Doctors sue state of Louisiana

Hundreds of doctors at a hospital near New Orleans sued the state Monday, seeking $100 million for care they say they have provided free to poor and uninsured patients since Hurricane Katrina.

The closure of state-funded Charity Hospital in New Orleans after Katrina sent the indigent to doctors in private practice and to the few open hospital emergency rooms in the area.

The lawsuit, filed by 381 doctors at West Jefferson Medical Center in Marrero, a suburb of New Orleans, said the physicians had not received a dime for their work.

Many doctors said they had had to cover the cost of uninsured patients treated in the emergency room. The patients also required follow-up care.

The doctors said the situation threatened to erode the quality of care as they struggled to manage their practices and shouldered the burden of hundreds of former Charity Hospital patients.

“Without this funding our healthcare system is at risk, putting our whole community at risk,” said Dr. K. Barton Farris, medical director of West Jefferson Medical Center’s laboratory.

Farris said the $100 million represented two years of care provided by doctors.

The hospital is not part of the lawsuit. It was unclear whether doctors from other hospitals might join the legal action.

Bob Johannessen, spokesman for the state Department of Health and Hospitals, said the agency had not seen the lawsuit.

But he said there was “no mechanism” to pay doctors for their uncompensated costs. He said a federal program paid the state to compensate hospitals, not individual doctors.

Johannessen said that after Katrina hit in August 2005, his agency requested more federal money to pay doctors. In March 2006, he said, the government provided money to pay doctors and hospitals for uncompensated services from Aug. 24, 2005, to Jan. 31, 2006, with $8 million going to doctors.

“We have not refused to pay physicians,” Johannessen said.

He said the state had asked several times for more federal money to compensate doctors but none had arrived.

Dr. Jonathan C. Boraski, president of West Jefferson’s medical staff and a reconstructive surgeon, said that “since the storm, the staff has asked for help ... to no avail.”

He said the extra patient load had become overwhelming.

West Jefferson records say 30% of patients admitted to the emergency room after Katrina were poor or uninsured. Outside the emergency room, the indigent account for 13% of the hospital’s admissions, up from 5.4% before the storm.

Farris said there were cases of uninsured diabetics coming to the emergency room to have a leg amputated because they had developed gangrene, and patients with high blood pressure needing emergency room care after suffering a stroke or heart attack.

“And that’s not the end of it,” Boraski said.

He said uninsured patients that he saw in the emergency room often needed six to 10 weeks of follow-up care. He said he had been covering the costs.

Dr. Nagarajan Chandrasekaran, an oncologist, said that before Katrina he would see one or two indigent patients a month. Now he sees at least one a day.

“It raises a serious ethical and moral dilemma,” Chandrasekaran said. “If these patients are not adequately treated, they are going to fall through the cracks.”

Doctors are feeling the strain, and many say they may not stick around.

“Physicians are stressed because of the increased workload and the difficulties of maintaining a practice with diminishing funds,” Farris said.

He said West Jefferson’s recruitment of new doctors had dropped by more than half from November to last month.

Dr. David C. Treen, a surgeon, said, “The young physicians in this community, who will be the backbone of the medical community ... are all considering leaving.”

ann.simmons@latimes.com