Evacuation Plan to Leave No Living Patients Behind

The Evacuation Plan to Leave No Living Patients Behind was a principle voiced by Susan Mulderick during Memorial Medical Center’s evacuation crisis: patients still alive were not to be abandoned in the hospital. Its force lay in the promise it made amid danger, but it was not a complete operational plan. It did not settle who would move each patient, when to move them, or how to reconcile limited transport with patients’ differing needs; those questions became urgent on the floors and remained central to later testimony about LifeCare patients.

Origin in the evacuation crisis

Years of emergency-preparedness meetings had not produced a unified response for the hospital’s first real crisis. Memorial had twenty separate preparedness plans, and the book describes staff having to improvise as floodwaters approached. In the hastily assembled command meeting, Karen Wynn saw the atmosphere shift from a hospital emergency to something like a military operation, with the immediate objective of acting before power failed.

Nearly two hundred patients needed to reach safety. Mulderick proposed moving the most critically ill first: around two dozen intensive-care patients, a similar number of newborns, high-risk pregnant patients, and dialysis patients, as well as two vulnerable bone-marrow-transplant patients. The proposed order reflected dependence on life support and the danger of losing electricity. It also made clear that a general promise to evacuate everyone could not by itself determine the sequence or method of evacuation.

What the principle required in practice

The difficulty was not only deciding who should go first, but finding enough ways to move them. Mulderick sought additional ambulances and helicopters, while the hospital relied on a mixture of available transport and outside assistance. At the helipad, confusion over how many patients a helicopter could carry prompted an Air Force captain to take charge of the flight line, clear the landing area, and keep people off the rooftops so pilots could operate. The scene exposed the gap between the plan’s universal aim and the constrained, coordinated work needed to carry it out.

The same gap appeared in the treatment of LifeCare’s remaining patients on the seventh floor. On Thursday, September 1, three LifeCare staff members told Mulderick that supplies were running low and that they were unsure how to move nine patients, including a large paraplegic patient. Two patients were reportedly in grave condition with very high temperatures. Mulderick told them that no living patients were to be left behind and directed them to speak with Anna Pou. She noted that Memorial doctors had previously prevented LifeCare’s DNR patients from being brought down to the staging areas because the space was crowded. She left the LifeCare leaders to decide whether to move their patients to the staging area and urged them to act.

That exchange made the plan a demand for action, not a solution to the dispute over who had authority to act. It required LifeCare’s staff to make decisions about patients whose condition and transport needs were difficult, while the evacuation itself was unfolding amid crowding and competing calls for rescue. The instruction expressed an intended outcome, but the evidence does not show that it supplied a settled procedure for achieving it.

Recollections and disputed meanings

In later interviews, LifeCare assistant administrator Diane Robichaux and physical medicine director Kristy Johnson both recalled Mulderick stating that living patients would not be left behind. Their accounts placed the assurance against the staff’s efforts the previous night to keep patients alive and cool: Robichaux described the use of rubbing alcohol and gravity-drip IVs, while Johnson recalled wetting cut-up blankets with Kentwood mineral water. Johnson also remembered Mulderick saying that she did not think LifeCare’s patients would survive, a concern that sharpened the staff’s questions about what the evacuation principle meant for them.

Robichaux testified that, after returning to the seventh floor, she spoke with Pou, who asked whether she wanted her staff to remain on the unit. Robichaux said she did not. Johnson later recounted that Therese Mendez called her back upstairs and told her that the patients were to receive a lethal dose; Johnson described being shocked. That was Johnson’s account of what she had been told, not proof that the evacuation instruction authorized such an act. The contrast between the stated aim of moving living patients and the later allegations became one of the central points requiring investigation.

Limits, aftermath, and significance

Mulderick later told investigators that her discussion of medication concerned palliative care and comfort, not hastening death. She said that giving a patient Ativan to relax them was an example; however, prescriptions for Ativan and other ordinary comfort medications had already been issued to patients by Pou and other doctors during the disaster. The distinction matters to the plan’s meaning: an evacuation commitment and decisions about medication were separate questions, even as later accounts brought them into the same contested history.

The investigation examined patient deaths and medication evidence, including toxicology results from patients who died after boats and helicopters began arriving on Thursday morning. Such findings formed part of the inquiry, but did not by themselves establish what the evacuation principle meant to individual staff members or resolve the differences among their accounts. For LifeCare witnesses, the remembered assurance remained a measure against which events were judged; for staff such as Gina Isbell, the deaths and delay in help remained sources of nightmares, guilt, and anger long afterward. The plan’s lasting significance is therefore double: it stated that patients should not be abandoned, while the crisis exposed how little a humane objective could guarantee without clear authority, workable transport, and procedures capable of carrying it through.