HAVEN TURNED TO HORROR
By Greg Miller and Ellen Barry Times Staff Writers Wed Sep 14, 7:55 AM ET
ST. BERNARD PARISH, La. There were flowerboxes on the railings and patios for patients to sit out in the bayou air. The rooms were clean and bright. Residents seemed well cared for by a staff that organized bingo games, showed movies on a big-screen TV and held Mass every Friday.
Such charms persuaded Steve Gallodoro and his siblings to entrust their increasingly feeble 82-year-old father to the care of St. Rita's Nursing Home in November. Two days after Hurricane Katrina struck, Gallodoro, a parish firefighter, was back at the familiar brick building this time among the first rescue workers to arrive at the flooded nursing home.
Gallodoro, 55, plunged into the water and forced his way through a window after seeing a body. In water 4 feet deep, he tried to make his way down a hallway toward his father's room.
He encountered another body. Then a third. And stopped.
"I was not prepared to go any further," he said. "I knew what I was going to find."
St. Rita's was supposed to be a place where patients could live out their final years in comfort and peace. Instead, it had become a scene of horror elderly and disabled patients abandoned in floodwaters that rose nearly to the ceilings.
In a city where hundreds of people recently lost their lives and thousands lost their homes, the tragedy at St. Rita's seems particularly incomprehensible and acute.
Few locations across the New Orleans region have accounted for more deaths. And although officials who finally recovered the bodies last week said they hoped it would help families find some closure, the reality is that the questions surrounding St. Rita's will haunt relatives and fuel investigations for years:
Why didn't the home's operators, Salvador A. and Mable B. Mangano, evacuate the facility before the storm arrived, as did every other nursing home in the area? When they made a last-ditch effort to move patients as the hurricane hit, why did they take some and not others? How did they decide which patients to take?
On Tuesday, the Louisiana attorney general announced the arrests of the Manganos, who were charged with 34 counts of negligent homicide after surrendering to Medicaid fraud investigators in Baton Rouge. The couple were booked into prison in Baton Rouge and released.
"We've got 34 people drowned in a nursing home that should have been evacuated," said Charles C. Foti Jr., state attorney general. "They were asked if they wanted to be evacuated. They refused. They had a contract to move. They did not." The operators' actions, he said, "resulted in the deaths of their patients."
A lawyer for the couple said in an interview last week that accounts that blamed the owners for the deaths were "grossly in error."
"At the end of the day, what my folks did to try to rescue these folks was nothing short of 100% heroic," said attorney James Cobb. "The idea that the owners abandoned these folks is absolutely not true."
Robert N. Habans Jr., another defense lawyer, said the Manganos were never informed that the evacuation order was mandatory. He said evacuation was complicated by patients needing oxygen and feeding tubes.
"When all the facts are out, any fair-minded person will conclude they are caring nursing home operators," Habans said.
St. Rita's is several miles beyond the most populated part of the parish. It is a tin-roofed brick structure with two wings branching off the main entrance.
Local residents said its grounds were always well-maintained the grass was mowed and the walkways were swept.
The home had occasional troubles. Earlier this year, a 19-year-old nursing assistant was arrested on felony warrants and accused of striking a mute, mentally disabled resident as many as 18 times with a clothes hanger.
But overall, St. Rita's reputation was good, and government records show that it was among the better nursing homes in the region.
A government database on nursing homes showed that inspectors found fewer problems at St. Rita's than at others recording six "deficiencies" at the facility, compared with an average of 10 for other Louisiana nursing homes.
The shortcomings arose in such areas as reviewing the work of nursing aides and maintaining a program to prevent the spread of infection, the database showed. But the deficiencies were all rated 2 on a 4-point scale, meaning they cause "minimal harm or potential for actual harm."
Like every nursing home in this part of Louisiana, St. Rita's was required to submit an updated evacuation plan every year. Larry J. Ingargiola, the director of the St. Bernard Parish office of emergency preparedness, said he approved St. Rita's plan this year, and that it would have worked if the Manganos had followed it.
"Their plan was to be out 72 to 48 hours" before a hurricane was scheduled to hit, he said, adding that the plan required the home to make advance arrangements for ambulance and bus service to transport patients to designated evacuation sites.
But in a part of the country where hurricanes threaten the coast with regularity, and fizzle more often than pummel, complacency can creep in. And for nursing homes, evacuations themselves carry considerable risk.
Officials said at least two patients at nursing homes in Plaquemines Parish, south of St. Bernard, died last year from the stress of being relocated in advance of Hurricane Ivan, which veered off toward the Florida Panhandle, leaving the area largely unscathed.
And because nursing homes bear the costs of transporting and providing for their patients, evacuations are a financial blow to small, family-run businesses like St. Rita's.
As a result, officials said, many nursing homes and other medical facilities are often reluctant to relocate their patients until it becomes clear that a storm is going to be severe. What puzzles and angers some officials about St. Rita's is that it was clear relatively early that Hurricane Katrina would land with substantial force.
"You have to be
to have been watching TV and not to know that storm was coming," said Ingargiola, who raised a common suspicion about the Manganos' motive.
"I've known them all my life. They're nice people," he said. "But when you make a decision over life and money, you've got a problem. They wanted to take a chance, and they took a chance on the wrong storm."
As Katrina approached, officials in St. Bernard said, they made numerous calls or visits to the area's nursing homes, including St. Rita's.
Dr. Bryan Bertucci, the parish coroner, said he had at least three conversations with the Manganos in the days before the storm. At first, he said, they indicated that they were preparing to evacuate St. Rita's. But the next time he called, they indicated they weren't sure, noting that they had five or six "special needs" patients who would be difficult to move.
In Bertucci's final conversation, the Saturday before the storm, he said the Manganos informed him they were staying put.
"I called Mable at 2 p.m., told her we had two buses and two drivers," Bertucci said. "Her response was, 'I have five nurses, a generator; I've spoken to families and they say it's OK.' "
Asked why he didn't force them to go, Bertucci said, "This is the United States of America. Our job is to advise people what to do, but they have to make their own decisions. In this instance, the decision made was poor."
Relatives of patients were checking with St. Rita's as well.
Gallodoro said he went out to the home a few days before the storm and asked the Manganos about their plans. He said they told him that they were preparing to evacuate, and were going to take residents to Baton Rouge, Alexandria or Lafayette.
At the same time, Gallodoro said, the rest of his family was making their own plans to leave, and debated whether to retrieve their father and take him with them.
Tufanio Gallodoro was a New Orleans native, a World War II veteran and a truck driver who was a member of the Teamsters union for 32 years. In retirement, he had kept a close bond with his grown children, who lived within a few miles of one another in St. Bernard Parish.
But strokes left the elder Gallodoro partially paralyzed and affected his speech. When in-home nurses were no longer enough, the family put him in St. Rita's. He stayed in Room 306, and the $3,000 it cost each month was largely covered by Medicaid.
"My sister struggled with the fact that we would be leaving him back," Gallodoro said. But he reminded her what had happened the previous year when she loaded their father and mother in the car and headed toward Memphis ahead of Hurricane Ivan.
Sixteen hours into the trip, the elder Gallodoro was suffering so badly that they had to abort the trip, and wound up spending the night with a stranger they met at a convenience store who offered the family shelter.
"I told my sister they're professional; they're equipped to handle it" at St. Rita's, Gallodoro said. "He's safer with them than he is on the road with you."
St. Bernard Parish lies at the edge of the city of New Orleans, bordered to the south by the Mississippi River, to the west by the Inner Harbor Navigation Canal and to the north by the Intracoastal Waterway. As one levee after another gave way, the parish surrounded by water was submerged.
With staggering swiftness, the water rose above the rooftops of many homes. That night, rescue crews and parish officials who were hunkered down in the government complex had to scramble to the second floor as the first filled up.
In the midst of this crisis, the nursing home named for the saint of desperate causes became one itself.
Water turned the rooms into aquariums.
It engulfed a wind chime hanging from the ceiling in Room 106, shared by Bernice Robino and Lois McCloskey. Across the hall, it surged past the bulletin boards over their beds where Georgette Martin and Helen Perret hung crosses and photos of their grandchildren.
Hospital beds washed across rooms, wheelchairs crashed into one another in the hallway, and the flowers and stuffed animals meant to add a happy touch to residents' rooms became mixed up with IV bags and pill bottles in a swirl of flotsam.
What happened to the patients as the water began flowing in through the doors and windows isn't entirely clear. By some accounts, the Manganos and their nursing staff mounted a valiant effort to save whomever they could.
At a meeting of St. Bernard Parish residents and officials in Baton Rouge this week, Russell Palazzolo, 38, said he was a friend of the Manganos and had been told that they had evacuated dozens of patients to their house, which is on the same property as the nursing home.
"They had 40 people at their house on the second floor," Palazzolo said.
But that left at least 34 people trapped inside St. Rita's. St. Bernard officials said the Manganos and their staff probably focused their belated evacuation effort on the most able-bodied patients, leaving the bedridden and brain-damaged behind.
Bertucci, the parish coroner who later helped recover the corpses, said some were found still in their beds. Others were strewn throughout the facility, in piles along hallways and common rooms. Although their bodies appeared tortured, Bertucci said their deaths were likely relatively peaceful.
"After that first gasp where they breathe in water, they relax, become hypoxic, and they die," he said.
On Tuesday, St. Bernard rescue crews moved out across the parish in boats to search for survivors. Gallodoro said he was heartened when he heard an initial report that the area surrounding St. Rita's had managed to stay dry.
But the end of the next day, he and a councilman set out in a boat to survey the damage, and found St. Rita's half-submerged. Gallodoro said he jumped out and swam to the front doors, trying to smash through the glass with the boat's anchor.
When he couldn't break through, he was towed by the boat to a raised patio, where he saw the first body. Forcing his way through a window, he saw a second, and then a third.
They went by boat to a nearby rescue center, where they discovered some St. Rita survivors had been relocated. Gallodoro said one of the home's nurses looked away when she saw him. He knew, he said, that his father had been left inside.
Leaving the rescue center, he saw Salvador Mangano sitting in a boat he had tied to a sheriff's amphibious vehicle. Gallodoro said he pulled alongside the St. Rita's owner and confronted him. He recounted a tense conversation.
"You've got 35 people floating in your place and you're riding around in a boat," Gallodoro said, using the official estimate at that time. "You didn't want to evacuate them because you might lose two or three, but now you've lost 35."
"There are bodies floating all over the place," he said Mangano replied.
And Gallodoro said he responded: "Those people had a choice to stay or leave. The 35 in your building were your responsibility."
At that point, he said, a sheriff had to intervene as the exchange became heated.
Gallodoro said he was torn over whether to go recover his father's body himself. The fire chief gave him permission, but said there were no body bags, and that there was no place to take his father's corpse.
The chief also warned that he would probably carry that final image of his father for the rest of his life.
Gallodoro said he decided instead to resume rescue work with the rest of his St. Bernard Fire Department colleagues a decision he's been replaying in his mind ever since.
It would be more than 10 days before the corpses in St. Rita's were removed. Officials who emerged from the facility said the bodies were so blackened and bloated that they were unrecognizable.
"I was a good fireman," he said. "I acted as a good fireman should act. But I question how I acted as a son. I only hope my father's up there and understands we were trying to save lives and it was difficult to leave him in the water."