ROBERT SIEGEL, Host:
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
Two years after Katrina, the city of New Orleans is still facing huge troubles with its health care system, particularly mental health care. Before the storm, there were 240 psychiatric beds in Orleans Parish - most of them were in use constantly. Today, there are only 30.
NPR's Alix Spiegel traveled to New Orleans to find out why there are so few psychiatric resources at a time when the city is experiencing an explosion in mental illness.
ALIX SPIEGEL: Cecile Tebo's shift as a mental health counselor for the New Orleans Police Department's Mobile Crisis Unit begins at 12 noon on Fridays. And by 12:03, her radio had already reported a call.
(SOUNDBITE OF POLICE RADIO)
Unidentified Man: Two, one, two, five, four. Two, one, two, five, four.
CECILE TEBO: Ten-four (unintelligible).
SPIEGEL: The job of the crisis unit, a large van equipped with leather arm and leg restraints, is to assist the police in their dealings with the mentally ill. You see, while erratic behavior by mentally ill people sometimes requires police intervention, mental illness is a disease, not a crime. And so Tebo and her partner, Earl Wilson(ph), will collect the person, do an evaluation, and then take them to a hospital where, theoretically, they will get psychiatric care.
EARL WILSON: Are you ready?
TEBO: We are ready to go. Okay?
WILSON: All right. We're on our way.
SPIEGEL: On Friday, Tebo's first caller is a tiny young woman with dirty hair to her waist, who recently came to New Orleans and who is completely disoriented. Tebo helps her into the van then sits quietly by her side while the woman sobbed into her shirt.
(SOUNDBITE OF WOMAN SOBBING)
SPIEGEL: Tebo and Wilson checked the woman into a nearby E.R. then returned to the van where on route to the next call, they play a morbid game. Tebo and Wilson try to figure out how long it will take before the desperate girl they've just dropped off will be released by the E.R. staff.
TEBO: I predict, right now, where it's going to happen, and the doctors is going to see her and he's going to release her in two hours out onto the streets of New Orleans where she has nobody here that she knows.
WILSON: I give it four hours. Because I think it's going to take that long to get to her.
SPIEGEL: It's not that the woman doesn't require hospitalization - both Tebo and Wilson believe that she does. But two years after Katrina devastated the city of New Orleans, there are almost no psychiatric beds in the city. There are only 30 adult beds in the Orleans Parish for a population of 300,000. Before the storm, there were 240 beds and that was considered low. Which is why, as Tebo explains over lunch, every time she and her partner show up at an E.R. with another patient, they meet with open hostility.
TEBO: Emergency room personnel had come out on the ramp where I have pulled up with my unit, and had attempted to get me not to come in the door, because once we come in the door the person becomes their responsibility.
SPIEGEL: Even though barring patients like this is against the law, Tebo says hospitals do it because they don't have the resources to handle the mentally ill. Then she tells me about another recent experience when she attempted to admit a highly disturbed paranoid schizophrenic into a busy E.R.
TEBO: So the doctor comes out. She comes out, arms flailing, and she said, get out, get out. I said, what? She said, you take this man out of my hospital right now. And I said, but why? And she said, because we have no psych beds. And she goes, I'm telling you right now, I want him out of my facility.
SPIEGEL: So is this possible? How is it possible that two years after Katrina in a city which suffered a trauma that clearly increased its emotional instability, there are so few psychiatric beds. It turns out this is a complicated and highly controversial question. But for Dr. James Moises, now medical director of Tulane University Emergency Department, the answer can be found at 1532 Tulane Avenue. That's the address of his former employer, Charity Hospital.
Charity was a public institution, funded by the state, which cared for the city's poor and indigent, and which by itself accounted for almost half the psychiatric beds in the city - nearly 100. During Katrina, though, the hospital's basement flooded and now it's closed despite the best efforts of Moises and his colleagues who have worked to get it up and running.
JAMES MOISES: Right after the storm in September of 2005, myself and about 200 other doctors and military personnel cleaned out Charity to get it ready to reopen as early as October of 2005 because every other hospital in the city was shuttered.
SPIEGEL: Moises says that they worked constantly for two weeks, brought three whole floors, they say, to spec. But around about the third week, they got a letter from the institution that runs the hospital, the Louisiana State University System. The letter said the doctors needed to leave the premises immediately.
MOISES: And to our surprise, the LSU System pretty much told us that if we were to go back into the hospital, they would arrest us.
SPIEGEL: Why did the LSU System do this? According to Dr. Moises, LSU had wanted to close the hospital even before the levees broke.
MOISES: They had on plans already to try to shutter and close the old Charity Hospital and build a new one. We saw the plans. They presented it in July of 2005, pre-Katrina. Well, the state legislature said, we're not giving you a billion dollars to build a new hospital. So when Katrina hit, it was the golden egg. It was an opportunity to keep the hospital closed and then convince the federal government and the state government that they needed money to build a new hospital.
SPIEGEL: Dr. Moises and other critics of the LSU System will tell you that there was no need to close. They could have gotten Charity up and running within a year. LSU, of course, doesn't see it this way.
MICHAEL BUTLER: They know very little about it and that they know is wrong, okay?
SPIEGEL: This is Mike Butler, CEO of the LSU Health Care Services Division.
BUTLER: It makes no sense from a fiscal point of view. It makes no sense from an operational point of view, no more than if you took a terminal patient, resuscitate him, and then put him back on life support. I mean, that's as a bad doing that. That building has outlived its usefulness. It was inappropriate for care and teaching before the storm, and to take money, dollars, expertise to try to get that back up, we can't do it.
SPIEGEL: Whether or not the building is viable, what is not in dispute, according to James Moises, is the effect of Charity's closure.
MOISES: When you took Charity Hospital out of commission, you created a health care crisis that continues today.
SPIEGEL: A crisis that in the case of psychiatric care is so intense that even mentally ill patients who were a threat to themselves or others are often turned away.
Cecile Tebo of the Mobile Crisis Unit talks about a man the police recently picked up - a schizophrenic who had been jumping on top of cars, threatening people with knives.
TEBO: I pull off of him, along with the police officers, about six knives, a whole bunch of ice picks. I would say, maybe 12, okay? So we go to the hospital and they were very quick for us to leave. You know, often they really want us to stay. They were, like, okay, you can go now. We'll take care of him. (Unintelligible), that's nice.
So I go, and I stopped off at a hardware store, get in my car, and who is walking down the highway but this man. It was no more than 15 minutes. And I pull over. I said, so did you even see the doctor? And he goes, nope. Don't need to see a doctor. And I said, let me ask you. Did they give you your knives and your ice picks back? And he goes, yes, ma'am, I got every last one of them because they're mine. And off he went.
SPIEGEL: Another of Tebo's schizophrenic patients was released by an E.R., returned home and stabbed his mother 17 times. Now, to be clear, it isn't just the lost of Charity psychiatric beds that has caused these problems. The issue is much broader. Because of the way that funding for the uninsured as Louisiana is organized, closing Charity, a public hospital, has forced a crisis for all the private hospitals in the city as well.
KEVIN JORDAN: We are losing the money.
SPIEGEL: This is Kevin Jordan, chief medical officer of a private hospital in New Orleans called Touro. He says that since Charity closed, hospitals like his have, for the first time in Louisiana history, taken on large numbers of uninsured patients. The consequence.
JORDAN: We know that in 2006 that we lost roughly 10.8 million. If we continue on the basis that we are going on now, we could actually lose anywhere from 15 to $18 million in aggregate this year. And then project it forward, that number could become anywhere from 20 to 25 million in the subsequent years.
SPIEGEL: With those kinds of losses, Jordan says, private hospitals can't afford to provide beds for the mentally ill. You see, while Jordan thinks that reimbursement for the core medical services his hospital is providing to the poor is inadequate, it is at least existent. Adult psychiatric beds, however, get no state or federal reimbursement at all, which is why hospitals like Touro, which had 42 psychiatric beds before the storm, can't afford to reopen those resources.
JORDAN: We can't commit to certain services that may not be well-funded or not funded at all, if - now, we have use that reserve amount of money or that pot of money in order to take care of the full broad - breath of services that are not compensated.
SPIEGEL: Even James Moises, who considers himself a mental health advocate, says he couldn't open beds at the private hospital where he works, Tulane, if he wanted to.
MOISES: As the goodwill of my heart, if I wanted to open up a 50-bed mental health ward, I would go bankrupt in two months. There would be almost no money coming in. Because I would be forced to take these patients because I have the capacity knowing good and well that every patient I take, essentially, is unfunded.
SPIEGEL: And so the city is stuck, and the situation is bad enough that people are being driven to desperate measures.
CALVIN JOHNSON: We constantly are faced with the situation of utilizing prison as the psychiatric facility.
SPIEGEL: This is Judge Calvin Johnson. He presides over a court in the city of New Orleans that deals exclusively with mentally ill people who get caught up in the criminal justice system. As judge of this mental health court, Johnson has access to whatever psychiatric resource that exists in the city, including the Parish Prison, which filled 60 psychiatric beds. And so, he says, people call him for help.
JOHNSON: People in the community, family members, call to get access. How can I get my family member into your program so my family member can get treatment? Well, I have to tell them that we don't pick people up off the street. The only way a family member can get here is if your family member is arrested. And so, what you have to do is have your family member arrested. Call the police and tell them they committed a crime.
SPIEGEL: Of course, as even Johnson will attest, there are problems with using the criminal justice system in this way. He talked about a case where a young schizophrenic man was taken to jail after the court issued a warrant for his arrest.
JOHNSON: And as best as we can piece this together, he was urinating in a urinal, and probably urinated on someone else. And he ended up being beaten to the point where he had operation on his frontal lobe and had to have a piece of it removed, because a piece of his skull was in his frontal lobe.
People who are mentally incompetent, who are in prison facilities, are very vulnerable to those individuals who aren't.
SPIEGEL: Still, Johnson feels that in many cases, it's better to have mentally ill people in jail where they can at least get consistent medical care than on the streets where they are left to fend for themselves.
So this is what it's come to in post-Katrina New Orleans. A judge, a man, by all accounts, committed to justice, is counseling the people of his city, to allow the police officers in order to get members of their own families put in jail.
JOHNSON: I don't know how America - this sounds to the rest of Americans, but that's the reality of our existence in the city of New Orleans. It may be wrong. It may be something that a judge should not do or even say, but that - that's what it takes.
SPIEGEL: The LSU System, which manages charity hospital, estimates that the replacement for Charity, the institution best able to relieve this situation, will be completed in roughly seven years.
Alix Spiegel, NPR News, Washington.
SIEGEL: There are people in New Orleans who have used Katrina as a chance to fix problems that existed before the storm.
Tomorrow on Morning Edition, we'll meet a judge who is working to reform the juvenile justice system.
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