Book Excerpt: 'Americans At Risk"

The truth is, we weren't prepared to prevent the flooding of New Orleans because we didn't make sure that the levees at the 17th Street Canal and Industrial Canal and along canals extending south from Lake Pontchartrain would stand up to a greater than category 3 hurricane. While the Bush administration's proposed FY 2004 budget included $297 million for civil works projects in the U.S. Army Corps of Engineers' New Orleans district, Congress approved only $40 million, of which $3 million was slated for New Orleans's East Bank Hurricane Levee Project. But the U.S. Army Corps of Engineers project manager, Al Naomi, reported that $11 million was needed. Congress ultimately approved $5.5 million, but because of the project's reduced budget, work on the levee system was halted for the first time in thirty-seven years. To correct this deficit, we should have mounted an organized emergency response but stunning governmental incompetence and lack of coordination got in the way on many levels. And we are unprepared to recover because everywhere you turn in the Gulf there are overwhelming needs, too few resources, unclear lines of authority and responsibility, and insufficient on-the-ground innovation and leadership.

In late January 2006, Senator Richard Burr of North Carolina asked me to meet with him at his office in the Dirksen Senate Office Building at the Capitol. This meeting was one of a series he had scheduled with experts to explore a range of ideas about what was needed to prepare specifically for a bioterror attack and, more generally, for disaster response. Dr. Robert Kadlec, a former White House expert on bioterrorism and counterintelligence, is staff director of the Senate Subcommittee on Bioterrorism. He had arranged the meeting and told me to be prepared for a frank and open discussion.

The conversation was focused and honest, and the senator listened carefully. One of my main points was how unprepared the U.S. health-care system was to respond to or recover from a major disaster. He responded knowledgeably on the topic and we spoke at length about the chronic fragility of the public health system.

In the senator's office were two other people: Jennifer Bryning, a very capable senior staff member, and Dr. Kathy Hebert. Dr. Hebert had started working in Burr's office as a special policy adviser just a few weeks earlier. Until that time she was in charge of the cardiology clinics at Charity Hospital in New Orleans. The venerable Charity was one of the nation's best-known health-care facilities for the poor. Because more than 25 percent of the New Orleans population was classified as poor, the need for a hospital that took all comers, regardless of income or insurance status, could not have been greater. More than half of the evacuees initially in shelters?some 270,000 people?did not have health insurance; for most of them, Charity Hospital had been their primary place for medical care. Charity took an enormous hit during and after Katrina and the floods that followed. Now the facility is shut down, its fate uncertain.

When the session ended, Kathy Hebert and I walked out to the outer office. As we stood there, in front of the receptionist's desk, Kathy said, "Irwin, thanks for coming. I'm sure this will be helpful. But, I am very worried about my patients." I asked what she meant.

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