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HURRICANE KATRINA VETERANS MUST TRAVEL ALL OVER

THE SOUTH FOR HEALTHCARE -- VA may not rebuild in

downtown New Orleans, but may head to the suburbs.

 

 

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Hurricane Katrina disabled the VA hospital in New Orleans

Now, veterans like Paul Hermann must travel all over the South for care

By Kate Moran
Staff writer

If the bone fusion in Paul Hermann's spine had disintegrated the summer before Hurricane Katrina, he would have made the short drive from his home in Slidell to the veterans hospital in downtown New Orleans to have it resealed.

But Hermann needed surgery the summer after the storm, and the hospital had been closed for nearly a year. His case file was shipped to the veterans hospital in Jackson, Miss., where doctors tarried over it for two months before arranging for him to have the surgery -- in Houston.

Hermann's ordeal is all too common these days. While the Department of Veterans Affairs makes plans to build a new hospital to replace the one lost to Katrina, retired military men and women -- many of them aging and frail, some of them with limited incomes -- have had to travel all over the South for medical care that was once available at their doorstep. Worst of all, the delays frequently worsen the conditions that need treatment. Cancers can spread or heart attacks recur.

While veterans can go to private hospitals if they have a heart attack or other emergency, they have to use veterans hospitals in Houston; Little Rock, Ark.; Alexandria; Biloxi, Miss.; or Memphis if they need elective surgery or laboratory work. Some are grousing that their treatment is put off and their families are put out by all the peregrinations.

Hermann said he can't complain too much. When he was forced to have his surgery at the veterans hospital in Houston, the VA paid for his flights and gave him a free hotel room. He is certain, however, that the surgery would have taken place faster if the veterans hospital had still been open in New Orleans.

And every day that passed without the operation was a day he was confined to a wheelchair.

"Because it took longer to have the surgery on my back, other parts of my body were affected," said Hermann, an Air Force veteran. "My legs began to atrophy. I have not been able to drive since September. Then you are on medication for pain. Luckily, I am the type of person for whom medication doesn't work after about a month, so I didn't get addicted to anything."

While Hermann takes the inconvenience in stride, some veterans groups are starting to raise a hue and cry over the lack of hospital services in New Orleans. They are particularly concerned that efforts to build a partnership with Louisiana State University is interfering with progress toward a new facility.

Economic engines

After they both lost downtown hospitals to Katrina, the VA and LSU decided to rebuild on the same plot of land so their new hospitals could share parking, laundry and laboratory services. New Orleans recovery czar Ed Blakely last week declared the hospital a linchpin in one of the city's most important economic sectors: medical research. But the state has ponied up only a fraction of the money needed to build the conjoined hospitals, and some veterans are growing impatient that their facility stands at the mercy of Louisiana politics.

When he visited New Orleans earlier this month, Jim Nicholson, secretary of the Department of Veterans Affairs, said his agency was committed to building a new hospital somewhere in the region but that the VA was starting to look outside downtown New Orleans, where LSU plans to build the sister facility as a partial replacement for Charity Hospital.

"A lot of the major medical needs that were once handled at the New Orleans facility are now being routed to Alexandria or Texas, and this is truly unacceptable when people get to that age where travel around the corner is difficult," said Forrest Travirca III, commander of the American Legion in Louisiana.

"My concern is also for the guys serving in Iraq and Afghanistan who are coming back with health issues," he continued. "We shouldn't have to be sending them all over the daggone country. They have served their time and deserve their benefits. Let's get the job done for all our veterans."

After the storm, the veterans administration hired an engineer to determine whether its downtown hospital on Perdido Street not far from the Superdome could be salvaged. Water had poured into the basement and sub-basement, where the electrical switches and fire alarms were housed. As the wiring in the basement marinated, mold infiltrated the upper floors, said Benjamin Campeau, the associate medical director.

Campeau said the engineer determined that refurbishing the hospital would cost more than building a new one, especially because the hospital, erected in 1952, had a limited life span.

Peripheral damage

"Water did not get to the first floor, but Katrina happened in August, and there was extensive peripheral damage to the building because of the high humidity," Campeau said. "The impact of the flooding went up through the building."

Next to the main hospital was a 10-story building that had housed both a parking garage and a nursing home for veterans. The building did not flood, and in December 2005, the veterans administration converted the nursing home into a clinic where veterans can go for routine medical care, rehabilitation and counseling.

"Within 100 days of the storm, we were open and ready for business," Campeau said.

The only remnant of veterans care within the city limits, the clinic now serves about 5,500 patients a week. . Other clinics are open in Slidell, LaPlace, Hammond, Lafayette, Jennings and Baton Rouge, and hospitals are running in Alexandria and Shreveport to care for the estimated 367,000 veterans living in the state.

Dr. Robert Lynch, a regional director for veterans health care, said his agency is exploring how to deliver specialty care without sending veterans all over the South. He said the VA is negotiating with at least one private hospital in the New Orleans area where VA doctors could treat patients until the new hospital is built.

"We are trying for a more definitive relationship with a single hospital," said Lynch, who declined to reveal which one the VA is courting.

While Lynch conceded that the current practice of referring patients to VA hospitals in other cities and states is "very inefficient," he said veterans have been grateful for the provisions the agency has made for their care.

"We are taking care of some patients up in Jackson, and they seem to be very appreciative of what we're doing for them," Lynch said. "Houston is doing all of our open-heart surgery and specialized orthopedic and neurosurgery. We have an outstanding center in Houston. I cannot speak for all the veterans, but they seem to be very pleased with it."

Kirkwood Litolff, a Vietnam veteran who lives in Metairie, said he was pleased with the care he received in Houston. But he gripes about the time it took to schedule surgery for his heart.

Different before storm

Litolff said his doctors in New Orleans referred him to Jackson for a stress test after the storm. From there, he had to go to Houston to have a stent placed in his heart. His wife drove him to Texas, and the couple paid for a hotel because they did not know about the free rooms available to veterans traveling to Houston.

"It was not bad, but it was not fast either," Litolff said. "You go a certain amount of time, and they decide to do something for you. I am pretty sure it would have been different before the storm, because they could do bypass operations in New Orleans."

He also misses the camaraderie that surrounded the old hospital on Perdido Street, where veterans used to congregate in the courtyard and at the coffee shop after their appointments.

"A lot of the veterans I saw just hung around by the hospital. It was a meeting place for them," Litolff said. "They went in there to eat and go shopping. It is still fairly busy at the clinic, but it's not like it used to be."

Claxton Young, 79, was sitting in the courtyard outside the coffee shop last week. The area was deserted except for a few nurses who emerged from the clinic on top of the parking garage for a lunch break or a smoke. Young was sifting through a bag of medications the clinic doctors had given him to relieve the symptoms of his cancer.

He said he has been to every hospital in New Orleans during the past two months. He called ambulances several times after he was overtaken with dizziness, but he said the emergency room doctors would give him a once-over and send him home.

Nobody plumbed the underlying problem until two weeks ago, when doctors at University Hospital diagnosed the cancer. As he sat in the sun outside the veterans clinic, he could not remember what part of his body was afflicted.

Young has an appointment to go back to the veterans clinic in six weeks, but he is eager to find a hospital where he can begin treatment. He said he never would have had to make multiple trips to local emergency rooms if the VA hospital had been open in New Orleans. He believes he would have been admitted right away.

"At least I would have gotten into a hospital where they would have followed up," Young said.

Stent in his heart

James Vice, a Houma resident and former Navy quartermaster, also found himself in the emergency room of a local hospital when he had a heart attack in October 2005. Doctors at Terrebonne General Hospital gave him an angiogram and put a stent in his heart. One month later, his doctor at the local VA clinic sent him back to the hospital, thinking his heart was about to fail.

"I told them at Terrebonne General that I have no health insurance at all. I am solely dependent on the VA for health care," Vice said. "I told them that if they would not accept my VA card, then they should not do anything to me. Everybody was agreeable. Next thing I know, they had turned me over to a collection agency."

Vice said his hospital bills were forgiven only after he enlisted help form U.S. Rep. Charlie Melancon's office. Now he is struggling to have surgery done on his hand. He made an initial trip to Houston to meet the doctor and then another trip to undergo the procedure. He had to postpone the surgery because the doctor did not tell him to stop taking his blood thinner. Now he is looking at a third trip to Texas.

"It's messy, to say the least," Vice said.

Hermann, the Air Force veteran who had back surgery in Houston, also is on the staff of the advocacy group Disabled American Veterans. He said he has heard about many patients like Vice who are treated at private hospitals and then socked with bills they thought would be paid by the VA.

Message loud, clear

Campeau, the associate VA medical director in New Orleans, said the government will pay for veterans to use private hospitals in a true medical emergency, or if their condition is directly related to military service. If the condition is not service-connected, the VA reviews the patient's income and ability to pay for care.

"We prefer to send patients to other VA hospitals as a first choice to provide their care," he said. "When other VA hospitals are not available, then we feed into the community hospitals."

When Dr. David Elizardi was working in the cardiology department at West Jefferson Medical Center after Katrina, he treated several veterans who would have received care at the veterans hospital before the storm. He said the veterans administration usually asked that the patient be transferred to a VA facility unless the condition was an emergency.

"One common issue was that a patient would present himself in the emergency room with chest discomfort," Elizardi said. "It would turn out not to be a heart attack, but the next correct move by the standard of care is that the patient needed to get an angiogram done. The messages we got from the VA were loud and clear: They would not pay for a non-emergent angiogram."

Elizardi said a social worker at West Jefferson would work with the veterans administration to have the patient transferred. On some occasions, the VA would ask the patient to drive himself to the hospital in Houston, and Elizardi would have to push for an ambulance to take the patient there.

"It was a sad thing to see these people who clearly needed care being punted around like pawns," said Elizardi, who is now working as a consultative cardiologist at Ochsner Medical Center.

During a recent debate on health care at the University of Nevada, presidential hopeful and New Mexico Gov. Bill Richardson said he would reform the health system for veterans by giving them a "hero's health card" that they could take to the hospital of their choice.

While hospital care is a particularly tough find for veterans in the New Orleans area, Richardson said veterans all over the country sometimes have to travel great distances for treatment.

Some veterans, including Vice, said they would prefer to have an insurance voucher they could present at a hospital in their area rather than travel to a veterans hospital in another part of the south. Others expressed skepticism about dismantling the veterans hospital network, which is a source of major research, especially on prosthetic limbs.

"Vouchers would be great for a disaster like Katrina, for a short period. But when you come back to reality, you have to have a hospital," said Jay Walsh, the American Legion's statewide service officer, who helps veterans connect with services and benefits. "Without the VA hospitals, who is going to do research on post-traumatic stress disorder? Who is going to do research on prosthetics?"

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Kate Moran can be reached at kmoran@timespicayune.com  or (504) 826-3491.

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Larry Scott  --