LSU Health Sciences Center New Orleans Department of Radiology

This case study chronicles the impact of Hurricane Katrina on the Department of Radiology at the Louisiana State University School of Medicine in New Orleans and the department’s subsequent efforts to recover and re-dedicate itself to providing quality patient care and resident education. Hurricane Katrina damaged the department’s facilities, severely decreased departmental cash flow, disrupted resident education, and resulted in faculty exodus. Because of the “catastrophic loss of resources” suffered by the department, the Accreditation Council for Graduate Medical Education (ACGME) proposed expedited withdrawal of accreditation for the Diagnostic Radiology Residency Program, to which the department agreed. Since Katrina, the program has taken steps toward regaining its pre-Katrina status as a successful residency program that produced satisfied, successful residents. These steps include the appointment of a new department head of radiology, the recruitment of academic directors for each of the nine subspecialties, the reopening of the University Hospital, and the growth of annual procedure volume. All institutions face the possibility of a natural disaster. It is imperative to have a plan in place to ensure continued resident education, patient safety, and ACGME accreditation.

Hurricane Katrina, one of the most deadly and most expensive hurricanes ever to hit the United States, made landfall slightly east of New Orleans early on Monday, August 29, 2005. The storm and its surge breached more than 50 canal levees, causing 80% of the city of New Orleans to become flooded by Wednesday, some areas with up to 15 feet of water. More than 90% of the city’s residents were forced to evacuate. The impact of Hurricane Katrina was far reaching and extended beyond the parish boundaries. It is estimated that complete recovery will cost billions of dollars and take many more years. This case study documents the impact of Katrina on the Department of Radiology at the Louisiana State University (LSU) School of Medicine in New Orleans.

Before Katrina, LSU radiology had a large, successful residency program with dedicated faculty members, modernized facilities, and strong finances. The radiology program had a complement of approximately 30 residents, along with clinical fellows in programs approved by the Diagnostic Radiology Residency Review Committee (RRC) in neuroradiology, vascular and interventional radiology, and musculoskeletal radiology. LSU radiology’s primary practice site was at the Medical Center of Louisiana in New Orleans (MCLNO), one of several hospitals within the LSU public hospital network (LSU Health Care Services Division [HCSD]). MCLNO was composed of two campuses, Charity Hospital and University Hospital, located within 1 mile of each other. The department also provided services at Kenner Regional Medical Center and some imaging services at the New Orleans Veterans Affairs Medical Center. Residents rotated through these other hospitals, as well as New Orleans Children’s Hospital. Faculty members included approximately 28 full-time clinical radiologists (not including one faculty member appointed to the dean’s staff who remained clinically active), along with two full-time research faculty members and one full-time and one part-time physicist. The LSU Diagnostic Radiology Residency Program was granted a 5-year review cycle on the basis of an Accreditation Council for Graduate Medical Education (ACGME) site visit on April 4, 2003, and routinely produced satisfied, successful residents who pursued both academic and community practice opportunities.

Katrina’s impact on LSU radiology

In the days leading up to Hurricane Katrina, some senior residents volunteered to take a code gray call, believing that this hurricane would be no different from those that had recently preceded it. Volunteering for a code gray call was considered a privilege, because residents who served a 24- to 48-hour code gray call were those considered the most versatile and capable (and they were also entitled to time off in the coming days to sort out whatever aftereffects of the storm might be left behind). Tropical storms and hurricanes are a common occurrence along the entire Gulf Coast; most citizens of this area had experienced such weather occurrences in the past, and although evacuation was commonplace for lay citizens, hospital evacuations were not planned for or undertaken. In recent hurricane scares, routine hospital operations had been suspended for 24 to 48 hours during voluntary evacuations of the city proper. However, in the days leading up to landfall, there was widespread concern that Katrina was bigger and potentially more devastating than its recent predecessors; satellite imagery revealed that Katrina filled the entire Gulf of Mexico. As such, neither the hospital nor the department had a formal evacuation plan in place. Essentially all the radiology residents and faculty members not in house for the code gray call appropriately moved to safer locations across the state and region.

Preparations for the storm also took place on the academic side of the campus operation. Anticipating a several-day interruption in operations, at a minimum, the LSU Health Sciences Center (LSUHSC) human resources department made arrangements to run payroll early, and contingency plans were made to relocate essential services at the main LSU campus in Baton Rouge or other state facilities in either Baton Rouge or Shreveport. Faculty and staff members are granted special leave for hurricane disruptions if they are not assigned to work as essential personnel either in a clinical setting or otherwise; Katrina went on to prove its exceptional character, as many of the faculty and staff members remained on special leave formally until November 30, 2005, even if they resumed some academic or clinical activities.

Facilities

Both MCLNO campuses experienced severe flooding, and as a consequence, both University Hospital and Charity Hospital sustained severe disruptions in critical utilities, including the loss of running water, and the facilities relied on generator power for emergency electrical needs. Immediately after the storm, streets had indeed taken on water, but only up to a level expected after such a storm. However, within about 10 to 12 hours after several levees were breached, the water level rose, flooding the entire basements of both hospitals. The plan was to keep patients two floors above any area that suffered flooding. As such, the first floors of both hospitals were evacuated, with patients being moved to the second floor. There were no injuries to any patients or staff members during the flooding.

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Table 1

Radiology Equipment Levels by Modality and Service Before and After Hurricane Katrina (March 2006)

Modality/Service Before Katrina ∗ After Katrina ∗ Kenner Regional Medical Center CT 4 (1 Philips [64 slice], 2 GE [8 slice], 1 Siemens [4 slice]) 2 (1 Siemens [6 slice], † 1 Philips [16 slice] † ) 1 MR 3 (1 Siemens [1.5 T], 1 Hitachi [0.3 T], 1 GE [1.5 T]) 0 1 Ultrasound 10 (3 ATL 5000, 2 Sequoia, 1 Philips-Mammo, 1 Philips HD [3D], 1 Acuson [XP-128] angiograph, 2 Acuson [XP-128]) 4 (2 ATL 5000, 2 Sequoia) 2 Nuclear medicine 7 (2 triple head, 3 dual head, 2 single head) 0 2 gamma cameras PACS 114 MV (22 MV 1000, 92 MV 300), 8 plate readers 16 MV (5 MV 1000, 11 MV 300), 4 plate readers 1 UniPACS Radiology 10 radiology rooms, 5 digital fluoroscopy, 2 digital mammography, 1 analog mammography, 1 stereotactic unit, 2 angiography, 8 mobile C-arms, 11 mobile units, 1 DEXA bone density 6 mobile units, 2 mobile C-arms, 1 general radiology room 5 radiology rooms, 1 fluoroscopy, 1 angiography, 2 mobile units, 1 DEXA bone scan

CT, computed tomography; DEXA, dual-energy x-ray absorptiometry; MR, magnetic resonance; MV, MagicView PACS workstation; PACS, Picture Archiving and Communication System.

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Table 2

Medical Center of Louisiana in New Orleans Radiology Staffing Levels by Modality and Section Before and After Hurricane Katrina (March 2006)

Modality/Section Pre-Katrina Staff ∗ Post-Katrina Staff ∗ Radiologic technologists 57 16 CT technologists 23 10 MR technologists † 8 2 Angiography/interventional technologists 5 2 Medical sonographers 11 5 Clerical support staff members ‡ 44 2 Physicists 2 1 Radiology registered nurses 19 0 Mammography technologists 5 0 Nuclear medicine technologists 8 0 Nuclear medicine pool technologists 2 0 Radiology technologist pool § 4 0

CT, computed tomography; MR, magnetic resonance.

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Communication

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Regrouping

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Residents

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Faculty members

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Closing the residency

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Table 3

Accreditation Council for Graduate Medical Education–Accredited Radiology Residency Programs to Which Louisiana State University Radiology Residents Were Outplaced

Ochsner Foundation Hospital University of Alabama University of South Alabama Duke Medical Center Fletcher Allen Hospital/University of Vermont University of South Florida University of Missouri–Columbia Jacobi Medical Center Boston University Penn State Hershey Medical Center University Hospital of Cleveland/Case Western Tulane University Health Sciences Center University of Tennessee–Knoxville University of Alabama at Birmingham ∗ University of Texas Medical Branch–Galveston Baylor University Medical Center University of Virginia Kaiser Permanente Brigham and Women’s Hospital Rush University Medical Center

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The recovery

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Table 4

Current Radiology Equipment Levels by Modality and Service at University Hospital and New Orleans Children’s Hospital

Modality/Service University Hospital New Orleans Children’s Hospital CT 2 1 MRI 1 1 Ultrasound 5 3 Mammography 3 0 Nuclear medicine 3 cameras (2 SPECT, 1 PET/CT) 2 cameras (both SPECT) RIS Fully integrated RIS/PACS Fully integrated RIS/PACS Radiography ∗ 4 7 Radiographic fluoroscopy 2 2 Angiography 2 (both single plane) 1 (biplane)

CT, computed tomography; MRI, magnetic resonance imaging; PACS, Picture Archiving and Communication System; PET, positron emission tomography; RIS, radiology information system; SPECT, single photon-emission computed tomography.

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Conclusions

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Acknowledgments

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References

1. Winstead D.K., Legeai C.: Lessons learned from Katrina: One department’s perspective. Acad Psychiatry 2007; 31: pp. 190-195.
2. Accreditation Council for Graduate Medical Education. Hurricane Ike inquiries. Available at: http://www.acgme.org/acWebsite/newsRoom/newsRm_IkeInq.asp . Accessed December 1, 2008.
3. US Department of Health and Human Services. Rules and regulations. Fed Reg 2008; 73: pp. 4864.
4. Accreditation Council for Graduate Medical Education. ACGME institutional requirements. Available at: http://www.acgme.org/acWebsite/irc/irc_IRCpr07012007.pdf . Accessed August 26, 2008.

LSU Health Sciences Center New Orleans Department of Radiology

Katrina’s impact on LSU radiology

Facilities

Communication

Regrouping

Residents

Faculty members

Closing the residency

The recovery

Conclusions

Acknowledgments

References

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