New Orleans is sicker than ever

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.