Cynthia Matherne

Cynthia Matherne was an experienced hospital emergency manager working from a flood-surrounded emergency operations center at New Orleans City Hall as Hurricane Katrina cut the city off. Responsible for tracking conditions at hospitals and nursing homes, she tried to turn scattered reports into urgent requests for rescue. Her work brought into focus the disaster’s central contradiction: institutions had rehearsed the possibility of hospitals becoming islands, but no agency had a clear plan to evacuate them once that happened.

Emergency Manager in a Flooded City

Matherne sat among desks in the municipal emergency operations center, where phones rang and uniformed and civilian officials moved between meetings. Her usual role was as a bioterrorism preparedness coordinator for the local hospital association. The position had been created after the September 11 attacks and anthrax mailings, when federal funding became available for emergency planning. Only recently had the program’s mandate expanded to include natural disasters, a belated recognition that floods and hurricanes were more frequent than bioterrorism attacks.

As the storm approached, Matherne’s preparedness work became immediate crisis management. New Orleans Mayor Ray Nagin had ordered an evacuation, but many residents lacked cars or other means to leave, and the city’s plans for transporting them had serious gaps, including too few drivers. Ambulances were overwhelmed with requests and some were immobilized in traffic; some began taking patients to the Superdome rather than out of town. The evacuation order did not itself supply a workable way to move people who depended on medical care. Matherne’s task was to understand what was happening inside the facilities where those people remained and get that information to officials able to respond.

The Exercise Becomes the Emergency

Matherne had attended a mock Hurricane Pam workshop the week before the storm. In a follow-up meeting two days later, as Katrina’s track moved west along the Gulf Coast, she wrote the storm’s name in the margin of a handout. During the exercise, participants had considered what to do if each hospital in an affected area became an island. They had also posed practical questions: which patients should be removed first, who should come next, and whether the first priority should be patients capable of making the trip. Matherne had not understood that the exercise was about to become an exacting rehearsal for events outside the conference room.

The crucial planning questions had not been answered. Matherne knew of no plan specifying how New Orleans hospitals should be evacuated after a hurricane, and she could not tell which agency, if any, was in charge. Hurricane Pam had assumed limited access to aircraft and other flight resources: for at least the first five days, rescuers would focus on saving people clinging to rooftops and trees, while hospitals were expected to sustain themselves for seven days. That was a longer period than the three days previously expected, but the underlying instruction remained that hospitals would have to manage on their own. By the time facilities were losing power and patients needed to be moved, that assumption offered no practical evacuation system.

Pressing for Rescue

After learning on Tuesday that at least two hospitals had lost power, Matherne sought out liaisons from the United States Coast Guard and the National Guard and asked them to rescue the people trapped inside. One serviceman replied that the occupants were in a safe building and had supplies. Matherne objected that patients could not be cared for without electricity. The exchange exposed a difference between the building’s apparent security and the medical function that had become impossible without power. Her urgency did not make the rescue system appear more coordinated: officials in uniform began avoiding her, and she recognized that her outburst had broken the command center’s code of composure.

Matherne understood the officials’ reluctance in the context of their own helplessness. She thought they might have resigned themselves to the prospect that some people in the flood zone would die; they, too, were performing a terrible triage. The local Coast Guard air station had been damaged, its radio antenna was down, and its generators repeatedly failed and were temporarily repaired. Fixed telephone lines were out, while satellite and cell-phone contact with superiors was intermittent. Because a rigid chain of command could not function reliably, helicopter crews often set their own priorities and rescued people as they encountered them. Against that improvised citywide response, Matherne was trying to direct attention to patients who could not simply climb onto a roof or signal from above.

Private Assets and Fragmented Priorities

By Wednesday morning, Matherne had concluded that private assets offered the best hope of rapidly evacuating private hospitals. When Tenet regional senior vice president Bob Smith reached her, she suggested possible resources: boats, wildlife and fisheries personnel with swamp boats, and staging or pontoon boats. Smith’s notes captured the breadth of the search, but Tenet had no experience organizing rescue operations, no corporate helicopters, no pre-storm disaster plan, and no rooftop landing option for its corporate jet. The company was still assembling a command center and looking for practical advice.

Matherne also told Smith that the parent company of Tulane University Hospital, a corporate competitor, had begun hiring helicopters on Tuesday morning, once it became clear that New Orleans was flooding. The example showed that private aircraft might help, but it did not amount to a ready-made solution: arranging private helicopters and bringing them into the disaster zone took time, and the city’s communications failures made coordination harder. Matherne’s information helped Tenet consider a course of action; it could not undo the hours already lost or supply a shared system for assigning rescue resources.

The competing priorities were visible in the changing lists of hospitals awaiting help. On Tuesday evening, state emergency medical officials had reportedly made Memorial a top priority. By Wednesday morning, Matherne told Smith that it ranked among the lowest of eight local hospitals needing evacuation assistance. Tenet later discovered a separate list maintained by state public health officials, on which Memorial stood sixth out of seven. The differing rankings reflected more than one institution’s position: they revealed the absence of a single, dependable account of where help was most urgently needed. A state official told congressional staff that evacuation was proceeding slowly and asked constituents to be patient; critical-care patients, the official said, were going first. Memorial’s critical-care patients had already been airlifted on Tuesday evening, but that did not mean the remaining hospital had a clear or timely path to safety.

What Her Work Reveals

Matherne’s role was not to command a rescue fleet but to identify the conditions that made rescue necessary, press agencies to respond, and help a hospital operator search for resources. Each step met a structural limit: no established evacuation plan, uncertain authority, damaged communications, constrained aircraft, and private organizations with little disaster experience. Her confrontation over electricity made the difference between a building that was standing and a hospital that could care for patients unmistakable; her later suggestions about boats and helicopters showed how much of the response depended on improvisation.

The broader account of deaths and disruption in New Orleans identifies delayed evacuation, inadequate transport, uncoordinated rescues, agency conflicts, and insufficiently robust hospital backup systems among the causes of the disaster’s toll. Matherne’s experiences place those failures at the point where warnings had to become action. Hurricane Pam had raised the prospect of isolated hospitals and limited flight resources, yet the exercise had not produced a workable plan for extracting patients or settled who would lead. In the emergency operations center, Matherne’s information and appeals could expose that gap and push others to look for help. They could not by themselves close it.