With just a handful of hospitals open, a crisis is unfolding in local emergency rooms bursting at the seams with patients needing critical care.
Sunday, February 05, 2006
By Bruce Hamilton West Bank bureau
John LeBlanc's father had been waiting in the East Jefferson General Hospital emergency room for seven hours when his son asked an admissions clerk how much longer. She couldn't tell him. Advertisement
Family members had rushed the 63-year-old Metairie man to the medical center suffering from congestive heart failure.
Becoming increasingly upset, the younger LeBlanc turned to the nurses. Although they didn't know either, he said they were sympathetic, adding that someone had waited 19 ½ hours the night before.
After 9 ½ hours, his father was admitted.
"Who would think that it would be the case at your hospital that you would have to wait that long when you need it?" said LeBlanc, adding that he's concerned residents have not been informed about the problem.
"I'm not upset with the hospital, because I understand the situation," the Metairie resident said. "The number of people I saw come in was unbelievable."
With the bulk of New Orleans' hospitals shuttered after major damage from Hurricane Katrina, open medical centers are packed with patients as the suburbs shoulder the region's health care in the face of rapid repopulation, staffing shortages, diminished capacity and reduced services.
Add to that Carnival and the onslaught of flu season, and the combination could wallop an already strained system where lengthy emergency room waits are now the norm, hospital officials said. Patients are spending nights in emergency rooms, and ambulances often are diverted elsewhere because hospitals are filled, officials said.
"The health care system in our region is jammed to the gills," said John "Jack" Finn, president of the Metropolitan Hospital Council of New Orleans.
"If we have a bad flu season or a good Mardi Gras, we're going to have way more patients than we can handle," said Dr. Mark Peters, president and CEO of East Jefferson Medical Center.
The rebuilding effort also is taking a toll, Peters said, noting that many injuries are the result of construction accidents. The influx of contractors and aid workers from outside the metropolitan area who don't have local health care providers also stresses the system when they seek treatment.
"I think it's a crisis now," Peters said. "This isn't an East Jefferson problem, it's not an Ochsner problem or a Touro problem. It's a health care problem for our region."
N.O. on life support
Of New Orleans' seven hospitals, only Touro Infirmary and Children's Hospital are open -- and overflowing, officials said.
Charity Hospital, the region's trauma center, is running a makeshift facility in the Ernest N. Morial Convention Center, but will be forced to close by March 1. However, hospital officials said they soon hope to open a trauma unit at Elmwood Medical Center, where they are negotiating a lease. Tulane University Hospital announced Friday it would reopen its emergency room and inpatient and outpatient services Feb. 14.
"By providing critical healthcare services to area residents, Tulane University Hospital and Clinic will play a key role in the rebuilding of the city of New Orleans and the region,'' Chief Executive Officer Jim Montgomery said in a news release.
But recognizing that Carnival could further tax the region's medical facilities, New Orleans has asked FEMA for a mobile hospital to accommodate Carnival-related injuries, such as falls, cuts and alcohol- and drug-related problems, said Dr. Kevin Stephens, director of the city's health department.
"We are right at our capacity in terms of emergencies and handling the population of the city," he said. "So, basically, what we're asking for is additional support to augment the services we have, and if we do have an unexpected surge, we'll have additional capacity to handle it."
It is certain to be welcomed by regional hospitals that are sharing the load of trauma cases as emergency medical personnel try to distribute patients to the closest and most appropriate facility.
Area hospitals are often challenged during Carnival season, Peters said. "That is magnified with what's happening post-Katrina."
More people, fewer beds
Medical center executives said the issue boils down to area hospitals trying to serve a burgeoning population -- estimates suggest the region has 930,000 people -- with fewer staffed hospital beds.
That number of beds has decreased from 53,000 metrowide before the storm to about 15,000, said Dr. Joseph Guarisco, chairman of the emergency medicine department at Ochsner Foundation Hospital.
"In the last couple weeks, there's been moments when it seemed we were losing the battle," he said, adding that several nights in mid-January, every bed in the area was full. Ambulances brought patients to the hospital but couldn't unload them, he said.
The problem isn't as dire for hospitals on the north shore and River Parishes, where all medical centers are open. But those facilities too are seeing increases in patient loads and wait times.
Slidell Memorial Hospital spokesman Sam Caruso Jr. said the patient load there has jumped 45 percent since the storm. "Business has increased dramatically," he said.
The emergency room at Northshore Regional Medical Center in Slidell has about an 8 percent increase in patient volume and longer wait times, according to a spokeswoman.
At nearly all area hospitals, wait times for treatment and admission have nearly doubled, Guarisco said.
Before Katrina, Ochsner boasted the best "door-to-doctor" time in the area at 30 minutes, Guarisco said. It's now an hour, but it can be as long as five hours or more in the emergency room that is seeing about 170 patients every day.
Emergency rooms triage patients based on their status, so those with minor injuries wait longest and trauma cases are treated immediately. At East Jefferson, patients with injuries that are not life-threatening typically wait two to six hours, a spokesman said.
At West Jefferson, which saw about 200 emergency room patients daily in January, a spokeswoman said the average wait is three hours.
Touro Hospital, which reopened its emergency room Sept. 28, has had some patients wait more than 24 hours, which was rare but not unheard-of before Katrina, said Leo Hirsch, the hospital's chief executive officer.
Touro is adding staff and beds, he said, noting that "I see the situation as improving."
Still, the need for more capacity at other hospitals exists, Hirsch said.
"We haven't really seen the onset of flu yet," he said. "We're just waiting to see what's going to happen. We do have a lot of sick people."
At East Jefferson and West Jefferson, hospital officials said they have housed some patients in their emergency rooms.
While East Jefferson's 450 beds have been filled nearly every day since mid-November, the hospital still houses five to eight patients in the emergency room each night, Peters said.
West Jefferson is adding 40 beds to meet demand. "We will be going from a staffed bed capacity of 320 to 360," said A. Gary Muller, hospital president and chief executive officer. "We'll be able to add good bed capacity, which will allow people not to be held in the emergency room."
Longer hospital stays
Compounding the need for more beds is the fact that patients are taking longer to leave hospitals, Peters said. Discharging patients is more difficult, partly because there are fewer nursing homes available, he said. And some patients who would be more easily cared for at home have too many storm-related disruptions there, he said.
As hospitals are compelled to open up additional beds to handle the booming patient loads, officials said they are still trying to hire staff even though most have reached their pre-Katrina staffing levels. With a limited pool of workers comes increased hiring competition.
"Everybody's having varying degrees of staffing challenges," Peters said.
West Jefferson is trying to hire about 30 traveling nurses to supplement its permanent staff, but a lack of housing stands in the way, Muller said. The hospital is renting hotel rooms in St. Charles Parish because the ones contacted in Jefferson and Orleans were full, he said.
"We literally can't get some people back to town because they don't have a house," Muller said.
Ochsner recently hired 40 workers after a job fair, said Chief Operating Officer Warner Thomas.
"We're doing fine on physicians, but there has been a challenge recruiting nurses, scrub techs, sterile processing techs and environmental and food service (personnel) because of competition."
Lightening the load
Residents do have a few alternatives other than emergency rooms for injuries that are not life-threatening.
The number of patients using emergency rooms for nonemergencies has a large role in the health care crisis, Peters said.
"I think that has been heightened from the storm," he said, adding that many Orleans Parish residents don't have access to their usual hospitals, clinics or primary-care doctors.
Finn, the hospital council chief, said patients who don't need emergency care should call their local hospital or medical society to find out where clinics or other doctors with a certain specialty are available.
"All of us have to make changes, because what we had for health delivery and what we have are two different things," he said.
In St. Bernard and Plaquemines parishes, federally financed clinics are available to residents. In Algiers, the Common Ground Collective, a grass-roots coalition, has opened a free clinic.
At West Jefferson Medical Center, the hospital has contracted with the nonprofit Jefferson Community Health Care Centers to set up an urgent-care facility outside West Jefferson's emergency room to care for patients with less serious injuries. The center takes patients on a sliding scale, meaning they pay less or nothing depending on their income and insurance.
"This is a new model of care for our community, and we're really proud of it," Muller said. "It creates access for patients, and avoids delays in the emergency room."
Carol Smith, executive director of Jefferson Community Health Centers, estimates that 65 percent of emergency room cases are not serious crises and can be handled at her facility, which opened on West Jefferson's campus in November. So far, the center is treating between 50 and 75 patients weekly, she said.
Such facilities not only provide immediate relief to area hospitals, but also to patients such as Tom Northrop, who suffered a paralyzing muscle spasm recently in Uptown New Orleans.
"He went to stand up, basically threw his back out and couldn't move," said his fiancée, Kristin Chasteen. "He was screaming in pain and short of breath."
She called 911, but when the paramedics arrived, they told the couple to expect a nine-hour wait to see a doctor at the hospital.
"They told us to find some friends with pain pills or muscle relaxers," Chasteen said.
The paramedics were apologetic, she said, but they also were disgruntled. They complained that residents shouldn't be invited to New Orleans while the health-care system is overwhelmed.
Looking ahead to Mardi Gras, Chasteen is worried.
"What the paramedics said is really scary," she said.
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Bruce Hamilton can be reached at firstname.lastname@example.org or (504) 826-3786. Staff writer Keith Darce contributed to this report.