Identifying Critical Public Health System Challenges in Responding to Katrina and

other Public Health Disasters

Kathy Hebert, MD,MMM,MPHRobert Wood Johnson Health Policy FellowSenate Subcommittee on Bioterrorism and

Public Health Preparedness

The Charity System

• Created in 1736, In New Orleans, L’Hospital de Charite de St. Louis was Louisiana’s first public hospital. The hospital has never closed. Rather it has evolved into the 5th largest public hospital system in the United States. The statewide expansion began in central Louisiana in 1939, and continued with the establishment of nine more facilities strategically located across the state.

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• Surge Capacity

Sally Phillips,RN,PhD

• Legal Issues During Disasters James Hodges,JD,LLM

• System Challenges for Chronic Diseases-George Mensah,MD

New Orleans

LSU University Hospital

VA Before Katrina

Veteran’s Hospital

VA Hospital back door view

Hurricane Katrina Response:New Orleans

• As of 9/7/05:– All 241 patients have been evacuated from the facility.– 272 Employees and 342 family members evacuated as well.

• 84 veterans admitted to the facility after the flood began.• Evacuation by air & ground to Houston, Alexandria, Jackson, and

Shreveport.– 10 Ventilator Patients by Helicopter,– 6 C-130 Sorties– National Guard truck convoy to buses and airhead

– ~ 15% Lost Homes; 25% Uninhabitable; 25% ok; remainder uncertain• ALL CARE GIVERS NEEDED ACCOMPANIED PATIENTS REGARDLESS

OF OWN CIRCUMSTANCES• Employees/Families are working and/or sheltering at evacuation sites

– VAMC – Current Status:• Facility secured with 30 VA police volunteers from around the nation.• A small engineering presence is maintaining the infrastructure.• The facility will need significant repair, possibly replacement

Hurricane Katrina Response: National Disaster Medical System

• NDMS supports the management and coordination of the Federal Medical Response to major emergencies and declared disasters

• VHA is responsible for 2/3 (49 cities) NDMS Federal Coordinating Centers which receive patients at airheads in 72 cities and regulate patients to private sector beds– 17 VA FCC’s Activated for Katrina

Hurricane Katrina Response:Volunteering, Serving, Giving

• As of November:– Over 2,000 VA personnel have volunteered to

serve VA and nation• VA Sites caring for Veterans• VA Sites, backfilling for other deployed personnel• VA & Community Sites Caring for All Americans

– Mobil Clinics– College Station– Waco & Marlin Shelters

– Secretary has established a fund to provide relief to employees who have lost homes.

Legal Issues

• Degradation in care-who jumps off the clift first breeches the standard of care

• Who is legally liable for the patient once they leave the hospital?

• Who is liable if a patient dies in the helicopter? In the airport?

• What if some hospitals evacuate and others don’t and the hurricane does not

hit ?

Electronic Health Care Records (EHR) New Orleans

• Patient electronic health care records (contained in data tapes) were taken from New Orleans to Houston.– No matter where New Orleans veterans are

now located, their health records are available.

– Continuity of Care is maintained.

• All prescription records are available through KVR . . .

COMMUNITY HEALTH: Hurricane Katrina Relief

• 62,000 New Orleans VA • Patients did not lose

their • medical records, even• when they lost their • City

– Their Electronic– Health Records – followed them– around the USA!

• VA Mobil Clinics Served

• Veterans & Community

Why is IT a Key Performance Strategy?Healthcare in the U.S., presents Multiple Challenges

Effectiveness:Safety Gap: 98,000 Americans die each year from medical errorsQuality Gap: Virtually every patient experiences a gap in care from best evidenceCompassion Gap: Not Patient-Focused

Efficiency:Value Gap: Health care inflation

Inferior outcomes per dollar31% Waste Estimated (Woolhandler)

Un-insurance / Under-insuranceAmerican health care is reactive, not preventive, predictivePatients / Payors (Govt) / Providers increasingly concerned about Value

Competitiveness

Information Gaps:1 in 7 hospital admissions occurs because care providers do not have access to previous medical records.*12% of physician orders are not executed as written* 20% of laboratory tests are requested because previous studies are not accessible.*1 in 6.5 hospitalizations complicated by drug error

1 in 20 outpatient prescriptions

* PITAC (President’s Information Technology Advisory Committee, 2004

Traditional Public Health Role in a Crisis

• Vaccinations

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New Role for Public Health in a Crisis

Chronic care• Coronary artery disease• Hypertension• Diabetes-refrigerated insulin• Cancer• Asthma/COPD• Renal failure-dialysis• HIV

Identifying Critical Public Health System Challenges in Disasters

• Communication

Information regarding disaster

Medical records/chronic diseases

Surge capacity

• Cost

• Clearing House

HRSA

• Program Funding LA (millions) 2004&5 Miss (millions) 2004&5• Surge capacity: beds $3,111,029 $572,000• Surge capacity: isolation $2,505,092 $95,000• Surge capacity: personnel/ESAR VHP $0 $25,000• Surge capacity: pharmaceuticals $1,038,834 $340,077• Surge capacity: PPE $1,520,452 $860,000• Decontamination $631,600 $310,000• Behavioral Health $0 $210,000• Trauma/Burn - $310,000• Communications $500,000 $1,557,191• EMS $1,522,000 $260,000• Hospital labs $73,000 $1,876,275• Education and Training $807,500 $700,000• Exercise and drills $273,000 $1,162,154

What Should The Public Healthcare System Look Like in the 21st

Century?

• Kathy_Hebert@help.senate.gov