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Patients Needing Care Overwhelm New Orleans's Hospital System
By Felicity Barringer, The New York Times
January 23, 2006
Lee Celano for The New York Times; With limited beds for admissions, patients can wait for hours at emergency rooms around New Orleans, like East Jefferson General Hospital.
The emergency rooms of this bedraggled region are facing their own emergency. As thousands of residents have begun returning in the weeks since New Year's, there are far more sick people than there are doctors, nurses, beds and equipment to take care of them.
The slow repopulation of the city picked up speed after the holidays as more schools reopened and, in the words of one emergency room doctor, the sicker people began to return. But only seven of what had been 15 adult acute-care facilities in the city and three surrounding parishes are open, and only one-third of the acute-care beds.
Hundreds or perhaps thousands of doctors and nurses never returned to New Orleans after the flood; long-term and psychiatric hospitals, not to mention hospices and rehabilitation centers, are now almost nonexistent in and around the city.
As a result, the returning residents have filled the functioning hospitals in and immediately around the city to capacity and beyond. Waiting times in emergency rooms have extended to as much as six hours, medical personnel at three hospitals reported.
Early one recent morning, doctors and nurses at East Jefferson General Hospital in Metairie, just outside of New Orleans, were already caring for five seriously ill or injured patients in the emergency room - because the hospital had no more beds to admit them to - while still managing a full load of incoming emergency patients near the entrance. Then two trauma victims from a car accident were brought in, followed by someone showing signs of appendicitis.
The staff had to "play musical chairs" with the accident victims and remaining patients to find everyone a bed and care for them, said Cheryl Carter, the nurse who directs emergency care.
"That's pretty much every day, pretty much every hospital," Ms. Carter said. "The waiting rooms look like a war center or a MASH unit. We look for more and more different ways to manage emergencies."
The city's sickest residents were among the first to leave New Orleans after Hurricane Katrina and should be the last to return, but that is not happening, said Dr. John Wales, chairman of the department of emergency medicine at East Jefferson, which for days has had more patients than it has beds. "I think they're coming back and the doctors who took care of them are not around," he said.
The Touro Infirmary is the only full-service hospital now functioning within the New Orleans city limits, and the lack of beds in the city has pushed patients to suburban hospitals like East Jefferson and filled them up. (Children's Hospital is also open in the city.) The situation is likely to get worse as flu season, which usually begins around late January here, hits its stride.
The thought of next month's Mardi Gras festivities has local doctors so worried they have formed a committee just to plan for care during the first large-scale, signature event in the distorted post-hurricane world. Dr. Jullette Saussy, who runs the 911 emergency medical service for the City of New Orleans, said that during Mardi Gras, the number of ambulance calls typically tripled, from an average of 120 a day to 360.
"There's a resource problem right now," said Dr. Peter DeBlieux, who heads the emergency department of Charity Hospital, a venerable institution for the city's poor, which no longer has a building and is operating out of Air Force tents in a far corner of the convention center. Patients with broken arms, he said, have at times been referred to Houma and Baton Rouge, cities that are, respectively, 50 and 80 miles away.
Five hospitals in the city, severely damaged by the storm, have been unable to reopen, including the Medical Center of Louisiana, the only Level 1 trauma center on the Gulf Coast, which is a combination of Charity and nearby University Hospital.
Some hospitals have opened neighborhood clinics or parking-lot tents for walk-in care, but some may never reopen, or may take up to a year to find the money to rebuild. The state wants to replace Charity, and its planned renovations to University Hospital could take several months or up to a year.
The city's rebuilding commission said in a report this week that if 65 percent of the region's prestorm population returns by July 1 - as many experts have predicted - the city will need to triple the number of hospital beds available, which would require hiring 2,550 medical staff members in less than six months and an "extraordinary expense" in housing them and paying them enough to return.
Cynthia Matherne, the designated regional coordinator for emergency management in an area that includes New Orleans and the parishes of Jefferson, St. Bernard and Plaquemines, said the problem of limited medical resources put pressure on emergency rooms from all directions.
"The problems we have are multiple," she said. Ordinarily, patients who have been stabilized after an emergency episode are gradually moved out to long-term acute care, rehabilitation or psychiatric facilities.
"But these have not reopened," Ms. Matherne said. "So all the psych patients end up being held in the E.R.'s. And when you're trying to discharge patients, there's no long-term care to discharge them to. There's no discharge to hospice care because there's none available." Home health aides are virtually nonexistent, she added.
"Hospitals are confronted with the question: How you are going to discharge these people?" Ms. Matherne said.
Dr. Saussy, of the New Orleans medical emergency response office, described a parallel problem among the ambulance units in the city. Because only Touro, with 273 beds, and Children's Hospital, with 125 beds, are open, city ambulances must often go to the three hospitals in nearby Jefferson Parish - East Jefferson General (444 beds), West Jefferson Medical Center (330 beds) and Ochsner Clinic Foundation (350 beds, expanding soon to 484).
"We have to wait hours to offload a patient," Dr. Saussy said. "That means we're not going to have that unit available to answer the next 911 call."
Ms. Matherne said the number of acute-care beds in the four parishes before the storm was 5,063, with an average of 4,083 filled each day. "Right now we're right at about 1,750 beds," she added.
Charity Hospital, once a magnet for some of the most severe medical emergencies - and for patients least likely to have insurance - is shuttered, leaving a jury-rigged emergency room under tents within the convention center. Dr. DeBlieux said 100 to 200 patients a day arrived with complaints ranging from major trauma or strokes to breaks and sprains.
Psychiatric patients are now being sent to emergency rooms unused to them. "We are overwhelmed with urban psychiatric patients we wouldn't have seen," said Dr. Joseph S. Guarisco, the chairman of emergency medicine at Ochsner.
Charity's lease at the convention center runs out in a few weeks, and the hospital is making plans to move its emergency room to another hospital building in Jefferson Parish.
In the early weeks after Hurricane Katrina, military medical units from the Army, Navy and Air Force set up temporary medical facilities around the city and helped with everything from diabetes to births to immunizations, but most of these units are gone.
For patients, a medical emergency usually means a long wait, unless it is life-threatening. Ben Cohen, who is 28 and lives in the Midcity neighborhood, started to have intense abdominal pain on Jan. 15 and spent four hours in the Touro emergency room before he was admitted. While there, he watched the single doctor on duty cope with a shooting victim and two trauma cases from a car accident.
"To their credit," Mr. Cohen said, "they did as good a job as they could have."
Dr. Wales at East Jefferson, like other emergency room directors, is trying to get more staff members to come back, particularly nurses and technicians and orderlies. "The issues include getting your existing staff a place to live," he said. "But they can't come back because there is no place. They won't come back without their families."
Dr. Wales added, "At many levels, the disaster continues to unfold."
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