Friday, February 24, 2006
New Orleans' Uninsured Get Primitive Care
By RUKMINI CALLIMACHI, Associated Press WriterThu Feb 23, 7:34 PM ET
Angela Jaster was wearing a turtleneck when she fell and broke her arm and so for days, she didn't change her shirt because she couldn't raise her arm.
The swelling stretched the fabric. Even though the pain was nearly unbearable, she did not consider going to the hospital, because in this flooded city there is only one for the uninsured and it doesn't treat broken bones.
It was only when the pain sent her into a hyperventilating panic several weeks later that her family called an ambulance and had her taken to the convention center.
In the same concrete structure where thousands of fleeing families waited in vain for food and water, they now wait for medical care, dispensed by a skeletal staff of doctors working out of a collection of military tents.
Inside their plastic and canvas walls, the doctors can only offer the most rudimentary care: They can X-ray bones, but not set them. They can draw blood and diagnose an ailment, but not treat it beyond prescribing pills. And with no ER and no capacity to operate, they can't do much more than stabilize trauma patients before sending them by ambulance elsewhere, often far away.
These tents are all that remain of Charity Hospital, the 270-year-old institution which for generations was the medical epicenter of the city's uninsured.
With their building flooded, the doctors of the disbanded hospital set up the tents first in a parking lot, then secured a lease inside the convention center. Yet even this bare-bones service is in jeopardy, as the convention center — the city's main economic engine — plans to reopen.
In just a few weeks, the hospital has been told, it will have to move the tents once again. Their options include a vacant department store, said Don Smithburg, CEO of the Louisiana State University Medical Center, which operates Charity.
"We're moving from one temporary fix to another," he said.
In spite of the space's obvious limitations, the convention center was in fact an improvement, he said. It's centrally located and its large parking bays provide arriving ambulances good access. Unlike the exposed parking lots where doctors previously pitched their tents, they now have a roof over their heads.
But the city's sputtering economy badly needs the revenue generated by the 95 yearly conventions which in previous years pumped nearly $1 billion into local hotels, restaurants and other venues, said Sabrina Written, spokeswoman for the Ernest N. Morial Convention Center.
"It's the economic lifeblood of the city. In order for us to stand up the economy, the convention center needs to open," she said.
For the poor in New Orleans' crumbling health care system, tents have replaced buildings and plastic has replaced walls as the temporary appears to have become permanent.
The ones it hurts the most are people like Angela Jaster, a 51-year-old social worker who suffered an excruciating, yet not life-threatening, injury.
Patients in imminent danger are quickly shipped off by ambulance to one of the seven private emergency rooms in the area.
It's those who are not quite at death's door who end up waiting, often as long as six hours, to be seen. If their ailments cannot be treated with a prescription, they are referred to a hospital elsewhere. Often, those hospitals are far away.
In Jaster's case, the doctors X-rayed her arm inside a tent where images of broken limbs hung like posters. But with no orthopedist on call, she was given an appointment at a hospital a 1 1/2-hour's drive away to get a cast.
"I don't have a car. The bus leaves in the evening, they can only see me in the morning — and there's no vacancies in the hotels," said Jaster, who a month after her fall has run out of options and says she plans to let the break heal on its own, treating the pain with nothing more than ibuprofen, a non-prescription painkiller.
Hers is a medical problem treatable in two visits: One to apply the cast and a second to take it off. Those with long-term health problems requiring multiple hospital visits are among the worst off.
"If you have cancer, my advice is move. If you need dialysis, go. Get out of here. If you have any major illness and are uninsured, we cannot possibly accommodate your needs. You will die sooner if you stay here," said Dr. Peter DeBlieux, the head of emergency services for what remains of Charity Hospital.
He summed up the situation on a hurried morning outside one of the tents, as dozens of tired patients waited to be seen in metal chairs nearby, some holding their chests, others wincing under the pain of a swollen gum or infected limb.
"It's very frustrating that I can't provide the type of care our mission calls for," he said, referring to the founding of the hospital, originally called 'L'Hopital des Pauvres de la Charite," French for the Hospital of the Poor of Charity.
Before the hurricane, Charity Hospital prided itself on treating trauma victims within the "golden hour," the ideal time in which to get treatment. Now, with the nearest Level 1 trauma center located in Shreveport, 340 miles away, "the golden hour has become the golden four hours," said DeBlieux.
Hurricane Katrina closed eight of the area's 16 hospitals, erased all but 1,760 of its 4,083 hospital beds and displaced around 2,000 of its 3,500 practicing doctors, according to trade groups and industry experts.
For the community — nearly a quarter of which was uninsured before the storm — the greatest loss was Charity. Founded in 1736, the storied institution had a nationally recognized trauma center where decades ago, the inventor of the first artificial heart trained.
It was the birthplace of jazz luminary Wynton Marsalis, rap mogul Master P and Mayor Ray Nagin. But most of all, it was the medical safety net of the city's least privileged, a one-stop shop where an uninsured woman could give birth, have chemotherapy or have a stent implanted in her faltering heart all in a single, centrally located high-rise.
Although the Aug. 29 hurricane laid waste to much of the city and dispersed as many as 300,000 of its 500,000 residents, the stress on the health care system has not lessened, because many of the people who returned lost their jobs and their health coverage, said Smithburg. They tend to come in with more severe injuries, a reflection of the dangerous work by many who are rebuilding the city, he said.
For sure, there has also been progress, especially lately: In the last month, heavily damaged Tulane University Hospital reopened its downtown emergency room and 63 of its 235 beds. And on Thursday, Louisiana State University and the federal Department of Veteran Affairs announced the possibility of constructing a new medical complex.
For the time being, though, the closure of Charity has strained all of the area's open hospitals, as they struggle to take in the cases deemed critical.
"The safety net has become more like a corridor," said DeBlieux.
On one recent weekend night, that corridor emptied out into the crowded parking lot outside the Ochsner Clinic Foundation's hospital, where head nurse Flo Smith frantically scrolled down a list of patients, trying to find beds for the ill.
"I've got every bed filled. Bear with me," she yelled as a paramedic, sporting a tattoo of Yoda on his biceps, wheeled in a pale man lying motionless on a gurney. He left him parked in the hallway, alongside another gurney, this one cradling a man on a respirator.
One of the people the hospital cannot afford to move is 57-year-old Prescilla Ybarra, who was brought in by ambulance earlier that day from the convention center.
For days, her pelvic infection festered, until it became so inflamed she could no longer relieve herself by sitting down. "I put newspaper down on the floor and did it standing up," she said, embarrassed.
Hospital staff say she waited too long, turning a treatable infection into a debilitating one requiring hospitalization. It's a waiting game that more appear to be playing, as the buildingless hospital prepares to enter its sixth month somewhere other than the convention center.