Report: Katrina medical response was chaos
Copyright 2006 The Times-Picayune Publishing Company
Volunteers cite lack of coordination
By SEAN REILLY
Times-Picayune (New Orleans)
Jeanie Hohenstein arrived at a Baton Rouge tent city in early October, eager to put her medical skills to work helping hurricane victims. She was part of an unprecedented federal mobilization of volunteer health professionals.
The first available assignment: a call for seven nurses to staff an animal shelter.
"We were somewhat amazed by that," Hohenstein, 41, a registered nurse, recalled last week from her Nebraska home.
She declined that opportunity, instead working on a mobile medical team that spent two weeks filling prescriptions and providing other services to evacuees in shelters around Louisiana. Hohenstein said that despite persistent organizational problems, she found the experience worthwhile.
Her story represents one snapshot in the massive — and sometimes muddled — medical response to Hurricanes Katrina and Rita. The outpouring of aid saved thousands of lives, a congressional inquiry recently concluded, but could have accomplished still more with better planning and coordination.
"Though there was the will, the medical response to Hurricane Katrina showed there wasn't always a way," says the report by the special House committee created to investigate the government's handling of the crisis.
Two months before the start of this year's hurricane season, Katrina offers sobering lessons for health officials.
On Alabama's Gulf Coast, Mobile County Health Officer Bert Eichold said he was pleased with his area's medical response to Katrina and noted that no lives were lost there in the hurricane's immediate aftermath. But local hospitals had to take in hundreds of patients from stricken facilities in Mississippi and Louisiana, sometimes with no advance notice and scant information about their medical condition or history.
A few lessons learned
Eichold said gasoline shortages made it tough for some employees to get to work; others had to contend with severe damage to their own homes. With regular power out, some hospitals also came close to running out of generator fuel.
"It created a lot of sweaty palms before the power got back on," he said.
Now, Eichold said, most hospitals are enlarging their fuel tanks. And in future disasters, the state health department plans to dispatch employees equipped with satellite phones to coordinate patient transfers out of hard-hit areas.
Throughout the Gulf Coast region, Katrina's confirmed death toll is about 1,600, a number that would have been far higher without the actions of public health officials and medical volunteers, according to the congressional report.
But while the storm yielded its share of improvised heroics — such as the New Orleans physician who used Wild Turkey bourbon as a sterilizing agent while giving injections at a makeshift clinic — it also exposed a sometimes fatal lack of preparation, congressional investigators concluded.
Because only small amounts of supplies and equipment had been "prepositioned" before Katrina made landfall Aug. 29, the report says, "it took days to respond to the catastrophe and deliver medical supplies to the Superdome and Convention Center." Particularly vulnerable was the "special needs" population, a group loosely defined as people needing extra medical attention. An estimated 215 people died in New Orleans hospitals and nursing homes.
The report offered mixed reviews of the volunteer effort nurse Hohenstein joined. Although a success overall, it "created confusion at the state level," the report states.
That system was in part an attempt to deal with the deluge of medical professionals — often moved by what they had seen on television — who offered their services after Katrina hit. Some didn't wait, simply showing up on their own.
Almost 30,000 doctors, nurses and other health workers have registered with the federal program, said Marc Wolfson, a spokesman for the U.S. Department of Health and Human Services, which organized the effort. About 1,500 have actually been called to serve. While the government pays their expenses, including travel, they are otherwise working for free, he said.
But Hohenstein and other members of her medical team said their work was hobbled by poor coordination with state officials and federal managers' apparent failure to prepare.
"I think they brought in a vast amount of volunteers without someone knowing what our role was going to be," Hohenstein said.
In some cases, the roughly 12-member team was sent to shelters that evacuees had already left or were in the process of leaving. Team members learned to call ahead.
More for show
Even when they weren't needed, the federal medical director told them to go anyway, said Dr. Eva Briggs, a New York family physician also on the team.
Like Hohenstein, Briggs suspected that government officials were using them as part of a public relations effort to make up for the initially flawed response to Katrina. Like two other physicians on the team, Briggs, who has previously served on church missions to the Dominican Republic, said she would not volunteer again through the federal government.
Wolfson declined to comment on specific criticisms.
In interviews, several other members of the team described the effort as disorganized, but found the work rewarding enough that they would do it again.
"Even though I saw it at its worst, I still fell in love with the people down there," said Suzanna Eller, a licensed mental health counselor from Seattle.
Their work drew praise from Louisiana officials.