By the time patients and volunteer docs (and many other professionals thankfully) began rolling in a couple of days later, the governor had issued an emergency decree which not only accepted licensure in any state but also extended the state’s malpractice coverage to those working in state sponsored operations, which applied to the large field hospital on the LSU campus in Baton Rouge, and the other facilities I visited in the area.

I watched the personel at the front desk sign up volunteers. They looked at a photo ID and a copy of the license and had them sign a logbook and a couple of forms–it took about 1 minute while I was watching.

As it turned out, the problem wasn’t really docs, but supplies, other personel such as nurses, space, and communication. The emergency hospital at LSU was an amazing operation appearing in an gym and adjacent basketball arena, triaging 50,000 people and admiting 5000, and disappearing in 8 days. An empty Kmart was transformed into an inpatient facility to supplement those. Perhaps a factor in it’s success was that so many of the docs were from the charity hospital system in which, due to chronic dysfunction, they were used to improvisation. Another factor was that the state government, for all it’s failures, had the medical response plan in place, had disseminated it, and rehearsed it with the top medical officers. On the fly it was transformed and scaled up to create an even more impressive surge hospital than anticipated.

The operation in Houston, I understand was even more impressive.

I would suggest that the most important thing for every doctor to do is participate in emergency response planning in his own local area. Involve everyone and be flexible and humble. In a major dislocation, you’ll have to make up some things as you go along but prior planning creates the backbone.

But problems about licensure in Louisiana, after the first 2 days at least, are either fiction or due to misunderstandings. I would also submit that it is for every person in such a situation to search his own heart about what is the right thing for him or her to do. Until the governor issued her decree, I had no malpractice coverage for those activities, but realized that, at least for me at that moment, it was simply not a consideration. Very little is accomplished of much import in such situations without breaking some rules, some laws, and violating some property rights.

I and a group of health professional went down to LA after Katrina (and during Rita) as part of Minnesota’s Medical Reserve Corps (my blog from the time is still up at mn-lifeline.bogspot.com if anyone is interested). We found the Louisiana medical board very receptive. They credentialed each of us (fastest process I’ve ever gone through) andour malpractice was covered by our home institutions. We were down thereto 2 months in 4 2 week shifts of providers.

The MRC was put together after 9/11. I think it is important that each state’s medical board have a disaster plan in place so that this can function. The federal government might be able to help by creating an emergency enrollment access to the FTCA (federal tort claims act) in such a situation to cover re malpractice issue.