Dr. John Wales
Dr. John Wales of East Jefferson Memorial Hospital provided an overview of the loss of medical resources in the New Orleans area post-Katrina:
"Well, I think one of the biggest problems is the loss of healthcare facilities. First of all, there is loss of population which is probably fine because I think the sickest people should be the first to leave and the very last to come back. For a while, they were coming back quicker than [the medical personnel] could provide services, which I thought was a big problem which should have been addressed way upfront. I think there should have been some public service announcements to really say "Before you come back, if you’re a patient who received care, please establish that your care is still here and still available so when you come back you will [be] provided those services." They did not do that, so that’s a problem. So people came back. They did not have medical records; they did not have a list of their medicines. They did not have a way of contacting their providers. Like I said, their medical records were unavailable and in many cases their facilities were gone, as were their physicians. So they would come in, sight unseen, long laundry list of chronic medical problems and not have a good base of information regarding their situations. Some including cancer patients and you’ve already started treating them. That’s a problem. That’s very much unheard of in today’s medical world. That just does not happen. So that was a new set. "Ok, so let me get this straight. You started some treatment at what hospital that doesn’t exist? What doctor is not around? What medications that you do not even know you’re on? This is going to be challenge." So we had to work through a lot of that."
"For the people . . . who did not have [chronic] medical problems, but found themselves with either injuries or illnesses, once again, they were in situations where they did not even know where to go for care because the standard places to go weren’t in existence. So we had a large influx of patients as far as Plaquemines Parish, St. Bernard Parish who normally do not come here. That was a concern because although they were setting up these clinics, they were sending in people – some of them had advanced problems who needed follow up care and there was not a really well coordinated system for follow up. There were attempts, at one point, to have certain patients, like the VA patients and maybe the LSU patients. . . there was some phone numbers. It was almost a daily update on the information and, early on, the pharmacies services did not exist. There’s no place to get medicines. We actually had to have our own pharmacy in the hospital with medications, some of which came from physicians’ offices in order to help provide for the care of the patients. This was for a couple of weeks or maybe a month – there were several groups, out of this hospital, [that] actually went to certain places like a fire station in order to be a clinic on Wednesday afternoons for that area that did not have anything else. It probably was not well coordinated, nor was it well funded, nor was it well resourced. . . . You did what you had to do."
Dr. Wales described the impact of Katrina on trauma care in the New Orleans area:
"I felt the infrastructure for LSU and Tulane Medical Center took a long time to come back. Tulane has Lakeside which I think they put together as quickly as they could. I think they probably did a decent job at that. Ochsner of course never went down, nor did West Jeff . . . Touro took a while to come back. . . Downtown Orleans, Tulane and LSU took a very long time to come back and probably a lot longer than any of us were interested in seeing. Yesterday wouldn’t have been soon enough for what we were looking for them to be able to do."
"I think there was concern that it took longer for that system to come back. The trauma care was a big concern because the doc trauma center was gone, so we had to . . . improvise initially. What are we going to do for trauma care? What are we going to do for children’s care because Children’s Hospital was gone? So we just kind of distributed the load basically, and then early on they established . . . [that] Elmwood Hospital would become the temporary trauma center, which was good. That was an LSU and, I think, Tulane enterprise; and that was a big deal. I think that came about around January after the storm, but up until that point there were issues."
According to Dr. Wales, it was a while before medical personnel outside of the New Orleans area realized how desperate the situation in New Orleans had become:
"There were also issues of people outside the region including the North Shore, St. Charles and other places who wanted to continue to send patients to this area, not realizing what was left. Thinking it was still the way it was before the storm. We had a long time convincing them of the fact we did not have the capability. So we’re trying to . . . provide everything we could."
Dr. Wales described the efforts of East Jefferson Hospital to absorb the cost of medical care for the indigent:
"This hospital did a great thing. They did provide a mechanism for the medical staff to be reimbursed by the hospital in cases where uninsured patients needed medical treatment. However, that, as far as I know, has never been reimbursed to this hospital. Although it’s been a great thing for the medical staff, the hospital probably had more financial risk, but I think it was the right thing to do. I think the CEO of the hospital did the right thing without worrying necessarily about how we’re going to pay for it; let’s just take care of the people first and that was the right thing. I think we all felt good about his decisions in that regard. It’s still coming back slowly. We’re still seeing people from St. Bernard and further out. We’re still seeing VA patients who probably do not have the same facility they’re looking to go to. We’re still putting together people’s lives."
"Then, we also had the whole deal of where they’re going to go after we do treatment and how they’re going to be cared for. They may be living with their next of kin or they may be living in a FEMA trailer. If you’re elderly in a wheel chair, it’s awfully hard to get around in a FEMA trailer. So we’re trying to coordinate a whole new set of social circumstances."
"We continue to explore options for patients who are still not connected back up. We still every week reestablish new patients as they start coming back and where they used to go and how they do use things. It’s better because certainly now we’ve got Tulane; we’ve got Touro; we’ve got University Hospital; but we have got a large number of facilities that aren’t back yet."
"This hospital did a great thing. They did provide a mechanism for the medical staff to be reimbursed by the hospital in cases where uninsured patients needed medical treatment. However, that, as far as I know, has never been reimbursed to this hospital. Although it’s been a great thing for the medical staff, the hospital probably had more financial risk, but I think it was the right thing to do. I think the CEO of the hospital did the right thing without worrying necessarily about how we’re going to pay for it; let’s just take care of the people first and that was the right thing. I think we all felt good about his decisions in that regard. It’s still coming back slowly. We’re still seeing people from St. Bernard and further out. We’re still seeing VA patients who probably do not have the same facility they’re looking to go to. We’re still putting together people’s lives.""Then, we also had the whole deal of where they’re going to go after we do treatment and how they’re going to be cared for. They may be living with their next of kin or they may be living in a FEMA trailer. If you’re elderly in a wheel chair, it’s awfully hard to get around in a FEMA trailer. So we’re trying to coordinate a whole new set of social circumstances."
"We continue to explore options for patients who are still not connected back up. We still every week reestablish new patients as they start coming back and where they used to go and how they do use things. It’s better because certainly now we’ve got Tulane; we’ve got Touro; we’ve got University Hospital; but we have got a large number of facilities that aren’t back yet."
With the overwhelming numbers of uninsured patients in the aftermath of Hurricane Katrina, medical personnel faced the dilemma of how to afford the cost. Dr. Wales provided this account of the impact of Katrina on medical care for the uninsured:
"There were a load of uninsured patients up until that point who had been provided care at Charity Hospital. We were kind of hoping . . . that we would have more Medicaid eligibility, but were thinking, "Let’s just get them on Medicaid." From what I understand, that never happened; so there really was not a big effort to provide a way to pay for the care. That was a really big concern for everybody involved. "How many millions are we going to lose? How can we lose millions to provide that care?"
Although damage to buildings and medical equipment had a significant impact on private practices, the loss of patients has made it difficult for many physicians in private practice to rebuild their practice. Dr. Wales shared the following remarks about the loss of patients:
"For instance, if you happen to be in St. Bernard Parish and you were a primary care physician or surgeon and now all of a sudden nobody lives there, you have no practice. So therefore you . . . have to find a practice with somebody that still has one. We had doctors from St. Bernard Parish who really pretty much joined our staff. We had several physicians who otherwise practiced in Orleans or St. Bernard who moved their practice lock, stock and barrel to East Jefferson, and we welcomed them with open arms. Today, they’ve been great medical additions to our staff. And if you ask them today it’s probably just now that their even close to the volume of business they had before."