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Charity in the eye of the aftermath

September 1, 2005 -- Yesterday the Associated Press released an astonishingly nurse-centric report on how New Orleans hospitals are coping with the devastation left by Hurricane Katrina, especially the flooding and power outages that threaten the operations of the hospitals themselves. Adam Nossiter's piece, "New Orleans Hospitals Trying to Make Do," includes quotes from three local nursing leaders working to care for patients in horrendous conditions, including two nurse managers at the legendary Charity Hospital. Without saying it is doing so, the story suggests the central role nurses play in keeping patients alive. By contrast, today's stories from CNN and The New York Times rely solely on physicians for their accounts of the deteriorating conditions at Charity, which reportedly now include sniper fire and perilously scarce resources.

The article explains that New Orleans hospitals faced "deteriorating conditions" after levees broke and put most of the city under water. The focus is Charity, the "state's biggest public hospital," where the halls were "dark and slippery" and "everyone needed flashlights." Outside, the water was 3-4 feet deep. With its backup generator running out of fuel, Charity nurses "hand-pumped ventilators for patients who couldn't breathe" and physicians "canoed supplies in from three nearby hospitals." (Note how this subtly illustrates the division of labor, suggesting that the nurses do not have time to get supplies, as it is their job to keep patients alive 24/7.) Charity nurse manager Mitch Handrich is quoted as saying that it is "like being in a Third World country. We're trying to work without power. Everyone knows we're all in this together. We're just trying to stay alive." Despite these conditions, injured patients kept coming; seeing a boat pull up with a man in pain, exasperated nursing supervisor Ray Campo is quoted as asking: "Where are we going to put him? We're the rescuee now. People coming here, it's like running into a burning building looking for shelter." Indeed, the piece notes that although police are working to get Charity more generators, all its 300 patients are to be evacuated, with about 25 sick babies to go first by helicopter to nearby hospitals. Other patients were reportedly evacuated eight miles by boat, then taken by ambulances to Baton Rouge for triage at the LSU Assembly Center. The piece explains that other area hospitals were also evacuating patients, including Tenet's 317-bed Memorial Medical Center and its 187-bed Lindy Boggs Medical Center. Still other hospitals remained open with backup power and limited supplies, but these were unlikely to last long. The piece notes that capable medical disaster teams are on their way from seven states.

The piece closes by describing the relatively good status of Ochsner Clinic in Jefferson Parish, "one of the few in the area still up and running," perhaps because it is "[p]erched a lofty 8 feet above sea level." The clinic was reportedly focusing on patients with life-threatening conditions, including "two near-fatal electrocutions of people who tried to return to flooded areas," and others injured by flying glass. The clinic itself had wet floors and broken glass, and the only power came from generators. Still, the clinic reportedly had adequate supplies and power as a result of good planning, and the piece quotes nurse Jackie Lupo, director of labor and delivery, saying: "I'm proud to tell you that, things are going--under the circumstances--really well." Though several women gave birth there during the crisis, according to clinic spokeswoman Katherine Voss, "[n]obody named one Katrina yet."

These scenes are reminiscent of the situation at hospitals in Houston--a city whose Astrodome is now set to receive some 10,000 refugees from New Orleans' overwhelmed Superdome--during Tropical Storm Allison in 2001. The TNT film "14 Hours," which premiered earlier this year, dramatized the experience of Memorial Herrman Hospital during this storm. There, as here, a major hospital worked desperately to cope with flooding and power failures until its patients could be evacuated. In our review, we noted that the movie deserved credit for placing skilled (if only marginally assertive) nurses at the center of the hospital's response to the life-threatening emergency.

Here, there is little doubt that Mr. Nossiter could have found physicians in New Orleans to give him status reports and colorful quotes about this disaster, and perhaps he should have gotten the perspective of at least one. The fact that the only identified clinicians in the piece are nurses suggests that he looked for those who were actually managing the patient population on the ground (or in the water). The nurses in this piece do not have a chance to display obvious clinical expertise, but neither does anyone else; note the canoeing physicians. Without apparently intending to say anything in particular about nursing, the report illustrates the central role nurses play in managing the overall conditions of hospital patients in disasters and at other times--a role that runs directly contrary to the message the mass media commonly sends, namely that physicians run the whole show.

Indeed, that more common message is what CNN sent today in its unsigned report about the sniper fire that appeared to halt the evacuation of Charity, even as conditions for the hospital's remaining patients and staff continued to deteriorate. That piece, "Sniper fire halts hospital evacuation," appeared to base its account of the gunfire and tragic conditions at the hospital entirely on the reports of two physicians. The New York Times sent a comparably physician-centric message yesterday in its broader piece, "10,000 Patients and Staff Members Await Evacuation from Barely Functioning Hospitals," by Reed Abelson and Alan Feuer. That report appeared to rely entirely on commentary by physician Kiersta Kurtz-Burke, whom it reached by phone at Charity, to describe the conditions at the hospital and the status of its patients. The piece did at least include a brief indirect quote from nurse practitioner Valorie Tucker, who "was on" a flight evacuating four premature babies from Ochsner to the University of Alabama in Birmingham. Tucker is reported to have noted that "except for a few tears, the babies remained stable during the flight."

We salute Adam Nossiter and the AP for their piece suggesting the key role nurses play in responding to this health care disaster.

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