United States Government Accountability Office

GAO Report to Congressional Committees

HURRICANE 

KATRINA 

Status of Hospital 

Inpatient and 

Emergency 

Departments in the 

Greater New Orleans 

Area 

September 2006 

 

GAO-06-1003 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

September 2006

HURRICANE KATRINA

Status of Hospital Inpatient and 

Emergency Departments in the Greater 

New Orleans Area 

Highlights of GAO-06-1003, a report to 

congressional committees 

www.gao.gov/cgi-bin/getrpt?GAO-06-1003.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Cynthia 

Bascetta at (202) 512-7101 or 

bascettac@gao.gov or Terrell G. Dorn at 

(202) 512-6923 or dornt@gao.gov. 

In the aftermath of Hurricane 

Katrina, questions remain

concerning the availability of 

hospital inpatient care and 

emergency department services in

the greater New Orleans area—

which consists of Jefferson,

Orleans, Plaquemines, and St.

Bernard parishes. Because of 

broad-based congressional interest,

GAO, under the Comptroller

General’s statutory authority to 

conduct evaluations, assessed

efforts to restore the area’s 

hospitals by the Department of 

Homeland Security’s (DHS) 

Federal Emergency Management 

Agency (FEMA); the Department of 

Health and Human Services (HHS);

and the Louisiana State University

(LSU) public hospital system, 

which operated Charity and 

University hospitals in New 

Orleans. GAO examined (1) the 

availability of hospital inpatient 

care and the demand for 

emergency department services,

(2) steps taken to reopen Charity 

and University hospitals, and 

(3) the activities that HHS has 

undertaken to help hospitals 

recover. To fulfill these objectives, 

GAO reviewed documents and 

interviewed federal officials and 

hospital, state, and local officials in 

the greater New Orleans area. GAO

also obtained information on the

number of inpatient beds for April 

2006, which was the most recent 

data available when GAO did its 

work. GAO’s work did not include 

other issues related to hospitals 

such as outpatient services or 

financial condition. 

While New Orleans continues to face a range of health care challenges, 

hospital officials in the greater New Orleans area reported in April 2006 that 

a sufficient number of staffed inpatient beds existed for all services except 

for psychiatric care—some psychiatric patients had to be transferred out of 

the area because of a lack of beds. Overall, GAO determined that the area

had about 3.2 staffed beds per 1,000 population, compared with a national 

average of 2.8 staffed beds per 1,000 population. Hospital officials told GAO 

they planned to open an additional 674 staffed beds by the end of 2006, 

although they reported that recruiting, hiring, and retaining nurses and 

support staff was a great challenge. With these additional beds, the 

population would have to increase from 588,000 in April 2006 to 913,000 by 

December 2006 before staffed beds would drop to the national average.

Hospitals also reported a high demand for emergency services, consistent 

with a June 2006 Institute of Medicine report, which found that emergency 

department crowding is a nationwide problem. 

Steps have been taken to reopen University Hospital, but as of July 2006, 

LSU had no plans to reopen Charity Hospital. LSU plans to open portions of

University Hospital in fall 2006 and would like to replace both hospitals with 

a new one. LSU and FEMA have prepared cost estimates to repair these 

hospitals. For Charity Hospital, FEMA’s estimate of $27 million is much 

lower than LSU’s estimate of $258 million, which covers, for example,

repairing hurricane damage and correcting many prestorm deficiencies. In 

contrast, FEMA’s estimate covers repairs for hurricane damage only—the 

only repair costs eligible for federal reimbursement. 

HHS provided financial assistance and waived certain program requirements 

to help hospitals recover in the area. For example, HHS included 

$221 million in hurricane relief funds designated for Louisiana through 

Social Services Block Grants, which may be used in part to reconstruct 

health care facilities. HHS also waived certain Medicare billing and other 

requirements and accelerated Medicare payments to providers, including 

hospitals, in the hurricane-affected states. 

Rebuilding the health care infrastructure of the greater New Orleans area 

will depend on many factors, including the health care needs of the 

population that returns to the city and the state’s vision for its future health 

care system. In light of the current sufficiency of hospital beds for most 

inpatient services, GAO believes a major challenge facing the greater New 

Orleans area is attracting and retaining enough nurses and support staff. 

HHS and the Department of Veterans Affairs (VA) agreed with the draft 

report. DHS said it had no formal comments on the draft. HHS, VA, DHS, and 

Louisiana’s Department of Health and Hospitals provided technical 

comments, which GAO incorporated where appropriate. LSU did not provide 

comments. 
Contents 

Letter 1

Results in Brief 4

Background 7

Sufficient Staffed Beds Existed for All Types of Inpatient Care 

Except Psychiatric Care; High Demand Existed for Emergency 

Department Services 10 

Steps Have Been Taken to Reopen University Hospital, but LSU 

Has No Plans to Reopen Charity Hospital 17 

HHS Has Provided Financial and Technical Assistance and 

Program Waivers to Help Address Restoration 24 

Agency Comments 29 

Appendix I Scope and Methodology 33 

Appendix II Comments from the Department of Health and 

Human Services 36 

Appendix III GAO Contacts and Staff Acknowledgments 39 

Tables 

Table 1: Status of Acute Care Facilities in the Greater New Orleans 

Area, April 25, 2006 8 

Table 2: Number of Available, Staffed, and Occupied Beds by Type 

of Care at Hospitals in the Greater New Orleans Area on 

April 25, 2006 15 

Table 3: LSU’s and FEMA’s Cost Estimates for Charity and 

University Hospitals 19 

Figure 

Figure 1: Open and Closed Hospitals in the New Orleans Area as of 

June 2006 12 

Page i GAO-06-1003 Status of Hospitals in New Orleans
Abbreviations 

ADA Americans with Disabilities Act 

ADAMS ADAMS Management Services Corporation 

CMS Centers for Medicare & Medicaid Services 

COSG Collaborative Opportunities Study Group 

DHS Department of Homeland Security 

FEMA Federal Emergency Management Agency 

HHS Department of Health and Human Services 

LSU Louisiana State University 

MCLNO Medical Center of Louisiana at New Orleans 

OFPC Office of Facility Planning and Control 

SSBG Social Services Block Grant 

VA Department of Veterans Affairs 

This is a work of the U.S. government and is not subject to copyright protection in the 

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reproduce this material separately. 

Page ii GAO-06-1003 Status of Hospitals in New Orleans
United States Government Accountability Office

Washington, DC 20548 

September 29, 2006 

Congressional Committees 

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 ever to hit the United States. Among the 

challenges facing the greater New Orleans area1

 in the aftermath of 

Hurricane Katrina is addressing the significant damage to hospital 

facilities, the loss of hospital staff who relocated to other areas, and the 

associated disruption of hospital inpatient care and emergency 

department services. For example, Charity and University hospitals, which 

are part of the statewide Louisiana State University (LSU) public hospital

system, suffered extensive damage as a result of the hurricane and 

remained closed as of June 30, 2006.

2

 Private hospitals serving the area

were also damaged and, like their public counterparts, have been short of 

nursing and support staff in the months following the hurricane. 

In responding to a natural disaster such as Hurricane Katrina, the federal 

government coordinates operations with state and local governments and 

the private sector according to the framework provided in the National 

Response Plan.3

 Under this plan, the Department of Homeland Security’s 

(DHS) Federal Emergency Management Agency (FEMA) has primary 

responsibility for emergency response and recovery planning and 

coordination, and the Department of Health and Human Services (HHS) 

has overall responsibility for coordinating public health and medical 

response to incidents. HHS is also designated as a support agency for longterm community recovery and mitigation. 

 1

For this report, we define the greater New Orleans area as Jefferson, Orleans, 

Plaquemines, and St. Bernard parishes. 

2

While part of the statewide LSU public hospital system, Charity and University hospitals 

are the two facilities that make up the Medical Center of Louisiana at New Orleans 

(MCLNO). MCLNO, through these hospitals and other facilities, is a primary provider of 

care to the uninsured population in New Orleans. 

3

The National Response Plan establishes a comprehensive all-hazards approach to enhance

the ability of the United States to manage domestic incidents. It establishes a framework of 

how the federal government coordinates with state, local, and tribal governments and the

private sector during incidents. 

Page 1 GAO-06-1003 Status of Hospitals in New Orleans
In March 2006, we reported on the status of the health care system in New 

Orleans as of that month.4

 As we reported, the availability of health care 

services—which includes those provided within and outside of a hospital

facility—is one of the factors that can affect whether and how quickly 

residents return to an area after a disaster.5 This report is a follow-up to 

our March 2006 report and focuses on hospital inpatient care; emergency 

department services; and efforts to restore hospital infrastructure, that is, 

facilities and staff. Specifically, this report discusses (1) the availability of 

hospital inpatient care and the demand for emergency department services 

in the greater New Orleans area, (2) steps taken by FEMA and LSU to 

reopen Charity and University hospitals, and (3) the activities that HHS 

has undertaken to help hospitals recover in the greater New Orleans area. 

Because of broad congressional interest, we performed this work under 

the Comptroller General’s statutory authority to conduct evaluations on 

his own initiative.6

To examine the availability of hospital inpatient care and the demand for 

emergency department services, we contacted nine operating public and

private acute care hospitals7

 in the greater New Orleans area to obtain 

information on the number of available, staffed, and occupied beds8

 for 

one randomly selected day in April 2006, and later we asked the hospital 

officials to provide the same information for the entire month of April, 

which was the most recent data available when we did our work.9

 Five 

 4

See GAO, 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, GAO-06-576R (Washington, D.C.: Mar. 28, 2006). 

5

Other factors include, for example, availability of housing, food, schools, and 

transportation. 

6

See 31 U.S.C. § 717(b)(1). 

7

Acute care hospitals treat individuals whose illnesses or health problems are short-term or

episodic in nature. 

8

Available beds are beds that are licensed, set up, and available for use. These are beds

regularly maintained in the hospital for patient use with supporting services, such as food,

laundry, and housekeeping. Available beds may or may not be staffed. Staffed beds are

available beds for which staff are on hand to attend to patients who occupy the beds. 

Staffed beds may or may not be occupied. Occupied beds are staffed beds that are being

used by patients. 

9

Ten hospitals were operating as of June 30, 2006, but we did not include one of them, 

Elmwood Medical Center, in our survey of available, staffed, and occupied beds because it 

is a temporary facility that was open for only 7 days in April and therefore data were not 

available for the entire month. 

Page 2 GAO-06-1003 Status of Hospitals in New Orleans
hospitals responded to our request for data for the month of April. We also 

obtained hospital estimates of the occupancy rates for the 12-month 

period prior to, and the 9-month period after, Hurricane Katrina for 8 of 

the 9 open hospitals. To determine the April 2006 population of the four 

parishes in the greater New Orleans area, we used estimates from the 

Louisiana Department of Health and Hospitals Bureau of Primary Care and 

Rural Health, which used two methodologies to estimate the population in 

each of the parishes. It used school enrollment data for Jefferson, 

St. Bernard, and Plaquemines parishes; and for Orleans Parish it used a 

survey of persons occupying residential structures. The survey had been 

conducted by the New Orleans Health Department in consultation with the 

Centers for Disease Control and Prevention. To examine the demand for 

emergency department services, we obtained information on emergency 

room wait times for 6 hospitals and the number of times that 8 hospitals 

diverted patients to other facilities for the 30-day period from March 28, 

2006, through April 26, 2006. We limited our work to examining the status

of hospital inpatient and emergency departments in the greater New 

Orleans area and did not examine other aspects of hospital services, such 

as outpatient services or the financial condition of the hospitals. We also 

did not address other issues related to the health care system, such as the 

status of primary care, medical research, or graduate medical education. 

To determine the steps that have been taken to reopen Charity and 

University hospitals—two public facilities eligible for federal disaster 

assistance—we reviewed LSU’s and FEMA’s damage assessments and cost 

estimates for the hospitals and LSU correspondence to FEMA regarding 

potential federal funding. We also reviewed FEMA regulations and 

guidance pertaining to disaster assistance. We toured Charity and 

University hospitals to examine the damage to these facilities. We also 

toured two temporary facilities that provided hospital outpatient care and 

emergency department services. These two facilities, established by LSU, 

were the Elmwood Medical Center and the Medical Center of Louisiana at 

New Orleans (MCLNO) Emergency Services Unit. 

To determine the activities undertaken by HHS to help hospitals recover,

we reviewed documents outlining HHS programs and activities related to

helping restore hospital inpatient care and emergency department services

after a disaster. We also reviewed written summaries created by HHS 

officials to document department activities to help restore hospital 

inpatient care and emergency department services after Hurricane Katrina. 

Page 3 GAO-06-1003 Status of Hospitals in New Orleans
In addressing all three objectives, we interviewed officials from HHS, 

FEMA, LSU (including LSU’s Health Care Services Division, which 

manages the public hospitals in the greater New Orleans area), and seven

of the nine hospitals that we contacted in the greater New Orleans area.

We also interviewed officials from the Department of Veterans Affairs 

(VA) because VA is considering building a joint hospital complex with LSU 

in New Orleans, the Louisiana Recovery Authority because it is the 

planning and coordinating body that was created in the aftermath of 

Hurricane Katrina by the Governor of Louisiana to plan for recovery and 

rebuilding efforts, and Louisiana’s Office of Facility Planning and Control 

(OFPC) because it is administering the design and construction of all 

Louisiana state-owned facilities damaged by Hurricane Katrina. We did not 

independently verify information we received from hospitals in the greater 

New Orleans area. We conducted our work from April 2006 through 

September 2006 in accordance with generally accepted government 

auditing standards. See appendix I for more information about our scope 

and methodology. 

While New Orleans continues to face a range of health care challenges, 

hospital officials in the greater New Orleans area reported in April 2006 

that a sufficient number of staffed inpatient beds existed for all services 

except for psychiatric care—some psychiatric patients had to be 

transferred out of the area because of a lack of beds. Overall, as of April 

2006, the greater New Orleans area had about 3.2 staffed beds per 1,000 

population, compared with the national average of 2.8 staffed beds per 

1,000 population reported by the American Hospital Association. Hospital 

officials told us that they planned to open an additional 674 staffed beds by

the end of 2006—390 of which would be at University Hospital—although 

they also reported that recruiting, hiring, and retaining nurses and support 

staff was a great challenge. With the addition of these beds, the population 

would have to increase from 588,000 in April 2006 to 913,000 by December 

2006 before staffed beds would drop to the national average. For all types 

of care, eight of the nine hospitals we contacted provided us with an 

estimated overall occupancy rate for the 9-month period following the 

hurricane (through April 2006) and for the 12-month period before the 

hurricane. The hospitals’ occupancy rates for the 9-month period after the 

hurricane ranged from 45 percent to 100 percent, or an average of 

77 percent, compared with a range from 33 percent to 85 percent, or an

average of 70 percent, for the 12-month period before the hurricane. The 

American Hospital Association reported that the average monthly hospital 

occupancy rate nationwide was 67 percent in 2004. Eight of the nine 

hospitals that remained open after Hurricane Katrina also reported a high 

Results in Brief 

Page 4 GAO-06-1003 Status of Hospitals in New Orleans
demand for services in their emergency departments, similar to the 

nationwide trend reported by the Institute of Medicine in June 2006 that 

emergency department crowding is a nationwide problem. 

Steps have been taken to reopen University Hospital, but as of July 2006, 

LSU had no plans to reopen Charity Hospital. FEMA and LSU have 

prepared damage assessments and cost estimates for these hospitals, 

some repairs have begun at University Hospital, and temporary facilities 

have been established to provide some services previously offered at both 

hospitals. FEMA’s cost estimates are considerably lower than LSU’s 

estimates. For example, LSU estimates the cost of repairing Charity 

Hospital at about $258 million, while FEMA estimates the cost at about 

$27 million. The difference between these two estimates is primarily due 

to two factors. First, LSU’s estimate covers whole building repair, meaning 

that it includes repairing damage from Hurricane Katrina as well as 

correcting many deficiencies that had been identified before the hurricane. 

In contrast, FEMA’s estimate covers repair costs for hurricane damage 

from flooding and wind only, since these are the only repair costs eligible 

for federal reimbursement. Second, in anticipation of a shortage of 

materials and labor over the next 3 to 6 years as a result of the hurricane, 

LSU’s estimate includes a 66 percent cost escalation over a commonly 

used index of labor and material for New Orleans, while FEMA’s estimate 

does not include such a cost escalation. According to FEMA, a cost 

escalation for materials and labor was not warranted based on FEMA’s 

recent contracting experience in the area. Repairs are currently under way 

to reopen portions of University Hospital (e.g., inpatient beds and a 

pharmacy) beginning in late September or early October. As of July 2006, 

LSU had no plans to reopen Charity Hospital. Rather, LSU is pursuing the 

possibility of a new facility to replace both Charity and University 

hospitals in the future. If LSU decides to replace these hospitals, a portion

of the funds FEMA authorized for repair may be used to build this new 

hospital. The amount of federal funding available for a new hospital will 

depend, in part, on FEMA’s initial estimated cost to repair Charity and 

University hospitals. In the meantime, LSU has established temporary 

facilities to provide some of the hospital functions previously provided by 

Charity and University hospitals in the short term, including an emergency 

services unit and a trauma center. 

HHS has been able to provide financial and technical assistance and has 

waived certain program requirements in order to help hospitals recover in

the greater New Orleans area. HHS financial assistance included 

$221 million in hurricane relief funds designated for Louisiana through 

Social Services Block Grants (SSBG); some of these funds may be used to

Page 5 GAO-06-1003 Status of Hospitals in New Orleans
reconstruct health care facilities. As of June 13, 2006, HHS was 

considering four applications from the greater New Orleans area for a 

Medicare extraordinary circumstances exception, which allows hospitals 

serving Medicare patients to apply for long-term reimbursement for capital

expenditures of greater than $5 million to repair hurricane-damaged 

facilities. Technical assistance to Louisiana is both ongoing and planned. 

Ongoing technical assistance has included providing consultation at 

Orleans Parish health planning committee meetings that addressed 

shortages of staff, hospital beds, and funding, and collaborating with 

survey agencies and hospitals to coordinate the application of

accreditation standards for temporary hospital facilities or hurricanedamaged facilities. Planned technical assistance is part of a broader effort 

to help redesign Louisiana’s health care delivery system, including the 

restoration of inpatient care and emergency department services in the 

greater New Orleans area. HHS officials said that this could include 

assisting Louisiana in development of future requests for Medicare 

demonstrations and Medicaid waivers designed to make Louisiana’s health

care system more effective and efficient. HHS has also waived certain 

Medicare billing and other requirements and accelerated Medicare 

payments to providers, including hospitals, in the hurricane-affected states 

such as Louisiana. 

Based on information provided by hospital officials, we believe a major 

challenge facing the greater New Orleans area is to attract sufficient 

nurses and support staff to operate the beds that are currently available. 

Since the number of staffed and available inpatient beds in the greater 

New Orleans area is above the national average, local and state officials 

are afforded time to deliberate the appropriate location and numbers of 

hospital facilities. Although LSU officials would prefer to construct a new 

hospital facility to replace Charity and University hospitals, decisions on 

the future of these hospitals and the overall provision of health care in 

New Orleans ultimately will be made at the highest levels of the state 

government. A number of federal, state, and local stakeholders will also 

have input into these final decisions. The decisions made will depend on a 

variety of factors. In addition to the major challenge of attracting and 

retaining hospital staff, other challenges will include the availability of 

funding, the health care needs of the population that returns to the city, 

and the state’s vision for the future of its health care system. Finally, as 

restoration of hospital inpatient care, emergency services, and hospital 

infrastructure proceeds, HHS’s efforts to conduct demonstrations and to 

waive certain program requirements will continue to be an important 

factor in addressing health care needs in the greater New Orleans area. 

Page 6 GAO-06-1003 Status of Hospitals in New Orleans
In commenting on a draft of this report, HHS and VA agreed with the draft 

report. DHS said it had no formal comments on the draft report. HHS, VA, 

DHS, and Louisiana’s Department of Health and Hospitals provided 

technical comments, which we incorporated where appropriate. LSU did 

not provide comments. 

Before Hurricane Katrina, 16 acute care hospitals operated in the greater 

New Orleans area. These hospitals included public as well as private forprofit and not-for-profit facilities. Because of the hurricane and resulting 

flooding, 7 hospitals remained closed as of June 2006. (See table 1.) 

Background 

Page 7 GAO-06-1003 Status of Hospitals in New Orleans
Table 1: Status of Acute Care Facilities in the Greater New Orleans Area, April 25, 2006 

Available beds Staffed beds Occupied beds Type of facility 

Facilities in New Orleans (Orleans Parish)a

Charity Hospital Closed Closed Closed Public 

Children’s Hospital 201 143 101 Not-for-profit 

Lindy Boggs Medical Center Closed Closed Closed For-profit 

Memorial Medical Center Closed Closed Closed For-profit 

Methodist Hospital Closed Closed Closed Not-for-profit 

New Orleans VA Medical Center Closed Closed Closed Federal 

Touro Infirmary 297 255 240 Not-for-profit 

Tulane University Hospital and Clinic 73 73 64 Not-for-profit 

University Hospital Closed Closed Closed Public 

Total 571 471 405

Facilities outside of New Orleans 

(Jefferson and St. Bernard parishes)b

Chalmette Medical Center Closed Closed Closed For-profit 

East Jefferson General Hospital 444 430 430 Public communityc 

Kenner Regional Medical Center 205 74 64 For-profit 

Meadowcrest Hospital 172 116 102 For-profit 

Ochsner Medical Center 498 432 394 Not-for-profit 

Tulane-Lakeside Hospital 82 62 28 For-profit 

West Jefferson Medical Center 356 293 265 Public communityc 

Total 1,757 1,407 1,283

Total for the greater New Orleans area 2,328 1,878 1,688 

Source: GAO analysis of documentation and interviews with hospital officials. 

Notes: The greater New Orleans area consists of Jefferson, Orleans, Plaquemines, and St. Bernard 

parishes. We did not include Elmwood Medical Center, a trauma center in Jefferson Parish, because 

it is a temporary facility that opened on April 24, 2006, after our survey began. 

a

New Orleans and Orleans Parish have the same geographical boundaries. 

b

Plaquemines Parish did not have an acute care hospital before Hurricane Katrina. 

c

East Jefferson General Hospital and West Jefferson Medical Center are publicly owned, not-for-profit 

community service district hospitals organized by the parish and governed by boards of directors. 

These hospitals are not part of the statewide system of 10 public hospitals. 

Page 8 GAO-06-1003 Status of Hospitals in New Orleans
Charity and University hospitals are part of the statewide system of 10 

public hospitals. Charity Hospital, which served as a Level I trauma 

center,10 was built in 1937. University Hospital was built in 1972. These 

hospitals served as the primary health care safety net for many local 

residents. About half of the patients served by these hospitals were 

uninsured, and about one-third were covered by Medicaid, the federalstate program for financing health care for certain low-income individuals. 

Charity and University hospitals served as a major state resource through 

training programs for professionals in medicine, nursing, dentistry, and 

public health. 

Charity and University hospitals are eligible for federal aid under the 

Public Assistance program managed by FEMA to help repair the damage 

caused by Hurricane Katrina. This program, authorized by the Stafford 

Act, provides grants to pay up to 90 percent of the costs of restoring a 

facility to predisaster condition.11 A facility is considered repairable when 

the cost of repairing disaster damages does not exceed 50 percent of the

cost of replacing the facility 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.12 Although initial grant obligations are 

based on FEMA’s estimate of the costs of repairs to restore the facility to 

its predisaster condition, reimbursements are based on actual, 

documented repair costs, which could be higher than the original estimate.

Alternatively, 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 replacement 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 

 10Trauma centers are designated based on resources and expertise to treat injuries of 

differing types and levels of severity. Level I trauma centers 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. 

11Robert T. Stafford Disaster Relief and Emergency Assistance Act (as renamed by The 

Disaster Relief and Emergency Assistance Amendments of 1988, Pub. L. No. 100-707, § 

102(a), 102 Stat. 4689), Pub. L. No. 93-288, § 406(c)(1)(B), 88 Stat. 143 (1974) (codified as 

added and amended at 42 U.S.C. § 5172(c)(1)(B) (2000). 

1244 C.F.R. § 206.226(f) (2005). 

Page 9 GAO-06-1003 Status of Hospitals in New Orleans
exceed 50 percent of its estimated replacement costs and a decision is 

made to replace rather than repair, funds authorized for repair may be 

used to build a new hospital, but reimbursements will be limited to 

90 percent of FEMA’s estimated cost to repair and restore the original 

facility to its predisaster condition. In addition, projects for hazard 

mitigation to prevent damage in future flooding events are eligible for 

Public Assistance funding. 

HHS is the federal government’s principal agency for protecting the health

of all Americans and providing essential human services. HHS’s Centers 

for Medicare & Medicaid Services (CMS) administers Medicare, which 

finances health care for elderly and certain disabled individuals, and 

Medicaid. In its support role for long-term community recovery and 

mitigation under the National Response Plan, HHS coordinates federal 

government health care support to state, regional, local, and tribal 

governments; nongovernmental organizations; and the private sector to 

enable community recovery, such as recovery from the long-term 

consequences of Hurricane Katrina and the subsequent flooding. 

In the greater New Orleans area, a sufficient number of staffed hospital 

inpatient beds existed for all types of care except psychiatric care; there

was also a high demand for emergency department services. According to

information we obtained from hospital officials, we determined that as of

April 2006 the greater New Orleans area had more staffed beds per 1,000 

population than the national average, and over two-thirds of these beds 

were within 5 miles of Charity and University hospitals.13 While hospitals 

were able to maintain a sufficient number of staffed beds, hospital officials 

also reported that recruiting, hiring, and retaining nurses and support staff, 

such as nursing aids, housekeepers, and food service workers, to staff the 

available beds constituted a great challenge. Eight of the nine hospitals 

that remained open after Hurricane Katrina reported a high demand for 

services in their emergency departments, not unlike emergency 

departments in other parts of the country, which are also experiencing 

high demand. 

Sufficient Staffed 

Beds Existed for All 

Types of Inpatient 

Care Except 

Psychiatric Care; High 

Demand Existed for 

Emergency 

Department Services 

 13By way of comparison, Medicare requires that commonly used services provided by 

managed care organizations must be available within 30 minutes of driving time. 

Page 10 GAO-06-1003 Status of Hospitals in New Orleans
According to information we obtained from hospital officials, we 

determined that as of April 2006, the greater New Orleans area had more 

staffed beds per 1,000 population than the national average. Before 

Hurricane Katrina, the population of the greater New Orleans area was 

about 1,002,000, with about 455,000 living within the city boundaries of 

New Orleans (Orleans Parish). The number of staffed hospital inpatient 

beds on hand to serve the people of the greater New Orleans area was 

3,958, or about 4.0 staffed beds per 1,000 population, as compared with the 

national average of 2.8 staffed beds per 1,000 population reported in 2006.14

The population of the greater New Orleans area remains in flux and is 

difficult to estimate, in part due to former residents living outside the city

and returning during the day and workers involved in reconstruction 

activities. PricewaterhouseCoopers15 estimated the February 2006 

population of the four parishes (Orleans, Jefferson, Plaquemines, and St. 

Bernard) to be 578,000, and the Louisiana Department of Health and 

Hospitals16 reported estimates of about 569,000 for January 2006 and 

588,000 for April 2006. In April 2006, the hospitals in the greater New 

Orleans area reported to us that they were able to staff 1,878 of the 2,328 

available beds. Based on their reports and the April 2006 population 

estimate, we calculated the four parishes had 3.2 staffed beds per 1,000 

population and 4.0 available beds per 1,000 population. About 69 percent 

of the available beds are within 5 miles of Charity and University hospitals, 

and about 91 percent are within 10 miles. Consequently, patients who live 

and work within Orleans Parish are close to hospital services. Figure 1 

shows the location of all the hospitals in the greater New Orleans area,

including the nine open hospitals we surveyed. 

Staffed Beds per 1,000 

Population Exceeded 

National Average 

 14American Hospital Association, Hospital Statistics 2006 Edition, 2006 Health Forum 

LLC. Used with permission. While the national average was reported in 2006 by the 

American Hospital Association, it is based on 2004 data, which is the most recent year for 

which nationwide data are available. 

15PricewaterhouseCoopers, Report on Louisiana Healthcare Delivery and Financing 

System (2006). This report was prepared for the Louisiana Recovery Authority Support

Foundation. Used with permission. 

16Louisiana Department of Health and Hospitals population estimates for the four parishes 

reported by the Greater New Orleans Community Data Center, Post Katrina Population &

Housing Estimates (June 8, 2006). 

Page 11 GAO-06-1003 Status of Hospitals in New Orleans
Figure 1: Open and Closed Hospitals in the New Orleans Area as of June 2006 

Source: GAO analysis of data provided by the hospitals in the greater New Orleans area.

Open hospital

Closed hospital

Dotted lines represent a 5- and 10-mile radius around University and Charity hospitals

Orleans

Parish

10-mile radius

LSU-Charity Hospital

Tulane University Hospital & Clinicb

Lindy Boggs Medical Center

New Orleans VA Medical Centerb

LSU-University Hospital

East Jefferson General Hospital

Memorial Medical Center

Methodist Hospital

Ochsner Medical Center

Elmwood Medical Centera

Tulane-Lakeside Hospital

Kenner Regional Medical Center

Chalmette Medical Center

Meadowcrest Hospital

Touro Infirmary

West Jefferson Medical Center

Children’s Hospital

Lake Pontchartrain

Lake

Catouatchie

5-mile radius

St. Charles

Parish

St. Bernard

Parish

Jefferson

Parish

Plaquemines

Parish

a

Elmwood Medical Center is included on the map because it was operating in June 2006. However, 

we did not include Elmwood in our survey because it opened on April 24, 2006, and so data on 

available, staffed, and occupied beds were not available for the month of April. 

b

Symbol placement for New Orleans VA Medical Center and Tulane University Hospital & Clinic has 

been altered slightly for legibility purposes. 

Page 12 GAO-06-1003 Status of Hospitals in New Orleans
Furthermore, hospital officials we surveyed told us that they planned to

reopen additional staffed beds by the end of the year. For example, LSU 

plans to reopen 166 beds at University Hospital in late September or early 

October 2006 and an additional 224 beds by the end of the year for a total

of 390 additional staffed beds. Tulane University Hospital and Clinic plans

to reopen an additional 117 staffed beds by the end of 2006. In all, 

hospitals plan to reopen at least 674 staffed beds by the end of 2006. Given 

these plans, even if the population of the greater New Orleans area rises 

30 percent by the end of 2006 over the estimated population as of April 

2006, there would be about 3.3 staffed beds per 1,000 population. This 

estimate assumes that the estimated population of 588,000 in April 2006 

would increase to 764,000 by December 2006. Furthermore, the population 

of the greater New Orleans area would have to increase by 325,000 or 

about 55 percent, to 913,000, by December 2006 before staffed beds per 

1,000 population dropped to the national average of 2.8. 

Occupancy Rates Were 

Higher Than They Were 

before Hurricane Katrina, 

but Staffed Beds Were 

Sufficient for All Types of 

Inpatient Care Except 

Psychiatric Care 

Consistent with nationwide data on occupancy rates (occupied beds as a 

percentage of staffed beds), information we received on estimated 

occupancy rates from hospitals in the greater New Orleans area 

demonstrated wide month-to-month fluctuations. Nevertheless, these 

hospitals were able to meet the demand for inpatient care, with the 

exception, in many cases, of psychiatric care. 

Post-Hurricane Katrina hospital occupancy rates in the greater New 

Orleans area are higher than they were before the hurricane. For all types

of care, eight of the nine hospitals we contacted provided us with an 

estimated overall occupancy rate for the 9-month period following the 

hurricane (through April 2006) and for the 12-month period before the 

hurricane. The hospitals’ occupancy rates for the 9-month period after the 

hurricane ranged from 45 percent to 100 percent, or an average of 

77 percent, compared with a range from 33 percent to 85 percent, or an

average of 70 percent, for the 12-month period before the hurricane.17 The 

American Hospital Association reported that the average monthly hospital 

occupancy rate nationwide was 67 percent in 2004, the most recent year 

for which nationwide data are available. 

 17While officials at the ninth hospital reported information on the number of available, 

staffed, and occupied beds, they did not provide information on occupancy rates. 

Page 13 GAO-06-1003 Status of Hospitals in New Orleans
We also obtained actual occupancy rate information from the nine greater

New Orleans area hospitals for one day—April 25, 2006—and five of them18

provided actual daily occupancy rate information for the entire month of 

April 2006. The five hospitals reported actual occupancy rates that ranged

from 70 percent to 89 percent (70, 75, 85, 86, and 89 percent). 

According to hospital officials, the greatest need was for medical/surgical 

care, adult critical care, and psychiatric care beds. For example, on 

April 25, 2006, the occupancy rate was 95 percent for medical/surgical 

care, 96 percent for adult critical care, and 100 percent for psychiatric 

care, compared with rates of 68 percent and 71 percent for obstetrics care 

and pediatrics care, respectively. (See table 2.) Hospital officials also told 

us that inpatient psychiatric care beds were frequently not available in the 

greater New Orleans area and that psychiatric patients were the only type

of patients that had to be transferred out of the greater New Orleans area 

because of a lack of beds. For example, an official at one hospital reported

that since Hurricane Katrina the demand for psychiatric services has 

overwhelmed that hospital’s 15-bed psychiatric unit, and the hospital has 

had to house up to eight psychiatric patients in the emergency department 

at one time until psychiatric beds could be found in other facilities. An 

official at another hospital reported that sometimes psychiatric patients 

have stayed in the emergency department for several days until an 

inpatient psychiatric bed could be found for them somewhere else in 

Louisiana. An official at a third facility stated that the facility’s case 

workers frequently spent all day calling other facilities in the state looking 

for an inpatient psychiatric bed. In one case, workers made 39 telephone 

calls before locating a facility that would accept the patient. 

 18The five are Children’s Hospital, Ochsner Medical Center, Meadowcrest Hospital, Touro 

Infirmary, and West Jefferson Medical Center. 

Page 14 GAO-06-1003 Status of Hospitals in New Orleans
Table 2: Number of Available, Staffed, and Occupied Beds by Type of Care at 

Hospitals in the Greater New Orleans Area on April 25, 2006 

Type of care 

Available 

beds

Staffed 

beds

Occupied

beds 

Percentage

of occupied

to staffed 

beds

(occupancy 

rate)

Percentage

of occupied

to available 

beds

Adult critical care 320 306 295 96 92

Medical/surgical care 1,100 895 851 95 77

Obstetrics 165 138 94 68 57

Pediatrics 350 262 185 71 53

Psychiatric care 95 57 57 100 60

Other (rehabilitation, 

skilled nursing care, 

etc.) 298 220 206 94 69

Total 2,328 1,878 1,688

Source: GAO analysis of data provided by the hospitals in the greater New Orleans area. 

Occupancy rates increased following Hurricane Katrina not only because 

of the loss of staffed beds but also because patients on average have been 

staying in the hospital longer. According to hospital officials, the average

length of stay has increased by about one-half day because there is a 

shortage of facilities to which patients can be discharged, such as skilled 

nursing facilities and long-term care facilities. In addition, because of the 

extensive destruction of housing, many patients may not have appropriate

housing to which they can return. According to a recent report prepared 

for the Louisiana Recovery Authority Support Foundation, a single-day 

increase in the average length of stay drives occupancy rates up about 

15 percent.19

Recruiting, Hiring, and 

Retaining Hospital Staff 

Posed Significant 

Challenges 

Hospital officials reported that recruiting, hiring, and retaining nurses and

support staff, such as nursing aids, housekeepers, and food service 

workers, to staff the available beds constituted a great challenge. The

officials told us that the demand for nurses was greater than the supply 

because (1) many nurses left the greater New Orleans area during and 

after the storm, (2) there was an insufficient supply of suitable housing for 

 19PricewaterhouseCoopers, Report on Louisiana Healthcare Delivery and Financing 

System. 

Page 15 GAO-06-1003 Status of Hospitals in New Orleans
nurses, and (3) local nurses were being recruited by facilities outside the 

greater New Orleans area. According to officials, the hospitals have been 

able to reopen beds and keep them open by having employees work 

overtime and by paying higher salaries for permanent and temporary 

contract staff. However, a shortage of skilled workers remains. For 

example, an official at one hospital reported that the hospital had to 

temporarily suspend its open heart surgery program because of its 

inability to hire operating room nurses and technicians with experience in

open heart surgery, even after offering a salary increase of over 30 percent. 

Officials also stated that competition from nonhospital employers for 

unskilled workers made it difficult for the hospitals to hire and retain 

them. For example, whereas the average hourly rate for food service 

workers was about $7 per hour before Hurricane Katrina, fast food 

restaurants are currently offering about $12 per hour, with one restaurant

chain, for example, offering a signing bonus of about $6,000. 

Hospitals Reported High 

Demand for Emergency 

Department Services 

The hospitals that remained open after Hurricane Katrina have reported a 

high demand for services in their emergency departments. Data reported

by some of the hospitals20 showed that wait times for emergency medical 

service vehicles to move stable patients from the vehicle into the 

emergency department varied from no wait time at one hospital to almost 

40 minutes at another hospital for the 30 days between March 28 and 

April 26, 2006. During the same 30-day period, four of these hospitals 

reported that their emergency departments were occasionally at capacity

and therefore temporarily diverted patients to other facilities. The four 

emergency departments temporarily diverted patients 8 to 26 times; three 

of the departments reported being in diversionary status from 5 to 48 

hours. Over this same period, officials from six of the nine hospitals also 

reported that an average of 7 patients per day had to be housed in the 

emergency department until a hospital bed was available after a decision

had been made to admit them to the hospital.21 This ranged from 1 patient 

per day at one hospital to 18 patients per day at another hospital. 

 20We obtained information on emergency room wait times for 6 hospitals and the number

of times that 8 hospitals diverted patients to other facilities for the 30-day period from 

March 28, 2006, through April 26, 2006. 

21Two hospitals did not house any patients in their emergency departments. The remaining 

hospital did not answer the question on this topic. 

Page 16 GAO-06-1003 Status of Hospitals in New Orleans
By comparison, demand for emergency medical services in other parts of 

the country is also high. For example, the Institute of Medicine reported in

June 2006 that emergency department crowding was a nationwide 

problem, with numbers of visits having grown by 26 percent from 1993 to 

2003. The Institute of Medicine also reported that patients are often 

boarded in the emergency department for 48 hours or more until an 

inpatient bed became available.22 Furthermore, an April 2002 report 

conducted for the American Hospital Association found that officials at 

many hospitals in urban areas described their emergency departments as 

operating at or above capacity.23 In addition, we reported in March 2003 

that because of a lack of inpatient beds about 2 in 10 of the 1,489 hospitals

we surveyed temporarily diverted patients from their emergency 

department more than 10 percent of the time—or about 2.4 hours or more 

per day—and nearly 1 in 10 hospitals temporarily diverted patients from 

their emergency department more than 20 percent of the time—or about 

5 hours per day.24 In our March 2003 report, hospital officials cited 

economic reasons for the lack of inpatient beds, including financial 

pressures and the inability to staff the available beds because of difficulty 

in recruiting nurses or the increased cost of hiring contract nurses. We 

also reported that for about 1 in 5 hospitals the average time that patients

remained in the emergency department after a decision was made to admit 

them as inpatients or transfer them to other facilities was 8 hours or more. 

FEMA and LSU have prepared damage assessments and cost estimates for 

University and Charity hospitals. FEMA’s cost estimates for repairs at 

Charity and University hospitals are considerably lower than LSU’s 

estimates. While repairs are under way to reopen portions of University 

Hospital beginning this fall, as of July 2006, LSU had no plans to reopen 

Charity Hospital. Rather, LSU intends to pursue the possibility of building 

a new facility, in collaboration with VA. Meanwhile, LSU has established 

temporary facilities to provide some of the hospital functions previously 

provided by the two hospitals. For example, LSU established the MCLNO 

Steps Have Been 

Taken to Reopen 

University Hospital, 

but LSU Has No Plans 

to Reopen Charity 

Hospital 

 22Institute of Medicine of the National Academies, Future of Emergency Care: HospitalBased Emergency Care at the Breaking Point (Washington, D.C.: June 2006). 

23The Lewin Group, Emergency Department Overload: A Growing Crisis; The Results of 

the AHA Survey of Emergency Department (ED) and Hospital Capacity (Falls Church,

Va.: April 2002).

24See GAO, Hospital Emergency Departments: Crowded Conditions Vary among 

Hospitals and Communities, GAO-03-460 (Washington, D.C.: Mar. 14, 2003).

Page 17 GAO-06-1003 Status of Hospitals in New Orleans
Emergency Services Unit, which is located in a former department store, 

and opened a trauma center at the Elmwood Medical Center.

LSU’s Cost Estimates for 

Repairing Charity and 

University Hospitals Are 

Considerably Higher Than 

FEMA’s Estimates 

LSU’s cost estimates for repairing Charity and University hospitals are 

considerably higher than FEMA’s estimates. Shortly after Hurricane 

Katrina struck the greater New Orleans area, LSU hired ADAMS 

Management Services Corporation (ADAMS) to assess the condition of the 

two hospitals. In addition to identifying safety and health issues with 

respect to physical construction and deficiencies, ADAMS was tasked with 

recommending specific corrective measures, including cost estimates, to 

make it feasible to restore the hospitals to a usable condition. ADAMS 

completed its assessment in November 2005.25 According to the ADAMS 

assessment, Charity and University hospitals’ structural systems, such as 

columns, beams, and flooring, were in functional condition, although 

further testing would be required to verify this condition. However, the 

mechanical, electrical, and plumbing systems were beyond repair, and 

there were significant environmental safety problems. ADAMS estimated 

the repair costs at $257.7 million for Charity Hospital and $117.4 million 

for University Hospital. ADAMS also estimated replacement costs at 

$395.4 million for Charity Hospital and $171.7 million for University 

Hospital. On the basis of these estimates, ADAMS determined that repair 

costs exceeded 50 percent of the replacement costs for the two hospitals. 

As a result, LSU officials told us they believed that the hospitals met the 

Public Assistance program criteria for replacement funding and that LSU 

could obtain 90 percent of the estimated cost to replace Charity and 

University hospitals through the Public Assistance program. 

FEMA’s cost estimates for repairing the two hospitals, however, are 

considerably lower than LSU’s estimates. FEMA completed its initial 

damage assessment in December 2005. However, FEMA’s initial 

assessment did not include elevator repairs because the elevators were not 

accessible at that time. FEMA completed its assessment of the elevators in 

April 2006.26 Like the assessment ADAMS did for LSU, FEMA’s initial 

 25According to LSU officials in May 2006, this assessment, including the cost estimates, has

not changed. 

26FEMA also completed damage assessments for all buildings on the Charity and University 

campuses, such as Charity’s laundry building and University’s pediatrics emergency center. 

FEMA’s rationale for assessing these buildings is that they are needed to completely 

restore Charity and University services. LSU’s assessments did not include all these 

buildings. Therefore, for comparison purposes, we report only FEMA’s and LSU’s cost

estimates for the main hospitals on the University and Charity campuses. 

Page 18 GAO-06-1003 Status of Hospitals in New Orleans
assessment found mechanical, electrical, and plumbing damage, among 

other things. FEMA estimated the repair costs, including the elevator 

repair costs, at $27 million for Charity Hospital and $13.4 million for 

University Hospital. FEMA also estimated replacement costs at 

$147.7 million to $267.3 million for Charity Hospital and $57.4 million to 

$103.9 million for University Hospital. From these estimates, FEMA 

determined that the repair costs did not exceed 50 percent of the 

replacement costs for the two hospitals. (See table 3 for a comparison of 

LSU’s and FEMA’s repair and replacement estimates.) 

Table 3: LSU’s and FEMA’s Cost Estimates for Charity and University Hospitals 

LSU’s estimates FEMA’s estimates

Charity Hospital 

Repair estimate (in millions) $257.7 $27

Replacement estimate (in millions) $395.4 $147.7 - $267.3

Repair cost as a percentage of

replacement estimate 65% 10% - 18%

University Hospital 

Repair estimate (in millions) $117.4 $13.4

Replacement estimate (in millions) $171.7 $57.4 - $103.9

Repair cost as a percentage of

replacement estimate 68% 13% - 23%

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

Notes: FEMA also completed damage assessments for all buildings on the Charity and University 

campuses, such as Charity’s laundry building and University’s pediatrics emergency center. LSU’s 

assessments did not include all these buildings. Therefore, for comparison purposes, we report only 

FEMA’s and LSU’s cost estimates for the main hospitals on the University and Charity campuses. 

Significant factors contributing to the differences between FEMA’s and LSU’s cost estimates are 

(1) the scope of work included in the estimates and (2) whether a cost escalator was used in 

developing the estimates. 

Two significant factors contribute to the differences between LSU’s and 

FEMA’s cost estimates. First, LSU’s cost estimates cover whole building 

repair, meaning that they include costs for damage from Hurricane Katrina

and many deficiencies that had been identified before the hurricane. For 

example, LSU’s estimates include costs for installing fire-rated doors and 

frames in all exit corridors throughout University Hospital, the lack of 

which was identified in 2003 as a problem that needed to be addressed. In 

contrast, FEMA’s estimates for Charity and University hospitals cover the 

repair costs for damage from flooding and wind only, since these are the 

only repair costs eligible for federal reimbursement under the Public 

Assistance program. Prior deficiencies are generally not eligible for 

Page 19 GAO-06-1003 Status of Hospitals in New Orleans
reimbursement. Second, LSU’s estimates also included a 66 percent cost 

escalation over a commonly used index of labor and material for New 

Orleans. The cost escalation was meant to anticipate material and labor 

shortages over the next 3 to 6 years as a result of the hurricane. FEMA’s 

estimates, in contrast, did not include a cost escalation for labor and 

material. According to FEMA, three of the five bids for a recently awarded 

contract for the New Orleans Arena were below the federal government 

estimate. Based on those bids, FEMA concluded that a cost escalation for 

labor and material inflation was not justified. 

State officials disputed FEMA’s cost estimates of the hurricane damage to

Charity and University hospitals. LSU maintained that these hospitals are 

not repairable, as defined by federal regulation. Specifically, LSU 

maintained that the cost of repairing the hospitals to their predisaster 

condition exceeded 50 percent of the cost of replacing the hospitals and 

that it was not feasible to repair the hospitals so that they could perform 

the functions for which they were being used immediately prior to the 

disaster. In a November 2005 letter to Vice Admiral Thad Allen,27 LSU 

noted that “It is not feasible to repair these facilities to restore the design, 

function, and capacity, as well as all required code and standard upgrades,

at a reasonable cost.” LSU further suggested in the letter that FEMA’s 

estimated costs were too low, noting that FEMA’s estimates did not 

include all eligible expenses that might be incurred in completing the 

repairs, such as those associated with compliance with the Americans 

with Disabilities Act (ADA). For example, the ADAMS assessment includes 

accessibility upgrades to bring Charity and University hospitals into 

compliance with current ADA requirements, including upgrades to the 

restrooms, telephones, and drinking fountains. Officials from OFPC, which 

administers the design and construction of all Louisiana state-owned 

facilities damaged in Hurricane Katrina, also told us that FEMA’s estimates 

for the two hospitals were too low and did not reflect the current market 

conditions (i.e., the shortage of labor and material). Officials from both 

LSU and OFPC provided several examples of FEMA’s underestimating the 

costs of repairs for facilities in the greater New Orleans area. For example, 

FEMA estimated the costs for repair to the engineering building on the 

University of New Orleans campus at about $286,000. The contract was 

awarded for about $689,000. However, FEMA officials cautioned against 

 27Vice Admiral Allen was the Federal Coordinating Officer for FEMA at the Joint Field 

Office in Baton Rouge. As of May 25, 2006, he assumed the duties of Commandant of the

U.S. Coast Guard. 

Page 20 GAO-06-1003 Status of Hospitals in New Orleans
using differences in estimated and actual repair costs for other facilities as 

benchmarks for comparing or adjusting the estimates for Charity and 

University hospitals, noting that each facility and its associated estimate 

are unique.

To help reconcile FEMA’s and LSU’s cost estimates, FEMA officials 

suggested that LSU select a few projects at Charity Hospital and put them 

out for bid. According to FEMA officials, this process would provide 

actual repair costs and could serve as a baseline for adjusting LSU’s or 

FEMA’s estimates as needed. FEMA officials noted that some repair 

projects at Charity Hospital would be necessary even if LSU opted to 

replace, not repair, the facility. Officials from LSU and OFPC told us that 

they questioned whether this would be the best use of time and resources, 

however, especially since they said they did not believe that restoring 

Charity Hospital to its predisaster condition would adequately meet the 

health care needs of the community. However, a senior OFPC official told

us that OFPC would evaluate whether some repairs were necessary to 

prevent further deterioration of the facility.28

FEMA has begun the process of obligating funds based on its assessments. 

As of June 16, 2006, FEMA had obligated about $21.5 million for repairs to 

Charity Hospital and $14.3 million for repairs to University Hospital. The 

funds are allocated to Louisiana’s Office of Homeland Security and 

Emergency Preparedness (i.e., the grantee), which then distributes the 

funds to LSU (i.e., the applicant) for reimbursement for the costs of 

repairing Charity and University hospitals. 

 28Although state officials dispute FEMA’s cost estimates, LSU did not file an appeal. 

According to FEMA guidance, applicants, such as LSU, may appeal FEMA’s decisions

regarding the provision of assistance, such as FEMA’s cost estimates, to FEMA. The

applicant (i.e., LSU) must file its appeal with the state within 60 days of receipt of a notice 

of the action that is being appealed. In turn, the state has a limited amount of time to 

review the appeal and submit a recommendation on the merits of the appeal to FEMA. 42

U.S.C. § 5189a(a)(2000). According to a FEMA official, FEMA considers the notice of action 

the date federal obligations begin. Federal obligations for University and Charity hospitals 

started this spring, and therefore the 60-day window for appeal has expired. 

Page 21 GAO-06-1003 Status of Hospitals in New Orleans
At the time of our visit in May 2006, repairs to University Hospital were 

under way, and portions of the facility were expected to reopen by late 

September or early October 2006, with the remainder of the facility 

expected to open by the end of the year. Initially, LSU officials had hoped 

to reopen a portion of the facility by the end of June 2006. However, 

according to LSU officials, estimates for reopening a portion of the facility 

in June—which assumed a 75-day construction schedule—were optimistic 

given the amount of repair work needed. An official from OFPC told us 

that several contractors estimated it would take 180 days to complete the 

work, which was more than 3 months longer than LSU requested. LSU and 

the winning contractor ultimately negotiated a 120-day construction 

schedule. According to this new schedule, LSU plans to reopen portions of 

University Hospital, including inpatient beds, a pharmacy, and a blood 

bank, in fall 2006. In addition, LSU plans to convert space on the first floor 

of the hospital for a Level I trauma center. This work is scheduled to be 

completed by the end of 2006. However, officials from LSU and OFPC 

stated that the schedule is subject to change, depending on the availability 

of resources and the ability of the contractor to complete the repair work 

on time.29 In addition, although LSU plans for University Hospital to be 

fully operational by the end of the year, a senior LSU official told us that 

LSU is pursuing the possibility of a new hospital that would allow it to 

close University Hospital in the future. According to this official, the 

building is near the end of its useful life. 

Repairs to University 

Hospital Are Under Way,

and LSU Is Pursuing the 

Possibility of a New 

Facility to Replace Both 

Charity and University 

Hospitals in the Future 

While repairs to University Hospital are under way, LSU currently has no 

plans to reopen Charity Hospital. Charity Hospital sustained significant 

damage as a result of Hurricane Katrina, in large part because of the 

flooding that occurred in the basement. In addition, according to officials

from LSU and OFPC, the facility was antiquated prior to Hurricane Katrina 

and was not well suited for a modern acute care medical facility. As a 

result, LSU does not want to invest significant resources in repairing the 

facility and would prefer to invest available funding in constructing a 

replacement facility. If LSU decides to replace Charity Hospital, LSU is 

authorized under the Public Assistance program to use funds approved for 

repair, including the $21.5 million already obligated, on a replacement 

facility. However, the amount eligible for reimbursement cannot be greater 

than 90 percent of FEMA’s initial cost estimates for repairs. 

 29To encourage the timely completion of work, LSU’s contract includes a provision for 

$1,800-per-day payment by the contractor for each calendar day past the scheduled 

completion date. 

Page 22 GAO-06-1003 Status of Hospitals in New Orleans
Prior to Hurricane Katrina, LSU had decided to support the construction 

of a new facility to replace both University and Charity hospitals, and it 

was seeking funding for the project when the storm occurred. LSU 

continues to support this option and has taken some initial steps, in 

collaboration with VA, to plan for a new facility. Like LSU’s Charity and 

University hospitals, VA’s New Orleans Medical Center sustained 

extensive damage as a result of Hurricane Katrina, and VA has determined 

that the existing facility is no longer suited for providing patient care. As a 

result, VA is also proposing to construct a new facility.30 LSU and VA 

formed the Collaborative Opportunities Study Group (COSG) to study 

options for constructing a new joint hospital facility. In its June 2006 

report, COSG recommended a “collaborative complex”—that is, separate 

VA and LSU bed towers connected by a corridor that houses facilities and 

services used by both entities. According to the June report, a 

collaborative complex would be more cost-effective than LSU and VA 

operating stand-alone facilities.31

LSU Has Established 

Temporary Facilities to 

Provide Public Hospital 

Functions 

Following Hurricane Katrina, LSU established several temporary facilities 

in order to continue to meet the health care needs of the population 

currently in the greater New Orleans area and to continue to fulfill LSU’s 

mission of providing care to the uninsured. Two key temporary facilities 

are the MCLNO Emergency Services Unit and the trauma center at the 

Elmwood Medical Center. The MCLNO Emergency Services Unit is located 

in a former department store in downtown New Orleans. It was originally 

established in the parking lot of University Hospital in October 2005. The 

facility was moved to the Ernest N. Morial Convention Center in 

November 2005 and eventually to its current location in March 2006. 

 30The Emergency Supplemental Appropriations Act for Defense, the Global War on Terror,

and Hurricane Recovery, 2006 provided VA with an additional $585.9 million for the

construction of major projects for necessary expenses related to the consequences of

Hurricane Katrina and other hurricanes of the 2005 season. Pub. L. No. 109-234, 120 Stat. 

418, 468. Portions of this funding could be used for a new VA medical center in New 

Orleans. 

31The COSG report also recognized key issues and challenges that must be addressed for 

the joint venture between LSU and VA to move forward, such as VA’s obtaining authorizing 

legislation. In our April 2006 report that examined the proposed joint ventures between VA

and its medical affiliates in Charleston and Denver, we also identified potential challenges 

with such partnerships, including institutional differences between VA and its medical 

affiliates and balancing funding priorities. See GAO, VA Health Care: Experiences in

Denver and Charleston Offer Lessons for Future Partnerships with Medical Affiliates, 

GAO-06-472 (Washington, D.C.: Apr. 28, 2006). 

Page 23 GAO-06-1003 Status of Hospitals in New Orleans
According to LSU officials, the MCLNO Emergency Services Unit provides 

a variety of outpatient services, including minor emergency services, 

dental care, radiology services, and services for victims of sexual assault, 

among others. According to LSU officials, the facility is not equipped to 

provide major emergency services. In order to accommodate the services

being provided, LSU set up cubicles and tents to serve as treatment rooms, 

storage, conference rooms, and offices. LSU plans to close the MCLNO 

Emergency Services Unit in October 2006, when University Hospital is 

reopened. 

LSU is also leasing space for a trauma center from the Ochsner Clinic 

Foundation at its Elmwood Medical Center. LSU opened the facility on 

April 24, 2006, to provide the trauma services previously provided at 

Charity Hospital. Charity Hospital served as the only Level I trauma center 

in the region.

32 According to LSU officials, the trauma center at Elmwood 

Medical Center houses a blood bank, laboratory, pharmacy, and treatment 

rooms, among other things. In addition, computed tomography and 

magnetic resonance imaging services are provided in mobile trailers on 

the grounds of the facility. LSU’s lease for this space expires at the end of

2006. 

HHS officials said that the agency’s efforts to restore hospitals’ health care 

infrastructure following Hurricane Katrina included financial assistance, 

technical assistance, and waivers that allow exceptions to some program 

requirements. HHS financial assistance included two opportunities for 

hospitals to receive additional funds for infrastructure repair—SSBG33 that

may be used to repair or rebuild health care facilities, and a Medicare 

extraordinary circumstances exception that allows damaged hospitals to 

receive payment for capital costs. SSBG funds generally cannot be used 

for construction; however, the Department of Defense, Emergency

HHS Has Provided 

Financial and 

Technical Assistance 

and Program Waivers 

to Help Address 

Restoration 

 32According to a senior LSU official, LSU’s trauma center at the Elmwood Medical Center

does not have Level I status because it is considered a temporary facility. 

33SSBG funds are allocated to the 50 states, the District of Columbia, the Commonwealth of

Puerto Rico, and the territories of Guam, American Samoa, the Virgin Islands, and the 

Northern Mariana Islands to furnish social services best suited to meet the needs of the 

individuals residing within the jurisdiction. Jurisdictions receive block grants and 

determine what services are provided, the eligible categories and populations of adults and 

children, the geographic areas of the jurisdiction in which each service will be provided, 

and whether the services will be provided by jurisdiction, state, or local agency staff or 

through grants or contracts with private organizations. 42 U.S.C. §§ 1397 et seq. (2000). 

Page 24 GAO-06-1003 Status of Hospitals in New Orleans
Supplemental Appropriations to Address Hurricanes in the Gulf of Mexico, 

and Pandemic Influenza Act, 2006, enacted December 30, 2005, specifically 

authorized the use of SSBG funds appropriated by that act for the repair, 

renovation, and construction of health facilities.34 The act appropriated an 

additional $550 million to the SSBG program, from which HHS designated

about $221 million for Louisiana in February 2006. 

In addition, four applications were submitted to CMS for assistance to 

hospitals in the greater New Orleans area under the Medicare 

extraordinary circumstances exception, which provides additional 

payments for unanticipated capital expenditures that exceed $5 million 

(after taking into account proceeds from other sources, such as insurance

or FEMA aid) and result from extraordinary circumstances, such as 

hurricanes. The provision does not provide a lump sum payment up front;

instead, it allows eligible hospitals that serve Medicare patients to 

depreciate the cost of the unanticipated capital expenditures over the life 

of the asset, once repairs have been made.35 Charity and University 

hospitals (submitting a joint application), East Jefferson General Hospital, 

Tulane University Hospital and Clinic, and Ochsner Medical Center have 

applied for this funding. As part of the approval process, HHS requested 

that each hospital provide a plan and a schedule for submission of 

documents to support its exception request. As of June 8, 2006, only 

Charity and University hospitals had provided estimates of their expected

capital expenditures, which they set at approximately $900 million, an 

HHS official said. 

HHS technical assistance to Louisiana related to restoration of the health

care infrastructure includes both ongoing and planned technical 

assistance.36 Since Hurricane Katrina, HHS has assigned staff members to 

assist hospitals and other state and local entities in Louisiana in evaluating

 34Pub. L. No. 109-148, 119 Stat. 2680, 2768. 

35For most hospitals, the payments under the extraordinary circumstances exception are

based on 85 percent of Medicare’s share of allowable capital costs attributed to the

extraordinary circumstance. If approved by CMS, the qualifying hospitals will receive funds 

for extraordinary capital expenditures, based on a formula that considers such things as 

each hospital’s normal payments through the Medicare Prospective Payment System. 

Qualifying hospitals request the depreciation payments on their Medicare cost reports after 

the repairs have been made. 

36HHS does not have a separate budget for technical assistance. Generally, the cost of

technical assistance activities was absorbed by the various agencies within HHS, an official 

said.

Page 25 GAO-06-1003 Status of Hospitals in New Orleans
health care challenges and identifying available resources. For example, 

HHS staff members did the following: 

• Provided consultation services at Orleans Parish health planning 

committee meetings that addressed shortages of staff, hospital beds, and

funding. As a result, an immediate need for registered nurses was 

identified, and HHS, in coordination with VA, made arrangements for 12 to

20 registered VA nurses on 2- to 4-week rotations through mid-April 2006 

to provide emergency room, medical-surgical, and intensive care unit 

services at Tulane University Hospital and Clinic. 

• Conducted joint weekly teleconferences beginning in January 2006 with 

the Joint Commission on Accreditation of Healthcare Organizations, state 

survey agencies, and hospital and other health care providers to 

coordinate the application of accreditation standards for hospitals that 

were providing care in temporary facilities or in facilities damaged by the 

hurricanes. 

• Facilitated meetings between St. Bernard Parish and a nonprofit medical 

center that led to the opening of a new primary and urgent care facility in

April 2006 after the parish lost all its health care facilities during Hurricane 

Katrina. 

Additionally, since Hurricane Katrina, HHS officials have chaired two 

federal interagency working groups, the President’s Health Care: Chronic 

Care and Facilities Restoration Workgroup and HHS’s Gulf Coast 

Recovery Working Group. The President’s Health Care: Chronic Care and

Facilities Restoration Workgroup produced two major working papers in 

2006, a summary of the federal payments available for providing health

care services and rebuilding health care infrastructure after Hurricane 

Katrina and a document that sets out guiding principles for the federal 

government in the rebuilding process.37 The federal payments summary 

served as the basis for two all-day interagency workshops in New Orleans 

on January 10, 2006, and February 9, 2006, sponsored by HHS and 

Louisiana, for local and regional health care providers and elected officials 

to identify information about available federal resources and to provide 

technical assistance in accessing them. While the President’s Health Care:

Chronic Care and Facilities Restoration Workgroup has disbanded, many 

 37The documents are Summary of Federal Payments Available for Providing Health Care

Services to Hurricane Evacuees and Rebuilding Health Care Infrastructure and Federal 

Principles for Rebuilding the Healthcare Infrastructure in the Gulf States. 

Page 26 GAO-06-1003 Status of Hospitals in New Orleans
of its members have been included in meetings of the Gulf Coast Recovery 

Working Group. The Gulf Coast Recovery Working Group is an HHS stafflevel group that meets regularly to resolve issues and offer advice on how 

to improve HHS programs supporting the recovery efforts. The Gulf Coast 

Recovery Working Group also began working with the Department of 

Homeland Security’s Office of the Federal Coordinator for Gulf Coast 

Rebuilding shortly after the office was established on November 1, 2005,

by Executive Order 13390 to lead the federal response.38 The Gulf Coast 

Recovery Working Group reports to the HHS Secretary and provides input 

to, and coordinates on a policy level with, the Federal Coordinator. 

Planned technical assistance is part of a broader effort to redesign the 

entire continuum of Louisiana’s health care delivery system, from primary 

care clinics to the restoration of hospital inpatient care and emergency

department services in the greater New Orleans area, HHS officials said. 

HHS plans to provide technical assistance to the Louisiana Healthcare 

Redesign Collaborative (Collaborative), a state and locally led effort to 

redesign the health care delivery system in Louisiana, including the 

existing hospital system.39 HHS’s Office of the Secretary expects to provide 

technical staff, guidance, and funds to support the redesign effort. In an 

address before the Louisiana state legislature on April 25, 2006, the 

Secretary of HHS committed to participating in the redesign effort but 

emphasized that the redesign effort must be locally led and governed 

according to guiding principles endorsed by all participants. A charter, 

signed July 17, 2006, places the Collaborative under the authority of the 

Louisiana Department of Health and Hospitals and includes guiding 

principles. To help coordinate technical assistance from HHS to the 

Collaborative, HHS has hired a full-time senior advisor to the Secretary of

HHS and plans to provide part-time staff from across HHS agencies. HHS 

officials said that the agency expected to work with the Collaborative to 

develop a health care system recovery proposal that could include 

 38The executive order referred to this position as Coordinator of Federal Support for the

Recovery and Rebuilding of the Gulf Coast Region. 

39In June 2006 the Louisiana Legislature approved House Concurrent Resolution No. 127, 

creating the Louisiana Healthcare Redesign Collaborative to serve as an advising body to 

the Secretary of the Department of Health and Hospitals for the development of

recommendations and plans for the redesign of the greater New Orleans area health care 

system. 

Page 27 GAO-06-1003 Status of Hospitals in New Orleans
requests for Medicare demonstrations and Medicaid waivers.40 HHS 

officials said that they expected that the redesign effort would produce a 

more efficient and effective health care delivery system in Louisiana. HHS 

officials noted that prior to Hurricane Katrina, Louisiana had one of the

most expensive health care systems in the United States, but that it 

generally ranked close to the bottom among states in terms of health care 

quality indicators. 

The Secretary of HHS has waived or modified various statutory and 

regulatory requirements to assist hospitals and other health care providers 

in states in which he had declared a public health emergency. For 

example, certain Medicare billing and other requirements were waived or

modified to accelerate Medicare payments in the hurricane-affected states, 

including Louisiana. Under the waivers, HHS has 

• paid hospitals the inpatient acute care rate for Medicare patients that 

remained in a hospital but no longer required acute level care, until the 

patient could be discharged to an appropriate facility; 

• relaxed the data requirements to substantiate payment to the provider 

when a facility’s records were destroyed; 

• allowed hospitals to have a responsible physician (e.g., the chief of 

medical staff or department head) sign an attestation of services provided 

when the attending physician could not be located; and 

• instructed its payment processing contractors to immediately process 

requests for accelerated payments for health care providers, including 

hospitals, affected by the hurricane.

In addition, after HHS received inquiries concerning whether hospitals 

could provide free office space, low interest or no interest loans, or other 

arrangements to assist physicians displaced by Hurricane Katrina, the 

Secretary permitted CMS to waive sanctions for violations of the physician

 40CMS conducts and sponsors Medicare demonstration projects to test and measure the

effect of potential program changes. Demonstrations study the likely impact of new 

methods of service delivery, coverage of new types of services, and new payment 

approaches on beneficiaries, providers, health plans, states, and the Medicare trust fund. 

Medicaid waivers allow states flexibility in operating Medicaid programs and include

waivers that test policy innovations or that allow states to implement managed care

delivery systems. 

Page 28 GAO-06-1003 Status of Hospitals in New Orleans
self-referral prohibition, known as the Stark Law,41 through January 31,

2006. This time-limited relief concerns statutory prohibitions against a 

physician referring Medicare patients to an entity with which the physician 

or a member of the physician’s immediate family has a financial 

relationship. HHS officials said that a waiver had been approved for one 

hospital in the greater New Orleans area for one physician. 

HHS officials said that few HHS programs or activities are designed to help

address the restoration of hospital inpatient care and emergency 

department services in the greater New Orleans area. The department 

does not have broad authority to respond to the needs of hospitals 

affected by a disaster, HHS officials said. They cited several issues that 

limit the agency’s ability to provide this type of assistance. First, agency 

officials emphasized that HHS’s role in financing health care services does

not easily translate into providing restoration assistance after a disaster. 

Second, HHS must consider whether proposed responses to problems 

identified in the greater New Orleans area could adversely affect other 

areas of the country. For example, Louisiana has requested that HHS 

adjust the wage index used in determining Medicare prospective payments 

to hospitals to account for the higher wages that must be paid to attract or 

maintain health care workers, including nurses and physicians, in the 

greater New Orleans area. However, HHS officials said that by law, 

changes to the wage index must be “budget neutral.” Practically, this 

means that if the wage index is increased for the greater New Orleans 

area, then the wage index must be decreased for another area, HHS 

officials said. 

We sent a draft of this report for comment to DHS, HHS, VA, and the State 

of Louisiana. Excerpts from it were also sent to LSU for comment. HHS 

agreed with the draft report, and its comments are included as appendix II. 

VA informed us by e-mail that it agreed with the draft report. DHS also 

responded by email and informed us that it had no formal comments on 

the draft report. DHS, HHS, and VA also provided technical comments, as 

did Louisiana’s Department of Health and Hospitals through an e-mail 

response. We considered all technical comments and incorporated those 

that were appropriate. LSU did not provide comments. 

Agency Comments 

 4142 U.S.C. § 1395nn (2000). 

Page 29 GAO-06-1003 Status of Hospitals in New Orleans
We are sending copies of this report to the Secretaries of Homeland 

Security, Health and Human Services, and Veterans Affairs and other 

interested parties. We will also make copies available to others on request. 

In addition, the report is 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 Terrell G. Dorn at (202) 512-6923 or 

dornt@gao.gov for issues related to medical facilities and FEMA. GAO 

staff members who made significant contributions to this report are listed 

in appendix III. 

Cynthia A. Bascetta Terrell G. Dorn, PE 

Director, Health Care Director, Physical Infrastructure 

Page 30 GAO-06-1003 Status of Hospitals in New Orleans
List of Congressional Committees

The Honorable Susan M. Collins 

Chairman 

The Honorable Joseph I. Lieberman 

Ranking Minority Member 

Committee on Homeland Security and Governmental Affairs 

United States Senate 

The Honorable Charles E. Grassley 

Chairman 

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 Daniel K. Akaka 

Ranking Minority Member 

Committee on Veterans’ Affairs 

United States Senate 

The Honorable Thomas M. Davis 

Chairman 

The Honorable Henry A. Waxman 

Ranking Minority Member 

Committee on Government Reform 

House of Representatives 

The Honorable Bennie G. Thompson

Ranking Minority Member 

Committee on Homeland Security 

House of Representatives 

The Honorable John D. Dingell 

Ranking Minority Member 

Committee on Energy and Commerce 

House of Representatives 

Page 31 GAO-06-1003 Status of Hospitals in New Orleans
The Honorable Lane Evans 

Ranking Minority Member 

Committee on Veterans’ Affairs 

House of Representatives 

The Honorable Nancy L. Johnson 

Chairman 

Subcommittee on Health

Committee on Ways and Means 

House of Representatives 

Page 32 GAO-06-1003 Status of Hospitals in New Orleans
Appendix I: Scope and Methodology Appendix I: Scope and Methodology 

To examine the availability of hospital inpatient care and the demand for 

emergency department services, we contacted nine operating public and

private hospitals in the greater New Orleans area.

1

 We randomly selected 

one day—April 25, 2006—and asked hospital officials to provide 

information on the number of available, staffed, and occupied beds2

 for 

that day, by type of patients served, such as critical care, medical and

surgical, and pediatrics. We later asked for the number of available,

staffed, and occupied beds for the entire month of April; however, only 

five hospitals responded to this request. From the hospital officials we also 

obtained estimates of the occupancy rates for the 12-month period prior 

to, and the 9-month period following, Hurricane Katrina for 8 of the 9 open 

hospitals. We weighted the estimated hospital occupancy rates by the 

number of staffed beds to obtain a weighed average. Further, we asked 

about plans to open more beds and about emergency department services 

provided for the 30-day period from March 28, 2006, through April 26, 

2006.

3

 We conducted telephone interviews with senior officials from seven 

of the nine hospitals to clarify information provided in their written 

responses to our survey.4

 We did not independently verify the data the 

hospitals provided on bed availability and the amount of emergency care 

provided. To determine the April 2006 population of the four parishes in 

the greater New Orleans area, we used estimates from the Louisiana 

Department of Health and Hospitals Bureau of Primary Care and Rural 

Health, which used two methodologies to estimate the population in each 

of the parishes. It used school enrollment data for Jefferson, St. Bernard, 

and Plaquemines parishes; and for Orleans Parish it used a survey of 

persons occupying residential structures. The survey had been conducted

by the New Orleans Health Department in consultation with the Centers 

for Disease Control and Prevention. We limited our work to examining the 

 1

Ten hospitals were operating at the time of our study, but we did not include Elmwood 

Medical Center in our survey because it is a temporary facility that opened on April 24, 

2006, after our survey began. 

2

Available beds are beds that are licensed, set up, and available for use. These are beds

regularly maintained in the hospital for patient use with supporting services, such as food,

laundry, and housekeeping. Available beds may or may not be staffed. Staffed beds are

available beds for which staff are on hand to attend to the patients who occupy the beds. 

Staffed beds may or may not be occupied. Occupied beds are staffed beds that are being

used by patients. 

3

We obtained information on emergency room wait times for 6 hospitals and the number of 

times that 8 hospitals diverted patients to other facilities for the 30-day period from 

March 28, 2006, through April 26, 2006. 

4

Officials from two of the hospitals did not respond to our request for an interview. 

Page 33 GAO-06-1003 Status of Hospitals in New Orleans
Appendix I: Scope and Methodology 

status of hospital inpatient and emergency departments in the greater New 

Orleans area and did not examine other aspects of hospital services, such 

as outpatient services or the financial condition of the hospitals. We also 

did not address other issues related to the health care system, such as the 

status of primary care, medical research, or graduate medical education.

To examine the Federal Emergency Management Agency (FEMA) and 

Louisiana State University (LSU) efforts to reopen Charity and University 

hospitals,5

 we reviewed LSU and FEMA damage assessments and cost 

estimates for the facilities, FEMA regulations and guidance, and the 

Department of Veterans Affairs’ (VA) damage assessment of its medical 

center in New Orleans. We toured Charity and University hospitals and the 

temporary facilities LSU has established to provide hospital outpatient 

care and emergency department services. We interviewed officials from 

FEMA; LSU (including LSU’s Health Care Services Division that manages 

the public hospitals in the greater New Orleans area); VA because it is 

considering building a joint hospital complex with LSU in New Orleans; 

the Louisiana Recovery Authority because it is the planning and 

coordinating body that was created in the aftermath of Hurricane Katrina 

by the Governor of Louisiana to plan for recovery and rebuilding efforts; 

and Louisiana’s Office of Facility Planning and Control because it is 

administering the design and construction of all Louisiana state-owned 

facilities damaged by Hurricane Katrina. We did not independently verify 

the damage assessments prepared by FEMA and LSU. We limited our 

review to the efforts to restore state-owned public hospital facilities. 

To determine the activities that the Department of Health and Human 

Services (HHS) has undertaken to help hospitals recover in the greater 

New Orleans area, we interviewed officials in various HHS agencies, 

including officials in the Centers for Medicare & Medicaid Services 

headquarters and Dallas and Atlanta regional offices, the Health Resources 

and Services Administration, the Administration for Children and Families, 

and the Office of Public Health Emergency Preparedness. Additionally, we

reviewed documents and summaries outlining HHS programs and 

activities related to helping restore hospital inpatient care and emergency

department services after a disaster. Finally, we reviewed applicable 

federal law and regulations. 

 5

While part of the statewide LSU public hospital system, Charity and University hospitals 

make up the Medical Center of Louisiana at New Orleans. 

Page 34 GAO-06-1003 Status of Hospitals in New Orleans
Appendix I: Scope and Methodology 

We conducted our work from April 2006 through September 2006 in 

accordance with generally accepted government auditing standards. 

Page 35 GAO-06-1003 Status of Hospitals in New Orleans
Appendix II: Comments from the Department Appendix II: Comments from the Department of Health and Human Services 

of Health and Human Services 

Page 36 GAO-06-1003 Status of Hospitals in New Orleans
Appendix II: Comments from the Department 

of Health and Human Services 

Page 37 GAO-06-1003 Status of Hospitals in New Orleans
Appendix II: Comments from the Department 

of Health and Human Services 

Page 38 GAO-06-1003 Status of Hospitals in New Orleans
Appendix III: GAO Contacts and Staff Acknowledgments 

Page 39 GAO-06-1003 

Appendix III: GAO Contacts and Staff 

Acknowledgments 

Cynthia A. Bascetta (202) 512-7101 or bascettac@gao.gov 

Terrell G. Dorn (202) 512-6923 or dornt@gao.gov

In addition to the contacts named above, key contributors to this report 

were Michael T. Blair, Jr., Assistant Director; Nikki Clowers, Assistant 

Director; Karen Doran, Assistant Director; Jonathan Ban; Michaela Brown; 

Nancy Lueke; Roseanne Price; and Cherie Starck.

Status of Hospitals in New Orleans

GAO Contacts 

Acknowledgments 

(290542) 
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