Starting over on common ground: Care must go on

Most hospitals in New Orleans remain closed, victims of floodwater from Hurricane Katrina. Hundreds of area doctors are scattered across the nation. At the small number of hospitals, clinics and other facilities that managed to reopen, physicians struggle to revive a crippled health care system more than a year after Katrina slammed the Gulf Coast.

Common Ground Health Clinic is one facility using what it can to meet the community's medical demands. Started after the storm, the clinic now operates in a former corner grocery, helping to mend an ailing city buckled by the hurricane's punch. In a building where curtains separate exam rooms, Ian Newmark, MD, and other volunteer physicians practice primary care, tending to patients with diabetes and hypertension and college students who volunteered to tear down abandoned homes but ended up with rashes.

"I realized they still need a lot of help. The health care system for the people in New Orleans is really broken. It's a catastrophe," said Dr. Newmark, chief of critical care medicine at Plainview Hospital in Plainview, N.Y., who volunteered for a week in August.

Of the 617 primary care physicians in New Orleans before Katrina, an estimated 140 returned to practice, according to a study in the Aug. 2 JAMA. Of the 196 psychiatrists, 22 continued to practice, the study said.

And even though the Louisiana Health Care Redesign Collaborative, a group working to help develop a new health care system, estimates a 35% drop in population since Katrina struck Aug. 29, 2005, the group said there still are not enough primary care physicians, psychiatrists or dentists to treat the Medicaid and uninsured populations.

The surviving hospitals strain to handle the patient load while one emergency department operates in an old department store. Charity Hospital closed. The emergency system has not recovered, and long waiting lines are harming patients, according to a survey by the American College of Emergency Physicians.

"Physicians are in bad shape. [Patients] have gone and very few have come back. What's the point of putting up an office in a bombed-out zone?" asked New Orleans pediatrician Floyd Buras, MD, president of the Louisiana State Medical Society. Dr. Buras' practice was destroyed by floodwater; he now borrows exam rooms at Children's Hospital in New Orleans.

After Katrina, Marc Rhoads, MD, tried to make the best of living in New Orleans. But his health system sent him to its clinic in Baton Rouge to help treat the booming population there. At one point, the pediatric gastroenterologist was juggling work at one hospital and one clinic in Baton Rouge then driving to his old clinic in New Orleans, spending nights with families or at a hotel.

In August he started as professor of pediatric gastroenterology at the University of Texas Medical School at Houston. Taking the position "was really more of an exhaustion thing and the loss of my research laboratory," said Dr. Rhoads, who also practices at Children's Memorial Hermann Hospital.

Internist John J. Kokemor, MD, though, decided to stay. He spent the early days of Katrina caring for patients at Memorial Medical Center in New Orleans. The hospital's basement flooded. The National Guard evacuated some dialysis patients while Dr. Kokemor and others continued treating patients.

"At night you could hear people swimming by or hear gunshots. You could hear people yelling from house to house at each other," he said.

Across the street, his practice in a 10-story office building stayed closed for seven weeks. The phones were down; power was erratic. But the four-doctor practice reopened in mid-October 2005 and is rebounding, even though many patients moved.

"We can't even estimate how many patients we've lost. Every day I think of people I've treated for 25 years and I haven't seen or heard from them," Dr. Kokemor said. "I think about the hurricane every day. I think about the hospital every day. I look out my window and I just get sick."

Bryan Bertucci, MD, practices in a center cobbled together by connected trailers in a Wal-Mart parking lot in Chalmette, La.

Katrina submerged his previous office in 13 feet of water. "I lost everything. All my records looked like giant spitballs. The walls actually caved in," said Dr. Bertucci, a family physician and coroner in St. Bernard Parish, where about 20,000 of the 67,000 residents have returned.

Dr. Bertucci said he was unable to get a U.S. Small Business Administration loan to rebuild his practice but still plans to stay. With Chalmette Medical Center closed, he said St. Bernard needs a 50-bed facility or it will continue to lose specialists.

"We could go somewhere else and life would be more comfortable and we could make more money, but we're needed here," he said. "I want this parish to get well, and I want to be part of that."