Year-End Check-Up

Boiled water, blue gloves and dogs running amok

This was the year public health and common sense parted ways. It began with Louisiana awash in unused quotas of H1N1 influenza vaccine, a not-unexpected scenario given the onerous paper work and computer hoops forced upon busy physician offices by a state health department with no prior experience as the sole distributor of a vaccine.

A much-anticipated and necessary change in command at the city’s health department culminated with a weekend reign by a physician with a suspended medicine license. The city was already paying rent on her shuttered Uptown Square private office thanks to former mayor Nagin’s health chief Kevin Stevens, who had converted it into a storeroom for a Westbank Clinic he never reopened.

Universities, nuns, nurses and others accelerated the expansion of primary health clinics running on high-octane dollars pouring in from afar. During 2010 we polished off the last third of a $100 million federal grant to sustain nonprofit clinics in the greater New Orleans area. This topped off several prior seedpods of money from private foundations including His Highness the Amir of Qatar, who previously gave Tulane $5 million for outpatient care in underserved areas of New Orleans.

The expropriation of massive parts of Mid-City leveled the playing field for parking lots and hospitals for what may well be an overabundance of hospital beds given shifts in how the country funds health care. No Louisiana State University Health Sciences Center business plan to date spells out how they will entice lost Charity patients to return, given the plethora of new neighborhood clinics staffed with physicians who may or may not refer them back to Charity for specialty care. And can experts really anticipate the capacity needed by a new Veterans Hospital given President Obama’s new health care access plan, whatever that turns out to be? We still have the skeletal remains of the old U.S. Public Health Hospital Uptown as an architectural remembrance of what happens when patients get up and leave.

By year’s end we were in a public health Armageddon – boil water alerts on the East Bank of the Mississippi, an unfunded SPCA no longer picking up stray dogs and blue-gloved gropings of blue-haired grandmothers at Louis Armstrong International Airport.

The nonprofit Louisiana SPCA has been our official dogcatcher for decades, and each year there’s a battle of the budget. The $2.15 million the city paid last year was enough to keep the trucks on the streets over the peak summer months, but the local nonprofit group put on the brakes last October. Landrieu’s first budget has only $1.5 million for all of 2011, a per-capita amount that puts New Orleans a full dollar behind Tangipahoa Parish. All this dog and cat poop hasn’t yet hit the fan. The city implies that the police can take over dog-catching for less.

The “boil water alert” from the 10-minute pump failure for a populace more accustomed to boiling water for shrimp and crabs lasted only a couple of days. If you blinked your eyes it was down the drain. The boil water “order” was downgraded to a precautionary “advisory.” The initial city notice even called for boiling water for pets, but city leaders never had time to truck in Kentwood Spring Water for the mule troughs at Jackson Square.

The rules mandating Mayor Landrieu to take to the steps of City Hall announcing a boil water advisory – while reassuring all that it was for precaution only – were actually written by feckless federal and state bureaucrats hiding under the mantle of the Environmental Protection Agency. Landrieu hinted, but didn’t say, that the alert was more for legal reasons than for good health policy. (See box for what happened in another Louisiana community.)

Since New Orleans nearly ended the year without a medically trained Director of Health, a physician from the state health department was on-hand to answer questions from the press. WWL-TV alerted me to the November press conference, and I was there with my question: “Can you cite a single instance when a short-term loss in water pressure such as (the one) we experienced caused even a single case of human illness in the last 100 years?”

“I’ll have to get back to you on that one,” answered the state physician, and I’m still waiting for her call. Actually, my question was an old attorney trick – never ask a question unless you already know the answer. The theory behind the federal regulation is that seepage of unpurified ground water can back flow into water systems that have lost pressure. This would be a definite cause of concern for cites without a sewerage system or for cites surrounded by cow ponds draining into underground aquifers. It doesn’t fit what happened here. The state physician also recommended using boiled water for showers. I wanted to ask how you get boiled water back into a shower, but I had already asked my question.

Local boiled water concerns were soon replaced with national press warnings about “contaminated” blue gloves as airport security pat-downs became more personal. After all, surgeons do change gloves between each surgery while airport screeners keep right on patting until they rip. I am not sure which germs the screeners fear, as there isn’t any medical literature on acquiring infections from pat downs that I can find. Plastic gloves weren’t handed out to Adam and Eve when they exited the Garden of Eden.

And to top off the year, the painkiller Darvocet was removed from the market for a litany of adverse effects never encountered by any local physician known to me. It was a non-narcotic painkiller lacking the constipating effects so common to its codeine and morphine relatives. I could have used one myself after reviewing 2010.

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