"I have a young man in our emergency room that is suicidal and needs medication and a psychiatric bed. We don't have one." So said a New Orleans psychiatric nurse six months after Hurricane Katrina, according to the Kaiser Commission on Medicaid and the Uninsured report Voices of the Storm: Health Care after Katrina (available online at http://www.kff.org/uninsured/7538.cfm). For more than a year, New Orleans has grappled with the Herculean task of rebuilding its entire health care system's infrastructure. Meanwhile, many residents of the once-major U.S. city still struggle with high rates of untreated depression and other chronic illnesses.
According to the Kaiser report pre-Katrina New Orleans had 2,269 staffed inpatient beds; six months later, there were just 453. The number of nursing home beds dropped from 4,954 to 2,735. And although access to nontraumatic acute care has generally been restored, preventive care, health screenings, diagnostic services, and continuity of care for people with chronic illnesses remain largely unavailable.
To many, this is an opportunity to improve health care access for the region's low-income residents. On October 19, the Louisiana Health Care Redesign Collaborative-a body appointed by the Louisiana legislature to help redesign the region's health care system-submitted to the U.S. Department of Health and Human Services a plan that recommends decentralizing medical services, creating a network of neighborhood clinics, and phasing in universal health insurance statewide over a five-year period, beginning with the four hardest-hit parishes.
Was it murder? Memorial Medical Center, one of the flooded hospitals, was the site of what Louisiana Attorney General Charles C. Foti, Jr., has characterized as murder. Two nurses and a physician-accused of giving lethal injections of two commonly used pain and anxiety drugs to four critically ill patients while waiting for the hospital to be evacuated-may go before a grand jury this month; Orleans Parish District Attorney Eddie Jordan will decide whether to pursue the case. A defense fund for the accused nurses has been established (http://www.memorialnursessupportfund.com). Douglas P. Olsen, PhD, RN, associate director of the Center for Health Policy and Ethics at the Yale University School of Nursing and a coordinator of Ethical Issues, says of the situation, "I think there's a general misunderstanding of the nature of care. All treatments carry risk. When you have unstable patients in very unstable situations, that risk is going to be even higher."
No matter what the case's outcome, some believe that the accusations may alter how clinicians respond during disasters-perhaps by making them hesitant to give care that could be seen as ethically suspect. Will this happen? "I hope not," says Olsen. "It would be a tremendous disservice."
Sylvia Foley
senior editor