Doctors still reeling after Katrina, sue state for uncompensated care

Louisiana officials say they are trying to free up money, now set aside for a ruined hospital, so that physicians treating uninsured patients can be paid.

By Amy Lynn Sorrel — Posted May 28, 2007

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New Orleans-area general surgeon Todd Belott, MD, recently operated on a man who had waited six days before he went to the emergency department, seeking treatment for appendicitis. The uninsured patient delayed seeking help because Hurricane Katrina destroyed his usual source of care -- Charity Hospital.

The delay allowed infection to worsen so much that Dr. Belott had to remove part of the man's colon.

Nearly two years after the storm struck on Aug. 29, 2005, Dr. Belott and other physicians with privileges at West Jefferson Medical Center, just outside New Orleans, say they are still overwhelmed with patients who used to rely on Charity Hospital. The devastation Katrina wrought on the health care infrastructure not only continues to harm patient access but is making it hard for the physicians who remain to stay financially afloat.

"We want to make sure our community survives post-Katrina," said general surgeon David C. Treen Jr., MD, vice chief of West Jefferson's medical staff. "But doctors cannot afford to stay, when there are opportunities elsewhere, without having to give away services at levels so financially burdensome [that] we can't continue."

Since Katrina, doctors have turned away no one, regardless of their ability to pay, said plastic and reconstructive surgeon Jonathan C. Boraski, MD. But without being able to refer patients to Charity Hospital, "there's no way to ease the burden," said Dr. Boraski, chief of the West Jefferson medical staff.

That's why Dr. Boraski, Dr. Treen, Dr. Belott and nearly 400 other physicians on the West Jefferson staff are suing the state for relief for acting as "surrogates" of Charity Hospital. Located in New Orleans proper, Charity Hospital has not operated since the storm. West Jefferson Medical Center is not involved in the lawsuit.

Doctors say the Louisiana Dept. of Health & Hospitals, which is responsible for funding the state's charity hospital system, has failed to compensate them for medical care they've provided to the poor and uninsured since Katrina hit. They are asking for $100 million for unreimbursed care.

According to the lawsuit, filed in April, the state has set aside nearly $400 million for Charity Hospital. Doctors say those funds should go to private physicians treating displaced Charity patients. Doctors estimate that 30% of patients seen at West Jefferson's ED are poor or uninsured. They account for 13% of the medical center's overall patient base, up from 5.4% before Katrina, the lawsuit states.

With nowhere else to go, patients also must return for follow-up care, said Dr. Boraski.

He recently treated an uninsured patient for lacerated hand tendons. "That care can take two to three months" of time and uncompensated costs, he said.

The physicians say their lawsuit is about more than just money.

"I'm 53 years old, and I have a practice that is barely surviving now. But what concerns me more is while this group of practitioners makes the best [of it] until they retire, there will be no one to take their place," he said.

The lawsuit is asking for compensation for services doctors have already delivered, Dr. Treen noted. "But it doesn't have anything to do with what we anticipate in the future."

Without payment for doctors, access for patients, both uninsured and insured, is at risk, he said. Dr. Treen is worried his younger partner -- Dr. Belott -- will be lured away.

Dr. Belott, who is 40, said he is doing everything he can to stay. "I think about it every day that I get a call from a recruiter. If things don't change soon, I eventually am going to have to make a change."

The state, meanwhile, says its hands are tied. Louisiana Dept. of Health & Hospitals spokesman Robert Johannessen declined to comment on the lawsuit. But he said federal and state law provides "no mechanism" for reimbursing physicians who treat the uninsured.

"We certainly support efforts to help all health care providers who've assumed uncompensated care," Johannessen said.

The health and hospitals department participates in a federal matching program that compensates public hospitals that treat a disproportionate share of uninsured patients, he said, but those funds cannot go directly to doctors.

In April, state health department Secretary Frederick P. Cerise, MD, MPH, wrote the U.S. Dept. of Health & Human Services requesting a waiver so some Charity Hospital funds could go to physicians providing care for the uninsured and the underinsured. The letter also requests $75 million over three years to expand primary care services, $160 million over five years to bolster mental health services, and additional funds to recruit more health care professionals and support graduate medical education programs.

Johannessen said the state petitioned the federal government immediately following Katrina for an additional pool of funds, $8 million of which went to physicians. The state health and hospitals department also is asking the Louisiana Legislature for an extra $64 million in Medicaid reimbursements for doctors.

West Jefferson physicians say they received some federal financial assistance immediately following the storm and some money from the hospital. But they insist that New Orleans' health care system is at risk if the state does not take responsibility for the uninsured and use the money set aside for Charity Hospital.

"The dollars need to follow the patients," Dr. Treen said.

Not only are physicians seeing more patients, Dr. Belott said, but the patients come in with advanced complications that require extra attention because they've waited to seek care.

"The difficulty, too, is getting them referred to a place where they can be taken care of without driving an hour out of the area," he said.

Citizens want health system repairs

As residents continue to rebuild New Orleans and their lives, they believe repairing the health system is a big part of that equation, according to a new Kaiser Family Foundation survey. The door-to-door poll found that 36% of people living in Greater New Orleans saw their health care access worsen since the storm. Eighty-eight percent said there are not enough hospitals, clinics and medical facilities to care for residents, and 89% said not enough services are available for uninsured and poor people.

Family physician Alix Bouchette, MD, said he is seeing more psychiatric patients who would have gone to Charity Hospital. According to the Kaiser study, 22% of Orleans Parish residents rated their mental health as worse than before Katrina.

After two years, Dr. Bouchette is just now resuming his afternoon clinic hours for regular patients, but he still has an influx of uninsured patients whose source of primary care is the emergency department.

He recently gave insulin samples and syringes to a diabetic he saw in the ED, knowing the patient could not afford to fill a prescription.

"I don't know how long I can sustain free medications for him," Dr. Bouchette said. "We are not trained to turn people away. We are going to do what we can, but that's really putting the burden on us."

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Katrina's lasting toll

[download pdf]

The health system damage caused by Hurricane Katrina is still limiting New Orleans-area residents' access to medical care, according to a house-to-house survey of 1,500 adults by the Kaiser Family Foundation. African-Americans are feeling the impact the hardest, found the poll, conducted in September and November 2006. Repairing the health system is a priority among residents in the recovery effort.

Access compromised (Greater New Orleans)
Ways health care needs are being met are worse than before 22%
Harder to get to medical care now than before 18%
Had regular doctor or nurse before storm, do not now 8%
Had regular place to go for care, do not now 5%
Newly uninsured 4%
Racial disparities (Orleans Parish) Whites African-Americans
Usual place of care is ED/no usual place of care 15% 47%
Uninsured 12% 33%
Difficult to get to usual place of care 5% 26%
Health needs not being well met 6% 15%
Skipped or postponed care in past six months 9% 11%
Skipped medication doses or took less than prescribed in last six months 4% 8%
Problems paying medical bills in last six months had major financial impact 3% 7%
Top health priorities (Greater New Orleans) One of the top priorities Very important
Reopening hospitals in your community 43% 51%
Bringing in more doctors, nurses and other health workers 37% 58%
Opening more emergency care services 32% 61%
Getting more community clinics up and running 30% 63%
Making mental health counseling and services more available 24% 59%

Note: Responses of somewhat important, not too important, not at all important and don't know are not shown.

Source: Kaiser Family Foundation, "Giving Voice to the People of New Orleans: The Kaiser Post-Katrina Baseline Survey," May

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