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Friday, May 12, 2006
CHAPTER 7: RESCUE PLAN FROM A TO Z
The Atlanta Journal-Constitution
Multimedia
Nashville — Within hours after the levees broke in New Orleans, executives of the nation’s largest for-profit hospital chain were thinking ahead: What would they do with their stranded employees after airlifting them to safety?
A risky helicopter rescue of Tulane Hospital’s most critical patients was well under way on the roof of a parking garage. But more than 1,000 doctors, nurses, employees and family members were also imprisoned by the floodwaters that surrounded the hospital and rushed inside, drowning the emergency generators. The Hospital Corporation of America would act decisively, not waiting for — or even expecting — government help.
From its hushed, cushiony boardroom, the company early Tuesday launched a sweeping plan that would later be regarded as a textbook example of disaster response. Jack Bovender, the CEO and the son and husband of nurses, led his team of executives, each of whom had years of experience in health care administration.
First, their evacuated employees would need to be decontaminated, fed and given clothes and a cot to sleep on. HCA set up three shelters 135 miles west in Lafayette, La., at a dance studio, a banquet hall and a catering center. The company ordered pharmaceuticals and supplies, and called upon its army of employees from around the country to assist in the relief effort.
Each employee would receive a tetanus shot and a six-day supply of the antibiotic Cipro to stave off cholera and other bacterial infections. New underwear, scrubs, flip-flops, toiletries and towels would be issued. Employees would receive information about how to get their paycheck, relief assistance, federal disaster benefits and cash. The plan was so comprehensive that HCA even arranged to have tampons and children’s toys available for any employee who wanted them.
The company would use private aircraft to fly in dozens of nurses and staff from other HCA facilities. Through its temporary staffing agency, 170 nurses stood by, ready to be deployed from nine U.S. cities. Staff organized volunteers in Lafayette to cook a down-home Cajun meal of jambalaya for the weary evacuees’ first night of freedom.
Knowing that many employees would have lost their homes to Hurricane Katrina and the flooding, Bovender had floated the idea of housing them in a chartered cruise ship. When the CEO of the Hospital Corporation of America speaks, a hierarchy of willing officials listens. But in no time Tuesday they nixed the notion. They would later laugh when Bovender himself summed up the findings of their cost analysis: It would be cheaper to fly everyone to Chicago and put them up at the Ritz-Carlton.
The federal government, on the other hand, would embrace the idea. While desperate New Orleanians still clung to their rooftops, the Federal Emergency Management Agency signed a six-month, $236 million contract with Carnival Cruise Lines for three ships to house evacuees.
Critics in Congress later lambasted the decision, calling it a “sweetheart deal” for the cruise line. Even with the ships at full capacity, the cost to taxpayers would have been $1,275 a week to house each evacuee. The ships, however, would never become as popular as the government envisioned. By the end of September, they were only half full, according to two U.S. senators. Apparently people who had lost everything to the water didn’t want to go live on it.
Instead of a ship, on Tuesday afternoon, HCA reserved 1,500 hotel rooms in Atlanta, Houston, Orlando, Nashville and Dallas. It chartered two 727 jetliners to fly to Atlanta and Houston. It would purchase 200 one-way tickets to get people from there to the destinations of their choice.
Throughout the elaborate preparations, Mel Lagarde, the executive in charge inside Tulane, remained in constant touch with headquarters in Nashville. His cool, calm voice over the speakerphone inspired the HCA executives; their regular updates from Nashville in turn gave Lagarde confidence and hope.
By late Tuesday afternoon, all but two of the hospital’s 31 most critical patients were en route to hospitals in Houston; Pensacola, Fla.; and Lafayette, Covington and Alexandria, La. Still, Sam Hazen, president of HCA’s Western Group, was worried. Most of the helicopters in use were designed to take only one to five passengers at a time. The flights to Lafayette and Pensacola, where many of the critical patients had been taken, took as long as four hours round trip.
Hazen did the math. We need to turn over these helicopters faster, he said.
The Louis Armstrong International Airport was only an eight-minute helicopter ride away, less than 20 minutes round trip. What if they turned the airport, closed to regular traffic, into a staging area? HCA already had a relationship with the company that operated one of the private hangars. The helicopters could refuel there and load up with food, water and other supplies for the return trip to Tulane. They could drop their employees at the airport, then bus them to the shelters in Lafayette.
The plan would go into effect the next morning, Wednesday, Aug. 31.
That day, another turning point would come with the arrival on the roof of someone who understood helicopters, human behavior and life-and-death situations.
The HCA executives didn’t even know it yet, but their rescue operation was in desperate need of “The Man.”
ON SUNDAY: At Charity Hospital, a student nurse tends to two mystery patients. Chapter 8 of 22.
CHAPTER 6: ROOFTOP DRAMA AS COPTERS HAZARD RESCUE
The Atlanta Journal-Constitution
Multimedia
New Orleans — Sharif Omar normally spent his days darting about Tulane Hospital armed with a walkie-talkie and cellphone as he directed the transporting of patients and oversaw food service and laboratory operations. On Tuesday, Aug. 30, the hospital administrator was ordered to the rooftop to do whatever one does to help a helicopter land.
The sun had barely come up when Omar walked across the enclosed bridge from Tulane to the Saratoga Street parking garage and went up to the roof. The hospital had lost emergency power and was surrounded by water. Patients’ survival depended on getting airlifted out.
Maintenance staff had worked through the night to reconfigure the rooftop into a helipad by removing light fixtures. In Nashville, at the hospital’s corporate headquarters, design and construction staff had tried to calculate whether the roof would support the aircraft. But Omar knew there were no guarantees.
Alone on the roof, he didn’t have to wait long before spotting the first helicopter from Acadian Ambulance Service flying toward him. He watched it maneuver through city buildings.
As the helicopter made its approach, Omar wasn’t sure how to help; he had no way to communicate with the pilot.
He literally held his breath.
Staff at Tulane had moved their most critical patients onto one floor in anticipation of Hurricane Katrina so they could be cared for more efficiently. At Charity Hospital, critical patients remained spread over four floors.
Tulane established clear lines of authority: The president of the hospital, Jim Montgomery, and Mel Lagarde, a division president for the Hospital Corporation of America, were in charge. At Charity, where a committee was at the helm, the chain of command was fuzzy.
At the private hospital, Tulane administrators were equipped with six to eight satellite phones. They had established a command center in a second-floor conference room, where they had miraculously found two working landlines. At Charity, the public hospital depended on irregular cellphone service and a single satellite phone that worked sporadically.
Tulane’s corporate owner, HCA, had learned the lessons of 9/11 — the need for a command and control structure and a reliable means of communication. Tulane had both. And it had something else Charity lacked: hope.
Montgomery and Lagarde were in constant communication with company headquarters in Nashville. They knew the corporation was mobilizing a rescue operation. As a wealthy company with 180 hospitals, HCA could draw on a cavalry of resources.
The two men also walked the halls of Tulane, keeping patients and their families informed. They held regular meetings with managers and separate meetings with physicians.
They maintained order, and they maintained calm. In the boardroom in Nashville, the sound of Lagarde’s quiet confidence over the loudspeaker helped executives keep their own emotions in check.
Up on the parking garage roof, the first helicopter landed and the rooftop held, to everyone’s relief. Tulane’s rescue had officially begun.
Staff had begun moving critically ill patients to the second-floor bridge to the parking garage, then to a holding area on the garage’s second floor. From there, they planned to drive patients by ambulance up six floors to the roof. When the ambulances wouldn’t go up the garage ramps — they were 2 inches too tall — they used pickup trucks instead.
First to be evacuated were 13 newborns from the neonatal intensive care unit and four children from the pediatric intensive care unit. Five of the 17 were on ventilators. Texas Children’s Hospital in Houston had agreed to take them. Montgomery watched as staff loaded the tiny babies on board.
Good God, he thought, how many of these people might not make it?
Hour after hour, helicopters landed and took the hospital’s most critical patients safely away, one or two at a time. The security in the city, meanwhile, was breaking down.
From the rooftop, dozens of people could be seen wading down Tulane Avenue carrying goods stolen from nearby stores. Looters took over the hotel next door where employees’ families had sought refuge during the storm, forcing them to move into the hospital.
But by late Tuesday afternoon, all except two of Tulane’s most critical patients had been evacuated. The two who remained were awaiting heart transplants.
One was a 15-year-old boy on a heart machine that was being powered by a portable generator. Once disconnected, the machine could be hand-cranked, but only for 30 minutes. So the boy could not be moved to the second-floor staging area until a helicopter arrived. And that copter had to be specially fitted with a battery system to keep the machine going. The Arkansas Children’s Hospital in Little Rock arranged to send the special aircraft.
As it grew dark, gunfire erupted on the streets below. Exercising caution, the Tulane command center agreed with Acadian Ambulance Service that it should halt its nighttime evacuation.
Omar sent all but one other person off the roof. He was still expecting the helicopter from Arkansas. He sat waiting in darkness.
Suddenly, a helicopter circled above. Jumping up, he wondered what he should do with the flashlight in his hand. This was the first chopper he would bring in at night. Should he point the light at the ground? At the helicopter?
At first he shone the light into the air. But he worried he might blind the pilot. So he trained it at the ground.
As the helicopter landed, Omar radioed on his walkie-talkie, Move the patient!
On the fourth floor of the hospital, 20 people began the arduous task of carrying the 15-year-old — and the 500-pound machine keeping him alive — down the stairs by flashlight. They had 30 minutes to get him down the stairs, across the bridge, onto the truck, up to the roof, onto the helicopter and hooked up to the battery.
They made it in time, and the boy lifted off. It was no small success. In 18 hours’ time, Tulane had evacuated all but one of the hospital’s 31 sickest patients. Across the street at Charity, where staff had been told the government was on its way, they were still waiting.
About 2 Wednesday morning, Omar lay down to sleep on the floor of his office. He was hot and exhausted but relieved.
So far, at least, no one had died.
ON SATURDAY: New scrubs, flip-flops and a Cajun meal — a comprehensive rescue and relief plan takes shape at HCA headquarters in Nashville. Chapter 7 of 22.
