WASHINGTON -- Eighteen months after Hurricane Katrina, the health care system in New Orleans remains in such disarray that patients with heart disease and cancer are getting inadequate care, local medical authorities told Congress yesterday. By one estimate, they said, the number of deaths might have increased by more than 40 percent from pre-Katrina figures.
The federal government has pumped in millions of dollars in aid, but hospitals and clinics that care for the poor - already strained before the storm - have yet to recover. Behind the failure to improve health care in New Orleans is a squabble between state and federal officials with competing visions.
As a result, people with severe mental illness often go without medication. Heart patients cannot get prescribed follow-up care, and some cancer patients must travel hours for chemotherapy. People line up before dawn in hopes of getting care at clinics staffed by volunteers.
"The current status of [the] health care infrastructure in New Orleans is tenuous and critically ill," Dr. Cathi Fontenot, medical director of the Medical Center of Louisiana at New Orleans, told the House Energy and Commerce Committee.
The director of the city's Health Department said his analysis of death notices before and after Katrina suggests that the number of deaths was up by more than 40 percent last year when compared with levels before the storm. Available data "strongly suggest that our citizens are becoming sick and dying at a more accelerated rate than prior to Hurricane Katrina," Dr. Kevin Stephens said.
There are some bright spots in New Orleans, such as a new network of community health centers. But a severe shortage of doctors and nurses is adding to problems, and the number of hospital beds in the metropolitan area is about half what it was before the hurricane.
"It's very difficult to accept the fact that these areas are still devastated more than a year and a half later, especially considering that this condition exists in the United States of America," said Leslie Hirsch, president of Touro Infirmary, a large private hospital in central New Orleans. "This situation involves all levels of government."
Traditionally, Louisiana has maintained what amounts to two systems: The poor and uninsured rely on public hospitals, while people with coverage are treated at private hospitals and have their own doctors.
The Bush administration wants the state to use much of the federal funding that has helped support public hospitals to instead subsidize private health insurance for people who lack coverage. Such a strategy would build on proposals President Bush outlined in his State of the Union message this year.
"It is time to level the playing field," Leslie V. Norwalk, Medicare and Medicaid's acting administrator, told the committee. The poor and uninsured should have the same kind of coverage as people with private insurance, she said.
But state officials said there was only enough money going to public hospitals to subsidize care for about half of the uninsured in the state.
"It's not a simple move," state Secretary of Health and Hospitals Fred Cerise told the panel. "Those funds are buying services today. We would have to get comfortable that we were insuring a critical mass of the population." Doing so would take an additional $1 billion a year, he estimated.