Dr. John Van Hoose
Dr. John Van Hoose credits the progressive, proactive leadership of the mayor of Lake Charles with guiding the city to develop a comprehensive disaster plan that emphasizes local accountability for emergency response. He described a mutual aid group that meets monthly for the sole purpose of anticipating and planning for the unexpected disaster:
"There is a mutual aid meeting . . . that meets monthly where the Office of Public Health, the Homeland Security. . . people from the hospital, me from the Medical Society, EMS people are there to discuss disaster preparations."
Dr. Van Hoose provided insight into some misconceptions that need to be addressed in planning for future disasters:
"Most of the time in a hurricane situation, you do not have very many injuries. Most of it is flooding and problems associated with that, as we had. On the other hand, if there are some injuries, obviously that’s got to be taken into account. Most of the time in hurricane-type, weather situations, the injuries do not occur in the disaster; the injuries occur in the cleanup of a disaster. People get chainsaw injuries; people fall off their houses – those kinds of things. So the majority of those injuries occur after the fact. But they’re still a part of the disaster, and they have to be prepared for. And if you do not have adequate medical staff. . . Let’s say . . . that for the next disaster, every hospital in the city decided that for a Category 3 or above, they were going to evacuate all of their patients and all of their medical staff to take care of those patients. Who’s going to be left in the city to take care of any injuries or things that happen later? And so, that to me demonstrates lack of planning. But that is the exact plan that exists today. Everyone wants to leave and nobody has any plans for taking care of the patients." Although Lake Charles did not experience the flooding that occurred in New Orleans, the success of their preparation, evacuation and response underscores the wisdom of building a solid, competent team representing various segments of the community, including the medical profession. Dr. Van Hoose comments: "The president of the Medical Society and the Chairman of the [local] Disaster Committee, who right now just happens to be me, are the first line contacts for the mayor. Our role isn’t to make decisions; our role is to advise him on decisions. So let me make it clear that he’s the one legally who’s responsible for making the decisions, but we can give him advice on those types of things. That was the particular issue with – say during the hurricane, with which patients could be transported, which couldn’t, which ones needed certain types of transport, what other types of support services need to go with them. I would view my [role] not so much that I would be the one helping get him that advice as lining up the right people that he needs – you know, that he needs to get the advice from."
Another issue related to licensing concerns required proficiency exams. According to Dr. Van Hoose, Louisiana is the only state that requires these exams, and many physicians refuse to take them. Thus, this exam creates one more impediment for recruiting physicians, particularly pathologists. Dr. Van Hoose described the issue as follows:
"If you have been out of medical school for more than ten years, you have to take a proficiency examination, and I think that you wind up with a lot of people who just say, ". . . Nobody else makes me do that. I’m not going to do that."
"For a [primary] medicine physician, it wouldn’t be a big deal; for a surgeon, it wouldn’t be a big deal. For a pathologist who has not . . . had to deal with IV dosing and drugs and anything like that for 20 years . . . [it is] a big deal . . . It’s a big deal for radiologists; it would be a big deal for ophthalmologists. For some of the specialties, it would be a big problem and would be a big hindrance. We have actually had problems in trying to recruit people in because of those kinds of issues."