Not So Easy

Contrary to its “Big Easy” nickname, New Orleans has always made me decidedly uneasy. To me it has been a city built on equal parts of contradictions: beauty and decay, extravagance and hardship, celebration and regret.

Unfortunately, the opposites that characterize New Orleans culture extend to its healthcare system, which before Hurricane Katrina was divided into a system of public hospitals that cared for the city’s burgeoning poor and a mix of nonprofits and for-profits that cared for everyone else. According to a report prepared by PricewaterhouseCoopers, one system was overburdened, while the other was overbedded.

When we visited New Orleans hospitals months after the disaster to report for this issue’s cover story, the dichotomy was still stark. In one little block of the city, you have Tulane University Hospital and Clinic, backed by HCA Inc., well on its path to reopening. When we visited, the ED was back open, and the walls were starting to go back up in the flood-damaged first floor. Across the street, Charity Hospital—one of two facilities that make up the public Medical Center of Louisiana at New Orleans—was a deserted relic. By all accounts, it will never reopen in the damaged shell.

The storm recovery has forced some hospitals and their leaders to take on unusual roles and missions. With MCLNO still shuttered, open hospitals like Tulane, Ochsner Medical Center and Touro Infirmary have seen their charity care burden skyrocket. Touro CEO Leslie D. Hirsch says his hospital could lose $30 million in uncompensated care.

Beyond the present burdens of physical recovery, the long-term vision of healthcare in the city is clouded by looming questions that no one can answer right now. Will the city be a compact version of its former self, built mostly for the tourist trade? Will the former residents of the city’s devastated wards return in large numbers? Will the city essentially rebuild the same healthcare inequities that existed prior to the storm?

Without much data to rely upon, the city’s hospital leaders are rebuilding, at least partially, on faith. Sure, there are billions of insurance and recovery dollars pouring into the city, and census projections show the population rebounding. Still, the leaders of New Orleans hospitals are rebuilding with a level of uncertainty that would make their counterparts in other cities shiver.

In many other cities, faith would not be enough. But in New Orleans, a city built on a swamp below sea level, faith has always sustained them through storms—and through contradiction.

Jim Molpus
Editor
jmolpus@healthleadersmedia.com