The New Orleans Tribune

State of Healthcare in New Orleans

Editor’s note: The following are excerpts are from
Dr. Stephens’ report on the State of Healthcare in New Orleans, which was delivered on Thursday, April 23, 2009.

Before Katrina, many of the citizens of New Orleans experienced poverty, poor education, marginal housing, limited job opportunities and limited mobility. For the past two decades, the United Health Foundation placed Louisiana at an overall ranking of 50. This ranking was due to a high percentage of children in poverty, a high percentage of uninsured citizens and a high rate of preventable hospitalizations. In our recovery, we must not only rebuild, we must redesign and rebuild our healthcare delivery system. If we only rebuild what we had, we will remain with the poorest of outcomes.

Louisiana Health Systems Poor Performance

The Commonwealth Fund has ranked Louisiana in the bottom quartile for 22 health indicators. Louisiana is also ranked in the bottom 5 for 15 health indicators. The map demonstrates a trend of poor performance in the South and West which are the states that large numbers of New Orleanians evacuated post-Katrina. The mortality experienced by our citizens showed a marked increase during the pre-Katrina period of January – June 2005. Hurricane Katrina unmasked the severity of our healthcare problems in New Orleans.

We now have the opportunity to really transform our old system to a new and innovative high performing healthcare delivery system.

Returning to Core Values

Because of Hurricanes Katrina and Rita, the New Orleans Health Department found itself with less funding for the fiscal year and a 75 percent reduction in personnel for all programs. The health care partners and relationships had also been significantly affected and many community organizations had to set up shop in satellite locations. Excelth Inc. took on the monumental task of working in Renaissance Village in Baton Rouge.

In reality, for several months after the storm, this city was struggling to care for those who had come back early on. The citizenry faced seemingly insurmountable obstacles.

Despite all of our efforts pre-Katrina/Rita, we were faced with the tasks of both rebuilding a destroyed healthcare infrastructure and meeting the additional needs of our community which were exacerbated by the disaster. Providing convincing evidence that financial support could be spent effectively on those who returned was time consuming. In addition to that, there was the additional objective of raising the bar and improving the conditions beyond their pre-Katrina status.

Consolidation of New Orleans Adolescent Hospital

The New Orleans Adolescent Hospital (NOAH) and Community Services provides a fully integrated hospital and community based mental health services for children and adolescents with serious emotional and behavioral problems. NOAH is a key New Orleans facility for the indigent and uninsured.

The City of New Orleans has faced a significant mental health care crisis since Katrina. Suicide rates have more than doubled in the wake of the storm:

2006: 14 suicides
2008: 42 suicides
2009: 20 suicides to date

According to our Emergency Medical Services reports, we have been averaging close to five suicides per month and 23 attempts per month. Each of these attempts will very likely require inpatient monitoring at an appropriate mental health facility.

The World Health Organization has acknowledged that large segments of the New Orleans population experience serious mental health issues that, such as depression, that are brought on by traumatic losses. Untreated, mental illness poses a serious threat to the patient and to the community at large. This was made painfully clear when New Orleans police officer Nicola Cotton died at the hands of a mental health patient in crisis.

The largest mental health facility in the City is located at the Orleans Parish Prison, where there are 60 beds. Criminalizing mental illness is an inhumanity that we will not tolerate.

According to data from the NOPD crisis unit, the city is averaging approximately 149 pick-ups per month from 911 calls for patients in crisis. These calls often exceed 200 per month and do not include calls for service where the patient is not transported or can be treated as outpatient. One of the main diagnoses is schizophrenia. Acute exacerbations of schizophrenia most often require inpatient hospitalization in order to stabilize these potentially violent patients.

The potential loss of NOAH or inpatient beds in New Orleans in light of increasing cases of mental illness and the large numbers who are indigent or uninsured would adversely impact progress that has been made in healthcare in New Orleans post-Katrina.

The State has estimated that the consolidation of NOAH with Southeast Louisiana Hospital would result in annual savings of $9.1 million. The quoted cost-per-bed comparison used in that analysis can be misleading, however. The cost-per-bed goes up when the number of beds is reduced. This phenomenon was observed at NOAH when the number of beds was reduced from 45 to 35 beds in 2009.

Need for Change

The State of Louisiana must change its approach to address the health care crisis. We simply can not keep doing things the same way and expect a different result. One proposal is for the State of Louisiana Department of Health and Hospitals to develop a policy of real choice and real community input.

Choice

Rather than having patients find and follow resources to Mandeville and other sites, we are proposing that a system be developed where the resources will follow the patient. In this system, patients will have the freedom and flexibility to choose providers and institutions most suitable to their needs. The resources will follow them to that provider and institution. Institutions will have to budget based upon their ability to attract and maintain our citizens. Currently, institutions like New Orleans Adolescent Hospital are totally dependent upon the legislature to appropriate and fund their budget. Their open beds are subject to the ebbs and tides of the Department of Health and Hospitals, not upon their ability to recruit and maintain patients and manage the revenues generated from these services.

Community Input

The community must have early input into decisions that cultivate the provision of health care services. Community forums and focus groups must be held to allow vetting of ideas prior to final decisions.

We must change what we do and the way that we have done things historically in order to have better health outcomes. Clearly, a major reform must take place. We, the New Orleans Health Department, stand ready to work with our state and federal partners to make these changes. Our goal is to empower our citizens to make choices that will improve upon their own health, thus creating a healthier New Orleans overall.