In January, when the New Orleans Neurological Society (NONS) met for the first time after Katrina, the reunion was bittersweet. The agenda was certainly unlike any neurological organization's meeting in the past. The members had to run elections for officers and recreate a roster of still-functioning New Orleans neurologists. The last official census in 2003 tallied 80 members, but now they could come up with only 30 names. Faculty layoffs, relocations, early retirements, and unexpected deaths — Tulane neurology chair Leon A. Weisberg, MD, died in December — had contributed to an accelerated attrition rate.
For the twenty or so neurologists gathered at the meeting, a primary concern was the general state of medicine in the city. Eighteen months post-storm, much of the health-care infrastructure in New Orleans is still devastated.
“Nothing has been done,” said Michael T. Happel, MD, a private practice neurologist who was re-elected to serve as treasurer. “There is an inertia that seems to be preventing progress,” he said. Although the federal and state governments have allocated some funds, he explained, they have yet to be disbursed to hospitals or the health-care providers who are caring for the uninsured.
A DECLINE IN STANDARD CARE
“The January meeting allowed us to regroup and reassess some of our most glaring needs,” Amy Gutierrez, MD, the newly appointed president of the NONS, told Neurology Today. She described a pervasive hopelessness among physicians in New Orleans. Until recently, Dr. Gutierrez, neurology program director at Louisiana State University (LSU), and the other five remaining LSU neurologists were working in cramped quarters not much bigger than closets and paying triple the normal rent. To make matters even more frustrating, their patients have to wait four months to be seen, and drive an hour away to get an EEG or an EMG. The breakdown of services is profound. “We can't administer tPA [tissue plasminogen activator], laboratory tests take forever, and ambulance response is poor,” Dr. Gutierrez said. “The decline in standard of care is demoralizing.”
Part of the problem is a lack of hospital personnel, said Tulane neurologist Jeffrey S. Nicholl, MD, who was appointed NONS secretary. “Housing has become so expensive in New Orleans that it's hard for nurses or lab techs to find affordable places to live,” he explained. Dr. Nicholl, who spent seven months after Katrina working in Houston at the VA and at Baylor College of Medicine in the clinical neurophysiology program, returned to New Orleans full-time a year ago. He has seen Tulane's neurology department shrink from fourteen members, before the flood, to five. He, like others, is saddened by the shut down of Charity Hospital and the VA hospital in-patient service. “We had in-patient neurology services at both sites and now they are gone,” he said.
LOSS OF SECURITY
Perhaps the most unsettling loss of all has been the loss of security, both personal and professional. There is a pervasive uncertainty about the future that affects nearly everyone. Neurologists in New Orleans are discouraged by ever-rising expenses, uncompensated care, and a soaring crime rate.
Although the NONS members have set goals to move forward, they are hamstrung by local, state, and federal governments that have yet to formulate a comprehensive solution, they report. The bureaucratic snarl that has stalled the process thus far is taking a steep toll on its physicians.
“You can run a MASH unit for a while if you know that there is a plan,” said Dr. Gutierrez, “but no one knows what will happen to health care here, and that makes the situation very bleak.”
In addition to hardships in providing care to patients, neurologists living in New Orleans face ongoing day-to-day challenges. Until recently, Aaron J. Friedman, MD, who took a temporary job in Georgia, had been separated from his wife. Their New Orleans home had been heavily damaged by the storm and its reconstruction has taken eighteen months. Finally back with his family, Dr. Friedman now commutes two hours a day to his new position in Houma, LA.
The uncertainty extends beyond health care. Just the other day, he went to a grocery store that is normally open until midnight, to find that it had closed at 6 PM. “It's a common experience,” he said. “New Orleans still has a long way to go.”