WASHINGTON — Eighteen months after Hurricane Katrina, the healthcare system in New Orleans remains in such disarray that patients with heart disease and cancer are getting inadequate care, local medical authorities told Congress on Tuesday. By one estimate, they said, the number of deaths may have increased by more than 40% 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 not recovered. Behind the failure to improve healthcare 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] healthcare infrastructure in New Orleans is tenuous and critically ill," Dr. Cathi Fontenot, medical director of the Medical Center of Louisiana at New Orleans, told a House Energy and Commerce subcommittee.
The director of the city's health department said his analysis of death notices before and after Katrina suggested that the number of deaths was up by more than 40% 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.
New Orleans has some bright spots in healthcare, including 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.
The main public hospital -- which had about 700 beds and was the region's top trauma center -- was severely damaged and remains closed.
"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 D. 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 healthcare systems: The poor and uninsured rely on public hospitals, whereas 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 always helped support public hospitals to 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 address this year.
"It is time to level the playing field," Medicare and Medicaid Administrator Leslie V. Norwalk told the committee. The poor and uninsured should have the same kind of coverage as people with private insurance, she said.
But Louisiana officials said there was not enough money going to public hospitals to subsidize insurance for all those in need -- only for about half of them.
"It's not a simple move," Louisiana Secretary of Health and Hospitals Dr. Fred Cerise told the panel. "Those funds are buying services today."
Cerise estimated it would take an additional $1 billion each year to make sure the vast majority of the population was insured.
Committee members of both parties urged state and federal officials to back away from the philosophical standoff and look for practical ways to work together.
"I fear that the state and federal governments will become locked into a colossal fight of dueling spreadsheets," said Rep. Bart Stupak (D-Mich.), chairman of the subcommittee on oversight and investigations that held the hearing.
"Perhaps rather than a one-size-fits-all plan ... the state and the federal government should attempt to address smaller portions of this problem," Stupak said.
"It sounds like we need to focus more about meeting needs today and talk about the future later," said Rep. Edward Whitfield of Kentucky, the panel's ranking Republican.
State and federal officials pledged to keep talking, but it was unclear how the impasse would be resolved.
In the meantime, doctors warned, patients would keep falling through the cracks.