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Thursday, September 15, 2005 - Page updated at 12:00 AM

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Nursing home became death trap

Los Angeles Times

ST. BERNARD PARISH, La. — There were flower boxes on the railings and patios for patients to enjoy 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 hit, Gallodoro, a parish firefighter, was back at the brick building — 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 spotting a body. In water 4 feet deep he worked 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 farther," 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 — 34 elderly and disabled patients abandoned in floodwaters that rose nearly to their ceilings.

In a city where hundreds of people have lost their lives, and thousands have lost their homes, the tragedy at St. Rita's seems particularly incomprehensible and acute. Few locations in the New Orleans region have accounted for more deaths. And while officials who 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, Sal and Mable Mangano, evacuate the facility before the storm arrived? 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 Manganos have been released on $50,000 bond each; each of the 34 counts carries up to five years in prison.

"We've got 34 people drowned in a nursing home that should have been evacuated," said Charles Foti, the state attorney general. "They were asked if they wanted to be evacuated. They refused. They had a contract to move. They did not." Their actions, he said, "resulted in the deaths of their patients."

The Manganos' attorney, Jim Cobb, told The Associated Press that his clients were innocent and had waited for a mandatory evacuation order from St. Bernard Parish officials that never came.

Cobb said the Manganos were forced to make a difficult decision as Katrina approached: risk the health of patients — many frail and on feeding tubes — in an evacuation, or keep them comfortable at the home through the storm.

"When all the facts are out, any fair-minded person will conclude they are caring nursing-home operators," said Robert Habans, another defense lawyer.

St. Rita's sits on a rural stretch of highway several miles beyond the most populated part of the parish. Local residents said its grounds always were well-maintained — the grass mowed, shrubs pruned, and walkways swept.

The home had occasional troubles. One employee, a 19-year-old nursing assistant, was arrested this year on felony warrants and accused of striking a mute, mentally disabled resident as many as 18 times with a clothes hanger.

Overall, though, St. Rita's reputation was good, and government records show that it was among the better-run 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," compared to 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 each year. Larry Ingargiola, the direct of the St. Bernard Parish office of emergency preparedness, said that he personally had 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.

And because nursing homes bear the costs of transporting and providing for patients, evacuations are a financial blow to small, family-run businesses such as St. Rita's.

As a result, officials said many nursing homes and other medical facilities often are reluctant to relocate 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 Katrina would land with substantial force.

"You have to be one dumb [expletive] to have been watching TV and not to know that storm was coming up our asses," 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."

Los Angeles Times reporters James Rainey and Ashley Powers and researcher Nona Yates contributed to this report; details on the Manganos' release were reported by The Associated Press.

Copyright © 2005 The Seattle Times Company

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