Laura Evans

Laura Evans, medical director of critical care at Bellevue Hospital Center, became the central decision-maker in a power-allocation crisis during Hurricane Sandy. With 56 adult intensive-care patients dependent on electrical equipment and only six outlets expected to remain usable, she organized a committee to decide who would receive them. Her response brought disaster-planning principles into an immediate hospital emergency, but also revealed how a process designed to be fair among professionals could leave patients and families outside decisions that directly concerned them.

Role and the Emerging Crisis

Evans was called to Bellevue Hospital Center’s emergency command center as officials anticipated a storm surge from the East River. Flooding threatened more than the hospital’s ordinary electrical service: water could disable pumps that delivered oxygen and vacuum suction, as well as pumps supplying fuel from underground tanks to backup generators. If city power failed, the small reserves attached to generators on the thirteenth floor would last only about two hours. The hospital’s 56-bed adult ICU held patients whose lives depended on electrically powered support, including life-support equipment, intravenous medication drips regulating heartbeats and blood pressure, and intra-aortic balloon pumps.

The command team believed a generator in a neighboring building, served by a separate and better-protected fuel pump, could continue operating. It could supply exactly six ICU outlets. That possibility converted a technical contingency into a patient-selection decision: hospital leaders turned to Evans for a list of those who should receive power. The six outlets were not a general reserve for the unit; they were a sharply limited resource against which dozens of patients’ needs would have to be weighed.

Applying a Disaster Protocol

Evans had access to planning guidance unavailable to clinicians at Memorial Medical Center during Hurricane Katrina. In 2008, after the arrests of health professionals involved in the Memorial case and amid concern that a severe influenza outbreak might force similar choices, New York planners had published a protocol for allocating ventilators. Experts in disaster medicine, bioethics, and public policy had designed the guidance for a pandemic overwhelming hospitals. Evans, seeking a procedure to organize decisions at Bellevue, voluntarily adapted those plans to allocate access to power outlets instead.

The adaptation was a consequential use of a protocol outside the situation for which it had been designed. The guidance offered a scoring approach based on how severely ill patients were, and Evans drew on it because the hospital faced a real shortage and needed an orderly way to choose. The book does not present the protocol as a ready-made answer to every question raised by Bellevue’s crisis; it shows Evans turning an existing framework into a practical tool under pressure, with decisions still requiring judgment and institutional agreement.

A Committee Rather Than a Single Decision-Maker

Evans assembled an ad hoc committee to make the selections. She believed the task should not rest on one person. The committee consisted of professionals who had no patients under consideration, allowing each patient’s primary doctor to continue advocating for that patient rather than judging the competing claims. Committee members could instead consider a wider range of factors and apply the scoring guidelines across the group. Doctors, nurses, and ethicists participated; patients and their families did not.

The committee’s decisions and their reasons were communicated to the rest of the staff. Some colleagues challenged the selections, but accepted them, and the team completed the list and moved patients between beds and outlets in about two hours. Evans also considered whether she could later explain how the decisions had been made. She wanted a process that could be described openly and applied consistently, in the hope that it would be as fair and equitable as possible. Knowing the story of Anna Pou and Hurricane Katrina, she was concerned both with being able to justify the decisions and with preserving the trust of a society that might scrutinize them.

The Limits of the Process

As the list was being completed, city utility power failed. Backup generators restored power after about seven seconds. The command center then warned that, apart from the six outlets, power could be lost within 60 to 90 minutes. Floodwater was filling the basement of the 25-story hospital and entering elevator pits with enough force to dislodge their doors. Evans and her colleagues prepared for the possibility that powered support would fail: two health professionals were stationed at the bedside of each ventilator-dependent patient to provide manual breaths with Ambu bags. Bright-orange extension cords connected to the backup system ran through patient corridors, while nurses counted drops on IV pumps so they could administer vasopressors manually if necessary.

Communicating the allocation to patients and families proved harder than compiling the list. Evans and her colleagues could not imagine how to tell people who would not receive outlets, feared that conversation, and postponed it. In retrospect, Evans believed families had a right to know. The staff also failed to ask whether any selected patient or family might voluntarily relinquish an outlet so another patient could use it. The omission marked a boundary in the committee’s approach: its structured comparison of patients supported consistency, but the process did not include those whose choices might have changed the allocation.

Narrative Significance

Evans’s episode connects the experience of Memorial Medical Center during Katrina to a later attempt to prepare for scarcity through explicit rules and shared decision-making. The protocol inspired by Katrina could help Bellevue staff produce and defend a list, but it did not eliminate fear, disagreement, or the difficulty of explaining who would receive life-sustaining support. Nor did a committee of professionals automatically make the process fully participatory. Evans’s role therefore illustrates both the value and the incompleteness of disaster planning: a framework can distribute responsibility and make decisions more transparent, while still leaving unresolved how patients and families should be informed or invited into the choice.