NEW ORLEANS — This city's health-care facilities have been shattered to an extent unmatched in U.S. history, and its hospital system faces grave challenges as residents begin returning, the vice president of the national hospital-accreditation organization said yesterday.

Several hospitals were probably damaged beyond repair by Hurricane Katrina, while some may try to rush back into business before conditions are safe, said Joe Cappiello, of the Joint Commission on Accreditation of Healthcare Organizations. Others, while rebuilding, may lose doctors and nurses to communities elsewhere.

"Essentially the health-care infrastructure of New Orleans is gone — it no longer exists," Cappiello said.

Of the city's more than a dozen hospitals, none has resumed normal operations.

Ways sought to offset reconstruction costs

WASHINGTON — House Republicans are looking at delaying some federal spending, including money for a prescription-drug benefit under Medicare and thousands of highway projects, to offset the cost of rebuilding the Gulf Coast, a leading GOP fiscal conservative said yesterday.

Rep. Mike Pence, R-Ind., said there is a need for dramatic spending cuts in "big-ticket items."

Sen. Lindsey Graham, R-S.C., said an across-the-board cut in spending, excluding defense spending, would be appropriate.

However, Democrats questioned how President Bush can cut the budget to pay for Katrina recovery and the war in Iraq and still support tax cuts for the wealthy.

Death toll

The death toll from Hurricane Katrina stood at 883 yesterday, including 646 in Louisiana.

Compiled from The Washington Post, The Associated Press and Reuters