One hospital struggles with more indigent care, staffing shortagesThe year 2006 will be one of tremendous change for the healthcare community in New Orleans as we put the cataclysmic events of the past year behind us and rebuild our healthcare delivery system. These changes will continue for at least a decade. Pre-Katrina, there were 14 hospitals in New Orleans, serving a population of 900,000. Today, there are just eight hospitals serving 550,000 residents in our region. Charity Hospital, the city's primary source for care of the indigent and medical training, was destroyed in the storm. So while the population is smaller, there are far fewer hospitals to care for the returning population. Our hospital, West Jefferson Medical Center, located across the river from New Orleans in Marrero, was spared the physical damage of Katrina, yet we are now faced with an increased indigent patient population resulting from the closing of so many local hospitals. We are also challenged by a staffing shortage. We will be part of the base that rebuilds the wonderful New Orleans area, but we can only imagine what the new New Orleans will look like. Our challenges began immediately after the storm, when our hospital's emergency department was inundated with mostly nonemergency patients. West Jefferson saw as many as 600 patients daily, up from a pre-Katrina average of 180. Our daily inpatient census jumped from 240 to more than 300 seemingly overnight. We immediately sought assistance from a federal disaster medical assistance team, or DMAT, which arrived a week later. For eight weeks, team members treated thousands of patients in medical tents erected just outside of our emergency room. The DMAT left in mid-November, and we partnered with a local community health clinic to fill the void by establishing a primary-care clinic on our grounds. The clinic will remain open indefinitely as we explore other ways to accommodate the community's increased need for access to care. The increased burden of this indigent care, coupled with reduced revenue and a commitment to pay and support our staff, will result in West Jefferson Medical Center posting an operating loss of $30 million for the fiscal year ended Dec. 31, 2005. Congress approved $42 million for our hospital as a disaster loan; however, our loan amount has been reduced to $31 million. It is our hope these loans will ultimately be forgiven to avoid placing hospitals in serious financial straits. We are optimistic about solving our staffing problems. As a result of the storm, 106 employees were not able to contact us and 465 were forced to take leaves of absence. We ramped up our recruiting efforts just as quickly as we could, running radio advertisements and holding job fairs. Our quick work paid off. We have hired more than 400 new employees, and though we still need to hire more nursing staff, we are managing our needs. We have received more than 10,000 applications from people eager to return to New Orleans. This leaves me with a great sense of optimism for our city's future. Katrina's aftermath has taught us to reassess our plans. The emergency department may need to be on the second floor to avoid a rerun of the harsh scenarios experienced in the now-closed hospitals of New Orleans. When Katrina hit, we were building a new power plant 20 feet above sea level, which will allow us to exist independently for up to seven days. It's scheduled to be finished early this year. We're adding our own well, too, so we won't be dependent on the public water supply. The lack of a Level I trauma center continues to be an unresolved issue. West Jefferson Medical Center, along with three other area hospitals, is designated to receive trauma patients until a Level I trauma center can be restored. These four facilities are handling the load for now, but a well-developed plan must be crafted to manage the trauma and indigent patient population of the region. Both the Louisiana State University and Tulane University medical training programs have relocated to other cities because of the closure of Charity Hospital. We are working with both programs to help them return. I feel strongly that the Charity Hospital system as we knew it should not be rebuilt and instead replaced with a community-based healthcare system. We continue to focus on the resources needed to provide care to a growing population. For example, we are increasing the number of primary-care physicians in Family Doctors, the physician-practice division of our healthcare system. We are buying land in the growing area of our market to anticipate new housing there. And we are exploring changes in payment from Medicaid and Medicare for proper reimbursement. Overshadowing this entire landscape are the levees that failed during Katrina. They must be secure for people to repopulate the area. If they are secure, businesses and schools will return and invest in the community. On Dec. 15, President Bush committed more than $3 billion to fortifying our levees so they are stronger than before. So while there is much work to be done, there is reason to be hopeful on many fronts. Note: West Jefferson Medical Center was without full power, air conditioning, running water and ample food supplies for several days after Katrina. Yet, the hospital remained open throughout the entire ordeal.
Beginning to rebuild
(Originally published Jan. 2, 2006)
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