Lawsuit hits medical access post-Katrina

A class-action lawsuit filed on behalf of more than 100,000 poor and uninsured patients spotlights the chronic deterioration of access to care in the aftermath of Hurricane Katrina -- and the need to restore it fast, say some New Orleans-area physicians.

A group of patients formerly treated at Charity Hospital, which was crippled in the 2005 storm, are challenging Louisiana State University over its decision to close the facility for good. The university's Health Care Services Division is in charge of the state-funded public hospital system in Louisiana. At press time in mid-February, the court had not certified the case as a class action.

According to the suit, filed Jan. 17, state law requires LSU to get legislative approval before shutting down any public hospitals or significantly reducing services. Patients allege that university officials failed to do that when they decided not to reopen Charity, which provided free primary and specialty care to thousands of low-income and uninsured patients in the New Orleans area.

As a result, Charity patients can't afford or access primary or specialty care without traveling long distances, chronically ill patients are getting worse, and mental health services are severely lacking, said S. Stephen Rosenfeld, a Boston attorney representing the patients.

They are asking LSU either to re-open Charity or to come up with alternatives to renew indigent care, which -- 2½ years after the storm -- remains a fraction of what it was before Charity was shuttered, Rosenfeld said. Even patients with insurance are affected, because the facility's closure has caused long wait times at other facilities. There is a "bottleneck in terms of health care," he said.

Some area physicians agree with the plaintiffs' complaints. The lawsuit follows a similar case a group of doctors at West Jefferson Medical Center brought against the state last April, seeking financial relief for the high levels of indigent care they continue to take on since Charity Hospital's closure. No hearing date has been set.

Emergency departments and doctors' private practices are absorbing a lot of Charity Hospital patients, said James P. Moises, MD, director of Tulane University Hospital & Clinic's emergency department and of emergency medicine at the university's School of Medicine. But the bigger problem is a lack of consistent outpatient care, he said.

"With such limited outpatient access, they bounce from ER to ER or primary care clinic to primary care clinic," said Dr. Moises, who worked at Charity Hospital before and during the storm.

Louisiana State University officials say they are doing all they can to shore up access to care in New Orleans and that Charity Hospital's fate was out of their hands.

"The fact is LSU didn't close Charity. Hurricane Katrina closed Charity," said Fred Cerise, MD, LSU's vice president for health care and medical education. "Now we are trying to deal with what's the best way to provide services in the aftermath."

He pointed to two Louisiana House and Senate resolutions adopted in 2006 and 2007 recognizing that Katrina forced Charity's closure when its bottom floors flooded. The measures also endorsed a plan to replace the hospital with a new facility in downtown New Orleans. Those plans are under way, and the facility is projected to open in 2012.

Meanwhile, LSU opened an interim charity facility in an office building and revived a majority of its satellite primary care and specialty clinics, said Dr. Cerise, former secretary of the Louisiana Dept. of Health & Hospitals. A major hurdle to restoring indigent patients' access to pre-storm levels is an overall shortage of doctors, nurses and other medical personnel.

LSU also has redirected state funds to other hospitals in the state, where many medical professionals and patients relocated, he added.

Doctors and patients contend that these efforts are not enough and say LSU is putting its interest in building a new hospital ahead of more immediate health care needs.

"There may need to be a new facility, but this is about what happens in the meantime," said Rosenfeld, the patients' lawyer. "To ignore the enormous need is simply improper."

Patients are asking the District Court for the Parish of Orleans for an independent evaluation of Charity Hospital's condition. They say this step was required under the 2006 House resolution but never done.

Internist F. Brobson Lutz, MD, a former director of New Orleans' Health Dept., said access to mental health services is "the most drastic area of concern." He said Charity Hospital's upper floors could house a psychiatric unit.

Dr. Moises said it would cost less to bring Charity Hospital back, as well as develop other potential sites, than to build a new hospital. "We need to re-establish access, and not in 10 years. We need to really address it, not just with Band-Aids."