Hurricane Katrina is still killing people almost two years after it struck.
Or is it?
There's some disagreement in the medical community -- though the closer one gets to local front-line caregivers, the stronger the consensus becomes that the storm continues to claim the lives of those who survived the immediate destruction.
The controversy erupted last week when the Louisiana Department of Health and Hospitals released a study by State Epidemiologist Dr. Raoult Ratard -- which DHH acknowledged was conducted "[i]n response to concerns about an increased death rate in Louisiana post-Katrina" -- that claimed to show the death rate in the Greater New Orleans area dropped during the first 10 months of 2006 compared to the 44 months prior to the storm. That area includes Orleans, Jefferson, St. Bernard, Plaquemines, St. James, St. John, St. Charles, St. Tammany, Tangipahoa and Washington parishes.
However, the study found that Orleans Parish actually observed what the author characterized as a "slight increase" in the number of deaths during the first quarter of 2006. But that increase was from 11.3 deaths per 1,000 people to 14.3 deaths per 1,000 -- which is hardly "slight," as New Orleans Health Department Director Dr. Kevin Stephens Sr. explained to the Associated Press:
"Slight, that's more than a 25 percent increase in the mortality rate in Orleans Parish," Stephens said. "That's a tremendous increase, a huge increase. And that's almost twice the national average."
The average mortality rate for the nation as a whole is 8.1 deaths per 1,000, according to the U.S. Centers for Disease Control and Prevention. Even before Katrina, Louisiana had one of the poorest health profiles in the nation, and the storm destroyed hospitals and clinics while leaving even more Louisianans impoverished and uninsured, as noted last year in a report (PDF) from the Joint Center for Political and Economic Studies.
One big problem with Louisiana's mortality study is it examined only state death certificates and thus failed to account for displaced residents who died elsewhere. Stephens has conducted research based on the number of obituaries since Katrina that indicates a 47 percent increase in the area's death rate. New Orleans Mayor Ray Nagin cited Stephens' statistics while discussing the health care crisis in his May 30 State of the City address, his first since Katrina. Stephens' study is scheduled to be published later this month in Disaster Medicine and Public Health Preparedness, a new journal from the American Medical Association.
Stephens' claims are supported by anecdotal evidence from physicians including Dr. Patrick Breaux, a cardiologist who has cared for residents of Orleans and St. Bernard parishes for 30 years. The AP reported that Breaux "watched with dismay" as his patients' obituaries began popping up in the local newspaper, and he called it "wrong" to say there was no increase in the death rate without examining all the information.
Meanwhile, Orleans Parish coroner Dr. Frank Minyard raised questions about the timing of the state's study:
"I don't know if they released this study with any ulterior motives, but I think it's suspicious that they would release it now," Minyard said. "We have been telling the state that we have people who can't get medical care, can't get psychiatric care. This might even influence the decision on rebuilding Charity Hospital."
In another AP story on the mortality controversy, Dr. Ronald Kessler -- professor of health care policy at Harvard Medical School and head of a group that's monitored 3,000 displaced Katrina survivors -- said reconstructing an individual's mental and physical state before death might help in determining exact causes of death.
Indeed, local mental health professionals tell the AP that they're encountering more people with psychological problems, which in turn affect overall health:
"We're seeing triple the number of people with mental health problems as we were before Katrina," said Leah Hedrick, social worker at Ochsner Hospital. "Depression, suicidal, anxiety, abuse of drugs and alcohol, and along with that comes a lot more physical problems."