5 October 2005

TO: All Commissioned Corps Officers

FROM: United States Surgeon General

Subject: Update on Hurricanes Katrina and Rita Response

We remain inspired by the reports of sacrifice and courage coming out of the Gulf States Region since it was pummeled by Hurricanes Katrina and Rita. The Commissioned Corps’ current wave of activities continues amidst the hope and endurance of the people of this region. Our officers are working in tandem with various levels of government and a myriad of volunteer groups in Texas, Louisiana and Mississippi – and their dedication and commitment continues to make us proud.

I am devoting this message to a single group of officers who are courageously working against odds to help restore the public health infrastructure of a city. The mission of “Team Orleans”, as we refer to them, is to work directly with local health and state health authorities to keep the hospitals open that did not close post-hurricanes, open the hospitals that had to close as a result of the storms, and look at all aspects of the ambulatory health system required to provide for the medical and public health needs of the city. In doing so, they have directly benefited from the generosity of New Orleans’ citizens.

“The southern hospitality of this urban area is undiminished even in light of the devastation they’ve experienced here,” says CAPT Vincent Berkley, M.D., PHS Commander of Team Orleans. He reports the hospitals that managed to stay open have served as hostels for staff and patients, extending this offer to PHS officers, providing food and shelter to all. “We would not be able to complete and continue our work here without the kindness of these folks. Their spirit to recover is high and they have welcomed us with open arms.”

Working in concert with the city, the state and the parishes, Team Orleans is assisting in the rejuvenation of the greater New Orleans health system and carrying out HHS Secretary Michael Leavitt’s plan for restoration of care to the city. PHS has been facilitating a different spirit of cooperation in the healthcare system that serves greater New Orleans according to CAPT Berkley. “We are coordinating with local hospital leadership to have an open and sharing relationship so we can optimize the best care for the people, in the best manner possible,” he says. Healthcare delivery never stopped in New Orleans, he says, there have always been and continue to be hospital beds available with PHS officers helping to coordinate the existing services.

Repopulation efforts have begun in New Orleans and surrounding areas. People are returning based upon their home zip code designation. The measured return is due to the city’s widespread geographical layout but more importantly, to ensure that proper resources and services are available when needed. This includes ambulatory care for the community. While a number of ambulatory care centers are open, those that are damaged are being assessed by FEMA and the State of Louisiana to see what should be done. Team Orleans is facilitating discussions with the appropriate stakeholders to demonstrate a model system for the devastated areas.

“We want to ensure they have a system of care that will reflect public health, preventive health and quality of health so all may return to their lives (pre-Katrina and Rita),” says CAPT Berkley. PHS began all of its work in New Orleans with preventive health in mind—one of the first successes was coordination of DMATS from across the country to set up an immunization program where more than 70,000 immunizations were given.

Corps members have been involved in the environmental efforts as well. In terms of waste management and water quality, items absolutely essential to running a health system, PHS officers have been working alongside their civil service colleagues from CDC and EPA to ensure proper waste management and good drinking water is available.

Of the 20 hospitals in greater New Orleans, at least 10 should be able to open over time during the next two months. Team Orleans faces a day-by-day and facility-by-facility situation. The following are excerpts from their daily reports:

The first priority for medical facilities in the city was to preserve the three functioning hospitals (Ochsner Clinic, West Jefferson and East Jefferson) and this has been accomplished. The main limitation in increasing bed capacity has been the inability to move hospital workers out of hospital beds and into other housing. Issues related to revenue loss and decreased functional capacity must be addressed.

The second priority is to assess and staff Kenner and Meadowcrest Hospitals. Both are thought to be operational but lack staffing. Kenner Regional Medical Center’s ER and OR are fully functional. The State of Louisiana’s Department of Health and Hospitals is now involved in the specific regulatory aspects of re-opening the facility in its entirety. Meadowcrest is off limits to hospital personnel and unavailable for patient care. The objective is to make both facilities operational over the next three-to-five weeks.

The third priority is to stand up Charity, Baptist and Methodist Hospitals. The loss of the Medical Center of Louisiana (Charity and University Hospitals) will mean a loss of two hospitals’ bed capacity and a loss of care to the disadvantaged. Visual inspection of Baptist indicates that it is in poor physical condition and will require significant repair. DoD will assist with the infrastructure repair. Water has been pumped out and physical assessment is in progress. At Methodist, cleanup is in progress and the plan is to have the facility operational in three-to-six months.

A team of PHS officers is in place to inventory requirements to preserve and determine the best way to bring an additional ten hospitals back into functioning capacity.

The Commissioned Corps will be steadfast in bringing relief, public health and medical care to those who have lost much of their world in these catastrophic events. The structures may be ruined or gone, but our public health force remains to assist these individuals as they begin to rebuild their lives.

As our mission continues, I salute and thank each and every one of you - you are truly an inspiration to all of us. You are demonstrating daily what it means to protect, promote, and advance the health and safety of this Nation.

Richard H. Carmona, M.D., M.P.H., F.A.C.S.

VADM, USPHS