A Long Term Care Nightmare Continues…
Timeline-
St. Bernard Parish, Louisiana, lies to the East of New Orleans and thus was closer to the path of the storm and were exposed to the storm surge from the Gulf of Mexico. St Bernard’s Parish was completely flooded via water surging into Lake Borgne.
A large portion of the flooding was apparently the result of levee failures along the Mississippi River – Gulf Outlet Canal, a 76 miles (122 km) canal.
The levees were sized to hold back up to 17.5 feet (5.3 m)of water; they held back the initial surge, but then they were breached in several areas by the 22 feet (6.7 m)surge.
The Parish's two shelters at Chalmette High School and St. Bernard High School suffered considerable damage with flooding. Chalmette High lost much of its roof, and St. Bernard High had many broken windows. There were estimates of 300-plus evacuees at both sites.
By August 29, about 150 people were sighted on rooftops in areas that were under approximately 8–10 feet or more of water. Among those on the roofs were WDSU reporter Heath Allen and a St. Bernard resident on a government complex rooftop. Residents reported that even oil platform service boats were utilized to rescue survivors.
Was it a Train or a Six Foot Wall of Water?
The levee breaches and overtopping resulted in floodwaters of 15 to 20 feet covering about 80 percent of the city. The catastrophic damage and loss of life inflicted by this hurricane is staggering, with an estimated 1,353 direct fatalities1 and 275,000 homes damaged or destroyed. According to the American Insurance Services Group, Katrina caused an estimated $40.6 billion in insured losses (as of June 2006). The National Hurricane Center typically doubles the estimated insured losses for an estimate of total damage losses in the U.S., giving an estimated total $81.2 billion in damage. Total economic losses could be greater than $100 billion. ***These impacts make Katrina the costliest hurricane in U.S. history and one of the five deadliest hurricanes to ever strike the U.S.
On Friday, August 26, the Weather Forecast Office - New Orleans/Baton Rouge contacted emergency managers in southeast Louisiana and coastal Mississippi to advise them to monitor Katrina. While they explained the uncertainty inherent in two and three day tropical cyclone forecasts, they noted the westward computer model trends and that Katrina could be a major hurricane at landfall – Category 3 or 4. They told them to prepare for potential hurricane watches and warnings the following day. Later that afternoon, the first Southeast Louisiana Hurricane Task Force conference call was held.
The final significant adjustment to the National Hurricane forecast occurred in the 10 p.m. CDT, August 26 advisory, 56 hours before landfall. The track was adjusted farther west to project a landfall in southeast Louisiana and a second landfall near the Louisiana/Mississippi border, and the intensity forecast projected Katrina as a major hurricane until final landfall. The forecast discussion noted an above average level of confidence in the forecast.
At 11 a.m. EDT on Saturday, August 27, NHC issued a hurricane watch from Morgan City, Louisiana to the mouth of the Pearl River (Louisiana-Mississippi border), including metropolitan New Orleans. Later that afternoon, and extended the hurricane watch eastward across southern Mississippi to the Alabama-Florida border. On the night of August 27, the hurricane watch was upgraded to a warning. The intensity forecast called for Katrina to be a major hurricane at landfall.
NHC introduced storm surge forecasts for southeast Louisiana and coastal Mississippi in the 11 p.m. EDT, August 27 forecasts may be as high as 25 feet.– 32 hours prior to Katrina's landfall in southeast Louisiana.
On Sunday morning, August 28, 10 tornado watches were issued in the south and east central United States as Katrina moved inland. Sixty-one tornadoes occurred from August 28 to August 30 from Mississippi to Pennsylvania.
The same Weather Office- New Orleans/Baton Rouge stated, “catastrophic hurricane expected” and urged residents to rush all protective measures to completion. At 10:11 a.m., August 28, updated statement emphasized the horrific impacts Katrina would likely create for southeast Louisiana and coastal Mississippi
URGENT - WEATHER MESSAGE
NATIONAL WEATHER SERVICE NEW ORLEANS LA 1011 A.M. CDT SUN AUG 28 2005
...DEVASTATING DAMAGE EXPECTED...
.HURRICANE KATRINA...A MOST POWERFUL HURRICANE WITH UNPRECEDENTED STRENGTH...RIVALING THE INTENSITY OF HURRICANE CAMILLE OF 1969.
MOST OF THE AREA WILL BE UNINHABITABLE FOR WEEKS...PERHAPS LONGER. AT LEAST ONE HALF OF WELL CONSTRUCTED HOMES WILL HAVE ROOF AND WALL FAILURE. ALL GABLED ROOFS WILL FAIL...LEAVING THOSE HOMES SEVERELY DAMAGED OR DESTROYED.
THE MAJORITY OF INDUSTRIAL BUILDINGS WILL BECOME NON FUNCTIONAL. PARTIAL TO COMPLETE WALL AND ROOF FAILURE IS EXPECTED. ALL WOOD FRAMED LOW RISING APARTMENT BUILDINGS WILL BE DESTROYED. CONCRETE BLOCK LOW RISE APARTMENTS WILL SUSTAIN MAJOR DAMAGE...INCLUDING SOME WALL AND ROOF FAILURE.
HIGH RISE OFFICE AND APARTMENT BUILDINGS WILL SWAY DANGEROUSLY...A FEW TO THE POINT OF TOTAL COLLAPSE. ALL WINDOWS WILL BLOW OUT.
AIRBORNE DEBRIS WILL BE WIDESPREAD...AND MAY INCLUDE HEAVY ITEMS SUCH AS HOUSEHOLD APPLIANCES AND EVEN LIGHT VEHICLES. SPORT UTILITY VEHICLES AND LIGHT TRUCKS WILL BE MOVED. THE BLOWN DEBRIS WILL CREATE ADDITIONAL DESTRUCTION. PERSONS...PETS...AND LIVESTOCK EXPOSED TO THE WINDS WILL FACE CERTAIN DEATH IF STRUCK.
POWER OUTAGES WILL LAST FOR WEEKS...AS MOST POWER POLES WILL BE DOWN AND TRANSFORMERS DESTROYED. WATER SHORTAGES WILL MAKE HUMAN SUFFERING INCREDIBLE BY MODERN STANDARDS.
THE VAST MAJORITY OF NATIVE TREES WILL BE SNAPPED OR UPROOTED. ONLY THE HEARTIEST WILL REMAIN STANDING...BUT BE TOTALLY DEFOLIATED. FEW CROPS WILL REMAIN. LIVESTOCK LEFT EXPOSED TO THE WINDS WILL BE KILLED.
AN INLAND HURRICANE WIND WARNING IS ISSUED WHEN SUSTAINED WINDS NEAR HURRICANE FORCE...OR FREQUENT GUSTS AT OR ABOVE HURRICANE FORCE...ARE CERTAIN WITHIN THE NEXT 12 TO 24 HOURS.
ONCE TROPICAL STORM AND HURRICANE FORCE WINDS ONSET...DO NOT VENTURE OUTSIDE!
***Could anything have been more clear as to the danger?
FATAL FLAWS
What were the many “fatal mistakes” that may have contributed to this mass drowning?
35 Charges of Negligent Homicide by the Louisiana AG- Charles
C. Foti, Jr- As defined, Mabel and Sal “demonstrated such a disregard of the interest of others that the offenders conduct amounted to a gross deviation below the standard of care to be maintained by reasonably careful people.” This was the prosecuters’ job to prove.
On Sunday August 28, according to a news release from the Louisiana State Patrol, they categorized Katrina as a mandatory evacuation. However, St. Bernard Parish reportedly didn’t make an official statement on Saturday August 27, because they would not be offering shelters.”
Mabel reported that “they would be notified and weren’t;”
In 20 previous years worth of storms, they had never evacuated nor lost a life;
Their nursing home was located on a patch of land with a somewhat higher elevation and hadn’t flooded in the past;
They had an emergency plan that was on file and they had done their usual preparations with residents and staff;
The standard operating procedure - evacuation plans for all nursing homes in the state was to initiate the plan 72 hours before a hurricane makes landfall;
The St. Rita’s filed plan specifically stated that “they were to evacuate 48 hours before a Category 3 storm or larger.”
All other nursing homes in the geographic area of St. Rita’s Home evacuated except them;
Mabel was concerned for the “special needs” patients who may not withstand a bus ride, (as others had died in other geographic locations);
Sal bought extra generators and gas to run the laundry facilities to “shelter in place” for the duration versus getting gas to evacuate;
They had prepared meals ahead of time in anticipation of staying;
The County Medical Examiner, Dr. Bryan Bertucci, recommended they evacuate and offered two buses and two drivers for all 70 residents to wherever they wanted to go; Mabel refused the offer and then she called again two hours later… but it was too late; He testified, it wasn’t his job to order or demand, but to strongly recommend.
The Manganos declined extra firefighters - emergency management staff when Steve Galodoro,(whose father resided at St Rita’s) offered, because “they had a plan and more nursing staff was coming”;
Defense Atty Jim Cobb, interviewed Director of Nursing, Diane C.
He asked, “But why were you still there? Who was watching the weather? Didn’t you see how bad they were saying Katrina was going to be? “ She replied, '' I was. `` I watched the weather on TV so much they called me Bob Breck.” (local meteorologist.) “Everyone knew how bad they were predicting it would be. Sal and Mabel knew it too. You couldn’t miss it.”
Diane C. told Defense Atty Jim Cobb when asked, “Tell me about the decision -making process you all used to determine whether you were going to stay or evacuate. How did that work?
DON replied, “There wasn’t no process. Sal and Mabel were the owners and Mabel was the Administrator. It was her call. You know, I’d been there for years and we never, ever evacuated before and everything turned out fine. ‘Just this time…. I shouldn’t even be here.” (referring to how she nearly died) p. 125 (Flood of Lies);
Louisiana AG Foti repeatedly stated to the media that Sal and Mabel had ignored a mandatory evacuation from the St. Bernard Parish Government while New Orleans Governor Kathleen Blanco and Mayor Nagin had issued the evacuation mandate for New Orleans on Sunday morning August 28. (Knowing that Bernard Parish is lower in elevation, was closer to the coast and surrounded by water on almost all sides, it would stand to reason that Mabel should have known the danger.(p. 49);
At 6 a.m. on Sunday August 28, Mabel “was intent on feeding her residents, staff and family members a hot breakfast, including hand feeding many residents” despite winds over 100 mph and loss of power from the regular generator. Sal also began preparing lunch as culturally, all things revolved around food for Louisian residents. It appeared that they were oblivious to the dire situation until “the wall of water that sounded like an oncoming train” abruptly struck on Monday morning.
GOVERNMENT RULES-
There are layers of bureaucracy that dictate what nursing facilities can and cannot do including Federal Guidelines, State Statutes, County and City policies and more.
One of the most glaring tragedies of Hurricane Katrina has to be the issue of whether the existing evacuation and nursing safety procedures were adequate at the time? The very learned advice of Attorney and Professor Robert Mead from the University of Kansas Law school says, NO. I won’t belabor the reader with lots of legal gobbledygook. But, some points are worth sharing -
Federal regulations by nature are broad and vague necessitating SNFs to develop their own plans; ** It is incredulous that these Federal Regs do not explicitly require that nursing homes follow their own plans, “only that they have a plan on file.”
The Federal and state legislatures historically have failed to hold nursing homes to a higher standard due to the power of nursing home lobbyists;
There needs to be alternatives to strengthen torts- acts of injury or harm to others resulting in civil suits and criminal lawsuits.
Attorney Mead recommends that strengthening Federal Regulations is the “superior path to take,” as well as threatening to withhold Medicare and Medicaid funds. Other penalties do not sufficiently motivate change;
In order for nursing homes to receive Medicare and Medicaid funds, the Feds require “the highest standard of care” and need to comply with all Federal and State codes.
Emergency preparedness must include detailed plans and procedures, training and drills. BUT, unannounced drills should not “upset residents”. The vital measure of how effective they truly are also appears absent.
Following Katrina, there were tricky ways in which legislators manipulated legislation and policy to exempt current nursing homes and hospital buildings and building codes from improvement, limiting them to newly built facilities;
“A Catch 22” exists with the evacuation of nursing home residents in an emergency. It is likely that compromised residents will die from transfer trauma or the actual event itself or in the aftermath months later. Such was the dilemma of Sal and Mabel Mangano…
Other “thorny matters-” Did liability exist because of negligence by the nursing home, or a resident’s underlying medical condition? Was it an “Act of God?”(i.e Was the threat foreseeable? Were the defendants’ precautions reasonable and meet a reasonable standard of care?
CMS - The Center for Medicare & Medicaid Services are not “the police for nursing homes”. Their purpose is to qualify providers for Medicare and Medicaid Programs. They cannot hold medical directors responsible.
COMING UP NEXT!
Lessons from the Defense ,James J. Cobb, Jr; Author of “Flood of Lies;
After Katrina - What Should Have been a Happy Ending;
And then .. the Final Ending!