Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (28 page)

When Matherne discovered that at least two hospitals had lost power on Tuesday, she made her best guess about who could help. She searched out liaisons from the Coast Guard and National Guard and asked them to rescue the hospitals’ trapped occupants.

One serviceman told her they were in a safe building. They had supplies. Matherne hadn’t expected to have to do any convincing. “They don’t have electricity!” she said. “You can’t take care of patients without electricity.”

She noticed the people in uniforms at the command center avoiding her after that. She knew her outburst had violated the emergency officials’ code of cool. It occurred to her that the Guardsmen had resigned themselves to the idea that some flood victims were going to die. These officials, too, felt helpless. They were performing an awful triage of their own.

The local Coast Guard air station where the helicopters were staging had been damaged by Katrina. Its radio antenna was down. Its generators undulated through states of failure and temporary repair. Fixed
telephone lines were out, and the station’s commanders had only intermittent contact with superiors via satellite and cell phones. Their old Nextels worked. The new Treos didn’t.

A rigid command protocol was therefore impracticable. Commanders sent down few tasks and had not yet divided the city into a grid to execute a systematic rescue plan. With so many people waving rags on rooftops, the Coast Guard air-response units, which could talk to one another when flying, worked freelance,
setting their own priorities, often rescuing people as they saw them.

By Wednesday morning, when Tenet regional senior vice president Bob Smith reached Matherne, she had concluded that the best hope for the rapid evacuation of private hospitals was to use “private assets.”

Smith was incredulous. His company had no experience mounting rescue operations. The corporate jet couldn’t land on a hospital rooftop, and the company had no corporate helicopters. It had no pre-storm disaster plan. He and his colleagues were
still setting up the command center in the ground-floor conference room with phoned-in advice from Tenet’s regional chief medical officer, the executive with National Guard experience who was on vacation in Oregon talking on speakerphone while his wife went down to the beach without him.

Smith
jotted down notes as he spoke with Matherne. “Boats,” he wrote. “Wildlife and fish,” for the state’s Department of Wildlife and Fisheries, which had a fleet of swamp boats that, Matherne supposed, might be able to help. “Staging and pontoon boats.”

From Matherne, Smith learned that Tulane University Hospital’s parent company, Hospital Corporation of America, a corporate competitor, had started hiring helicopters to assist in that hospital’s evacuation on Tuesday morning as soon as it became clear the city was flooding. When Smith finished speaking with Matherne, he contacted HCA for advice. The HCA executives wished him luck. Contracting with privately owned helicopters and bringing them into the disaster zone had
taken time, and communications problems in New Orleans had made the process more difficult.

Smith wondered how to begin arranging an airlift. Michael Arvin told him about a phone message he had received late Tuesday from the representative of an
air logistics company in a Dallas suburb. It was an offer of assistance.

“Call them,” Smith said.

Meanwhile, other Tenet executives attempted to convince government officials to prioritize the evacuation of Memorial and the company’s other marooned hospitals. Staff at every agency seemed happy to nudge another agency. Someone from a senator’s office offered to appeal to Gov. Kathleen Blanco and the Centers for Medicare & Medicaid Services. But people at the Centers for Medicare & Medicaid Services directed Tenet to contact the head of the appropriate hospital association. That association, the Federation of American Hospitals, appealed to the US Department of Health and Human Services, which appealed back, on behalf of patients in general, to the Federation, the American Hospital Association, the nation’s hospitals, and the Federal Emergency Management Agency. Billionaire Ross Perot, whose son was a Tenet contractor, appealed to the Coast Guard and the Navy. There was no locus of responsibility. Fingers pointed every which way, much as they had when New Orleans flooded in the 1920s.

To make matters more confusing, the federal, state, and local communications systems were not interoperable, much as the city’s electrical systems had not been interoperable in the 1927 flood, when the utility NOPSI couldn’t supply emergency power to the city’s drainage pumping plant because it ran on a different frequency. Also, the software that authorities were attempting to use to manage the current disaster didn’t sort information in a shareable way. Multiple agencies and officials appeared to be maintaining separate priority lists for hospital evacuations, which perhaps explained why Memorial was variously first, second, or
last on “the list.” The bureaucratic complexities were incomprehensible to key Tenet officials and bred panic in them. “We are in dire need of help from the Navy!!!!” Michael Arvin wrote in an e-mail to a woman in California, asking her to seek assistance from a particular admiral she knew. “We are getting runaround from local USCG and US Navy.”

“Admiral Mike retired …” came the woman’s reply.

On Tuesday evening, EMS officials in the state capital had supposedly made the evacuation of Memorial a top priority. However, by Wednesday morning, Matherne, at the emergency operations center in New Orleans, told Tenet’s Bob Smith that Memorial was among the lowest on her list of eight local hospitals that needed help evacuating. Tenet officials later discovered yet another prioritization list was being managed by state public health officials. On it Memorial ranked sixth out of seven.

“Evacuation is going SLOWLY,” a state official explained in an e-mail sent to staff of Louisiana’s US Senators and congressional Representatives, who had been hearing from constituents trapped at hospitals. “Please ask your folks to be patient.”

According to the e-mail, critical care patients were “going out first.” Memorial’s critical care patients had been airlifted out on Tuesday evening.

The message also said: “The hospitals that are flooded and without generators are being evacuated FIRST.” Presumably news of Memorial’s power loss over a dozen hours earlier hadn’t reached this particular set of officials, despite the daylong presence at Memorial of the tall man who introduced himself as a state health officer.

Tenet executives, generally out of touch with the hospital since the previous evening, hadn’t mentioned in their missives for help that the hospital had lost power. They could have inferred that from the sudden loss of electronic communications and Sandra Cordray’s warnings about an impending power loss the previous evening.

One Tenet official wrote to Tenet’s general counsel:

Our number one priority for the last two days is getting our hospital’s evacuated.… For some reason no one seems to want ot help us with this. We have 2000 people at Memeorial (150 patients) but we do not seem to be a priority. We need help on this one from any angle.

The lead agency coordinating the federal public health and medical response was among the most hamstrung. The US Department of Health and Human Services (HHS) had an official emergency coordinator assigned to a five-state region that included Louisiana. However,
in her four months on the job, she had not visited the state, communicated with its emergency health officials, or participated in the recent Hurricane Pam exercises. Still, the state of Louisiana requested that the federal officials take charge.

When a Tenet employee contacted the HHS coordinator to ask how to enter the disaster area, she directed him to the Louisiana Hospital Association. A Tenet official’s appeal to the HHS deputy secretary resulted only in a promise to pass word to FEMA.

Rather than providing assistance to Tenet, HHS officials were requesting it. Tenet officials, along with hospital CEOs around the country, participated in a call with the head of the agency, HHS secretary Michael O. Leavitt, early in the afternoon. Leavitt asked the nation’s hospitals for medicines and staff to establish federal emergency field hospitals in the disaster region.

The conference call left one Tenet official angry. “Field hospitals are great, but we can’t get people out,” he wrote to the head of the Federation of American Hospitals, Charles N. Kahn III, asking for an immediate conference call with HHS. “Today has been a complete wreck. I don’t know how much clearer it can be said.”

“HHS is only a side player here,” Kahn responded. “We have to get them to push FEMA and the locals. I am working on that.”

LifeCare’s corporate chief financial officer was also on the conference call with HHS. The company was making as poor progress as Tenet was
in getting its patients to safety. Senior vice president Dubois had spent much of Wednesday trying to locate the four LifeCare patients flown out of Memorial by the Coast Guard early that morning, and to move them to other LifeCare locations.

Dubois had engaged a fleet of ambulances from Lone Star Ambulance in Texas, where LifeCare had a contract, to pick up patients being flown or boated out of Memorial and a LifeCare hospital near the New Orleans airport, which was not flooded but was having power issues. She sought permission for the ambulances to go to the city but did not get it. Dubois advised the LifeCare staff at Memorial to send the patients with whatever transport officials arranged for them. Dubois was upset to learn, late in the day, that four LifeCare patients and seven LifeCare staff members from Memorial were stranded on the corner of Napoleon and St. Charles Streets. She worked the phones in the evening to seek help for them from the Coast Guard and Knox Andress—the disaster preparedness coordinator she still thought worked for FEMA.

The Federation of American Hospitals’s Charles Kahn sent an appeal to an HHS official in the early evening. “I cannot over emphasize the urgency of these situations,” Kahn wrote. He included a list of the immediate needs of area hospitals, but left out several hospitals, including New Orleans’s biggest medical center, the public Charity Hospital, which was not a Federation member. Kahn’s message also failed to mention the power situation at any of the hospitals. The status update for Memorial that appeared in his appeal had been written nearly twenty-four hours earlier.

At Tenet headquarters in Dallas, Michael Arvin’s contact with the private air logistics company proved fruitful, and the company began lining up helicopters to arrive in New Orleans on Thursday morning. Though these were regular helicopters normally used for firefighting and other purposes, Tenet executives began referring to them as “air ambulances.”

As Tenet planners sought flight clearances, they told officials they would be rescuing their own patients. What they really needed help with, they said, was moving out “800 community members” who had sought refuge at Memorial. “Our real need is to get the local residents out of the hospital by boat,” a Tenet vice president wrote to Sen. Mary Landrieu’s staff. Landrieu offered to intervene with the governor on behalf of the hospitals—another pivot in the circular game of telephone.

Corporate officials seemed fixed on safety concerns at Memorial. “Our last communication with them indicated they were also having security problems with the local citizens,” Tenet’s Bob Smith wrote to a Navy captain. “This situation is getting to a critical point with no security.”

Tenet distributed an update for communications managers to upload to each affected hospital’s website. It said: “Martial law is in place in New Orleans.” It was as untrue as it had been when the radio announcers had said it.

By the time a Tenet official reached Memorial’s emergency room manager on Wednesday evening as Karen Wynn stood watching, there was better news to share. Though the details were vague, Tenet had received word that Louisiana’s Department of Wildlife and Fisheries would send boats to Memorial.

Just before ten p.m. the private aviation services company confirmed that it had received Tenet’s signed contracts for a half dozen helicopters of various sizes. They would converge from around the country to begin arriving at Memorial early Thursday morning, one as early as six a.m.

But the news from Memorial to Tenet was grave. Tenet vice president Bob Smith summarized in an e-mail to Tenet leaders what he said he learned via
HF radio communications. “They have 115 pts. in-house, 30 bed bound and 40+ wheelchair bound. Expect up to 60 are fragile and may die within the next 24 hours.”

Smith’s business development director, Michael Arvin, the other
main point of contact with the hospital, shared similar conclusions with company employees who had offered assistance with the evacuation.

Conditions in Memorial are deteriating fast. We may lose 30-45 patients overnight. There is rampant looting in the streets and the hospitals do not have security to protect. It has become our priority to get all patients and employees/families out of Memorial.

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