Ms. Susan Dantoni
Susan D’Antoni, Executive Director of the Orleans Parish Medical Society at the time of Hurricane Katrina described the impact of the disaster as follows:
"We started out with 11 hospitals in New Orleans . . . I think three were back open by November or December. Touro Infirmary never closed. So we lost several hospitals. We lost ancillary services. We lost clinics. We lost doctors’ offices. Physicians had very different scenarios as to their professional and personal loss, which dictated when they could or would come back. If a physician lost his or her home, but yet had a surviving medical practice, then it meant facing the considerable challenge of finding unaffected and available housing, just to be able to start seeing patients who had returned to New Orleans. If a physician’s office and home were destroyed, then it meant a much more substantial time to get re-established, and, if the challenges were too great and opportunities existed elsewhere, potentially they would never come back."
Ms. Dantoni provided this insight into the loss of personnel following Katrina:
"So we lost the hospital; we lost clinics; we lost doctors’ offices and, so physicians depending on whether or not they were private practice or part of a group practice or a hospital-based physician, all had very different scenarios as to when they could or would come back. And part of that was based on their own personal loss, too. If they lost their home, but yet they had a medical practice, then it meant coming back and finding where [they were] going to live, just to be able to start seeing patients. If they had lost both, then it was going to mean a much more substantial time and potentially they would never come back. . . .. I think [for] many the fear was, "Do I have to start all over again somewhere else? Am I going to have a future here?"
She also raised the need for some way of assisting physicians who would have preferred staying in the area to rebuild their practice:
"If a model could be developed by the state and/or federal government to ensure adequate and appropriate physician care in an area after a disaster, I think that could have made a big difference. So many of our very bright, very talented physicians who were committed to New Orleans would not have left to practice elsewhere if a bridge funding program had been available to provide income until they could get re-established. Many physicians in office-based practices considered relocation as the most immediate option for them. They were in survival mode too, and they were trying to take care of their own families’ needs as well as their own professional ones."
Ms. D’Antoni, former Director of the Orleans Parish Medical Society who relocated to Washington, DC, post Katrina, recommended a prevention strategy, such as the healthcare professional shortage area designations for guaranteeing a critical mass of physicians following a catastrophic event:
"One of the greatest missing pieces was the fact that there was little or no pre-planning to guarantee adequate physician care after the storm. Physicians are, for the most part, small business owners. If their medical practices are devastated and their patients leave the area, they have no way of making a living to take care of their own personal needs. Model scenarios could be developed to anticipate the impact of a disaster of this magnitude on physician supply. For example, in the immediate aftermath of Katrina, we lost 50% of the physicians. If we want to guarantee that an area still has enough physicians of appropriate specialties left, then prior to a disaster, we need to know that, for a returning population of "x", we need a particular number of primary care physicians, "x" number of OB/GYNs, "x" number of psychiatrists, and "x" number of surgeons. And, prior to the disaster, agreements could be developed with those physicians to provide funding for a period of time, whether that’s three months or six months or a year. This is necessary, in the aftermath of a disaster, because physicians will have no guaranteed income given the disruption of their medical practices, the possible relocation of their patients, and for those patients who do return, given the loss of businesses and jobs, the uninsured rate increases significantly. After Katrina, the uninsured rate increased 400%. In order to make sure that we are able to care for the health care needs of the returning population, we have to put in place some sort of guarantees, contracts with physicians, who are willing to stay or return quickly after a disaster to provide care to returning citizens."
Dr. DeSalvo described the need for revising the credentialing procedures of the Louisiana State Board of Medical Examiners:
"The biggest problem I’m having right now – and again, not in their purview but something they can influence – is physician credentials. It’s a huge problem."
"There’s no emergency privileges system for doctors who are applying for a license. . . These doctors that I’m bringing in for the summer – for example, 3 of them are from out of state. They turned in their fingerprints in March – which is one of the steps in the process. And they just found out two weeks ago that their fingerprints are smudged. And they have to start over, so I’ve lost 2 – 2 ½ months time. And they’re not going to have their license when I’m ready for them to start in July. So I have a ready provider; I have the money; I have the need. But [I cannot hire them until fingerprints are cleared]. . . So, in other words, like for these guys, they’re in good standing. They should get a temporary license until their full license goes through but there’s no mechanism for that in the state."