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Related Article: Perspective, N Engl J Med 2006 :354 ;1550 -1551 .
On September 2, 2005, when Wildlife and Fisheries boats finally evacuated patients and staff from Charity Hospital in New Orleans, we could not fully comprehend the devastation of our health care infrastructure. Reflecting recently on the vast scope of the rebuilding effort, Fred Lopez, vice chair for education at Louisiana State University (LSU) School of Medicine, observed, "The desperate week we spent inside Charity after Katrina is the one that everybody saw on CNN, but that was the easiest week of the last six months."
Immediately after Hurricane Katrina, our crisis was acute, our options limited, and our decisions necessarily quick. Now, with the crisis in the chronic phase, options backed by conflicting interest groups abound, resulting in cumbersome decision making and dangerously slow implementation. During the crisis, two principles contributed to survival: initiative for self-rescue and professional teamwork. As we heal our infrastructure, these principles continue to guide us.
Although many citizens have yet to return, area hospitals are scrambling to meet local needs. The population of metropolitan New Orleans is approximately 24 percent smaller than before the hurricane, but only 15 of 22 area hospitals are open, with 2000 of the usual 4400 beds. According to data from the Times-Picayune, before the storm, New Orleans had only 3.03 hospital beds per 1000 population, as compared with the average of 3.26 per 1000 for U.S. cities; today, there are 1.99 per 1000. "The number one current problem is total hospital capacity," says Joseph Uddo, chief of general surgery at East Jefferson General Hospital in neighboring Jefferson Parish. "Emergency department patients can't move into the hospital because beds aren't available. We have no surge capacity."
Moreover, open hospitals must deliver ever greater amounts of uncompensated health care. Patrick Quinlan, chief executive officer (CEO) of the Ochsner Clinic Foundation, says uncompensated care in his facility has tripled since Katrina. "Many people have lost their jobs, and we have throngs of transient workers in town without health insurance," reports Les Hirsch, CEO of Touro Infirmary. Reimbursement for uncompensated care has yet to come, and, Hirsch notes, there is "a huge debate regarding how best to have uncompensated care dollars follow the patients, rather than following...