by Sheri Fink
6 clobbered an alarm panel with her shoe: Budo, Katrina, p. 76.
7 “We have sent three helicopters”: Interviews with Michelle Pitre-Ryals, LCDR Russell Hall, LT Shelley M. Colbert (nee Decker), and the auxiliary member, Michael Richard; Michelle Pitre-Ryals, “Fair Treatment Process Dispute Resolution Form,” October 22, 2005 (includes a diary of events written shortly after the storm); Shelley Decker, “Katrina AAR” (two versions, one undated and the other dated October 3, 2005); and copies of handwritten Unit Logs dated August 31, 2005, furnished by the United States Coast Guard. All of the documents state that the sources heard at the time that helicopters were “waved off” Memorial’s helipad (variously described as three US Coast Guard helicopters and/or five US Navy helicopters); the interviewees had strong memories of these events when they were interviewed in 2013.
8 “Where are you going?”: Recollections of Karen Wynn in interviews with author in 2008 and 2009. Thao Lam declined to be interviewed.
9 Certain medical conditions, such as a stroke: Zimmerman, J. L., Hanania NA. Chapter 111, “Hyperthermia,” in: Hall, J. B., G. A. Schmidt, L. D. Wood, eds., Principles of Critical Care, 3rd ed. (New York: McGraw-Hill, 2005); http://www.accessmedicine.com/content.aspx?aid-2282701.
10 A woman who had been hired: Mark and Sandra LeBlanc patiently sat for many interviews with the author over the years, and their depositions in Preston, et al v. Tenet and their own suit against LifeCare were also consulted. Their memories remained quite consistent, but when there were variances, their earlier accounts were relied upon more heavily. Elvira LeBlanc’s sitter, Jill Wilson, declined to be interviewed, but she filed a brief account of her experiences in Orleans Parish Civil District Court on October 10, 2012, as part of her objection to the Preston, et al v. Tenet settlement. It was consistent with the LeBlancs’ accounts. The LeBlanc family first came to public attention through the work of journalists, including Kathleen Johnston and Drew Griffin, “Family Blames Hospital for Mother’s Death,” CNN, May 25, 2006; http://www.cnn.com/2006/US/05/25/johnston.memorialdeath/, and later in Jeffrey Meitrodt’s remarkable five-part series, “For Dear Life: How Hope Turned to Despair at Memorial Medical Center,” Times-Picayune, August 20–24, 2006; http://www.nola.com/katrina/index.ssf/memorial_medical_center/for_dear_life/.
11 Susan Mulderick had climbed up to the helipad: Susan Mulderick interview with state investigators, January 6, 2006; interview with USCG flight mechanic AST2 Randal Ripley, July 2013; LTJG Catharine Gross report of HH60J aircraft no. 6017 search and rescue activities for Aug 30–31, 2005. Mulderick’s recollections align so closely with Ripley’s and with the content of the report written shortly after the events by Gross, that although the sources did not mention each other’s names, it seems likely they were recalling the same conversation. Mulderick, however, told investigators that one reason she stopped the airlift was because the unnamed crewman told her he would drop patients in a field in Baton Rouge. Both Ripley and Michael Richard, the auxiliary member assisting with coordination in Alexandria, said that patients would not have been dropped in a field that night; Richard had helped arrange hospital placements for them.
12 a LifeCare respiratory therapist: Charles Lindell interview with state investigators, November 2005.
13 John Russell, a Korean War veteran: The account of John Russell is based on his medical records (provided with kind permission of his stepdaughter, Linda Gagliano) and the recollections of Gagliano and medical professionals involved in Russell’s care.
14 It was not true that there was no oxygen: It is a mystery why some at the hospital were convinced there was no oxygen and others insist that while the oxygen tank supplies ran low, they never ran out. One possibility is that the situation became so chaotic and roles were so confused that those who knew where the tanks were did not realize people were looking for them. Some employees said that additional oxygen tanks were dropped off by arriving helicopters, but some sources said that they were never moved down from the helipad, or that, almost unbelievably, Memorial and LifeCare staff “didn’t have a wrench or anything” to open the valves on the tanks (Andre Gremillion interview with investigators December 30, 2005. He described breaking his watch trying to use it to open a tank valve; also, Charles Jarreau interview with author October 29, 2008, said there were no wrenches). The EMS call was from an EMS unit at 11:15 a.m., saying that it had received a call from an Acadian Ambulance leader relaying the information.
15 Took a turn on the second floor […] might not make it: Author’s interview with Dr. Pou, July 2008.
16 its walls sweating: Described by many people, including Edwin “Roy” Mathews in StoryCorps interview MBX006447.
17 The SARBOO: US Senate, A Nation Still Unprepared, Chapter 22, p. 366; “Post-Landfall Evacuation,” pp. 368–9 (footnotes 13–19); see also p. 270 (footnote 173).
18 “We desperately need these boats…”: WWL, August 30, 2005, noon hour.
19 Twenty minutes later: Copy of EMS call logs; Cramer did not respond to several requests for an interview.
20 blunted vowels and head-spinning pace: To experience the uniqueness of Cajun-inflected English, search YouTube for Cajun English. One example: http://www.youtube.com/watch?v=7tMIkTUmtTA.
21 The LeBlancs couldn’t understand it: There are several possibilities: one is that the woman was not speaking in an official capacity or that the LeBlancs misunderstood her or misremembered what she said. Another is that officials were prioritizing hospitals that had not yet transported all of their critical care patients. Yet another is that, having dispatched Carl Cramer the previous evening, and, possibly, having communicated with Coast Guard officials who were trying to execute an overnight rescue operation, state EMS officials believed Memorial was taken care of. As discussed later in the book, poor communications between various agencies could have accounted for a number of different prioritization schemes. The communications problems experienced by people in the state emergency operations center trying to coordinate with local and federal resources are detailed in “DHS/FEMA Initial Response Hotwash: Hurricane Katrina in Louisiana, DR-1603-LA,” FEMA, February 13, 2006; see also “State of Louisiana-Hurricanes Katrina and Rita: After-Action Report and Improvement Plan,” US Department of Homeland Security/State of Louisiana, 2006.
22 He believed his mother needed an IV: According to records in Preston, et al v. Tenet, in which Vera LeBlanc was a named plaintiff in the class action, LeBlanc had difficulty swallowing, but she had a feeding tube by which fluids could be administered. However, dehydration had been a problem for her even before the hurricane.
23 A nurse wrote “1,” “2,” or “3”: A few doctors later recalled having used a category 4 for DNR patients to differentiate them from other very seriously ill patients (3s). Patients were often triaged on wards before they were brought downstairs, and some were re-triaged at various times during the crisis—the ad hoc rating systems used were similar, but not identical.
24 Pou and her coworkers were performing triage […] at its heart, a question of moral priorities: For excellent analyses of triage, see, in particular: Sztajnkrycer, Matthew D., Bo E. Madsen, and Amado Alejandro Báez, “Unstable Ethical Plateaus and Disaster Triage,” Emergency Medicine Clinics of North America 24, no. 3 (2006): 749–68; Veatch, Robert M., “Disaster Preparedness and Triage: Justice and the Common Good,” The Mount Sinai Journal of Medicine 72, no. 4 (July 2005): 236–241; Iserson, Kenneth V. and John C. Moskop, “Triage in Medicine, Part I: Concept, History, and Types,” Annals of Emergency Medicine 49 (2007): 275–281. Moskop, John C. and Kenneth V. Iserson, “Triage in Medicine, Part II: Underlying Values and Principles,” Annals of Emergency Medicine 49 (2007): 282–287; Baker, Robert and Martin Strosberg, “Triage and Equality: An Historical Reassessment of Utilitarian Analyses of Triage,” Kennedy Institute Ethics Journal 2 (1992): 103–123.
25 “creative non-conformists”: Sanders, David and Jesse Dukeminier Jr., “Medical Advance and Legal Lag: Hemodialysis and Kidney Transp
lantation,” UCLA Law Review 15 (1968): 366–80.
26 A story in LIFE: Alexander, Shana, “They Decide Who Lives, Who Dies: Medical Miracle and a Moral Burden of a Small Committee,” LIFE (November 9, 1962); http://books.google.com/books?id=qUoEAAAAMBAJ&lpg=PA1&dq=life%20magazine%20nov%201962&pg=PA101#v=onepage&q&f=false.
27 However, in countries such as South Africa: Fink, Sheri, “Life and Death Choices as South Africans Ration Dialysis Care,” ProPublica, December 15, 2010; http://www.propublica.org/article/dialysis-south-africa. See also “Rationing Health,” a series of radio stories by Sheri Fink, David Baron, and Patrick Cox for PRI’s The World, http://rationinghealth.org. The first episode in the series, “South Africa: Rationing by Committee,” aired December 14, 2010, and can be heard at: http://www.theworld.org/2010/12/entire-program-%e2%80%93-december-14-2010/.
28 at least nine well-recognized triage systems: START, Jump START, Homebush, Triage Sieve, Pediatric Triage Tape (PTT), CareFlite, Sacco Triage Method (STM), Military Triage, CESIRA. See Lerner, Brooke E., et al, “Mass Casualty Triage: An Evaluation of the Data and Development of a Proposed National Guideline,” Disaster Medicine and Public Health Preparedness, vol. 2, supplement 1 (September 1, 2008): S25–34. The authors compared these systems and proposed a new, national standard, “SALT,” and later developed other techniques to help organizations using different systems work together in emergencies: Lerner, E. Brooke, David C. Cone, Eric S. Weinstein, et al., “Mass Casualty Triage: An Evaluation of the Science and Refinement of a National Guideline,” Disaster Medicine and Public Health Preparedness, 5 (2011): 129–137.
29 in his memoirs: Larrey, Dominique-Jean. Memoirs of Military Surgery, and Campaigns of the French Armies, vol. 2, trans. Richard Willmott Hall (Baltimore, MD: Joseph Cushing, 1814); 1st American ed. trans. from the 2nd Paris ed., p. 123; http://babel.hathitrust.org/cgi/pt?id=hvd.hc2l2t#view=1up;seq=8.
30 In one very small study: Described in an unpublished report written by a codeveloper of a new commercial triage method: Navin, Mick. “Pennsylvania Triage Program Demonstrates Profound Inconsistencies of Current Protocols and Advantages of the Sacco Triage Model” (Bel Air, MD: ThinkSharp, Inc., January 30, 2004). The study is also described in Navin, Mick and Bob Waddell II, “Triage Is Broken,” EMS Magazine 34, no. 8 (2005): 138–142; http://www.emsworld.com/article/10323785/triage-is-broken.
31 Pou would later say: Dr. Anna Pou appearance on Garland Robinette’s “Think Tank” show on WWL radio, May 12, 2008.
32 set out by John Rawls: Rawls, John. A Theory of Justice (Cambridge, MA: Harvard University Press, 1971).
33 sparked a debate: The debate was triggered by John M. Taurek’s “Should the Numbers Count?,” Philosophy and Public Affairs 6, no. 4 (Summer 1977): 293–316.
34 “There is no such thing as a sum of suffering”: Lewis, C. S. The Problem of Pain (London: Centenary Press, 1940 and New York: HarperCollins, 2001).
35 members of the general public typically favored: Described in Veatch, “Disaster Preparedness and Triage.”
36 On a fifth-floor hallway: The daughter wished to remain anonymous. Several nurses from the fifth floor confirmed and expanded on her story, and it was also retold in Pitre-Ryals’s “Fair Treatment Process.” The account of James Lafayette is based on his medical records (kindly provided by his family), and the deposition of a son, Samuel, who accompanied his father to the hospital (deposition taken May 15, 2008, for Preston, et al v. Tenet), as well as the recollections of several Memorial staff members involved in his care. Emergency medicine doctor Karen Cockerham explained that in general (not specifically in reference to Mr. Lafayette, in an interview in July 2013) the ER staff tried to admit as few patients as possible before the storm and strongly suggested that others who were sick but stable evacuate; Mr. Lafayette and his son, who came by ambulance, did not have the means to do so, and Samuel Lafeyette said in his deposition that a female doctor advised them to wait out the storm in the lobby.
37 Now a man: Nurses in the ICU were also told to leave Wednesday afternoon when they still had a DNR patient.
CHAPTER 6
Interviews
J. T. Alpaugh; Dr. Horace Baltz; Mark LeBlanc; Sandra LeBlanc; Keith Brisbois; Dr. Ewing Cook; Minnie Cook; Marc Creswell; Curtis Dosch; L. René Goux; Cathy Green; Dr. Bob Hendler; Frances Haydel (wife of patient Julius Haydel); Curtis Hebert; Gina Isbell; Dr. Bryant King; Dr. John Kokemor; Karen Lagasse; AST2 Jaason Michael Leahr; Father John Marse; Cynthia Matherne; Dr. Anna Pou; Dr. Paul Primeaux; Sudeep Reddy; Rodney Scott; Karen Wynn.
Notes
1 Merle was, until recent months: The account of Merle Lagasse is based on her medical records (obtained with kind permission of her daughter, Karen), photographs, and the recollections of Karen and medical professionals involved in Merle’s care, mentioned in the text.
2 company logo: Danna, Denise and Sandra E. Cordray. Nursing in the Storm (New York: Springer Publishing Company, 2010), p. 128.
3 A Coast Guard lieutenant reached Susan Mulderick: Mulderick’s June 7, 2008, deposition in Preston, et al v. Tenet. Acadian’s Keith Brisbois recalled in an interview with the author in 2013 having arranged for one more flight to take two remaining critical patients that morning, but he said the priorities had shifted once all critical patients seemed to have been moved from Memorial. Aerial footage taken by Helinet shows a green Air Med (division of Acadian) helicopter on the helipad at what appears from the sunlight and shadow patterns to be roughly midday (can be screened on www.abcnewsvsource.com, reference no.: VSKATRINA0007, time stamp 7:28 a.m. is clearly incorrect based on sun position; additional screening copy kindly provided by J. T. Alpaugh of Helinet). Alpaugh speculates on the video: “It appears this hospital may still be in operation and running, running somewhat normally.” The video shows cars in the parking lot across the street from Memorial covered to their tops with water and other details described in this section.
4 the president’s peregrination of grounding rescue flights: Several sources were convinced this was the case, however the author was unable to confirm this upon reviewing copies of temporary flight restrictions (notices to airmen: NOTAM) provided by the Federal Aviation Administration in response to a FOIA request. In an interview with the author in 2011, Marc Creswell, at the time a field training officer for Acadian who helped coordinate the Katrina air medical response, said that he recalled the airspace was closed: “For medical aircraft, it’s thirty minutes prior to and then the entire amount of time the president is in the area and then just a few minutes after he leaves.” In fact, in interviewing some sources many years after the events, there may have been confusion between President Bush’s overflight on Wednesday and his visit to Louisiana on Friday, September 2, when air traffic was reportedly stopped while he was in the area (see, for example, Krupa, Michelle. “Bush Visit Halts Food Delivery,” Times-Picayune, September 3, 2005; http://www.nola.com/katrina/index.ssf/2005/09/bush_visit_halts_food_delivery.html).
5 Green vines spilled: Description based on photographs from the time.
6 A World War II veteran: Julius Haydel.
7 pregnant ICU nurses: This set of events based on interviews with Karen Wynn and accounts of the ICU nurses (with pseudonyms) in Budo, Katrina.
8 After Rolfie’s death: Horace Baltz. The Kat’s Paw: Memorial Medical Center—Katrina (unpublished manuscript) and interviews with Dr. Baltz and Dr. Ewing Cook and Minnie Cook.
9 At around two p.m.: The nurse taking care of Ms. Burgess noted in her chart Dr. Cook’s presence at 2:15 p.m.