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Health Care on the Gulf Coast, One Year Later

By Sarah Abruzzese, CQ Staff

The Gulf Coast is still struggling to provide health care services a year after Hurricane Katrina, with low-income residents still the hardest hit, according to panelists at a Kaiser Family Foundation discussion on Tuesday.

Several panelists at the discussion, which was titled "Health Care One Year After Hurricane Katrina," spoke of a system stretched beyond reasonable limits, recounting stories of suffering health care providers unable to rest, intent on counseling patients while suffering the same plight: homelessness and uncertainty.

Among those low-income survivors the foundation spoke with for its latest report, "Health Experiences of Low-Income Katrina Survivors," almost all were suffering from emotional or mental trauma, while few reported receiving formal counseling. According to the report, the loss of facilities made it difficult for survivors to connect with care often because they lacked transportation information. Survivors also went without needed medical care and medications for weeks and in some cases months after Katrina, the report said.

And nearly a year later, survivors are still having trouble taking care of their most basic needs, living day to day. "Those who were uninsured continued to describe major problems connecting with care due to long waits, limited health care resources, and unaffordable costs," the report said.

Resources are an issue throughout New Orleans, with shortages of mental health care providers, nursing staff, and facilities. And the future might be bleak for nursing home administrators, according to David Dosa, assistant professor of medicine at Brown Medical School, who said the elderly are not a focus in the event of a catastrophe.

While nursing homes are increasing their supplies to prepare for the next crisis, many homes where patients were shifted have not received payments for care since last year.

Comparing Hurricane Katrina's approximately 100,000 square miles of devastation to the Dust Bowl of the 1930s, Irwin Redlener, president of the Children's Health Fund and director of the National Center for Preparedness at Columbia University's Mailman School of Public Health, said that what happened to the Gulf Coast was a series of unprecedented realities that have created an ongoing health crisis. Redlener said the crisis isn't finished, with people suffering from health issues that were "mildly out of control" a few months ago, but are now "wildly out of control." Redlener said planning for immediate needs should mean equal planning for the future.

Fred Ceris, secretary for the Louisiana Department of Health and Hospitals, said the decimated infrastructure in New Orleans left health care leaders with an opportunity to innovate and rebuild a system. But that opportunity was heavily hampered by a high cost of care, due to an ineffectual and costly delivery system.

Plans call for the implementation of everything from an interoperable electronic medical records system to a more patient-oriented system with decentralized facilities. Karen DeSalvo, chief of general internal medicine at the Tulane University Health Sciences Center, said the goal is to have decentralized care facilities tied to a central facility where patients can be referred to for testing and serious medical issues. However, getting there might take as long as eight years, she said.

According to a recent poll, frustration with the slow response to rebuilding the Gulf Coast is shared by a majority of Americans. Seventy percent of respondents in the foundation poll, titled "The Public's View on the Response to Hurricane Katrina," said individuals have not gotten the help they need. And 56 percent said the federal government has not done enough.

Not only have Americans not forgotten Hurricane Katrina, their opinion of the federal government has changed because of it, said Drew Altman, president and chief executive officer of the Kaiser Family Foundation. In fact, 53 percent of Americans polled for the survey were so disappointed by the government's handling of the catastrophe that it negatively impacted their confidence in the federal government. "Not good news," Altman said, adding that Americans "have a pretty realistic view" of the state of things in the Gulf Coast region.

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