which served east New Orleans, remain closed. Construction began June 25 on a new hospital to replace the Veterans Administration Medical Center, which closed due to flood damage.

“The hospitals that would be located in the Ninth Ward/New Orleans East/Gentilly area are basically non-existent. Methodist Hospital, which had an oncology center, had approximately 300 beds,” Ferdinand said. “Patients now have to seek care at two downtown hospitals or Oschner Hospital, which is located outside the city in Jackson Parish.”

Patients in that area needing hospital care attention have to drive over a causeway to get downtown, a trip Ferdinand said takes at least 20 minutes on a good day and upward of 90 minutes when traffic is bad.

Differences among hospitals

Marianne Billeter, PharmD, BCPS, manager of clinical pharmacy services at Ochsner, agreed that there have been challenges, and that the city is still in a recovery phase, but she said her hospital has grown since the disaster.

Billeter said that Ochsner has acquired eight new facilities since Katrina, and that all of those facilities are providing top-notch care in various sites. “We have a strong solid organ transplant center, we treat a broad cross-section of cancers, [and] our cardiology centers are as strong as anywhere in the country. We have everything that you would see in an academic medical center anywhere in the United States.”

“Regarding infectious diseases, maybe we have seen more resistant pathogens, but that is only because we are tertiary care centers,” she said. “If we have seen a shift in uninsured patients, it has more to do with the economy than anything else.”

Though the medical capacities of Ochsner are stronger than ever, scars remain.

“We learned some hard lessons in the wake of the storm,” she said.

Disaster preparation has become an even bigger component to the functioning of Ochsner than it was before Katrina, according to Billeter. Routines have been tightened, and supplies are more rigorously accounted for. Perhaps most importantly, an attitude of self-sufficiency has taken hold.

“We have learned not to rely on anybody, particularly federal agencies,” she said. “Of course we will help the region and help other institutions if we have the capacity and opportunity to do so, but the lesson we learned was that you need to take care of your own staff and patients in a disaster situation. It sounds cold, but the cardinal rule is to preserve supplies. Our goal was to be as completely self-sufficient as possible if something like this happens again, and we have achieved that goal.”

Lack of medical care

Denise Johnson, DNP, clinical director of the Louisiana Breast and Cervical Cancer Program — New Orleans site, a CDC-funded clinic that treats women who do not have health insurance, lives on the east side of the city. She said the lack of medical care, as much as any hurricane-related damage, had driven residents to leave.

“When people see the French Quarter they’re seeing the tourist side of it,” she said. “Where we live, some areas still look like they did when the storm hit 5 years ago. I want them to stop ignoring New Orleans East.”

The National Guard rescued Johnson and her family from University Hospital, also known as Little Charity, 6 days after the storm made landfall in the city. She could not evacuate before the storm because her husband was ill, so Johnson volunteered at the hospital. Going back home was out of the question because the house took on 8 feet of water.

Because their home was damaged by flooding, Johnson lived with friends in town for a year while her family relocated to Houston for 2 years. She and her patients were fortunate in that most of Johnson’s patient records, stored on the 10th floor of Big Charity, did not sustain damage. Although it meant walking up 10 flights of stairs in a dark hospital, she was able to get those records out to physicians treating her patients in cities like Houston and Atlanta.

“It was a task walking up 10 flights of stairs. There were no elevators or air conditioning, but with security we were able to walk up to the oncology ward and access records for the women we could find and get them treatment,” she said.

Johnson said she was offered a job in Texas that would have paid her more, but leaving New Orleans never crossed her mind.

“This is where my roots are. I was born and raised in this city. My mother is buried here, my father is buried here,” she said. “I feel like there is a need to be here to help women who are less fortunate. I always knew I was coming back.”

Roy S. Weiner, MD, associate dean for clinical research and training and associate director of clinical research for Tulane Cancer Center, agreed that there is little in the way of medical resources on the east side. He attributed some of that to the usual bureaucratic red tape.

“There are some contractual issues with purchasing facilities and renovating facilities. Things are to some extent ensnared in business issues as companies try to open and run hospitals in an area of need,” he said. “Some of it is red tape, some of it is haggling over business.”

At the time of the storm, Weiner was director of the Tulane University Cancer Center. He said the oncology unit re-opened to patients Oct. 1, 2005, and is now back to treating about 25% of the city’s patients with cancer, the same as before the hurricane.

Tulane Hospital reopened downtown Feb. 14, 2006, and Lakeside Hospital, a university-owned facility in Metairie, La., never closed. Weiner said that, immediately after the storm, administrators ramped up operations at Lakeside “until it was bursting at its seams” while the downtown hospital underwent repairs.

Weiner has described Hurricane Katrina as a “nightmare,” but said there has been some triumph in the tragedy. Tulane as an institution is undergoing what he called, “enforced modernization.” The hospital is emphasizing ambulatory care, and reserving in-patient procedures for tertiary and quaternary care such as organ transplantation and neurosurgery.

“We have, of necessity, accelerated our modernization of health care so that the patient spends more time at home, less time in the hospital and is able to get fairly sophisticated care as an outpatient rather than being admitted,” he said. “We were headed in this direction, but much more slowly. The storm had the beneficial effect of accelerating the process.”

He added that the school has become less of an ivory tower and is playing more of a part in the city on both an institutional and personal level. University president Scott Cowen has been nationally recognized for creating the Institute for Public Education Initiatives to support the transformation of public education in New Orleans. Weiner in July became president of a charter high school for science and math in the city, something he admits he probably would not have done before the storm.

“Tulane looks much more outside itself now, rather than seeing itself as a cloistered academic silo that it may have resembled before Katrina,” Weiner said. “Many people at Tulane are vitally interested in rebuilding the community.”

Without pretending that New Orleans is a paradise — Weiner acknowledged the lack of medical care in New Orleans East, the still-struggling school system and the endemic corruption the city is known for — the Crescent City is on the rise in his mind.

“I’m seeing a tremendous amount of positive outcome as a result of this part of the world getting shaken by its shoulders by Katrina,” he said. “I totally believe that New Orleans is and will be a better place in virtually every aspect because of how we have recovered from Katrina.” – by Jason Harris and Rob Volansky

Overall, I would say that the health care systems in the city have not recovered. However, I must qualify that by saying that the region is moving in the right direction, and that some parts of the city are further along than others.

The Jefferson Parish section is doing well, while Orleans Parish and St. Bernard Parish have a long way to go.

Unfortunately, what a lot of it boils down to is money. Some finances have been mismanaged, and this has affected the entire community, including the health care system. We are now seeing a situation where there are large disparities between those who can pay and those who are on Medicaid.

Regarding specific institutions, Methodist Hospital sat there for a long time, possibly as a result of financial concerns. It looks like the city is going to buy it, but it is going to take a few years to get up and running. Old Charity Hospital closed, leaving many poorer patients to fend for themselves. Touro Hospital has been bought by Children’s Hospital. Those two facilities seem to be working together to take care of adult and pediatric patients. Ochsner has bought Baptist Hospital, and that particular hospital has developed a strong obstetrics program. The VA hospital has remained closed, and many of those veterans are unable to afford to go anywhere else for care.

A real key to the initial recovery were out-of-state volunteers and volunteers from the universities. In the immediate aftermath of the storm, temporary volunteers — mainly nurses — came into the city and were very helpful in the emergency, but then they returned to their homes and left a void. It seems like medical personnel are returning to New Orleans to stay. Residents from Tulane and Louisiana State Universities have been involved in a number of outreach programs, and we are now seeing increases in the number of graduates coming out of those schools.

Having said that, prospective research is probably the area where the city has suffered the most. Although economically disadvantaged individuals — particularly those in the black community — have had a hard time staying in care, for the most part, patient care was not interrupted. However, we are hoping that with increases in class size at LSU and Tulane will come a return to more research.

Ochsner has led the way in staying on top of management and education in infectious diseases. We have been holding weekly and monthly citywide infectious diseases education programs with people from around the region, including LSU and Tulane.

As for Ochsner, though we are still working as a non-profit, we are up to about 750 doctors and are on our way to becoming more financially viable. We have an association with the University of Queensland in Australia which has brought in more young clinicians and residents who are willing to help.

In the end, if we can continue to work to overcome economic and political obstacles, the will is there. It may take time for all sections of the city to get up to speed, but we are definitely on our way

– George Pankey, MD
Infectious Disease News Editorial Board member