I smell a rat, or the mystery of the disappearing disaster funding in Louisiana

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I said a prayer of gratitude when I turned in for bed on the night of August 28, 2005. Hurricane Katrina, according to the nightly news, had just barely brushed New Orleans. All was well in my adopted city.

I awoke Monday morning to the news that the levies were giving way to the swell of the rushing waters. I felt myself sinking into a state of shock, much like one experiences with the news of a death in the family. I remained hypnotized in front of my television for the next three weeks. Now, a sad two years later, hurricane season is upon us again. Last summer’s El Niño protected our vulnerable coast lines but this year there the turgid ocean waters are free to seethe, simmer and wreck havoc at their will. I grew up in Lake Charles, Louisiana on Small Bayou. Small Bayou runs off the Lafitte Bayou and legend has it that Jean Lafitte buried his treasure there. At least that’s what my Dad believed. So off we would go in our 1945 wooden Chris Craft boat before daylight every Saturday and Sunday morning; fishing, treasure hunting, drinking Bush Bavarian beer (I was thirteen) and having an all-round Tom Sawyer/Huckleberry Finn good time. My mother frowned on our adventures. She wouldn’t participate in such foolishness.

My parents eventually left Lake Charles when I was a student at L.S.U. in Baton Rouge. I had fallen in love with south Louisiana and could not bring myself to leave. At the age of twenty-seven I enrolled in an Emergency Medical Technician class in Lake Charles. By then I had a Bachelor’s Degree, but I wasn’t doing what I considered meaningful work. So, I became an Emergency Medical Technician and eighteen months later found myself working as the Executive Director of Emergency Medical Services for a five parish region.

The good old days

Those were the good old days. By 1978 David Boyd, M.D. had defined the “Golden Hour.” That golden hour meant that you better get your injured or your cardiac-arrested patient to definitive medical care in one hour or, as Freddie Mercury put it, “another one bites the dust.” The Feds seemed to take note of Boyd’s work and put some funds in the coffer for development of local EMS systems. In 1979 I wrote a federal grant application for funding our rural EMS system, got some money, talked long and hard with public officials and the medical community to support our system.

It was controversial, at best. I’ll never understand why, but EMS remains a controversial topic among the Louisiana powers-that-be. Regular people don’t have a problem with the concept of being prepared, but Louisiana politicians have never come to terms with the idea.There were a lot of us in those days working to build a state-wide EMS system. Norman McSwain, M.D., Professor of Surgery at Tulane Medical School in New Orleans and Medical Director for the Louisiana Bureau of Emergency Medical Services, was off and running all over the state of Louisiana, flying in and out of small towns and bayou communities in his little red Alfa Romeo Spyder, grabbing anyone and everyone and preaching the word—train your people to respond to emergencies; heart attacks, shootings and for God’s sake, put a disaster plan in place.

Be prepared - we did

No matter how small or how large your community, be prepared. We have hurricanes here, man. People fall dead of heart attacks. Women drop babies where they shouldn’t. Learn CPR, put in a 911 system, know the basics of how to take care of the sick and injured and for God’s sake, have a disaster plan in place. In a short time, we had installed 911 systems, trained ambulance personnel as EMT’s and developed mutual aid agreements among the parishes that carefully outlined detailed disaster plans. We were rolling right along. By 1982 we were training police and fire personnel as First Responders and had taught more than 30,000 people in our rural parishes how to do CPR and administer the Heimlich maneuver. Nineteen eighty-two was high cotton for me. I was appointed Director of the Bureau of Emergency Medical Services for the State of Louisiana. I moved to Baton Rouge, full of adrenalin, hope and plans for the future. Young and naïve, I had no understanding of politics whatsoever. Norman McSwain and I were going to make Louisiana a showpiece on how to deal with crisis—medical or natural. We took on our mission at break-neck speed, traveling, spreading the gospel of EMS and we were getting things done.

Then it was grant time again. The federal government had changed its procedure for doling out funds. In the past, grant money was dispersed to the individual EMS Councils. Now, federal EMS funding would be given in a lump sum to individual state offices in the form of block grants. The state EMS lead agencies would then distribute the funds to the individual entities responsible for developing local EMS systems.

Initially I saw no problem with the change in the procedure. Instead of the federal government evaluating local needs, the state office would serve as the fairy god mother. Indeed, the feds gave us a big hunk of money and I was like a Mom whose kids got too much Halloween candy. I couldn’t wait to give it all away. My staff and I, with some outside consultants, reviewed our regional grant applications and allocated all of that federal money to the regional EMS Councils—on paper that is. I was ecstatic.

I sent my recommendations to my boss, Jack Edwards, a Huey P. Long wanabee, even down to his white spats. He personally delivered my packet to his boss, Dr. Jonathan Roberts, on loan to EMS from the Carville, Louisiana leprosy colony. Together Edwards and Roberts paid me a private visit, instructing my secretary to hold my calls.

“Well,” said Roberts, looking out of my office window. Edwards was staring down at his white spats and pumping his right leg as he always did when dispensing bad news, “I think you are going to have to change your plans. I think this money can be better used elsewhere.” “But it’s EMS money,” I responded. I think it came out as a question, an incredulous question. “It’s a block grant for God’s sake.”

Roberts was now studying Edwards’ white spats. “The feds won’t even know.” “But, what about EMS?” I asked. “The regional EMS Councils need that money. They are counting on that money. The parishes are behind them. They need EMS systems.” I now, unfortunately, quite clearly saw the loophole that the block grant process provided. “Honey, don’t worry your pretty little head about it. You can come up with some reason why their funding got pulled.”

Roberts rolled his eyes and nudged Edwards. They got up abruptly and left. I was mad. Hopping mad. I called Dr. McSwain and in a burst of hysteria I related to him what had just happened. He didn’t say much. He didn’t have to. I could visualize his normally happy guise, now scowled and red with anger. “Don’t worry,” he said, “we’ll get those crazy bureaucrats. They can’t get away with robbing these poor people.” We vowed to fight and fight we did. We called every politician and person-of-means and power that we knew. It took about three hours for Roberts and Edwards to find out. I was hand-delivered a notice of termination. They sent Dr. McSwain his pink slip in the mail, I think, firing him as Medical Director.

I cleaned out my desk. I couldn’t clean out my confused, disillusioned head. Dr. McSwain hired me to work for Tulane Medical School on a trauma research project and I began working in New Orleans. The State Bureau of EMS died; the regional EMS Councils became defunct. In short order, everyone forgot about that golden hour and they forgot about the disaster plans.

Not Dr. Norman McSwain. He became Police Surgeon for the City of New Orleans, Chief of Trauma at Charity Hospital and stayed on as Professor of Surgery at Tulane. I later was told that our EMS money had been given away to an undisclosed New Orleans politico for rodent control and to the Shreveport Poison Control Center, which already had more millions that it could spend. I moved to Texas.

Not just pointing fingers...

I’m not suggesting that blame should be pointed just at the politicians in Louisiana. Had EMS funding not been relegated to block grant distribution by the feds, state politicians could not have diverted the federal money to their own pork projects. But despite 9/11, George Bush has done everything within his power to suppress coordinated disaster management. In many ways I carry an overwhelming guilt. If I hadn’t been so politically naïve, maybe I could have negotiated a way to keep my job and preserve some of our EMS money. I’ll never know. I do know that Norman McSwain, M.D. and others on his bandwagon have done everything they could to keep disaster management in place and they will continue to do so.

This dedicated cadre is trying to rebuild the Big Easy. But there is little help, despite what you read in the press. Louisiana government officials made a conscious decision years ago not to earmark funds for emergency medical services and disaster planning.Today, June 1, 2007 marks the beginning of hurricane season. Is the Gulf Coast ready for another assault? One can always hope for the best, but should another Katrina hit, it is doubtful that the outcome would be much different than it was two years ago.So to my Louisiana family, laissez le bon rouleau de temps, mes amis, and may the horrors of Katrina serve as a harsh example of what happens when we don’t pay attention to the performance of our elected officials. After all, according to Dr. Phil, “past behavior is the best predictor of future behavior.”