Monday, August 31, 2009

Memorial Medical Center During Hurricane Katrina

The New York Times Magazine reported the brutal conditions Memorial Medical Center staff faced in the aftermath of Hurricane Katrina. The story focused on medical care, specifically on allegations of euthanasia of acutely ill patients.

Forty five patient corpses were removed from MMC, ten of which expired before Katrina struck. The report suggested over half received medication hastening their death. Of the 35 deaths, 25 occurred on the LifeCare unit, which rented a floor in Memorial. Their mortality rate after Katrina was 48%. Tenet Health owned Memorial Medical Center had 10 deaths.

The NYT story didn't mention several items:

1. The Carlyle Group purchased LifeCare Hospitals just weeks before landfall. The deal closed August 11, 2005. Katrina struck the Gulf Coast on Monday, August 29.

At LifeCare that afternoon (Tuesday, August 30), confusion reigned. The company had its own “incident commander,” Diane Robichaux, an assistant administrator who was seven months pregnant. At first everything seemed fine; Robichaux established computer communications with LifeCare’s corporate offices in Texas and was assured that LifeCare patients would be included in any FEMA evacuation of Memorial. But as the day wore on, the texts between LifeCare staff members and headquarters grew frantic as it became clear that the government’s rescue efforts and communications were in chaos.

Surely LifeCare headquarters in Dallas apprised their new owners of their struggling Memorial unit. What help did they request from the politically connected Carlyle Group? Who did Carlyle leaders call in the Bush White House?

2. LifeCare sued Tenet as a result of damages from the storm. Damages arose from loss of power and lengthy delays in evacuation. Tenet settled the LifeCare suit, but their confidential settlement is sealed from public view. Tenet eventually hired medical evacuation helicopters, in an HCA like move:

Soon after sunrise on Thursday, Sept. 1 — more than 72 hours into the crisis — Memorial’s chief financial officer, Curtis Dosch, delivered good news to hospital staff gathered on the emergency-room ramp. He had reached a Tenet representative in Dallas and was told that Tenet was dispatching a fleet of privately hired helicopters that day.

3. LifeCare's defense (in wrongful patient death suits) states patients became wards of the federal government when FEMA evacuation teams arrived in New Orleans. This is patently laughable, but it serves as a defense for ceasing patient treatment, stopping IV's needed to keep patients hydrated. Yet, patients received non-indicated pain medications.

The (Memorial) administrator told him that the hospital was in survival mode, not treating mode. Furious, Mark LeBlanc (relative of LifeCare patient) asked, “Do you just flip a switch and you’re not a hospital anymore?

4. Memorial Medical Center warranted not one mention in the White House Katrina Lessons Learned report. Who omits the hospital with the highest patient death toll? Frances Fragos Townsend did.

After several helicopters arrived and rescued some of the LifeCare patients, Air Force One flew over New Orleans while President Bush surveyed the devastation. Few helicopters arrived after that.
Helicopters were available, just not ordered to help by Defense Secretary Rumsfeld.

5. A year after the report was released, Tenet (also with no mention in the LL report) appointed Jeb Bush to its Board of Directors. However, MMC's political links have a bipartisan flavor.

6. Accrediting bodies required Memorial and LifeCare to have comprehensive disaster plans, including evacuation components. The Lessons Learned report sparsely refers to triage and patient evacuations. It doesn't clarify methods used or evaluate performance. This abdication helps LifeCare/Memorial, which flipped the normal triage method of evacuating seriously ill patients first. Industry and government have not come to grips with appropriate evacuation or triage methods.

Typically, medical workers try to divvy up care to achieve the greatest good for the greatest number of people. There is an ongoing debate about how to do this and what the “greatest good” means. Is it the number of lives saved? Years of life saved? Best “quality” years of life saved? Or something else?

Pou has also been advising state and national medical organizations on disaster preparedness and legal reform; she has lectured on medicine and ethics at national conferences and addressed military medical trainees. In her advocacy, she argues for changing the standards of medical care in emergencies. She has said that informed consent is impossible during disasters and that doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have Do Not Resuscitate orders — an approach that she and her colleagues used as conditions worsened after Katrina.
If Dr. Pou's method becomes the new standard, does that help the Carlyle affiliate's defense?

7. LifeCare's obligation to patients did not end when power failed on the seventh floor. LifeCare credentialed physicians and hired competent clinical staff to care for its patients. It's hard to believe an ENT doctor, Dr. Anna Pou, was LifeCare's chief clinician. LifeCare clearly had a duty to keep Memorial doctors and nurses with questionable motives away from its patients.

8. The NYT story implies political influence from prosecutors in the grand jury. LifeCare went from zero lobbying dollars in 2005 to $560,000 in 2006. Did it fund calls to the New Orleans prosecutor, who allowed a grand jury to select what evidence they wished to hear? How much was spent to influence the President's Lessons Learned report? It couldn't function better as a risk management document for Carlyle's newest affiliate or Tenet Health.

Tenet spent over $1.3 million on lobbying in 2005 & 2006. Landrieu Public Relations, a New Orleans based firm with strong local connections, received roughly $200,000 to lobby the House and Senate. The Stafford Act was the main topic. It's the law that allows FEMA to respond to disasters. Did Phyllis Landrieu speak with Rep. Rahm Emanuel, once mentored by the CEO of GTCR Golder Rauner? GTCR sold LifeCare Hospitals to Carlyle just weeks before landfall.

A different lobbying firm, Quinn Gillespie & Associates, discussed corporate governance changes with the Executive Office of the President in early 2006. In less than a year, President Bush's brother Jeb was named to the Tenet Board. Did George W. trade a report omission for a board position?

9. Robby Dubois and Earl Reed ceased employment with LifeCare/Carlyle. Ms. Dubois attributed Katrina stress as her reason. Mr. Reed was the man in charge in Dallas. He could fill in the organizational side of the Memorial debacle, should he testify. However, odds are high that Carlyle purchased his silence.

10. Fran Townsend, author of the hapless Katrina investigation, landed a job with Baker Botts. She heads up their risk management consulting division. The dough boy in Baker Botts is James A. Baker, III, long connected to the Carlyle Group. Was Fran rewarded for minimizing LifeCare's exposure in her Lessons Learned report? On that sole parameter, she excelled.

11. LifeCare's SEC filings state:

We are currently defending ourselves against a variety of Hurricane Katrina related lawsuits or matters under review by the Louisiana Patient Compensation Fund. We are vigorously defending ourselves in these lawsuits, however, we cannot predict the ultimate resolution of these matters.

We maintained $15.0 million of general and professional liability insurance during this period, subject to a $1.0 million per claim retention. We believe that under our insurance policies, only one retention is applicable to the Hurricane Katrina matters since these matters all arose from a single event, process or condition.

Our insurance carriers are currently paying all costs related to these claims, but have sent reservation of rights letters which challenge, among other things, the application of one retention to the Hurricane Katrina related matters. To the extent it is ultimately determined that a separate retention applies to each of these claims, we could experience significant losses related to these Hurricane Katrina matters which would negatively impact our financial position, liquidity and results of operations.

Carlyle leaders hate a level playing field. Their good name was not mentioned in the NYT piece. Carlyle Managing Director William Kennard sits on the board of the New York Times. Did that have any impact on any still untold aspects of the Carlyle-Tenet-Bush Katrina debacle?

Having evacuated a Texas Gulf Coast 165 bed hospital before a record hurricane and endured in a flooded, 725 bed Virginia teaching hospital, LifeCare's legal defenses are a canard. Funny, that sounds like Kennard.

(The LifeCare case in the last link is on page 35 of the document.)

Update 3-29-14:  The hellish five days before rescue are chronicled in a book, Five Days at Memorial by Sheri Fink.  I am grateful someone investigated the events at Memorial.  I'd love to know what happened at the White House and what actions Carlyle officials took, both during and after the storm.  I'd also like to know the events precipitating Jeb Bush's appointment to the Tenet Healthcare Board, given Tenet owned Memorial Medical Center when Katrina make landfall.  

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