American Hospital Association

The Federation of American Hospitals became a link in the improvised effort to evacuate hospitals stranded by Katrina, carrying appeals between private operators and public agencies. Its involvement illustrates both the need for a coordinating intermediary and the weaknesses of a system in which responsibility and information circulated through overlapping institutions without a clear command center.

Position in the Evacuation Network

As hospital companies sought help, the Federation entered a chain of referrals rather than a unified response. One proposed route ran from a senator’s office to Governor Kathleen Blanco and the Centers for Medicare & Medicaid Services; the federal agency redirected the request to the relevant hospital association, and the Federation appealed to the Department of Health and Human Services. HHS then appealed back to the Federation, the American Hospital Association, hospitals, and FEMA for assistance with patients more generally. Requests moved among organizations, but no single point of responsibility emerged.

That circular process mattered to Tenet Healthcare, which was trying to secure evacuation for Memorial Medical Center and other marooned hospitals. The Federation was one of the channels through which Tenet’s appeals might reach officials able to mobilize a response, but the layered referrals did not themselves get patients out. The broader coordination effort was further hampered by incompatible communications systems and separate, inconsistent evacuation priority lists.

Appeals and Frustration

The failure of the referral chain became explicit after a conference call with HHS Secretary Michael O. Leavitt. A Tenet official, frustrated that the call had sought medicines and personnel for field hospitals while Tenet could not evacuate its patients, asked Charles N. Kahn III, the Federation’s head, to arrange an immediate follow-up with HHS. Kahn replied that HHS was only a secondary player and that the Federation needed to persuade FEMA and local officials to act. His response recognized the limits of appealing to one agency and the need to press elsewhere in the system.

In the early evening, Kahn sent an HHS official a list of area hospitals’ immediate needs and emphasized the urgency of the situation. Yet the appeal left out Charity Hospital, New Orleans’s major public medical center, which was not a Federation member. It also failed to mention the power situation at any hospital. The Memorial status update it included had been written nearly twenty-four hours earlier, making the appeal an incomplete and outdated picture of the emergency even as it sought to convey its urgency.

Limits of Representation

The omissions exposed a structural limit in the Federation’s role: it could transmit information and advocate for hospitals, but its membership boundary shaped which institutions appeared in its appeal. Charity Hospital’s absence was particularly consequential in a citywide crisis, because the public hospital was facing severe conditions while remaining outside the Federation’s membership. The appeal’s silence about power also obscured a central operational danger for hospitals attempting to care for patients and arrange evacuation.

The Federation’s Katrina-era activity therefore carried a double significance. It was a conduit through which private hospital leaders tried to reach government decision-makers, and its leader understood that no single federal office could resolve the crisis alone. But the repeated referrals, uneven hospital coverage, and stale information in its own appeal show how coordination could reproduce the very fragmentation it was meant to overcome.