United States Department of Health and Human Services

The Centers for Medicare & Medicaid Services occupies two distinct places in the account: federal hospital programs helped make continued racial discrimination financially untenable, while, during the Katrina evacuation crisis, the agency redirected an appeal for help rather than coordinating an immediate response. The contrast links a powerful federal policy lever in the history of hospital integration with the fragmented institutional channels confronting stranded hospitals in an emergency.

Federal Programs and Hospital Integration

In the mid-1960s, Medicare and other federal hospital programs made hospitals ineligible for reimbursements if they discriminated against patients or maintained racial segregation. The federal funding condition brought pressure to bear on hospitals that had resisted integration, including Southern Baptist Hospital, later Memorial Medical Center. Baptist refused to join the programs. In a 1966 statement, it said it believed it could serve people better without governmental conditions on its operations. The book presents the reimbursement rule as a significant institutional force in the struggle over access to care, though it does not attribute the creation or administration of those programs to the Centers for Medicare & Medicaid Services alone.

Jannie Burgess’s history gives the policy conflict a personal dimension. She worked for decades as a nurse in New Orleans hospitals and nursing homes, yet her light-brown skin meant she could care for patients at private hospitals where she herself could not receive treatment. Born only months after Baptist opened in 1926, she waited more than four decades before she could be a patient there. The federal programs’ nondiscrimination condition stood against the kind of exclusion that had shaped her working life.

Referral During the Evacuation Crisis

During Katrina, Tenet Healthcare executives sought government help to prioritize the evacuation of Memorial and the company’s other stranded hospitals. In that effort, a contact from a senator’s office offered to appeal to Louisiana Governor Kathleen Blanco and the Centers for Medicare & Medicaid Services. Tenet officials were also directed toward federal and hospital-association channels as they searched for assistance.

When Tenet contacted the Centers for Medicare & Medicaid Services, the agency directed the employee to the head of the relevant hospital association. The Federation of American Hospitals then appealed to the Department of Health and Human Services, which in turn appealed back to the Federation, the American Hospital Association, hospitals across the country, and the Federal Emergency Management Agency. The sequence sent requests onward through a succession of organizations, but the book describes no clear center of responsibility for arranging the evacuation.

Institutional Limits and Significance

The agency’s brief appearance in the evacuation effort is defined by referral rather than direct operational action: Tenet sought help, and the request was sent to an association. The broader chain included government offices, hospital associations, private hospitals, and emergency agencies, while officials maintained separate priority lists and communications systems that could not readily interoperate. Memorial consequently appeared in different places on evacuation lists, and the overlapping channels deepened uncertainty about who was responsible for getting patients out.

Set beside the earlier reimbursement condition, this episode reveals two different forms of federal influence in the book. Federal programs could attach consequences to discriminatory hospital practices; during the disaster, however, a federal agency’s contact with a private hospital was only one step in a diffuse appeal process. The account does not claim that the Centers for Medicare & Medicaid Services controlled evacuation operations, but its referral helps show how institutional authority and practical responsibility failed to align when patients needed rescue.