Dr. Louis Minsky
Dr. Louis Minsky addressed the importance of ongoing planning meetings in the success of handling masses of evacuees:
"The department and parish had established emergency planning under the MMRS, the Metropolitan Medical Response System, which came under the auspices of the federal government. The committee which I headed during the pre-Katrina time primarily involved local and regional hospitals and medical groups communicating and developing plans of action should an event occur. Before Katrina, "an event" was to be a terrorist attack on American soil."
"Region 1 MMRS includes the nine parishes surrounding Baton Rouge. We had Lane Memorial Hospital, Our Lady of the Lake Hospital, Baton Rouge General Hospital, St. Elizabeth in Gonzales, River West, and Point Coupee General. This committee also included emergency medical services from Baton Rouge, the Fire Department and local responders. We were under Joanne Morrow’s department. She is the head of the Office of Emergency Preparedness. She’s the Director for East Baton Rouge Parish. We met and planned – in fact, just two years prior to Katrina, we had been to Anniston, Alabama, where we trained in a scenario event, putting into action the guidelines of local, state, federal government, CDC interactions and plans, and developed strategies. When Katrina occurred, all of these plans became operative. We had our local hospitals represented at the table for East Baton Rouge Parish; we had a physician volunteer corps, which was probably the weaker part of it all. We were developing a Volunteer Physician Corps prior to Katrina, but never had really put together – the difficulty with the disaster with Katrina, as I saw it, was the local government attempting to act cohesively with state government. . . ."
"As hard as it was, we got through this, I think, very well overall; but I would venture to say that most communities aren’t prepared in that manner, so there has to be some core group in that community or region that is already tying together. Maybe it’s a little local parish medical society, or county/parish medical society, or a state medical society, but there has to be a group of individuals who meet regularly to discuss how to break down those political barriers, [such as] Our Lady of the Lake talking to Baton Rouge General. We had the people responsible for the transfers talking; we had physicians involved, and so we knew that the Lake could care for this and the General could care for this, and we would share those, and we would make sure that beds were being appropriately used and we were working with the medical transport system, EMS and the Fire Department, but the transfer of patients from a shelter to a hospital or medical facility or from hospital to hospital or directly from ground zero to the hospital was all communicated through one center for the most part by far in Baton Rouge. . . "
"I think that planning ahead and the ability to know the people to call and to already have this communication of "What are we going to do if somebody drops the bomb, or if we have an earthquake, or we have a huge forest fire, or we have a chemical plant explosion," . . . [creates] an open door policy between the hospitals to communicate. That provides your beds."
Dr. Minsky noted the need to plan for patient return as well as departure when evacuation is necessary:
"The State requires nursing homes and home health agencies to have emergency plans. These plans and contracts came without forethought as to how transportation would occur, when would you actually leave. Sometimes patients refused to leave. This was unprecedented. There was great difficulty getting these people out of New Orleans. After the storm, we had to find transportation back for them. . . . DHH mandates that nursing homes and home health agencies have an emergency plan, but enforcing those plans presents great challenges."
Dr. Minsky noted the following regarding communication and cooperation among hospitals in the Baton Rouge area as they worked to effectively handle the influx of evacuees:
"Hospitals cooperated better than they ever have on a regular day-to-day basis. We had EMS and Acadian Ambulances on standby at the River Center; we had transportation going back and forth. We were communicating with the hospitals, "Who can take this patient? Who can’t? Let’s just don’t go turn them in to the Emergency Room and walk away. Let’s try and figure out who has a bed and where is the bed." The same thing with the incoming helicopters."
A common concern across interviewees and focus group members was the difficulty in verifying credentials of the large numbers of medical personnel who came from other areas to aid in the relief efforts. Dr. Minsky addressed this concern as follows:
"Credentialing was a huge issue. The credentialing process failed. . . Local hospitals have this in place. All the hospitals, in fact, had come up with emergency credentialing venues. What was not anticipated was the large number of physicians and medical people that would come from outside of the area to help, very generous people came. We had physicians sitting in the bleachers at the Assembly Center with nothing to do."
"I had to have personal cell phone numbers of some of the people at DHH in order to be able to communicate and get information passed by the port [authority]. I think it’s imperative that we have a plan of action, a hotline or a place where physicians can call before they come and we can say, "You know, we do need your 20-physician team, but we don’t need you until Wednesday. We don’t need you until Thursday. We don’t need you today. The patients are not here today, but we are anticipating this to occur tomorrow."
"[We also need a place to] credential medical [professionals] when they get here, and then to schedule them. For the first week or so, Our Lady of the Lake Hospital was very gracious in scheduling our local physicians. We knew the number to call and our local physicians could call and volunteer. This proved very efficient."
Dr. Minsky suggested that there be alternative sites to send evacuees when the original site is experiencing the impact of the disaster as well:
"For Baton Rouge, the difficulty was we were just up the road suffering a lot of the same consequences that New Orleans suffered. This should not be the stopping place for a million-plus people out of New Orleans. You certainly want to keep them close to home. Many people anticipate "We’re just going to turn around and go home," but you can’t assume you’re going to turn around and go back home. There needs to be better points in plan of where you will move the displaced people and then what you will do once they’ve been displaced for a certain period."
Dr. Minsky described the problems that arose in providing medical care for evacuees:
"From the patient standpoint, there needs to be a method of registration and a way to follow that patient. Many of these patients were split, sent different places and lost. We had a great deal of difficulty reuniting a lot of people. How do you put those people together? So identification and tracking from the start, from ground zero. . . . Where does that displaced person register when they’re moved and then how do you track them?"
Although hospital and emergency personnel in Baton Rouge had trained and planned for responding to a disaster, Dr. Minsky described the unanticipated challenges to their response efforts posed by an influx of medical personnel:
"The major shelter in Baton Rouge was to be the River Center. This was to be the Red Cross shelter. We had hundreds of physicians and ancillary medical people coming in from around the country. So there were a lot of potential areas for conflict in this whole scenario. DHH and the State were following protocol at LSU and Red Cross was attempting to do their thing at the River Center. Red Cross never had a medical shelter; they had a first aid station. These people came with two days of medicine in their pockets thinking when the clouds blew over they would go home. It turned into a need for blood pressure control, diabetic control, dialysis needs. As we know, this became an extended stay."