Last year's hurricane and flood devastation in Louisiana and Mississippi trained a harsh spotlight on healthcare deficiencies in underserved areas. But it also underscored the predicament of physicians who crossed state lines to render emergency care and to augment the region's tattered healthcare system by treating patients with chronic illnesses, as well as an alarming number of people with depression and anxiety brought on by the storm.
Doctors who work in federally funded healthcare facilities get medical-malpractice insurance through the Federal Tort Claims Act, but the law as written does not extend liability protection to doctors who travel to disaster sites out-of-state, a loophole made painfully clear in Katrina's aftermath.
"The federal government and the states need to provide (emergency) malpractice coverage for physicians like myself to go into affected areas," Maria Crawley, a pediatrician who serves as the mobile medical unit medical director at the federally funded La Clinica de Familia in Las Cruces, N.M, said Monday at a press briefing in Washington, D.C.
The briefing was sponsored by the National Association of Community Health Centers (NACHC), which released a progress report on the rebuilding of the Gulf region's healthcare system one year post-Katrina.
"The Federal Tort Claims Act only covers doctors at their homebase," Crawley told United Press International. "We need to expand this law so (out-of-state) doctors are covered in times of emergency or disaster."
Crawley said her two-week, medical-relief stint last spring in Mississippi's Biloxi-Gulfport region would not have been possible without her New Mexico clinic's "gap' coverage, which she noted was expensive.
Another option might be to waive medical liability altogether for doctors who treat disaster victims, she said. A similar policy was included in a medical tort reform bill that died in the senate earlier this year, which would have insulated doctors from liability for treating indigent patients.
However, Crawley was skeptical whether a similar safeguard for disaster-relief doctors would ever see the light of day. "The world is run by lawyers -- it'll never happen," she told UPI.
Dan Hawkins, NACHC's vice president for federal, state and public affairs, who also spoke at the briefing, said that legislation that would solve the interstate medical liability problem has been pending in Congress since last October. "Let's pass it, so we never get caught flat-footed again."
At any rate, from what Crawley said she observed in the Gulf region last spring, the need for medical aid across state lines hadn't abated seven months after Katrina ravaged the area.
Although she had gone to the region to treat pediatric patients, Crawley said she saw mostly adults with chronic medical conditions like diabetes and high blood pressure who were still without a primary care doctor to treat their conditions day-to-day and whose medical records were lost in the disaster.
Similar to that seen in returning Iraqi war veterans, Crawley also reported seeing high levels of depression and anxiety in the patients she treated. "The stress and anxiety levels were overwhelming," she said. "Everyone needed something for sleep."
Crawley said she also observed a phenomenon doctors have come to refer to as "Katrina Crud," or a constellation of symptoms like chronic cough, and asthma-like respiratory problems, likely caused by the mold enveloping the region and the airborne spores stirred up in the rebuilding efforts.
But as New Orleans and other affected areas struggle to regroup, health experts say the flip side of Katrina's fallout is an opportunity to remold Louisiana's healthcare system into one emphasizing primary care, where community health centers would serve as the backbone.
The new system would replace the present and -- some critics say 'broken' -- institutional one, based on the state's unique, two-tiered system of private and charity hospitals. Before the hurricane hit, Louisiana was the only state in the country with separate hospital systems for insured and uninsured residents, with the latter channeled into the charity hospital system.
"The refashioned (healthcare) system should have community health centers as its core," NACHC's Hawkins said at the briefing. Such a system "is the right solution for people in need, especially those in disaster zones."
Under the new structure, inpatient care would remain, but it would be primary care -- such as the services of internists and pediatricians -- at community health sites that would be the system's foundation, he said.
Michael Andry, CEO of New Orleans-based EXCELth Inc., an organization that advocates and supports the development of healthcare services for the indigent and underserved, agreed, noting that "Any place with charity hospitals has increased the disparity in healthcare."
Instead, a primary care-focused system would "keep healthy people out of the hospital," a strategy Andry said could save as much as $450 million "by not inundating (the area's) emergency rooms."
But for now, Hawkins noted, one year since Katrina struck, "only a tiny portion" of the funds appropriated by Congress, and community block grants for healthcare relief "have found their way to affected community health centers."
Hawkins told UPI that federal funds earmarked for the region's community health centers pay for the sites' day-to-day operations, but that the centers get no upfront funding for "brick and mortar" rebuilding -- those expenses can only be reimbursed. And for now, the reimbursement process is stuck in a morass of red tape, he said.
The federal aid should instead go directly to the rebuilding effort, Hawkins told UPI. "(The Federal Emergency Management Agency) has the money, but they have no system for dispensing it," he said.