While all of the city's major hospitals had detailed evacuation and emergency plans, officials said, none were prepared for a catastrophic flood. And each responded differently when disaster struck.
At Memorial Medical Center, where 45 bodies were discovered this week, staff members said they could do little more than try to comfort dying patients.
Frightened and exhausted nurses and doctors squeezed hand-held ventilators for patients who could not breathe. The cook reduced the daily meal ration from three to two to one. Doctors ranked patients for evacuation by helicopter, taping a number to each patient, with 3 for the sickest and 1 for the least critical.
Charity and University, two public hospitals that are part of the Louisiana State University system, did not have the money to hire helicopter companies to evacuate patients, said Don Smithburg, the system's chief executive. As a result, they were among the last to be evacuated.
The two hospitals relied almost entirely on the military and federal authorities. Charity and University managed to evacuate their 28 babies — 18 of them in intensive care — only by early Friday morning, nearly two days after the other hospitals. Twenty bodies were left behind at the two hospitals; 12 of the patients had died before the storm.
At Memorial, a private 317-bed hospital opened in 1926, "there were patients who were lying on the floor," said Dr. John J. Walsh Jr., a surgeon who stayed until the early hours of Friday, Sept. 2, when helicopters finally evacuated the last patients.
The hospital's owner, the Tenet Healthcare Corporation, the country's second-largest hospital chain, said on Tuesday that of the 45 dead, 25 were patients in an 82-bed acute-care ward run by LifeCare Holdings, of Plano, Tex., that was full at the time of the storm.
A Tenet spokesman, Harry Anderson, acknowledged that the failure of ventilators, dialysis machines and heart-rate monitors contributed to the deaths of patients. The hospital's generators shut down "as part of a general failure of the entire electrical system," not because of low fuel, he said. Of the 45 bodies, 8 to 11 had died before the storm.
Dr. Louis Cataldie, the state's emergency medical director, said he did not fault the management for the deaths.
The suffering at the hospital played out over four anguished days. On Sunday, Aug. 28, as city officials ordered an evacuation of the city, hundreds of residents began streaming into Memorial, in the city's Uptown section. About 260 patients were there, not including the LifeCare ward. In the early hours of Monday, hospital employees awoke with relief. The wind had shattered windows and the glass walkways connecting the buildings and parking garages, and water had pooled around the complex, but there was little structural damage. Around 4:30 a.m., the main power lines to the hospital were disrupted and the backup generators kicked on. By dusk on Monday, most of the people who had taken refuge in the hospital had left. But hundreds of people stayed behind. All of them assumed they would be able to leave within a day or so.
On Tuesday morning, the hospital's chief executive, L. René Goux, called an emergency meeting. The administrators decided to evacuate the hospital and not to admit more evacuees from the neighborhood.
The telephones had died, and Goux began sending frantic e-mail messages to Tenet's headquarters in Dallas, requesting assistance. Company officials began calling the Coast Guard, the National Guard and even H. Ross Perot, the investor and former presidential candidate, who is a friend of Tenet's chief executive, Trevor Fetter.
Meanwhile, workers at Memorial managed to clear up an abandoned landing pad, on top of the Magnolia Street parking garage, for use as a heliport. They strung together extension cords from the generator to the landing pad and shined lights to guide the pilots. Getting patients to the helipad was not easy. They were passed through a three-by-three-foot hole on the second floor, which led from a maintenance room into the parking garage. From there, vehicles drove the patients up the ramp. Then they had to be unloaded and carried up three flights of steps to the landing pad.
Nothing was clear. At least two helicopters tried to land on the helipad and deliver evacuees to the hospital, which was trying to clear everyone out. Some pilots only wanted to take pregnant women, or babies.
Meanwhile, private boats started ferrying away the 1,800 residents who had taken shelter at Memorial. They were taken to dry land on St. Charles Avenue. From there, they left on foot or in buses.
Around 1:30 a.m. on Wednesday, the generators started to fail. Lights flickered and died.
On Wednesday evening, the boats stopped — before everyone could be evacuated. About 115 patients were left. And helicopters never arrived that night.
By Thursday morning, doctors were in crisis mode. At 9 a.m., six helicopters chartered by Tenet finally started arriving, carrying away wave after wave of patients and evacuees. The last living patient left that evening. For others, help had come too late.
John J. Finn, president of the Metropolitan Hospital Council of New Orleans, said the chiefs of the city's 20 hospitals had realized late last year in a planning exercise that they should come up with a plan to cope with a devastating hurricane.
