[Senate Hearing 109-611]
[From the U.S. Government Publishing Office]
S. Hrg. 109-611
LESSONS LEARNED FROM KATRINA IN PUBLIC HEALTH CARE
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HEARING
BEFORE THE
SUBCOMMITTEE ON BIOTERRORISM AND PUBLIC HEALTH PREPAREDNESS
OF THE
COMMITTEE ON HEALTH, EDUCATION,
LABOR, AND PENSIONS
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
SECOND SESSION
ON
EXAMINING LEGISLATIVE IMPROVEMENTS TO ENSURE OUR NATION IS BETTER
PREPARED FOR PUBLIC HEALTH EMERGENCIES
__________
JULY 14, 2006 (New Orleans, LA)
__________
Printed for the use of the Committee on Health, Education, Labor, and
Pensions
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
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COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS
MICHAEL B. ENZI, Wyoming, Chairman
JUDD GREGG, New Hampshire EDWARD M. KENNEDY, Massachusetts
BILL FRIST, Tennessee CHRISTOPHER J. DODD, Connecticut
LAMAR ALEXANDER, Tennessee TOM HARKIN, Iowa
RICHARD BURR, North Carolina BARBARA A. MIKULSKI, Maryland
JOHNNY ISAKSON, Georgia JAMES M. JEFFORDS (I), Vermont
MIKE DeWINE, Ohio JEFF BINGAMAN, New Mexico
JOHN ENSIGN, Nevada PATTY MURRAY, Washington
ORRIN G. HATCH, Utah JACK REED, Rhode Island
JEFF SESSIONS, Alabama HILLARY RODHAM CLINTON, New York
PAT ROBERTS, Kansas
Katherine Brunett McGuire, Staff Director
J. Michael Myers, Minority Staff Director and Chief Counsel
__________
Subcommittee on Bioterrorism and Public Health Preparedness
RICHARD BURR, North Carolina, Chairman
JUDD GREGG, New Hampshire EDWARD M. KENNEDY, Massachusetts
BILL FRIST, Tennessee CHRISTOPHER J. DODD, Connecticut
LAMAR ALEXANDER, Tennessee TOM HARKIN, Iowa
MIKE DeWINE, Ohio BARBARA A. MIKULSKI, Maryland
JOHN ENSIGN, Nevada JEFF BINGAMAN, New Mexico
ORRIN G. HATCH, Utah PATTY MURRAY, Washington
PAT ROBERTS, Kansas JACK REED, Rhode Island
MICHAEL B. ENZI, Wyoming (ex
officio)
Robert Kadlec, Staff Director
David C. Bowen, Minority Staff Director
(ii)
?
C O N T E N T S
__________
STATEMENTS
FRIDAY, JULY 14, 2006
Page
Burr, Hon. Richard, Chairman, Subcommittee on Bioterrorism and
Public Health Preparedness, opening statement.................. 1
Landrieu, Hon. Mary L., a U.S. Senator from the State of
Louisiana, opening statement................................... 42
Alexander, Hon. Lamar, a U.S. Senator from the State of
Tennessee, opening statement................................... 42
Cerise, Fred, Secretary, Louisiana Department of Health and
Hospitals; Dr. Sharon Howard, Division of Public Health,
Louisiana Department of Health and Hospitals; Donald R.
Smithburg, CEO, Louisiana State University Healthcare Services
Division; Dr. Janice Letourneau, Assistant Dean, Louisiana
State University Health Science Center; Dr. Paul K. Whelton,
Senior Vice President for Health Sciences and Dean, Tulane
University School of Medicine; Dr. Patrick J. Quinlan, CEO,
Ochsner Health System; Dr. Jeffery Rouse, Deputy, New Orleans
Coroner's Office; and Gery Barry, CEO, Blue Cross and Blue
Shield of Louisiana and Vice Chair, Louisiana Healthcare
Redesign Collaboration......................................... 3
Prepared statements of:
Donald R. Smithburg...................................... 9
Janice Letourneau........................................ 14
Paul K. Whelton.......................................... 19
Patrick J. Quinlan....................................... 28
Gery Barry............................................... 38
(iii)
LESSONS LEARNED FROM KATRINA IN PUBLIC HEALTH CARE
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FRIDAY, JULY 14, 2006
U.S. Senate,
Subcommittee on Bioterrorism and Public Health
Preparedness, Committee on Health, Education,
Labor, and Pensions,
Washington, DC.
The subcommittee met, pursuant to notice, at 1:39 p.m. in
the U.S. Supreme Court Hearing Room, Louisiana U.S. Supreme
Court Building, 400 Royal Street, New Orleans, Louisiana, Hon.
Richard Burr, chairman of the subcommittee, presiding.
Present: Senators Burr, Alexander, and Landrieu.
Opening Statement of Senator Burr
Senator Burr. Good afternoon. Let me take the opportunity
to apologize to the panelists that we have for our tardiness.
We'll apologize profusely to the next group, that we will loop
back around.
I want to thank Senator Alexander for his work at setting
up this two-subcommittee field hearing together in New Orleans.
We're grateful to the State of Louisiana and to the city of New
Orleans, to Senator Landrieu, for the opportunity to learn from
the witnesses on these two issues of critical importance,
education and public health preparedness, which will be the
subject of the afternoon hearing.
I want to thank all of you for your willingness to attend
the Subcommittee on Bioterrorism and Public Preparedness
hearing. I'd like to take this opportunity to welcome the
panelists and to thank them for taking the time to share your
experiences and lessons learned from Hurricane Katrina. I know
you are all extremely busy and I along with the entire
subcommittee appreciate your willingness to be with you today
and, more importantly, you with us.
It's been almost a year since Katrina touched the shores of
Louisiana and devastated so much of this beautiful city and the
Gulf Coast. Its impact on the public health and the health care
system has been significant. Then your State experienced
Hurricane Rita. I might add here as the Senator from North
Carolina, we're used to the annual summer experience of storms
as well.
Rita additionally damaged the health care system in places
like Cameron Parish, which forced several hospitals to
evacuate. Today your testimony will help us make the necessary
legislative improvements to ensure our Nation is better
prepared for public health emergencies, whether natural,
deliberate, or accidental. This field hearing will assist us as
we move forward to reauthorize the Public Health, Security, and
Bioterrorism Preparedness and Response Act. That legislation,
which was passed in 2002 shortly after 9-11, began to move this
country in the right direction. But as we have seen from the
effects of Hurricane Katrina, it has not done enough. We must
ensure that the failures of Katrina are not repeated. We can
and must do better.
One of the pressing issues that our public health and
medical response system faces is our ability to increase our
capacity to take care of people in large public health
emergencies. We need to think systematically about how to
develop surge capacity within our health care delivery system.
We must also maintain a well-trained and well-prepared public
health workforce. This is no small task since 45 percent of the
current health workforce is eligible for retirement in the next
5 years.
In relatively short order, I hope we will produce and mark
up legislation that addresses a number of lessons learned from
this disaster. I think your testimony today will provide
critical input into that effort. I certainly look forward to
your testimony.
I want to once again thank Senator Landrieu for the
incredible help that she has been, but more importantly the
incredibly loud voice she has been for this community and for
this State, and specifically for the health care delivery
system. It is impossible for us in Washington, DC., to
understand the magnitude of the disaster, and to also
understand the tremendous magnitude of the challenge to start
over again. We certainly are appreciative for her insight. She
has been a tremendous spokesperson.
We have foregone any other statements from the members and
because we've truncated the time a little bit let me give you
the rules. I will introduce our entire group and then we'll
start from left and move right, if that's okay, from my left
and move to the right. Each of you have 8 to 10 minutes to
share with us those things that you think are most important. I
hope that fits within the confines of what you had planned.
Our panel today is made up of a number of individuals, and
I'll try to get it in the correct order: Fred Cerise,
Secretary, Louisiana Department of Health and Hospitals; Sharon
Howard, Louisiana Department of Health and Hospitals, Division
of Public Health; Don Smithburg, CEO, Louisiana State
University Health Systems, which is I believe 9 of the 11
public facilities; Dr. Letourneau, Assistant Dean, LSU; Dr.
Whelton, Dean, Tulane University School of Medicine; Dr.
Quinlan, Ochsner Health Systems, a four-hospital system; Dr.
Rouse, Deputy, New Orleans Coroner's Office; and Gery Barry,
CEO, Blue Cross and Blue Shield, and also serves as the Vice
Chairman of the Louisiana Healthcare Redesign Collaboration.
With that, Dr. Cerise.
STATEMENTS OF DR. FRED CERISE, SECRETARY, LOUISIANA DEPARTMENT
OF HEALTH AND HOSPITALS; DR. SHARON HOWARD, DIVISION OF PUBLIC
HEALTH, LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS; DON
SMITHBURG, CEO, LOUISIANA STATE UNIVERSITY HEALTHCARE SERVICES
DIVISION; DR. JANICE LETOURNEAU, ASSISTANT DEAN, LOUISIANA
STATE UNIVERSITY HEALTH SCIENCE CENTER; DR. PAUL WHELTON,
SENIOR VICE PRESIDENT FOR HEALTH SCIENCES AND DEAN, TULANE
UNIVERSITY SCHOOL OF MEDICINE; DR. PATRICK QUINLAN, CEO,
OCHSNER HEALTH SYSTEM; DR. JEFFERY ROUSE, DEPUTY, NEW ORLEANS
CORONER'S OFFICE; AND GERY BARRY, CEO, BLUE CROSS AND BLUE
SHIELD OF LOUISIANA AND VICE CHAIR, LOUISIANA HEALTHCARE
REDESIGN COLLABORATION
Dr. Cerise. Thank you, Senator, and thank all of you for
your interest and your visit today and your support over the
past year as we try to pick up the pieces and move forward.
In terms of looking at public health preparedness and
lessons that we've learned, I think the overriding lesson that
we've seen is a basic shift in our thinking of what we make of
a traditional public health disaster, in terms of infectious
disease and outbreaks of disease and that type of thing, in
regards to what we saw after this disaster, and that is just a
total disruption of the health care delivery system and along
with that lack of access to care for people with chronic
disease, people with urgent needs.
There was a lot of talk about and concern about outbreaks
and toxic soup that people were in, and it turns out that we
didn't have toxic soup and we didn't have outbreaks of
diseases. We were doing surveillance on all of our shelters and
hospitals. That didn't materialize, but probably the access to
primary care providers, access to specialty providers, access
to pharmaceuticals, routine things like that that were
available before the storm, were challenged for some in the
population, the uninsured and Medicaid population, but became a
problem for everyone and remains a problem for some months
later after this episode.
So I'm going to go through a few components that stand out
for me that would help us in the immediate phase and in the
recovery phase as we look back and see the lessons learned. I
can tell you, the whole experience exaggerated the deficiencies
that we have in the system today. They just stood out. But it
also accelerated some of the improvements that we were
embarking upon beforehand and it's brought together people to
move some of those improvements ahead. I'm going to give you a
few examples.
First, in terms of an emergency response network, we do not
have a coordinated statewide emergency response network in
Louisiana. That was something that we could have used at the
time. We did okay in terms of phone calls and contacts with
providers, but it was all pieced together in the midst of the
hurricane, and that's how we moved people around the State. We
know that having an emergency response network with electronic
real-time information from providers across the State on what
is your capacity, what can you accommodate, are important
things. It is an important system to have in place, not only at
the time of a crisis like this, to handle surge capacity as you
discuss, but also it's the kind of system that can be useful
and save lives every day when you're looking at time-sensitive
illnesses, to be able to direct emergency personnel or someone
with trauma or heart attack or stroke to the right place that's
got the right capacity to treat that person with the right
resources.
So, coming out of this, our legislature did appropriate
$3.5 million for some of the manpower and basic infrastructure
to develop what's called the LERN system, Louisiana Emergency
Response Network. It is not all we need in terms of
connectivity to connect first responders to the ultimate
hospital that people will be brought to, but, as I said, this
kind of highlighted the need for that and it has jump-started
some of the response there.
Another area where the deficiencies were highlighted had to
do with information technology. You're probably well aware of
this, the many number of people who were dispersed and did not
have adequate information on the health care, the health care
needs of those individuals as they were dispersed, and paper
records had either been destroyed or they were just
inaccessible at the time.
There were a couple of striking examples of where things
worked well. The VA system, as you know, has a very nice
electronic record. As veterans were displaced across the
country, they were able to access those records and be well
taken care of.
There was another private-public effort that happened in
the immediate 7 to 10 days after the hurricane called
katrinahealth.org, where, using information from the major
chain drugstores, from the major health plans, from Medicaid,
using claims data, the pharmacy information was put together
and as a physician I could call, I could call the AMA and they
would verify that I am who I say I am, give me a password, and
I could go to this Web site and type in a person's name, a date
of birth, and a zip code, and if I'm from an impacted area, and
it would give me the last 6 months of that person's
prescription drug history, which actually pieces together a
fair amount of the medical history from that.
That was put together within 7 to 10 days after this
incredible tragedy and was not--demonstrates a couple of
things. One, you can do this type of thing. You can put these
things together. The limitations oftentimes are human
limitations more than the technical ability to put these
records together.
In the aftermath of Katrina we were able to work with the
office of the National Center for Health Information
Technology. Our State received a grant to help work with the
Gulf States Collaborative to develop a prototype for a health
information exchange to be able to share information that's
electronically available now across providers, among providers,
so that we will be able to access patient information in
different sites, not just at the source where the original
paper record resides.
We obviously have a long way to go here. The interoperable
piece has been jump-started and pushed ahead briskly because of
the communications now that have occurred as a result of people
working together in the aftermath of the hurricane, but that
is--I think it was the highlight of the deficiency of our
health care system, not only in Louisiana, but it's a
deficiency nationwide, and that pushed to develop
interoperability among various medical records not only in the
case of a tragedy, but in the case of routine everyday office
practice, to have information available for the patient
wherever that person happens to show up. It improves safety, it
improves efficiency and those types of things.
Another area that we were challenged in, again having to do
with people with chronic disease, was access to
pharmaceuticals. Again, traditionally in public health
disasters we think about things like having access to
biologicals and things, antidotes for biological weapons, and
that sort of medicine stockpile that is available. The
stockpile we needed was the stockpile of medicines for blood
pressure and diabetes and heart disease and things like that.
As people were displaced, obviously many people then didn't
have medication, didn't have access to that information. So
that's another system that was put in place in the immediate
aftermath, to try to piece that together, and going forward it
has continued to be a challenge for us as support systems for
people who do not have regular access to pharmaceuticals now
had to be recreated. So that remains a challenge for us today.
Then finally, I'm going to end on the issue of workforce
and sharing and I'm going to say a few words about that as
well. But I'll just say that in the immediate aftermath of the
hurricane there was an outpouring of volunteerism. We had
Federal teams come into the State and there was a lot of
support for the immediate aftermath. Sustaining that response
has been difficult. Making the transition from those Federal
teams to using State and local resources has been a challenge.
The reimbursement mechanisms are not set up to be able to put
those teams in place. The rules are to fund those teams that
come in from out of State to do that work. To be able to have
the flexibility to engage local providers, nurses, physicians,
and other health workers early on in the process to make that
transition could keep those people engaged and help limit the
spread of those workers that ended up spreading all over the
country and also would provide that source of care for those
individuals in smaller practices and the larger practices as
well in trying to get back on their feet, to deal with the
disconnect then in the number, the lack of volume of regular,
routine visits to support that practice.
So that's a very brief description of how I've seen the
public health crisis in terms of really looking at it in terms
of disruption of the delivery system for a lot of people that
rely on that delivery system for routine care today.
Senator Burr. Thank you, Dr. Cerise, and if I would read
your name tag up there versus my writing I wouldn't have
mispronounced your name. I apologize.
Dr. Cerise. Oh, you're not the only one that does that.
Senator Burr. Sharon.
Dr. Howard. I think the lesson that we learned with regard
to the public health workforce is that our public health
infrastructure is extremely fragile, and I say it's fragile
because of some of the things that the Senator already talked
about: the fact that 45 percent of the workforce in public
health is eligible for retirement. In addition to that, we have
a shrinking workforce. I would think in the last 5 years we've
lost over 300 nurses.
The other concern that we have with regard to the public
health workforce is that because of the changing role of public
health, because of the fact that we are prepared to protect the
health of the public as it relates to a manmade disaster or a
natural disaster, our skill level has to be enhanced. We in
public health are used to doing preventive health. We're used
to doing those things that we need to do to keep the public
healthy. But now what we have to do is we have to enhance our
skill set because, as Dr. Cerise said, we're charged with the
responsibility of manning special needs shelters, and when you
staff those special needs shelters those individuals who are in
those special needs shelters are those individuals who are
chronically ill or who have acute medical problems, and our
workforce is used to dealing with babies and our workforce is
used to doing family planning, and our workforce is used to
doing immunizations.
So one of the lessons that we have learned is that we're
going to have to enhance our skill set in order to be able to
address our changing role in public health because of the fact
that we have a shrinking workforce in public health. We have no
redundancy. We have a lack of redundancy in staff, and that was
quite evident during the response to Hurricane Katrina and the
response to Hurricane Rita. Because of that lack of redundancy,
we had people who were on their feet for hours and hours and
hours.
We did what we usually do. We packed 3 days of clothes, and
they're not the best of clothes, and you go to work. So we did
that. We packed our 3 days of clothes and it ended up being 3
months, 4 months, 5 months, 6 months.
We have a responsibility after the storm. The
responsibility that we had after the storm on the environmental
side is that we have to make sure that the water is safe for
people to drink and we have to make sure that people get the
information that they need to get in order to be able to come
back into the community after the disaster and be safe.
We issued 135 press releases during the whole response to
Hurricane Katrina and for Rita. Normally in the span of time we
would issue 35 press releases. But 135 press releases delivered
everything from having that N-95 mask on when you went back in,
to dealing with, in the beginning of the response, what you
need to take with you to have your medications.
I'd just like to end with your understanding that the
public health infrastructure is fragile. But just talking about
some of the things that we did with that public health
infrastructure: We opened up special needs shelters across the
State in the unimpacted area; We took care of over 2,000
special needs patients; We sent strike teams--we're talking
military stuff now--we sent strike teams to general shelters
and to special needs shelters. Those strike teams were made up
of our staff and our volunteers and our LSU partners, etcetera,
to do immunizations.
We did surveillance because we have a responsibility to
check on injuries. We have responsibility to make sure that
when you have people in these closed confined areas, large
numbers of people, that disease doesn't spread. So we had
surveillance teams. We called them drop-down surveillance
teams. And we had an electronic system that we were able to
record that information in.
We did 110,000 tetanus shots. We managed an enormous
donated pharmacy of pharmaceuticals and medications that were
given to us from just the well-meaning and wonderful people
from across the country. We managed our strategic national
stockpile. Again, like Dr. Cerise said, we didn't have a lot of
the things that we needed in there because basically that
strategic national stockpile is configured in such a way that
it is to take care of biological kinds of things. We needed
antibiotics, we needed IV fluids, etcetera.
So I would hope that something could be done on a
Congressional level to kind of change the composition of that
so that it can be for manmade disasters as well as natural
disasters.
I just would like to end with saying that we could not have
done this without the help of our Federal partners. We could
not have done this without the help of our private hospitals
and our public hospitals in Louisiana. We also had the
responsibility of credentialing over 2,000 volunteers that came
to the State to help us.
Senator Burr. Thank you, Ms. Howard.
Don Smithburg.
Mr. Smithburg. Thank you, Mr. Chairman, members of the
committee. I'm Don Smithburg, CEO of the LSU Hospitals and
Clinics here in Louisiana. We thank you for your interest in
health care in Louisiana, especially after Katrina and Rita. I
particularly want to thank and recognize and acknowledge
Senator Landrieu for her extraordinary leadership both here in
the affected area and of course on Capitol Hill. I also thank
you for your invitation to appear here today and the
opportunity to at least attempt to answer any questions that
you may have about the public hospital system and what we've
learned from the catastrophe and about how we are preparing for
the future.
I represent 9 of the 11 State public hospitals and over 300
clinics that traditionally have been called here in Louisiana
the charity hospital system. In other States what would be
known as a county hospital is actually under the state-owned
governance structure through LSU here in Louisiana, and all of
those public hospitals that you might know of as being locally
governed is actually under the State aegis here.
Our hospitals and clinics constitute the health care safety
net, as a result, for the State's underinsured and uninsured,
particularly the working uninsured. We see two-thirds of our
patients have traditionally been hard-working, employed
Americans. Louisiana has one of the highest rates of
uninsurance in the Nation. Over 20 percent of the population
have nothing and another 21 percent of our citizens in
Louisiana are on Medicaid, and that was before Rita and
Katrina. Since the hurricanes, there is an estimated 120,000-
U.S.-person increase in the ranks of the uninsured as
businesses fail because of the storms' destruction.
The LSU hospitals have also played an integral role in
supporting the education programs of our medical schools and
health training institutions. Our flagship hospital here in New
Orleans is commonly known as ``Big Charity.'' It's actually two
facilities, the charity hospital and university hospital,
operated as one medical center umbrella. It also includes the
only trauma center in south Louisiana. There were thousands of
Tulane and LSU students and residents in training when Katrina
hit here in New Orleans and when her floods forced the multiple
failures in the levees.
In recent months, LSU and the Department of Veterans
Administration have been engaged in an historic and
collaborative effort that we hope will result in rebuilding one
chassis that will support two hurricane-hardened hospitals,
both able to better serve their respective patient populations
and conserve Federal and State resources at the same time.
Now, what happened at Big Charity when the levees failed?
In brief, the city's streets and hospital basements flooded.
Power to the city was lost and hospital emergency generators
were able to operate for only a short time because of a lack of
access of fuel to feed those generators. Supplies of essentials
such as food and water were not allowed to be brought in to
augment our own depleted stores. Restrooms did not work and
maintaining sanitary conditions was difficult at best. External
communications were exceedingly limited.
The result was that patient care and safety was
compromised, especially for such critically ill patients as
those on ventilators. Staff in the hospitals worked heroically
to care for patients, manually ventilating some for hours and
then for days. It became imperative to evacuate both patients
and staff, but the hospital itself had no means to do so.
The committee is perhaps looking for the lessons from this
disaster with an eye toward improving not only the Gulf Coast
emergency preparedness, but also that of a potentially
vulnerable Nation. From our perspective there were several
general lessons and many others at the hospital operational
level. On evacuation, there proved to be in our view inadequate
ability or insufficient priority to evacuate patients and staff
from Big Charity in a reasonable period of time. In the future
we will not again assume that agencies that are physically and
bureaucratically remote from our hospitals will come to our
rescue. Instead, we have developed a means to transport
patients and staff should the need arise.
In fact, when Rita approached southwest Louisiana a few
short weeks after Katrina--and we operate facilities in
southwest Louisiana as well--we did evacuate threatened
patients and staff from Lake Charles, Lafayette, and Homa,
Louisiana, to facilities in Baton Rouge and Alexandria that
were out of harm's way. We took care of ourselves without
asking or expecting help, and it worked.
At this point, our 2006 evacuation costs are unbudgeted and
are conservatively estimated at $2 million to $4 million this
season just for our anticipated hospital evacuations in New
Orleans, Homa, and Lafayette. Because our region suffered and
continues to suffer, we likely will be evacuating from storms
that if it weren't for Katrina we would not have considered
leaving.
I fear that our fear may create patient care risks,
although I have no real solution for that dilemma.
Another major lesson from the crisis was the need for
reliable communications, as has already been described. Our
police radios in New Orleans and other affected areas worked,
but only intermittently. Ham radio was most reliable, but it's
slow. Satellite phones were generally useless for us. The
communications problem undoubtedly does have a technological
problem and we need to determine the best way to stay in touch
in emergencies and put the appropriate equipment in the right
hands.
In a time of major emergency, it became clear that our
public hospitals are embedded in an extended, multilevel,
multiagency, multigovernment bureaucratic structure, no one
part of which is responsible for our rescue. We do not have a
single parent organization to act on our behalf, such as the VA
or private hospital companies, but instead are dependent on the
coordination and the gelling of a diverse set of scattered
entities that work together only intermittently and in some
cases with unrelated contract employees brought on for a
particular disaster, such as the FEMA structure.
Let me emphasize this. After Katrina's floods struck, the
State Department of Health and Hospitals, the Louisiana
Hospital Association, and others of authority quickly
determined that our public hospital should be in the top
priority group for evacuation, given the critical condition of
our patients. They were and have been consistent on that. We
were all rowing in the same direction, and then suddenly some
other authority seemed to supersede.
To this day, I do not know if the evacuation priorities
were reordered once teams got to New Orleans or when FEMA got
involved or if anyone actually coordinated our hospital rescue.
I do know that numerous State agencies and military branches
were logistically involved, performed well, as did private
resources, but under whose order, if any, remains a mystery.
We learned many other lessons and have developed ongoing
plans and processes to take the actions that these lessons have
taught us. Some of these identified needs are: host facilities
able to accommodate evacuated patients. This includes
developing surge capacity on our own hospitals--and I'm almost
done--and making other arrangements, such as temporary housing.
We have within our system the capability to accommodate
surge capacity, but in Katrina our plan was overridden. We lost
contact with all of our patients and thousands of our staff.
A system to provide a continuing flow of information on
evacuated patients and staff. This involves creating backup IT
systems and protection of medical records from potential
damage.
This is very key to us: Temporary housing for staff whose
homes were destroyed or damaged, but who are able to work in
the disaster area.
Last, security to protect our people and our assets.
We know now that it is essential to plan for the worst
case, not just something approaching it, and to prepare for the
aftermath of a crisis, not just the episode itself. As was
quoted in the New York Times just a couple of weeks ago by a
New Orleanian as she was commenting about depression and
suicide, quote: ``I thought I could weather the storm and I
did. It's the aftermath that's killing me.''
Thank you very much.
[The prepared statement of Mr. Smithburg follows:]
Prepared Statement of Donald R. Smithburg
Mr. Chairman and members of the committee, I'm Don Smithburg, CEO
of the LSU Hospital & Clinic System in Louisiana. I thank you for your
interest in health care and in Louisiana after Katrina and Rita. I also
thank you for your invitation to appear today and the opportunity to
answer any questions you may have about Louisiana's State public
hospital system, about what we have learned from catastrophe, and about
how we are preparing for the future.
I represent 9 of the 11 State public hospitals and over 350 clinics
that traditionally have been called the ``charity hospital system'' in
Louisiana. I would like to describe this system briefly.
Our hospitals and their clinics constitute the health care safety
net for the State's uninsured and underinsured, particularly the
working uninsured--\2/3\ of our patients are hard-working Americans. In
your States, this role is generally a local government function, but in
Louisiana it is the responsibility of a state-run and statewide
hospital and clinic system under the aegis of LSU. Every individual in
the State is eligible to receive services in any of our facilities
regardless of where they live or their ability to pay. Louisiana has
one of the highest rates of uninsurance in the Nation; over 20 percent
of the population and estimated to include over 900,000 individuals.
Another 21 percent of the citizenry is on Medicaid. So 41 percent of
Louisiana's population is without private health insurance. That was
before Katrina and Rita. Blue Cross of Louisiana has recently projected
a 120,000 person increase in the ranks of the uninsured as businesses
fail because of the storms' destruction. In New Orleans alone, the
uninsurance rate is 41 percent since Katrina.
The LSU hospitals also have played an integral role in supporting
the education programs of our medical schools and training
institutions, and that includes not only LSU but also Tulane and the
Ochsner Clinic Foundation. Our LSU system flagship is in New Orleans,
commonly known as ``Big Charity,'' is actually two facilities, Charity
Hospital and University Hospital, operated under one medical center
umbrella. At our New Orleans facility alone, there were over 1,000
Tulane and LSU medical students and residents in training, and many
more nursing & allied health students, when Katrina struck and the
multiple levee failures devastated our institution.
Some of these same students at Big Charity had rotations at the VA
hospital in New Orleans as well. The VA facility sits a stone's throw
from Big Charity and was also devastated by the flooding. In recent
months, LSU and the Department of Veterans Affairs have been engaged in
an historic and collaborative effort that we hope will result in
rebuilding one plant that will support two hurricane-hardened
hospitals, both are able to better serve their respective patient
populations and conserve Federal and State resources at the same time.
I know you will understand that the destruction of Charity Hospital
is felt especially deeply here. ``Big Charity'' was the second oldest
continuing hospital in the Nation and has endured as one of the most
significant medical institutions in the Nation over the 270 years. It
was established in 1736. The hospital was destroyed once before by a
hurricane, in 1779, but rebuilt just 5 years later; without FEMA, by
the way. Today, it sits in ruins.
emergency preparedness
Having created both a statewide and a public hospital system, it is
natural and appropriate that Louisiana would turn to this system in
times of emergency. Under State emergency preparedness plans, our
hospitals are designated as the lead facilities in each region to
accept patients who have special acute needs that may become emergent
in a crisis or catastrophe. We have regarded it as our hospitals'
obligation to gear up for potential disasters and to continue to
operate when others may not be able to. We have the capacity as a
system to transfer patients to our facilities in other parts of the
State, if necessary. And since Louisiana's only Level I trauma and
specialty care centers--in New Orleans and Shreveport--are operated by
LSU, special medical needs generally could be accommodated internally.
Louisiana's emergency preparedness plans, and our role in them,
were fundamentally sound up to a point. Clearly, that point was
surpassed by the magnitude of Katrina in the New Orleans area. Our
hospitals were prepared to help the victims of disaster, but not to be
a victim ourselves.
the reality of disaster and the paucity of response
What happened at Charity and University Hospitals when the levees
failed? In brief, the city streets and hospital basements flooded.
Power in the city was lost and hospital emergency generators were able
to operate for only a short time because of lack of fuel. Supplies of
essentials, such as food and water, were not allowed to be brought in
despite our attempt to deliver such basic supplies and provisions.
Restrooms did not work and maintaining sanitary conditions was
difficult. External communications were exceedingly limited since
telephones generally did not work. The sentinel result was that patient
care and safety was compromised, especially for such critically ill
patients as those on ventilators. Conditions didn't meet the standards
we would expect of Third World countries. Staff in the hospitals worked
heroically to care for patients, manually ventilating some for hours
and then days. In a few instances staff administered intravenous
nutrition to one another. In sum, it became imperative to evacuate both
patients and staff. But the hospital itself had no means to do so.
You are looking for the lessons from this disaster with an eye
toward improving not only Louisiana's future emergency preparedness,
but also that of a vulnerable Nation. From our perspective, there were
several general lessons and many others at the hospital operational
level.
Evacuation. First, as this committee is aware, there proved to be
inadequate ability--or insufficient priority--to evacuate patients and
staff at Charity and University Hospitals within a reasonable period of
time. In the future we will not again assume that agencies that are
physically and bureaucratically remote from our hospitals will come to
our rescue. Instead, we have developed the means to transport patients
and staff should the need arise. Quite simply, a trauma center is
designed to stand in place in order to take in casualties after a
disaster. This season, we are prepared to evacuate without reliance on
the government.
Should assistance be available, we will gladly accept it, and
certainly we will work cooperatively with agencies at any level to
create an effective means to deal with all aspects of emergencies such
as Katrina and Rita. But we will also exercise our capacity to take
care of our own people within our system.
In fact, when Rita threatened Southwest Louisiana a few short weeks
after Katrina, we did evacuate threatened patients and staff from Lake
Charles, Lafayette and Houma to facilities in Baton Rouge and
Alexandria. We didn't wait for the established cavalry as we did after
Katrina's floods. We became our own cavalry and took care of ourselves
without asking or expecting help. And it worked.
Since the storms, we have developed contracts with out-of-state
ambulance companies to be available to transport patients in the event
of emergency. These contracts stipulate that the companies' capacity
must be devoted exclusively to our hospitals for the particular
emergency. We hope that FEMA would reimburse our system should a future
catastrophe require the activation of these transportation services. At
this point, our 2006 evacuation costs are unbudgeted, but are estimated
at $2.5 million this season for evacuations affecting New Orleans,
Houma and Lafayette.
Communications. One major lesson from this crisis was the need for
reliable communications. Both in New Orleans and Bogalusa (along the
Louisiana-Mississippi border, where our hospital received serious wind
damage, communications with our central office, the State Office of
Emergency Preparedness and others were exceedingly difficult. In the
case of Bogalusa, there was silence for 2 days. Our police radios
worked in New Orleans, but only intermittently in about 45 second
intervals. Ham radio was most reliable, and it is a technology we will
continue to invest in--but it is slow. Interestingly, cell phone text-
messaging worked in a number of cases even though cell phone
conversations often did not. Satellite phones were generally useless
for us. Although several different technologies failed or were of very
limited use, the communications problem undoubtedly has a technological
solution. We need to determine the best way to stay in touch in
emergencies, and put the appropriate equipment into the right hands.
It is not enough to have disaster plans. We must understand what
they call for and be prepared to implement them unless unforeseen and
overriding factors arise. To give you one concrete example, despite the
designated role of our hospitals to receive evacuated patients, we
received far fewer than we had capacity for. I personally worked at the
State Office of Emergency Preparedness headquarters to help move both
the patients and the staff from Charity and University to other LSU
hospitals that were prepared to accept them, but this approach--the
planned approach--was overruled by FEMA. Instead, patients from Charity
and University Hospital were taken to the N.O. airport, ultimately put
on military transports and scattered across the country. Only medical
records, but no staff, accompanied them. To our knowledge, no record
was kept of who was on what plane, where they came from or where they
were taken.
Immediately after the evacuation, it was as if our patients had
disappeared, and when the calls from families came asking about those
in our care, we could not tell them where they were. Staff spent
literally weeks calling hospitals across the country asking if any of
our patients had been transferred there. Despite these efforts and
those of the Louisiana Hospital Association, we never did find out
where all our patients were taken.
In a time of major emergency, it became clear that our hospital is
imbedded in an extended, multilevel, multiagency, multigovernment
bureaucratic structure, no one part of which was responsible for our
rescue. We do not have a single ``parent'' organization to act on our
behalf, such as the VA or hospital companies, but instead are dependent
upon the coordination and the jelling of an exceedingly diverse set of
scattered entities that work together only intermittently and in some
cases with contract employees brought on for a particular disaster.
Hopefully, something can be done to tighten this structure. But its
deficiencies are the reason that we must establish contingency plans to
take care of ourselves.
Other Lessons. We learned many other lessons and have developed
ongoing plans and processes to take the actions that these lessons
taught. Identified needs include:
A stockpile of supplies for a longer period than
previously thought, at least 2 weeks. Supplies should include food,
water, medications, generators, gasoline, flashlights, and red bags and
buckets with lids.
Receiving facilities able to accommodate evacuated
patients. Includes developing surge capacity in our own hospitals and
making other arrangements such as temporary housing as well.
A system to provide a continuing flow of information on
evacuated patients and staff, including clinical information, location,
and family contacts. This involves creating backup capacity for
clinical IS systems and protection of medical records from potential
damage.
Temporary housing for staff whose homes were destroyed or
damaged but who were able to work.
Security to protect our people and our assets.
We have also come to understand that we must help shape the
capabilities and expectations of the outside world. We cannot afford
for emergency preparedness entities and health care providers to
maintain unrealistic expectations of what our hospitals can do in the
event of a disaster that overwhelms us all. Coping with disaster is our
problem, and we hope it is on the way toward resolution. All providers
and agencies must craft realistic contingency plans of their own.
We know now that it is essential to plan for the worst case, not
just something approaching it, and to prepare for the aftermath of a
crisis not just the immediate crisis period itself. As was quoted in
the New York Times 2 weeks ago, a New Orleanian said as she reflected
on depression and suicide: ``I thought I could weather the storm, and I
did. It's the aftermath that is killing me.''
Thank you again for your interest and for the opportunity to share
LSU's perspectives on these critical matters.
Senator Burr. Thank you, Mr. Smithburg.
Dr. Letourneau.
Dr. Letourneau. Thank you, Mr. Chairman, and subcommittee
members and staff.
There are many lessons from Katrina--patient, cultural,
operational, and personal lessons. Today I will relate some of
the lessons we have learned in the context of our sizable
research enterprise. As a matter of introduction, since I'm not
Dr. Hollier, I am Janice Letourneau. I'm Associate Dean for
Faculty and Institutional Affairs at the LSU School of Medicine
here in New Orleans, Professor of Radiology and Surgery, an
academic physician.
As the representative from the academic component of LSU,
I'm pleased and wish to thank the members of the subcommittee,
as well as those from multiple Federal agencies and our
Congressional contingency, for all their support and
intervention during the storm and in the aftermath. It really
was an incredible disaster and, as Don has mentioned, it
remains a disaster.
LSU Health Sciences Center in New Orleans is comprised of
six professional schools and it serves the health care needs of
1 million patients each year. Katrina and its attendant
flooding severely impacted the center, forcing us to
temporarily relocate to Baton Rouge. Both the academic campus
and the two major teaching hospitals were flooded. As a
consequence, we continue to recover in a very strategic and
global way.
Over the past 10 years, the State has invested heavily in
us as an institution, its infrastructure, and also its research
programs. As a result, we were in a growing phase. We had added
100 new faculties over the 3 years preceding Katrina. With
that, we saw a dramatic increase in our research programs. A
good example is the addition of four new basic science
department heads in the school of medicine over the last 4
years. These people did what they were supposed to do: They
hired new faculty--talented people that came in with funding,
developed new sources of funding; and our successes are
outlined in the table that's included in the printed testimony.
Coincident with the growth in the faculty, we saw expansion
of our graduate and our post-doctoral training programs and
continued growth of our interdisciplinary research institutes
and centers.
But the storm changed all of that. It challenged our
ability to maintain our existing programs and it really
arrested our ability to operate in any way that we knew from
the past. Progress was basically arrested by the physical
damage and the human tragedy of Katrina. For example, with this
disruption of clinical services that you've heard about
execution of clinical trials has become very difficult and as a
consequence of that the Health Sciences Center and the school
have lost $7 million in annual revenue in comparison with last
year, just on the basis of clinical trials. Additionally, 17
NIH-funded investigators have left the institution since the
storm, leaving with them about $5.5 million of funding.
Immediately following the evacuation we established
ourselves operationally in Baton Rouge. The infrastructure for
operations was quickly established and really miraculously we
started classes within 4 weeks to the day from landfall of
Katrina. Temporary administrative, teaching, and some research
space was established at Pennington. But the two hugest
challenges that we faced were really communication and housing.
The communications strategies are outlined in the printed
testimony. Housing was addressed more creatively in conjunction
with an important commitment by FEMA to provide funding for a
Finnjet passenger ferry and also for temporary trailer housing
on the LSU campus.
After restarting our classes, we looked--we turned next to
the continuity of our research programs, assuming that our
campus would really not be habitable for the next 6 to 9
months. Individual investigators developed idiosyncratic
strategies along with their supervisors, identifying their
family needs, their laboratory needs. Some of these people
wound up staying in the Baton Rouge area. Some of them went in
dispersed fashion around the country to host institutions and
with other scientists as they re-established their research
program. There really was a diaspora of our investigators
around the country and to some extent around the world.
As the city became more inhabited, temporary facilities
were also established at our partner institution, the Research
Institute for Children at Children's Hospital, and also at
Ochsner.
This has also been a pretty productive time for our faculty
for grant-writing because the labs haven't been fully
operational, and the successes that we've had in grant-writing
are also outlined in the testimony.
The campus was flooded with 3 to 7 feet of water and that
destroyed the electrical and mechanical systems of our major
buildings. Five major multistory buildings were affected on the
downtown campus, as were two major buildings on the dentistry
campus. The estimated losses range at this point, with
assessments still ongoing, at about $100 million.
The content loss, particularly the losses of research
animals and biomedical specimens, are particularly difficult to
value.
Things are looking up. We've been back on campus now for 6
months doing research. Our buildings are mostly open. The
ground floors remain closed. Now, at 9 and 10 months, classes
are resuming. Administrative operations have also resumed here
in downtown New Orleans. The School of Dentistry will likely
remain in Baton Rouge for the entire coming year.
What are the lessons? Our immediate goal is to focus on
faculty retention and continuity of our research program, but
the lessons are: that a clear understanding and commitment to
the institution's mission--education, discovery, and service--
is critical to maintaining the loyalty and morale of students,
staff, and faculty. In a disaster of this magnitude, crisis
management, assessment, recovery, and even rebuilding all occur
contemporaneously. Information is very dynamic in nature and
communication becomes even more important than it was before,
and communication pathways must be redundant.
Assessment of facility and scientific loss is extremely
complicated and difficult, and our senior investigators have
helped tremendously with excellent recommendations on
mitigating damages and minimizing losses for the future.
Retention of students and faculty is critical to restoration of
successful scientific programs. The departure of scientists
after Katrina is most frequently associated, not just with
professional losses, but with the personal losses and
frustrations that they've experienced as well. Some of the loss
of funding has been counterbalanced by new opportunities and
funding that's arisen.
Several factors have contributed to the survival of our
research enterprise, including the investments that we've
talked about before by the State and Federal Government, the
resilience and creativity of our leaders, the thoughtful
support and intervention of multiple agencies, as we've talked
before. But the research enterprise is still very fragile, but
there is an exciting set of opportunities on the horizon.
There is a new announcement today from the NIH, thanks to
Dr. Zerhouni and Hitt, providing for a funded 1-year extension
on
R-type research grants for investigators who choose to stay in
New Orleans. With these kinds of opportunities, we hope that we
will emerge with a new focus and energy in the pursuit of our
scientific discovery.
Thank you very much.
[The prepared statement of Dr. Letourneau follows:]
Prepared Statement of Janice Letourneau
overview of growth
The Louisiana State University Health Sciences Center in New
Orleans (LSUHSC-NO) is the primary care provider for all citizens in
the State of Louisiana. It serves 1,000,000 patients a year and is the
primary educational center for health care professionals in the State,
and comprises Schools of Medicine, Graduate Studies, Dentistry,
Nursing, Allied Health, and Public Health. Hurricane Katrina, which
struck southeastern Louisiana on Monday, August 29, 2005, has severely
impacted the education, service, and research mission of the Health
Sciences Center, essentially requiring a temporary relocation of the
Center to Baton Rouge, which is 60 miles inland from New Orleans. The
two major teaching hospitals for LSUHSC in New Orleans (Charity and
University Hospitals) were flooded and Charity suffered significant
structural damage. There is a tremendous ongoing institutional planning
effort for continued recovery of this academic medical center.
The past 10 years have witnessed a tremendous State investment in
LSUHSC-NO, which has resulted in dramatic growth in its research
programs. This investment included infrastructure development, research
resources and the successful recruitment of new department heads, a new
Dean of the School of Medicine, a new Chancellor of the Health Sciences
Center and the creation of a School of Public Health. This has resulted
in a true sense of mission at the Health Sciences Center, and in the
recruitment of 100 new faculty members over the past 3 years. All of
this progress has essentially been brought to a halt by the damage and
human tragedy inflicted by Hurricane Katrina.
Within the Basic Science Departments at LSUHSC-NO, four new Heads
of Departments (Genetics in 2000, Pharmacology in 2001, Physiology in
2002, Biochemistry in 2004) were recruited within the last 4 years, and
LSUHSC-NO is currently recruiting a new Head for the Department of
Anatomy and Cell Biology. This has resulted in the expected additional
recruitment of talented, NIH funded faculty and further infrastructure
development in terms of space, equipment, and core research support
services. Coincident with this growth has been the significant
expansion of graduate and post-doctoral research training programs and
the continued growth of Centers of Excellence in Alcohol Research,
Cancer, Cardiovascular Biology, Research Institute for Children, Oral
Biology and Neuroscience and expansion of programs in Gene Therapy,
Human Genetics, Immunobiology and Infectious Diseases.
Because of this activity, NIH supported research on campus has
increased from $18,743,273 in fiscal year 2001 to $39,950,000 for
fiscal year 2006 (through 3-1-06). The storm, however, has had a
serious impact on our progress. For example, clinical trials were
deeply impacted by Katrina with a loss of more than $7,000,000 from
fiscal year 2005 to fiscal year 2006. Seventeen NIH funded
investigators have left the institution since the hurricane for a total
loss of $5.7M per year. Table 1 provides historical data regarding
LSUHSC-NO research awards.
Table 1.--LSU Health Sciences Center in New Orleans Historical Research Awards
----------------------------------------------------------------------------------------------------------------
FY-2001 FY-2002 FY-2003 FY-2004 FY-2005 FY-2006
----------------------------------------------------------------------------------------------------------------
NIH................................ 18,105,247 19,503,425 21,228,872 35,738,211 37,192,393 38,950,000
NIH Subcontract.................... 633,026 2,137,522 1,953,888 2,387,258 2,402,823 1,518,873
Other Federal...................... 2.324,944 3,934,947 7,152,543 5,946,337 4,903,991 1,997,611
Private............................ 3,266,902 5,950,971 3,257,737 4,111,303 4,947,378 2,582,949
State.............................. 8,061,668 8,201,246 9,810,431 8,628,646 3,833,636 2,541,984
Clinical Trial..................... 5,948,597 11,642,094 7,805,895 7,546,581 9,013,377 1,855,564
----------------------------------------------------------------------------
Total............................ 38,340,384 51,370,205 51,209,365 64,358,336 62,293,598 49,446,981
Included Above:
NIH Supplements (15 request)..... 10 Awarded 1,192,000
NIH Awards Since Katrina......... 12 New Awards 4,384,188
----------------------------------------------------------------------------------------------------------------
The recruitment of Larry Hollier, M.D. from Mt. Sinai Medical
Center as Dean of the School of Medicine in January of 2004 and his
recent appointment as Chancellor of the Health Sciences Center has
provided further impetus for growth and expansion. Thus, LSUHSC-NO has
a group of experienced and respected leaders committed to the
development of educational and research programs at the forefront of
academic medical centers.
post-katrina recovery activities
Following the evacuation from New Orleans, administration and
support services for the Health Sciences Center were established in
Baton Rouge. An organizational center was established at the LSU
systems office in Baton Rouge during the storm and this served as base
camp for leadership and staff. Information was provided through the
LSUHSC Web site and by using phones to answer questions from students,
staff, and faculty.
The Health Sciences Center in New Orleans was temporarily relocated
in Baton Rouge. Classes began on Monday, September 26 for all of its
schools. Infrastructure required for operations were quickly
established (i.e. Information Technology, Human Resources, Benefits,
Grants Administration). All financial systems became operational within
2 weeks of the storm and all payrolls were delivered. This was a
tremendous undertaking.
One of the biggest challenges in completing the operational
initiative of the Health Sciences Center when it relocated to Baton
Rouge was finding housing for faculty, student, and staff. Baton Rouge
doubled its population due to the influx of New Orleans evacuees.
LSUHSC-NO addressed this need by providing a FinnJet Ferry Boat docked
on the Mississippi River that housed up to 1,000 students, faculty, and
staff. In addition, 400 one and two bedroom trailers were place on LSU
property in Baton Rouge as part of a University Village for faculty and
students.
At the departmental level, chairs communicated with faculty
immediately after the storm through text message since direct phone
calls were problematic. The LSUHSC e-mail system was down for 2 weeks
further complicating communications. As expected, individuals evacuated
to different areas of the country to find a personal comfort zone for
their families. LSUHSC-NO's priority was the personal safety of its
students, faculty, and staff.
Through text messaging, limited phone connections, and alternative
e-mail accounts the Health Sciences Center community was able to
establish and maintain contact. The great majority of faculty and staff
suffered personal loss and damage to homes to varying degrees. Many
faculty, staff, and students completely lost their homes.
Our mission during this time was to provide a personal and
professional anchor for individuals. LSUHSC-NO held conference calls
with the faculty and also with students to bring people together for
mutual support.
continuity of research and education programs
The next step was to provide a mechanism for continuity of our
research and education programs as individuals tackled the issues
facing them. Due to the importance of finding a personal comfort zone,
it was decided either to support faculty in Baton Rouge with lab space
or to work with other universities where faculty may have found that
comfort zone for the family and their specific situation. Initial
anticipated timeframe of 6-9 months following Hurricane Katrina for an
operational campus at LSUHSC in New Orleans, the Health Sciences Center
moved aggressively to make sure that investigators in temporary
locations had what they needed in terms of space, equipment, and
resources.
Financial systems were made operational, and a research supply
store was set up at Pennington Biomedical Research Center. In addition,
each investigator was provided with a ``purchasing card'' so that they
could buy what they needed immediately. For investigators at different
universities, LSUHSC-NO covered all personnel and supply costs through
LSUHSC as normal and arrangements were made for direct shipping of
supplies and reagents to the investigator's laboratory.
The laboratories were made operational by sharing equipment, buying
small equipment used on a daily basis, obtaining additional items from
individual laboratories at the Health Sciences Center, and the
graciousness of the individual institutions housing the investigators.
Graduate students beyond the first year of the program were with
their mentors or collaborators as were fellows. First year students
began classes in the interdisciplinary course framework of the School
of Graduate Studies on Monday, September 26 in Baton Rouge and these
classes started in New Orleans beginning January 2006.
In many cases, individual faculty gravitated toward the labs of
established collaborators. Several faculty set up operational space at
LSU affiliated schools or centers in Baton Rouge (Pennington Biomedical
Research Center, LSU School of Veterinary Medicine, LSU School of Life
Sciences) while others set up their laboratory at other institutions
across the country.
In mid-November, laboratories were set up at Children's Research
Institute at Children's Hospital and the Ochsner Clinic Foundation in
New Orleans as many faculty members and staff began to return home to
New Orleans.
In addition to laboratory activities, 105 grants were submitted to
NIH since Hurricane Katrina hit the coast. Fifty-eight of these grants
were new submissions. As of 3/1/06, 15 requests for administrative
supplements ($3,717,329) have been submitted to NIH post-Katrina; 10 of
these requests have been awarded for a total of $1,192,000.
LSUHSC-NO was contacted by multiple institutions, colleagues, and
departments around the country offering space, support, and
encouragement. The numerous and generous offers of lab space and
support from the research community has provided flexibility to address
our challenges. All of the individual programs, investigators, and
institutions that welcomed displaced investigators should be recognized
for their tremendous effort, graciousness, support, and hospitality.
damage assessment
The entire Health Sciences Center was flooded with 3-7 feet of
water on the first floor of each building, which destroyed electrical
cores, water pumps, and fire pumps. Five major buildings with 5-10
floors each were affected on the downtown campus and the two major
buildings on the School of Dentistry campus. A full-assessment of
damage to the buildings and the full extent of lost research material
and damage to equipment is ongoing. A detailed report with daily
updates can be monitored at http://www.lsuhsc.edu/.
The personal damages along with the losses and disruptions of
research programs are having a severe impact on career development for
both new and established investigators. It should not be overlooked
that this impact also includes the graduate students and post-doctoral
fellows. This includes issues with manuscript generation and
publication delays as well as grant submissions and grant renewals, all
of which will have a lasting impact on our mission and the many
contributions of the NIH and NSF supported research programs in
Louisiana.
the return to new orleans
Less than 6 months after the floodwaters left the downtown campus,
the upper floors of the Medical Education Building, the Lion's/LSU
Clinic Building and the Mervin L. Trail Clinical Sciences Research
Building were opened, allowing researchers to move back into their
labs.
Just 9 months after Hurricane Katrina forced the institution to
relocate all of its classes and operations, the majority of the
downtown campus functions have returned. Classes have begun for the
Schools of Allied Health Professions, Graduate Studies, Medicine,
Nursing, and Public Health. The two student residence halls have
reopened, along with the Library, Administration, and Resource Center.
On the Florida Avenue Campus, which sustained the worst flooding,
work on the Dental School Clinical and Administration Building is
ongoing. The School of Dentistry has organized its efforts in Baton
Rouge and continues to educate its dental students, dental hygiene
students, dental laboratory technology students, and residents. In
addition, a 32-chair clinic, a student dental laboratory, and a
preclinical laboratory continue to be housed in three vacant buildings
made available through Louisiana State University.
summary
In summary, our immediate goal is to focus on faculty retention and
continuity of our research programs. We will also concentrate on
programmatic development with emphasis on program retention and
institutional restoration.
Senator Burr. Thank you, Dr. LeTourneau. We are also
pleased with Dr. Zerhouni's decision and I think that shows
just the type of leadership we've got at the NIH.
Dr. Whelton. Senator Burr, Senator Alexander, it's an honor
to welcome you to the city and I'm very grateful that you're
here to see our progress and our challenges firsthand.
In the immediate aftermath of Hurricane Katrina, I learned
several valuable lessons. First I should say, faced with an
overwhelming crisis, health care providers performed in an
exceptional manner and they are among my heroes of Katrina.
Second, the academic community, key Federal agencies,
especially for us the NIH and CDC, the local health care
institutions, including Ochsner, have been unbelievably
supportive.
Third, New Orleans was probably better prepared for an
emergency than most cities in the United States, but certainly
our city, even though better prepared, was not sufficiently
prepared for an overwhelming challenge like Katrina. Before
Katrina our medical group cared for approximately 50,000-odd
patients per month. Immediately after the storm, they
established clinics, many free clinics. We reopened our health
sciences buildings in October, our Tulane Lakeside Hospital in
November, and our downtown university hospital in February.
We've progressively increased both clinical availability and
the number of inpatient beds, which, while still much lower
than pre-Katrina, now we have an average daily census of about
200 and we expect to get back up to 300 to 400 in the
foreseeable future.
In order to assure a cadre of well prepared public health
professionals in Alabama, Arkansas, Louisiana, and Mississippi,
we've worked very hard to advance our Tulane South Central
Center for Public Health Preparedness. This center trains more
than 17,000 front-line practitioners and public health leaders,
and we've added a variety of training opportunities specific to
the lessons learned from Katrina.
Talking a little bit about our research enterprise, despite
Katrina-related losses of more than $120 million in research
income and facilities, we're back on our feet and I expect that
our research awards during the current year will be somewhere
between $100 million and $105 million. That is about 95 percent
of our awards last year.
I want to turn for a moment to talk a little bit about my
view of the current State of health care in New Orleans. Let me
first talk about patients. If your schedule had permitted an
opportunity to tour our facilities, you would have seen very
busy clinics, overcrowded emergency rooms, and very limited
capacity to meet the demand for inpatient beds. In addition,
you would have noted a very high level of uncompensated care.
Whereas approximately 3 percent of our inpatients at the
downtown hospital lacked health insurance pre-Katrina, the
corresponding rate has been as high as 47 percent post-Katrina.
If insufficiently addressed, this high level of uncompensated
care could well undermine the financial capacity, particularly
of practitioners, but also of institutions, to meet their
obligations.
Turning to infrastructure, throughout Orleans Parish there
is a major shortage of clinics, of inpatient beds, and of both
acute care and nursing home beds. Our progress in rebuilding an
effective health care system post-Katrina is moving far too
slowly to meet the needs of current citizens and temporary
residents, much less the anticipated health care needs, as New
Orleans continues to repopulate over the next 12 months.
This problem is being felt disproportionately in many of
the areas of greatest need. As an example, there's not a single
designated psychiatric bed in Orleans Parish today.
Now let me talk a little bit about providers. Approximately
3,200 physicians were practicing in the New Orleans
metropolitan area prior to Katrina. Today it's not certain, but
that number is thought to be somewhere between 1,400 and 1,600
physicians, of which Tulane practitioners represent about a
quarter. Federal estimates suggest that New Orleans has lost 77
percent of its primary care providers, 89 percent of its
practicing psychiatrists. Many of those who remain are finding
it very difficult to meet their financial obligations. If we
lose our remaining network of primary care physicians and the
specialists, it's going to be very challenging and I might add
very expensive to rebuild.
Compounding this, we've had to reduce the size of our
medical residency training programs post-Katrina. If this
reduction in size persists into the future, one of the most
reliable pipelines for the attraction of highly skilled health
care practitioners to our region will be diminished.
Today I ask for your support in reauthorizing important
programs such as the Public Health, Security, and Bioterrorism
Response Act. I strongly support Secretary Leavitt's
recommendation that we redesign the health care system in
Louisiana's Region 1. This to me is a long-term goal. In the
short term, we need assistance to provide health care
appropriate to the current needs of our community.
In closing, let me say that I'm again very grateful you're
here, that my colleagues and I, at Tulane, are fully committed
to playing a leadership role in health professional training,
in health care delivery, in promotion of wellness and economic
revitalization of our community. I want to thank you for the
privilege for being able to testify today.
[The prepared statement of Dr. Whelton follows:]
Prepared Statement of Paul K. Whelton
Mr. Chairman and members of the subcommittee, thank you for the
opportunity to speak with you today regarding the public health
recovery in the city of New Orleans since Hurricane Katrina's historic
landfall on August 29, 2005. It is an honor to welcome you to our city.
On behalf of our students, faculty, researchers, staff and patients, I
would like to express our gratitude to you for coming to see our
progress and challenges first-hand.
I want to thank the subcommittee for supporting public health
recovery efforts in New Orleans. We are particularly appreciative of
Secretary Leavitt's commitment to the long-term recovery of our
region's healthcare system. The support from Federal agencies such as
the National Institutes of Health, the Centers for Disease Control and
Prevention, and the Department of Veterans Affairs continues to be
invaluable as we recover.
We have made significant steps forward despite almost overwhelming
challenges, but still have a long way to go before health care and
public health preparedness in our city and region are robust enough to
serve our current population--including temporary laborers and
volunteers. Together, we must ensure the presence of a sustainable
public health and healthcare system that meets both the routine needs
of our region, as well as the needs of our population, during any
future disasters.
public health and medical care: the tulane commitment
Tulane University was founded as a public-health-oriented medical
school 172 years ago in response to community needs--epidemics of
yellow fever, cholera and malaria. Except for 3 years during the
American Civil War, Tulane University, which today includes its Health
Sciences Center, School of Medicine, School of Public Health and
Tropical Medicine, and hospitals and clinics, has served our community
without interruption, including before, during and after Hurricane
Katrina. Our commitment to the success of New Orleans began long before
Katrina reached our shores and our resolve to be a vital part of the
community's rebirth following the hurricane has never wavered. That
commitment is sealed in our mission and in our hearts.
Prior to Hurricane Katrina, Tulane University was the largest
private employer in Orleans Parish. Today we are the single largest
employer in the Parish and we remain one of the fastest-growing
economic engines in southeastern Louisiana. Before Katrina,
approximately 8,000 faculty, students and staff worked at the Tulane
University Health Sciences Center. With more than 350 full-time faculty
members, our medical group was one of the largest in the region
overseeing care for approximately 1,000 inpatients and 50,000
outpatients per month. Our medical and public health training programs
were amongst the most competitive in the Nation. With annual research
awards of approximately $140 million per year, a recent three-fold
increase in awards from the National Institutes of Health, and evolving
partnerships with other academic institutions in our region, Tulane
supported a vibrant research and discovery community. We had an annual
operating budget in excess of $650 million at the Health Sciences
Center and Tulane University Hospital & Clinic, along with major
additional responsibilities at the Southeast Louisiana Veterans Health
Care System (Tulane provided approximately 75 percent of the physician
services) and the Charity System Medical Center of Louisiana, New
Orleans.
Throughout and immediately after Katrina, Tulane faculty, students
and staff remained to provide essential services. They performed
admirably and many emerged as heroes who saved lives under extremely
challenging conditions. Not a single life was lost at the Tulane
University Hospital & Clinic. Our staff took whatever measures were
necessary to save human lives, including hand ventilation of patients
for prolonged periods when electricity was unavailable. In addition to
safely evacuating all of our patients, faculty, staff, students and
friends, we evacuated many of our research animals and humanely
euthanatized those that could not be evacuated. Moreover, we preserved
key cell lines for both clinical care and research, and vital
equipment--saving U.S. taxpayers millions of dollars.
In the immediate post-Katrina environment, Tulane was the largest
ambulatory care provider in Orleans Parish, with clinics that remained
open 7 days a week. Our medical personnel provided free care for about
400 patients per day in the absence of any formal healthcare
infrastructure. The majority of those who received care were uninsured
or under-insured. Our faculty provided care under awnings, in police
precincts, in tents, and in parking lots. Although we are a private
institution, we remained true to our mission of meeting the healthcare
needs of the community. Indeed, we are still operating the Covenant
House clinic in the French Quarter, one of the four free clinics that
we established following Katrina. In conjunction with the Children's
Health Fund we established a mobile pediatric unit, still in operation,
which has allowed us to serve children in their own neighborhoods
without regard to their parents' ability to pay for the services
rendered. Additionally, we were able to place our clinical faculty
throughout Louisiana, focusing on the sites where New Orleanians
evacuated in the diaspora, such as Alexandria, Baton Rouge, Lafayette,
Pineville and the New Orleans Northshore-Covington area.
The commitment of our healthcare professionals to helping the
community has been extraordinary and universal amongst faculty, staff
and students. As one of many examples, we, in conjunction with Common
Ground, are running a special Latino Health Outreach Project Clinic on
the West Bank section of the city. This clinic was the brainchild of
Catherine Jones, a third-year student in Tulane's combined medical
degree and master of public health degree program. Jones, a native of
New Orleans, heard the distressing news--of uninsured, nonEnglish-
speaking day laborers--while an evacuee with her family in Texas. She
immediately returned to Louisiana, and with the help of others provides
free health care for up to 50 New Orleanians each day in an abandoned
storefront in Algiers.
On February 14, Tulane University Hospital & Clinic (TUHC) became
the first hospital to reopen in downtown New Orleans following the
hurricane. TUHC serves as a vital resource for repopulation of the
city. The opening of the hospital was critical to assuring the success
of this year's Mardi Gras and was a sign that the city was ready to
welcome back both tourists and the business community.
As reported by the Government Accountability Office in March 2006,
63 beds were staffed in February at the downtown TUHC. Today, that
number is 93, which represents a 48 percent increase in 5 months, but
this is still only 40 percent of our pre-Katrina 235-bed capacity.
Concurrently, we have been staffing approximately 60 beds at our
Tulane-Lakeside Hospital in Jefferson Parish, which we reopened in
October. This represents about half of the 119-bed capacity at that
hospital.
Through the summer, we have been adding outpatient clinics
throughout the city and region. At our downtown campus, we have
reopened emergency, urgent care, transplant and multispecialty clinics.
The Tulane Cancer Center infusion and clinical treatment clinics are in
the process of reopening, with cancer radiation therapy and other
clinics planned to open in August.
With much appreciated help from our colleagues in south Texas, we
maintained the integrity and quality of our School of Medicine training
programs. Likewise, with help from the other accredited schools of
public health, we provided our public health students the opportunity
to continue their studies at many of the Nation's best schools. Our
School of Public Health and Tropical Medicine, the oldest in the
Nation, restarted its educational programs in New Orleans in January.
And as of last week, all of our medical students and medical residents
have returned to the city. Medical students, and especially medical
residents, often decide to stay and practice where they receive their
medical education and training. Returning our trainees to New Orleans
is a vital step in the rebuilding of the health professions workforce
for our region. Also, the public health students who are enrolled at
Tulane, and the many that stay after graduation, contribute to
improving the community's health through public health outreach
initiatives, education endeavors and research.
While learning, our medical students and residents participate in
clinical rotations and training programs that add to the clinical care
resources of the city. We retained 98 percent of our medical student
body. I am pleased to report that we were able to fill our residency
slots for the 2006-2007 year with highly-qualified candidates--in most
instances they were our first or second choices. Also, after receiving
more than 7,000 applications for admission to our MD program
(consistent with recent years' numbers), our incoming medical school
class is among the largest in our history and has an academic profile
congruent with prior entering classes. In addition to this, many have
chosen Tulane because they want to participate in rebuilding the
community's healthcare system. All combined, these promising results
reflect the interest of young health professionals in providing care in
a challenging environment.
Before the storm, the city's medical district was an epicenter for
the training of healthcare professionals, including more than 1,400
medical residents. Tulane lost vital medical resident training
positions due to the closure of the Charity System's Medical Center of
Louisiana, New Orleans and the Southeast Louisiana Veterans Health Care
System inpatient facilities in New Orleans. TUHC has helped by opening
up nearly 50 additional temporary residency positions. Furthermore, we
have placed medical residents at our Tulane-Lakeside Hospital in
Jefferson Parish and several other hospitals in the community,
including the Ochsner Medical Center, Touro Infirmary, West Jefferson
Medical Center, East Jefferson General Hospital and Slidell Memorial
Hospital. TUHC is negotiating a lease of approximately 40 beds to the
VA--expected to become operational by October 1st. Not only will these
beds help serve the needs of local veterans and their families who must
now travel many miles for inpatient services, but they will serve as a
vital part of our medical resident training program. Despite all of the
above, it remains a challenge to find appropriate training environments
for training of our medical residents.
Despite research inventory and facilities losses of more than $120
million, Tulane University remains the region's largest research
enterprise and the area's only institution to be ranked in the top 100
for receipt of awards from the National Institutes of Health. Last year
the university received more than $140 million in research awards, with
more than $110 million awarded to faculty at the Health Sciences
Center, the largest in our history. I expect our health sciences
faculty will end the year with awards totaling between $100 million and
$105 million (90 to 95 percent of last year's total). Again, this is
another example of our commitment to the region's economic recovery.
Our School of Public Health and Tropical Medicine has assiduously
monitored public health concerns and provided information through
initiatives--from recovery issues to nondisaster health maintenance,
e.g., nutrition and heart disease. Specifically, faculty from the
Tulane Department of Environmental Health Sciences worked alongside
Federal, State and local health officials to provide real-time guidance
to community residents for pressing environmental health issues--from
drinking water safety and air pollution to mold remediation. The school
has retained more than 80 percent of its students and already has
exceeded its goals for fall enrollment, with a similar academic profile
to that of previous years. An exiting development last fall was the
start of our new undergraduate program in public health, one of a few
in the Nation. Already, enrollment has exceeded expectations and in a
few years the program will produce young, vibrant public health
professionals.
public health and medical care: the key challenges
Fragmented Healthcare Infrastructure
Currently, a safety net for the uninsured is lacking. The burden on
hospital bed capacity, as well as the lack of financial support to care
for this growing segment of the population, is seriously threatening
the functioning and sustainability of what was already a fragile city
public health and healthcare system. The loss of the Charity and VA
system's inpatient capacity has exacerbated the situation. Accelerated
in the aftermath of the storm and its related economic fallout, patient
capacity to pay for health care has been greatly diminished. Before
Katrina, the percentage of uninsured patients in New Orleans was
already larger than the national average. At Tulane, the number of
uninsured outpatients has risen from around 6 percent pre-Katrina to
recent numbers of 20 percent for Tulane-Lakeside and 40 percent for
Tulane University Hospital & Clinic. HHS funds to help 32 States
shoulder increased medical costs attributable to Katrina had covered a
fraction of Medicaid providers' costs at hospitals for claims of
uninsured patients through Jan. 31. Also, the Louisiana Legislature has
authorized financial support to Louisiana hospitals for care of
patients without health insurance but this assistance does not address
the financial plight of the physicians who provide the care. The bottom
line is that (a) the funding directed to help hospitals is insufficient
and (b) support is not reaching the individual healthcare providers and
many, especially physicians, have made the decision to relocate to
other regions of Louisiana or to other States. Many more are
considering relocation. Compensation for care of uninsured patients is
a growing crisis that could lead to further deterioration of our
region's healthcare infrastructure.
In addition to the financial challenges for healthcare
professionals and healthcare systems, there is an acute shortage of
clinics and inpatient facilities. This is disproportionately being felt
in some key areas of need. For example, there is not a single
designated inpatient psychiatric bed in Orleans Parish. In addition,
when patients are discharged from hospitals there are few options
available for homecare or institutional care, such as nursing homes.
This has resulted in a prolongation of hospital stays by approximately
20 percent--further exacerbating the shortage of inpatient beds and
cost of care.
Loss of a Competent Healthcare Provider Workforce
The considerably decreased patient base and permanent relocation of
hundreds of physicians continues to significantly impair our
community's ability to provide quality care. Repopulation cannot occur
without a commensurate investment to retain and recruit physicians,
nurses and other health professionals. Retention of physicians and
public health professionals is already a problem and could get worse
before stabilizing. This should be a very high priority. If we lose our
network of medical professionals in New Orleans--which includes a mix
of primary care physicians and specialists--it will be challenging and
expensive to rebuild. Before Katrina, the Orleans Parish Medical
Society estimated 3,200 physicians were practicing in Orleans,
Jefferson and St. Bernard parishes. Today, they estimate the number is
between 1,400 and 1,600 physicians, of which Tulane practitioners
represent about one-fourth of those currently in practice.
Disaster Preparedness
Public health and healthcare preparedness are integral to disaster
readiness. Multi-faceted challenges, such as disaster recovery and
preparedness, cannot be solved with monolithic solutions. While we need
to look broadly and think long-term, my biggest immediate concern is
for the middle phase of recovery--simplified, I'll refer to it as Year
2. We have moved beyond the rescue and rebounding phase of Year 1. Now
Federal emphasis is on long-term rebuilding starting in Year 3. I
support the Department of Health and Human Services and Secretary
Leavitt's redesign for Louisiana Region I. With Federal assistance, our
long-term prospects look promising. My fear is for this gap between
Years 1 and 3. The next 6 to 9 months are critical, and I am hoping
that this subcommittee can help address this concern. By helping us
now, you will further the understanding of this middle period of
insecurity to the benefit of future disaster recoveries. The importance
of a successful execution of this middle phase has been demonstrated
internationally. For example, investment during this transition period
after the Kobe, Japan disaster provided a critical foundation for
subsequent long-term, sustainable recovery. Please keep our second
post-Katrina year in mind and in motion.
public health and medical care: looking forward
Assuring a Robust Healthcare Infrastructure
In my opinion, a Federal policy for care of those without health
insurance is much needed. This should be an immediate priority for New
Orleans, because if unaddressed, it promises to undermine the capacity
of the healthcare provider community to survive. In New Orleans, there
appear to be three groups of uninsured patients: (1) residents who did
not have insurance before Katrina; (2) residents who had health
insurance prior to Katrina, but no longer do so, either because they
lost their job or lack the resources to continue paying for their
insurance; and (3) day laborers who are temporary residents and lack
any form of health insurance. We need a better understanding of the
relative contribution of each group and ways in which their acquisition
of health care can be encouraged and facilitated.
Strengthening the Healthcare and Public Health Workforce
Healthcare providers make choices to stay or leave a distressed
community. In this context, it could be valuable to have a national
registry of physicians, as well as other healthcare professionals. In
addition to helping patients locate their providers, such a registry
could help providers from unaffected areas who want to assist in
recovery efforts. This concept not only creates surge capacity in a
seamless fashion nationwide, but also comports with the Federal
emphasis on regional preparedness. We could also utilize Public Health
Service personnel to rebuild the healthcare infrastructure and to fill
provider gaps as needed--current examples of need include nursing,
mental health and dental health. However, while volunteers might be
effective in the short-term, ultimately our community needs the
stability and quality that comes from the long-term commitment of local
providers.
The ability to support healthcare providers is pivotal to retaining
a competent clinical staff. I am grateful to the Board of Tulane and
the university administration for ensuring that payroll and benefits
were covered for our faculty, clinicians and medical residents, and to
our clinical partners at HCA, who did an outstanding job in evacuating
patients and staff and in helping to place them in jobs at other
facilities. While we benefited from a temporary relaxation of the Stark
law through 2005, there needs to be consideration of a national policy
which extends that time frame in the aftermath of a disaster, so that
hospitals and organizations with the resources can help doctors with
housing and other accommodations. We, as a Nation, also need to
consider bridge-income strategies for healthcare providers, beyond SBA
loans and Medicare patches, which would be effective in retaining the
healthcare provider workforce. This is an ever-growing concern as the
cost of living and the cost of doing business continues to increase as
a result of the post-disaster regional economic environment.
Next, we need to enhance health professionals' knowledge of public
health emergency preparedness. In maximizing Tulane's academic disaster
expertise for public health and biodefense, starting this fall, our
School of Public Health and Tropical Medicine will offer the Nation's
only concentration in disaster management for a Master of Public Health
or Master of Science in Public Health degree. The degrees will be
offered both onsite and on-line, to help create a readiness workforce.
Tulane will work to enhance the South Central Center for Public Health
Preparedness and the South Central Public Health Training Center, which
we launched in 2002, to serve the public health workforce in the four-
state region of Alabama, Arkansas, Louisiana, and Mississippi. In the
2004-2005 year the South Central Center for Public Health Preparedness
trained 17,550 and the South Central Public Health Training Center
trained 6,965 professionals. For 2005-2006, the respective numbers
exceeded 17,000 and 8,700. Training and education provided by these
centers addressed critical disaster preparedness and response
components such as Incident Command, Chemical Terrorism, and sessions
specific to the lessons learned from Hurricane Katrina. Continued
Federal support will help our efforts for first-time and continuous
training of public health professionals and first responders: EMTs,
police officers, fire fighters, nurses and doctors.
Tulane took the lead in assuring disaster preparedness. Both the
School of Public Health and Tropical Medicine and the School of
Medicine have in place schoolwide emergency preparedness and response
plans. Parts of the plan were successfully exercised through drills
this spring. Now, every faculty member, staff and student can develop a
personal preparedness plan to be executed in time of disaster.
The Public Health Security and Bioterrorism Preparedness and Response
Act
The Public Health Security and Bioterrorism Preparedness and
Response Act is an important vehicle to solidify collaboration of
public and private sector resources. Specifically, the following
programs are illustrative of the synergism between academia and
government to assure frontline preparedness and response:
a. CDC's public health preparedness grants for State health
departments--These grants are vital mechanisms for disaster planning
and response. Diminishing the commitment to this program will severely
hamper Louisiana's and other States' abilities to respond to disasters.
b. Centers for Public Health Preparedness--Funded through the CDC,
this program is administered by the Association of Schools of Public
Health and is a proven strategy for training first responders, medical
personnel, public health specialists and EMTs. Of special note is that
the center, led by the Tulane University School of Public Health and
Tropical Medicine, provides life-long, just-in-case and just-in-time
training and education to disaster personnel in four States including
Mississippi, which also shares the threats of the Gulf Coast.
c. HRSA's hospital preparedness program--Tulane participates in the
regional system established by the State of Louisiana under this
program. Having a primed regional hospital system will allow for
critical surge capacity in times of crisis.
d. Electronic database (ESAR-VHP)--While the funds are limited,
Hurricane Katrina showed the real need for a database that facilitates
advanced registration of health professionals, so that they can be
mobilized at a moment's notice. Tulane will participate with the State
in implementing this program.
e. HRSA health professions terrorism training grant--While
Louisiana was not a recipient under this grant program, the goal of the
program to assure a cadre of trained public health professionals is
just what we need to respond to terrorism and assure care during
disasters.
f. Expansion of the national stockpile--Tulane's hospitals
participate in the stockpile program. Hurricane Katrina has
demonstrated the importance of having the appropriate supplies--both
accessible and tailored to local needs.
g. City readiness initiative--The city of New Orleans currently
does not participate in this initiative. However, the HELP Committee
could consider the eligibility of cities like ours, even though the
population size might not appear to substantiate the need. Having the
funds provided through this initiative will make a difference in the
readiness of our city.
public health and medical care: conclusion
Reinventing New Orleans' healthcare systems will prove vital to
rebuilding the economy in New Orleans, as the two are interdependent.
This is not a theory, but a proven correlation in models of developing
countries. Rebuilding New Orleans' healthcare systems is not only
essential for its region's residents, it is also valuable to Federal
lessons for biodefense, as well as for re-inventing healthcare systems
across the Nation.
I ask that you consider New Orleans' impending needs for:
Assuring we have a robust healthcare infrastructure,
including provisions to help the uninsured.
Strengthening our healthcare workforce, to allow for
repopulation and economic recovery.
Reauthorizing the Public Health Security and Bioterrorism
Preparedness and Response Act and funding the programs, which will help
for this and future disaster recoveries, as well as improved planning.
Despite enormous challenges and financial losses at the Tulane
University Health Sciences Center, we remain committed to preserving
the integrity and quality of our educational, clinical and research
programs, which result in great economic opportunities for the region
and State. As the leader in disaster preparedness and recovery, the
Federal Government should support institutions such as ours in
maintaining their missions and serving as economic engines for their
communities.
The public health and medical care community in the New Orleans
metropolitan area faces many serious challenges. However, with the
support of the American people and through our public leaders such as
those of you on this subcommittee, we will recover. My colleagues and
I, at Tulane, are fully committed to the rebirth of our community and
to working with you toward achieving a mutual goal of excellence in
health care and disaster preparedness. Thank you.
Senator Burr. Thank you, Dr. Whelton.
Dr. Quinlan.
Dr. Quinlan. Thank you. I'd like to open by saying that I
endorse the comments made by my colleagues and especially by
Dr. Whelton. I understand that the purpose of this is mainly to
share our experience so that others won't have to have quite
the same experience that we all did.
With that, I'll dispense with my submitted testimony and
share some additional ideas that I think are exportable, which
remains a real lesson. Some things are local in nature, but
this is something where there are a number of things that I
think we could apply to any disaster.
With regard to--I would say, though, parenthetically with
what Paul just said, that if in fact there are 1,400-1,600
clinicians left in the region, we have 550 of them. We're about
a third. So about the sustainability question, there has been a
rightful focus on redesign and improving things for the future.
I think it's not only an opportunity, it's an obligation.
But if there's no today, then we don't need to plan on
tomorrow. We are suffering similar losses that Paul mentioned
and our institutions are similar in that we're both private
institutions, we're both private, not-for-profit, and we don't
fit the categories of typical public assistance that some of
our other colleagues do. So I would ask you, when you return to
Washington, to please address that, because we get a great deal
of sympathy but very little help. We are obliged and willingly
will be up for the next disaster, but our ability to do so is
becoming in question. So we need to focus on the today and we
can talk about that offline in the future.
As far as our perspective, we're a very large institution.
We're the largest one in the State, about 1.1 million visits a
year, lots of clinics, hospitals, etcetera. Our main campus is
our anchor. We're about 15 minutes from this point. We're on
the edge of Orleans Parish.
Often in the discussion of New Orleans we confuse Orleans
Parish with greater New Orleans. There are a few hospitals that
have borne the brunt of this disaster and we are one of them.
The U.S. Public Health Service used our board room as the
command post on day one of the recovery or day two, and that
was a very instructive vantage point. So the remarks I have are
borne of our success when we stayed open.
I have a good story to tell. I can speak from experience
about what works and I can speak from experience from what I
observed as the situation evolved with all the incoming
agencies and players and what were impediments to success. I
think these are some of the lessons learned.
No. 1, about communication, I think everyone knows that the
way to decapitate your opponent is first to destroy their
communications in wartime. The same thing happens in peacetime,
but the effect is the same. We kept our communications open. We
have redundant buried T1 lines into our other sites, so we have
a very large network that reaches into Baton Rouge and the
north shore. So we retained our Internet capability and our
phones and that was invaluable to understanding how to respond
to the disaster.
We also have a mature electronic medical record that knits
our system together so that our patients when they did evacuate
were able to get uninterrupted care. So I endorse the concept
through experience of the importance of an electronic medical
record.
The key to our success was culture and it's a performance-
based culture with an emphasis on teamwork. We can't instill
that everywhere in the country, but what you can instill it in
is in the response teams from the various governmental
agencies. They need to have a culture of performance and
teamwork and the ability to integrate and do things
differently, and we can talk about that.
We heard other testimony about the idea, which we say is:
expect to be alone, plan for a worst case scenario. I think
most disasters are felt to be more finite in terms of your
planning. Plan for the worst and if you're not ready for the
worst then don't be surprised. We did plan for the worst and
fortunately we were ready for this one, but we're under no
illusion that we might be ready for the next one because by
definition you're surprised. Otherwise it's not a disaster. But
I think that we need to prepare for that.
One of the things that we were prepared for that I would
think needs to be part of all disaster preparedness is to
provide for security. Fortunately, we had 20 armed guards so
that our folks had a sense of security and were able to focus
on their jobs at hand and not be distracted by concerns for
their own safety or the safety of their colleagues or patients.
Some of these things I'm going to talk about almost sound
like platitudes, but I can tell you that if you don't practice
them you'll lose a huge amount of emotional energy and actually
engage in counterproductive behavior. That is, practice
gratitude. We witnessed so many acts of kindness and generosity
and courage by our people at Ochsner for the patients and
families and so many nameless volunteers and donors from around
the region and country. This was the untold story. Ninety-nine
percent good news, 1 percent bad news. Unfortunately, we only
saw the 1 percent bad news.
Furthermore, take heart in the great number of highly
competent, dedicated, and hard-working public servants at every
level of government. In our focus on failures, we overlook the
successes that were the product of exceptional effort and
skill. At times our systems were simply not worthy of the
people who served them.
This is an important one: Cultivate curiosity, particularly
in times of stress. We tend to miss what we don't know or don't
anticipate or we try to force things into previous experiences
that just aren't right. We tend to find what we're looking for
and overlook what we're not, and we tend to see and hear what
we believe. Catastrophe requires that we throw out old
assumptions and think anew. We just need to know that
catastrophes by definition are going to be different because
the environment's different. We have to have people who are
alert, who ask many more questions than talk, and that they're
onsite and learn rather than just react.
It's kind of a nebulous concept, but when you can see
people who clearly did that they were successful. The people
who came preloaded weren't. So it's an attitude and it gets
back to the culture that we need to develop for first
responders.
We need to learn to practice patience. We have a democracy,
which tends to be noisy and complicated. You can write the book
on that. Our governments are restrained by a host of
regulations and statutes, all of which are not completely
clear, as you well know. This complexity is often exacerbated
by the grey areas of authority.
Not uncommonly in our lengthy experience, administrative
and legislative bodies each contend that the other has the
authority to act without action by the other party, resulting
in gridlock or deadlock. A pressing need and a divided
authority is a stressful combination, particularly for those
onsite, and it requires a lot of patience and goodwill to sort
this out.
The next one is the most important one: Get onsite and stay
there. The proper response depends upon on-site assessments.
While there are very good reasons to headquarter away from
disaster, these reasons are insufficient when contrasted with
the need for timely and accurate information and good
leadership. You live by the principle that if you aren't there
you simply don't know, and if you don't know you can't
criticize, you can't judge.
I cannot tell you how many times I heard countless people
rolling through on a telephone trying to get up to speed,
getting it partially right, and then moving on. It took a very
complex and difficult situation and made it nearly impossible.
It's a small wonder that anything got done, given the
fragmented nature of this approach. People, even as they become
to this day knowledgeable in their particular job, be it at
FEMA or anything else, sometimes you have some very good ones
and just when they're up to speed their rotation is over and we
start over again. That is not the way to run a disaster of any
size. That's fine for a tornado. It will not work for the next
giant earthquake. It won't work for a bioterrorist incident, I
promise you that.
The other is, as I mentioned, stop the revolving door.
During the crisis and post-crisis, rotating assignments were
common. Just as they became knowledgeable, they were replaced.
Common remarks are: I just didn't understand, and there's a
gulf of understanding between X and here, be it Washington or
Baton Rouge. Consistency will improve a difficult situation.
Inconsistency will make it worse.
The punch line here is: Use the private sector. We talked
about stockpiling things. Don't bother for the most part if
it's going to be of real scale. In government only the armed
services are trained and configured for operations with both
speed and scale. Until you've done something logistically, you
don't understand. This is huge. Nobody's ready for it, and the
next one could be bigger. The rest of government is best suited
for maintenance and marginal change.
That's the nature of our government by choice, by training,
by configuration, by temperament, and with limitations of
regulations and statutes that are incapable of rapid large-
scale response. We need to recognize that as the reality and
plan differently.
Private enterprise was and is collectively capable of
massive, timely response. We are a production economy, we are a
supply chain economy. We need to tap that.
If we don't, shame on us; we won't be ready for the next
one.
This was our clear experience. We suggest that a public-
private partnership for a large-scale disaster response is the
most successful option for the future. You need to become a
manager and manage distribution. Do not get in the storage
business. You won't be ready. Industry is very good at that.
We need to harness it. Do not try to reinvent it. We can't
afford it, simply.
This collaboration should be formalized and built to a
scale sufficient for the worst case scenarios. If we can access
the capabilities of the private sector, we will achieve
success.
Finally, consider the incentives and counterincentives
presented to all players. Our institution, Paul's institution,
others have stepped up, borne the expense, stepped in for
government at every level. However, the incentives simply
aren't there. In fact, when you look at it there are counter-
incentives. Our business interruption insurance was greatly
compromised by the fact that we fought successfully to stay
open, and in response there has been nothing but thanks. Now,
that's a side story, but the point is around the country if you
expect private institutions to stand up, much like you will
mobilize the private sector for supply and sustainability, you
need to make sure that that's actually a common sense,
straightforward thing to do, rather than being put in some sort
of double bind where if you do the right thing you'll pay and
in fact jeopardize your own existence.
So I hope those things are helpful and I think every one of
those are exportable and was applicable to our situation and
will be to others. Thank you.
[The prepared statement of Dr. Quinlan follows:]
Prepared Statement of Patrick J. Quinlan
Good afternoon, Mr. Chairman. I am Patrick J. Quinlan, M.D., Chief
Executive Officer, Ochsner Health System (OHS), in New Orleans, La. I
appreciate the opportunity to speak to you and your colleagues about
the current state of healthcare in the greater New Orleans area, and
the potential for re-building and re-designing our healthcare sector.
For nearly 60 years, OHS has cared for residents in the greater New
Orleans and Baton Rouge communities. Our main campus, including the 478
acute-care bed hospital and clinic, is located in Jefferson Parish,
less than a mile from the Orleans Parish line and only a 15-minute
drive to downtown New Orleans. In addition, we have 24 clinics
throughout the New Orleans area and a sub-acute nursing facility/
inpatient psychiatry/inpatient rehabilitation hospital two miles from
our main campus. In Baton Rouge, we have three clinics, 70 physicians
and 50 percent ownership of an acute care hospital. Recognized as a
center for excellence in research, patient care and education, OHS is a
not-for-profit, comprehensive, independent academic integrated health
care system, and the largest nongovernmental employer in Louisiana.
With more than 7,400 employees--including more than 600 physicians in
nearly 70 medical specialties--OHS is also one of the largest
nonuniversity-based physician-training centers in the country, annually
hosting over 325 residents and fellows, 450 medical students and 400
allied health students.
When Hurricane Katrina hit the Gulf Coast, no one could have truly
imagined the intense devastation it would leave in its wake. The wind
and the rain wreaked havoc across Alabama, Mississippi and Louisiana.
The health care system as we knew it in New Orleans was devastated. The
universities responsible for 70 percent of the medical education in the
State were closed. Knowing that the storm was headed their way,
hospitals began sending home patients deemed well enough to be
discharged. Those in critical condition or requiring special
assistance, such as ventilator-assisted breathing, remained in the
hospital. When hospital staff emergency teams arrived for work during
the weekend before the storm hit, they expected it might be only a few
days before they were able to return home. However, when the levees in
New Orleans broke, the situation changed dramatically. We, and our
colleagues in the New Orleans metropolitan area, faced a dire situation
beyond our imagination.
Throughout the onslaught of Hurricane Katrina, and during its
devastating aftermath, OHS remained open, caring for patients and
continuing our medical education programs. This afternoon, I would like
to tell you how my hospital system prepared for the storm; what our
facilities did to ensure our doors remained open to provide critical
health care services to our community; what we have done subsequently
to ensure continued provision of all critical health care needs to the
community; how we have maintained medical education for the region; and
answer any questions you and your colleagues might have about our
experience.
planning for disaster
Hospitals routinely plan and train to deal with disaster, whether
it's the derailment of a train carrying hazardous substances, a
multiple-vehicle accident on a nearby interstate, a plane crash, or a
natural disaster such as a hurricane or earthquake. As hospitals plan
for disasters and the prospect of going without public services such as
electricity and water, we prepared to be on our own for at least 72
hours, in the event it takes that long for assistance to arrive from
the State or Federal Government. Our plan, which we revise after every
disaster or ``near-miss'' event, had been revised most recently on June
1, 2005, less than 3 months before Hurricane Katrina struck.
On Friday, August 27, our entire executive leadership team had
assembled in New Orleans for the first day of a 2-day leadership
retreat. Late in the afternoon, we were notified that the storm had
turned to the West and likely would strike the area. We immediately
initiated the first phase of our disaster plan, which included
notifying essential personnel and securing previously stockpiled
supplies.
Under the most recent disaster plan, two teams of essential
personnel, Teams A and B, were created to ensure continuity of care and
relief for employees on duty at the time disaster strikes. Each team
was to include staff members from all departments, e.g. security,
housekeeping, dietary, nursing, physicians, house staff, IT, media
relations, research, etc. Team members had been identified and
committed by June 1.
From previous experience, we realized the importance of not only
adequately stocking essential supplies onsite, but also creating a
back-up system to ensure additional supplies could be secured in times
of an emergency. On Friday, we activated our supply chain and began to
secure the additional supplies we had stockpiled off-site. Important
supplies included: 400 flashlights; 100 head lamps; 2,000 batteries;
4,000 glow sticks, including 2,000 with lanyards; 600 SpectraLink
wireless telephones with 1,800 batteries; 450 oscillating fans, one per
patient; 250 box fans for work and sleeping areas; 20 55-gallon drums
of water on each floor for commode flushing; 3000 gallons of water for
drinking (we also have a deep water well on campus with a 10,000-gallon
holding tank for additional water in an emergency); 60,000 gallons of
diesel fuel; 10 pallets of sandbags; 8 pallets of plastic bags; 100
blue tarps; 20 dehumidifiers; 5 pallets of plywood; and 50 additional
shop vacuums. We also increased our food supply. At this time, we
inspected our power sources. Our emergency generators are all located
above our facility's second floor and our transformers were located on
the ground level, behind 10-foot floodwalls.
On Saturday, August 28, executive leadership met with the vice
presidents, directors, and managers and agreed to order Team A onsite
by Sunday afternoon. Staff then began discharging the appropriate
patients and moving those that would be unable to leave the facility.
The families of the remaining patients were given ``boarding rules''--
one family member per patient would be allowed to stay. Similarly,
staff was discouraged from bringing family members to work unless they
absolutely could not make other arrangements. All patient and personnel
families were pre-registered and given ``special'' parking passes to
access our parking garage. During previous storms, we experienced
problems with people in the community attempting to use our garage to
protect their cars and boats. Under the revised plan, we stationed
armed guards at the entrances to the garage to ensure that hospital
staff, patients and their families could access the garage, and that
all entrances were kept clear.
On Sunday, ``sleeping'' assignments were made. Due to concerns
about the predicted high winds, patients were removed from the highest
floors of the hospital. Patients were also moved into hallways and
rooms without windows to protect them in the event of flying glass.
Because OHS is a research facility, we house numerous research animals,
which were evacuated to facilities in northern Louisiana. After
evacuations were complete, we settled in to wait and see what Hurricane
Katrina would bring.
weathering the storm
Ochsner's main campus survived the actual hurricane quite well. We
sustained some roof and structural damage to our main facility, but
overall the news was positive. Our generators functioned properly, the
Internet was up and running, and our internal communications system was
fully operable. Employees lost cellular phone and beeper capabilities
due to damage to local cell towers; however, we had planned for such an
event, and staff members were armed with SpectraLink wireless
telephones. As a result, communication critical to patient care was
uninterrupted. Our land-based telephones also remained in working order
due to redundancy in our carrier network. Our medical record system is
entirely electronic, and with power and the Internet operable, we did
not have concerns about the availability of critical patient
information. We had adequate supplies and believed we would be able to
ride out the next few days.
However, as the situation in and around New Orleans rapidly
deteriorated with the breach of the levees, conditions inside the
hospital also took a turn for the worse. On the second day, one of our
generators failed due to a mechanical problem, and we were forced to do
without air conditioning. As a result, our Internet servers were shut
down to prevent them from being damaged by the heat. Unfortunately,
server shutdown meant the electronic medical record system was
inoperable. We attempted to send our helicopter out to secure the
needed parts for the generator, but all nongovernmental aircraft were
temporarily grounded. We were, however, able to locate the necessary
parts the next day to get the generator up and running again.
Conditions in our immediate area continued to worsen. Our main
facility is located a few miles from the I-10/Causeway where large
numbers of people attempting to make their way out of New Orleans after
the storm congregated. Many of those gathered turned to the hospital
for assistance on their way. However, we are a hospital, not a shelter.
We tried to point people in the right direction to get the help they
needed, and also dispatched medical personnel to the site to care for
individuals in need, transferring those needing hospitalization back to
our campus. Conditions in our neighborhood further destabilized as
floodwaters began to rise; looting of nearby businesses began. At that
point, we felt compelled to ask the National Guard to assist us in
securing the safety of our patients and staff, and placed OCF on
lockdown.
Operations inside the hospital similarly were beginning to show
signs of strain. Although we had made extensive plans for securing and
relieving essential personnel with the Team A and B designations, and
had gone to great lengths to keep staff apprised of the situation--
setting up a telephone tree as well as a dedicated Web page with
information--we had difficulty securing relief staff. Many had
evacuated with their families to Baton Rouge and beyond. Fortunately,
we were able to locate a good portion of staff members there and bring
them in by bus convoy. As the floodwaters continued to rise, the same
convoys were used to evacuate exhausted staff and their families, as
well as patients who could be moved and their family members, to our
facilities in Baton Rouge. These same convoys were our lifelines for
supplies as well, enabling us to continue functioning.
At their height, the floodwaters rose as far as the doors on one
side of the hospital, but we maintained the ability to leave and enter
the building from other entrances and faced no real danger. Instead, we
realized that rumor and speculation were a larger threat to the
internal stabilization of the hospital than the floodwaters, and
created an internal communication system to keep staff and patients
informed of the conditions within the hospital and the city at large.
The leadership team met twice daily to be updated and then fanned out
across the facility, sharing the news they had just heard and answering
questions. This open and honest communication policy went a long way
toward assuaging staff and patient fears, and keeping the hospital in a
calm state.
Toward the end of the crisis, we began to run low on food. However,
we had an ample supply of water and were able to make do until relief
shipments could be brought in. We also ran low on insulin, but because
our telephones had been unaffected, we were able to secure 10,000 doses
donated from sanofi-aventis pharmaceutical company.
reaching beyond our walls
With the situation in OHS' main facility well in-hand, our
leadership team sought to inform local officials and offer assistance
to other health care facilities hit harder by the storm. Since our
land-based telephone system was operable, we believed this would be
easy. However, we had great difficulty trying to contact other
hospitals and local agencies that were not as fortunate in the quality
of their communications systems. We even found it difficult to locate
the proper State and Federal officials to offer our assistance.
According to our regional emergency plan, we report to the
Jefferson Parish Office of Emergency Preparedness (OEP). However, the
OEP system was overwhelmed and communication was impossible. When our
attempts to reach the Jefferson OEP failed, we attempted to reach the
Baton Rouge OEP. This was also challenging, as it appeared that the
bandwidth of their system could not accommodate the high volume of
incoming requests and was overloaded. We eventually successfully
contacted the Orleans Parish OEP following the levee break, requesting
both information, as well as assets. During this exchange, we became
aware of their communications difficulties with the downtown hospitals
that were in the midst of evacuating.
It was virtually impossible to coordinate air evacuation due to the
various agencies involved--both military and civilian--and their lack
of ability to communicate. We sent a vice president through the
floodwaters downtown to the Orleans OEP with a hand radio to try and
assist their coordination efforts, but were unsuccessful in reaching
them. We instead found a widespread lack of coordination: police
communication systems that were ineffective due to infrastructure
damage and volume, and a National Guard system that was able to
facilitate communications amongst guard units, but had difficulty
communicating with local authorities. Of external communications,
satellite systems were unreliable, and cell service, for a while, was
virtually eliminated. Text messaging and Internet were the most
reliable methods of communication.
Communication improved on day four when the United States Public
Health Service (USPHS) arrived, and interagency daily meetings at OHS'
main facility began. In addition to the USPHS, these meetings included
``all'' hospitals and representatives from the Jefferson and Orleans
OEP health care divisions. The USPHS was able to facilitate requests
through the previously frustrating channels. They were particularly
helpful with things like fuel and security; however, they did not have
access to many of the assets we required. Prior to the USPHS's arrival,
we were so frustrated in our inability to notify authorities that we
were open and able to accept patients, that we used large trash bags to
spell ``OPEN'' on our garage roof hoping to attract the attention of
the armada of helicopters flying overhead.
recovery
With our Board's permission, and because of our commitment to the
community, and at a great expense to Ochsner, we have kept our
workforce on payroll throughout and after the immediate crisis. We have
recruited to fill both professional and nonprofessional positions in
order to be able to open approximately 100 additional beds to serve the
needs of the community. We have leased one of our facilities, the
Elmwood Medical Center to the State to be used as a Level I trauma
center. Even as our indigent care discharges have nearly quadrupled and
our cost of operations has escalated, we have re-dedicated ourselves to
be the healthcare safety net for the region. Despite operational losses
of nearly $70M, we have maintained all of our primary, tertiary and
quaternary services, including state-of-the-art cancer treatment, solid
organ transplant, and cardiovascular interventions. We have received
virtually no financial relief for our efforts and to offset our losses.
Because we are a private not-for-profit institution, we have not been
eligible to directly receive loans from the Community Disaster Loan
program. HRSA grants, similar to what was offered to NYC institutions
following the 9/11 disaster, have not been made available to us.
We have also become the academic safety net for the region. Shortly
after the hurricane, we invited investigators from both Tulane and
Louisiana State Universities to use our research laboratory facilities
in order that their research could continue uninterrupted. This has
allowed numerous investigators from both universities to not only
maintain their NIH funded work, but also to secure additional funding.
Our teaching programs have continued uninterrupted. We had a very
successful match for our residencies programs this year. Despite, our
concerns of top students not wanting to continue their training in New
Orleans, all of our programs filled at approximately the same or
improved level from prior years. We even increased our match numbers by
5 this year, despite the State offering a $10,000 bonus to students who
matched into the competing University programs.
Since we have an extensive infrastructure for academic activities,
we have offered to host additional LSU and Tulane-based residents and
medical students at our facilities. We are doubling the number of
medical student rotations to over 900 annually. At this time, it
appears we will have 50 to 75 additional residents training at our
institutions. We are doing this even though it imposes a significant
financial risk to us. The April ruling by CMS for temporary transfers
of CAP FTEs during a disaster intends to ameliorate the financial
burden. However, there are two aspects that significantly adversely
affect our ability to host the residents. The ruling that the
additional CAP transfer positions must be averaged over a 3-year period
will have us not breaking even until the third year. At this time, when
our cash flow is a significant issue, given our operating losses
secondary to the hurricane, it is problematic that we will be able to
continue to host the residents. Additionally, the 3-year maximum time
period is significantly short of the time it will take for LSU and
Tulane to restore their teaching facilities.
The training of these house staff is critical to the New Orleans
region being able to maintain an adequate public health workforce.
Prior to the hurricane, the Louisiana Medical Education Commission has
reported that Louisiana was in a relatively steady state in regards to
the training and establishing of new physician practices relative to
the number of physicians leaving practice. With large numbers of
physicians having left New Orleans after the hurricane, any threat to
the New Orleans region training programs will significantly affect the
public health workforce and the ability to care for the healthcare
needs of citizens in this region. Therefore, it is extremely important
that the 3-year rolling average be abolished and the 3-year maximum
time limit for this emergency ruling be extended.
As you undoubtedly will learn from the LSU and Tulane
presentations, the universities will be scrutinized extensively this
summer by their accrediting bodies. Both the Accreditation Council for
Graduate Medical Education (ACGME) and the Liaison Committee for
Medical Education (LCME) will evaluate the respective residency
training programs and medical school curricula. It is imperative that
the medical schools demonstrate adequate teaching sites and supervision
for both the residents and the students. If not, they will lose
accreditation, faculty will leave, and students and residents will not
be trained in their programs locally. The development and deployment of
an appropriate public health workforce will not occur. This will result
in the worsening of what already is a crisis.
One of the success factors for Ochsner during and immediately after
the hurricane has been our electronic medical record. This is the only
fully functioning electronic medical record in the region. This was and
continues to be a life saver for our patients. No matter where they
arrived after the hurricane, their health record was available to them.
This type of record is of paramount importance for all of our
residents, whether in the midst of a disaster or in the course of their
routine care. Because we recognize this, we have been working with
local and State groups in the planning of health information technology
for the region. We offer the use of our electronic medical record to be
used by other institutions and patients in the region. The ability to
make this available will require funding to adapt it to other
institutions' platforms.
summary and conclusion
Ochsner Health System is a nonprofit (501c3) independent academic
integrated health care system. We have stayed open during the hurricane
and expanded our ability to care for patients and maintain the academic
programs in New Orleans. This has occurred at great financial impact to
us. We have as of yet received no significant financial assistance to
offset our losses. Our academic activities have allowed the two
universities to return to New Orleans, and so far to remain in
compliance with their accrediting bodies. Our electronic medical record
is unique in the region and has been the lifeline for our patients.
As you help to plan and oversee the rebuilding of healthcare in
this region, we ask you to consider:
Stabilizing the public healthcare workforce by asking CMS
to amend its April Emergency Ruling to void the 3-year rolling average
and 3-year time limit on the Cap transfer positions;
Securing the availability of necessary healthcare services
by assisting us in identifying funding to offset our hurricane-related
operating losses;
Ensuring the availability of patients' medical records
during a disaster, as well as, for routine care by assisting the
implementation of our electronic record for all providers regionally.
We look forward to working with this committee and staff to forge
ahead toward a shared goal of improving the healthcare in New Orleans.
Senator Burr. Dr. Quinlan, thank you, and let me assure you
that your points on logistics has been a primary focus of the
subcommittee as we've looked at what the future should look
like, and I wish I could assure you that I had all the answers.
Logistics will always be a challenge, but we have heeded
everybody's advice that the private sector must be included in
that process or it will not work, and I agree.
Dr. Rouse.
Dr. Rouse. Thank you. I'm a 31-year-old psychiatrist, born
and raised in New Orleans. I'm not here to detail grand
recovery plans or report on any comprehensive programs that I
oversee, because I don't oversee anything. I'm a whistleblowing
psychiatric foot soldier and my sole intent today is to report
accurately what I have seen and experienced from the very front
lines of the medical and psychiatric response to Hurricane
Katrina and to ask of you three things.
When the storm hit, I had already evacuated with my wife
and two small children to Houston. But when I saw the images of
my home town on television I had to get back. I rushed back to
Baton Rouge, volunteered in the extraordinary field hospital
set up on LSU's campus. Then with medical supplies, my
backpack, and frankly my firearm, I broke back into my home
town and offered medical and psychiatric assistance to the
members of the New Orleans Police Department, and I was quickly
commandeered.
Along with a Homeland Security medic, we set up a medical
and respite clinic for NOPD and Federal law enforcement
personnel in the gift shop of the Sheraton Hotel downtown,
using whatever supplies we could scrounge. We worked for a week
straight, nights and days, providing badly needed medical
support to the rescue workers who braved the rancid flood
waters.
However, we were starkly alone. Promises of medical
reinforcement from the United States Public Health Service were
only promises. Nearly a week after the storm, while the Baton
Rouge field hospital was closing down, volunteer doctors were
being turned away by FEMA, while we were still screaming for
assistance. Scientologists, Tom Cruse's cult, were in New
Orleans providing massages before we saw any organized Federal
medical help with the NOPD. In my sleep-deprived eyes, there
was a crisis and organized help was merely a wish.
Now, 10 months after the storm, I'm not working any more as
an ad hoc emergency room doctor, but as the deputy psychiatric
coroner for Orleans Parish. What that means is under Louisiana
law I provide medical-legal oversight over involuntary
psychiatric commitments and I assist families in getting
treatment for persons potentially dangerous to themselves or
others because of psychiatric illness.
I can state unequivocally that now, with respect to mental
health, we are in no less of a crisis than I faced in that week
after the storm. In fact, mental health is the chief public
health problem facing our area in my somewhat shrill opinion
right now.
Let me present to you the grim facts regarding our mental
health situation in the greater New Orleans area. The suicide
rate spiked dramatically after the storm. In Orleans Parish,
conservative estimates suggest a tripling of the per capita
suicide rate through the end of 2005. Estimates from nearby
Jefferson Parish also suggest increased suicide rates and
attempted suicides during this time period. Most of these
people had no previous history of emotional or psychiatric
difficulties.
My boss, the Orleans Parish coroner, Dr. Frank Minyard,
estimates that the effects of ongoing psychological stress
account for as many deaths as the direct effects of Katrina.
This is especially relevant to our elderly population and
locals will tell you that the obituary pages in our newspaper
are noticeably longer.
At the coroner's office we are committing more patients per
capita than we ever did before the storm, and as the months
tick on more and more of these patients we deem especially
dangerous, such as having access to weapons or a history of
fighting with law enforcement. Unfortunately, local law
enforcement has been forced to use deadly force three times on
the psychiatrically ill since the storm, something that was
virtually unheard of before the storm.
The NOPD and other local law enforcement agencies are
spending an inordinate amount of time handling calls for
service regarding the mentally ill. This overwhelming demand on
our law enforcement community drains precious resources at a
time when proactive community policing is most necessary. Every
officer that sits in an emergency room for hours and hours with
a psych patient is one less officer available to my community,
to my wife, and my two small children at home.
Hospital security at several of the institutions
represented before you today refused to take custody of these
patients on arrival to the emergency room, in my nonlegal
opinion a likely violation of State and Federal law.
Studies have shown that increased use of illegal drugs and
alcohol is rampant in our communities, and we've lost about 89
percent of our psychiatrists, as you've already heard. Budget
cuts have forced both Tulane and LSU departments of psychiatry
to lay off about half of their faculty at this time of greatest
need. The remaining local outpatient psychiatric providers have
seen dramatically increased caseloads and they have been heroic
and creative in finding ways to deliver quality mental health
care under the current circumstances. However, the treatment
options for the suicidal, the drug addicted, or the violent
psychiatric patient are a most critical need.
The metropolitan New Orleans area had approximately 450
psychiatric inpatient beds before the storm and now we have
about 80. Tulane DePaul Hospital, a large Columbia HCA-managed
psychiatric hospital in uptown New Orleans, lies mostly
undamaged, but empty, reportedly because of financial concerns.
Patients now wait in emergency rooms for psychiatric placement
for days and days, often confined to isolation rooms with
medication treatment only. Emergency rooms are inundated with
these psych patients. Veterans with need for psychiatric
hospitalization to this day are shipped as far away as Houston,
and there are no public detoxification services currently
available for drug addiction in the local area. We have a
critical psychiatric bed shortage. We are now New York without
Bellevue, Washington, DC., without St. Elizabeth's, and North
Carolina without John Olmstead in Butner.
Now, in this time of greatest need I paint this picture to
ask you three simple things. No. 1, for the sake of my State
and for any communities affected by future disasters, please
amend the Stafford Act. As it's written, FEMA is prohibited
from funding any direct mental health activities that are
considered psychiatric treatment. I think we've learned that a
disaster of this magnitude demands a Federal response flexible
enough to assist all of its citizens in all capacities,
including the mental health effects that I just listed.
As specified in the Stafford Act, the provision of, quote,
``crisis counseling'' by those without mental health training,
it's simply not sufficient. If a dirty bomb contaminates
Manhattan or San Francisco experiences a major earthquake, you
can be assured that our experience of a post-Katrina mental
health crisis will unfortunately be repeated. Please remove
this arbitrary prohibition. We lost many of our local health
workers due to budget cuts when we needed them most, because of
this limitation.
No. 2, if you are going to have a strategic national
stockpile, please add psychiatric medication to it. It's not in
there currently and inevitably you will have people who need
continuation of existing psychiatric medication as well as
assistance in basic things such as sleep and anxiety reduction
during this stressful time.
Then finally, on behalf of the mental health, the law
enforcement, the criminal justice, and the emergency room
communities of this area, I ask the subcommittee to put its
full weight of its power to force the State of Louisiana
Department of Health and Hospitals, the LSU Health Care
Services Division, and the Office of Mental Health to abide by
its moral and legal obligation to re-open its full-scale acute
psychiatric emergency room for the New Orleans metropolitan
area. There's already a Federal consent decree known as the
Adam A decree issued in the early 90s. This forced the State to
have a behavioral health emergency room. This 25-bed
psychiatric emergency room on the third floor of Charity
ensured timely and appropriate mental health treatment for the
acutely psychiatrically ill and for those suffering from drug
abuse. First responders could bring patients there and be back
out on the streets within 15 minutes.
Now the New Orleans area is faced with a behavioral public
health emergency of unprecedented magnitude and we do not have
the capacity to care for the suicidal and the psychotically
violent. The third floor of Charity or DePaul Hospital, in my
frank opinion, could be reopened right now with these two keys
right in front of me and the current mental health crisis in my
home town would be dramatically and rapidly mitigated.
We're a year after Katrina. Current plans from the State
with regards to a psychiatric emergency room remain tentative
at best, likely underfunded, and call for as few as six beds.
There are six psychiatric patients waiting in the halls of
just one local emergency room right now.
As I felt during the immediate aftermath of the storm,
there is still a crisis in my home town and organized health
remains merely a wish. Please put pressure on this issue from
the top down and enforce the full spirit of the Adam A consent
decree. For future disasters, I urge you to maximize and
augment psychiatric care and learn from the bitter lesson we
are still enduring. It's a matter of public health, public
safety, and society's obligation to care for its ill, including
the mentally ill.
Thank you.
Senator Burr. Dr. Rouse, thank you, not just for your
testimony but for the way you responded personally to the
disaster here. It was our intent as we introduced the public
health legislation that the Stafford Act would be one of those
areas we would address. Washington is a strange town
jurisdictionally and sometimes it's tougher when you produce
legislation that crosses different committee jurisdictions. It
will not be part of this effort, but let me assure you the
committee is working with those two committees of jurisdiction
to make sure we look at that issue very seriously.
Dr. Rouse. Thank you.
Senator Burr. Mr. Barry.
Mr. Barry. Thank you. First of all, I'd like to thank the
subcommittee for traveling here to Louisiana to conduct your
hearings here. We appreciate that very much. For me it's a
personal privilege to appear before you this afternoon to share
what I might regarding what Katrina and Rita have taught us
about our vulnerabilities.
As you mentioned, I am President and CEO of Blue Cross-Blue
Shield of Louisiana. We're the manager of medical benefits for
just over 1 million people in the State of Louisiana, which
represents about half of those who do have private health
insurance.
Unlike my colleagues on the panel, I want to make it clear
I was not involved in any on-the-ground operations related to
patient care during or after the hurricane. My observations are
drawn primarily from the vantage point of assisting those 1
million Blue Cross members in securing the health care services
that they needed during the immediate crisis and what has
proved to be a very long and painful aftermath.
But that has meant working closely not just with those
members, but, just as importantly, with care providers. We've
also worked closely with their employers and with the agents
and brokers who serve them.
I'd like to speak briefly about the public health side of
Hurricanes Katrina and Rita. We've all seen those televised
images of the hurricanes' physical and emotional toll on the
citizens of our State. Those are seared into our consciousness
and the comprehensive histories of Katrina and Rita have
already been written and they need no embellishment here. But
from a public health standpoint, as you've heard from my
colleagues, there is a very important aspect of Katrina's and
Rita's legacy which, while less obvious, is perhaps even more
important. And that legacy is that of people's inability to
access critical health care services when needed and the
inability of caregivers to provide the care that is most
appropriate.
While these issues existed to some degree before the
hurricanes, they turned extraordinarily acute after the
hurricanes, teaching us what I see as four very important
lessons, lessons which, as you've already heard, continue to
this day taking an immense toll on public health. We are still
learning these lessons.
Lesson one, that a metropolitan area's health care capacity
is easily overwhelmed. We've spoken already about the surge on
health care demand, and it wasn't simply the loss of hospital
infrastructure. As you've heard from other people on our panel,
a number of doctors and nurses have also left the area and,
while the area is smaller in population than it was before in
terms of residents who have left and have still gone, by our
reckoning looking at our claims data doctors and nurses have
left the area in even greater proportions.
We would also indicate that, based upon what we're seeing,
that about three-quarters of the physicians who had been
practicing in the New Orleans area are no longer submitting
claims to us, so that they clearly have left this area, leaving
it grossly underserved in our view.
Lesson two, something you've also heard a little bit about
already: that logistical and communication issues make it
difficult to even properly use what limited health care
capacity has remained. In the period immediately following
Hurricane Katrina, many needed and willing medical
professionals already within the area or coming into the area
were not engaged due to credentialing and licensing issues,
fears of professional liability, or lack of centralized
coordination.
There was also obviously a loss of contact between
physicians and the ill patients that they were attending prior
to the hurricanes, rendering appropriate clinical follow-up
with these patients impossible. Normal referral patterns among
independent practitioners have also been thoroughly disrupted
with the migration of so many doctors, leading to disruptions
and patient care.
Surprisingly, there is no centralized information or
database from which patients or referring physicians can even
determine or public health planners can determine which nurses
or which doctors have remained in or have returned to the
affected areas.
Resource shortages in certain key areas within the system
are creating bottlenecks in the care continuum, for example,
the inability to discharge hospitalized patients due to
shortage of home health care nurses needed for follow-up; the
excess demand on area emergency departments due to shortages in
primary care.
Lesson three, the widespread loss of patient records put
large numbers of patients at risk. Dr. Cerise had spoken about
that in his remarks. There were efforts made to help remedy
that situation immediately after the hurricanes. Through
katrinahealth.org, our own organization quickly put together a
patients claim-based health record which has a lot of valuable
information for attending physicians to use in the care of
those patients who left their communities or even left the
State.
In practice, those efforts and those capabilities did not
garner as much physician uptake as one would have hoped and we
believe the reason is that we were missing the requisite
provider awareness and education that's required to utilize
these tools. So we need to anticipate not just having those
types of tools available, but using tools such as that have to
become part of clinical practice for them to be effective.
Lesson four, and I'd like to spend just a little bit of
time on this because I think it's a point that can't be
overstressed, although a number of my colleagues have made
comments with respect to it, and that is that the normal
methods of reimbursement which health care providers rely on
are very easily disrupted in an event such as Hurricanes
Katrina and Rita. For example, during the height of the
emergency and its aftermath, providers were preoccupied with
meeting immediate patient needs and not with gathering patient
documentation which would later be needed to submit claims,
particularly in the case of Medicaid patients and the
uninsured.
Some of the unique aspects of health care financing in
Louisiana, particularly the dependence on the, quote, ``charity
system'' for indigent care and our heavy dependence on Medicaid
and disproportionate share of funding, created unanticipated
systemic vulner-
abilities. Closure of LSU's Big Charity Hospital left LSU
Health Services and Tulane and LSU Schools of Medicine without
their normal revenue source. Charity's closure significantly
increased the percentage of uninsured and Medicaid patients
treated by other hospitals in the area, which are not normally
compensated for providing those services, or at least not on
the same basis.
We're seeing that prolonged impatient lengths of stay due
to these difficulties in discharging are creating losses on
Medicare-based DRGs. Independent physicians, particularly those
serving the Medicaid population, face difficulties maintaining
their practices due to the dispersion of their former patients
and lack of critical mass in most neighborhoods for developing
new patient bases, which makes it difficult for them to come
back.
Surprisingly, we've seen that private insurance has so far
remained resilient to Katrina-induced demographic and economic
disruption. Of more than--we have more than 800,000 of our
members who are covered under group insurance plans and so far
we've only seen a loss of about 30,000 because of people who
have lost their employer-provided coverage. We expect that is
going to continue to go up as some businesses who are
struggling to maintain operations over time may not be able to
do so.
One of the things that we found worked with regard to the
privately insured process is that we granted a 90-day grace
period for premium payments, and we continue to pay full
reimbursement for all medical services provided to all of our
patients regardless of whether premiums were paid, and we saw
that that provided a very important bridge to those customers
to be able to live through the crisis and, surprisingly, the
great majority of those who suspended those premium payments
came through and made those payments in December. So there has
been much more resilience in that private insurance customer
base than we would have thought, which has been helpful in
helping to support the remaining capacity that we have in the
New Orleans area.
However, we are seeing that our claim level in the New
Orleans area has been somewhat modestly reduced, which is
testimony to the compression that exists within the health care
system because of the excess demands being placed on it and the
lack of full access to privately insured patients is further
compromising the financial integrity of the system that
remains.
We're also seeing a lot of workers who are coming in and
the rebuilding efforts are not covered, not only for private
health insurance, but they don't have workers compensation
coverage, and those uninsured workers who have come into the
area are also creating a burden for our hospital
infrastructure.
I do have a set of several recommendations. In the interest
of time, I would just like to emphasize, I think a lot of these
issues that we've pointed to do have solutions, but they
require thoughtful solutions. Some of those need immediate
attention. One of the recommendations as we think about
emergency preparedness that would be easily overlooked is the
need to have a quick response in the immediate aftermath of the
disaster, to have a coherent public policy response that
involves public sector and private sector to deal with the
emerging immediate issues that no one can anticipate on the
heels of such a devastating event, so that we get in front of
these issues and that the toll does not linger to the degree
that it has here in our area.
Thank you very much.
[The prepared statement of Mr. Barry follows:]
Prepared Statement of Gery Barry
introduction
First, I'd like to thank the subcommittee for traveling to
Louisiana and for conducting your hearings here. Being on the ground
and witnessing first hand our long road to recovery will itself provide
you with invaluable insights as you think about how to protect our
communities from large-scale external threats to public health and
healthcare. It's a privilege for me to appear before you this afternoon
to share what Katrina and Rita have taught us about our
vulnerabilities.
I'm President and CEO of Blue Cross Blue Shield of Louisiana. I
moved to Louisiana from Connecticut to assume this position just 10
months before the hurricanes hit. More recently, I have served as chair
of the Health Systems Redesign Workgroup under the Louisiana Recovery
Authority. This effort has now evolved into the LA Healthcare Redesign
Collaborative chaired by Dr. Fred Cerise, Secretary of Department of
Health and Hospitals.
To give you context for my observations, let me take a minute to
give you some background on our company. We are a traditional Blue
Cross organization. By that I mean we are an exclusive statewide Blue
Cross Blue Shield licensee, governed by a local board of directors. We
are a not-for-profit, but tax paying organization owned by our
policyholders. We employ about 1,400 Louisianians. We are the manager
of medical benefits for just over 1 million of Louisiana's 4.4 million
residents, representing just about half of those with private health
insurance.
My observations are drawn from the vantage point of assisting our
one million members in securing the healthcare services they needed
during the immediate crises and this long and continuing aftermath.
This has meant working closely with not just these members, but just as
importantly, their care providers. We have also worked closely with
their employers and with our agents and brokers who serve them. Having
said that, my observations are personal ones and do not necessarily
reflect those of our company or of the Redesign Collaborative.
The Public Health Side of Hurricanes Katrina and Rita
Televised images of the hurricanes' physical and emotional toll on
the citizens of South Louisiana are already seared into our
consciousness. Comprehensive histories of Katrina and Rita and their
immediate aftermath have already been documented and need no
embellishment here. However, from a public health standpoint, there is
an aspect of Katrina's and Rita's legacy which, while less obvious, is
even more important. This legacy is that of peoples' inability to
access critical healthcare services when needed and the inability of
caregivers to provide care that is most appropriate.
While these issues existed to some degree before the hurricanes,
they turned extraordinarily acute after the hurricanes, teaching us
four very important lessons.
lesson 1.--a metropolitan area's healthcare capacity is easily
overwhelmed
Pre-Katrina, the New Orleans area, by almost any measure,
appeared to have excess clinical capacity, at least in terms of in-
patient beds, nursing home beds, and clinical specialists. Katrina's
decimation of the health system created an unexpected shortage.
Katrina's toll on the healthcare capacity in the New
Orleans area was swift and deep. Only 3 out of the 15 or so hospitals
in the area remained open throughout the ordeal.
Shortly after the hurricane, shock waves of excess demand
for healthcare services spread quickly throughout the State as evacuees
from the affected areas arrived, many in need of care.
Today, most of the hospitals in the New Orleans area
remain closed, including Big Charity. Those few that have since
reopened (e.g., Tulane) are operating at reduced capacity.
While many area residents left and are still gone, doctors
and nurses who had been practicing in the New Orleans area left in even
greater proportions. Based on Blue Cross Blue Shield of Louisiana
claims data, about three quarters of the some 4 thousand independent
physicians who were practicing in Orleans, Jefferson or St. Bernard
parishes prior to Katrina remain unaccounted for, i.e., have not
submitted claims since the hurricane.
According to many service providers on the ground in the
New Orleans area, the per capita need for healthcare has increased
significantly due to hurricane-related causes (mental health,
accidental injury and stress-induced increases in morbidity). This
surge occurred without the spike from potential hurricane-related
disease outbreaks that some had feared. Thank goodness.
lesson 2.--logistical and communication issues make it difficult to
properly use the limited healthcare capacity available
In the period immediately following Hurricane Katrina,
many needed and willing medical professionals already within the area
or coming into the area were not engaged due to credentialing or
licensing issues, fear of professional liability and the lack of
centralized coordination.
Loss of contact between physicians and the ill patients
they were attending prior to the hurricanes rendered appropriate
clinical follow-up with these patients impossible.
Normal referral patterns among independent providers have
been thoroughly disrupted, leading to disruptions in patient care
itself.
There is no centralized information or database from which
patients or referring physicians can determine which nurses and doctors
have remained in or have returned to the affected areas.
Resource shortages in certain key areas cause bottlenecks
throughout the care continuum, e.g., the inability to discharge
hospitalized patients due to the shortage of home healthcare nurses
needed for follow-up.
lesson 3.--the widespread loss of patient records put large numbers of
patients at risk
Paper medical records housed in affected physician offices
were entirely destroyed.
Many ill patients who evacuated left without their
medications or prescriptions.
Doctors and hospitals in surrounding areas who were seeing
many patients for the first time had little or no patient medical
history or other pertinent information to go on as they were treating
these patients.
Post-hurricane efforts to reconstruct meaningful medical
record proxies either through claim histories (as done for Blue Cross
Blue Shield of Louisiana members) or through pharmacy data (as done
collaboratively through katrinahealth.org) were technically successful;
in practice, they did not garner much uptake at the time as the
requisite provider awareness and education could not be achieved in a
timely manner.
lesson 4.--the normal methods of reimbursement which healthcare
providers rely on are easily disrupted
During the height of the emergency and its aftermath,
providers were preoccupied with meeting immediate patient needs and not
with gathering patient documentation which would later be needed to
submit claims, particularly in the case of Medicaid patients and the
uninsured.
Some of the unique aspects of healthcare financing in
Louisiana, particularly the dependence on the ``Charity'' system for
indigent care and our heavy dependence on Medicaid and
``Disproportionate Share'' funding, have created unanticipated systemic
vulnerabilities. Some examples:
Closure of LSU's Big Charity Hospital left LSU Health
Services and Tulane and LSU Schools of Medicine without
significant revenue sources.
Charity's closure significantly increased the
percentage of uninsured and Medicaid patients treated by other
hospitals in the area which are not normally compensated for
providing those services.
Prolonged inpatient lengths-of-stay due to difficulties in
discharging are creating losses on Medicare-based DRGs.
Independent physicians, particularly those serving the
Medicaid population, face difficulties maintaining their practices due
to the dispersion of their former patients and the lack of critical
mass in most neighborhoods for developing new patient bases.
Private insurance has so far remained resilient to
Katrina-induced demographic and economic disruption. Of the more than
800,000 whose group insurance is provided by Blue Cross Blue Shield of
Louisiana, about 30,000 have lost their employer-provided coverage.
Lapse rates in individually purchased coverage have been lower than
normal. However, per capita claims levels in the immediate hurricane-
affected areas have remained somewhat lower (10 percent) than expected,
due apparently to the compression on the healthcare delivery system for
the reasons stated above. For providers, this reduction in services to
privately-insured patients, while modest, adds to their financial
strain.
Many new workers in the New Orleans area are arriving at
hospitals needing medical attention, but are uninsured even for
workers' compensation.
conclusion
To respond appropriately to a major communitywide or regional
disaster, whether natural or man-made, we must overcome the systemic
weaknesses exposed by Katrina and Rita. In redesigning our health
system in Louisiana following the hurricanes, we have the opportunity
to build a new system that is sufficiently flexible and adaptable in
the face of disasters. Specifically, we need to:
Insure reliable, real time communication capabilities
exist among first responders, government officials and the many
involved in the management and delivery of healthcare for the immediate
and surrounding area;
Establish plans in advance for networking with other
clinical resources, both those in the area and those from out of the
area, to establish capacity for dealing with a surge in demand
following a disaster-induced shut down in clinical capacity in the
immediately affected area;
Better communicate and integrate the efforts of all
parties, public and private into the immediate emergency response;
Quickly and effectively coordinate public policy follow-up
to resolve acute and structural issues associated with the aftermath of
the disaster;
Establish electronic patient health records for everyone;
Maintain a real time electronic registry of healthcare
professionals in the area with complete tracking of those moving into
or leaving the area;
Redesign public reimbursements for health care services to
make sure they work for all providers delivering care during and
following a disaster;
Consider requiring businesses involved in the affected
area's redevelopment to provide workers' compensation and health
insurance benefits to their workers;
Provide temporary support to people losing their employer-
provided health insurance through a mechanism such as the Health
Coverage Tax Credit available to those losing their jobs under
international trade agreements.
Thank you for your kind attention. I would be happy to respond to
any questions you might have.
Senator Burr. Mr. Barry, thank you, and thank you, to all
the witnesses, not only for your information, but for your
ability to modify the schedule that we had and to accommodate a
much shorter period. I can assure you that I think each one of
you and every member who's here from the U.S. Senate could
spend a day together with you sharing the first-hand
information that you've gone through.
It strikes me just how well each one of you has a handle on
what you've been through, where you are today, but more
importantly where you need to get to. That has not gone
unnoticed, I will assure you.
I wish I could sit here today and tell you that we could
produce one piece of legislation in Washington that would
address all of the issues that you have raised, and if I said
that you would know it to be disingenuous. We can't do that.
But we're attempting to begin the process and over some period
of time we will hopefully be able to address the meat of what
has been raised.
Those that will benefit from it are not only New Orleans or
Louisiana; it will be communities that are faced with very
similar degree of disasters and tragedies in the future that
won't have the challenges that you have had here.
This is an official hearing and for that reason I will
assure you all written testimony will be made a part of the
record without objection.
It's important that you know, in addition to Senator
Landrieu, myself, and Senator Alexander, we're joined today by
over 50 staff members from additional members of the HELP
Committee in Washington. Typically we would take a period of
time to pose questions to you and solicit those answers. For
the purposes of this truncated process, I'm going to ask all of
you, if you would, to be open to written questions. Give us the
opportunity to go back with the testimony that you've provided
for us. It would help us to ask questions that might be of more
value to both of us. And if you would, in as timely a fashion
as you find it able to do, respond to those questions for the
committee.
I want to once again thank Senator Landrieu and Senator
Vitter. If it wasn't for these two individuals I'm not sure
that Washington would have had the attention. I reminded Mary
as I came up, North Carolina had a rather significant storm, I
think now 6 years ago. It involved a tremendous amount of
flooding. This year we put the last people into permanent
housing, 6 years later.
I don't want to suggest that I know the magnitude of what
you've gone through. I know how the next crisis of the day
overshadows the last one, and when you're in the community that
was affected everybody forgets and focuses on what just
happened. What your Senators have been able to do is to keep
Washington focused on the fact that there was a disaster, there
is still a problem, and there continues to be a need for
Washington to address on an ongoing basis the challenges that
you're faced with. Let me assure you that we do recognize that
need.
Once again, I thank the Senators for joining me. I thank
you for testifying.
Senator Landrieu. May I ask just one question?
Senator Burr. You may certainly.
Opening Statement of Senator Landrieu
Senator Landrieu. Thank you all so much for your patience
today, but also the forcefulness in which and the
professionalism in which you give this testimony. This is a
story that must be told. And I know you've told it many times
and you've told it again today, but we need to continue to tell
it so that we can get the response that we need: No. 1, to
continue to address the nightmare that many of us, all of us,
are still going through here; to help the people that are in
this region and this city and this State.
But as you all stated, we don't want to see this ever
happen to anyone again. So the testimony that you're giving
will help all the government structures, all the private sector
structures, all the faith-based organizations, all the
professionals, to know what needs to be done so that we can try
to prevent this kind of suffering and catastrophe from
happening again. So I just wanted to thank you all very much.
Opening Statement of Senator Alexander
Senator Alexander. Let me add my thank-you, and I'm going
to preside over the transition from Health to Education.
But if all of you will permit me a personal word first,
this is a very distinguished panel and I know you all are
extremely busy. You had other things to do today and because of
our schedule you had to change yours. We thank you for that. We
understand how busy you are.
Second, the personal note is this: Literally 40 years ago
this moment, I was a law clerk to Judge John Minor Wisdom in
this building. I was actually a messenger. He already had a law
clerk and he wanted two, so he promised to treat me as a law
clerk. And I lived here for a year on Felicity Street, and I
was making so little money that I played in a washboard band on
Bourbon Street at Your Father's Moustache, which burned down
about 15 years ago, which may have had something to do with the
music there.
But this brings back a lot of memories to me. I believe
this was the old Wildlife Fisheries Building at one time, and I
came here every single day. So this brings back a lot of
memories.
Thank you very much for coming, and now I'd like to invite,
apparently------
Senator Burr. Lamar, before you do that. Without objection,
I would ask that the record be kept open for 10 days for
additional questions and answers.
Senator Alexander. Now we will shift from Senator Burr's
subcommittee to the Subcommittee on Education and Childhood
Development. I believe the entire first panel that was to be
here at 9:30 has waited until now, so I'd like to invite them
to come forward to the table and we'll begin with them.
[Whereupon, at 3:05 p.m., the subcommittee was adjourned.]