Department of Health and Human Services, United States

The US Department of Health and Human Services (HHS) was the lead federal agency coordinating the public-health and medical response to Hurricane Katrina, but the book depicts its role as severely constrained and poorly connected to hospitals’ immediate needs. As hospitals struggled to move patients from New Orleans, HHS’s activity centered on seeking medical resources for a federal field-hospital response; Tenet’s requests for evacuation help, by contrast, met redirection and an offer to relay the problem to FEMA. The contrast makes HHS a revealing part of the crisis’s larger pattern: responsibility for a response existed on paper, while practical authority and assistance remained scattered across agencies and organizations.

Federal Coordination Before the Storm

Louisiana had received more than $17 million through a federal grant program intended to help hospitals prepare for bioterrorism and other emergencies. During a preparedness call, a FEMA representative asked which hospitals in flood-prone areas had placed both generators and electrical switching equipment above ground-floor level. Only two of roughly eighteen hospitals in and around New Orleans had done so; Memorial Medical Center was not among them. This funding and planning context does not establish that HHS administered the grants, but it shows the federal preparedness environment in which the agency’s later coordination role operated.

The book places HHS within a response system whose weaknesses were visible before landfall. Planning for the Hurricane Pam exercise had extended over more than a year, and a federal exercise had taken place in New Orleans that week. Its scenario anticipated more than two thousand hospital patients remaining in the city during a catastrophic hurricane. Yet officials had not worked out how to move so many patients to safety, and federal health officials had not participated in the latest planning sessions. Around 2,500 hospital patients remained in New Orleans as Katrina advanced. The scale of the evacuation problem was therefore not wholly unforeseeable, even though the means to solve it were not in place.

A Regional Coordinator With Little Local Engagement

HHS had assigned an emergency coordinator to a five-state region that included Louisiana. In the four months she had held the job, however, she had not visited the state, communicated with its emergency-health officials, or participated in the recent Hurricane Pam exercises. When the crisis came, Louisiana asked federal officials to take charge. The coordinator’s limited prior contact with the state sharply qualified the agency’s ability to serve as an informed bridge between local hospitals and federal resources.

The breakdown became concrete when a Tenet employee contacted the coordinator to ask how to enter the disaster area. She directed him to the Louisiana Hospital Association. A Tenet official then appealed to the HHS deputy secretary, but received only a promise that the message would be passed to FEMA. Neither exchange, as presented in the account, supplied the company with a route into the city or a means of evacuating its patients. The referrals moved the request onward without resolving the immediate logistical barrier.

National Resources, Local Evacuation Needs

Early in the afternoon, Tenet officials and hospital executives from around the country joined a conference call with HHS secretary Michael O. Leavitt. Leavitt asked hospitals nationwide to provide medicines and staff for federal emergency field hospitals in the disaster region. That request addressed a genuine medical need, but it did not answer Tenet’s urgent problem: its patients were still inside Memorial, and the company could not get them out. One Tenet official, frustrated by the mismatch, wrote that the day had been a complete wreck and requested an immediate call with HHS.

Charles N. Kahn III of the Federation of American Hospitals responded that HHS was only a side player and that the organization needed to get the department to push FEMA and local authorities. His reply captures the uncertainty over who could turn a federal request or appeal into operational help. HHS could solicit medicines and staff from hospitals across the country, but Tenet’s account shows that this national mobilization did not itself open access to New Orleans or provide transport for people already trapped there.

Limits and Consequences

That same evening, Kahn sent HHS an urgent list of area hospitals’ immediate needs. The appeal omitted several institutions, including Charity Hospital of New Orleans, which was not a Federation member. It also did not mention the hospitals’ power problems, and its status information for Memorial had been written nearly twenty-four hours earlier. The omissions and stale update illustrate how even a formal channel for escalating urgent needs could provide an incomplete picture of conditions on the ground.

The account does not assign HHS sole responsibility for the evacuation failure. Roads were jammed, ambulances were immobilized, transport was scarce, and the agencies and levels of government involved did not coordinate effectively. But HHS’s limited local engagement, its referral of Tenet’s access question, and the gap between its field-hospital request and the company’s evacuation appeal make the department an important example of that fragmentation. The decisive consequence in this episode is not a single action by HHS but the distance between federal coordination and the practical work of moving vulnerable patients to safety.