Sufficient Staffed Beds Existed for All Types of Inpatient Care Except Psychiatric Care; High Demand Existed for Emergency Department Services

In the greater New Orleans area, a sufficient number of staffed hospital  inpatient beds existed for all types of care except psychiatric care; there  was also a high demand for emergency department services. While hospitals  were able to maintain a sufficient number of staffed beds, hospital officials  also reported that recruiting, hiring, and retaining nurses and support staff,  such as nursing aids, housekeepers, and food service workers, to staff the  available beds constituted a great challenge. The number of staffed hospital inpatient  beds on hand to serve the people of the greater New Orleans area was  3,958, or about 4.0 staffed beds per 1,000 population, as compared with the  national average of 2.8 staffed beds per 1,000 population reported in 2006. PricewaterhouseCoopers estimated the February 2006  population of the four parishes (Orleans, Jefferson, Plaquemines, and St.  Bernard) to be 578,000, and the Louisiana Department of Health and  Hospitals reported estimates of about 569,000 for January 2006 and  588,000 for April 2006. Furthermore, the population  of the greater New Orleans area would have to increase by 325,000 or  about 55 percent, to 913,000, by December 2006 before staffed beds per  1,000 population dropped to the national average of 2.8. Hospital officials also told  us that inpatient psychiatric care beds were frequently not available in the  greater New Orleans area and that psychiatric patients were the only type  of patients that had to be transferred out of the greater New Orleans area  because of a lack of beds. For example, the Institute of Medicine reported in  June 2006 that emergency department crowding was a nationwide  problem, with numbers of visits having grown by 26 percent from 1993 to  2003. Steps Have Been Taken to Reopen University Hospital, but LSU Has No Plans to Reopen Charity Hospital

FEMA and LSU have prepared damage assessments and cost estimates for  University and Charity hospitals. While repairs are under way to reopen portions of University  Hospital beginning this fall, as of July 2006, LSU had no plans to reopen  Charity Hospital. In  contrast, FEMA’s estimates for Charity and University hospitals cover the  repair costs for damage from flooding and wind only, since these are the  only repair costs eligible for federal reimbursement under the Public  Assistance program. Repairs to University Hospital Are Under Way, and LSU Is Pursuing the Possibility of a New Facility to Replace Both Charity and University Hospitals in the Future

At the time of our visit in May 2006, repairs to University Hospital were  under way, and portions of the facility were expected to reopen by late  September or early October 2006, with the remainder of the facility  expected to open by the end of the year. HHS plans to provide technical assistance to the Louisiana Healthcare  Redesign Collaborative (Collaborative), a state and locally led effort to  redesign the health care delivery system in Louisiana, including the  existing hospital system. For  example, certain Medicare billing and other requirements were waived or  modified to accelerate Medicare payments in the hurricane-affected states,  including Louisiana. DHS also  responded by email and informed us that it had no formal comments on  the draft report. DHS, HHS, and VA also provided technical comments, as  did Louisiana’s Department of Health and Hospitals through an e-mail  response. LSU did not provide comments. To examine the Federal Emergency Management Agency (FEMA) and  Louisiana State University (LSU) efforts to reopen Charity and University  hospitals, we reviewed LSU and FEMA damage assessments and cost  estimates for the facilities, FEMA regulations and guidance, and the  Department of Veterans Affairs’ (VA) damage assessment of its medical  center in New Orleans. We interviewed officials from  FEMA; LSU (including LSU’s Health Care Services Division that manages  the public hospitals in the greater New Orleans area); VA because it is  considering building a joint hospital complex with LSU in New Orleans;  the Louisiana Recovery Authority because it is the planning and  coordinating body that was created in the aftermath of Hurricane Katrina  by the Governor of Louisiana to plan for recovery and rebuilding efforts;  and Louisiana’s Office of Facility Planning and Control because it is  administering the design and construction of all Louisiana state-owned  facilities damaged by Hurricane Katrina. To determine the activities that the Department of Health and Human  Services (HHS) has undertaken to help hospitals recover in the greater  New Orleans area, we interviewed officials in various HHS agencies,  including officials in the Centers for Medicare & Medicaid Services  headquarters and Dallas and Atlanta regional offices, the Health Resources  and Services Administration, the Administration for Children and Families,  and the Office of Public Health Emergency Preparedness. Additionally, we  reviewed documents and summaries outlining HHS programs and  activities related to helping restore hospital inpatient care and emergency  department services after a disaster.
Why GAO Did This Study

In the aftermath of Hurricane Katrina, questions remain concerning the availability of hospital inpatient care and emergency department services in the greater New Orleans area--which consists of Jefferson, Orleans, Plaquemines, and St. Bernard parishes. Because of broad-based congressional interest, GAO, under the Comptroller General's statutory authority to conduct evaluations, assessed efforts to restore the area's hospitals by the Department of Homeland Security's (DHS) Federal Emergency Management Agency (FEMA); the Department of Health and Human Services (HHS); and the Louisiana State University (LSU) public hospital system, which operated Charity and University hospitals in New Orleans. GAO examined (1) the availability of hospital inpatient care and the demand for emergency department services, (2) steps taken to reopen Charity and University hospitals, and (3) the activities that HHS has undertaken to help hospitals recover. To fulfill these objectives, GAO reviewed documents and interviewed federal officials and hospital, state, and local officials in the greater New Orleans area. GAO also obtained information on the number of inpatient beds for April 2006, which was the most recent data available when GAO did its work. GAO's work did not include other issues related to hospitals such as outpatient services or financial condition.

What GAO Found

While New Orleans continues to face a range of health care challenges, hospital officials in the greater New Orleans area reported in April 2006 that a sufficient number of staffed inpatient beds existed for all services except for psychiatric care--some psychiatric patients had to be transferred out of the area because of a lack of beds. Overall, GAO determined that the area had about 3.2 staffed beds per 1,000 population, compared with a national average of 2.8 staffed beds per 1,000 population. Hospital officials told GAO they planned to open an additional 674 staffed beds by the end of 2006, although they reported that recruiting, hiring, and retaining nurses and support staff was a great challenge. With these additional beds, the population would have to increase from 588,000 in April 2006 to 913,000 by December 2006 before staffed beds would drop to the national average. Hospitals also reported a high demand for emergency services, consistent with a June 2006 Institute of Medicine report, which found that emergency department crowding is a nationwide problem. Steps have been taken to reopen University Hospital, but as of July 2006, LSU had no plans to reopen Charity Hospital. LSU plans to open portions of University Hospital in fall 2006 and would like to replace both hospitals with a new one. LSU and FEMA have prepared cost estimates to repair these hospitals. For Charity Hospital, FEMA's estimate of $27 million is much lower than LSU's estimate of $258 million, which covers, for example, repairing hurricane damage and correcting many prestorm deficiencies. In contrast, FEMA's estimate covers repairs for hurricane damage only--the only repair costs eligible for federal reimbursement. HHS provided financial assistance and waived certain program requirements to help hospitals recover in the area. For example, HHS included $221 million in hurricane relief funds designated for Louisiana through Social Services Block Grants, which may be used in part to reconstruct health care facilities. HHS also waived certain Medicare billing and other requirements and accelerated Medicare payments to providers, including hospitals, in the hurricane-affected states. Rebuilding the health care infrastructure of the greater New Orleans area will depend on many factors, including the health care needs of the population that returns to the city and the state's vision for its future health care system. In light of the current sufficiency of hospital beds for most inpatient services, GAO believes a major challenge facing the greater New Orleans area is attracting and retaining enough nurses and support staff. HHS and the Department of Veterans Affairs (VA) agreed with the draft report. DHS said it had no formal comments on the draft. HHS, VA, DHS, and Louisiana's Department of Health and Hospitals provided technical comments, which GAO incorporated where appropriate. LSU did not provide comments.