New Orleans' Emergency Rooms Overtaxed

Many hospitals in New Orleans were disabled by flooding after Hurricane Katrina, and only six fully operational emergency rooms remain in the metropolitan area. Medical workers worry that the city's health care infrastructure may not be able to accomodate returning residents.

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New Orleans is rebuilding, and every day more people move back to start again. Medical professionals worry that the city's healthcare infrastructure might not be able to accommodate this repopulation. They point specifically to problems with emergency rooms. Since many hospitals in New Orleans were disabled by flooding, there are only six fully operational emergency rooms in the metropolitan area, and even patients in crisis are forced to wait.

NPR's Alix Spiegel has the story.

ALIX SPIEGEL: On the morning of January 6th, Ed Mason(ph) woke up early. His wife was sick, she had a bad nerve in her back which made it hard for her to walk, and she had roused her husband so he could help her to get out of bed.

ED MASON: So I got up on my side and I started around the bed, and when I did, boom, I hit the wall. My legs just gave way and my arm, I couldn't do anything with my arm, and it, just, I hit the wall. And I knew just what it was. I told my wife right then, I said, Honey, I think I had a little stroke. I said, I'm going to have to go to the hospital. That's the first thing you go, you go to the hospital right away when you have something like that.

SPIEGEL: Ed Mason knows a lot about what to do when you have a stroke. For years he was an EMS worker in Jefferson Parish, outside New Orleans, and though he is now in his 80s, he still has a desk job in the EMS office. So Mason understood that it was important to treat his stroke right away. He called his granddaughter for help and within minutes he was on his way to the nearest hospital, the East Jefferson ER. But the first sign of trouble met him at the door. When he arrived at the emergency room there were no wheelchairs at the entrance.

MASON: And they couldn't hardly find one, but they found one and they brought me in there. And I told them, I said, I had a stroke this morning. And then they set me outside, out in the waiting room, and I waited and waited and waited.

SPIEGEL: One hour passed, and then two. Before Katrina, patients at East Jefferson ER who reported that they had suffered a stroke were treated immediately, as soon as they came in the door. But since the storm, wait times have increased. And on that particular day, the nurses apparently could not take Ed Mason. He did not appear to be in immediate danger, and the ER was incredibly crowded. Mason says it was overflowing with people.

MASON: Oh, jeez, I mean, you don't know, all over the place, all around, all the seats, chairs were taken, some people standing up. And I sat out there and watched the clock go around. I just kept wondering why they didn't take me in the back, why they didn't take me in the back right away, you know. But they didn't. I just sat there and waited.

SPIEGEL: It's not clear exactly how long Mason was in the ER waiting room. Estimates range between two and four hours. What is clear is that at some point his boss, Robert Chadborn, the Chief of the Jefferson Parish EMS, heard that his employee had had a stroke, and came down to the emergency room to find Mason's face drooping and his speech significantly slurred.

ROBERT CHADBORN: At that point in time, you know, we intervened and kind of told the emergency department physicians and the emergency department nurses, look, you know, we see visible changes. And that certainly put him a little bit higher up in the triage chain. You know, but if that's happening to just one of my employees, you know, it has to be affecting everyone in the region. And my heart bleeds, because people aren't getting the care that they should be getting. And it's no fault of anyone.

SPIEGEL: The problem, Chadborn and other medical professionals say, is that flooding from Katrina took out most of the hospitals in New Orleans. And so, almost five months after the storm, with more people coming back every day, the few hospitals with functional ER units are dangerously overburdened. Again, Bob Chadborn.

CHADBORN: You know, here we are, three major hospitals functioning, three other hospitals trying to come up to full capacity. Every day is stress. I lie awake at night wondering what's going to happen the next day, you know, where are we going to bring all these people? There's no place to go, no place to offload the passengers.

SPIEGEL: Offload times, that is, the amount of time it takes for an ambulance to transfer a patient from the actual vehicle into an emergency room, is a particular problem. Because emergency rooms are so backed up, ambulance workers often must sit in the dock with patients who need to be monitored for hours.

Nationally, offload times are around 20 minutes, and before Katrina that was roughly how long it took in New Orleans. But according to Joseph Uddo, a surgeon at East Jefferson who also works on the New Orleans Healthcare Reconstruction taskforce, since Katrina, offload times are way up, usually around two hours, but sometimes more.

JOSEPH F: The off-load times have peaked out around 400 minutes. There have been times when it's been in the 400-minute range.

SPIEGEL: Four hundred minutes, that's six hours and forty minutes just sitting in the emergency room driveway. And since EMS workers are tied up monitoring patients, there are fewer ambulances on the road and EMS workers are unable to respond as quickly to 911 calls. Despite these problems, Joseph Uddo believes that patients with critical problems are still getting the care they need. If you're in an immediate life and death situation he says, you will get treatment.

UDDO: No patients with a time-sensitive illness is being postponed so the overall medical intervention of the patient's need is not being adversely affected.

SPIEGEL: But Cheryl Carter, the director of the East Jefferson Emergency Room, has a different view of the problem. When asked whether she thought that patients in critical need were getting the same kind of care that they got before Katrina, she paused for a long time.

CHERYL CARTER: I don't know if I could say that. I think that the longer EMS is tied up in hospitals waiting for beds to open up for them to off-load their ambulance, the less likely they're going to be able to respond to the 911 call. That could definitely impact someone's chance of survival. It could be the difference between life and death or it could be the difference between a functional life or a life with severe disability. So, time is of essence.

SPIEGEL: Carter says that the emergency room nurses and doctors at East Jefferson have done an incredible job under the circumstances, but there just isn't room for all the people who need help. Because of limited hospital space, patients, even chest pain patients, are routinely left on stretchers in hallways as they wait for care, and elderly patients in pain must sit in wheelchairs for hours. Carter says that dealing with these conditions has been hard on her staff.

CARTER: You know, when you can see bones sticking out of skin and you don't have beds to put people in and you're trying to relieve pain from a waiting room, those are things that tug at your heartstrings. We don't enjoy making people wait but there are limits to what you can provide when you have these kinds of numbers.

SPIEGEL: Carter says that the situation is serious enough that she would counsel people with long-term health problems to stay away from the city of New Orleans.

CARTER: If you are chronically ill and in need of ongoing medical treatment, you may want to be in a different place for your own safety.

SPIEGEL: Carter and other medical professionals are particularly worried about what will happen during Mardi Gras. The number of ambulance calls typically triples during the festival but given the limited number of hospital beds, Carter says even a very small increase in the number of ER patients will cause a crisis. She says a coalition of hospitals has been working to come up with some kind of plan but it's impossible to predict what will happen.

CARTER: I think we all have to say a prayer and cross our fingers and hope. It's going to be really tight if we can't find those resources.

SPIEGEL: Alix Spiegel, NPR News.

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