Tenet Healthcare

Tenet Healthcare was the for-profit corporate owner overseeing Memorial Medical Center during Hurricane Katrina, and the distance between its headquarters and the hospital became part of the disaster itself. From Dallas, employees scrambled to assist storm-stranded hospitals, while at Memorial decisions about evacuation and the release of patients depended on corporate coordination that could be slow, fragmented, and difficult to trace. In the aftermath, Tenet’s response to investigators, its handling of records, and its eventual sale of Memorial placed the corporation at the center of debates over responsibility for the crisis and its consequences.

Corporate Structure and Emergency Response

Tenet’s headquarters in Dallas became an improvised operations hub as the hurricane affected six of the company’s Gulf Coast hospitals. Dozens of employees from different departments worked at banks of phones and computers on the ground floor. The effort was substantial, but those staffing the headquarters had little experience in disaster management. The book presents a corporation mobilizing people and communications under pressure without the established expertise needed to coordinate a complex emergency effectively.

The scramble for outside assistance exposed a wider problem: no single agency or organization seemed to own the task of evacuating marooned hospitals. Tenet executives tried to persuade government officials to prioritize Memorial and the company’s other facilities. Appeals traveled between a senator’s office, the governor, the Centers for Medicare & Medicaid Services, hospital associations, federal agencies, the Coast Guard, and the Navy, with one organization directing the request to another. The result was a chain of referrals rather than a clear command structure. Tenet was seeking help, but the effort also revealed how corporate needs, public authority, and emergency responsibility could remain dispersed when patients needed action.

Tenet pursued a private aviation option as well. A contact with an air-logistics company led to a plan to assemble helicopters normally used for firefighting and other work; executives began calling them air ambulances. Just before ten at night, the company had signed contracts for six helicopters of different sizes, expected to converge on New Orleans and begin arriving at Memorial early Thursday morning. One was expected as early as six. This plan offered a concrete route to evacuation, but it came after a period in which patients and staff were already exposed to rising water and worsening conditions.

Memorial and LifeCare Evacuation Delays

At Memorial, coordination between the hospital and LifeCare Hospitals, which operated a separate patient-care unit in the building, became entangled with Tenet’s corporate approval process. LifeCare’s patients had not yet moved, and Memorial’s proposed route to Coast Guard transport required asking the corporate overseers at Tenet for permission. The reason that permission should have been necessary for LifeCare to use federal rescue resources was unclear. The uncertainty itself mattered: responsibility for patients was split across institutions even as the window for safe evacuation narrowed.

From Memorial’s fourth-floor command center, community-relations manager Sandra Cordray sent a message to Michael Arvin at Tenet about the LifeCare patients. The message did not convey urgency. More than an hour later, LifeCare’s Robbye Dubois, writing from Shreveport, was still waiting for approval to send ambulances and expected that process to take hours. She had not heard from Arvin and requested his number before eventually speaking with him after nine in the evening. She then reported that ambulances would go to a staging area, that critical patients would be transported first, and that rising water might prevent trucks from reaching the hospital until morning. The promised transport thus remained conditional on both corporate arrangements and the physical limits imposed by floodwater.

Tenet’s role in this episode was not simply to provide or withhold a resource. Its approval became a gate through which a separate operator sought access to evacuation, while communication delays consumed time and the water changed what vehicles could do. The company’s later private helicopter contracts showed that it could arrange transportation outside the public chain of appeals, but the contracts were for a plan beginning the following morning. The narrative sets the two efforts beside one another: uncertain corporate coordination for LifeCare’s immediate movement and a newly assembled private fleet for later arrivals.

Records and the State Investigation

After the deaths at Memorial, a government investigator requested a list of deceased patients and the hospital’s disaster plan from the company’s owners. Tenet’s attorney responded by asking that the questions be put in writing, then supplied a corporate summary, newspaper accounts emphasizing employee heroism, and press releases attributing the deaths to forces beyond the hospital’s control. The book describes this response as an early source of suspicion, not as proof of a corporate role in the alleged crimes.

Memorial pathologist John Skinner had recorded the names, birth dates, and locations of the dead before leaving the hospital and faxed handwritten notes to Tenet officials in Texas. The material was entrusted to the company’s regional chief medical officer, who had worked on the unfolding disaster from vacation in Oregon. During the week and a half before the bodies passed into the coroner’s custody, little was done with the information. Tenet telephone operators recorded calls from frantic families in a database, and relatives who reached the medical officer directly received what information he had. Only after the bodies were retrieved and the investigation had begun did company officials print patient-chart face sheets with identifying information.

Investigators later said that Tenet’s attorneys had been grudging in their cooperation, that there were delays, and that some potentially relevant records appeared to be missing. The company maintained that it had provided the records in its possession. In a later written response, Tenet stated that it had produced all requested medical records, in both hard copy and electronic form, and that Memorial had made its records and the facility available to investigators. The disagreement is central to the account: investigators’ suspicion about incomplete production is reported alongside Tenet’s explicit denial that requested records remained undisclosed.

The investigation also generated speculation about whether any decision to inject patients had come from higher up. Investigator Butch Schafer wondered whether corporate officials might have known of, or issued, an order to euthanize the sickest patients and clear remaining workers on September 1. He considered possible explanations that included concern about feared disorder and the cost of another day of overtime and leased helicopters, while acknowledging how far-fetched the latter possibilities sounded. The book presents this as Schafer’s question and suspicion, not an established finding. Tenet later denied responsibility for the alleged crimes and said the named doctor and nurses had acted without the knowledge, approval, or acquiescence of the hospital or its key physician leaders.

Financial Consequences and the Sale of Memorial

Tenet’s corporate history also formed part of how investigators and readers assessed its conduct. Schafer noted that the company had paid nearly $400 million the year before Katrina to settle claims that doctors at one of its hospitals had performed unnecessary heart surgeries and procedures on healthy patients. In 2006, Tenet’s planned sale of Memorial and other New Orleans hospitals was tied to another major financial settlement: the $56.8 million sale was to help fund a nearly billion-dollar settlement ending investigations into Medicare overcharging in Louisiana and other states. The company’s insurers also agreed to pay $340 million for Katrina-related damage and business interruption at five hospitals.

The announcement that Tenet would sell Memorial to a local nonprofit hospital system came hours before a press conference by Charles Foti concerning arrests in the patient-death investigation. The transaction had been in process for months, so its timing did not establish that the investigation caused the sale. It did, however, place a major corporate transfer beside the public crisis over responsibility. The book also situates Tenet within the longer institutional history of the hospital: Memorial had developed from a merger of Southern Baptist Hospital and Mercy Hospital and had later been sold to the for-profit company.

Litigation, Defense, and the Company’s Legacy

Claims against Tenet and Memorial over deaths and personal injuries cited deficiencies in electrical systems, emergency preparedness, and evacuation plans. The litigation was certified as a class action and reached jury selection in 2011. In the broader wave of roughly two hundred post-Katrina hospital suits, claims were allowed to proceed as general negligence cases rather than medical-malpractice actions, which would have capped damages. The class action against Tenet and Memorial settled before trial for $25 million, without an admission of wrongdoing. The settlement was to be divided among participating patients, visitors, family members, and others who had been at the hospital during or after the storm; LifeCare staff were included, while Memorial employees were excluded under the applicable provisions of Louisiana law. LifeCare had settled with families who sued years earlier.

Tenet’s position affected individuals beyond the families bringing civil claims. As Anna Pou’s attorney, Rick Simmons, built a proactive defense against possible indictment, he also sought to keep her post-storm conversations with a Tenet attorney confidential. He worked with roughly two dozen lawyers representing other Memorial staff, and the group considered a media strategy that warned prosecution could drive health workers away from New Orleans. John Thiele, meanwhile, faced legal bills that exceeded the medical-staff fund set aside to help doctors. Tenet executives balked at paying for his defense, arguing that he was not an employee and had not been required to remain for the storm. The contrast between his having been called on to care for patients whose physicians were unreachable and the company’s refusal to fund his defense sharpened questions about the boundary between corporate employment and practical responsibility.

The book’s later comparison with another hospital system’s hurricane preparations makes the limits of Tenet’s Katrina response visible without turning every difference into a claim about corporate intent. At public Charity Hospital, staff held frequent meetings, ran a flashlight talent show, and used preparedness equipment and portable generators to keep ventilators and monitors operating. Memorial’s patients, by contrast, were ventilated by hand after its power failed; two similar generators were later used for lights and fans in common areas and on the helipad rather than for medical equipment. In a later storm, the narrator observed a nonprofit parent organization with a local command center offering organized assistance to its own hospitals and others in the region, unlike the support Tenet and LifeCare headquarters had provided during Katrina. Across these comparisons, Tenet emerges as a company capable of mobilizing employees, contracts, and substantial resources, yet whose crisis coordination and subsequent accountability remained contested.