By Mary Agnes Carey, CQ HealthBeat Associate Editor
March 13, 2007 -- More than a dozen witnesses told a House panel Tuesday that the New Orleans area continues to struggle with providing basic health care services more than 18 months after Hurricane Katrina devastated the Gulf Coast.
Medical professionals cited a shortage of both primary care physicians and specialists, a lack of hospital beds, and mental health services as major problems, adding that bureaucratic holdups at the federal, state and local level are preventing the financial assistance necessary to help the region's health care system recover. Other complications include high rates of uninsured, low literacy and many non English-speaking residents, witnesses said during the hearing, which lasted nearly seven hours.
In the worst-hit parishes of Orleans, Plaquemines, Jefferson, and St. Bernard, the loss of hundreds of thousands of homes and the closure of health care facilities displaced thousands of physicians, mental health providers, nurses, and other health professionals, said Rep. Bart Stupak, D-Mich., chairman of the House Energy and Commerce Oversight and Investigations Subcommittee.
A few weeks ago, Stupak said, majority and minority committee staff visited the New Orleans area to evaluate the current status of health care services. "Unfortunately, what our staffs found is that much of the region's health care infrastructure still remains crippled and major problems remain unresolved," he said.
St. Bernard Parish, which lost 100 percent of its homes, offices and buildings and 154 of its residents after Hurricane Katrina, has faced numerous obstacles in delivering care and trying to rebuild its medical infrastructure, said Bryan Bertucci, a family physician and coroner for the parish.
"Our biggest hindrance is the overwhelming lack of medical facilities," he said. "Our 194 bed hospital is gone. Of 150 physicians only six remain. Only 10 registered nurses remain. To see certain specialists residents are often required to travel 30 to 60 miles. "He said the area has also encountered "one financial roadblock after another" as it has tried to rebuild. Its hospital, Chalmette Medical Center, was a fee-for-service hospital and received no funds. Because it was not a part of the parish budget, it could not qualify for Community Block Grant money, Bertucci said. He also said he has been unable to get a Small Business Administration loan to rebuild his office.
"We need a hospital. We need your help," Bertucci told the committee.
Some lawmakers and witnesses blamed a dispute between Louisiana state officials and the Department of Health and Human Services (HHS) over how to rebuild the New Orleans health care system as the culprit preventing the region from receiving the federal funds it needs to rebuild its medical infrastructure.
In his opening statement, Energy and Commerce Committee Chairman John D. Dingell, D-Mich., said that Oct. 20 2006, Louisiana Governor Kathleen Babineaux Blanco submitted a plan to HHS for a series of pilot projects for Region 1 in New Orleans, where many of the devastated parishes are located.
"What Secretary [Michael O.] Leavitt sent back is not even a formal plan," Dingell said. "It is a loose confederation of spreadsheets and bullet points that ask the state to disassemble it's statewide public hospital system and replace it with some form of insurance program."
Frederick P. Cerise, secretary of the Louisiana Department of Health and Hospitals, said at the hearing that his state would need $1 billion in new federal "disproportionate share hospitals" or DSH funding to implement the HHS proposal and allow hospitals to maintain their current level of care services.
"Without substantial additional funds that swap doesn't work for us," Cerise said.
Acting Centers for Medicare and Medicaid Services Administrator Leslie V. Norwalk said the administration wants to work with Louisiana officials to overhaul the state's current health insurance system that she said provides one level of health care for those with insurance and another one for the uninsured.
"There may be debate on the details, but I would say that everyone agrees the system is broken down and needs attention," she said.
When Norwalk began to detail the amount of federal aid that has been provided to help the New Orleans area, Stupak told her to "spare us the stats because all of the other witnesses said there's not enough funding in the system."
Some Republicans on the panel said they would like a clearer accounting of how additional federal funds have been spent on recovery efforts. Rep. Michael C. Burgess, R-Texas, asked that "at some point, I hope someone will give me a spread sheet" detailing where federal money has been spent. "I'm getting criticized at home" for the increased federal spending on Katrina, Burgess said.
Both lawmakers and witnesses expressed frustration over ongoing problems with the New Orleans health care system and what the federal government's role should be in the region's recovery.
"I've told the leadership of this House that we're tired of hearings. We want things to start happening," said panel member Charlie Melancon, D-La.