2005 New Orleans levee failures and flooding

The 2005 New Orleans levee failures and flooding turned Hurricane Katrina into a cascading civic and medical emergency: water entered a city whose evacuation and hospital plans could not reliably move or protect everyone at risk. The rising flood exposed not only the vulnerability of levees and electrical infrastructure, but also the unequal ability of residents to escape and the consequences of plans that had identified hazards without preparing workable responses.

Evacuation and the limits of escape

At about ten in the morning, Mayor Ray Nagin ordered an immediate evacuation of New Orleans. The decision came after hours of delay over logistical and legal questions. Yet an order to leave could not itself supply the means of departure. Many residents had no car, while traffic had already clogged the interstate. The city’s transport arrangements had significant gaps, including too few drivers. The New Orleans Superdome was designated a shelter of last resort, and shuttle buses were meant to take people there; Nagin specifically urged people with medical conditions, including those needing dialysis, to go, without clarifying what assistance would be available once they arrived.

The evacuation problem was especially acute for people who depended on institutions for care or transport. Hospitals and their workers were exempted from the order because officials feared that injured people would have nowhere to go if hospitals closed. Meanwhile, dispatchers at Acadian were overwhelmed by calls to move patients from hospitals, nursing homes, and homes. Many of the roughly two dozen ambulances available were trapped in traffic, and some began taking patients to the Superdome rather than attempting to leave the city. In St. Bernard Parish, Chalmette Medical Center began evacuating, but ambulances did not return after carrying away the first critically ill patients. Other proposed transfers faced roads so congested that patients might have spent as long as a day in an ambulance. The crisis therefore began with a stark mismatch between the command to evacuate and the actual capacity to transport people.

Warnings and known vulnerabilities

The danger to hospitals was not wholly unforeseen. Federal officials had asked which hospitals in flood-prone areas had placed generators and electrical switching equipment above ground level. Only two of roughly eighteen hospitals in and around New Orleans had done so; Memorial Medical Center was not among them. A planning exercise earlier that week had assumed that more than 2,000 hospital patients would be in the city during a catastrophic hurricane, but planners had not determined how to get them to safety in a flood. A federal emergency response leader later reported that about 2,500 patients remained in New Orleans as Katrina approached.

At Memorial, plant operations director Eric Yancovich had examined government storm-surge estimates after Hurricane Ivan narrowly missed the city. Memorial sat three feet below sea level, and the models indicated that a major storm could bring twelve to fifteen feet of water around it. Yancovich’s hand-drawn calculations showed that less than four feet of street flooding could carry water over the loading dock and into the hospital. Although the generators themselves were on the second floor, parts of the emergency power distribution system were at ground level or below it. In a memo, he warned that relatively little water could disable most of the medical center and predicted that patients might have to be moved to the newer Clara Wing, where he believed the electrical circuitry was better protected.

Some defenses were improved: floodgates were added and the vent for the underground diesel tanks was raised. But Yancovich also recommended elevating emergency power transfer switches and pumps supplying medical air and vacuum suction. A partial bid for electrical work exceeded a quarter of a million dollars, and he recorded that the work was not expected to be approved because of limited capital. The vulnerability was therefore more than a technical surprise. Staff had identified the weak links, but the proposed repairs had not been funded.

Water reaches the hospital

When an Acadian ambulance worker confirmed that a New Orleans canal had been breached, Memorial’s command team shifted operations from assault mode to survival mode. Employees who had expected to hand over to the next team and go home began to understand that they might be stranded at the hospital. Soon afterward, a National Guardsman told Yancovich that the levees had failed and warned him to prepare for fifteen feet of water. Yancovich asked him to bring the news to the command center with him rather than leave him to announce it alone.

Water then appeared at the hospital’s sewer vents and flowed along Claiborne Avenue. Staff and others watched it advance through the city, while reports identified a breach in the 17th Street Canal levee, described as 200 feet wide. Susan Mulderick called an unplanned meeting and told the command team that as much as fifteen feet of water was expected around the hospital. The staff’s emergency plans did not fit the situation: the hurricane plan did not anticipate flooding, the flooding plan did not anticipate evacuation, and the evacuation plan did not account for loss of power or communications. Across twenty separate plans totaling 273 pages, there was no guidance for a complete power failure or for evacuating when the streets were flooded; helicopter evacuation was not addressed, and no helicopter provider had been arranged.

The power system fails

Memorial’s backup system depended on interconnected generators, fuel, transfer switches, and distribution equipment. The three large generators had been intended to support the hospital during emergencies, but routine tests were brief and the equipment was not built for prolonged operation. The plans nevertheless assumed that the generators would sustain the hospital for at least seventy-two hours. By the time maintenance workers began struggling to keep them running, they had already been in use for two days.

Workers first dealt with an overheated engine by adding water to its radiator. Later, low oil pressure and partial outages prompted attempts to prime the motors with diesel and retrieve more fuel from a generator in the surgery building. When one generator could not be restarted, workers in rubber boots waded through knee-deep basement water to investigate the electrical system. About a third of the automatic transfer switches were at a low level and appeared to be submerged. The workers used a bypass handle to connect the load from a failed generator to a working one, then tried to adjust the electrical load and prevent a short circuit. Another generator failed, and scavenged parts did not produce a successful repair. At about two in the morning on Wednesday, August 31, nearly forty-eight hours after Katrina made landfall near New Orleans, the last backup generator surged and stopped. The failure converted a predicted vulnerability into an immediate loss of the hospital’s remaining power.

Unequal consequences and the aftermath

Flooding did not produce identical outcomes at every hospital. Charity Hospital, the public hospital, also flooded and lost power, plumbing, computers, telephones, and elevators; it had no helipad and no corporate overseer. Its evacuation was not complete until Friday afternoon, September 2, a day after Memorial’s. Charity had about twice as many patients across its two campuses and fewer staff in proportion to patients, yet fewer than ten patients died. Staff continued care in patient rooms under severe conditions. Workers later credited morale-building practices, including meetings every four hours and a flashlight-lit talent show, alongside preparation that included portable generators, oxygen-powered ventilators, and a ham radio system.

The wider accounting of deaths and suffering after the flood pointed to interacting failures rather than a single cause: the delayed evacuation order, shortages of buses and drivers, uncoordinated rescues, poor communications, and hospitals and nursing homes that had neither evacuated before the storm nor invested in backup power and water systems robust enough for a prolonged emergency. Flood risk, transport access, institutional resources, and the ability to maintain care were unevenly distributed. The episode also exposed a recurring weakness in disaster response: preparations could identify a plausible catastrophe yet leave basic questions of movement, power, and supply unresolved. In 2010, a US disaster medical team in Port-au-Prince again faced oxygen shortages and failing supply chains while caring for patients, including Nathalie LeBrun. That later episode did not repeat the New Orleans flood, but it underscored how quickly medical care becomes precarious when essential systems and supplies cannot be sustained.