When Hurricane Katrina struck New Orleans nearly 5 years ago, orthopaedists in the city had no guidelines. There was no book to consult on rebuilding a practice or a residency program in a city with half its population gone and the remaining half in varying degrees of psychological distress, with offices and homes destroyed, government in confusion, and loved ones dispersed around the country. They had to figure things out for themselves…and figure things out they did.

J. Ollie Edmunds Jr., MD, president of the Louisiana Orthopaedic Association, states, “While a number of orthopaedic surgeons have left the state, we have also attracted new orthopaedists from around the country. Although the population of the city remains less than before the storm, the number of patients per orthopaedist has returned to its pre-Katrina level. Our residents are now doing significantly more surgical cases per resident than they were before Katrina.”

Dr. Edmunds, professor of orthopaedic surgery and chief of hand and upper extremity at Tulane University Medical School, adds, “New Orleans still has that cultural uniqueness and charm that makes living here very special.”

Attracting new residents and surgeons Jacques S. Whitecloud, MD, a specialist in physical medicine and rehabilitation at Tulane, was thrilled to see the doors open to a trauma solution. “Although there was a temporary trauma center after Hurricane Katrina closed Charity Hospital, the new trauma center at LSU Interim Public Hospital was officially renamed “The Spirit of Charity Trauma Center” and is the only Level 1 Trauma Center in south Louisiana.

“We have at least three orthopaedic residents per year now at Tulane. With a 5-year program, that means we have 15 residents at various levels of training,” says Dr. Whitecloud. “Prior to Katrina we had six residents a year. The Accreditation Council for Graduate Medical Education (ACGME) required us to show that our residents had plenty of cases during their training. Tulane is now fully accredited by the ACGME Residency Review Committee (RRC) and has more faculty than before Katrina.

“In the wake of Katrina, only one person was doing pelvic reconstructions for all of greater New Orleans,” he continues. “Now we have three. We still face the reality that the surgeon will often be willing to come here, but the family is hesitant.”

One intrepid surgeon willing to join the orthopaedic rebuilding efforts is Paul B. Gladden, MD, who came from Jacksonville, Fla. “In deciding to come here after the storm, I factored in my wife (who is growing to love the city), and issues such as crime and weather. I decided that natural disasters are part of most intriguing major cities, and that crime is an issue in every major city. The benefits of the culture and environment of NOLA significantly outweigh the risks.”

Traveling around the United States, Dr. Gladden meets those who almost seem to think that rescue efforts are still underway.

“I am surprised to learn how naïve people outside of New Orleans are about the city’s status,” he says. “People think it is still underwater and won’t make it back. The citizens of this city have done a terrific job of rebuilding, and I am glad I am here to help. The city’s infrastructure is stable but could use some improvements; in particular, flood management and street repair need a boost. To my colleagues around the country I say, ‘don’t count us out as strong supporters and contributors to the field.’”

John A. Davis Jr., MD, a spine specialist at Tulane, came to New Orleans from Cleveland three months before Katrina. “I was going to embark on a spinal cord injury project at Charity Hospital, but the facility didn’t survive the storm and many projects were delayed. So we ended up covering the majority of orthopaedic trauma call for Tulane—without residents.”

Describing the path back for the residency program, Dr. Davis says, “As part of the approval process, the RRC has requested a copy of our hurricane plans. One obstacle to getting residency slots was that we didn’t have enough facilities. Not only are there more hospitals open now, but we have a presence at a hospital on the north shore of Lake Pontchartrain so our residents could continue training in the event of yet another hurricane.”

Ideas on further development
Fredric H. Warren, MD, chair of orthopaedics at Ochsner Health System, says that at times there is additional pressure on its surgeons.

“Ochsner has rebuilt to a full contingent of 13 orthopaedists covering all subspecialties. But the workload has changed,” he says, “because in addition to elective surgeries, we have had an increase in trauma. While there is now a Level 1 trauma center, at times they get overwhelmed and have to distribute the work. In many cases, it is not distributed equally because of the shortage of orthopaedists at some hospitals.”

The next time he has the gavel at a local orthopaedics meeting, Dr. Warren has a message: “Let’s join forces.” He explains, “We have three training programs in metro New Orleans…we should combine our efforts. While turf issues would likely arise, together we could build one of the best training programs in the country.”

Andrew G. S. King, MD, professor and chairman of orthopaedics at LSU Health Sciences Center, thinks philosophically: “There is no bad event that doesn’t have some good outcome. Everyone had to examine things in a new light, something that we don’t often get to do in life.

“The most challenging issue has been recruitment,” he continues, “because the lingering perception is that New Orleans is unsafe. Anyone who comes here will definitely have an ample supply of interesting patients. Aside from the city’s zest and fascinating history, New Orleans has always been a center of medical education.

“The days of teaching people through a charity hospital are gone from the city,” adds Dr. King. “You must teach medical professionals in integrated hospitals of academic excellence. The idea of having a hospital that is for the indigent while the rest of the population goes elsewhere shouldn’t be resurrected.”

Dr. King adds that LSU will be bringing several new people on board. “We have had a lot of interest in our program and hope to hire four or five new faculty members by the end of the year,” he says. “Most will be young surgeons just out of fellowship, something exciting for residents because they’re closer to them in age.”

Few orthopaedists have the opportunity to participate in re-creating a city’s orthopaedic infrastructure. Those in New Orleans are finding an unparalleled experience that provides rich growth…and seasoning.

Editor’s Note: In June 2006, Elizabeth Hofheinz, a senior writer for Orthopedics This Week and a native of New Orleans, interviewed four orthopaedic surgeons and a physical medicine specialist in the aftermath of Hurricane Katrina. This year, she returned and prepared this report.

Additional Links about orthopaedics in New Orleans:
Comeback in the Crescent City
Making a fresh start after Katrina
Hurricane Katrina devastates Gulf Coast
In Katrina's wake
New Orleans Lagniappe