Expert: Fleeing nursing sites no safe bet

Calling their first witness Thursday in the St. Rita’s nursing home trial, defense attorneys challenged a basic assumption underlying the case: that evacuating nursing homes in advance of hurricanes saves lives.

Medical studies on nursing home evacuations show that the number of elderly residents in an evacuated region who die in transit is about the same as the number who would have been killed by the storm if they hadn’t left, said Dr. Brobson Lutz, a New Orleans physician and public health expert.

“The bottom line on all the research is that there is no evidence-based proof that you actually save lives by evacuating patients from nursing homes,” he said Sal and Mabel Mangano are on trial for negligent homicide in the deaths of 35 residents who drowned in their St. Bernard Parish nursing home during Hurricane Katrina.

It was clear from the physician’s testimony that he was speaking about nursing home evacuations as a broad public health issue and was not suggesting that 35 residents would have died on the roads had they been rushed from St. Rita’s as the hurricane approached in late August of 2005.

Defense attorneys have said the Manganos feared some residents might not survive the ordeal of an evacuation.

Lutz called that a valid medical concern. He said he reviewed medical records for the 59 residents at St. Rita’s and concluded that “one or more residents likely would have died” during an evacuation.

But Assistant Attorney General Julie Cullen noted that St. Bernard’s other three nursing homes evacuated a total of nearly 200 residents, with just one death, a 90-year-old hospice patient.

“Don’t you think that’s a safe risk to take?” Cullen asked.

Judge Jerome Winsberg sustained a defense objection to the question.

Lutz was the only witness called by the defense before court was adjourned Thursday morning. The trial is scheduled to resume Tuesday after a four-day Labor Day break.

Prosecutors said they will appeal Winsberg’s decision Thursday to admit as evidence in the case a document indicating 32 of 74 nursing homes in the New Orleans area did not evacuate before Katrina.

The document was produced by Joseph Donchess, executive director of the Louisiana Nursing Home Association, who had been scheduled to be the defense’s first witness.

Donchess is expected to testify Tuesday after the 1st Circuit Court of Appeal in Baton Rouge has had a chance to review the prosecution’s emergency appeal.

Lutz said a nursing home with 50 to 60 residents typically has one or two deaths during an evacuation. He said the mental and physical stress begins with loading the buses, which usually takes several hours.

“It’s not like getting a kindergarten class and telling them to hop on a bus,” he said. “It takes three or four people to carry some of these residents onto a bus.”

But Cullen suggested the injuries an elderly person might suffer while being loaded onto a bus pale in comparison to the trauma endured by the 24 residents who were rescued as Katrina’s storm surge swamped St. Rita’s, flooding the one-story home nearly to the ceiling within 20 minutes.

“What about elderly people who are pulled out of windows, pulled onto boats and pulled onto rooftops?” she asked Lutz. “Would you expect that to result in physical and psychological injuries?”

Lutz was instructed not to answer after Winsberg sustained another defense objection.

Cullen also questioned Lutz about St. Rita’s state-mandated evacuation plan, which according to previous testimony, relied on transportation provided by Sal Mangano’s company, which owned a single nine-passenger van.

“Could a nursing home evacuate 60 residents using a nine-passenger van?” she asked. “Is there anything feasible about that plan, in your medical opinion?”

Lutz said it would not have been a workable plan unless the home received substantial help from an ambulance service and relatives who picked up their loved ones.

The case, which was moved to West Feliciana Parish after the defense requested a change of venue, began with jury selection Aug. 13. Prosecutors called 40 witnesses over 10 days of testimony, and the defense’s case is expected to last about a week.

In dismissing jurors for the four-day break, Winsberg instructed them to refrain from reading about or watching news coverage of the trial. But football, he said, was a different matter.

“Before you go, just let me say: Go Tigers. Go Saints. And let’s not forget the most important one: Roll Green Wave,” said the judge, who got his undergraduate and law degrees from Tulane University.

By: Paul Rioux http://www.nola.com/news/t-p/capital/index.ssf?/base/news-5/1188539843239140.xml&coll=1&thispage=2