Displaced Doctors

Hurricane Katrina destroyed hospitals in New Orleans and one of the city's largest hospital complexes, Charity, and nearby University Hospital took a double hit when rains from Hurricane Rita flooded them again. Many doctors have been left jobless...and homeless. We talk to a doctor about how she and other doctors are coping.

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BRIAN NAYLOR, host:

This is TALK OF THE NATION. I'm Brian Naylor in Washington, sitting in for Neal Conan.

Tomorrow on TALK OF THE NATION, a look ahead to the first Monday in October. That's when the Supreme Court returns from its summer break. There will be a new chief justice of the United States, and we'll look at some of the cases likely to come before the court.

After Hurricane Katrina, most of New Orleans hospitals were deluged, along with everything else. One of the city's largest public hospital complexes, Charity Hospital, took a double hit when it was flooded again this past weekend by rains from Hurricane Rita. Tulane University and its hospital also suffered flooding as a result of Hurricane Katrina. Its medical staff and patients were evacuated and sent to other hospitals in surrounding areas, and even as far away as Florida and Texas.

Dr. Karen DeSalvo is chief of general internal medicine and geriatrics at Tulane University. Since the hurricane, she is also the special assistant to the university president for public medical services. She joins us now by phone from New Orleans. Dr. DeSalvo, welcome to TALK OF THE NATION.

Dr. KAREN DeSALVO (Tulane University): Why, thank you. I'm glad to be here.

NAYLOR: If you have a question or comment about medical need in the aftermath of Hurricane Katrina, you can give us a call now at 1 (800) 989-TALK. Tell me, Dr. DeSalvo, where are you today?

Dr. DeSALVO: Today I am in New Orleans. I have been mostly in Jefferson Parish today, but we'll be going into Orleans later on this afternoon. For those people who are not familiar with New Orleans, parishes are sort of our county, and so the city of New Orleans consists of Orleans Parish, which is at the core, and then in sort of a C-shape surrounding it to the west and south is something called Jefferson Parish. Then there are some other parishes sort of to the east, and all that's significant mostly so that people understand where most of the devastation is right now and what the health infrastructure is that exists in those areas.

NAYLOR: Now when you say you've been to those different parishes today, or in the past couple of days, are you visiting patients, going to clinics? What kind of medicine are you able to practice these days?

Dr. DeSALVO: Well, you know, there are patients here, and those patients are not only the heroic first responders and now what I call second responders, which are the people working to rebuild our city, there are civilians left behind or who stay behind from the storm, and so there certainly is a lot of need. We are seeing patients in a number of sites in Orleans Parish and also in Jefferson. I say my principal patient is the health-care system of the greater New Orleans area; although I do occasionally get to see a single human being, it's mostly--that's the great work being done by frankly some of the doctors who stayed behind, by many volunteer doctors and a lot of our residents in training who have been working tirelessly since the storm.

NAYLOR: Tell us a little bit, what's the state of the infrastructure of the medical community these days? We saw a lot of TV pictures of darkened and flooded hospitals and heard lots of terrifying accounts of what went on in some of those hospitals and the lack of air conditioning and power. How do things stand right now?

Dr. DeSALVO: It's pretty slim. So in Jefferson Parish, we had three hospitals that were able to remain open through the storm, and they continue to function. We have another hospital now that's just starting to kick in and has been reopened and hopefully another to follow. In Orleans Parish, today is the first day that we've had a functional emergency room that was not a military unit. We've been relying and very thankful for the assets that the military has brought to us to sort of augment what was the early days in Orleans Parish, which was mostly tents and, in some cases, we were lucky to find a cement awning down by the casino to set up a table and start seeing patients. There are doctors seeing patients at gas stations, just about anywhere you can find that's protected from sun and rain.

And as time has gone on, we've gotten some assets, like mobile units, and been able to get into some buildings that were not flooded, that were doing some health care previously. But it's been pretty much a day-to-day change, you know, whatever sort of shelter you can find and however you can pull together some resources. Now that's really a lot of the ambulatory and emergency services. What we don't still have at all in Orleans Parish is any inpatient beds, with the exception of what the military is able to offer itself down at the convention center.

NAYLOR: What about Charity Hospital? That was the largest, I guess. What's the situation like there?

Dr. DeSALVO: The Charity Hospital is the safety net hospital for Orleans Parish and really the entire region, so we drew patients from other areas in the region, sometimes even from Mississippi. It served a huge population. To give you some scale, we saw about 200,000 outpatient visits a year at that clinic or at that hospital, so not only was it an inpatient bed hospital with 500 beds that were continuously full, but we saw a lot of outpatient care, and that entire infrastructure is gone. And so Charity, plus University Hospital, which is its sort of other campus, are both pretty well destroyed. The state has condemned both buildings. I've seen University Hospital as recently as a few days ago. It is in pretty bad shape. It took a lot of water. It had a lot of wind damage and now, of course, they're dealing with the residual of that, which is the significant amount of mold and rotting.

Charity Hospital--there was a valiant attempt on the part of the 82nd Airborne and the German pump guys and some faculty who had remained during the storm to try to clean it and get it open, but it does not look like, from a structural standpoint, that it was able to--we'll be able to reopen it, because it did sustain some damage from the storm. And as you say, it continued to leak a little bit from the pipes.

So those two major facilities, which not only provided care for the underinsured and the uninsured in our city and in our region, they also served as the sort of cornerstone for these two major training programs of my university, Tulane, and that also of LSU. And many of the physicians that are now here on the ground working are, indeed, those faculty and residents from those programs, who are doctors without hospitals, because all of our hospitals were wiped out from the storms. Not only Charity University, but the VA Hospital, which was our training unit, and then Tulane University Hospital, which was flooded. Now eventually, we might be able to reopen Tulane and the VA Hospital, but we're looking at a, you know, several month time horizon, and so that's why we have just picked up where we could and started to do what we can in collaboration with great volunteers, organizations that have brought us mobile units and with the military.

NAYLOR: I'd like to go to a call here, if I might. Macklin(ph) from Lafayette, Louisiana, joins us on TALK OF THE NATION. Thank you for calling.

MACKLIN (Caller): Yes.

NAYLOR: Hi.

MACKLIN: Hi. My question is, is that--OK, my sister was evacuated from University Hospital over in New Orleans, and they sent her all the way up to Duluth, Georgia, and I was wondering, you know, when she gets well, you know, how does she get back down here? I mean, we've been struck by Rita and we have no means of getting her.

NAYLOR: That's a good question. Dr. DeSalvo, can you shed any light on how are patients going to get back into New Orleans?

Dr. DeSALVO: This is a major problem that he describes, especially as it relates to the sort of secondary punch we got from Rita. We had really been relying on the hospital services, including laboratory services, in the western parishes, where this gentleman is, and that area, as many people obviously know, was really hard hit by Rita. And so now in the whole sort of southern area, we have this complete lack of infrastructure in some towns. Patients that were evacuated out of University and Charity Hospital were taken to hospitals that could accept them, and I'm sure that everyone understands that there was a problem with having availability of beds, because evacuees drove to certain distances and then were admitted, and so they just began to fly people to where they could be taken.

The specific reference of getting people back, I am sorry I can't speak to the plan for what University Hospital has. The officials who run University Hospital, which is really the state of Louisiana, I'm sure have a plan for that, and I think if you were to call the Department of Health and Hospitals in Louisiana, they could give you some guidance on that. I would certainly try to help this gentleman if offline I could get his contact information. We are, sir, the physicians that work in those hospitals and so are disconnected from the administrative functions.

NAYLOR: All right. Macklin, thanks for your call. Good luck.

MACKLIN: Thank you. I didn't hear what she was saying. I was on a cell phone, but thank you.

Dr. DeSALVO: Good luck.

NAYLOR: All right. Let's go to Jane now in Marin County, California. Jane, welcome to TALK OF THE NATION.

JANE (Caller): Yes. Yes, thank you very much. Good morning. I have a question. I heard during all the--on the news during the first hurricane, Katrina, that there was only one hospital in New Orleans that had a helipad landing. I want to know if of the three hospitals--those were the statistics I heard on the news--I want to know if that's true, number one. Number two, was that helipad able to be used? And number three, shouldn't one of the priorities for Homeland Security see to it that as many hospitals across our nation have helipad landings on their hospitals, and do you have any suggestions for Homeland Security as far as hospitals and medical care is concerned? And I'll take my answer over the radio. Thank you so much.

NAYLOR: Oh.

Dr. DeSALVO: Those are...

NAYLOR: Thanks for calling.

Dr. DeSALVO: ...excellent series of questions. So I do have several suggestions. We all do. I bring them from here, and she raises some points about the architecture of our hospitals. I'll address her specific question about the helipads first and then I'll talk about what some of the thoughts are we have about preparedness. The helipad for the three downtown hospitals was at the Superdome, and then patients were to be transported from the Superdome the two blocks to those hospitals, which clearly fell apart when those streets were flooded.

And what was done downtown was that the Tulane Hospital created a helipad on its parking deck, and they did that by coming in and knocking down lights and then first flying in lighter units. When they knew what they could support, they began bringing in more until they had some sense of what the structural soundness of the parking deck was, and they evacuated patients not only from Tulane, but also patients from Charity Hospital off of that parking deck.

The other hospitals don't have that capacity, and so they were evacuated, some through the Tulane parking deck, some through boats, some through military vehicles, including, for example, the Arkansas National Guard who came down and took the patients out of the VA Hospital.

So, you know, in retrospect, in hindsight, it sort of seems obvious that there should be some specific guidelines for building hospitals in areas, and I'll give you a very small example, in addition to a helipad, but during the storm, communications was impossible. It continues to be very, very difficult and...

NAYLOR: Dr. DeSalvo, can I--let me just interrupt you for a moment to remind our listeners and stations that you're listening to TALK OF THE NATION from NPR News.

Dr. DeSALVO: OK. I'm sorry.

NAYLOR: Thank you. I'm so--no, I'm sorry. Please, go ahead.

Dr. DeSALVO: That's OK. One of the things we learned was that the landlines worked, OK, so when the physicians in the hospital wanted to communicate with the outside world, they could use a pay phone because their cell phones wouldn't work. So one sort of regulation should be that all, you know, hospitals in potential flood zones should have telephones on the second floor, so that there is always a way to have a landline to communicate out. I mean, there's clearly some sort of basic architectural issues that we should think about.

And I guess the final point I would make is about preparedness in general of the medical profession. We certainly have a prepared plan in place for hurricanes called a code gray status. We know who's to come to work. There's expectations of how you stay there, what the allocation of duties are once you're there. But this whole idea of preparing people for natural disasters through specified training and making sure that we have ready-made kits available with things like head lamps, so that the physicians going in there don't bring what we consider normal tools, like stethoscopes, but also survival tools, which apparently was much more necessary than we had planned. And, you know, we weren't the only area that could face a natural disaster. There could be earthquakes, tsunamis, tornadoes, so I think it's something we all hope to translate to the rest of the medical community, that there's some importance that physicians get some training in disaster preparedness, not just the first responders.

NAYLOR: I'd like to take another call now. This is Julia in Savannah, Georgia. Thanks for calling TALK OF THE NATION.

JULIA (Caller): Yes. Thanks for taking my call. I'm actually a physician in Savannah, and I have one of your New Orleans patients in my rehabilitation unit, and I'm just so impressed by the creativity of both you, Dr. DeSalvo, and so much of the country and just trying to find new solutions, and, of course, someday we'll have hurricanes as well. I mean, it's just our time next. In any case, we're learning a lot. But I was concerned about the residency training programs in the medical schools. My understanding is the students have been dispersed basically. What's the plan for all that, the orthopedics, the OB/GYN? What do you do with all those people?

Dr. DeSALVO: It's a wonderful question, and I can tell you that the first week of post-storm--well, once we got everyone out of the hospitals, the next week was really devoted to thinking about jump-starting our medical school. And as you've read in the paper, what we decided to do is remove the medical students and the undergrad students for us from New Orleans where there's really no habitable place. There's no sewage. There's no water in the heart of the town, where they live, and put them in Houston. So principally, our medical students and our undergraduate teaching programs are now in Houston, and we are integrating them into very kind hosts of Baylor and UT-Houston, Galveston...

JULIA: Yeah.

Dr. DeSALVO: ...and A&M. What we've done with our health staff is try to keep as many of them in south Louisiana as possible, again, because they want to be here because they want to be part of the recovery and because we want to be on deck, if you will, to open up hospitals as they--or excuse me, to staff the hospitals as they open.

JULIA: OK.

Dr. DeSALVO: And so many hospitals in the area have been really welcoming and have allowed us to do temporary training sites in regional hospitals, so that's been Tulane's plan and, indeed, we've been able to put for medical about two-thirds of our training program right here in the southern Louisiana area so that at any time, we're able to serve the people of the region. And I want to say that the residents have been particularly wonderful. They have not stopped a beat, and they have been really committed to this city, and I'm incredibly proud of the creativity and work that they have done.

NAYLOR: Tha...

JULIA: Well, thanks so much for taking my call.

Dr. DeSALVO: Mm-hmm.

NAYLOR: Thank you, Julia, for calling. Dr. DeSalvo, in the last couple of moments we have here, I just wanted to ask you a little bit about the community of physicians in New Orleans. I imagine many of you all suffered the same problems as the rest of the population, losing your homes, being evacuated. What's the--have doctors--coming back? Do you expect that most physicians will return and resume their practices in New Orleans?

Dr. DeSALVO: The challenge is that most physicians in private practice, they're essentially small business owners. And until we can think of some legislative ways or some regulatory ways to lighten the load, the tax load, etc., on small business owners, it's going to be hard for them to set up shop. There's also significant reimbursement issues for them. Physicians associated with academic medical centers, like myself, like those at LSU, and those at the large hospitals, such as Ochsner, who are employed, are able to continue working, and--because we do have a better source of income. That's mostly who we're seeing now. It's a great unknown. We don't know how many will come back. We don't know how long that will take, and part of that is we don't know where they could possibly work, since we lost completely--much of the infrastructure in Orleans Parish. The...

NAYLOR: Well, thank you for your time today. Dr. Karen DeSalvo is chief of general internal medicine and geriatrics at Tulane University. Since Hurricane Katrina, she is the special assistant to the university president for public medical services.

This is TALK OF THE NATION from NPR News. I'm Brian Naylor in Washington.

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