Through Hell and High Water

DR. BEN DEBOISBLANC

MEL LAGARDE

CHAPTER 14: ROOFTOP BLOWUP AS FEARS FOR PATIENTS MOUNT

By Jane O. Hansen | Friday, May 19, 2006, 12:56 PM

The Atlanta Journal-Constitution

New Orleans — John Holland, the Georgia pilot running the Tulane Hospital helipad, wrote down the precise number of critical patients Dr. Ben deBoisblanc said he needed to evacuate from Charity Hospital: 21.

But on Thursday, Sept. 1, more than 30 crowded into Tulane’s parking garage — and not all were on ventilators or stretchers. Some were able to walk. And one was a prisoner.

Jim Montgomery, president of Tulane, was livid. He still had the last of his own patients to get out, as well as 700 hospital employees and their family members, including 100 children.

Some of his employees were not pleased that Charity people were interrupting their own long-awaited rescue, especially nonmedical staff who did not understand the crisis patients faced. With many helicopters taking only one or two people at a time, the evacuation was, in the words of one doctor, like emptying a swimming pool with a teacup.

When Montgomery heard that the number of Charity patients was growing and some weren’t even on stretchers, he left the command post and headed for the garage.

You told me it was going to be 21 patients; you got 33, Montgomery said to Dr. Ben. I told you we’d take critically ill patients, and people who are ambulatory are coming over here.

One was a prisoner who had gone without dialysis for nearly a week, a life-threatening condition. Like Grady in Atlanta, Charity was where sick inmates were taken for treatment.

Dr. Ben radioed back to Charity. Do not bring any more patients. They’re not taking any more.

To Dr. Ben, the rejection was another reminder of his hospital’s second-class status. The Tulane administrators didn’t care about Charity patients. They were simply in the way.

Montgomery saw it differently. So did Mel Lagarde, the Hospital Corporation of America executive who had stationed himself at Tulane. They’d been airlifting patients for two days. They had a process that was working. They had rules everyone was following, and they weren’t about to let Dr. Ben take control.

Dr. Ben was the passionate physician frantic to save his patients. Lagarde was the coolheaded corporate leader who had helped put in motion an effective rescue operation.

What would play out that day in the Tulane garage occurred against a backdrop of competing cultures, different perspectives and the fear of losing lives.

From one vantage, a private hospital stepped in to do what the government had not: It rescued the sickest and most helpless.

The other view said the have-nots were first abandoned by their government, then relegated to second-class status as the haves put their own safety above the lives of the have-nots.

Two hospitals. Two universes. And they were on a collision course.

It was the arrival of a military Black Hawk that touched off the showdown.

The Charity staff had been told the military was sending Black Hawks to the Tulane roof to evacuate their patients. But when one landed that afternoon, Charity staff watched as Tulane employees boarded to a round of applause.

Dr. Ben ran to the rooftop, yelling at Holland and anyone he could grab. He accused Tulane administrators of hijacking helicopters intended for Charity, while his staff hand-ventilated patients who had waited hours in the hot, stuffy garage.

Lagarde, who was on the roof, knew the physician was desperate, and he understood why. He had gone down to the seventh-floor holding area and surveyed the scene of sick Charity patients lying on the floor. He’d ordered Tulane staff to find additional oxygen cylinders for patients who were running out. But Dr. Ben kept accusing him of not giving priority to Charity patients, of not understanding how ill they were.

After the Black Hawk took off, Lagarde braced himself. But as the enraged physician walked up to him, the calm executive also lost his cool. Red-faced, standing nose to nose with Dr. Ben, Lagarde yelled back,

These are our helicopters. Where are yours?

With a walkie-talkie in each hand, Dr. Ben screamed into both, not knowing who might be listening. Get some helicopters down here NOW!

From their staging area one floor below, the Charity staff had seen only one thing: Healthy adults leaving before their very sick patients.

They didn’t know that the Black Hawk had seats and could take only people who could sit up. It could not — and its military pilot would not — take patients on stretchers.

They didn’t know that another helicopter they had watched fill up with able-bodied people had been contracted by Hibernia National Bank to take away 40 bank employees. Tulane had agreed the day before to let the bank use its rooftop as a landing site.

The whole atmosphere angered the Charity crew. Their experience in the garage magnified the fundamental difference between the two hospitals. Tulane could pick up a phone, call HCA and anticipate a cavalry of resources. Charity could pick up a phone and call CNN.

Another difference between them was in the arrangements they had made for their patients once they were evacuated. Tulane’s leaders considered it imperative to know where patients were going and had taken great pains to line up receiving hospitals. But Charity staff were at a different level of desperation. All they cared about was getting their patients out.

A quarrel broke out when a Tulane pediatric surgeon defended the helicopter operation, and Dr. Granville Morse, an emergency medicine resident at Charity, argued back.

I don’t know what your problem is, the Tulane surgeon said to Morse. Nobody would transport critically ill people in a school bus. They would put them in an ambulance. Some of these helicopters weren’t outfitted to take patients, the surgeon said.

Is your parking garage outfitted to be an ICU? Morse yelled back. Can you honestly say these patients are better off here?

Holland sympathized with the Charity staff. He knew they couldn’t see the whole picture. They didn’t understand that most pilots had no way of knowing which people they were supposed to carry. All they had were the coordinates for Tulane and where they would be headed. Holland also knew that the evacuation of Charity’s critical patients would take time. Two days earlier, it had taken 18 hours to evacuate the most critical of Tulane’s patients.

Holland assured Dr. Ben he was on his side, and the physician believed it, but he was not a patient man, and he was used to being in control. He kept returning to the roof, demanding someone pay attention to him. He believed that out of sight, Charity patients remained out of mind.

Late Thursday afternoon, Dr. Ben’s worst fear became a reality.

A patient in her mid-50s, suffering from emphysema, grew short of breath. Miss Mabel was one of the nursing home patients found earlier in the week by the National Guard and brought to Charity.

Although she had a tracheotomy and was on a ventilator, she had been alert and able to communicate before Charity staff brought her to the garage. Her biggest concern was making sure her family knew where she was.

In the Tulane garage, as they waited for a helicopter, Miss Mabel became increasingly unstable. Without monitoring equipment, the medical personnel had no way to anticipate the crisis, nor could they diagnose exactly what was going on. One theory was the anxious woman’s airway had become blocked by a mucous plug. About 4 that afternoon, a resident cradled Miss Mabel in his arms as she took her last breath.

Dr. Ben had not expected Miss Mabel to die. Had the woman been evacuated in a more timely fashion, he believed her death might have been prevented.

Then, a second crisis arose with another nursing home patient — an elderly man who had been cared for in the fourth-floor unit where student nurse Susan Sanborn worked. On the Tulane rooftop, Holland had just loaded him onto a helicopter when his heart stopped. Holland made the difficult decision to take his body off the helicopter. They had to make room for someone else.

At the height of the chaos, a CNN reporter and cameraman arrived on the Tulane helipad.

A shrill Dr. Ben shouted into the reporter’s microphone, “Two of them have already died here on this ramp waiting to get out!”

They had died because Tulane was evacuating its own staff before Charity’s patients, he told the reporter.

At the end of the day, when the doctor appeared on the roof with a bullhorn, Holland took it from him, then had him removed. Dr. Ben was escorted to the seventh floor, where a Tulane police officer blocked his return with an M-16.

TOMORROW: Fear drives one unit in Charity Hospital to set up a barricade. Chapter 15 of 22.

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