Memorial Medical Center evacuation during Hurricane Katrina

The evacuation of Memorial Medical Center during Hurricane Katrina was a rescue effort shaped by a known flood risk, a collapsing power system, and a shortage of reliable transport. It unfolded in stages rather than as a single organized departure: helicopters arrived and left, airboats ferried people through flooded streets, and staff repeatedly revised who would go first. The failure of the generators turned the hospital’s infrastructure into an immediate threat, while the sorting system used to move patients out placed the sickest and those with DNR orders at the back of the line.

A known vulnerability becomes an emergency

After Hurricane Ivan narrowly missed New Orleans in September 2004, plant operations director Eric Yancovich studied storm-surge models and sketched the hospital’s entrances and outdoor equipment against the elevation of Magnolia Street. Memorial stood below sea level; his calculations indicated that less than four feet of street flooding could send water over the loading dock. Although the generators themselves were on the second floor, critical parts of the emergency electrical distribution system were at or below ground level. In a warning to his supervisor, Yancovich predicted that flooding could disable most of the medical center, cut power, and force patients into the newer Clara Wing.

Some protective work had been done, including floodgates and raising the vent for underground diesel tanks, but larger improvements remained proposals. Yancovich recommended elevating emergency power transfer switches and pumps supplying medical air and suction. A partial bid for electrical work exceeded a quarter of a million dollars; he doubted it would be approved for lack of capital. When floodwaters approached, the vulnerability was no longer a planning calculation. The hospital’s command team believed it had only hours before generator power failed, and Memorial’s chief executive, L. René Goux, had warned Tenet Healthcare Corporation that evacuation appeared likely.

The first flights and a rescue that did not happen

Near sunset, an orange-and-white Coast Guard Jayhawk landed on Memorial’s helipad beside a smaller private aircraft. From the LifeCare nursing station, staff and patients could watch transport teams carry a patient to the helicopter and hurry back beneath its rotor blades. Yet LifeCare’s patients did not move with that flight. Memorial said it would seek corporate permission from Tenet to transport them using Coast Guard aircraft, while a message about the request conveyed little urgency. The delay mattered in a region where medical helicopters were scarce and a long flight to an out-of-state hospital could keep an aircraft unavailable for hours.

That evening, the emergency department was also receiving people from outside the hospital. A stabbing victim waded up the ramp and required urgent air transport; other residents arrived by boat with children, seeking food and help. Staff secured exits as people crossed the surrounding water toward the hospital, while security faced the departure of the National Guard and then local police officers. These demands competed with the effort to evacuate patients and highlighted how Memorial had become both a medical facility and a refuge for people stranded nearby.

At about eleven that night, a Coast Guard Jayhawk arrived to begin evacuating the remaining patients. Instead, someone on the helipad told its crew that no patients still needed to leave and suggested returning after daylight. The crew was redirected to Tulane Hospital with an Acadian coordinator and medical equipment collected from private helicopters. It lifted away from Memorial without a patient aboard. At that point, the hospital’s census had fallen from 187 to about 130, but 52 LifeCare patients remained on the seventh floor, including seven who depended on ventilators. The building also held 460 Memorial employees, 447 family members, and 52 LifeCare employees.

Power failure and improvised triage

Memorial’s three teal generators, each rated at 750 kilowatts, had already been running for two days, although the disaster plan expected them to support the hospital for three. On-site maintenance workers were not generator mechanics. After one engine overheated, they added water to its radiator and restarted it. Later, amid low oil pressure and partial outages, they carried diesel and tried to keep the system working. One generator failed; engineers in rubber boots waded through knee-deep basement water to reach the electrical building and connect some of its load to another generator. They found that a substantial share of the automatic transfer switches was at a low level and might have been submerged, just as Yancovich had predicted. A second generator failed, and there were no spare parts for an effective repair. After a two-hour struggle, the last generator surged and died at about two in the morning on Wednesday, August 31, nearly forty-eight hours after Katrina made landfall near New Orleans.

With power gone, the hospital became hot, dark, and difficult to navigate. Water stopped running, toilets backed up, and sewage odors mixed with the smell of unwashed bodies. Phones, televisions, computers, and overhead paging no longer carried messages; staff relayed information by voice on stairways. At a morning command meeting, leaders planned to consolidate patients near exit points and sought the hospital’s color-coded emergency triage armbands. The intended bands marked patients who could walk as green, those needing assistance as yellow, those dependent on care as red, and patients with DNR orders as black.

When staff could not find enough official armbands, they devised a numbered system for the more than one hundred remaining patients. Category 1 patients, in comparatively good health and able to sit or walk, would leave first; category 2 patients needed more help; category 3 patients, judged very ill and including those with DNR orders, would leave last. In the dim light, nurses read charts by flashlight and wrote numbers on paper with a marker, taping them to patients’ clothing or writing directly on hospital gowns. Roughly three dozen category 1 patients were directed to the emergency-room ramp. About seventy category 2 patients waited along a corridor leading toward the parking garage and helipad. Around eighteen category 3 patients were gathered near a Hibernia Bank ATM and a planter of striped dieffenbachia.

The numbers organized movement, but they also determined where people waited and how long they would remain exposed to the conditions inside. Staff continued basic care—changing diapers, fanning patients, and offering sips of water—while most other interventions became limited after patients left their rooms. Anna Pou helped coordinate the movement, searching floor by floor with coworkers for cots and stretchers and receiving patients in the second-floor lobby. The act of sorting was rapid and practical, but the book also records a doctor’s discomfort at seeing a person’s immediate prospects reduced to a number on a gown.

Boats, revised priorities, and renewed rescue efforts

The first airboat evacuees were transferred at a drop site to waiting ambulances, and the round trip to Memorial took more than an hour. A closer dry location near a Rite Aid and a Copeland’s Restaurant was identified in the city’s southwest “sliver by the river,” but no ambulances were waiting there, and people had to wade through shallow, dirty water to reach dry ground. As the operation shifted, boats carried relatively few patients who were well enough to be discharged; doctors oversaw loading at the emergency-room ramp, and hospital employees and relatives were also allowed to leave. Some people hesitated when they did not know where they were going, or refused to leave without belongings such as a purse. The evacuation line stretched from the ramp through the emergency department into reception.

On Wednesday evening, officials told Memorial’s emergency-room manager that Louisiana’s Department of Wildlife and Fisheries would send boats. Tenet also confirmed contracts for six helicopters of different sizes, expected to begin arriving the next morning, and a satellite phone was being sent. The information brought hope without certainty: hospital leaders could not tell exhausted staff exactly when or how they would be evacuated. The situation report to Tenet described 115 patients still inside, including 30 confined to bed and more than 40 dependent on wheelchairs, and warned that as many as 60 were fragile and might die within a day.

Before sunrise on Thursday, doctors gathered in a radiology suite and objected to the earlier decision to stop the Coast Guard evacuation. John Walsh urged the doctors to act rather than wait for another scheduled meeting. He left with an anesthesiologist on the plant-operations director’s fishing boat to organize a more concerted rescue, while another anesthesiologist went to find Pou and Roy Culotta and ask them to reassess the patients still waiting. At a ramp meeting, Curtis Dosch reported that Tenet was dispatching privately hired helicopters and a satellite phone. The news did not answer when transport would arrive, but leaders renewed their assurance that boats and helicopters were expected and that everyone would get out that day.

The evacuation’s unfinished promise

The evacuation exposed a gap between a hospital’s expectation of functioning as a refuge and the practical limits of rescue in a city surrounded by water. Memorial’s failure was not simply that its generators stopped: Yancovich had identified the low-lying components that could disable them, while proposed repairs had not been funded. Once the system failed, darkness, heat, loss of water, and broken communications narrowed the staff’s options at the same time that the number of people needing help exceeded available transport.

The patients’ outcomes make the unevenness of the effort concrete. Four LifeCare patients who left by Coast Guard helicopter were successfully transferred to other hospitals, but five ventilator-dependent patients did not make it out. One died while being carried down the stairs; a woman in a deep coma with a DNR order never left the seventh floor. The episode’s central contradiction remains visible in the sequence: staff worked to move patients through improvised routes and dangerous conditions, yet a helicopter capable of carrying them once departed empty, and the categories meant to speed evacuation reserved the final place for some of the most vulnerable.