A Katrina Hospital Catastrophe Update: The Health-Care Money Mill At Work

Memorial staffers prepare the last patient to be evacuated.

Angles proliferate in the extraordinary story of the Memorial Medical Center in Uptown New Orleans becoming marooned by Hurricane Katrina in August 2005 and how the deaths of at least 17 of the 45 patients who perished were hastened by a doctor and two intensive-care nurses who injected them with lethal doses of drugs to put them out of their misery.

Sheri Fink covered a goodly number of these angles in an August 30 New York Times Magazine cover story that focused on the life-and-death choices that Memorial's staff had to make. If ever a piece was a shoo-in for a Pulitzer Prize, this one is.

As I noted in my own extensive post, Fink's takeout is not just timely because of the health-care reform mess, but timeless insofar that it also is a model for how quality investigative journalism can survive at a time when it is disappearing.

Yet I noted that a key piece of this tragedy is merely alluded to: What happens to locally owned hospitals like Memorial attuned to the needs of their communities when they are taken over by big national chains, in this case Tenet Healthcare, for whom profits always are more important than patients.

From the lowliest housekeeper to Tenet executives ensconced in air-conditioned comfort at the company's headquarters in Dallas, myriad actions had to be taken and decisions made in the wake of the devastation, but although Tenet did dispatch some helicopters, it was otherwise shockingly imperious the needs of its staff and it appears that it made no effort to airlift or float in necessities and additional staff.

(Something else occurred to me since I posted my piece: How is it that Brad Haber, a photographer for the Dallas Morning News, was able to be all over Memorial and provide a grim photographic record, while Tenet didn't seem to be able to make it to the scene of an unfolding tragedy at one of its major hospitals?)

Now comes Josh Levin in Slate magazine who mines another key piece of the tragedy that should be a wake-up call for people not convinced of the enormous power of the health-care industry to block any reform that will impact on its profit making.

While Fink did note that there was a "hospital within a hospital," an 82-bed long-term-care facility called LifeCare that leased space from Memorial, and that all 17 of the patients given lethal drug cocktails were housed there, Levin explains that LifeCare was created less to fill a medical need than to be a money mill, in this instance to take advantage of the way Medicare payouts work. The fact that it was on a separate floor with a separate staff with separate administrative control was an attempt by the federal government to ensure that Tenet wasn't scamming Medicare.

LifeCare, as Levin notes, was a long-term-care hospital (LTCH), which is not to be confused with a "long-term-care facility," which is common parlance for a nursing home. An LTCH specializes in patients with major health problems such as people who need ventilators to breathe, have neuromuscular problems and organ failure.

Would it surprise you to know that Medicare patients make up 83 percent of the entire LTCH caseload? It shouldn't.

Top photograph by Brad Loper/Dallas Morning News/Corbis