The Big Health Care Vacuum

Dr. Floyd Buras, a Louisiana pediatrician, remembers the day vividly. The mayor of New Orleans finally let him visit his office on the corner of Robert E. Lee Boulevard and Franklin Ave., two whole weeks after Hurricane Katrina hit the U.S. Gulf Coast. The building had been sitting in 12 feet of water for more than 14 days. Everything inside was destroyed, including medical records reduced to the state wet toilet paper, according to Forbes. It gets worse.

A few weeks later, when those same medical records had dried out, they had hardened and turned into a paper mache-like substance, forcing the doctor to hire a concrete removal service to dig it all out. But most damaging yet? His patients were gone.

"We drew from the areas most severely affected by the storm. The patients left, and they haven't come back. If you talk about a medical practice being people; doctor-patient relationships, that was destroyed," said Buras, who started his practice in the late 1970s, and is now trying to begin again with 800 patient charts instead of 15,000.

Since that day, Buras and his associate have relocated to two rooms at an area Children's Hospital, and are renting office space from a computer training school upstairs.

"They had the same issue, no people to train," said Buras, who is president of the Louisiana State Medical Society. "It's mutually beneficial. They get some revenue from unused space, and we have a place to call home."

The most exceptional aspect of Buras' misadventure is that it is by no means exceptional. Thanks to Katrina and the ensuing floods, health care in New Orleans has largely disappeared. The entire infrastructure is damaged, if not destroyed completely.

Susan D'Antoni, executive director of Orleans Parish Medical Society, said that the city's Orleans and St. Bernard parishes (the hardest hit) went from having nine hospitals to three. The metropolitan area, as a whole, lost half its hospital beds and about 40 percent of its physicians. The total number of doctors in the St. Bernard Parish went from 75 to three. For all intents and purposes, the network of charity hospitals for indigent patients is gone. Meanwhile the number of uninsured has increased by up to 500 percent, courtesy of an incredible loss of jobs (and benefits), plus the incoming temporary labor force needed to rebuild the city.

"One of the major issues is that so much of our population is uninsured or under insured because people lost jobs, and there's a major influx of immigrant workers," said Dr. Ruth Berggren, an associate professor at Tulane University Health Sciences Center in New Orleans, who specializes in the section of adult infectious diseases.

Compounding matters is the fact that the nature of the work this temporary labor force does is particularly taxing on their health. Fixing roofs and cleaning up debris left behind by floods means injuries, heart attacks and illnesses for workers-problems for which the decimated health system is unprepared.

For Buras, who does not qualify for government financial assistance, the process of rebuilding his practice is going to occur despite the odds. His insurance company stated it won't be insuring the building again unless it is raised 12 feet, which would cost a hefty $100,000 out of Buras' own cash-strapped pocket.

"It may not be worth the effort," said the 56-year old doctor.

Buras plans to stay in New Orleans, however, where many younger physicians have left. With back mortgage payments, student loans and tuition for their own children to pay, they've had little choice but to pack their bags and begin again elsewhere.

"Ten years from now, when I'm ready to retire, there's not going to be anybody here to take my place," Buras said. But Buras and his counterparts also see an opportunity in this vacuum, an opportunity to truly start again.

"Rather than trying to rebuild Charity Hospital and refund all government programs, why don't we just create an insurance program and take all of the money and buy everybody an insurance program? We'd love to see things redone, and we could do it easily. We wouldn't have to get rid of the old. It's already gone," Buras said.

This hints at a larger issue that affects the health care delivery system and infrastructure across the U.S. Right now, the system in place rewards the health care system financially when people are sick. Many industry experts want to turn that around, so that money flows when people are out of the hospital. Ultimately, that will result in greater stability. Maybe the mother of all silver linings is this chance to begin anew.

As one medical professional stated, "How often do you get a clean slate?"

-- Stephen Marsi

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