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Hospitals seek help to stanch bleeding
Lack of beds, staff testing limits of post-Katrina medical system
Monday, June 05, 2006
By John Pope
Staff writer

On a seemingly quiet, hot Sunday over Memorial Day weekend, five ambulances sat lined up for hours outside the emergency-room door at West Jefferson Medical Center.

But they weren't at the Marrero hospital because the drivers were hanging out on a slow day, waiting to be called into action, said A. Gary Muller, the medical center's president and chief executive officer.

The ambulances were backed up because the patients inside were waiting to be taken inside for treatment, he said.

The reason for the enforced idleness is a complex, intertwined set of circumstances that make up the reality of health care in the post-Katrina New Orleans area, where staff numbers are depleted and the number of available beds is down. All that results in longer stays for inpatients now that many post-discharge programs such as home health care are depleted or nonexistent, Metropolitan Hospital Council of New Orleans President John "Jack" Finn said.

"There's no long-term care, no home care," he said. "Sometimes we don't have homes to send them to."

Hospitals are hard-pressed to expand their services because some nurses and technologists are reluctant to return to New Orleans and because hospitals south of Lake Pontchartrain are losing money -- anywhere from $900,000 to $9 million a month -- because they have to pay more for temporary personnel and care for uninsured people who otherwise would have gone to Charity Hospital, Finn said.

"There's no clear hope on the horizon," said Dr. Patrick Quinlan, chief executive officer of the Ochsner Health System.

In the absence of an all-encompassing health-care plan that would include provisions for caring for uninsured patients and restoring the medical-education programs for which New Orleans used to be famous, local hospital administrators are heading to Baton Rouge today to urge the Senate Finance Committee to include $120 million in the state budget to reimburse hospitals for uncompensated care.

"We'd like to get . . . out of this ditch," Muller said. "We can't get people in here if we can't get paid."

This is not money that would have gone to Charity and University hospitals, which have been shut since the storm blew through in August.

"That money was stripped out of the budget in the first special session (after Katrina) and given to other hospitals in the Charity system because they had increased their loads," Finn said.

In the overall state budget, he said, "a surplus was declared, but instead of putting the money back into the budget to pay for free care, it was distributed elsewhere, such as for a teacher pay increase."

It's a problem that has swept across south Louisiana in the wake of Hurricanes Katrina and Rita. According to a Louisiana State University study, uncompensated care there has risen by 86 percent.

The situation "is a catastrophe of proportions that nobody understands," Quinlan said. "It's more like losing a war."

Although people in the New Orleans area have become aware of the importance of rebuilding levees, Quinlan said many don't grasp the importance of restoring New Orleans' health-care system: a process that, he said, will require more than this one-time appropriation.

"Levees don't cost money when they're sitting there," he said. "Hospitals do."

But it's going to take more than money to rebuild the local health-care system, hospital leaders said, because they can't lure enough people back to the New Orleans area.

"There's apprehension among health-care workers" about working in local hospitals, Quinlan said. "To get someone to come to New Orleans now is not an easy thing. It has put the growth of the city at risk."

Without full-time personnel, hospitals have had to pay more for temporary nurses and technicians. For instance, Ochsner has spent about $7 million more for part-time nurses than it did before Katrina, Quinlan said, and Muller said West Jefferson has about 90 temporary nurses, compared with none before Katrina.

If the local health-care network is to rebound, "we're going to need more staff," Finn said, "and it's going to be a real battle to get them here. We're continuing to slide."

"People can persevere if there's hope," Quinlan said. "Right now we can't paint that picture."