Child Hurricane Evacuees In "Urgent" Need Of Care, Report Says

Children who evacuated their homes because of Hurricane Katrina and now are living in hotels or trailers are in "urgent" need of primary care and mental health care, according to a study conducted by the Mailman School of Public Health at Columbia University and the Children's Health Fund, the New York Times reports. For the survey, 650 in-person interviews with evacuee families living in hotels or trailers were conducted in February. For comparison, the study used National Survey of Children's Health statistics for urban Louisiana families from 2003. According to the study, 34% of displaced children have conditions such as asthma, anxiety and behavior problems, compared with 25% before Katrina. Fourteen percent of displaced children went without prescribed medicine at some point during the three months prior to the survey, compared with 2% before the hurricane. Meanwhile, more than half of mothers and other female caregivers scored "very low" on a mental health screening exam. Those women were more than twice as likely to report that at least one of their children had developed an emotional or behavioral problem since Katrina. About 50% of children who had primary care doctors before Katrina no longer had doctors, and many parents who said their children still have doctors also said they had not yet tried to contact them. In addition, 44% of parents and guardians said they are uninsured -- in many cases because they lost their jobs after Katrina -- and nearly 50% of parents have chronic conditions. According to the survey, 37% of parents or guardians said their health was "fair" or "poor," compared with 10% before the hurricane. The study says that displaced families are still not being given a chance to recover, and instead, "[c]hildren and families who have been displaced by the hurricanes are being pushed further toward the edge." The study's authors recommend an expansion of Medicaid to provide universal disaster relief and emergency mental health services, in addition to sending doctors and counselors from the federal U.S. Public Health Service Commissioned Corps to the region.

Reaction
Irwin Redlener, co-founder of CHF and director of Mailman's National Center for Disaster Preparedness, said, "Children do not have the ability to absorb six or nine months of high levels of stress and undiagnosed or untreated medical problems" without long-term health consequences. Redlener added, "This circumstance is being widely misinterpreted as an acute crisis, somehow implying that it will be over in the near term, which is categorically wrong. This is an acute crisis on top of a pre-existing condition. It's now a persistent crisis with an uncertain outcome, over an uncertain timetable." David Abramson, the study's principal investigator, said that all of the Gulf Coast's safety net systems "seem to have either been stretched or completely dissipated." Erin Brewer, medical director of the Louisiana Department of Health and Hospitals' Office of Public Health, said, "I think [the study] told us in number form what we knew in story form." Brewer added, "We're talking about a state that had the lowest access to primary care in the country before the storm. And a population within that context who were really, really medically underserved and terribly socially vulnerable." Brewer said that some trailer sites are regularly visited by mobile health clinics but noted that such programs are not universally available. Anthony Speier, director of disaster mental health for Louisiana, said, "The struggle for our mental health system is that our resources are designed for people with serious mental illnesses and behavior disorders. But now the vast population needs these forms of assistance." Speier added, "What we really from my vantage point could benefit from is a source of treatment dollars" (Dewan, New York Times, 4/18).

Public Hospital System
In related news, Louisiana should begin dismantling its statewide public hospital system and delay rebuilding two New Orleans hospitals operated by Louisiana State University that were damaged in flooding from Hurricane Katrina, according to an early draft of a report by PriceWaterhouseCoopers, the New Orleans Times-Picayune reports. The report, which was commissioned by the Louisiana Recovery Authority's Support Foundation, states that "unbalanced financing" has led to the private sector producing "far more care than is needed" for insured residents and the public sector producing "far less care than is required" for uninsured residents. The report also states that LSU-operated Charity and University hospitals should not be rebuilt because "Katrina essentially right-sized the overbuilt hospital system" in the New Orleans area. About half of the region's 4,602 hospital beds are still not functional because of Katrina, and the region's hospital bed occupancy rate was 56% prior to the hurricane, according to the report. The report finds that functioning hospitals' complaints about being overburdened are primarily due to a lack of nursing home beds and long-term care facilities for patients who are discharged. Donald Smithburg, head of the LSU Health Care Services Division, said the report's recommendation that the region does not need additional hospital beds is "unconscionable." The report -- which includes recommendations on creating a medical records system, improving long-term care and addressing mental health needs -- is scheduled to be released later this month. The recommendations, which still could be changed, require approval from LRA, Gov. Kathleen Blanco (D) and the state Legislature (Moller, New Orleans Times-Picayune, 4/15).

Care 'Unacceptably Primitive'
A report published last week in the New England Journal of Medicine states that health care in New Orleans remains "unacceptably primitive" seven months after Katrina, CQ HealthBeat reports. The report -- written by Ruth Berggren and Tyler Curiel, professors of medicine at Tulane University Health Sciences Center -- states that "[w]ithout rapid, coordinated and effective help from government agencies, we fear that disproportionate human suffering and death will continue to plague greater New Orleans." The report cites hospital bed shortages and a lack of government assistance as ongoing problems in the "chronic" phase of the health care crisis created by Katrina. According to the authors, federal legislation is "warranted to ensure that CMS dollars" for graduate medical education salaries go to medical school residents who are providing health care to uninsured city residents. The report also states that reimbursements for caring for the uninsured should "follow patients, rather than hospitals." CMS Deputy Administrator Leslie Norwalk said that regulatory changes have been made to help fund the medical school resident training programs and that for the past two weeks federal funding has been going to Louisiana providers who care for the uninsured and Medicaid beneficiaries (Reichard, CQ HealthBeat, 4/14).

The report is available online.


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