This is the accessible text file for GAO report number GAO-06-576R 
entitled 'Hurricane Katrina: Status of the Health Care System in New 
Orleans and Difficult Decisions Related to Efforts to Rebuild It 
Approximately 6 Months After Hurricane Katrina' which was released on 
March 28, 2006. 

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March 28, 2006: 

Congressional Committees: 

Subject: Hurricane Katrina: Status of the Health Care System in New 
Orleans and Difficult Decisions Related to Efforts to Rebuild It 
Approximately 6 Months After Hurricane Katrina: 

Among the challenges facing New Orleans in the aftermath of Hurricane 
Katrina is the significant destruction and disruption of health care 
services. Hurricane Katrina, which made landfall near the Louisiana-
Mississippi border on the morning of August 29, 2005, and the 
subsequent flooding caused by the failure of the New Orleans levee 
system resulted in one of the largest natural disasters to hit the U.S. 
Among other things, the hurricane resulted in the sudden closure of 
hospitals and loss of other health care providers, including one of the 
largest hospitals in the area, Medical Center of Louisiana at New 
Orleans (MCLNO), which suffered extensive damage and remains closed. 
MCLNO, consisting of Charity and University Hospitals, is part of the 
statewide Louisiana State University (LSU) system and served as the 
primary safety net hospital for many local residents. About half of its 
patients were uninsured, and about one-third were covered by Medicaid. 
Furthermore, MCLNO also served as a major teaching hospital and the 
only Level I trauma center in the area. The availability of health care 
services is one of the factors that can affect whether and how quickly 
residents return to the area. 

We have undertaken work to provide a snapshot of the status of the 
health system in New Orleans and efforts to rebuild it approximately 6 
months after Hurricane Katrina devastated the area. We are performing 
this work under the Comptroller General's authority to conduct 
evaluations on his own initiative.[Footnote 1] To conduct our review, 
we obtained information on (1) estimates of the availability of health 
care services; (2) efforts by state and local officials to plan for the 
rebuilding of the health care system; and (3) assessments of the damage 
to the MCLNO facilities, cost estimates for repair or replacement, and 
the costs that are eligible for federal funding. The Ranking Minority 
Members of the House Committee on Energy and Commerce and its 
subcommittees on Health and on Oversight and Investigations requested a 
briefing on the preliminary observations of our review. We briefed the 
committee and other committees of jurisdiction on February 15and 16, 
2006. In addition, Comptroller General David Walker's testimony before 
the Senate Homeland Security and Governmental Affairs Committee on 
March 8, 2006, discussed the significant damage to the health care 
infrastructure in New Orleans. This report documents the information 
presented in those briefings and testimony. 

To obtain information on health care services, we conducted interviews 
in the New Orleans metropolitan area with administrative and medical 
staff officials at 4 hospitals and the city health department, and 
visited an ambulatory care center at the New Orleans Convention Center 
and a neighborhood that experienced severe flooding from the hurricane. 
We also reviewed data submitted daily by hospitals to an Internet 
database about their bed capacity. In addition, we conducted interviews 
in Baton Rouge with officials of the Louisiana State University (LSU) 
Health Care Services Division and the Louisiana Department of Health 
and Hospitals (DHH). The Comptroller General also met with LSU 
officials. Finally, we reviewed documents and planning reports that 
described the New Orleans area before and after Hurricane Katrina. Our 
information is limited to what officials reported to us, and we did not 
independently verify hospital-reported data on bed availability. 
Furthermore, the status of health care services has changed since our 
visit and continues to change as local conditions evolve. To obtain 
information on assessments of the damage to the MCLNO facilities and 
estimates for repair or replacement, as well as what costs are eligible 
for federal funding, we toured Charity Hospital and reviewed LSU's 
consultant report that included facility assessments and cost 
estimates. We also reviewed the Stafford Act, Federal Emergency 
Management Agency (FEMA) regulations and guidance, and obtained FEMA's 
assessments and estimates for repair. In addition, we interviewed 
officials with FEMA, LSU, and LSU's consultant, ADAMS. We also reviewed 
the LSU and FEMA assessments and estimates to identify their purpose, 
scope, and assumptions, and compared estimates using RS Means 
2005[Footnote 2] estimating guide and industry practices. We did not 
validate FEMA's or LSU's estimates. Our site visits were done in 
December 2005 and January 2006. We conducted our work from December 
2005 through March 2006 in accordance with generally accepted 
government accounting standards. 

Results in Brief: 

Since Hurricane Katrina hit New Orleans, the health care infrastructure 
was severely damaged and the availability of health services declined 
significantly. The area's only Level I trauma unit was closed, and the 
number of staffed hospital beds in the City of New Orleans was 
estimated to be about 80 percent less in February 2006 than before 
Hurricane Katrina, according to figures reported by hospitals. At the 
time of our visit, many safety net clinics in the city were closed, and 
those that were open were reported to have limited capacity. Relatively 
little was known about the status of physicians and other health care 
workers. 

Efforts to rebuild the health care system were being affected by 
several factors, including uncertainty about how quickly the population 
would return and how a future health care system should be configured, 
particularly since some experts noted that New Orleans had an 
oversupply of hospital beds before Hurricane Katrina. Residents are 
expected to return to the area slowly, and their return will be 
affected by the availability of housing and other services. Uncertainty 
about how quickly the population would return to New Orleans, as well 
as who would return, was making it difficult for local officials to 
plan the restoration of health services. Although various planning 
efforts were completed or underway, at the time of our visit no clear 
consensus had emerged. 

The MCLNO facilities, which were either in poor physical condition or 
needed significant repairs prior to Hurricane Katrina, sustained 
significant damage from the hurricane. Prior to the disaster, both 
hospital facilities had documented deficiencies and were having 
difficulty meeting health care standards. Because they were affected by 
the disaster, the facilities are eligible for federal aid under the 
Public Assistance program managed by FEMA. FEMA's estimate for 
repairing the damage was considerably lower than an LSU estimate 
prepared by ADAMS, a consultant to LSU. Because the lower FEMA estimate 
determines federal funding, LSU is likely to receive less federal funds 
than it expected. The LSU repair estimate of $117.4 million for 
University Hospital and $257.7 million for Charity Hospital, which 
included correcting some pre-disaster condition deficiencies, exceeded 
50 percent of the buildings' replacement value and indicated that 
replacement of the facilities was the best option. However, FEMA's 
estimate of $12.4 million for University Hospital and $23.9 million for 
Charity Hospital, which included only those repairs required to return 
the facilities to pre-disaster condition, totaled significantly less 
than 50 percent of each building's replacement value. Although FEMA has 
decided that these facilities are only eligible for reimbursement of 
repair costs, should LSU repair the facilities, the total reimbursement 
could increase as additional problems are discovered. Therefore, given 
the uncertainty about the ultimate amount of the federal contribution 
and the uncertainty of how a future health care system should be 
configured, LSU faces a complicated decision about whether to repair 
Charity and University hospitals or build a new facility. 

Background: 

Charity and University Hospitals, together known as the MCLNO, are part 
of the statewide system of ten public hospitals.[Footnote 3] Charity 
Hospital has been continuously operating since 1736 and built its 
current facility in 1937; the University Hospital facility was built in 
1972. MCLNO served as the primary safety net hospital for many local 
residents. About half of its patients were uninsured, and about one-
third were covered by Medicaid. In fiscal year 2004, it provided more 
than 25,000 inpatient admissions, over 300,000 clinic visits, and 
135,000 emergency visits. MCLNO served as a major state resource 
through its training programs for health professionals, including 
medicine, nursing, allied health, dentistry, and public health. In 
fiscal year 2004, MCLNO trained 618 medical residents and fellows and 
2,265 nursing and allied health students. 

The MCLNO facilities damaged by the disaster are eligible for federal 
aid under the Public Assistance program managed by FEMA. This program, 
authorized by the Stafford Act, provides grants to pay up to 90 percent 
of costs for restoring a facility to pre-disaster condition. According 
to federal regulation, a facility is considered repairable when 
disaster damages do not exceed 50 percent of the cost of replacing a 
facility to its pre-disaster condition, and it is feasible to repair 
the facility so that it can perform the function for which it was being 
used as well as it did immediately prior to the disaster.[Footnote 4] 
Although initial grant obligations are based on FEMA's estimate of the 
costs of repairs to restore the facility to its pre-disaster condition, 
reimbursements are based on actual, documented repair costs, which 
could be higher than the original estimate. Alternately, if FEMA's 
estimated repair costs exceed 50 percent of its estimated replacement 
costs, FEMA is authorized to grant up to 90 percent of its estimated 
costs to replace a facility. There is a possibility for additional 
federal reimbursements under the Public Assistance program for required 
code upgrades that are triggered by the repairs. Code upgrades, 
although eligible for reimbursements, are not included in determining 
whether repair costs exceed 50 percent of replacement costs. In the 
event that FEMA's estimated repair costs do not exceed 50 percent of 
its estimated replacement costs, funds authorized for repair may be 
used to rebuild a new or improved facility, but reimbursements will be 
limited to 90 percent of FEMA's estimated cost to repair and restore 
the original facility to pre-disaster condition. In addition, projects 
for hazard mitigation to prevent damage in future flooding events are 
eligible for Public Assistance funding. 

Under the Public Assistance program, FEMA is authorized to reimburse up 
to 100 percent of eligible costs for emergency work, including costs 
associated with providing emergency medical services. Currently under 
this provision, FEMA has funded numerous emergency medical services 
throughout the New Orleans area. 

The Health Care Infrastructure Was Significantly Damaged: 

The health care infrastructure in the New Orleans area, including 
emergency, hospital, and clinic facilities, was severely damaged by 
Hurricane Katrina. The MCLNO, along with its Level I trauma unit, was 
forced to close.[Footnote 5] Level I trauma services are available in 
the state in Shreveport, Louisiana. Other Level I trauma units are 
located outside of the state in Houston, Texas; and in Mobile and 
Birmingham, Alabama.[Footnote 6] 

Other health services in New Orleans were also severely damaged, 
including hospitals, emergency services, and safety net clinics. 

Hospitals: The number of staffed hospital beds in the City of New 
Orleans was about 80 percent less in February 2006 than before 
Hurricane Katrina, according to figures submitted daily by hospitals to 
an Internet database about their bed capacity.[Footnote 7] Of the 9 
acute care hospitals in the city prior to Katrina, only 3 had re-opened 
at a capacity of approximately 456 staffed beds as of February 22, 2006 
(see table 1).[Footnote 8] 

Table 1: Number of Staffed Beds at Acute Care Facilities in the Greater 
New Orleans Area Before and After Hurricane Katrina: 

[See PDF for image] 

Source: GAO analysis of data from the GNOEMS online Internet hospital 
reporting system and from the Bring New Orleans Back Health and Social 
Services Committee Hospital and Specialty Care Subcommittee. 

[A] New Orleans and Orleans Parish have the same geographical 
boundaries. 

[B] Parentheses indicate a decrease. 

[C] At the time of our visit, Tulane University Hospital and Clinic was 
undergoing repairs from flooding and an official said they expected to 
reopen in February with 63 beds, along with emergency department 
services. Tulane opened its limited facility on Feb. 14, 2006. 

[End of table] 

Emergency Care: Increased demand has been reported at the open 
emergency departments and has led to slow unloading of patients from 
ambulances and to patients being housed in the emergency department 
because hospital beds were not available. For example, according to 
data reported by hospitals on February 22, 2006, wait times for 
emergency medical services (EMS) vehicles to offload stable patients 
into emergency departments varied from no wait at some hospitals to as 
long as 2 hours reported by 2 hospitals, and hospitals reported that 38 
patients had been admitted and were being housed in the emergency 
department. 

Safety Net Clinics: More than three-fourths of the safety net clinics 
in the New Orleans area were closed, and many of those that were open 
had limited capacity, according to data gathered by officials at the 
DHH. For example, prior to Katrina, 90 clinics were in operation, 
including 70 clinics run by MCLNO, with the remainder being federally 
qualified health centers, mental health or addictive disorder clinics, 
or other specialty clinics. Post-hurricane, 19 clinics were open 
according to DHH figures, generally operating at less than 50 percent 
of pre-Katrina capacity. 

At the time of our visit, primary and emergency department care was 
available within the city, though at reduced levels, and access to 
specialty and diagnostic care was very limited, local health care 
officials said. Two hospitals were open with reduced bed capacity, and 
MCLNO was operating a limited emergency care clinic called "Spirit of 
Charity" at the Ernest N. Morial Convention Center in downtown New 
Orleans. Spirit of Charity medical personnel were using donated Air 
Force field mobile hospital tents and portable buildings set up on the 
convention center floor to handle minor emergencies such as simple 
fractures and lacerations, conduct medical assessments, and manage 
overdoses and intoxication, MCLNO officials said. The clinic's medical 
personnel were seeing an increasing number of patients each month, with 
more than 4,500 visits in December 2005, officials said. At the time of 
our visit, MCLNO officials said Spirit of Charity would have to leave 
the convention center site by early March.[Footnote 9] 

In addition to the severe damage sustained by health facilities, 
maintaining and attracting the workforce for these facilities is also a 
serious issue for local officials. An estimated 3,200 physicians lived 
in the metropolitan area before Hurricane Katrina, with 2,664 of those 
physicians residing in New Orleans itself, according to DHH figures. We 
were unable to obtain an estimate of how many physicians are currently 
in New Orleans. Hospital officials said they faced a shortage of 
support staff, such as food service or janitorial workers, who were 
unable to return due to a lack of housing or were being offered higher 
wages at hotels and restaurants. 

Long-Term Decisions About the Health Care System in New Orleans Are 
Affected by Uncertainties About the Future: 

As the city struggles to restore some capacity to meet the immediate 
needs of the population currently there, long-term decisions about how 
to rebuild it are affected by questions about whether the health care 
system should be rebuilt to its pre-Katrina configuration and 
uncertainties about the returning population. Some health policy 
researchers have noted that the efficiency of the pre-Katrina health 
system in New Orleans could be improved by moving away from New 
Orleans' hospital-centric system. Some local officials have also 
suggested that the health care situation prior to the hurricane was 
less than ideal and the city has a chance to rebuild a better system. 

Uncertainty about how quickly the population will return to New 
Orleans, as well as who will return and where people will settle, poses 
difficult challenges for officials attempting to plan the restoration 
of health care services, such as how much capacity will be required and 
where to locate services. Prior to Katrina, the 2000 Census estimated 
the city's population at 484,674 people. The most recent estimates of 
the size of the population found that as of December 2005, the number 
of people who remained in the city each night (referred to as the 
"core" population) was about 156,900, a decline of approximately 68 
percent, according to figures reported by DHH. The population increased 
by about 100,000 during the day, including former residents living 
outside the city and returning during the day and workers involved in 
reconstruction activities. The estimates showed that most of those 
returning were between the ages of 35 and 44. DHH noted that relatively 
few children had returned, in large part because most schools in New 
Orleans remain closed. One projection estimates that the population in 
2008 will be 247,000, about half of the pre-Katrina population, due to 
a lack of housing and other services. 

Over the long term, rebuilding the health care system will be vital to 
attract people back to New Orleans and ensure its recovery. State, 
local, and federal governments all have important roles to play in the 
recovery process. At the state and local levels, commissions to plan 
for the future health care system have been established, and one has 
completed its work. The Mayor of New Orleans' Bring New Orleans Back 
Commission issued recommendations to shift the focus, to the degree 
possible, toward ambulatory care, wellness and preventive medicine, 
health promotion, and chronic disease prevention and away from 
institutional care; maintain a university teaching hospital in New 
Orleans; and build capacity for electronic medical records. The 
commission also noted the difficulty of doing effective planning 
without reliable information on the population and what segments of the 
population will return. The Louisiana Recovery Authority, established 
by the Governor, included one task force dedicated to health care 
issues. At the federal level, the Department of Health and Human 
Services has a support role under the National Response Plan for long-
term community recovery and mitigation to enable community recovery 
from the long-term consequences of a large-scale incident.[Footnote 10] 

Despite the multiple planning efforts that had been completed or were 
still underway, a clear consensus on how to rebuild had not yet emerged 
at the time of our visit. Several hospital officials we interviewed 
said they were looking for strong local leadership to emerge. LSU 
officials were not waiting for the results of the planning efforts and 
were proceeding with their own plans. LSU officials said they intended 
to fulfill their statutory mission of care for the uninsured and also 
did not want to abandon the work in trauma services and health 
professions' education. In particular, LSU officials were focusing on 
the disposition of the Charity Hospital facility. In February 2006, 
they signed an agreement with the Department of Veterans Affairs to 
explore the feasibility of jointly building a teaching hospital and 
Level I trauma center in downtown New Orleans. 

Funds Available From FEMA to Repair MCLNO Hospitals Will be Limited to 
Hurricane Damage: 

Hurricane Katrina and the subsequent flooding caused by the failure of 
the New Orleans levee system have exacerbated the already deteriorating 
physical conditions of Charity and University Hospitals. Prior to the 
disaster, both hospital facilities had documented deficiencies and were 
having difficulties meeting health care standards. LSU Health Care 
Services Division had decided to support the construction of a new 
facility to replace both Charity Hospital and University Hospital and 
was in process of seeking funding for the project when the storm 
occurred. 

FEMA's estimate for repairing the damage to the MCLNO facilities caused 
by the hurricane was considerably lower than an estimate prepared by 
ADAMS, a consultant to LSU. LSU's estimate included correction of pre-
disaster deficiencies that under the Public Assistance program are 
ineligible for federal funding, while FEMA's estimate included only 
repair to what it considered damage caused by the hurricane. 

Shortly after Katrina struck the New Orleans area, LSU hired ADAMS 
consulting to conduct a facilities assessment and develop an initial 
estimate for repair of the MCLNO facilities. The estimate developed for 
Charity Hospital was $257.7 million and for University Hospital was 
$117.4 million. These estimates included whole building repair, meaning 
that they addressed damage from Katrina and many deficiencies that had 
been identified before the hurricane. ADAMS also estimated replacement 
costs at $395.4 million for Charity Hospital and $171.7 million for 
University Hospital. Based on these estimates, ADAMS determined that 
repairs exceeded 50 percent of replacement costs for the MCLNO 
facilities. 

As noted earlier, the LSU estimate is for a whole building repair. This 
estimate also includes a 66 percent cost escalation over a commonly 
used index of labor and material cost for New Orleans. The cost 
escalation was meant to anticipate material and labor shortages over 
the next 3-6 years as a result of the hurricane. According to the LSU 
assessment, the structural systems, such as columns, beams and flooring 
systems, are in functional condition, although destructive testing 
would be required to verify this condition. However, the mechanical, 
electrical, and plumbing systems are beyond repair and there are 
significant environmental safety problems. Repair cost estimates were 
based on visual inspections of systems. 

FEMA's basis for its estimate for repair cost for the MCLNO facilities 
was for work to rectify the damage from flooding and wind only, since 
these are the only repairs eligible for federal reimbursement. The 
agency conducted surveys and prepared estimates based on FEMA 
regulations and guidance. Its estimate for repair of Charity Hospital 
was $23.9 million and for University Hospital $12.4 million. 

Like the LSU estimate, FEMA's cost estimate was based on a visual 
survey. Unlike the LSU estimate, it was detailed in exact material 
items needed, such as number of doors and windows and costs associated 
with installation. FEMA also used a cost index of labor and material 
for New Orleans with no cost markups. A recently awarded contract for 
renovation work for the New Orleans Arena had three out of five bids 
submitted at below the government estimate. Based on this data, FEMA 
concluded that cost increases to its original estimate due to wage and 
material inflation were not justified. Table 2 compares LSU's repair 
and replacement estimates to FEMA's. 

Table 2: LSU and FEMA Estimates for Charity and University Hospitals: 

[See PDF for image] 

Source: ADAMS 2005 Emergency Facilities Assessment and FEMA Project 
Worksheets. 

[End of table] 

Based on its assessment and estimates, LSU believed that its facilities 
were damaged beyond 50 percent of their total replacement cost, meeting 
the Public Assistance program criteria for replacement funding. Based 
on FEMA's initial repair and replacement estimates, repair costs as a 
percentage of replacement costs ranged from 9 to 22 percent, well under 
the threshold for qualifying for replacement funding. Although LSU 
could appeal the estimate that FEMA developed, it will not be able to 
increase the scope of eligible repairs to correct pre-disaster 
deficiencies. Consequently, LSU is likely to receive federal funds that 
will be significantly below its original expectation. 

Over time, should LSU decide to proceed with repairs to one or both 
facilities, FEMA's estimate and the subsequent federal reimbursement is 
likely to increase. For example, FEMA's current estimate does not yet 
include clean up or removal of environmental hazards such as asbestos 
or mold, does not include any elevator repairs, and does not include 
code upgrades that may be triggered by renovation work. Any of these 
costs, if found to be legitimate, may be eligible for reimbursement 
above and beyond the initial FEMA grant. Even including all of these 
factors, it is unlikely that the repair work cost totals will reach 50 
percent of the replacement costs. 

Should LSU decide to rebuild the hospitals, LSU is authorized under the 
Public Assistance program to use funds approved for repair on a 
replacement facility. However, the amount eligible for reimbursement 
will not increase past the initial FEMA grant for repair, pending any 
appeals of the estimate and their resolution. 

Concluding Observations: 

Approximately 6 months after Hurricane Katrina hit New Orleans, city, 
state, and hospital officials we interviewed generally agreed that the 
local health care system had been severely compromised and that the 
number of operating facilities and available health care providers 
remained much smaller than before the hurricane. Population return is 
projected to be slow, and population projections suggest that New 
Orleans will be smaller in the future compared to its pre-Katrina 
status. 

Apart from self-reported hospital data, it has been difficult to find 
firm information about the returning population and the status of the 
workforce. The lack of reliable information makes planning difficult 
and can create risks for moving forward due to uncertainties about what 
the future will look like. Although various planning efforts were 
completed or underway, at the time of our visit no clear consensus had 
emerged. 

Because MCLNO played a major role in the pre-Katrina health care 
infrastructure in both New Orleans and for the State of Louisiana, 
LSU's decision about rebuilding these facilities could have significant 
implications for health care service delivery in post-Katrina New 
Orleans and for statewide training and Level I trauma care. Faced with 
uncertainty about how quickly the population will return, how a future 
health care system should be configured, how much LSU will receive from 
the Public Assistance program for repair of Charity and University 
hospitals, and uncertainties about availability of other funds, LSU 
faces a complicated decision about whether to repair Charity and 
University hospitals or build a new facility. Since the facilities were 
severely damaged and were already outdated, proceeding with federal 
funding for repairs may be wasting tens of millions of dollars. Further 
major renovations or new replacement facilities would be needed to 
provide facilities that meet the standards of modern health care 
delivery. If LSU decides to build a new facility, FEMA Public 
Assistance funds would likely not cover the cost. 

We provided a draft copy of this report to DHS and LSU for review and 
comment. DHS and FEMA officials provided oral comments and LSU 
officials provided comments via e-mail. These were technical comments 
which have been incorporated as appropriate. 

We are sending copies of this report to the Secretary of DHS and other 
interested parties. We will also make copies available to others on 
request. In addition, the report will be available at no charge on the 
GAO Web site at http://www.gao.gov. Contact points for our Offices of 
Congressional Relations and Public Affairs may be found on the last 
page of this report. 

If you or your staffs have any questions about this report, please 
contact Cynthia Bascetta at (202) 512-7101 or BascettaC@gao.gov for 
issues related to health services. Please contact Katherine Siggerud at 
(202) 512-2834 or SiggerudK@gao.gov for issues related to health 
facilities. Major contributors to this report were Terrell Dorn, 
Assistant Director; Linda Kohn, Assistant Director; Michaela Brown, 
George Depaoli, and Karen Doran. 

Signed by: 

Cynthia Bascetta: 
Director, Health Care: 

Signed by: 

Katherine Siggerud: 
Director, Physical Infrastructure: 

List of Committees: 

The Honorable Charles E. Grassley: 
Chairman: 
The Honorable Max Baucus: 
Ranking Minority Member: 
Committee on Finance: 
United States Senate: 

The Honorable Michael B. Enzi: 
Chairman: 
The Honorable Edward M. Kennedy: 
Ranking Minority Member: 
Committee on Health, Education, Labor and Pensions: 
United States Senate: 

The Honorable Larry E. Craig: 
Chairman: 
The Honorable Daniel K. Akaka: 
Ranking Minority Member: 
Committee on Veterans' Affairs: 
United States Senate: 

The Honorable John D. Dingell: 
Ranking Minority Member: 
Committee on Energy and Commerce: 
House of Representatives: 

The Honorable Steve Buyer: 
Chairman: 
The Honorable Lane Evans: 
Ranking Minority Member: 
Committee on Veterans' Affairs: 
House of Representatives: 

The Honorable David R. Obey: 
Ranking Minority Member: 
Subcommittee on Labor, Health and Human Services, Education and Related 
Agencies: 
Committee on Appropriations: 
House of Representatives: 

The Honorable Bart Stupak: 
Ranking Minority Member: 
Subcommittee on Oversight and Investigations: 
Committee on Energy and Commerce: 
House of Representatives: 

The Honorable Sherrod Brown: 
Ranking Minority Member: 
Subcommittee on Health: 
Committee on Energy and Commerce: 
House of Representatives: 

(290521): 

FOOTNOTES 

[1] See 31 U.S.C.  717(b)(1). 

[2] RS Means provides a series of estimating and cost index guides used 
in the construction industry. 

[3] Eight hospitals are operated by the LSU Health Care Services 
Division and two hospitals are operated by the LSU Health Sciences 
Center in Shreveport, Louisiana. 

[4] 44 C.F.R.  206.226(f). 

[5] Trauma centers are designated based on existing resources and 
expertise to treat differing types and severity of injury. Level I 
trauma units are able to treat any type of injury, no matter how 
severe. According to the American College of Surgeons, a Level I trauma 
center has a full range of specialists and equipment available 24-hours 
a day and admits a minimum required annual volume of severely injured 
patients. 

[6] MCLNO announced plans to re-establish a Level I trauma unit in the 
New Orleans area working in conjunction with another facility. 

[7] The Internet database is called "GNOEMS" and was developed by the 
Greater New Orleans Healthcare Taskforce with the assistance of the 
U.S. Public Health Service. 

[8] Before Hurricane Katrina, some health care experts characterized 
New Orleans as having an oversupply of hospital beds. 

[9] Spirit of Charity was moved to a former department store located 
near Charity Hospital on March 11-12. Costs associated with this move 
and leasing of the site were funded by FEMA under the Public Assistance 
program. 

[10] We will be following the Department's efforts to fulfill this role 
in the coming months.