Note: This is Part Two of the fourth diary inspired by a map titled Where They Were Found that was published by The Times Picayune.
Previous diaries are Where They Were Found - The Data Tells The Story, Just a Circle on a Map and Another Circle, Another Story.
The circles on the map you're looking at represent locations where bodies were found after Hurricane Katrina. The size of the circle indicates the number of bodies and the six largest circles mark locations where 10-20 bodies were found at a single location.
Part I of this diary covered Touro Infirmary (#2 on the map at the right) and Charity Hospital (#5). Today's installment covers the remaining hospital and looks at the current status of each of the three hospitals.
"We’re not even a blip on their radar" - Lindy Boggs Medical Center (#3)
Lindy Boggs is the wife of the late Hale Boggs, former House Majority Leader of the US Congress. She won the special election following his death in a plane crash in 1973 and represented LA-02 until 1991 when she was succeeded by William Jefferson. The hospital that bore her name was originally constructed in the 1920's and operated as a Catholic affiliated hospital until it merged with Baptist Hospital (later Memorial Medical Center) in 1994. In 1995 both hospitals were acquired by Tenet Healthcare. In addition to normal hospital services, Lindy Boggs was home to a well regarded transplant unit and a hospice care facility.
The aerial photo shows the hospital surrounded by 4-5 feet (based on the tops of the cars being visible) of the floodwaters that inundated the neighborhood. In the upper left of the picture you can see the raised section of roadway that later became one of the evacuation points for the hospital's residents.
During the hurricane itself, the hospital suffered a few blown out windows, but in general the staff felt that they had weathered the worst. Then as it did at the other hospitals, things began to go wrong. The generators, once again located in the basement, failed when the floodwaters reached the hospital. Communications were out and the staff had no way to request help. The staff began to realize that they were totally cut off - as Dr. Glenn Johnson, vice chief of staff at Lindy Boggs said, "We’re not even a blip on their radar".
When the flooding reached the hospital staff members raced to move patients to upper floors. With the generators gone, the elevators were out and the patients had to be carried up the stairs. No electricity meant no air conditioning and many of the hospice patients succumbed during the first 24 hours as temperatures in the building soared.
By Tuesday morning the floodwaters reached eight feet deep and nearby residents began fleeing their flooded homes, trying to make it to the supposed safety of the hospital. Dr. Johnson watched in horror as a man tried to make it to the hospital while floating an infant behind him on an inflatable raft. The man went under and the infant was left floating alone. No mention was made if the man or the infant eventually made it to the hospital. All told, approximately 500 local residents made their way to the hospital through the floodwaters.
The loss of the generators meant all of the normal life support equipment that the hospital counted on was out of action and the staff hurried to rig alternatives. Patients on mechanical ventilators where ventilated manually, with a staff member squeezing a balloon to force air into the patient's lungs - one squeeze for each breath. The staff ran half hour shifts and when they became exhausted, family members were trained to take over. In some cases they kept this relay going for literally days. For some patients there was no alternative available. Those requiring dialysis were on a slow countdown to see if they could be rescued before their own body poisoned them with accumulated waste.
Still without communications the staff tried to call for assistance the only way that they could - signs on the roof designed to catch the attention of the helicopters that were beginning to appear in the sky over the city. They asked for airdrops of medicine, food and water, all items that they were rapidly running out of. When that failed to work, they turned to foraging for critically needed medicines.
Urban hospitals aren't isolated buildings. They're generally complexes and around those complexes there tends to spring up a collection of secondary doctors offices and support industries. Foraging teams made their way through the floodwaters to those doctors offices to gather whatever drug samples they could locate and returned to the hospital with their finds floating behind them in plastic garbage bags.
On Tuesday afternoon the staff started to make preparations to evacuate the hospital on their own. They managed to locate several boats in a nearby garage and hot-wired the engines. Back at the hospital, Dr. Johnson began to prioritize the patients, planning to move the most critical ones first. But the next day, before they could implement their plans, a team of firefighters from Shreveport arrived at the hospital to check for survivors. According to the firefighters, they took one look at the situation and realized that they had stumbled onto "a full blown MCI".
MCI stands for "Mass Casualty Incident". The firefighters' training kicked in and they began a standard response to a MCI, which is to first get as many survivors out of the area as quickly as possible and then work the remaining critical cases. While that approach is specifically designed to save lives, it sometimes meant separating family members that had tried to stay together through the ordeal. Worse, it meant informing patients and families that the most able-bodied would leave first. Family members pleaded for loved ones in worse shape to be evacuated first and the firefighters had to refuse. Dr. Johnson was in charge of grading the patients, those who could walk would go first, those with limited mobility second and the patients on life support would go last. He literally marked the patient's forehead A, B, or C (ambulatory, wheelchair, critical) with a Marks-a-Lot. Dr. Johnson later said that he wondered to himself if that was what it was like at places like Auschwitz where people were graded and the marks they received meant that they lived or died.
The patients were ferried by boat to a bit of higher ground near the hospital where they waited for helicopters to evacuate them. However, in the middle of the process, the firefighters received orders to withdraw before sundown because of gunfire and looting going on in the city. They pleaded to be allowed to stay but were only given an additional 45 minutes before they had to leave the scene. By the time they left they had managed to get nearly 400 people out.
On Thursday, the only patients that remained at the hospital were those that were deemed likely to die during the evacuation. The transplant team had stayed behind with their patients who by now desperately needed care unavailable at the hospital. Using the "borrowed" boats, the surgeons ferried as many patients as possible to a post office that was being used as a heliport to wait for the properly equipped medivac helicopters that where beginning to arrive. In spite of their efforts, not all of the patients got out. Some of those that didn't likely knew what was happening to them as first the firefighters and then the remaining staff bypassed them to evacuate patients with slightly higher chances of survival.
The Doctor Who Wouldn't Leave
Finally, only Dr. James Riopelle remained at Lindy Boggs. Under his care were the last living occupants of the hospital, the more than 50 dogs, cats and guinea pigs that patient's families and staff members brought to the hospital to ride out the storm with them. He promised the evacuees that he would care for their pets for as long as possible, but could not guarantee their safety. Some people made the painful decision to euthanize their pets because they feared that they would be abandoned and starve to death or worse. Dr. Riopelle's wife, Dr. Jamie Manders, who evacuated from the hospital with the ambulatory patients, was on the ground in Houston and was emailing and phoning anyone she could think of to get assistance to her husband and his charges. Once the news of Dr. Riopelle's refusal to abandon the pets reached the media Dr. Manders was able to arrange with Tenet Healthcare and a Dallas vet to have Dr. Riopelle and the pets rescued.
Unfortunately, the first attempt to retrieve the pets on Sunday nearly ended in tragedy. After Dr. Riopelle and the security team hired by Tenet transfered the pets to the post office landing pad, the helicopter coming to pick them up was flipped on its side by the downdraft of a second helicopter. Though the engine exploded, the pilot managed to get out safely. Dr. Riopelle was forced to return the pets to the hospital.
The next day, on Monday September 5th, a full week after Katrina hit, a second attempt was made to rescue Dr. Riopelle and the pets. This time two helicopters arrived. Dr. Riopelle assumed that the tall guy who got out of the second helicopter was a reporter because of the barrage of questions he asked and the cameraman who accompanied him. It turns out that "the tall guy" was actor Matthew McConaughey. Word of Dr. Riopelle's situation had reached Oprah Winfrey, whose production company then sent the second helicopter and McConaughey to assist. The Tenet and Oprah teams evacuated the animals to Dallas where they were placed with foster homes until they could be reunited with their owners.
Putting a Face on the Numbers
I want to take a moment here and personalize this story a bit by highlighting a single victim. Artist Hugh Ricks illustrated numerous JazzFest, Mardi Gras, Congo Square and Louisiana World's Fair posters. He was in Lindy Boggs recovering from gall bladder surgery when Hurricane Katrina hit. He was severely dehydrated when he was evacuated on Thursday to Louis Armstrong International Airport and from there moved to a hospital in Fort Worth. He passed away on Sept. 16th from liver failure brought on by the dehydration.
Aftermath
Touro Infirmary reopened its emergency room on Sept. 28th 2005, less than one month after the storm. On October 12th, 2005, it reopened its full compliment of medical and surgical services, including the neonatal unit. It was just in time, because the first post-Katrina baby born in a New Orleans hospital was born at Touro that same day.
Charity Hospital was closed after Katrina as has not yet re-opened. Some components of the Medical Center of Louisiana have re-opened, most notably University Hospital, but the loss of Charity Hospital is particularly telling. Prior to Katrina, the Medical Center of Louisiana had 550 staffed beds, including 98 psychiatric beds. The current count of staffed beds is below 200 - 171 beds at University Hospital and an additional 25 psychiatric beds at another facility. The loss of psychiatric services is a particularly painful blow to a city struggling with the rash of stress and depression related issues that followed Katrina.
A team of approximately 200 former Charity Hospital doctors and nurses led by Dr. James Moises spent a month cleaning and decontaminating several floors of the hospital, hoping to restore some services, but were ordered to stop by the LSU Health Sciences Center and threatened with criminal trespass. LSU plans to build a new $1.2 billion academic hospital that will replace Charity, but does not expect to complete the work until 2012. In January of 2008 citizens of New Orleans filed a lawsuit to try to force LSU to re-open Charity hospital. Dr. Moises and others believe that LSU does not want to re-open even a part of Charity Hospital for fear of endangering the FEMA funding that will cover the majority of the cost of the new hospital.
Lindy Boggs Medical Center and Memorial Medical Center, both operated by Tenet Healthcare were closed after the storm. In October 2005, Tenet laid off the 2400 employees of both facilities because the hospitals would be closed for six months or more.
In June 2006 Tenet announced that they planned to sell multiple properties in the Greater New Orleans area. In July 2006 Oschner Health Systems acquired Memorial Medical Center and two other Tenet hospitals. Memorial Medical Center was renamed Oschner Baptist Medical Center. The hospital is currently operating at limited capacity as renovations continue.
In May 2007 Tenet announced the sale of Lindy Boggs Medical Center for $9.4 million to Victory Real Estate which plans to demolish the buildings and build a retail development on the site. In late 2006 a group of doctors including former Lindy Boggs staff tried to purchase the hospital from Tenet but were turned down. A December 2007 article in The Times Picayune indicates that the reason for the refusal was tied to the sale of other properties to Oschner Health Systems. As part of the purchase, Oschner required that Tenet agree not to sell Lindy Boggs to anyone who would use the site for health care purposes for three years after the sale.
In late 2007 Victory Real Estate obtained a permit which will allow them to proceed with the demolition of Lindy Boggs Medical Center.
Conclusions
First, it has to be said that the medical professionals in New Orleans worked tirelessly to save the patients in their care. Due to efforts that can be only described as heroic, they largely succeeded. However, without detracting from the efforts of those professionals, we have to acknowledge that fatality rates among patients in New Orleans hospitals approached 10% (154/1749 = 0.088 or 8.8%). Not included in that count are patients that died during the evacuation or at the triage stations setup at Louis Armstrong International Airport and the LSU Assembly Center in Baton Rouge.
The primary weakness exposed in each of the hospitals covered was the backup power system. What should have been just a difficult situation turned into a days long life and death nightmare. In contrast, Oschner Clinic in Jefferson Parish had nearly 400 patients during the hurricane. Its generators were protected by high floodwalls and Oschner didn't lose a single patient.
Another weakness was the assumption that help would arrive in 48 hours or less. While that may have been a valid assumption with the professionally run FEMA of the Clinton administration, that was a lethal mistake when dealing with the political appointees of the Bush administration.
But no matter what the faults in the emergency planning of the hospitals, the greatest condemnation belongs to the Bush administration. It botched the rescue efforts so thoroughly that its actions can only be viewed as a textbook example of how not to save lives. FEMA's response seems to have been little more than a PR damage control exercise. As each new disclosure appeared in the media FEMA would respond by directing resources to fight that particular fire. Never did they live up to the "Emergency Management" portion of their title by taking control of the situation and working the whole problem; instead they careened from incident to incident, pulled back and forth by the negative media more than anything else.
FEMA's performance was so bad that Dubya's "You're doing a heck of a job Brownie" quickly became a pop culture expression of contempt. Artist George Rodrigue of Blue Dog fame required only four words to deliver a blistering condemnation of FEMA's efforts when he reworked a traditional phrase yelled during Mardi Gras parades into a painting titled Throw Me Something FEMA.
What happened at these hospitals is the Republican idea of "personal responsibility" taken to the n-th degree. In their world it's up to you to save yourself because it's to expensive or to inefficient for the government to do it.
I say it's past time to call them on their bullshit. Because if we don't then the Bush & Brownie Show may play in your hometown next time.
Sources - Lindy Boggs Medical Center
The fight to save patients, MSNBC interview with Dr. Glenn Johnson, vice-chief of staff, Lindy Boggs Medical Center
Hope turns to anguish at intensive-care unit, USA Today
Katrina survivors upset over pets left behind, MSNBC
Doctor refuses evacuate New Orleans hospital without animals
Lindy Pet Rescue Update a web forum post about Dr. Riopelle's rescue
Long-distance chauffeurs, The Associated Press
Tenet Flunks The Katrina Test, Tenet Shareholder Blog
Ricks Family Home Page
Sources - Aftermath
New Orleans' Touro Infirmary reopens emergency room, Business Network
First Post-Katrina Baby Born at New Orleans Hospital, PRNewswire
Touro Infirmary anticipates baby No. 1,000, Business Network
Psyched Out, Gambit Weekly. A article on the loss of psychiatric hospital spaces in New Orleans
Loss of Charity Hospital's crisis intervention unit limits options, Business Network
New Orleans hospital adds 10 beds for mentally ill, The Times Picayune
Lawsuit filed to force Charity Hospital to re-open, The Times Picayune
Reopening New Orleans Charity Hospital's first three floors possible, Business Network
NOLA Area Medical Services Update, Bay Area Radical Health Collective
Pact Seals Demise Of Mid-city Hospital, reprint of Times Picayune article by The Urban Conservancy
Victory developers seek demolition permit for Lindy Boggs Medical Center, The Times Picayune
Memorial Medical Center / Oschner Baptist Medical Center, Wikipedia
Sources - General
After Katrina - Hospitals In Hurricane Katrina, The Urban Institute
154 Patients Died, Many in Intense Heat, as Rescues Lagged, reprint of New York Times article by Global Action On Aging. Warning: Article opens with a picture of the makeshift morgue in the chapel at Memorial Medical Center. Not graphic, but may be disturbing
Master index of NOAA aerial photos used in this diary
Note: George Rogrigue's Blue Dog doesn't refer to a weak-spined "centrist" Democrat, but instead to the Cajun legend of the loup-garou, a French version of a were-wolf.
A Correction
In Where They Were Found - The Data Tells The Story I mistakenly stated that "one of those large circles marks the location of one of the most controversial events of the storm, the alleged euthanization of patients at Memorial Medical Center after days without power or supplies". I simply assumed that one of the circles was Memorial Medical Center, but I didn't verify the hospitals at each location until I started researching Just a Circle on a Map. It turns out that Memorial Medical Center isn't represented on the map by a large circle, but instead by the small cluster of individual circles on Napoleon Avenue just above the word "UPTOWN" on the map. I don't know for certain why Memorial Medical Center isn't shown more prominently, but I'm going to hazard a guess that the data for this map was culled from public sources such as death certificates, etc. Given that at the time the map was published (12/20/2005) the investigation of the incident was still going on (autopsies were ordered for all 45 of the bodies found at that location) it's likely that death certificates had not yet been issued for the majority of the people who died there.
NOLA/GULF BLOGATHON--ALL TIMES PACIFIC
Thurs., Apr. 17
7AM Louisiana 1976
9AM commonscribe
11AM buhdydharma
1PM mlharges
3PM Mike Stagg
5PM alpelican
Fri., Apr. 18
7AM YatPundit
9AM Mike Stagg
11AM Louisiana 1976
1PM mlharges
3PM chigh
5PM Bodhiness