Dr. Peter DeBlieux supported Dr. Buras’s point as follows:
"The resources and the planning, both from LSU’s stand point, the hospital’s stand point, were right on. We knew that there could be a flood. The anticipation was that the water would come and the water would go. Directly after the storm, we were able to walk around the hospital, walk to the Superdome and back unimpeded. That night after the levees broke, it became problematic. The anticipation was that the water would come up and the water would go down, not that the water would come up and stay. Result, the hospitals in the surrounding areas had no high-water vehicles; both Charity Hospital and University Hospital could not be accessed. University Hospital could only be accessed by boat, couldn’t even be accessed by high-water vehicle. Charity, if you had an intake over six feet for a high-water vehicle, it could make its way in. But the University Hospital was surrounded by eleven feet of water. . . . The man-made component, the failure of the levee, was the part that caught us unaware."
Dr. DeBlieux expressed the following concern about the efforts made to salvage University Hospital:
"Since the storm, nobody has gone back in to Charity Hospital; it’s still tremendously damaged. The effort has been made to recover University Hospital, which was equally damaged, but more importantly, more likely to flood again."
Dr. DeBlieux noted that Elmwood Hospital was limited to serving only trauma patients:
"Additionally, we set up shop as a trauma center at Elmwood Hospital; we were allowed to care for trauma patients in that environment, only trauma patients. We’re not allowed to see other patients in that facility. Patients with medical problems, patients with pediatric problems, patients with neurological problems, they were not welcome to that facility. It was thought of as to be competing with the local area hospitals."
Dr. DeBlieux provided this overview of the impact of the closure of Charity Hospital on services for the indigent or uninsured:
"[The impact was] catastrophic. The emergency department saw nearly 200,000 patients a year; the clinic system saw I believe 800,000 patients a year. This was moved from a sector. Now, there was a lot written about the number of hospitals that closed. The ones that we had, whether we had too many hospitals, but when we were trying to do recovery efforts, that was very difficult because the private sector hospitals which do not have an indigent care mission were unfamiliar with to our patient population. And so there was resistance for caring for those patients and resistance on those patients for accessing health care from those areas. So both from an emergency department standpoint and a clinical standpoint, those patients care needs have not been met. Because – A - we’re still battling recovery efforts, particularly in regards to some services, those services predominantly being psychiatry; ear, nose and throat services; then neurosurgical services. Those services are wanting in our current environment."
When asked how the needs of the indigent have been met since Katrina, Dr. DeBlieux gave the following account:
"Well, how they are addressed now is we have a 200 bed hospital; we have a clinic system that is back online. How they were addressed a year ago is a dramatically different answer. How they were addressed two years ago is a dramatically different answer."
"[In the days following Hurricane Katrina,] the emergency department functioned on the U.S. Naval Ship Comfort for about ten days; we set up a field hospital in the parking lot of University Hospital. That lasted for about a month. We combined forces with the military, and delivered health care at the Convention Center. From the Convention Center, the military went on their way and we continued health care there; we [were seeing] approximately 100 to 150 patients a day. And the from there, we went to Lord and Taylor, that space on Poydras next to the Dome; we delivered health care there before moving back to this hospital."
When asked if a 200 bed facility is adequate for the existing need, Dr. DeBlieux continued:
"There’s debate over that. It’s very difficult to say. I can tell you that I worked yesterday in the emergency department and saw at least three patients that have yet to be plugged back into a clinic system. They had been back in New Orleans for an excess of nine months and had yet to see a doctor and these are people with diabetes, high blood pressure, heart conditions, some with cancer. So, it is not a robust system yet. . . .We just moved into clinic space at the Lord and Taylor building. Our medical office building, which will provide urgent care services, cardiology, space for stress tests and clinic visits, cancer screening, space for colonoscopies, mammograms, pap smears, the like is not up and functional. Likewise, psychiatric services in the area are anything but functional. . . ."
"There is a lobby in the private hospitals that are trying to limit the size of that hospital because they view that as a direct threat. It doesn’t make sense because the facility is not going to be actualized for another seven years. The projected census in the metropolitan area is going to skyrocket. We are not meeting the health care needs for our community now. This is not the time to play small. "
Dr. DeBlieux described the dilemma faced by hospitals as they try to address the needs of the uninsured and the legal impediments to reimbursement for indigent care, conditions which underscore the need for a facility that can manage the current and future needs of those who cannot afford to pay for medical services:
"If you have the private-pay hospital perspective, you’d say, their perspective is that they are seeing far too many indigent patients, that the money is not following the patients. So they feel that their burden is too great to the indigent-care patients and they are not being paid enough to see those patients."
"Some of the area hospitals . . . are county-based hospitals and have an indigent care mission and do not advertise that mission. For example, yesterday, I saw an individual who works – he does not have insurance. He broke his leg, was seen at one of those two hospitals, was treated in the emergency department, and then told, "You can see one of our doctors for follow up in orthopedics but he’s going to charge you a lot of money on the front end or you can go to Charity Hospital for free care." Charity Hospital does not provide free care unless you can prove that you qualify. An individual with a job does not always qualify for free care. He’ll receive a bill just like he’ll receive a bill at the other hospital. That was not explained to him. Those private physicians will not see those patients without up-front money."
"Now, to argue their point . . . if that patient stays within that system, the physician performs an operation on that patient, fixes that patient, never gets paid by that patient. If that patient has a bad outcome, that patient can sue that clinician even though that clinician never received one penny. So why should the clinician increase their liability?"
"And then it gets worse. Are you ready for this? This state does not allow that physician to write off that bad debt. So in other words, if the physician said "Let me take my hourly work and put that into a pile and assess how much I would charge that individual; let me write it off for my taxes," that’s not allowed. There is a disincentive on two levels: your liability is increased, they do not get paid. They not only do not get paid, they can’t write it off. That’s crazy. It makes it that much more important for us to stand up our facility for complete care because it is not available to our patients in the private sector."
When asked about the impediments to a complete care facility for indigent care, Dr. DeBlieux stated the following:
"Funding from state and federal government for a new facility, funding from state and federal government to compensate those physicians that are providing that care to the community. It is very interesting, there is a cannibalism going on in the city right now. The private hospitals aren’t getting funded to the level they need to write off their indigent care services and then we aren’t getting the money we need to build a new hospital. If ground breaking on a new hospital took place today, it could take seven years. So here we are stuck putting money into a hospital right now that will likely flood again, given the same circumstances."
Dr. DeBlieux described the impact of Katrina on LSU HSC Medical Center Louisiana at New Orleans and the implications for the community:
"The residency program went from 72 positions a year to 52. Went down 20 positions. That’s a substantial loss of manpower; it’s a substantial loss of physicians who are trained in this area. If those . . . that’s just a microcosm, right? There are all of these other residency programs that have either been discontinued or reduced in size. Approximately 70% of Louisiana physicians trained within this complex. Seventy percent of Louisiana physicians, the people who are out there practicing, trained within the Charity Hospital complex, between LSU and Tulane."
"And so, that number of trainees has dramatically gone down. The number of medical students who chose to stay in Louisiana, from both Tulane and LSU, has decreased. The likelihood that people that train here stay here has diminished. So, you are losing generations of future physicians who are not choosing either to train here or stay here. If you train here, you are more likely to stay around this area. That’s the natural course of trainees around the country. So if we then reduce those numbers, the likelihood that those physicians will stick around is remote."
"We lost tremendously talented faculty; significant others no longer had jobs in this area. They are gone. Our faculty has been heavily recruited to go elsewhere, and we have lost faculty in that fashion as well. Very talented senior level faculty. Bringing faculty here is very challenging, very hard to do.
When asked to elaborate on the factors that impeded faculty recruitment, Dr. DeBlieux referred to the school system, the health care system and concerns regarding public safety and crime. In addition, he described the uncertainty of the future of the medical system in New Orleans:
"The whole turmoil about whether or not the medical center would come back. There is a whole push to move the medical center to Baton Rouge. And that unsteadiness, that un-readiness to invest in this area is a vote of no confidence. So if you are talking about individuals who are weighing job offers between California, New York, and here and the system is not firmly behind the medical center, it makes it very difficult to retain and recruit individuals in that environment. [Moving the center to Baton Rouge] would collapse the health care system in New Orleans. . ."
Dr. DeBlieux provided the following account of the impact of Hurricane Katrina on mental health services in the New Orleans area:
"Prior to the storm, Charity Hospital sublet the third floor of Charity Hospital to the Office of Mental Health and they provided psychiatric services, both acute care services as well as in-patient care services. After the storm, LSU has gone into DePaul hospital and has roughly 70 to 80 beds there. We have had to create an emergency room extension here of 20 beds to meet the needs of the acute psychiatric population."
"Two weeks ago, we had 35 patients here, 20 in the extension and 15 occupying space in the emergency department with acute psychiatric illnesses. If those patients are taking up space in my emergency department, then I am not seeing chest pain, stroke patients; patients with diabetes, high blood pressure, pediatric patients, and also trauma patients."
"The number of psychiatric beds has grown steadily from DePaul and then NOAH - New Orleans Adolescent Hospital, but there is still a substantial need for psychiatric beds. There still is not enough robust out-patient mental health services available. There is not a system right now where psychiatric patients can easily access their psychiatric medication. They are working on that. They are developing a partnership with New Orleans Police Department Crisis Unit where they will check up on psychiatric patients - make sure that they have access to their medication and their clinic visits. That is just beginning."
When asked about the extent to which the percentage of psychiatric issues has increased since Katrina, Dr. DeBlieux explained:
"All of the surveys done looking at post traumatic stress disorders have been positive, very positive, so that’s substantial. So that means it exacerbates existing psychiatric conditions; it means those people who are on the edge, not diagnosed psychiatric illness, are now tipped into psychiatric illness, and those people are that much closer to the break. Their coping mechanisms are decreased; their likelihood of depression increased; the likelihood of substance abuse increased. All of those things impact mental health."
Access to adequate, affordable healthcare eludes many across all socioeconomic levels, as described in the following statement by Dr. DeBlieux, director of Emergency Medical Services at the University Interim Hospital:
"There is a disconnect. There’s the haves and the have-nots. Then there are the deeply affected poor. The "haves" are those people who have insurance and their ability to access care is impaired because there are not enough physicians and care providers and hospital beds in the area. So, it still is difficult for those patients that want second opinions for cancer treatment, second opinions from a neurologist, second opinions from a surgical sub-specialist, such as ear, nose and throat because there is not enough of those physicians in the area. Many of those people seek their cancer care and specialty care outside of our region. They get impacted."
"There are those individuals who are the working class poor; these are people who have jobs but cannot afford health insurance, people who pay bills. They cannot access health care; there are not enough hospital beds for them within the Charity system. There is not enough clinic visit space for them within the system. These are increasing, both in beds and clinic system, but they are not at an ideal number right now."
"And then there are the woefully poor, and those are the individuals that either have Medicaid, which is fully funded and have access to care and can go anywhere in our system – our metropolitan healthcare system, which means any of the area hospitals."
"Then there are the homeless populations. These are people who aren’t working, who don’t have jobs, who don’t have Medicaid, so their needs aren’t being met either."
Dr. DeBlieux echoes Dr. DeSalvo’s assessment of the importance of affordable, accessible primary care as follows:
"It’s essential . . . In the last six months, we’ve opened up six community care clinics. When I discharge a patient and offer them follow up, instead of having to wait months for a medicine clinic follow up, they will get a follow up within two weeks. This is a tremendous advantage. The problem is we continue to see people who have been disconnected from their medical care. As people come back to the city, and they are coming back, they need to be reconnected to health care. So that’s being done. The clinic system is more decentralized than it’s ever been. Ever. That’s a tremendous advantage."
Dr. DeBlieux described the urgency of resolving plans for a hospital to service the large numbers of trauma and psychiatric patients:
"Prior to the storm, Charity Hospital sublet the third floor of Charity Hospital to the office of mental health and they provided psychiatric services, both acute care services as well as in-patient care services. After the storm, LSU has gone into DePaul Hospital and has roughly 70 to 80 beds there. We have had to create an emergency room extension here of 20 beds to meet the needs of the acute psychiatric population . . ."
"Two weeks ago, we had 35 patients here: 20 in the extension and 15 occupying space in the emergency department with acute psychiatric illnesses. If those patients are taking up space in my emergency department, then I am not seeing chest pain, stroke patients, patients with diabetes, high blood pressure, pediatric patients, and then trauma patients..."
"The number of psychiatric beds has grown steadily from DePaul and then NOAH - New Orleans Adolescent Hospital - but there is still a substantial need for psychiatric beds. There still is not enough robust out-patient mental health services available. There is not a system right now where psychiatric patients can easily access their psychiatric medication. They are working on that. They are developing a partnership with New Orleans Police Department Crisis Unit where they will check up on psychiatric patients - make sure that they have access to their medication and their clinic visits. That is just beginning. . . "
When questioned regarding the increase in post-traumatic stress since Katrina, Dr. DeBlieux continued:
"All of the surveys done looking at post traumatic stress disorders have been positive, very positive, so that’s substantial. So that exacerbates existing psychiatric conditions; it means those people who are on the edge, not diagnosed psychiatric illness, are now tipped psychiatric illness, and those people are that much closer to the break. Their coping mechanisms are decreased; their likelihood of depression has increased; and the likelihood of substance abuse has increased. All of those things impact mental health..."
"There is a lobby in the private hospitals that is trying to limit the size of particular hospitals because they view them as a direct threat. It doesn’t make sense because any new facility isn’t going to be actualized for another seven years. The projected census in the metropolitan area is going to skyrocket. We are not meeting the health care needs for our community now. This is not the time to play small."
According to Dr. DeBlieux,
"There is a disincentive on two levels: your liability is increased, they don’t get paid, they not only don’t get paid, and they can’t write it off. That’s crazy. . . I think pushing to have private physicians or all physicians in the state have the ability to write off bad debt would incentivize indigent care treatment."
Some physicians recommended creating an electronic database for storing and accessing medical records. According to Dr. DeBlieux:
"LSMS could champion an electronic database for patient records. You in fact agree your medical records, meds, allergies, your problems could be kept and unlocked in the case of a disaster. It is not public information; you agree to make it public information. There needs to be a central depository for your records so if you evacuate to Tennessee and you say, "Here’s my code. Access my medical records," you have an old EKG, an old medical list of your medical problems, your medication, your allergies, that kind of information would be incredibly helpful."
Dr. DeBlieux offered the following explanation of the complexity of the decision of whether to move the medical school to Baton Rouge:
"There are two different pieces to this: there’s a service piece, and there’s an education piece. And so the service piece can easily be duplicated. You could move the medical school, move everything away, and just provide the service, hire some people to do the yeoman’s work and divorce yourself from education, which means this medical center will not train physicians to invest into the community and invest in the state. Move that to Baton Rouge and that has to be recreated there. It is not robust enough there right now to foster those individuals. What you’d like to do is provide an environment where both medical schools could utilize that environment so you don’t have to duplicate services because Tulane is not going anywhere. So it would make sense to have LSU and Tulane in the same area, utilize the same resources in the same hospital, educational resources. So, to create that in Baton Rouge and create that in New Orleans doesn’t make sense. You could consolidate services."
When asked if he was saying that having the educational component in New Orleans is pretty critical to having services provided on an adequate level in the future, Dr. DeBlieux replied:
"I would say so. It is very difficult to get academic individuals to buy into 100% service. Academic individuals like to spend part of their time educating, which is what they are supposed to do - medical students and residents - as well as performing their own research and their own publications. They understand that it’s not a free ride and service is a major component of their job. If you remove the medical school from its environment, all you’d have are residents rotating through, and it would be very difficult to recruit and retain top notch faculty who are doing research and who are doing publication. . ."
"It is very important that you understand that we fully expect to lead the country by a large margin in cancer, in the effects of uncontrolled hypertension and uncontrolled diabetes, because our patient population, both indigent as well as working class poor, as well as insured, have taken this opportunity to be on medication holidays. For their diabetes medication, their high blood pressure medicine, from their cancer screening routines, their colonoscopy, mammogram, the like."
Given the fragile state of physical and mental well-being in southern Louisiana, Dr. DeBlieux believes that failure to maintain an active medical research and teaching presence in the New Orleans area would be catastrophic. In addition, a robust medical research and teaching facility in Louisiana is critical in understanding and responding to medical needs of citizens throughout the state:
"What I would like to see from LSMS is . . . an unbiased report of health care, [with] a fact sheet that goes out to the community so our legislators can be educated and the community can be educated of the need to promote a medical center in New Orleans and the need for the rebirth here. It’s very important that individuals in this State understand that a robust medical center here helps Bogalusa, Lallie Kemp, Hammond, Prairieville, Shreveport, Pineville, and Lake Charles. They don’t see it, but their physicians are likely to be trained here and then go there."