1. Jacobson, Joy

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On Sunday, August 29, when Hurricane Katrina gathered its colossal force in the Gulf of Mexico and aimed it at New Orleans, Tammy Daigle, LPN, an employee of St. Rita's Nursing Home in nearby St. Bernard Parish, knew exactly what to do: get out.


"A category five headed straight for you. You would too," said Daigle, age 42, in a recent interview with AJN. She and her husband and two sons left their mobile home in St. Bernard Parish for the Tuscaloosa, Alabama, area the day before Katrina ravaged the Gulf Coast. She hasn't returned but assumes her home was destroyed.


Many of St. Rita's residents were far less fortunate; 34 were found dead in the ensuing floodwaters, and on September 13 the facility's owners, Salvador and Mable Mangano, both age 65, were charged with 34 counts of negligent homicide. Louisiana attorney general Charles Foti said in a news conference that all Medicaid-funded nursing homes in the state must have an evacuation plan in place and that the Manganos failed to implement theirs. In fact, Foti said, state officials offered two buses to the facility, which the Manganos turned down. "We feel we have criminal negligence," Foti said, because the Manganos "did not follow a standard of care a reasonable person would follow."


Was a plan in place? Daigle said that in her four months of full-time employment at St. Rita's she had never participated in a drill or even heard discussion of an evacuation plan. When she left the day before the storm, she did so knowing there would be two nurses at St. Rita's, working their usual shifts. She often worked seven or eight consecutive 12-hour shifts, she said, but wasn't scheduled to work the day the storm hit. "If I'd have been scheduled I'd have been there," she said.


Daigle also said that she understands the dilemma the Manganos faced. Transporting dozens of patients and their medications, not to mention adequate food and water, is a risky and expensive undertaking, especially if a storm might veer off course. (Indeed, the first deaths reported in Louisiana as a result of the storm were three New Orleans nursing home residents who died during evacuation to Baton Rouge by school bus. And on September 23, before Hurricane Rita struck, 23 elderly residents being evacuated from a Houston nursing home were killed aboard a bus near Dallas when a brake fire triggered explosions of oxygen tanks.) Of several residents receiving hospice care at St. Rita's, Daigle said, "I doubt any would have made it. But are you going to lose three or 35? They made a mistake, like a drunk driver makes a bad decision," and they must pay the consequences, she said.


The New York Times reported on September 19 that "at least 91 patients died in hospitals and 63 in nursing homes not fully evacuated until five days after the storm," and Foti has said that the state will be investigating all such deaths in New Orleans. And although no one has accused any nurses of patient abandonment or negligence in the aftermath of Katrina, as the death toll rises in the health care facilities affected, nurses will surely be debating whom they should be protecting first during a disaster: themselves and their own families or the lives of their most vulnerable patients.

FIGURE. On September... - Click to enlarge in new windowFIGURE. On September 16, a wheelchair with a slipper still on the footrest sits in the mud left behind by Hurricane Katrina at St. Rita's Nursing Home in St. Bernard Parish, Louisiana. Facility owners have been charged with 34 counts of negligent homicide after residents were found dead in the floodwaters. Former employee Tammy Daigle, LPN, told