by Sheri Fink
41 it seemed to one: Dr. John Kokemor.
42 The head pharmacist had requested: E-mail sent by Memorial pharmacy director Curtis Hebert, 7:00 p.m., Sunday, August 28, 2005.
43 “Rene’s major concern…”: Sent 9:03 a.m. Monday, August 29, 2005.
44 was unable to reach his wife: The nurse documented this in Everett’s chart.
CHAPTER 4
Interviews
Knox Andress; Dr. Horace Baltz; MAJ Betty Bennett; Kamel Boughrara; Keith Brisbois; LT Shelley M. Colbert; Dr. Ewing Cook; Minnie Cook; Marc Creswell; Dr. Richard Deichmann; Rebecca DeLasalle; Dr. Windsor Dennis; Hugh Eley; John Ferrero; Faye Garvey; Dr. Juan Jorge Gershanik; Cathy Green; LT Catharine Gross; LCDR Russell Hall; Dr. Robert Hendler; Gina Isbell; Dr. Bryant King; CDR Scott Langum; Wayne Leche; Father John Marse; CDR (ret.) William F. McMeekin; Therese Mendez; LT/O3E Sean Moore; Dr. Susan Nelson; Dr. Paul Primeaux; Dr. Angela Reginelli; Michael Richard; AMT2 Randal Ripley; Karen Sanford; Rodney Scott; Mike Sonnier; Dr. Kevin Stephens; Dr. Robert Wise; Karen Wynn; Eric Yancovich.
Notes
1 WWL, a popular: For more details on the effort, see Moody, Reginald F., “Radio’s Role During Hurricane Katrina: A Case Study of WWL Radio and United Radio Broadcasters of New Orleans,” PhD diss., University of Southern Mississippi; Ann Arbor, Mich.: UMI Microform, 3268460, 2006.
2 martial law had been declared: Jefferson Parish President Aaron Broussard on WWL broadcasts, including during the eleven p.m. CDT hour of August 29, 2005.
3 “My question is…”: WWL 11:13 p.m., CDT, August 28, 2005.
4 “We’re very frightened…”: WWL 4:22 a.m., CDT, August 30, 2005.
5 The meeting took place: Descriptions based on photographs taken in the room during the disaster.
6 “soul surviving”: Lindzy Louis IV, recorded June 23, 2007 for the oral history project “Surviving Hurricanes Katrina and Rita in Houston Collection” (AFC 2008/006), Archive of Folk Culture, American Folklife Center, Library of Congress, Washington, DC (Interview SR012, Accession # SKR-CJ-SR02).
7 Tropical Storm Allison: See, for example, “Tropical Storm Allison, June 2001: RMS Event Report” (Newark, CA: Risk Management Solutions, 2001); “Lessons Learned from a Hospital Evacuation During Tropical Storm Allison,” Suburban Emergency Management Project, Biot Report #216, May 21, 2005 (“Lesson 1: Flooding will occur on a flood plain. Don’t be surprised when it happens, especially when your hospital is built on a flood plain…”). Several lawsuits were filed against hospitals after Allison, including one brought by the family of Charles Brunkenhoefer (172nd District Court, Jefferson County, TX, no. E-169,673), who died after the hospital where he was being treated lost power. In another case, Texas Woman’s University sued the Methodist Hospital for allegedly having diverted surface water into a tunnel leading to the campus of the other hospital (151st District Court, Harris County, Texas, no. 2003-31948).
8 known then as the Joint Commission: The organization’s name was changed in 2007 to The Joint Commission. Memorial’s JCAHO hospital accreditation program and home care program survey, May 17–19, 2005, organizational ID no: 8778.
9 a fairly typical number: Dr. Robert Wise, personal communication, 2010.
10 paved the way for state licensure: In Louisiana, accreditation by JCAHO was acceptable by the health department in lieu of its annual re-survey (“9309. Exceptions,” Louisiana Register, vol. 29, no. 11, November 30, 2003, p. 2404).
11 By 2005, more than a billion: “Hospitals Rising to the Challenge: The First Five Years of the U.S. Hospital Preparedness Program and Priorities Going Forward,” UPMC Center for Biosecurity (now known as the UPMC Center for Health Security), March, 2009; http://www.upmchealthsecurity.org/website/resources/publications/2009/2009-04-16-hppreport.html. $135 million in 2002 and $515 million in 2003 and in 2004.
12 a three-page form: Memorial’s was essentially identical to a sample hazard vulnerability analysis tool published by Kaiser Foundation Health Plan, Inc. in 2001, “Kaiser Permanente: Medical Center Hazard and Vulnerability Analysis”; http://www.calhospitalprepare.org/sites/main/files/file-attachments/kp_hva_template_2010.xls.
13 far exceeded federal requirements: As of July 2013, the US Centers for Medicare & Medicaid Services had still not issued a proposed rule on emergency preparedness, which had been listed in the Federal Register in fall 2010 and was later “scheduled for publication in early 2012,” according to CMS, “in response to concern about the ability of healthcare providers across the United States to plan for and respond to emergencies.” (CMS Spotlight, “Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers: CMS-3178”; http://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/Spotlight.html) The long-belated rule, inspired in part by the failures of preparedness after Hurricane Katrina, would make it a requirement for health care facilities, including hospitals, to meet certain preparedness standards in order to participate in Medicare and Medicaid. According to observers of the process, CMS received pushback against potentially costly new requirements, delaying the adoption of the rule. The “systemic gaps” in healthcare preparedness remained unfilled.
14 Arvin, in Texas, had no background: Oral deposition of Michael Arvin, August 26, 2010, in Preston, et al v. Tenet.
15 Atlanta was a former Baptist hospital: Greene, Glen Lee. The History of Southern Baptist Hospital, revised edition (New Orleans: Southern Baptist Hospital, 1976, and original 1969 edition), p. 24.
16 new inpatient hospitalist: “Hospitalists Now on Staff,” Connections (May 2005).
17 “I’m in charge…”: This account is from Dr. Cook (interviews with author in 2007, 2008, 2009, and 2013). Dr. King confirmed those recollections in 2009 and 2013. He said he believed that his patient required telemetry monitoring: “Patients who needed certain things, if we can provide them, we should still have them,” and he thought the interaction may have taken place at an earlier point in the disaster.
18 A rusting helipad: Staff sent the Southern Baptist Hospital helipad site plan chart to Coast Guard personnel. “Growing to Serve You Better,” Spectrum (Spring 1985), p. 19, described the Helistop and other “Project 2000” construction projects under way in 1985, including the creation of the six-story Clara Wing and power plant building.
19 Black Hawk, weighing more than 11,000 pounds: Empty weight reported on various specification sheets; http://www.sikorskyarchives.com/S-70A%20(UH-60M%20Black%20Hawk,%20HH-60M).php. One Jayhawk landed at Memorial weighing 18,500 pounds, less than half full of fuel, according to co-pilot LT Catharine Gross.
20 a nurse’s husband: LT/O3E Sean Moore (rank as of July 2013).
21 A nurse’s husband sat in a chair: The photograph of the unnamed husband holding the baby is in Bernard, Marirose and Pamela R. Mathews. “Evacuation of a Maternal-Newborn Area During Hurricane Katrina,” MCN (July/August 2008). The description of the NICU baby rescue draws on several sources, including the above article; a StoryCorps interview with Pamela Mathews, her husband Edwin “Roy” Mathews, and nurse Jo Lincks (interview MBX006447, March 18, 2010, archived in the Library of Congress’s Folklife reading room); photographs of the rescue taken by Memorial staff; Gershanik, Juan, “EVACUATE! My Katrina Experience,” fax dated December 27, 2005, with four-page story; Feiler, Alan, “God’s Hands in the World,” Baltimore Jewish Times, September 9, 2005; and on interviews with staff, including Dr. Gershanik.
22 Pilots from out of town: Several USCG pilots interviewed by the author described the difficulty of locating Memorial, also reflected in unpublished USCG documents, including “Summary of Action for the Distinguished Flying Cross: LCDR SCOTT LANGUM,” covering August 28 to September 4, 2005. “LANGUM deftly navigated to the assigned position through the darkened obstacles, only to find the location of the hospital inaccurate. With no positive guidance, Lieutenant Commander LANGUM began a low level search over unlit wires, reading the signs on each building to locate the hospital.”
23 Could Deichm
ann convince the pilots: When this passage was checked with Dr. Deichmann in June 2013, he did not remember the scene, the conversation, or the “pointed look” that Dr. Gershanik had recalled.
24 More than an hour had passed on the helipad: Gershanik, Juan, “EVACUATE! My Katrina Experience.”
25 Another surgical ICU nurse: The flashlight episode is described by Lori Budo in her book, Katrina Through Our Eyes: Stories from Inside Baptist Hospital (Lexington, KY: CreateSpace, 2010). Budo wrote in an introduction (p. 9) that her book was a “fictionalized account of the ICU staff and their families, based on their experiences after Hurricane Katrina […] I wrote about the people I know and love; these are our stories.” The names in the book, except for Budo’s and Cathy Green’s (in a concluding essay, “The Baptist”) are fictionalized, however the details track well with other sources and interviews, and some material is therefore used here, as described in these Notes. The author made several requests to interview Ms. Budo throughout the process of researching these events, and contacted her prior to the publication of this book to confirm the stories and other details about her; however through her attorney, Edward J. Castaing Jr., she declined to talk.
26 Helen Breckenridge: The account of Helen Dennis Breckenridge’s death is based on interviews with her brother and ICU staff members. The staff members did not name Ms. Breckenridge, but as only two female ICU patients died during the disaster according to a comparison of death records and the patient census, her identity was easily inferred. The following documents were also used: a court petition filed by her brother, Dr. Windsor S. Dennis (“Petition in suit for temporary and, subsequently, permanent interdiction”) in Orleans Parish Civil District Court and associated records, power of attorney, affidavit, stipulation, and judgment in case no. 2005-11439; toxicology report of Helen Buckenridge [sic], completed January 13, 2006, National Medical Services Inc.; autopsy performed October 20, 2005 (Orleans Parish coroner’s office #KAT-J-0322-05); and Times-Picayune obituary, October 27, 2005.
27 A DNR order was different: “Louisiana Advance Directives: Legal Documents to Assure Future Healthcare Choices,” Peoples Health. Interviews with experts, including Dr. Susan Nelson (board-certified internist, geriatrician, and hospice/palliative medicine physician, chairwoman of the LaPOST Coalition, an organization devoted to raising awareness about Louisiana’s initiative on medical advance decision making).
28 nurse who was also an Air Force captain: Betty Bennett (now MAJ), Air Force Reserve.
29 “The babies will be taken to wherever…”: The quotes in this exchange are from the Bernard and Matthews article. When checked with Dr. Deichmann in June 2013, he did not remember the conversation.
30 The electrocardiograph showed: Settlement approval petition filed in Evelina Barnes and Jeffrey Blackmore o/b/o Samuel Barnes v. LifeCare Hospitals, Inc., in Civil District Court, Orleans Parish, Louisiana, December 3, 2008.
31 “How y’all doing?”: Dr. Pou’s words were recalled by LifeCare respiratory therapist Charles Lindell, November 10, 2005, in an interview with state investigators.
32 worked on the assumption that FEMA was coordinating: Mulderick said in her August 16, 2010, deposition in Preston, et al v. Tenet that Sandra Cordray asked LifeCare if they needed assistance. “They indicated that they were working with their corporate or management structure to manage the evacuation of their patients. They initially did not request our help.” In an interview with the author in June 2013, Acadian Ambulance’s Keith Brisbois recalled having gone to LifeCare soon after the decision to evacuate was made, to offer Acadian’s help. He said he was surprised to be told that LifeCare was awaiting word from the corporate office about their transportation contract, which he believed to be held by Acadian. It is clear from text and e-mail communications that later in the day, LifeCare personnel did request evacuation assistance from Memorial, Tenet, and Acadian.
33 Andress was a nurse: Andress deposition in Preston, et al v. Tenet, available in the federal court record, and interviews with Mr. Andress.
34 a system to supply the sites: US Senate, Hurricane Katrina: A Nation Still Unprepared, Chapter 24, “Medical Assistance.” For an excellent, concise overview of the failures in medical preparedness and response to Katrina, see Bergal, Jenni, “Health Care” in City Adrift: New Orleans Before and After Katrina. (Baton Rouge, LA: Center for Public Integrity, Louisiana State University Press, 2007).
35 They said the conditions in the Superdome are breaking down: WWL, during the seven p.m. broadcast hour, August 30, 2005.
36 Kathleen Blanco announced: WWL, during the ten p.m. broadcast hour, August 30, 2005.
37 He wrote back to Cordray to reassure: E-mail from Michael Arvin to Sandra Cordray and other Memorial and Tenet officials, sent 10:39 p.m., August 30, 2005.
38 The Guard would continue sending helicopters: These events are well remembered and well documented by those involved in them. Several people situated at the Coast Guard emergency command center in Alexandria, Louisiana, said in interviews with the author in 2013 that they tried to persuade Memorial staff to allow them to continue the evacuation throughout the night. Dr. Paul Primeaux told the author in 2008 that he took a call from the Coast Guard when he was in the command center and, enthusiastic about the prospect of continuing the evacuation overnight, carried the message to Dr. Richard Deichmann on the helipad, but that Dr. Deichmann did not believe it was advisable to continue. Dr. Deichmann did not remember this exchange with Primeaux, but in his book, Code Blue: A Katrina Physician’s Memoir (Bloomington, IN: AuthorHouse, 2006), he described making the same decision later in the night, as depicted in Chapter 5.
39 The Acadian Ambulance flight coordinator: Marc Creswell (interviewed in 2011 and 2013); additional colleagues coordinated from Acadian’s base in Lafayette, Louisiana. For an interesting account of Acadian’s work during the Katrina disaster, see Judice, Ross, The Katrina Diaries: First Hand Accounts from Medics and Miracle Workers (2011); http://www.scribd.com/doc/101037393/Ross-Judice-Acadian-Ambulance-The-Katrina-Diaries. For an account of the various private helicopter companies that helped evacuate hospitals, see: “Air Medical Community Response to Hurricane Katrina Disaster: Hospital Evacuation and Patient Relocation by Helicopter and Fixed Wing Aircraft,” Association of Air Medical Services, January 9, 2006.
40 A long, low-set Coast Guard Jayhawk: LTJG Catharine Gross (now LT) report of HH60J aircraft no. 6017 search-and-rescue activities for Aug 30–31, 2005.
CHAPTER 5
Interviews
Dr. Bill Armington; Dr. Frederick “Skip” M. Burkle Jr.; LT Shelley M. Colbert; Dr. Ewing Cook; Minnie Cook; Dr. Richard Deichmann; Robbye Dubois; John Ferrero; Linda Gagliano (stepdaughter of John Russell); LT Catharine Gross; LCDR Russell Hall; Dr. Edmund G. Howe, III; Gina Isbell; Dr. William LaCorte; Larry Lafayette and Samuel Lafayette (sons of James Lafayette); AST2 Jaason Michael Leahr; Mark LeBlanc; Sandra LeBlanc; Wayne Leche; Father John Marse; CDR (ret.) William F. McMeekin; Therese Mendez; Stephanie Moore; LT Sean Moore; Angela McManus; Michelle Pitre-Ryals; Cheri Pizani; Dr. Anna Pou; Michael Richard; AMT2 Randal Ripley; Karen Sanford; CDR Mark Vislay; Stella Wright; Karen Wynn; Eric Yancovich.
Notes
1 Overnight, two nurses cared for the two surviving: According to ICU nurse David Fatzinger, interview with state investigators, January 11, 2006, he and one other nurse took care of the two surviving patients with DNR orders that night. Author’s interview with ICU nurse Karen Sanford in 2007 also touched on this.
2 wondered aloud if they would ever: This discussion, the talk of who would play whom in the television movie, and the cat story are from Lori Budo, Katrina Through Our Eyes: Stories from Inside Baptist Hospital (Lexington, KY: CreateSpace, 2010), pp. 73–76.
3 A doctor sent a security guard: Deichmann, Richard. Code Blue: A Katrina Physician’s Memoir (Bloomington, IN: AuthorHouse, 2006), pp. 61–62. Dr. Deichmann recalled this occurred at about 1:30 a.m. Susan Mulderick, when she spoke with state investigators in 2
006, said she was approached by LifeCare staff in the Memorial command center on the fourth floor about a possible Coast Guard evacuation at around 1:30 a.m., but before the power went out. She said by that point gathering the people needed to move patients was “going to be a task, ’cause everyone had dispersed,” and communications within the hospital were difficult. LifeCare’s Diane Robichaux, speaking with investigators in 2005, recalled the conversation having taken place somewhat earlier, at about 11:30 p.m., according to a time line prepared by LifeCare leaders shortly after the disaster.
4 “There’s a guy out saying, ‘We need to move patients…’” […] “Everybody get up!”: Many people at the hospital recalled experiencing some version of this mysterious event. The man or men were most likely from the Coast Guard, tasked to continue the air evacuation overnight (the boat story is an anomaly—it’s possible the Cooks misremembered this).
5 A battle was under way […] the last backup generator surged and then died: The battle of the generators was reconstructed from a variety of sources, including members of Memorial’s plant operations crew in interviews with the author or with investigators (the latter including Chief Operating Officer Sean Fowler, who described praying when the switch was flipped), Memorial’s generator maintenance and repair records, photographs of the equipment, and several expert reports and diagrams on the power failure prepared for litigants in Preston, et al v. Tenet, including a fantastic video schematic. The experts disagreed over the ultimate cause of the power failure—namely whether the flooding played a role or not. See Fink, Sheri, “Trial to Open in Lawsuit Connected to Hospital Deaths After Katrina,” New York Times and ProPublica, March 20, 2011; http://www.nytimes.com/2011/03/21/us/21hospital.html. An expert hired by the plaintiffs, Jerry Watts, concluded that the floodwaters shorted out Memorial’s electrical transfer switches and many distribution panels, much as the plant operations director had predicted. However, Gregory Gehrt of ccrd Partners, an expert hired by Tenet, attributed the power shutdown to mechanical problems in the hospital’s three 750-kilowatt diesel generators, which were located well above the water. Codes and standards at the time required only that potential for flooding and other local hazards be given “careful consideration” in electrical-system design. The 2012 National Fire Protection Association (NFPA) standards improved on this, saying that the systems “shall be designed” to protect against these hazards, but as of June 2013 had not yet been adopted by hospital regulating bodies. (See, for example, Fink, Sheri, “NYU Hospital’s Backup System Undone by Key Part in Flooded Basement,” ProPublica, November 1, 2012; http://www.propublica.org/article/nyus-backup-system-undone-by-key-part-in-flooded-basement.) Hospital generators had to be tested monthly, but only for short periods. The NFPA publishes the national electrical code, including specific requirements for health care facilities. NFPA 99, Standard on Health Care Facilities, has been adopted by most state health departments and licensing agencies; NFPA 110, Standard for Emergency and Standby Power Systems, covers emergency power systems (“Compendium of Health Care Electrical References,” Nash Lipsey Burch, LLC, Nashville, TN, undated, unpublished document). A year after Katrina, JCAHO published a Sentinel Event Alert (“Preventing Adverse Events Caused by Emergency Electrical Power System Failures,” issue 37 (September 6, 2006); http://www.jointcommission.org/sentinel_event_alert_issue_37_preventing_adverse_events_caused_by_emergency_electrical_power_system_failures/). It warned that meeting NFPA codes and standards was “only a start,” and that “recent experiences demonstrate that emergency power systems that meet these standards are not always sufficient during major catastrophes.” In response, in 2007, the organization required that emergency generators be tested once every thirty-six months for a minimum of four continuous hours (on top of the previous requirement that they be tested twelve times a year for thirty minutes). Still, hospital and nursing home generator failures in recent prolonged utility outages, including Hurricanes Gustav (2008), Isaac (2012), and Sandy (2012), suggest that many of these systems are inadequate.