The extensive flooding on Tulane Avenue made reaching the local medical facilities impossible except by boat or canoe, as shown here, or by helicopter. [Photo
courtesy of J. Ollie Edmunds Jr., MD, and Duane Belongie, MD.]

AAOS Now

Published 8/1/2007
|
Jennie McKee

It’s not always easy in the Big Easy

No one expected recovery to be quick, but significant challenges remain

J. Ollie Edmunds Jr., MD, remembers how it was in August 2005. “Levees on the 17th Street canal broke and overtopped, releasing oily, brown, brackish water into more than 80 percent of the city of New Orleans,” he recalls. “The Superdome’s roof was ripped off, coffins floated out of graves, hospitals and orthopaedist’s offices were flooded, and the lower 9th ward looked like Hiroshima after the atomic bomb hit.”

Dr. Edmunds describes the enormous effect the storm had on the city’s medical community.

“New Orleans physicians had their lives turned upside down. In many cases, their practices were gone, long-established patient referral patterns were gone, and professional relationships disappeared.”

“It’s hard for Americans to imagine a major city without electricity, civil services, postal service, telephone service, transportation capabilities, or adequate police protection,” agrees Ben F. McKown, director of the Louisiana Orthopaedic Association (LOA). Physicians, patients, and nurses left in droves. Two years later, an estimated 200,000 displaced New Orleanians are still living in other cities and towns around the nation.

“We’ve had a horrible time rebuilding our membership contact information,” says McKown, due in part to the extreme disruption in postal service after Katrina. It was difficult for the LOA to keep tabs on its members as orthopaedists moved first to temporary offices and then to more permanent locations.

Although many orthopaedists have returned to New Orleans, the exodus of healthcare workers—as well as the different patient demographics in the city, which include a higher number of uninsured, migrant workers—have affected their practices and livelihoods.

Few hospitals and fewer staff
Dr. Edmunds estimates that about half of the hospitals in New Orleans are back in operation, and says that the resources of many are stretched to capacity.

“Three of the five hospitals I practiced in are still closed,” he says. “It’s really hard to reopen hospital beds if nurses, cooks, and orderlies are living in trailers from the Federal Emergency Management Agency (FEMA), if they can get housing at all. The limited numbers of open hospitals are overtaxed, understaffed, and overflowing.”

Both mental health care and trauma care face serious challenges; with the closure of “Big Charity” Hospital, New Orleans is without a Level I trauma center. The state-run “Little Charity”/University Hospital has been renovated, however, and is now open for trauma patients, notes Dr. Edmunds.

According to Barry Riemer, MD, the biggest problem the city’s healthcare services face isn’t the physical infrastructure, but the lack of nurses and other healthcare staff.

“We don’t have nurses to open beds,” says Dr. Riemer. “We could solve this problem in a day if we had adequate nursing staff. We also have problems attracting other support personnel, like medical assistants,” he continues, adding that some local fast food restaurants are paying new employees more than hospitals can pay.

The impact of the uninsured
Treating the influx of migrant laborers who moved to New Orleans to help rebuild the city is also challenging. Most are uninsured and cannot afford to pay for care, making it harder for orthopaedists to make a living.

“Uninsured, unemployed people are relying on care from private hospitals,” says Donald C. Faust, MD. “The state has given some funding to the hospitals, but they haven’t given any funding to the doctors who are on call and treating these patients.”

“When patients come in the emergency department under the Emergency Medical Treatment and Active Labor Act (EMTALA) and the Consolidated Omnibus Budget Reconciliation Act (COBRA), you can’t turn them away,” says Dr. Edmunds. “Even if they don’t have social security numbers or are illegal aliens, the hospital still has to evaluate and treat or transfer them. Basically, the hospital is taking care of them for free, and so are the physicians on call—the orthopaedic surgeons and anesthesiologists. That’s a big problem.”

Looking to the future
Dr. Edmunds loves New Orleans and its rich cultural heritage, but acknowledges that he’s not sure what the future holds for the Big Easy.

“What’s going to happen in the future? I don’t really know. The rebuilding is going to be slow, but it’s well worth the effort. Be patient and watch the trees grow in the forest; don’t count the rings inside of each tree,” he says, using a metaphor from his hobby of growing trees to describe how he feels about the reconstruction and revitalization of New Orleans.

“Good things are happening that haven’t been reported in the media,” says Raoul P. Rodriguez, MD. “The school system is doing better. Next year at Tulane, we’ll have the largest first-year class we’ve ever had. The convention center is full and operational, and housing opportunities are opening up. The patient population is slowly increasing. I think it’s just a matter of time for areas of the city that were devastated by the hurricane to be built back up.”

Although the crime rate, which Dr. Edmunds acknowledges is still high in parts of the city, has received a significant amount of media attention, Dr. Rodriguez feels that the prevalence of crime in the city has been exaggerated.

“As far as we’re concerned, the city’s very safe,” says Dr. Rodriguez. “In most big cities, you do have crime problems. I think that’s something that the press has taken a little bit out of proportion.”

Felix “Buddy” Savoie III, MD, shares Dr. Rodriguez’s optimism. “There are lots of buildings to be torn down and new buildings to be built, schools to restructure, neighborhoods to re-form, and people and businesses to attract,” he says. “Taking care of the people involved is a challenge and a mission. It may take many years, but I believe with the wonderful people here it will happen.”