Federal Emergency Management Agency (69b5c4c9)

The Federal Emergency Management Agency (FEMA) is presented as a major architect of disaster preparedness and a participant in the response to Hurricane Katrina, but not as a single, reliably coordinated command. Its funding and planning could identify hazards in advance; during the emergency, however, fragmented authority, inadequate transport, and incompatible systems impeded the movement of patients. The book’s account uses FEMA to trace the distance between having plans and making a system work when people need evacuation and care.

Preparedness Before Katrina

After the September 11 attacks and anthrax mailings, Louisiana received more than $17 million through a federal grant program intended to help hospitals prepare for bioterrorism and other emergencies. Yet advance investment did not ensure that hospitals could withstand flooding. During a conference call as Katrina approached, a FEMA representative asked which hospitals in flood-prone areas had located both their generators and electrical switching equipment above ground-floor level. In and around New Orleans, only two of roughly eighteen hospitals had done so; Memorial Medical Center was not among them. The question exposed a concrete vulnerability, but it arrived alongside a larger preparedness problem: patients would remain inside facilities whose power systems were at risk.

FEMA had also sponsored the Hurricane Pam emergency exercise in New Orleans. The scenario anticipated a catastrophic storm with more than two thousand hospital patients in the city, a scale close to the roughly 2,500 patients who remained there as Katrina advanced. Planning sessions had taken place over more than a year, but officials had not worked out how to move so many people to safety through a flood. Federal health officials had not participated in the latest planning sessions. The exercise had made the scale of the problem imaginable without producing a workable means of evacuation.

The difficulty extended beyond hospitals. New Orleans Mayor Ray Nagin ordered an immediate citywide evacuation, but many residents had no cars or other way to leave, and officials knew that the transportation plan had too few drivers. People who could evacuate independently were already caught in traffic. The New Orleans Superdome was designated a shelter of last resort, and shuttle buses were intended to bring people there, including those with medical conditions. Yet the mayor did not specify what care they could expect. FEMA’s place in the preparedness picture therefore sits beside a wider mismatch: planning recognized a mass emergency, while the means to protect people who depended on transportation and medical support remained inadequate.

Evacuation and Divided Responsibility

As hospitals and nursing homes sought transportation, the regional ambulance network was overwhelmed. Acadian dispatchers received calls from threatened facilities and private homes; many of the roughly two dozen ambulances made available were stuck on the interstate, and some patients were taken to the Superdome rather than out of the city. At Memorial, administrator Susan Mulderick recognized that the hospital could not manage the crisis alone. She sought more ambulances and helicopters and contacted a helicopter-transport company, only to learn that it had already been engaged to evacuate Tulane Hospital. The company provided a contact for an Air National Guard officer coordinating civil and military evacuations. The scene makes the limits of any one institution’s planning plain: the need for transport was immediate, while available resources and lines of coordination were divided among many actors.

Tenet executives later tried to secure priority evacuation for Memorial and other stranded hospitals by appealing through government and industry channels. A senator’s office offered to contact Louisiana Governor Kathleen Blanco and the Centers for Medicare & Medicaid Services; those officials directed Tenet toward a hospital association, which appealed onward to federal departments and emergency agencies. The appeals circulated, but responsibility did not settle in one place. Separate agencies maintained separate hospital-priority lists, and communications systems could not reliably share information. Memorial appeared as first, second, or last on different lists. FEMA was part of this crowded response environment, but the account emphasizes that no clear locus of responsibility emerged from it.

The federal public-health response was itself constrained. Louisiana asked federal officials to take charge, but the designated health emergency coordinator for a five-state region had not visited Louisiana, contacted its emergency-health officials, or taken part in the recent Hurricane Pam exercises during her first four months in the role. When a Tenet employee asked how to enter the disaster area, she referred him to the Louisiana Hospital Association. Another appeal to a senior federal health official produced a promise to pass the message to FEMA, rather than a direct evacuation solution. In a call with hospital leaders, the federal health secretary instead asked hospitals nationwide to provide medicines and staff for field hospitals in the disaster region. For Tenet, the immediate problem remained that its own patients and staff could not get out.

Confusion About Assistance

LifeCare also struggled to move patients from Memorial. Its senior vice president arranged for Lone Star Ambulance vehicles from Texas to collect patients leaving by boat or helicopter, but could not obtain permission for the ambulances to enter the city. She told staff at Memorial to use whatever transport officials arranged. Later she learned that four LifeCare patients and seven staff members were stranded at Napoleon and St. Charles Streets, and spent the evening seeking help from the Coast Guard and Knox Andress, whom she believed still worked for FEMA.

The confusion had a further consequence in litigation. LifeCare argued that its case should be heard in federal rather than state court, asserting that a federal official, Knox Andress, had advised its administrators that FEMA would rescue their patients. During the proceedings, Andress clarified that he was a nurse in Shreveport who performed regional disaster-preparedness work under a federal grant; FEMA had never employed him. The court found that he did not qualify as a federal officer and sent the case back to Louisiana district court. The episode shows how a mistaken understanding of who represented FEMA could shape expectations during the emergency and later become an issue in determining where a lawsuit belonged.

Institutional Change and Continuing Weaknesses

The book also places FEMA within a longer history of federal medical-response restructuring. Before Katrina, the National Disaster Medical System, which includes Disaster Medical Assistance Teams, had been moved out of the federal health department and placed under FEMA and the Department of Homeland Security as part of a broad governmental redesign after September 11. After Katrina, the system was returned to the federal health department, which coordinates national health-care resources in emergencies. A congressional investigation described confusion over the medical teams’ command structure and criticized failures in the federal medical response, including chaotic conditions at the airport and restrictions that kept some physicians from assisting.

Later emergencies tested whether reorganization had resolved the practical problems. In Haiti, after the 2010 earthquake, disaster teams again encountered supply-chain and procurement difficulties: oxygen, fuel, and equipment ran short, and some supply caches contained heaters instead of air conditioners. The book notes subsequent efforts to revamp supply, resupply, and logistics, including distributing supplies around the country and anticipating specialized needs. Those changes mark an institutional response to failures exposed by Katrina, but they do not erase the recurring problem: plans and organizational charts cannot by themselves guarantee that equipment, authority, and transportation will reach patients in time.

Significance

FEMA’s role in this account is neither simple command nor absence. It sponsored an exercise that anticipated a mass casualty and evacuation challenge, participated in identifying hospital power vulnerabilities, and became one of many agencies to which officials turned for help. Yet the response was divided across federal, state, local, corporate, and medical organizations whose communications and priorities did not align. The resulting delays affected patients who could not evacuate on their own and facilities dependent on outside rescue. By following FEMA through preparation, crisis coordination, legal dispute, and later restructuring, the book distinguishes planning activity from operational capacity—and shows how responsibility can be widely distributed even as the consequences of delay are borne by people awaiting care and transport.