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face transplant

Surgeon hopes new face gives new outlook
Plans advancing for world's first face transplant

Saturday, September 17, 2005; Posted: 10:22 p.m. EDT (02:22 GMT)
Dr. Maria Siemionow used photographs of disfigured patients to bring other doctors into her corner.

CLEVELAND, Ohio (AP) -- Cleveland Clinic In the next few weeks, five men and seven women will secretly visit the Cleveland Clinic to interview for the chance to have a radical operation that's never been tried anywhere before.

They will smile, raise their eyebrows, close their eyes, open their mouths. Dr. Maria Siemionow will study their cheekbones, lips and noses. She will ask what they hope to gain and what they most fear.

Then she will ask, "Are you afraid that you will look like another person?"

Because whomever she chooses will endure the ultimate identity crisis.

Siemionow wants to attempt a face transplant.

This is no extreme TV makeover. It is a medical frontier being explored by a doctor who wants the public to understand what she is trying to do: give people horribly disfigured by burns, accidents or other tragedies a chance at a new life. Today's best treatments still leave many of them with freakish, scar-tissue masks that don't look or move like natural skin.

These people already have lost the sense of identity that is linked to the face; the transplant is merely "taking a skin envelope" and slipping their identity inside, Siemionow contends.

Her supporters note her experience, careful planning, the team of experts assembled to help her, and the practice she has done on animals and dozens of cadavers to perfect the technique.

But her critics say the operation is way too risky for something that is not a matter of life or death, as organ transplants are. They paint the frighteningly surreal image of a worst-case scenario: a transplanted face being rejected and sloughing away, leaving the patient worse off than before.

Such qualms recently scuttled face transplant plans in France and England.

Ultimately it comes to a hospital, doctor and patient willing to try it.

The first two are now in place. The third is expected to be shortly.

Unknown risks, many complications
The "consent form" says that this surgery is so novel and so many of its risks unknown that doctors don't think informed consent is even possible.

Here is what it tells potential patients:

Your face will be removed and replaced with one from a cadaver, matched for tissue type, age, sex and skin color. Surgery should last 8 to 10 hours; the hospital stay, 10 to 14 days.

Complications could include infections that discolor your new face and require a second transplant or reconstruction with skin grafts. Drugs to prevent rejection will be needed lifelong, and they raise the risk of kidney damage and cancer.

After the transplant you might feel remorse, disappointment, or grief or guilt toward the donor. The clinic will try to shield your identity, but the media likely will discover it.

The clinic will cover costs for the first patient; nothing about others has been decided.

Another form tells donor families that the person receiving the face will not resemble their dead loved one. The recipient should look similar to how he or she did before the injury because the new skin goes on existing bone and muscle, which give a face its shape.

All of the little things that make up facial expression -- mannerisms like winking when telling a joke or blushing at a compliment -- are hard-wired into the brain and personality, not embedded in the skin.

Some research suggests the end result would be a combination of the two appearances.

Surgeons will graft skin to cover the donor's wound, but a closed casket or cremation will be required.

It took more than a year to win approval from the 13-member Institutional Review Board, the clinic's gatekeeper of research. Siemionow assembled surgeons, psychiatrists, social workers, therapists, nurses and patient advocates, and worked with LifeBanc, the organ procurement agency she expects will help obtain a face.

At first, not everyone was on her side, acknowledged the board's vice chairman, Dr. Alan Lichtin. After months of debate, Siemionow brought in photographs of potential patients.

Looking at the contorted images, Lichtin said he was struck by "the failure of the present state of the art to help these people." He decided he didn't want to deprive the surgeon or patients of the chance.

The board's decision didn't have to be unanimous. But in the end, it was.

Surgeons wished they could have done a transplant six years ago, when a 2-year-old boy attacked by a pit bull dog was brought to the University of Texas in Dallas where Dr. Karol Gutowski was training.

Other doctors had tried to reattach part of the boy's mauled face but it didn't take. The Texas surgeons did five skin grafts in a bloody, 28-hour surgery. Muscles from the boy's thigh were moved to around his mouth. Part of his abdomen became the lower part of his face. Two forearm sections became lips and mouth.

"He'll never be normal," said Gutowski, now a reconstructive surgeon at the University of Wisconsin-Madison.

Surviving such wounds can be "life by 1,000 cuts." Patients endure dozens of operations to graft skin inch-by-inch from their backs, arms, buttocks and legs. Only small amounts can be taken at a time because of bleeding.

Surgeons often return to the same areas every few weeks, reopening old wounds and building up skin. Years later, many patients are still having surgeries. A face transplant -- applying a sheet of skin in one operation -- could be a better solution.

Despite its shock factor, it involves routine microsurgery. One or two pairs of veins and arteries on either side of the face would be connected from the donor tissue to the recipient. About 20 nerve endings would be stitched together to try to restore sensation and movement. Tiny sutures would anchor the new tissue to the recipient's scalp and neck, and areas around the eyes, nose and mouth.

Picking a patient
Siemionow, 55, went to medical school in Poland, trained in Europe and the United States, and has done thousands of surgeries in nearly 30 years. The success of this one depends on picking the right patient.

She wants a clear-cut first case. No children, because risks are too great. No cancer patients, because anti-rejection drugs raise the risk of recurrence.

"You want to choose patients who are really disfigured, not someone who has a little scar," yet with enough healthy skin for traditional grafts if the transplant fails, she said.

The person must bond with the transplant team, especially Siemionow. How much would she want to know about the person?

"Everything possible. It's a commitment on both sides," she said.

Dr. Joseph Locala will decide whether candidates are mentally fit. His chief concern: making sure they realize the risks.

"They almost need to understand as much as the surgeon," he said.

A psychiatrist who has worked with transplant patients for 11 years, Locala knows they often have been coached on what to say to be chosen. He'd veto candidates who had abused alcohol or drugs, because they may not comply with medications.

Likewise someone who had attempted or seriously threatened suicide, or with little family or friends for support.

"I'm looking for a psychologically strong person. We want people who are going to make it through," he explained.

Dr. James Zins, chairman of plastic surgery, expects to be among the 10 to 12 doctors involved in the transplant and has been screening patients.

"We get some pretty strange calls from people who are really not candidates," he said. For someone to be chosen, "they're going to have to get a pass from every member of the team."

Matthew Teffeteller might seem an ideal candidate.

Hair is driving him crazy. What used to be a beard can't grow through the skin-graft quilt that Vanderbilt University doctors stitched over parts of his face that were seared off in a car crash. Trapped under this crust, hair festers, leading to staph infections, pain and more surgeries.

"It's a nightmare and it never ends," he said. "Being burned is the worst thing that can happen to you. I'm about sure of it."

Teffeteller, 26, lives south of Knoxville,Tennesee in the foothills of Great Smoky Mountains National Park where he worked, ironically, as a fire fighter. The day after Valentine's Day in 2002, he was taking his pregnant wife to buy a cowboy hat and go country line dancing to celebrate their first anniversary.

"The next thing I remember, everything just went all to pieces...there was a big explosion. I remember seeing gas splash off of the windshield," he said.

Rear-ended by a truck, his car flipped and caught on fire. His wife died. He was burned trying to free her.

"They said my face was charcoal black," he said.

He didn't see it for two months, until he glimpsed a mirror on his way to therapy.

"Oh, my God," he thought. "I remember seeing my eyes pulled open. I remember my ears were burned off, and I remember my bottom lip being pulled down."

Ethical concerns
Three years later, his face still frightens children. Yet he wouldn't try a transplant.

"Having somebody else's face ... that wouldn't be right. When I look in the mirror, I might be scarred but I can still tell that it's me," he said.

"I'd be afraid something would go wrong, too. What would you do if you didn't have a face? Could you live?"

Bioethicist Carson Strong at the University of Tennessee wonders, too.

"It would leave the patient with an extensive facial wound with potentially serious physical and psychological consequences," he wrote last summer in the American Journal of Bioethics.

Such worries led the Royal College of Surgeons in England and the French National Ethics Advisory Committee to decide it shouldn't be tried. Any doctor considering it should examine soul and conscience, Strong wrote.

Ironically, people most emotionally devastated by disfigurement are those most likely to seek a transplant and least able to cope with uncertain results, media attention and loss of privacy, ethicists from England wrote in the same journal.

One worried that a donor family might have unhealthy expectations of seeing a loved-one "live on" in another person's body, or that recipients might want to see and approve a potential face.




Candidates Screened for First Face Transplant
By MARILYNN MARCHIONE, AP
Dr. Maria Siemionow, seen here performing micro-surgery at the Cleveland Clinic, wants to attempt the world's first face transplant.

CLEVELAND (Sept. 17) - In the next few weeks, five men and seven women will secretly visit the Cleveland Clinic to interview for the chance to have a radical operation that's never been tried anywhere in the world.
They will smile, raise their eyebrows, close their eyes, open their mouths. Dr. Maria Siemionow will study their cheekbones, lips and noses. She will ask what they hope to gain and what they most fear.
Then she will ask, "Are you afraid that you will look like another person?"
Because whoever she chooses will endure the ultimate identity crisis.
Siemionow wants to attempt a face transplant.
This is no extreme TV makeover. It is a medical frontier being explored by a doctor who wants the public to understand what she is trying to do.
It is this: to give people horribly disfigured by burns, accidents or other tragedies a chance at a new life. Today's best treatments still leave many of them with freakish, scar-tissue masks that don't look or move like natural skin.
These people already have lost the sense of identity that is linked to the face; the transplant is merely "taking a skin envelope" and slipping their identity inside, Siemionow contends.
Her supporters note her experience, careful planning, the team of experts assembled to help her, and the practice she has done on animals and dozens of cadavers to perfect the technique.
But her critics say the operation is way too risky for something that is not a matter of life or death, as organ transplants are. They paint the frighteningly surreal image of a worst-case scenario: a transplanted face being rejected and sloughing away, leaving the patient worse off than before.
Such qualms recently scuttled face transplant plans in France and England.
Ultimately, it comes to this: a hospital, doctor and patient willing to try it.
The first two are now in place. The third is expected to be shortly.
The "consent form" says that this surgery is so novel and its risks so unknown that doctors don't think informed consent is even possible.
Here is what it tells potential patients:
Your face will be removed and replaced with one donated from a cadaver, matched for tissue type, age, sex and skin color. Surgery should last 8 to 10 hours; the hospital stay, 10 to 14 days.
Complications could include infections that turn your new face black and require a second transplant or reconstruction with skin grafts. Drugs to prevent rejection will be needed lifelong, and they raise the risk of kidney damage and cancer.
After the transplant you might feel remorse, disappointment, or grief or guilt toward the donor. The clinic will try to shield your identity, but the press likely will discover it.
The clinic will cover costs for the first patient; nothing about others has been decided.
Another form tells donor families that the person receiving the face will not resemble their dead loved one. The recipient should look similar to how he or she did before the injury because the new skin goes on existing bone and muscle, which give a face its shape.
All of the little things that make up facial expression - mannerisms like winking when telling a joke or blushing at a compliment - are hard-wired into the brain and personality, not embedded in the skin.
Some research suggests the end result would be a combination of the two appearances.
Surgeons will graft skin to cover the donor's wound, but a closed casket or cremation will be required.
It took more than a year to win approval from the 13-member Institutional Review Board, the clinic's gatekeeper of research. Siemionow assembled surgeons, psychiatrists, social workers, therapists, nurses and patient advocates, and worked with LifeBanc, the organ procurement agency she expects will help obtain a face.
At first, not everyone was on her side, acknowledged the board's vice chairman, Dr. Alan Lichtin. After months of debate, Siemionow brought in photographs of potential patients.
Looking at the contorted images, Lichtin said he was struck by "the failure of the present state of the art to help these people." He decided he didn't want to deprive the surgeon or patients of the chance.
The board's decision didn't have to be unanimous.
In the end, it was.
Surgeons wished they could have done a transplant six years ago, when a 2-year-old boy attacked by a pit bull dog was brought to the University of Texas in Dallas where Dr. Karol Gutowski was training.
Other doctors had tried to reattach part of the boy's mauled face but it didn't take. The Texas surgeons did five skin grafts in a bloody, 28-hour surgery. Muscles from the boy's thigh were moved to around his mouth. Part of his abdomen became the lower part of his face. Two forearm sections became lips and mouth.
"He'll never be normal," said Gutowski, now a reconstructive surgeon at the University of Wisconsin-Madison.
Surviving such wounds can be "life by 1,000 cuts." Patients endure dozens of operations to graft skin inch by inch from their backs, arms, buttocks and legs. Only small amounts can be taken at a time because of bleeding.
Surgeons often return to the same areas every few weeks, reopening old wounds and building up skin. Years later, many patients are still having surgeries. A face transplant - applying a sheet of skin in one operation - could be a better solution.
Despite its shock factor, it involves routine microsurgery. One or two pairs of veins and arteries on either side of the face would be connected from the donor tissue to the recipient. About 20 nerve endings would be stitched together to try to restore sensation and movement. Tiny sutures would anchor the new tissue to the recipient's scalp and neck, and areas around the eyes, nose and mouth.
"For 10 years now, it could have been done," said Dr. John Barker, director of plastic surgery research at the University of Louisville, where the first hand transplant in the United States was performed in 1999.
Several years ago, these doctors announced their intent to do face transplants, but no hospital has yet agreed. They also are working with doctors in the Netherlands; nothing is imminent.
However, Siemionow had been doing experimental groundwork. She already had creatures that resembled raccoons in reverse - white rats with masks of dark fur - from years of face transplant experiments. She developed a plan and got clinic approval before going public, and insists she is not competing to do the first case.
"I hope nobody will be frivolous or do things just for fame. We are almost over-cautious," she said.
Siemionow, 55, went to medical school in Poland, trained in Europe and the United States, and has done thousands of surgeries in nearly 30 years. The success of this one depends on picking the right patient.
She wants a clear-cut first case. No children because risks are too great. No cancer patients because anti-rejection drugs raise the risk of recurrence.
"You want to choose patients who are really disfigured, not someone who has a little scar," yet with enough healthy skin for traditional grafts if the transplant fails, she said.
The person must bond with the transplant team, especially Siemionow. How much would she want to know about the person?
"Everything possible. It's a commitment on both sides," she said.
Dr. Joseph Locala will decide whether candidates are mentally fit. His chief concern: making sure they realize the risks.
"They almost need to understand as much as the surgeon," he said.
A psychiatrist who has worked with transplant patients for 11 years, Locala knows they often have been coached on what to say to be chosen. He'd veto candidates who had abused alcohol or drugs, because they may not comply with medications.
Likewise someone who had attempted or seriously threatened suicide, or with little family or friends for support.
"I'm looking for a psychologically strong person. We want people who are going to make it through," he explained.
Dr. James Zins, chairman of plastic surgery, expects to be among the 10 to 12 doctors involved in the transplant and has been screening patients.
"We get some pretty strange calls from people who are really not candidates," he said. For someone to be chosen, "they're going to have to get a pass from every member of the team."
Matthew Teffeteller might seem an ideal candidate.
Hair is driving him crazy. What used to be a beard can't grow through the skin-graft quilt that Vanderbilt University doctors stitched over parts of his face that were seared off in a car crash. Trapped under this crust, hair festers, leading to staph infections, pain and more surgeries.
"It's a nightmare and it never ends," he said. "Being burned is the worst thing that can happen to you. I'm about sure of it."
Teffeteller, 26, lives south of Knoxville, in the foothills of Great Smoky Mountains National Park where he worked, ironically, as a fire fighter. The day after Valentine's Day in 2002, he was taking his pregnant wife to buy a cowboy hat and go country line dancing to celebrate their first anniversary.
"The next thing I remember, everything just went all to pieces...there was a big explosion. I remember seeing gas splash off of the windshield," he said.
Rear-ended by a truck, his car flipped and caught on fire. His wife died. He was burned trying to free her.
"They said my face was charcoal black," he said.
He didn't see it for two months, until he glimpsed a mirror on his way to therapy.
"Oh, my God," he thought. "I remember seeing my eyes pulled open. I remember my ears were burned off, and I remember my bottom lip being pulled down."
Three years later, his face still frightens children. Yet he wouldn't try a transplant.
"Having somebody else's face ... that wouldn't be right. When I look in the mirror, I might be scarred but I can still tell that it's me," he said.
"I'd be afraid something would go wrong, too. What would you do if you didn't have a face? Could you live?"
Bioethicist Carson Strong at the University of Tennessee wonders, too.
"It would leave the patient with an extensive facial wound with potentially serious physical and psychological consequences," he wrote last summer in the American Journal of Bioethics.
Such worries led the Royal College of Surgeons in England and the French National Ethics Advisory Committee to decide it shouldn't be tried. Any doctor considering it should examine soul and conscience, Strong wrote.
Ironically, people most emotionally devastated by disfigurement are those most likely to seek a transplant and least able to cope with uncertain results, media attention and loss of privacy, ethicists from England wrote in the same journal.
One worried that a donor family might have unhealthy expectations of seeing a loved-one "live on" in another person's body, or that recipients might want to see and approve a potential face.
No way, said Siemionow.
"It's not a shopping mall. They need to rely on our judgment. If they are starting to shop, they are not good candidates," she said.
Siemionow said critics should admit that risks and need for the transplant are debatable.
"Really, who has the right to decide about the patient's quality of life?" she asked. "It's very important not to kind of scare society.... We will do our best to help the patient."
If all of the candidates back out, "that's OK. It means that we are not ready yet," she said.
But if a transplant succeeds, many people who live in misery could benefit, said Gutowski, the Wisconsin surgeon.
"Someone's got to push the envelope," he said. "In retrospect, we'll know whether it should be done."
09-17-05 17:00 EDT

Music Map

www.music-map.com. I'll be using this site to help me buy gifts. You know how the kids will say they want so-and-so's new cd and you have no idea who they are talking about? Or just the opposite, you mom or aunt or someone wants to get that oldie on cd but you haven't a clue who the artist is. Well, this will help you find other artists that they might like too. I cannot vouche for the accuracy but play around and see what you get. If you look up Tara MacLean there are only 3 results! It's kinda fun if you want to kill a little time. Give it a try! Start with Sarah McLachlan!

WHITE HOUSE RESPONSE

The White House press secretary is asked:

What's George W. Bush's position
on Roe vs. Wade?

He replies:

The President really doesn't care how people get themselves
out of New Orleans.



Like I said before... what an incredible asshole!

45 Bodies Are Found in a New Orleans Hospital- 3 stories

September 13, 2005
45 Bodies Are Found in a New Orleans Hospital
By KIRK JOHNSON
Correction Appended
NEW ORLEANS, Sept. 12 - The bodies of 45 people have been found in a flooded uptown hospital here, officials said Monday, sharply increasing the death toll from Hurricane Katrina and raising new questions about the breakdown of the evacuation system as the disaster unfolded.
Officials at the hospital, the Memorial Medical Center, said at least some of the victims died while waiting to be removed in the four days after the hurricane struck, with the electricity out and temperatures exceeding 100 degrees.
Steven L. Campanini, a spokesman for the hospital's owner, Tenet Healthcare, said the dead included patients who died awaiting evacuation as well as people who died before the hurricane struck and whose bodies were in the hospital morgue.
Mr. Campanini said the dead might have also included evacuees from other hospitals and the surrounding neighborhood who gathered at Memorial while waiting to evacuate the city.
Repercussions from the storm continued to echo in Washington, where the director of the Federal Emergency Management Agency, Michael D. Brown, a walking symbol to many people here of government failure in the crisis, resigned. Mr. Brown was relieved of his role in the day-to-day disaster operations here on Friday. (Related Article)
President Bush, meanwhile, toured the ghostly streets of the city standing in the back of an open-air truck flanked by the mayor of New Orleans and the governor of Louisiana, who have been sharply critical of the federal performance.
In Baton Rouge, 1,000 people from the devastated St. Bernard Parish, just east of New Orleans, crowded the State Capitol and were told that memories of their community might be all they have left.
Flights were set to resume at the Louis Armstrong New Orleans International Airport, and city officials said they were creating a new command center downtown at a closed hotel.
Mr. Bush's appearance with Mayor C. Ray Nagin of New Orleans and Gov. Kathleen Babineaux Blanco, both Democrats, suggested that at least some of the bitterness over the response to the disaster had lifted.
On Mr. Bush's most recent visit to the stricken area, on Sept. 5, Ms. Blanco learned that he was making the trip from news reports.
The president, in a brief question and answer session with reporters after his tour on Monday, said that government coordination in rebuilding the city and the region was paramount and that local vision should determine the direction of the reconstruction. "It's very important for the folks in New Orleans to understand that, at least as far as I'm concerned, this great city has got ample talent and ample genius to set the strategy and set the vision," Mr. Bush said after his 40-minute tour. "Our role at the federal government is, you know, obviously within the law, to help them realize that vision. And that's what I wanted to assure the mayor."
Mr. Bush also returned to accusations that racial discrimination was involved in government's response to the hurricane, saying "the storm didn't discriminate" and neither did the rescuers.
Mr. Nagin and Ms. Blanco have said federal delays in sending aid had compounded the damage of the storm and heightened the anarchy in the days after the storm, when tens of thousands of people were trapped for days at sites like the Convention Center and the Superdome without food or water.
Mr. Nagin said in a radio interview Monday, when asked about his meeting with the president, "If anything, he told me he kind of appreciated my frankness and my bluntness."
The news that 45 bodies had been found at Memorial was also a reminder of how much else, in the physical structure and in the human toll, might yet remain unknown.
On Monday, the authorities elevated the statewide death toll from Hurricane Katrina to 279; of those, 242 were from the New Orleans metropolitan region. In Mississippi, Gov. Haley Barbour said the toll there was 218.
In Baton Rouge, there were more reminders of the thousands of people who may have no community to return to at all.
More than 1,000 displaced residents from St. Bernard Parish crowded the State Capitol to learn about the state of their devastated houses. No one has been permitted to re-enter the area to retrieve belongings or examine their houses. News of the meeting traveled by word of mouth and Web sites, and people lined up for blocks outside the Art Deco Capitol, where Gov. Huey P. Long was assassinated in 1935. Some drove from Houston.
Local officials did not try to hide the bad news.
"You will not recognize St. Bernard Parish," the parish president, Henry J. Rodriguez Jr., told hundreds of residents in the marble foyer of the Capitol. "All you will have left of St. Bernard Parish is your memories."
Mr. Bush also saw the devastation first-hand on his tour of New Orleans. His tour passed by smashed cars, tree branches and rubble.
For most of the ride, Ms. Blanco, Mr. Bush and Mr. Nagin stood in a military truck and had to duck under low wires and branches. At one point, Vice Adm. Thad W. Allen of the Coast Guard, who succeeded Mr. Brown last week as head of hurricane relief, removed his Coast Guard cap to shield Mr. Bush from a wire.
City officials said they had moved most of the makeshift emergency operations command center that they had set up at City Hall since the storm arrived across the street to a battered Hyatt hotel, where power has been restored and Mayor Nagin keeps a suite.
In Ballroom E on the third floor of the hotel, 100 computer stations were set up at pods of circular tables to handle 24-hour work by groups like the New Orleans police, 82nd Airborne Division of the Army, the Coast Guard, National Guard and public health officials.
Edward Minyard, a contractor with Unisys who is in charge of setting up the center, said the operation was very likely to grow to as many as 500 positions, meaning as many as 1,500 people working in shifts around the clock.
In Harrison County, Miss., in the Gulfport-Biloxi region, a list of 600 missing persons was distributed by the coroner's office, though authorities emphasized that the people on the list were not necessarily missing. The names are of people who have been sought by family members.
"We have rescued everybody that we think could possibly be rescued," said Joe Spraggins, the head of emergency management for the county.
Gulfport-Biloxi International Airport, which began running commercial flights at the end of last week, expects to return to its regular flight schedule in two weeks, Colonel Spraggins said.
Delta, Northwest and AirTran Airlines plan to begin operating limited schedules on Tuesday, he said. Northwest said it would resume scheduled commercial service to the New Orleans airport on Tuesday, with its first inbound flight in 10 days scheduled to arrive from Memphis at 10:44 a.m. Repairs began on Monday on the Twin Span Bridge on Interstate 10, connecting New Orleans and Slidell. Within 45 days, the eastbound span is to be repaired, providing one lane of traffic in each direction.
Reporting for this article was contributed bySewell Chan in Baton Rouge, La.; Michael Luo and William Yardley in New Orleans; and Campbell Robertson in Gulfport, Miss.Correction:Sept. 14, 2005, Wednesday:A front-page article yesterday about hurricane recovery efforts misstated the day Northwest Airlines was scheduled to resume commercial service to the New Orleans airport. It was yesterday, not today.


--------------------------------------------------------------------------------
45 bodies found inside New Orleans hospital
President tours devastated city with mayor, governor
- Kirk Johnson, New York Times
Tuesday, September 13, 2005



New Orleans -- The bodies of 45 people have been found in a flooded uptown hospital here, officials said Monday, sharply increasing the death toll from Hurricane Katrina and raising new questions about the breakdown of the evacuation system as the disaster unfolded.

Hospital officials said that at least some of the victims had died while waiting to be evacuated in the four days after the hurricane struck, with the electricity out and temperatures rising to over 100.

Steven L. Campanini, a spokesman for the hospital's owner, Tenet Healthcare, said the dead included not only patients who died while awaiting evacuation, but also people who died before the hurricane struck. The dead may also have included evacuees from other hospitals and from the surrounding neighborhood who gathered at Memorial Medical Center for shelter or safety to wait evacuation from the city.

The announcement, which raises Louisiana's official death toll to nearly 280, came as President Bush got his first up-close look at the destruction. On Monday, the president toured the city's ghostly streets standing in the back of an open-air truck flanked by the mayor of New Orleans and the governor of Louisiana, who have both been sharply critical of the federal government's performance.

In Baton Rouge, about 1,000 people from devastated St. Bernard Parish just outside New Orleans crowded the state Capitol and were told that memories of their community might be all they have left. Flights were set to resume at the Louis Armstrong Airport, and city officials said they were creating a new command center downtown at a closed hotel.

Bush's appearance with New Orleans Mayor Ray Nagin and Louisiana Gov. Kathleen Babineaux Blanco, both Democrats, suggested that at least some of the acrimony over the response to the disaster had lifted. On Bush's last visit to the stricken area Sept. 5, the governor learned the president was coming only from news reports.

The president, in a brief question-and-answer session with reporters after the tour, said that government coordination in rebuilding the city and the region was paramount and that local vision should determine the direction of the reconstruction.

"It's very important for the folks in New Orleans to understand that, at least as far as I'm concerned, this great city has got ample talent and ample genius to set the strategy and set the vision," Bush said after his 40-minute tour with the governor and mayor. "Our role at the federal government is, you know, obviously within the law, to help them realize that vision. And that's what I wanted to assure the mayor."

But the discovery of the bodies on Sunday night at Memorial, a 317-bed hospital in the city's uptown section, overshadowed the upbeat talk about the future.

Armed National Guard troops guarded the entrance to the hospital and would not allow anyone inside. The entire bank of windows of the hospital's emergency room was shattered, lying near the stretchers and chairs inside. Pieces of plywood covered broken windows as high as the hospital's top floor, eight stories above. Cars in the parking lot were caked with grime from the floodwaters. The area surrounding the hospital, however, was dry.

Nagin and Blanco have said that federal government delays in bringing aid to the stricken city and the region had compounded the storm's damage and heightened the anarchy in New Orleans in the days after the storm, when tens of thousands of people were trapped for days in places like the Convention Center and the Superdome without food or water.

The news that 45 bodies had been found at the hospital was a reminder of how much else, in both the city's physical structure and the hurricane's human toll, might yet remain unknown.

Campanini, the hospital spokesman, said Tenet Healthcare did not yet know how many of the 45 deceased were patients and how many had gathered there for shelter or safety. The hospital had begun stocking food and supplies and transferring patients to other hospitals before the hurricane hit, he said. But it still had 115 patients by Tuesday, when the levees broke and water began flooding the city.

With private helicopters and help from the Coast Guard and the New Orleans Fire Department, the hospital evacuated 2,000 people, including the majority of patients, he said. Campanini stopped short of blaming the authorities, but he said the need for evacuation was well known. "There were reports across the entire New Orleans and Biloxi area that there were frail and elderly patients who were not surviving," he said.

Robert Johannessen, a spokesman for the Louisiana Department of Health and Hospitals, said Monday that it had confirmed that 45 bodies were found inside Memorial hospital, but he said he could not confirm Campanini's account of how they had died. He said the circumstances of the deaths were still under investigation.

The Associated Press contributed to this report.

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URL: http://sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/09/13/MNG3HEMQHM1.DTL

45 Bodies Recovered From Flood-Stricken New Orleans Hospital As City Slowly Climbs Back to Life
By BRETT MARTEL
The Associated Press
Sep. 12, 2005 - The bodies of 45 patients have been found at a flooded-out hospital, a state health official said Monday amid otherwise encouraging signs large and small that New Orleans is climbing back two weeks after it was slammed by Hurricane Katrina.

The bodies were found Sunday at 317-bed Memorial Medical Center, which was abandoned more than a week ago after it was surrounded by floodwaters, said Bob Johannesen, a spokesman for the Department of Health and Hospitals.

The Louisiana death toll rose to 279, up from 197 on Sunday, Johannesen said.

Meanwhile, more than half of southeastern Louisiana's water treatment plants were up and running again Monday, and business owners were issued passes into the city to retrieve vital records or equipment as New Orleans continued to stir back to life.

Also, President Bush got his first up-close look at the destruction in New Orleans on Monday, taking a tour that took him through several flooded neighborhoods. Occasionally, he had to duck to avoid low-hanging electrical wires and branches.

In Washington, Federal Emergency Management Agency director Mike Brown announced he is resigning "in the best interest of the agency and best interest of the president." Brown has been vilified for the government's sluggish response to the tragedy. Last week, he was stripped of responsibility for overseeing the cleanup and was abruptly recalled to Washington.

As for the discovery of the bodies at the hospital, Johannesen said he had no further information, and Police Chief Eddie Compass declined to answer any questions, including whether police received any calls for assistance from those inside Memorial Medical Center after the hospital was evacuated.

"I can't say nothing," Compass said, referring questions to a spokeswoman for Mayor C. Ray Nagin who did not immediately return a message seeking comment.

Dr. Jeffrey Kochan, a Philadelphia radiologist volunteering in New Orleans, said he spoke Sunday night with members of the team that recovered the bodies. He said they told him they found 36 corpses floating on the first floor.

"That's what they were talking about last night," Kochan said. "These guys were just venting. They need to talk. They're seeing things no human being should have to see."

To prevent looting, business owners wanting to enter the city's central business district and take what they needed to run their companies were required by police to obtain passes.

Traffic was heavy on the only major highway into the city that was still open, and vehicles were backed up for about two miles at a National Guard checkpoint across the Mississippi River from New Orleans.

Among the businessmen allowed back was Terry Cockerham, owner of Service Glass, which installs windows at businesses downtown. He has been working out of his house because his business was destroyed by looters and flooding.

"This is about the most work I've ever had," he said. "We'll work seven days a week until we get this job finished. I don't want to get rich. I just want to get everything back right."

There were also signs of life at businesses elsewhere in the city.

In the French Quarter, Nick Ditta was at Mango Mango, the bar he manages on Bourbon Street, searching for time cards. "It's a mess man. There is no doubt about it," Ditta said. "But our people are going to get paid. That's all I'm worried about."

During his visit to New Orleans, the president denied there was any racial component to the way the government responded to the disaster, disputing assertions that Washington was sluggish because so many of the victims were poor and black.

"The storm didn't discriminate and neither will the recovery effort," Bush said. He also rejected suggestions that the nation's military was stretched too thinly with the war in Iraq to deal with the Gulf Coast devastation.

Though 50 percent of New Orleans remained flooded down from 80 percent during the darkest days and teams continued to collect hundreds, perhaps thousands, of corpses, there were clear signs of recovery: Over the weekend, trash collection resumed, and the Louis Armstrong New Orleans International Airport reopened for cargo traffic. It planned to open to limited passenger service starting Tuesday.

A plane carrying equipment to rebuild New Orleans' mobile phone networks took off from Sweden on Monday after waiting more than a week for a go-ahead from the United States. The shipment included network equipment donated by the Swedish cell phone giant LM Ericsson.

"Each day there's a little bit of an improvement," Coast Guard Vice Adm. Thad W. Allen, commander of the New Orleans relief efforts, told NBC on Sunday night. "And in the end run, maybe a week, two weeks from now, someone's going to wake in the morning and have something they didn't have the day before, and that's hope."

State officials said Monday that 16 of southeast Louisiana's 25 major wastewater treatment plants were up and running again.

In the effort to drain the flooded area, 41 of 174 permanent pumps were in operation, and officials expected an increase in temporary pumps within 24 hours.

As of late Sunday, water in many parts of the metropolitan area was going down at least a foot a day, the Army Corps of Engineers said. Once the streets are dry, crews can begin removing debris, checking buildings and other structures for soundness, and restoring utilities.

Military cargo airplanes were set to begin spraying the area on Monday to kill flies and mosquitoes. The standing water from Katrina is expected to worsen Louisiana's already considerable mosquito problem. Before the storm hit, the state had logged 78 cases of mosquito-borne West Nile virus and four deaths from the disease this year.

Insurance experts doubled to at least $40 billion their estimate of insured losses caused by Katrina a figure that would make it the world's costliest hurricane ever. Risk Management Solutions Inc. of Newark, Calif., put the total economic damage at more than $125 billion.

In the French Quarter, burnt-orange rubble from terra-cotta roof tiles sat in neat piles for collection along the curb. Bourbon Street was cleaner than it ever is during Mardi Gras. And Donald Jones, a 57-year-old lifelong resident, said he was no longer armed when walking his street.

"The first five days I never went out of my house without my gun. Now I don't carry it," Jones said over the weekend. "The only people I meet is military."

Army Lt. Gen. Russel L. Honore, commander of active-duty troops engaged in hurricane relief, reiterated Sunday the number of dead would be "a heck of a lot lower" than initial projections of perhaps 10,000.


Associated Press writers Erin McClam, Mary Foster, Colleen Long, Warren Levinson and Howie Rumberg contributed to this report.

Bush Accepts Blame for Katrina Response

* Bush: 'I take responsibility' for federal failures after Katrina
Bush to address nation Thursday about Katrina

Tuesday, September 13, 2005; Posted: 3:14 p.m. EDT (19:14 GMT) WASHINGTON (CNN) -- President Bush said Tuesday he takes responsibility for the federal government's failures in responding to Hurricane Katrina.
"Katrina exposed serious problems in our response capability at all levels of government and to the extent the federal government didn't fully do its job right, I take responsibility," Bush said during a joint news conference with Iraqi President Jalal Talabani. (Watch Bush's comments -- 0:47)
Bush was responding to a reporter's question about whether Americans should be concerned that the government is not prepared to respond to another disaster or terrorist attack after it took several days for aid and troops to arrive in New Orleans and other areas devastated by Hurricane Katrina.
He repeated his desire to find out exactly what went wrong on every level of government.
"It's in our national interest that we find out exactly what went on ... so we can better respond," Bush said.
A bipartisan joint congressional committee is to review the response at all levels of government to the hurricane and report its findings to Congress no later than February 15.
Bush praised the first responders and the U.S. Coast Guard, who risked their lives to rescue New Orleans residents stranded on their rooftops.
"I'm not going to defend the process going in, but I will defend the people on the front line of saving lives," Bush said.
Earlier in the day, the White House said the president will address the nation Thursday night about the Hurricane Katrina disaster.
The 9 p.m. ET address is the latest administration reaction to Katrina, which roared ashore on August 29.
"The president will talk to the American people about the recovery and the way forward on the longer-term rebuilding," White House spokesman Scott McClellan told reporters, according to Reuters.
Bush is expected to make his address from storm-wracked Louisiana, where the president toured damaged New Orleans neighborhoods on Monday.
On Monday, Federal Emergency Management Agency Director Mike Brown resigned, after questions were raised about his qualifications and for what critics call a bungled response to Katrina's destruction. (Full story)
Bush chose David Paulison, director of FEMA's preparedness division, as interim director.
Paulison said Tuesday he planned to focus on getting people out of shelters "and into some type of either semi-permanent or permanent housing."
Speaking at a news conference, he also pledged to help victims by working with state and local officials.
"This has to be a partnership, because ultimately the communities are entitled to take responsibility and empower themselves," Paulison said.
Paulison, who is also administrator for the U.S. Fire Administration, was a former fire chief in Miami-Dade County, Florida.
Brown's resignation came three days after Homeland Security Secretary Michael Chertoff recalled him to Washington and replaced him as point man for Katrina relief efforts.
Since then, Vice Adm. Thad Allen, the Coast Guard's chief of staff, has been leading FEMA's mission along the Gulf Coast.
Chertoff said he expects to make other appointments to FEMA in coming days, "including a permanent deputy director to augment the resources available to assist with FEMA's vital mission."
Brown's fall came quickly. On September 2, Bush told the 50-year-old lawyer, "Brownie, you're doing a heck of a job." (Watch Brown's interview with CNN on September 2 -- 2:11)
Sen. Ted Kennedy, D-Massachusetts, applauded the latest development. "I think it is clearly in the country's interest," Kennedy said.
Senate Majority Leader Bill Frist said he was not surprised.
"Things didn't go as well as it should have," said the Tennessee Republican. But Frist added, "Now, I am very pleased where we are."


PeopleNews
Bush Accepts Blame for Katrina Response
By Stephen M. Silverman
CREDIT: OLIVIER DOULIERY / ABACA
Stating that "to the extent that the federal government didn't fully do its job right, I take responsibility," President Bush on Tuesday accepted blame for part of the sluggish and stumbling response to Hurricane Katrina and its disastrous aftermath.
"Katrina exposed serious problems in our response capability at all levels of government," Bush said at a joint White House news conference with Iraqi President Jalal Talabani. "And I want to know what went right and what went wrong."
Facing sharp criticism and the lowest approval ratings of his five years in office, Bush has scheduled a speech to the nation from Louisiana for Thursday evening, the Associated Press reports. It will be his fourth trip to the devastated Gulf Coast since the storm struck two weeks ago.

More on this storyHurricane Katrina: How You Can HelpKatrina: How to Locate Family & FriendsGeneration K: Children of the StormLast week, the president had said it was too early to start a game of finger pointing at the federal government for the problems of the relief effort.
Meanwhile, R. David Paulison, in his first full day on the job as acting Federal Emergency Management Agency, told reporters in Washington that the government would speed up its efforts to find more permanent housing for the tens of thousands of hurricane survivors now in shelters. "We're going to move and get them the help they need," Paulison said.
Bush's comments Tuesday came in response to a reporter's question on whether the United States is capable of handling another terrorist attack, given its halting and widely criticized response to Katrina.
"That's a very important question," Bush said. "And it's in our national interest that we find out exactly what went on – so that we can better respond."
The president went on to say: "I'm not going to defend the process going in, but I am going to defend the people who are on the front line of saving lives. I also want people in America to understand how hard people are working to save lives down there in not only New Orleans, but surrounding parishes and along the Gulf Coast."



I'm in complete shock. This is an administration that has denied making any mistakes at all. I guess that was just while he was trying to get in for that second term. Now he's worried about what the history books will say about him. They might just say that he's an uncaring asshole. They should get quotes from Celine Dion and Kanye West, even the guys on meet the press can see that taking 5 days to get water to people is rediculous. This is America, land of excess isn't it? The gap between those who have and those who have not has just become visible to the mainstream. Will it evoke a change? Lord help us if it doesn't.

5 things

I was tagged by Angel (Thanks Soy Sarah!).

Here are my answers (in no particular order)...5 things that I miss from my childhood:
1. playing softball and knowing I was good.
2. my grandpa and grandma
3. playing "Barbies" with my friend Tim with his GI Joe and Tanto, my Barbies, Ken and Crystal and somehow managing to catch the tomato patch on fire.
4. Rocky Horror every Saturday night proceeded by a game of SPOONS and followed by breakfast at the truck stop.
5. innocence and ignorance.

Now I tag:
lealea

ava

camile

shelly & angie

recovering straight girl

"I regret the president's decision"

Katrina
Please take a look at the size of this hurricane. It's as big as fucking Texas.
Red Cross
Burger King
I'm appauled by this. Protecting his buddies at Haliburton and sacrificing the victims of Katrina. What a slimy bastard. You've got to be kidding me right? It's not enough that these people have lost so much already, now Bush wants to ensure not only that his buddies over at Halliburton get the job, but also that they can make big profits by paying sub standard wages to the very people who have lost homes, jobs, communities, and family members. I'm sure Mike Brown doens't live in New Orleans or Biloxi. Put his ass to work building. Why haven't they gotten Jimmy Carter and Habitat for Humanity involved here? Screw Haliburton's money mongers. I'm pissed. Read for yourself.

Bush lifts wage rules for Katrina
President signs executive order allowing contractors to pay below prevailing wage in affected areas.
September 11, 2005: 11:59 AM EDT

WASHINGTON (Reuters) - President Bush issued an executive order Thursday allowing federal contractors rebuilding in the aftermath of Hurricane Katrina to pay below the prevailing wage.

In a notice to Congress, Bush said the hurricane had caused "a national emergency" that permits him to take such action under the 1931 Davis-Bacon Act in ravaged areas of Alabama, Florida, Louisiana and Mississippi.

The Davis-Bacon law requires federal contractors to pay workers at least the prevailing wages in the area where the work is conducted. It applies to federally funded construction projects such as highways and bridges.

Bush's executive order suspends the requirements of the Davis-Bacon law for designated areas hit by the storm.

Bush's action came as the federal government moved to provide billions of dollars in aid, and drew rebukes from two of organized labor's biggest friends in Congress, Rep. George Miller of California and Sen. Edward Kennedy of Massachusetts, both Democrats.

"The administration is using the devastation of Hurricane Katrina to cut the wages of people desperately trying to rebuild their lives and their communities," Miller said.

"President Bush should immediately realize the colossal mistake he has made in signing this order and rescind it and ensure that America puts its people back to work in the wake of Katrina at wages that will get them and their families back on their feet," Miller said.

"I regret the president's decision," said Kennedy.

"One of the things the American people are very concerned about is shabby work and that certainly is true about the families whose houses are going to be rebuilt and buildings that are going to be restored," Kennedy said.
katrina_wages.

A carrot, an egg and a cup of coffee

A carrot, an egg and a cup of coffee. . You will never look at a cup of coffee the same way again.


A young woman went to her mother and told her about
her life and how things were so hard for her. She
did not know how she was going to make it and wanted
to give up. She was tired of fighting and struggling.
It seemed as one problem was solved, a new one arose.


Her mother took her to the kitchen. She filled three
pots with water and placed each on a high fire. Soon
the pots came to boil. In the first she placed
carrots, in the second she placed eggs, and in the
last she placed ground coffee beans. She let them
sit and boil, without saying a word.

In about twenty minutes she turned off the burners.

She fished the carrots out and placed them in a bowl.

She pulled the eggs out and placed them in a bowl.

Then she ladled the coffee out and placed it in a
bowl.

Turning to her daughter, she asked, "Tell me, what do
you see?"

"Carrots, eggs, and coffee," she replied. Her mother
brought her closer and asked her to feel the carrots.
She did and noted that they were soft. The mother
then asked the daughter to take an egg and break it.
After pulling off the shell, she observed the hard
boiled egg. Finally, the mother asked the daughter
to sip the coffee. The daughter smiled as
she tasted its rich aroma. The daughter then asked,
"What does it mean, mother?"

Her mother explained that each of these objects had
faced the same adversity. Boiling water. Each
reacted differently. The carrot went in strong, hard,
and unrelenting. However, after being subjected to
the boiling water, it softened and became weak. The
egg had been fragile. Its thin outer shell had
protected its liquid interior, but after sitting
through the boiling water, its inside became hardened.
The ground coffee beans were unique, however. After
they were in the boiling water, they had changed the
water.

"Which are you?" she asked her daughter. "When
adversity knocks on your door, how do you respond?
Are you a carrot, an egg or a coffee bean?"

Think of this: Which am I? Am I the carrot that seems
strong, but with pain and adversity do I wilt and
become soft and lose my strength? Am I the egg that
starts with a malleable heart, but changes with the
heat? Did I have a fluid spirit, but after a death,
a breakup, a financial hardship or some other trial,
have I become hardened and stiff? Does my shell look
the same, but on the inside am I bitter and tough
with a stiff spirit and hardened heart?

Or am I like the coffee bean? The bean actually
changes the hot water, the very circumstance that
brings the pain. When the water gets hot, it releases
the fragrance and flavor. If you are like the bean,
when things are at their worst, you get better and
change the situation around you. When the hour is
the darkest and trials are their greatest, do you
elevate yourself to another level? How do you handle
adversity? Are you a carrot, an egg or a coffee bean?

SO LONG, LITTLE BUDDY

Bob Denver, whose portrayal of the pratfall- and blunder-prone titular first mate on Gilligan's Island made him an iconic television figure, died Tuesday from complications of cancer treatment. He was 70. Prior to being shipwrecked with the Skipper and Professor et al., Denver gave beatniks a prime-time face as Maynard G. Krebs on The Many Loves of Dobie Gillis. "It's a sad, sad day," sighs Denver's Island costar Tina Louise. (Ginger). "His boyish charm worked for both children and adults. He will be so missed."

How sad it is to see all of the people you watched as a child die. First Mr. Rodgers, now Gilligan. So long little buddy.

Vacation is over you incredible ASSHOLE

MY GOD HE RUBS ME THE WRONG WAY!
WHAT A FUCKING ASSWIPE.



I love Michael Moore's sarcasm. I think he has a career in politcal comedy. He reminds me of Paula Pountstone, but he's much more in your face about it... which I LOVE! Go Michael! I see another documentary on the way Mr. Bush

The images of the destruction and the loss from hurricaine Katrina are so awful, I get a visceral reaction every time I see another family devastated, another angry black man shouting because speaking gets nobody's attention. I'm appauled at the lack of assistance. I'm sure there are hundreds of troops in Iraq that would love to come home and help with this crisis. Now, read what Michael Moore says... he's so right on the money.

Vacation is Over... an open letter from Michael Moore to George W. Bush

Friday, September 2nd, 2005
Dear Mr. Bush:
Any idea where all our helicopters are? It's Day 5 of Hurricane Katrina and thousands remain stranded in New Orleans and need to be airlifted. Where on earth could you have misplaced all our military choppers? Do you need help finding them? I once lost my car in a Sears parking lot. Man, was that a drag.
Also, any idea where all our national guard soldiers are? We could really use them right now for the type of thing they signed up to do like helping with national disasters. How come they weren't there to begin with?
Last Thursday I was in south Florida and sat outside while the eye of Hurricane Katrina passed over my head. It was only a Category 1 then but it was pretty nasty. Eleven people died and, as of today, there were still homes without power. That night the weatherman said this storm was on its way to New Orleans. That was Thursday! Did anybody tell you? I know you didn't want to interrupt your vacation and I know how you don't like to get bad news. Plus, you had fundraisers to go to and mothers of dead soldiers to ignore and smear. You sure showed her!
I especially like how, the day after the hurricane, instead of flying to Louisiana, you flew to San Diego to party with your business peeps. Don't let people criticize you for this -- after all, the hurricane was over and what the heck could you do, put your finger in the dike?
And don't listen to those who, in the coming days, will reveal how you specifically reduced the Army Corps of Engineers' budget for New Orleans this summer for the third year in a row. You just tell them that even if you hadn't cut the money to fix those levees, there weren't going to be any Army engineers to fix them anyway because you had a much more important construction job for them -- BUILDING DEMOCRACY IN IRAQ!
On Day 3, when you finally left your vacation home, I have to say I was moved by how you had your Air Force One pilot descend from the clouds as you flew over New Orleans so you could catch a quick look of the disaster. Hey, I know you couldn't stop and grab a bullhorn and stand on some rubble and act like a commander in chief. Been there done that.
There will be those who will try to politicize this tragedy and try to use it against you. Just have your people keep pointing that out. Respond to nothing. Even those pesky scientists who predicted this would happen because the water in the Gulf of Mexico is getting hotter and hotter making a storm like this inevitable. Ignore them and all their global warming Chicken Littles. There is nothing unusual about a hurricane that was so wide it would be like having one F-4 tornado that stretched from New York to Cleveland.
No, Mr. Bush, you just stay the course. It's not your fault that 30 percent of New Orleans lives in poverty or that tens of thousands had no transportation to get out of town. C'mon, they're black! I mean, it's not like this happened to Kennebunkport. Can you imagine leaving white people on their roofs for five days? Don't make me laugh! Race has nothing -- NOTHING -- to do with this!
You hang in there, Mr. Bush. Just try to find a few of our Army helicopters and send them there. Pretend the people of New Orleans and the Gulf Coast are near Tikrit.
Yours,
Michael Moore
MMFlint@aol.com
www.MichaelMoore.com
P.S. That annoying mother, Cindy Sheehan, is no longer at your ranch. She and dozens of other relatives of the Iraqi War dead are now driving across the country, stopping in many cities along the way. Maybe you can catch up with them before they get to DC on September 21st.