AAMC Reporter: March 2006

New Orleans Institutions Face Post-Katrina Challenges

Six Months Later, Life Slowly Returns to Normal

In the first days following Hurricane Katrina, many members of New Orleans' academic medical community pushed aside personal concerns and risked their own well-being in a now-famous effort to treat legions of storm victims under hellish circumstances.

"I lost all perspective of time," said William Pinsky, M.D., executive vice president and chief academic officer of Ochsner Clinic Foundation in New Orleans. "We were all working 24 hours a day for probably four to six weeks after the hurricane."

But now, six months after one of the worst natural disasters in American history, these academic medical professionals face new challenges.

"Right now, this is the difficult time," Pinsky said.

The AAMC member institutions in this region — Louisiana State University School of Medicine in New Orleans (LSUSOM-New Orleans), Tulane University School of Medicine (TUSOM), and their affiliated clinical facilities, along with the Ochsner Clinic Foundation — are confronting a diverse range of obstacles, from heavy monetary losses to wholesale relocation to bewildered students.

Financial Tolls

According to Sam McClugage, Ph.D., LSUSOM-New Orleans associate dean for admissions, the school and its affiliated teaching hospitals, Charity and University (which employs both LSUSOM-New Orleans and TUSOM staff), suffered a net loss of $90 million, due mostly to heavy property damage, and were unable to immediately cover the costs because of an overall drop-off in patients following New Orleans' evacuation. These losses led to speculation in November from former LSUSOM-New Orleans Dean Larry H. Hollier, M.D., now chancellor of the LSU Health Sciences Center, that LSUSOM-New Orleans might be forced to close barring an emergency funding allocation. Since then, Louisiana Gov. Kathleen Blanco has guaranteed school officials that the necessary resources will be available to keep the school open, McClugage said. 

"If the patients aren't there, you don't have the funding," said McClugage. "So unless we had a bailout, we couldn't make payroll."

McClugage, who estimated 70 percent of Louisiana's health care workforce are LSUSOM-New Orleans graduates, said school and state leaders were committed to saving the school and that the storm and its repercussions had a silver lining.

"There were furloughs and staff cutbacks, but now the picture is looking a lot brighter as people and patients come back," McClugage said. "There was a consciousness that we could not let this place die. The disaster made us focus intently on the bottom line, and that allows you to become leaner and meaner. Out of this chaos came great opportunity."        

LSUSOM-New Orleans' campus and University Hospital will re-open in June, McClugage said. Until then, temporary facilities at the Pennington Biomedical Research Center in Baton Rouge — opened by the school just four weeks after the hurricane — will remain open. Charity Hospital remains closed.

The storm also took a staggering financial toll on the TUSOM and Ochsner Clinic Foundation.

Ochsner officials projected losses of $65 million to $75 million but had no staff cutbacks and operated at full capacity throughout the ordeal.

Marc J. Kahn, M.D., associate dean for admissions and student affairs at the TUSOM, said the university will welcome a full class back to its regular New Orleans facilities starting in July. Paul Whelton, M.D., senior vice president for health sciences at Tulane Medical Center, estimated total costs to the school in lost research, building repairs, and other expenditures could reach hundreds of millions of dollars. This academic year, approximately 300 Tulane medical students temporarily attended classes at Baylor College of Medicine in Houston.

In mid-February, Tulane University Hospital and Clinic reopened its emergency room, five operating rooms, two intensive care units, a pharmacy, several cardiology laboratories, the radiology and outpatient surgery departments, and a number of inpatient beds.

A Resilient Spirit

Tulane medical students attending orientation at Baylor College of Medicine in Houston

Six months after the storm, personal stress and displacement remain chief concerns. Approximately 1,600 of Ochsner's 7,400-member staff did not return following the hurricane, and the foundation has stepped up employee assistance and communications to help ease tension.

"We've passed the acute phase, with all the adrenaline rush that comes along with it," Pinsky said.

"About half of our employees had their homes lost or severely damaged. So now our issue is, how do we keep everyone focused while dealing with insurance people, or if they are displaced? And [Ochsner's] bursting at the seams with patients. Everyone's doing more than normal, so the stress level is very high," Pinsky said.

Students and residents also find themselves affected.

Charles Hilton, M.D., LSUSOM-New Orleans' associate dean for academic affairs, said almost all those performing residencies at University or Charity hospitals at the time of the storm were relocated to one of three state teaching hospitals — Earl K. Long in Baton Rouge, University Medical Center in Lafayette, or Leonard J. Chabert Medical Center in Houma — or to in-state private hospitals.

However, the relocations did not happen without difficulty. The Medical Center of Louisiana at New Orleans — which oversees all the area's public hospitals — has been unable to cover resident stipends.

"Usually the institutions pay the residents, but right now there's no institution funding stream to pay them. So the medical school has been paying the residents. That has been a problem."

Hilton added that it is unclear how many residents will fill the school's 110 open resident slots following Match Day on March 16.

"There may be some specialties that will cause residents to come rushing into New Orleans, and with others that may not be the case. We simply don't know what's going to happen."

Kahn predicted New Orleans might experience a temporary resident shortage.

"The residency programs are recruiting, and we hope to get enough residents," he said. "Our residency numbers will be smaller now than they were pre-Katrina, because there are less patients for them to work with, but as people return, those numbers will all go up. I'm optimistic. We will need residents to help patients."

Ochsner Clinic Foundation is doing its part to keep students and residents local. Since the storm, Ochsner added 30 extra residents, mostly from Tulane, for a total of 355, while the monthly number of students performing clinical rotations at Ochsner doubled — from 33 students in January 2005 to 66 students this January.

"We have reached out to help the two medical schools," Pinsky said. "We're helping keep residents here in the area, and we're looking forward to recruiting a strong class from the [resident] match."

Lisa Wu, a fourth-year Tulane medical student taking classes at Baylor, called post-storm adjustments "difficult" and said she does not plan to perform her residency in New Orleans, applying instead mainly to programs in and around her native Seattle.

"When the hurricane struck, people were in various stages of [residency] application," Wu said. "Everyone was trying to locate their [dean's letter] writers and so forth, and it was nearly impossible."

"But it's to be expected. You just have to be patient. Eventually, we ended up having some great faculty who wrote letters for all of us. But in the meantime, I was really wondering if it was going to happen," Wu said.

Andrew Coyle, a first-year Tulane medical student taking classes at Baylor, will return to the Crescent City. Coyle, who hopes to specialize in infectious diseases, plans to assist with recovery efforts, possibly through a residency.

"I can't wait to get back to New Orleans," Coyle said. "There are so many opportunities for service. A lot of things happen in New Orleans now that are similar to what happens in developing countries. The medical system is in disarray, and a lot of planning, organization, and re-building is necessary. Katrina created a whole re-set."

Baylor officials will use two separate match processes to help preserve Tulane tradition within Baylor's walls.

"We wanted the Tulane students to feel as if they are still Tulane students, just attending a different campus," said Peter G. Traber, M.D., president and CEO of Baylor College of Medicine. "So while Baylor puts its matches up on a bulletin board, Tulane hands out each match individually in envelopes, so that's what we're going to do for the Tulane students."

Overall, officials agree that despite the myriad problems that still exist, there is much to be proud of as residents, students, and institutions return to New Orleans, and academic medicine's recovery continues.

"Bringing Tulane University students to Baylor has gone much more smoothly than one might have initially imagined," said Traber. "It was a struggle at first, but it's gone well. We will miss the Tulane students when they go."

Kahn said TUSOM'S temporary move to Baylor went off "without a hitch."

"All in all, it has gone far better than expected," he said. "There have been a lot of phone calls, a lot of e-mails, and a lot of late nights, but together we're getting it done."

"There is no guidebook that shows you what to do when a city is flattened," Wu said. "Given those circumstances, people did what they had to do."

—By Scott Harris

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