Through Hell and High Water

DR. BEN DEBOISBLANC

MEL LAGARDE

CHAPTER 4: A DARING RESCUE PLAN -- BUT WILL IT WORK?

By Jane O. Hansen | Wednesday, May 10, 2006, 04:43 AM

The Atlanta Journal-Constitution

Nashville — Jack Bovender immediately understood the enormity of the situation at Tulane Hospital. The chairman and CEO of the nation’s largest for-profit hospital chain had just walked into the boardroom Tuesday morning about 8 o’clock when Mel Lagarde called from New Orleans, his voice filtering through the speaker system so all could hear.

*The water is coming in.

*It was rising a foot an hour.

We’re going to lose our backup power.

Among the executives gathered at the table, the sense of urgency ratcheted up. CNN was broadcasting reports that the 17th Street levee might have been breached. The update from Lagarde, a division president, meant a new challenge.

Just the day before, Bovender and the others had been preoccupied with the company’s hospital in Gulfport, Miss. Of the Hospital Corporation of America’s four facilities in Katrina’s path, it had sustained the most wind damage from the hurricane.

Now Bovender was thinking: *The whole ballgame is going to significantly change.

*Tulane had ventilator-dependent patients, babies in intensive care.

We’ve got to get the critically ill out of there as quickly as we can.

Lives were at stake. With no power or water pressure, Tulane would need to evacuate not just its critical care patients but the entire hospital — more than 1,200 patients, staff and family members who’d taken refuge there.

It was the direst situation the company had faced in its 37-year history.

Located down a carpeted hall behind two huge wooden doors, the boardroom at HCA headquarters was well-suited as a command post, with its massive mahogany table, large flat-screen TV, computers and sophisticated communications system. Bovender, who had spent three years in the Navy’s Medical Service Corps, would be the man in charge.

Short, with gray hair and clear-rimmed glasses, the 60-year-old Bovender became both chairman and CEO in 2002. He was at the helm when HCA paid the last of nearly $1.7 billion to settle Medicare and Medicaid fraud claims stemming from a nine-year investigation by the U.S. Department of Justice.

Bovender had grown up around hospitals; his mother was a nurse. So was his wife. He’d dreamed of being a hospital administrator since he was a young man.

He had learned that the job involved a lot more than medicine and money. HCA’s facilities in Florida had taught Bovender that running a hospital corporation also meant being prepared for disasters.

Four hurricanes had ripped through Florida in 2004, leading HCA to convene its hospital leaders from around the country to bolster their readiness for storms. They concluded that medicine, food, water, diesel fuel and portable generators should be stockpiled on site and in nearby warehouses. Hospitals needed to be armed with satellite phones to ensure communication when phone service and cell service were disrupted. Increased generator capacity would help preserve air conditioning — critical to the operation of computers that run lifesaving medical equipment.

By the time Katrina hit, HCA executives felt more than ready. But they had prepared for a hurricane, not a flood.

Although the company often used medevacs to airlift critical patients, HCA for the first time would have to evacuate an entire hospital. It would need a lot of helicopters.

How many? Bovender asked.

*At least 20.

Get them.*

Bovender’s team went to work, studying a color-coded map and assessing all the corporation’s assets in the region, from supplies to hospitals.

The plan was to move Tulane’s critically ill babies, children and adults first. But it wasn’t just a matter of getting sick people out. They had to arrange for continued medical care. They had to line up receiving hospitals.

Where would they take the patients? Where would they stage medical personnel to assist in the evacuation? Where would they refuel the helicopters?

Engineers studied Tulane’s garage. Its rooftop hadn’t been designed to function as a helipad. Was there enough room to land there safely? How many cars could it normally hold? Could it bear the weight of a helicopter? How many?

Ed Jones, a vice president of supply chain operations, moved to a side room off the command center where there was a phone. He called Chuck Hall, president of HCA’s North Florida Division in Tallahassee. Although Katrina had merely brushed the state as a Category 1 storm the week before, Hall’s command center was still up and running.

*We need to identify as many helicopters as we can, *Jones told Hall.

They required a variety of types, from medevacs equipped as ambulances that could carry one or two patients on stretchers, to those that could carry ambulatory patients in seats. They needed large high-volume helicopters for staff and their families, and ones that could carry supplies.

With a cellphone in his left hand, a BlackBerry in his right and a landline phone cradled on his neck, Jones leased helicopters from HCA contractors as well as other companies.

A police department north of Chicago offered a helicopter used in Amber Alerts, complete with a cop trained in night vision. An HCA competitor — Sacred Heart Hospital in Pensacola, Fla. — volunteered a medevac.

Within hours, Jones and Hall had lined up choppers from Atlanta, St. Louis, Chicago, Mobile, Houston, Pensacola and Ocala, Fla. They would eventually secure 24 helicopters, including two privately owned Black Hawks that could carry between 15 and 20 people and one Russian Mi-8. Jones began hounding the Federal Aviation Administration for clearance to fly the craft into New Orleans.

He would earn the nickname “Chopper Ed.”

At Tulane, as water inched up the stairs toward the backup generators, Lagarde and Jim Montgomery, the hospital’s president and CEO, did not sit back.

Soon after being awakened in the middle of the night, Montgomery had called Acadian Ambulance Service, a company with air ambulance helicopters based in Lafayette, La. He told them he needed to evacuate 13 critically ill infants, four critically ill children and 14 critically ill adults.

In the next four hours, atop the Saratoga Street parking garage adjoining the hospital, the Tulane maintenance crew dismantled four 15-foot light poles to make way for helicopters. HCA had once sought FAA approval to convert the rooftop into a helipad. But the hospital had never gotten the go-ahead. No helicopter had ever landed there.

By the end of the day, both in Nashville and in Tulane’s darkened command center, the guiding principles were clear:

We’re not going to wait for the government to rescue us. We have to rely on ourselves. We won’t take no for an answer.

Already, they were looking ahead to what they would do with the more than 1,000 Tulane staff and their family members who had joined them at the hospital before the storm. Many had lost their homes. Where would they take them?

Bovender tossed out an idea.

What if we secured a cruise ship?

ON THURSDAY: At Charity Hospital, staff is reduced to practicing Third World medicine. Chapter 5 of 22.

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