Kathy Hebert, MD,MMM,MPH Robert Wood Johnson Health Policy Fellow

1. Identifying Critical Public Health System Challenges in Responding to Katrina and other Public Health Disasters Kathy Hebert, MD,MMM,MPH Robert Wood Johnson Health Policy Fellow Senate Subcommittee on Bioterrorism and Public Health Preparedness

3. 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.

5. Visits by Zip Code

6. Surge Capacity Sally Phillips,RN,PhD • Legal Issues During Disasters James Hodges,JD,LLM • System Challenges for Chronic Diseases-George Mensah,MD

7. New Orleans

8. LSU University Hospital

9. VA Before Katrina

10. Veteran’s Hospital

11. VA Hospital back door view

12. 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

13. 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

14. 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.

15. 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?

16. 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 . . .

17. 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

18. 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 errors • Quality Gap: Virtually every patient experiences a gap in care from best evidence • Compassion Gap: Not Patient-Focused • Efficiency: • Value Gap: Health care inflation • Inferior outcomes per dollar • 31% Waste Estimated (Woolhandler) • Un-insurance / Under-insurance • American health care is reactive, not preventive, predictive • Patients / 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

19. Traditional Public Health Role in a Crisis • Vaccinations

20. Visits by Zip Code

21. New Role for Public Health in a Crisis Chronic care • Coronary artery disease • Hypertension • Diabetes-refrigerated insulin • Cancer • Asthma/COPD • Renal failure-dialysis • HIV

22. Identifying Critical Public Health System Challenges in Disasters • Communication Information regarding disaster Medical records/chronic diseases Surge capacity • Cost • Clearing House

23. 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

24. What Should The Public Healthcare System Look Like in the 21st Century? • Kathy_Hebert@help.senate.gov