Dr. Floyd Buras
Dr. Floyd Buras, the President of the LSMS during Katrina and Rita, intimated that the preparations that were in place at the time of Katrina would have been adequate had the levee system held. In his estimation,
"If the levees had held, New Orleans would have been cleaned up in two days."
Dr. Buras, a New Orleans native whose practice is now one-fifth the size it was prior to Katrina, was able to provide some perspective on the financial costs of struggling to rebuild a practice in the current environment:
"But what happened was so many people just gave up and moved away, got an offer from somebody out of town. . . . I still get them, but after the storm I’d say I got three emails a week from a physician-hunter looking for people to go work in other places. You beat your head against the wall enough; you finally say "Well why am I sitting here doing this when I could be offered four times the money to go work in Florida or North Carolina?"
"Well you know you look and say, "How stupid am I to turn down a big grant like that just to try to rebuild my home." Retrospectively. . . I feel good, and I’m helping my city come back; but I feel bad that after three and a half years I’m still spending more money than I’m taking in. And we’re at the point now where I probably could survive another year and then if things do not turn around, we’ll have to close."
In addition, Dr. Buras provided some insight into the role of government in impeding efforts to rebuild the medical infrastructure:
"You know the old joke, "We are from the government, and we are here to help you" is very often really an admonition that the government is here to help itself. You know the government is big business, and its object is to preserve itself; and anything it can do to help itself, it is going to do. And so you have got a conflict here where tremendous amounts of resources were being poured into the region to try to help it recover, but the Louisiana government took advantage of the situation to pad its own resources and not distribute them."
"The example being the five hospitals that have remained open after the storm and which were providing all of the indigent healthcare; and the federal government authorized funds to go to those hospitals to help them. But the way the rules are written, they have to go through the state government. The state got hold of those funds and they kept them and did not distribute them to the people who were doing the work. And so now we all are in the same difficult situation where we have been providing the care for the last three months but we have not been compensated for it; and now we are running out of reserves and we are reaching the end of our ropes. . . Not that there were a lack of funds. Plenty of funds were appropriated. They just got directed in other directions from where they were intended to go."
Dr. Buras lost his practice in the Gentilly area of New Orleans where floodwaters neared 12 feet. He provided the following description of the impact of the Stafford Act:
"The Stafford Act basically says that it is illegal for the federal government to do anything that will be beneficial to a private business. For example, are you familiar with the WIC program? It gives nutritional formula to kids. I cannot keep the WIC papers in my office. The patients have to go pick up the papers to bring to me. If I kept WIC papers in my office to sign and fill out, it might be construed by the FBI that I was enticing you into my private business by giving away free federal milk. And that would be illegal."
"So the same reason why Methodist has never gotten any assistance and that hospital remains closed is because it was owned by a private entity. It did not qualify for federal assistance. . . The federal government cannot do anything that would help a private business. . ."
"I cannot emphasize enough, though, that the major destruction to the practice was the disappearance of the population. . . People have not come home. . . I am a pediatrician – look at the neighborhood. None of the schools in the area have reopened. So there are not even enough children in the neighborhood to reopen a school. . . "
"It is a chicken or egg you know. If you do not have schools, the people will not come back. But if people do not come back, you cannot build a school. And that is the same phenomenon we had. The banks will not lend us any money because there are no people so they are not confident that we can pay back a loan. Since we’re private, the Stafford Act prevents the federal government from giving me any assistance."
Dr. Buras offered the following recommendations for addressing these concerns:
"In the immediate scenario after the storm, the government needs to hire local physicians and nurses and give them jobs. In other words instead of having all these medical helpers come in from California, Oregon, Chicago or wherever, go offer the local physicians a job. Say, "We’re going to put up a city clinic or a government clinic, or we’re going to have a rescue clinic and we’re going to hire you and you’re going to run our clinic for us." Because what happened is physicians came back; they tried to reopen their practices and there were no patients, so they simply took a job someplace else. But if they had been rehired, they would’ve stayed."
When asked what level of government should intervene in this way, Dr. Buras replied:
"It can be city; it can be state; it can be federal. It doesn’t matter to me. It’s just whoever’s got the biggest pocket instead of [giving temporary relief workers from out-of-state] these big block grants. And they come down here and they open up a clinic and people volunteer. That’s great; but in the meantime, you've got local people who are struggling to make ends meet who are basically unemployed standing around while you give all the recovery money to people who’ve moved here from other places. They’re going to go back home in a month or two when it is all over. Meanwhile we’re stuck here trying to make ends meet, and you’ve given all the money to somebody else."
"One thing you especially want to do is hire nurses because, even more than physicians, the nurses moved away. So then the hospitals are in a tremendous bidding war for nurses because there aren’t enough of them. Nurses can find jobs anywhere. What they should have done was just hired us all."
"In other words, instead of bringing in a tent city from [out of state] and setting it up in a parking lot of a shopping mall and staffing it with volunteers from all over the country, if they’d have put up the tent city and then hired the local doctors and nurses to go in and work it, many things would have happened. Number one is that people who were here would have had enough money to survive so they wouldn’t have to leave town to look for jobs. Number two, the patients who were here could find where their previous physician was located and go to his tent and see his same old physician. And then number three, it would give everybody a toehold to re-establish themselves in the community."
"But what happened was so many people just gave up and moved away, got offers from somebody out of town. I still get them, but after the storm I’d say I got three emails a week from physician-hunters looking people to go work in other places. You beat your head against the wall enough. You finally say, "Well why am I sitting here doing this when I could be offered four times the money to go work in Florida or North Carolina?"
"I feel good that I’m helping my city come back, but I feel bad that after three and a half years I’m still spending more money than I’m taking in. And we’re at the point now where I probably could survive another year; and then if things do not turn around, we’ll have to close."