As Hurricane Rita barreled down on the Texas Gulf Coast, threatening the low-lying region with massive flooding and winds of more than 100 mph, nursing home operators faced a life-or-death decision: to evacuate their frail and elderly charges -- or not.
For Brighton Gardens in Bellaire, the choice was simple. They chartered two buses, loaded 53 patients and the necessary staff on board Thursday afternoon and sent them up Interstate 45 to safety in Dallas, a 230-mile trip that would take 24 hours.
Sixteen hours into the journey, the biggest bus burst into flames, then exploded in a fireball fueled by the oxygen tanks the patients carried to help them breathe. The blast lighted the sky along the slow-moving freeway and kept rescuers at bay. At least 24 of the 45 passengers died in the Friday morning accident.
The tragedy renewed a debate that began last month in the aftermath of Hurricane Katrina over what to do with the weak, the elderly and the disabled when disaster strikes. During Katrina, 51 elderly patients died after they were left behind in six New Orleans nursing homes, prompting investigations and criminal charges. At least 90 elderly patients died in that city’s hospitals.
Even with the best intentions, those who care for the frail and elderly face a dilemma, and every resolution is fraught with risk. Because they can be so fragile, the elderly fare the worst in a disaster. In particular, they are often unable to tolerate high temperatures, and traveling under such conditions increases the risk of injury -- or death.
“Sometimes you have to accept that, because staying is certain death,” said Dr. Robert Sullivan, an emeritus senior fellow at the Duke University Center for the Study of Aging and Human Development. “New Orleans proved that.”
There was no way to anticipate the bus fire outside of Dallas on Friday, which shut down the main northerly evacuation route out of Houston for four hours. The incident caused a 200-mile traffic jam that only dissipated after safety officials took the unprecedented step of moving the bus five miles away with the bodies still inside.
At 6:07 a.m., the Dallas County Sheriff’s Department began receiving 911 calls from cars on the interstate in the city of Wilmer reporting that a bus was on fire and that the fire appeared to be coming from one of the wheel wells, said Sgt. Don Peritz, a sheriff’s spokesman.
The first responders arrived two minutes later, Peritz said: sheriff’s deputies and Wilmer police, but not firefighters. The bus was engulfed in flames. Passengers were lying on the shoulder of the roadway.
The deputies tried to get into the bus to see if they could rescue anyone else, Peritz said, but “they were driven back by the intense flames and very thick smoke and several explosions on board the bus.... Those were oxygen canisters on board the bus.”
Harry Wilson, 78, was among the first evacuated to the roadway because he was among the last to be loaded onto the charter bus. A stroke had paralyzed his left side, said his daughter-in-law Linda Wilson, and five men had to carry him off the bus.
“They got him off and put him on the side of the road,” said Wilson, from her home in Tampa, Fla. He ended up “on a pile of fire ants. He got bitten up. He had burns on his hands from the fire on the bus.”
But he was alive, and more than half the other passengers were not so fortunate. Watching the rescue attempts, Harry Wilson borrowed someone’s cellphone and called his wife to tell her what had happened.
“If the situation had been different, and he had been able to walk, he would have been grabbing and pulling people off himself,” his daughter-in-law said.
Linda Wilson said she and her husband, Jeffrey, have raced to safety ahead of hurricanes before, and that she would rather that her father-in-law be “moved knowing that a Category 5 hurricane was headed that way.” The nursing home “did what they thought was the right thing.”
Meghan Lublin, spokeswoman for Sunrise Senior Living, which operates Brighton Gardens and more than 400 nursing homes around the world, said in disasters such as hurricanes, “we follow the weather situation closely and follow the advice of local safety officials.”
If evacuations are necessary, the nursing home charters buses with air-conditioning and bathrooms. The most seriously ill patients are transported by ambulance.
“We never not evacuate someone because we thought it would be too difficult for them,” Lublin said. “We would find a safer way to evacuate them.”
Twenty-one of the 61 nursing homes in the path of Katrina evacuated their residents before the storm, said Joseph Donchess, executive director of Louisiana Nursing Home Assn. Katrina forced emergency relief specialists to rethink their strategies for dealing with vulnerable populations.
Donchess said many nursing-home managers were reluctant to take action because of their experience during Hurricane Ivan last year, when the 80-mile bus trip from New Orleans to Baton Rouge, La., became a 12-hour crawl. The storm damage in New Orleans from Ivan turned out to be minimal.
But, Donchess said, “Patients were dying on the buses.”
After seeing Louisiana’s difficulties, Texas officials made a point of evacuating the most vulnerable -- the elderly, infirm, disabled and those without transportation -- well in advance of Rita.
Tom Costello, a FEMA representative in Houston, said Friday that his agency helped evacuate 3,400 people who were unable to transport themselves. Many were elderly and infirm, he said.
But getting out quickly did not save everyone in Katrina, either. The first nursing home to evacuate had one patient die en route to Baton Rouge and another die at a hospital shortly after arrival.
Donchess said that for the elderly and the infirm, it was nearly impossible to balance the risks of traveling against the dangers of staying when disaster occurs.
“I guess God knows the answer to that,” he said. “I don’t.”
More than 1.5 million Americans are in nursing homes or assisted-living facilities, according to U.S. census figures. Susan Feeney, director of public affairs for the American Health Care Assn. in Washington, said most are about 85 years old. Often they are very sick, Feeney said. Many are immobile, as they recover from strokes or conditions such as broken hips, she said. Others are on ventilators.
“It is a very hard decision. You don’t know whether you are going to do more damage to someone who is very sick when you move them,” Feeney said.
But, she stressed, “The lesson of Katrina is that we can’t leave them there.”
Al Breaux, administrator of Morris Lahasky Nursing Center in Erath, La., used that reasoning as Rita approached. He said Friday that, when air-conditioned buses were not available, he used two school buses to take 55 residents to a high-school gymnasium in Pineville, 110 miles north.
An additional 15 patients -- those who require feeding tubes or oxygen -- made the four-hour trip in ambulances, Breaux said.
“It wasn’t fun, but we saved lives,” said evacuee Rose Broussard, 74. “The windows were down so the air could come in.”
Caregivers rode with the residents to provide food, water and medicine. Four of the ambulance patients, rankled by the journey, were taken to an emergency room, where they were stabilized, Breaux said.
“I don’t think people realize,” he said, “how traumatic it is to move a nursing home.”
Times staff writer Alan Zarembo contributed to this report. Mehren reported from Boston and La Ganga from Houston.