1. Nelson, Roxanne BSN, RN


Katrina's effects are still taking a toll.


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In July a New Orleans grand jury refused to indict Dr. Anna Pou on charges that she gave lethal injections to four patients who died in the days after Hurricane Katrina. While her exoneration was good news to medical professionals, the health care infrastructure across the Gulf Coast is still in a troubled state. Two years after Katrina, nurses, physicians, and other health care workers remain in short supply, and a number of facilities have yet to reopen.


"I don't think people realize how devastated the coast has been and how difficult it has been for nurses to continue to take care of their patients while dealing with the loss of their own home[s], living in [Federal Emergency Management Agency] trailers two years after the storm, trying to cope with insurance agents, state and federal emergency systems, and so on," said Ricki Garrett, executive director of the Mississippi Nurses Association. "We are beginning to see more posttraumatic stress disorder, compassion fatigue, and other emotional issues."


In New Orleans, dust and mold remain problems. Results of a recent survey by the Henry J. Kaiser Family Foundation (KFF), released in May, showed that since Katrina, 19% of area residents reported declining physical health and 16% reported deteriorating mental health. More than one in three residents (36%) reported reduced access to health care. Data from the Louisiana Department of Health and Hospitals show that in the first three months of 2006, the mortality rate in Orleans Parish rose by more than 25%-from 11.3 deaths per 1,000 parish residents per month to 14.3.


At a congressional hearing on post-Katrina health care, Diane Rowland, executive vice president of the KFF and executive director of the Kaiser Commission on Medicaid and the Uninsured, pointed out that the health care system in Louisiana was strained before Katrina. Twenty-three percent of the state's population lived below the poverty level and almost 20% lacked insurance. Most of the poor and uninsured were cared for by the state-run Charity Hospital system.


Now, Charity Hospital has closed permanently and other storm-damaged facilities are not fully operational. The problems at present include a severe workforce shortage, a growing population of uninsured, and a critical shortage of mental health services. Before the hurricane struck, New Orleans had 196 practicing psychiatrists. In April 2006, there were 22.


Joe Ann Clark, executive director of the Louisiana State Nurses Association, pointed out that besides hospitals, other types of institutions are also affected, particularly nursing homes. "It is most difficult to entice any type of worker back to New Orleans," she said. "There are labor shortages in all areas of the city, and in Baton Rouge as well."


The Greater New Orleans Health Service Corps is using federal funds for incentive programs to attract and retain health care workers. It is offering candidates loan repayment, a sign-on bonus, malpractice premium payment, relocation expenses, and an income guarantee. Practitioners must work full-time for three years at a facility that accepts all patients, regardless of ability to pay, and is located in a federally designated health professional shortage area. And the Louisiana Education Loan Authority is waiving the interest on state loans to nursing students who promise to work in the state after graduating.


As we went to press, the Louisiana Department of Health and Hospitals announced that it will be receiving a $100 million federal grant to support and expand clinics in the state. As part of the grant, $4 million has been designated for recruiting health care workers for new clinics.

FIGURE. Southeastern... - Click to enlarge in new windowFIGURE. Southeastern Louisiana University nursing student Kristy McMurray interviews a patient at the Greater New Orleans Medical Recovery Week last winter. Held at a park in New Orleans, the health fair convened more than 400 clinicians from around the country and around the world to provide free care to more than 5,000 patients. Despite such efforts, two years after the hurricane the area's health care infrastructure remains hobbled.

Roxanne Nelson, BSN, RN