Connie Gistand, MD, MPH

Connie Gistand, MD, MPH

2007-2008

Clinical Assistant Professor, Tulane School of Medicine; Staff Physician Tulane Student Health, New Orleans, LA

Dr. Connie Gistand, is a native of Winnfield, Louisiana. She is a Magna cum Laude graduate of  Grambling State University and later received her Doctorate of Medicine Degree from the University of Iowa School of Medicine.  Dr. Gistand completed her Internal Medicine training at Ochsner Foundation Hospital in New Orleans, Louisiana and is a Board Certified Internist and Hypertension Specialist. In October 2001, she joined the faculty at Tulane School of Medicine.   In June 2003, she was promoted to the rank of Assistant Professor and still serves as adjunct faculty in the Tulane School of Medicine. During her appointment at Tulane, Dr. Gistand served as the Medical Director of the Tulane Medicine Clinic at the Medical Center of Louisiana where she devoted a significant portion of her time to resident supervision and teaching.

In 2007, she was one of 5 recipients of the Harvard University/ Commonwealth Fund Fellowship and later received her Master’s Degree in Public Health from Harvard University.  As a Harvard University Fellow, Dr. Gistand had the privilege to study and collaborate with physicians from all over the world from Canada to Nigeria to Japan regarding national and international health care systems; race related health care outcomes; and the development of universal healthcare systems.  

Dr. Gistand is actively involved in her local community where she frequently serves as a columnist on health related matters for the New Orleans Tribune Newspaper. In addition, she has served as a member of the Advisory Board of the Reach 2010 National Black Women’s Health Project, a member of the 2003 Louisiana Governor’s Health Care Reform Panel, a physician volunteer and consultant for the Essence Health and Fitness Panel, and member of the Louisiana State Medical Society and New Orleans Medical Association.  She has been invited by local medical groups, universities, and community organizations to lecture at college campuses, health workshops and other various community events.

In November of 2009, Dr. Gistand joined the Louisiana Department of Health and Hospitals (DHH) as the Medical Director for the Region 3 Office of Public Health (OPH). Region 3 is a seven parish public health region in southeast Louisiana. In her role as Medical Director for the Office of Public Health, she oversaw a wide array of public health programs including tuberculosis, STDs/HIV, immunizations, tobacco cessation, injury prevention, etc.

In the role of public health Medical Director for Region 3, Dr. Gistand served as the Chief Executive Officer for the Assistant Secretary for the Office of Public Health in directing the execution of public health programs and all matters impacting the administrative operations of the Office of Public in Region 3. Dr. Gistand was also the designated Public Information Officer (PIO) for the Office of Public Health for this region of the state.  She was responsible for relaying information to public, media, and elected officials on relevant public health issues and concerns.

Dr. Gistand served as the medical consultant for the seven regional parish health clinics, OPH nurse practitioners, and represents DHH/OPH on environmental health issues in the region. The Office of Public Health is one of the principal agencies in emergency preparedness for the state of Louisiana. As a result, Dr. Gistand served as the DHH/OPH lead over all emergency preparedness activities in Region 3 in consultation with the Assistant Secretary, State Health Officer, Community and Preventive Health Center Director/OPH Medical Director, and the Center for Community Preparedness. As the Region 3 Incident Commander, she was responsible to help maintain 24-hour response capabilities for public health emergency operations, coordinate medical and/or sanitation services in the region during disaster-related emergencies, and coordinate the delivery of health and medical services for evacuees in regional medical special needs shelters during a declared disaster.  Moreover, she worked with local and state officials in partnership with the CDC and the Governor’s Office of Homeland Security and Emergency Preparedness to ensure that mass vaccination plans were fully operational in the event of a large scale medical emergency or natural disaster and that medical special needs shelters were operational for this region of the state.

Her clinical and research interests are in the areas of Hypertension, Health Care Disparities, and Social Determinants of Health.

An Analysis of Mental Health Needs in New Orleans Two Years Post Katrina

Background:

Hurricane Katrina was the most devastating natural disaster in US history creating a disaster region as large as Great Britain, killing more than 1000 people, uprooting 500,000 others and causing more than $100 billion in damages.1 Before Hurricane Katrina hit landfall in August 2005, New Orleans had a largely poor and African American population with one of the nation’s highest uninsurance rates, and relied heavily on the Charity Hospital system for care of its residents. The aftermath of Katrina devastated the New Orleans health care safety net, entirely changing the city’s health care landscape and leaving many without access to care. It is well established that natural disasters lead to increased prevalence of mental illness in the range of 5% to 40%.2-3 In the many months after Katrina numerous studies and surveys have demonstrated increase in the prevalence and incidence of mental illness and also an increased need for mental health services for the city of New Orleans. Ongoing exposure to destroyed homes, debris, blighted housing, decimated neighborhoods, increase in crime and unemployment, and lack of affordable housing have contributed to the stressors experienced by residents of the city. Lack of inpatient psychiatric beds, Psychiatrists, Social Workers and other mental health paraprofessionals have contributed to the mental health crisis that has now engulfed the city. The suicide rate in the first four months after Katrina rose almost 300% over pre-storm levels, according to the coroner’s office statistics. In a survey after the hurricane conducted by the Centers for Disease Control and Prevention, 26% of respondents said at least one person in their family needed mental health counseling but less than 2% were receiving any.4  According to a survey in 2006 of the Journal of the American Medical Association, only 22 of 196 practicing psychiatrists had returned to the city since the storm.5 This prompted the Louisiana Department of Health and Hospitals in April 2006 (eight months after the disaster) to declare Orleans Parish as a primary care and mental health care shortage area.6
  
The Metropolitan Human Services District is the local administrative entity responsible for the delivery of mental and behavioral health services for residents of a three parish area including Orleans Parish.  This agency has been wrought with significant turnover in its leadership since Katrina and has come under tremendous scrutiny for its inability to provide the necessary mental health services despite receiving tremendous amounts of federal and state funding to carry out its mission. This, in turn, prompted the Governor of Louisiana to issue an Executive Order in February 2008 bringing control and oversight of the agency under the auspices of the Louisiana Department of Health and Hospitals.7
    
The goals of this project were to review the current literature on the mental health needs assessment/analysis for the city of  New Orleans and provide recommendations to MHSD and the state of Louisiana on how effectively meet the mental health needs of persons in this area.

Methods:

Literature review of incidence of Hurricane associated mental illness and findings of the Hurricane Katrina Community Advisory Group.  Federal and state policies, regulations and statutes were reviewed for precedence and models. A series of structured interviews were conducted with the former and current Executive Director of MHSD, Chairman of the Board of MHSD, and the Louisiana Public Health Institute (LPHI).

Recommendations: 

Recommendations consist of a series of short term and long term plans.

Short term:

  • Partner with LPHI to adopt and implement its crisis response recommendations.
  • To address workforce shortages, would strongly encourage implement UCLA psychological training workshops. This is a program funded by Kellogg Foundation that offers free sessions structured to provide mental health education and training to clergy, parents, caregivers, teachers and others. Recipients of these sessions would be trained to recognize the warning signs of depression or other behavioral health disorders.
  • Expand Medicaid Eligibility so that more uninsured patients can receive mental health services.
  • Implement an “incident to service” plan similar to that developed in North Carolina. This legislative act allows licensed clinical social workers and clinical nurse specialists with psychiatric certification to provide mental health services under the direct supervision of a licensed physician and in some cases allows these professionals to enroll as Medicaid providers and bill for their services.
  • Increase Medicaid and Medicare reimbursement for physician services.
  • Increase partnerships with private organizations and non profit organizations certified to provide counseling and crisis intervention services.

Long term:

  • Amendment to the 1974 Stafford Act. This federal statute is designed to supplement the efforts of the affected state and local governments in expediting assistance, provide emergency services and aid in reconstruction of devastated areas during an emergency. It mandates funding for mental health treatment only to be used for crisis management, and not for continuing treatment. An amendment would allow for continuing mental health treatment in times of disaster.
  • Comprehensive disaster management plan which includes a method to provide mental health services immediately following a disaster and provides a method for continuity ofcare for existing mental health patients.
  • Collaboration and integration of behavioral health in primary care training and practice.
  • Expansion of available inpatient psychiatric beds.

Preceptor:

Donald T. Erwin, M.D., Chairman, Metropolitan Human Services District, New Orleans