Federal Emergency Management Agency

The Federal Emergency Management Agency (FEMA) is presented as one part of a fragmented disaster-response system: it sponsored planning and helped fund preparedness, but its presence did not ensure that hospitals had workable evacuation arrangements or that agencies and facilities shared a clear understanding of who was coordinating rescue. During Hurricane Katrina, the gap between the expectation of federal help and the actual organization of transport became especially consequential for patients at Memorial Medical Center and LifeCare Hospitals of New Orleans.

Preparedness and known hospital risks

FEMA’s role in the lead-up to Katrina included sponsoring the Hurricane Pam emergency exercise in New Orleans. The exercise took place earlier in the week the storm approached and modeled a catastrophic hurricane with more than two thousand hospital patients still in the city. The number of patients who might need evacuation was therefore not an unforeseen feature of the emergency. Yet the planning had not produced a workable answer to how so many people could be moved to safety through a flooded city, and federal health officials had not taken part in the latest planning sessions.

The vulnerability of hospital power systems was also under discussion before landfall. In a conference call immediately before the storm, a FEMA representative asked which hospitals in flood-prone areas had placed both their generators and electrical switching equipment above ground-floor level. Only two of roughly eighteen hospitals in and around New Orleans had done so; Memorial was not among them. An emergency response leader from the Centers for Disease Control and Prevention later warned colleagues that many hospital generators were expected to lose power as floodwaters rose. The call exposed a known infrastructure risk, but identifying it did not itself supply a way to move patients or protect every hospital’s power distribution equipment.

Those risks had a longer history. After Tropical Storm Allison flooded Houston in 2001 and disrupted power at hospitals in the Texas Medical Center, New Orleans’s health director asked city hospitals whether they could withstand fifteen feet of water and whether they would support seeking federal funds to elevate generators. The initiative stalled amid the high cost of improvements. After Hurricane Ivan nearly struck New Orleans in 2004, Memorial reviewed its hurricane plans and examined storm-surge models with the U.S. Army Corps of Engineers. The models indicated that twelve to fifteen feet of water could surround the hospital in a severe storm, while calculations by plant operations director Eric Yancovich showed that less than four feet of street flooding could send water over a loading dock and into the building. The FEMA representative’s pre-Katrina inquiry thus concerned a risk that had been recognized but not resolved.

Evacuation needs exceed transport capacity

When New Orleans Mayor Ray Nagin ordered an immediate evacuation, many residents lacked cars or other means to leave, and officials knew that public transport arrangements had serious gaps, including too few drivers. The Superdome was designated a shelter of last resort, and the mayor specifically urged people with medical conditions to go there, without explaining what assistance would be available. Meanwhile, Acadian Ambulance dispatchers faced calls to move patients from hospitals, nursing homes, and private homes. Many ambulances were stuck in interstate traffic, and some began taking patients to the Superdome rather than out of the city.

The difficulty was not confined to a single facility. At Chalmette Medical Center, ambulances carried away an initial group of critically ill patients but did not return. A New Orleans hospital’s plan to send nine of its sickest patients to western Louisiana seemed to require an urgent and costly airlift; road congestion could leave them in an ambulance for many hours. These examples establish the wider setting in which hospitals sought help: the need for transport was known, but available vehicles, routes, and coordination did not meet it.

Confusion over federal coordination at LifeCare

At Memorial, incident commander Susan Mulderick sought additional ambulances and helicopters. Her former husband, who worked for a helicopter-transport company, told her that his firm had already been hired to evacuate people from Tulane Hospital and supplied the number of an Air National Guard major in Baton Rouge who was coordinating civil and military evacuation efforts. This was a separate contact from FEMA, but it illustrates the multiple organizations and channels through which hospital leaders were trying to arrange assistance.

LifeCare, which operated a hospital unit inside Memorial, was trying to secure transport for its own patients. Its New Orleans administrator, Diane Robichaux, gave Memorial’s command center a list of fifty-three patients still needing evacuation; two of the original fifty-five had died. Seven patients depended on ventilators, another used assisted breathing, and five needed dialysis. A paramedic at Memorial believed Acadian had a transportation contract with LifeCare and expressed surprise that the facility was waiting for direction from corporate officials.

LifeCare’s Shreveport staff believed FEMA knew about their situation and would coordinate an evacuation. That understanding came through Knox Andress, whom they thought worked with FEMA. Andress was actually a nurse at a Catholic hospital in Shreveport who volunteered as a regional hospital disaster-preparedness coordinator. His title, HRSA District Regional Coordinator, came from a federal hospital bioterrorism-preparedness grant; it did not make him a FEMA employee. He took the volunteer role seriously and participated in training, but he did not control rescue resources or speak for FEMA.

According to messages passed between Shreveport and Robichaux, Andress said that FEMA and the Louisiana Department of Health and Hospitals were aware of LifeCare’s circumstances, would evacuate ventilator-dependent patients first, and would get back to them about timing. The messages conveyed awareness and an expectation of eventual assistance, not a confirmed time or transport assignment. When a LifeCare employee pressed Andress again, his answer remained that the agencies had the information and would evacuate hospitals in an order that was still unclear. The distinction between being known to an agency and being included in a specific evacuation plan was not made clear to LifeCare’s staff.

The Coast Guard offer and its limits

In the afternoon, Memorial offered LifeCare patients a possible place on Coast Guard helicopters bound for Baton Rouge, with only twenty minutes to decide. Before LifeCare could answer, the offer was withdrawn: Memorial’s representative had assumed LifeCare’s patients were included in the number requested from the Coast Guard, but they were not. Mulderick had requested transport for two hundred people, a number only slightly greater than the Memorial patient count. LifeCare’s patients had not been included in that request.

LifeCare’s corporate senior vice president, Robbye Dubois, continued calling from Shreveport and urged Robichaux to explain at the helipad that LifeCare was located inside Memorial and also needed evacuation. At Memorial, Robichaux was told that the hospital was using Coast Guard transport to move patients toward Baton Rouge and other Tenet facilities, rather than relying on FEMA for its own evacuation. She nevertheless believed LifeCare remained on a FEMA list and that FEMA had a plan for the other hospitals. The expectation that the federal agency would reach LifeCare persisted alongside the concrete fact that the Coast Guard request made by Memorial did not include its patients.

LifeCare also received an assurance that Memorial would help coordinate if difficulties arose. Yet the account leaves the agencies’ respective functions unclear to the staff: FEMA was treated as if it might arrange an airlift, although it did not operate rescue helicopters. As hospital communications faltered and power failed in part of Memorial, Robichaux stopped using the pharmacy computer to exchange messages with Shreveport and went to check on two ventilator patients. The immediate problem had shifted from anticipated transport to maintaining care inside the building.

Institutional limits and the aftermath

The book situates FEMA’s actions within a broader pattern of delayed decisions, incomplete preparation, insufficient transport, and poor communication among agencies and levels of government. Its account does not attribute the entire evacuation failure to FEMA. Instead, it shows a mismatch between planning activity and operational capacity: the hurricane exercise anticipated thousands of hospital patients, federal officials asked about generator placement, and federal preparedness money had supported hospital planning, while the practical means to evacuate patients remained uncertain.

In its retrospective assessment, the book names the mayor’s delayed evacuation order, shortages of buses and drivers, uncoordinated rescue efforts, jurisdictional disputes, incompatible communications, and inadequate hospital backup power and water systems among the factors behind the disaster’s deaths and subsequent health-care disruption. These are described as interacting failures, not as the responsibility of one organization alone. FEMA’s place in the narrative is therefore neither absent nor all-encompassing: it participated in planning and preparedness, but the existence of those activities did not prevent the breakdown between warning, coordination, and the actual delivery of help.