Tulane Hospital CEO’s account of Katrina

This is a letter from the CEO of Tulane Hospital, Jim Montgomery.  I think they’re to be commended.  It’s long, so keep going into the extended entry.  And his post-script should be a wakeup call for all of us.

I thought it might be easier to compose an email to all of you at once
that
tells some of the story of the past few days.  First and foremost I
felt your
prayers and heard your concerns that were registered with
Donna and others
and they comforted me and kept me calm which was
essential in this time.

This storm as of noon Friday the 25th didn’t seem like it would be
much
of an event, but by 5pm things began to look different.  We met as
a
group on Saturday to begin our routine preparations for a hurricane.

Donna left for her brother’s home and I went home to put things
together
there.  I started to think what do I absolutely not want to lose in
case
the house would be swept away and the answer only revealed the photos of

the family thru the years so that and few clothes was all I took.

The
Storm:  God’s Natural World has an awesome power.  From the small
observation
windows from our tallest floors, we observed awnings being
blown off, a
blinding rain and a general sense if God’s ever angry we’re
going to lose
big.  Our first inspections revealed little damage.  A few
broken windows and
some roof damage but the building held up well.  In
fact, if you were in the
inner core of the facility you only vaguely
heard it.  We even walked around
late in the afternoon since there was
only limited flooding no worse than a
heavy thunderstorm.
Overconfident, we even stated we had absorbed the best
punch that nature
could throw and we seemed intact.

At 1:30 am on
Tuesday morning began the biggest crisis and challenge of
my life and in the
life of Tulane and no doubt New Orleans.  I was
awakened by my COO who told
me the water in the boiler room was rising a
foot an hour since midnight and
if it continued at that rate at best we
had only another two to three hours
before we would lose all power since
we already were on emergency power since
early Monday morning.  We had
only 7 ventilator patients whose lives would
be in jeopardy, and we had
to move fast to get them out.  We had no boat and
no helicopter pad.
Houston we have a problem.

I called Acadian
Ambulance (who I know well) but had no business
connection to our hospital
and asked their immediate help.  We have a
parking deck connected to the
hospital that we had evaluated as sturdy
enough to support helicopter flight,
but it had four light poles in the
middle.  I want to tell you what happened
in the next four hours was
nothing short of a miracle.  Our maintenance group
got the light poles
down; Acadian agreed to pick our patients up, we made
arrangements with
our other HCA hospitals to take them. Our staff and
physicians got their
patients ready, and most importantly, the water rise
began to slow to an
inch/hr and a little after the sun came up copters were
on the roof and
patients began to be transported.

Early on Tuesday
morning we met with our key managers who were at the
hospital.  We prayed for
support and comfort and guidance for what we
knew was going to be a difficult
period.  We talked about what we knew,
and what we didn’t know which was
considerable because we had no contact
from FEMA or the Mayor’s office.  We
had no idea why the water was
rising and from what limited facts we had, no
one did.  We had to assume
that it would keep rising and we would lose power
and then we would have
no power at all.  Thus, no light, no ac, suction,
oxygen, elevators,
phones ie. Everything that is precious to good care.  We
had to get out
so we hatched a plan and I tried to stay out of the way and
let our
physicians and nurses triage patients; others determined what
vital
supplies we needed replenishing; HCA was working frantically
to
coordinate a transportation effort to pick up patients and eventually,

our staff.  How many people?  Good question. At least 1200 which
included
a total of 160 patients, employees and physicians and their
families and 76
dogs and cats that I didn’t know about at the time.

Tuesday:  The looting
began.  We witnessed people, dozens of them,
wading in front of the hospital
with bag after bag of stuff from
different stores in the vicinity.  Bandits
took over two hotels adjacent
to us and forced out many of our employees
families who had been housed
there forcing them back to the hospital creating
further complications.
That night our people on the roof evacuating patients
heard gunshots in
the air but they continued their work. The lawlessness and
insurrection
certainly was a distraction but our Tulane Police were great,
and they
are very capable. Late in the day we ran out of fuel so our
generators
shut down and the building began to get hot.  The last of the
ventilator
patients had to go up six stories by way of pickup trucks since
the
elevators shut down and our ambulance was too tall to squeeze to
the
top.  During the day, I had a conversation with a patient’s father
who
told me that the parking deck pad would hold big helicopters.  How
did
he know?  Because he was a Blackhawk pilot.  Ok.  Then there
appeared
out of nowhere this guy, John Holland, who was sent in by HCA to be
our
Flight Coordinator – whatever that is.  "The man" had arrived who
would
communicate with the birds in the air and boy is that important
because
our patients had begun to fly away.

Wednesday:  If you would
like to know if we slept.  Here’s a little
experiment.  Try heating the
bedroom up to about 90-95 degrees.  First,
you’re hot and then you sweat and
get cold and then the cycle repeats.
Daybreak and I tell you patients are
being moved into a queue to move.
I saw our staff, residents, and faculty
move sick patients with a grace
and dignity that was most impressive.  This
was our third day and the
stress on our people began to show.  Everyone was
asking when, where, &
how were we going to get out.  The city sewer
system was obviously
backing up and spilling out and creating an acrid smell
that over the
next few days made it almost impossible to breath. With no
water
pressure you can’t bathe.
But here’s a general observation:  if
everyone smells the same you
really don’t notice it, you just feel
unclean.  On this day, the La.
Wildlife and Fisheries Department showed up to
help us move some
patients that we had inherited from the Superdome on Sunday
night.  Yes,
over 60 extra medically needy people with chronic
conditions.  So by
boat we sent them and their love ones away.  I met a woman
whose most
valuable possession was her pillow and her radio that I
personally
promised her to protect.  It’s in my office now.

The Big
Birds began to fly.  Blackhawk’s down.  Instead of one or two
patients they
could move up to four with some additional staff.
Beautiful sight but there
was more to come.  By the end of the day we
had moved all but about twenty
patients including two who weighed more
than 400 lbs and one artificial heart
assist-device patient, which was
the challenge of the week since the device
itself weighted more than 500
lbs.  So imagine hauling this weight three to
four floors down a dark
stairwell at 90 plus degrees.  It was a young man’s
job and it was done.
Let me tell you that the coordination from the patient’s
room to the
staging area to the helipad into the helicopter was a work of
art
composed by many painters.  It truly was a thing of beauty and
it
touched everyone who was there.

By the end of day, HCA had
constructed an extraction plan for the
remaining staff.  Helicopter to the
airport, buses to pick up and take
to Lafayette.  Sounds good but there were
lots of needs and who knows
what the government may decide to
do.

Thursday:  Line up and get ready.  Have a little breakfast.  We

basically were living on Strawberry poptarts, honey oat bars and
for
dinner a little protein, tuna fish.  Fortunately, I like all of them
but
I’m sure I lost ten lbs. or so.  Anyway, the line was formed and
I
personally counted.  700 hundred people. Our staff, physicians,
their
children and spouses, and just to top it off 76 dogs and
cats.  Holy
God.  How are we going to deal with that? So we relegated
them
immediately to second-class citizenship to another line and pray we

don’t have to put the pets to sleep if no one will haul them.

At
first there were just a few small copters and we had some patients to
move
and it was slow.  Moving through the line people were calm with a
few
exceptions but overall they managed their plight well.  Then a
situation
developed.  A frantic Medical Director of Critical Care showed
up by boat
from Charity.  Major problem.  Charity was in a meltdown.  He
had 21 critical
care patients many being hand ventilated for two days
and he couldn’t get any
help from the state.  You may have heard this
story reported by CNN.  Their
version and ours differs but raise your
hand if you think the media gets it
right all the time.  Can you help me
he asked?  This was a tough question
but it had only one answer.  We
would give them access to the small aircraft,
which wasn’t going to help
us move our staff anyway.  So that process began
much to the chagrin of
our non-professional staff and family.  They just
didn’t understand it.
Our nurses and doctors did but it increased the crowd’s
intensity.
Midday and it was moving slow.  It didn’t look good.  Then from 3
to 5
things happened.

A Chinook helicopter is big.  Two rotors and it
carries about 50-60
people.  It moves with a slow deliberate confidence that
is hard to
describe.  But one showed up.  We had questioned about could it
land so
we asked "the man, John" and he said yes but nothing else could be
on
the pad when it did due to the turbulence.  I want to tell you as
it
approached cheers broke out from below and people thought they had a

chance.  So for a few hours we made progress and then it
stopped.  No
more big birds, big problem.  What happened?  Don’t know.  I
called my
daughter Megan where Donna was staying
and she seemed
elated.  "You’re back".  "What?" I asked.  She tells me
Gov. Blanco had just
announced that Tulane had totally been evacuated.
According to my account she
was about 400 people short in her analysis.
But we now had a new
problem.  They think we’re not here.  Better let
someone know.

I
called the La. Nat’l Guard.  Guess who answered, Brad Smith, the
patient’s
father I spoke of earlier.  He had gotten a ride back with
some of the
Wildlife boys and was now flying sorties into New Orleans.
He quickly got a
hold of the Office Of Emergency Preparedness and let
them know we still
needed help.  So maybe Friday we’d get out.  People
were remarkably calm when
we told them they’d be there another day.  The
just sat down and began to
prepare to go to bed.

We left the hospital and remained in the parking
deck.  One it was
cooler, two there would be less confusion in the morning
and three it
was safer since there was less territory for our Tulane Police
to
patrol.  I know the media has played up the anarchy, and no doubt
there
was some concern, but I always thought we were safe.

So imagine
trying to fall asleep on your concrete driveway without a pad
or
pillow.  It’s kind of tough.  Then throw in an unexpected helicopter
landing
at 1 am.  The wind is a little dicey.  The bird dropped off 50%
of the
Marines in New Orleans.  One guy who need to go to Charity so we
had to take
him over.  Next event for the evening: at 4 am we were
treated to a massive
explosion at a warehouse on the river several miles
away.  I happened to be
looking directly at it at the time.  It must
have reached a 1000 ft in the
air.  Then by the end of the evening we
began actually to get cold.  But it
finally ended.

Friday:  The end is pretty anti-climatic.  At 8 o’clock
unexpected
Chinooks began showing up taking 60 people at a time.  I wonder if
our
pilot friend in the Guard had anything to do we it but I haven’t asked

him yet.  So in a matter of 2 1/2 hrs. everyone was gone but our
Police
and the last remnants of management.  So after attempts to arrange
a
coordination with Charity to use the helipad, we left for home
sweet
home.

Obviously, this is only phase one of a complicated
recovery for New
Orleans.  Each of you no doubt is praying for this
recovery.  So many
people have lost so much and it reaches far beyond New
Orleans.

I talked to the Chairman of the Board of HCA yesterday upon
returning
and told him it was the worse and most difficult challenge I have
ever
been personally involved with but at the same time I don’t think
I’ve
ever felt as great a sense of accomplishment from anything I’ve
been
involved with.  Our staff performed like clockwork and it was
a
beautiful thing to observe.  Our success in this week is simply
measured
by the fact that we didn’t lose a patient during this trying time.

Jim

P.S. This event is just below a nuclear catastrophe in its
degree of
magnitude, and it’s clear we’re not ready and if we don’t do better
the
next time a really hard rain’s a-gonna fall.