For three weeks, spanning August and September, much of the national nursing home community was glued to goings-on in a place they had never heard of before: St. Francisville, LA. Or at least they should have been.

Hiring bodies might want to re-examine their priorities if they hear of any nursing home leaders who say they weren’t aware of what was happening, or didn’t care, about the trial of Sal and Mabel Mangano.

If there was anything their trial brought to the forefront it was that caring counts. Initially reviled around the world as nursing home owners who deserted their residents, leaving 35 to drown in the aftermath of Hurricane Katrina, the Manganos were totally cleared of all criminal charges.
After a three-week trial that cost hundreds of thousands of dollars and drew intense speculation from far-flung international ports to the Louisiana Supreme Court, the Mangano jury took less than four hours to reach their uncompromising verdict: not guilty. Thirty-five times not guilty on negligent homicide charges, and twenty-four times not guilty on cruelty to the infirm charges.
The rest of the nursing homes in their vicinity had loaded up and escaped the ravages of Katrina, and the deadly flooding that occurred afterward. But not the Manganos, who actually refused offers of evacuation buses.
Why did they do it?
The overriding reason the jury acquitted seemed to be that many other people and entities also had made errors during the storm. No one thing or person was responsible.
But more important for nursing home operators around the country was the other big reason: Jurors said they felt that the Manganos truly cared about their residents. They not only sheltered in place with the residents, they invited others to do so, too, and about 30 extra people took them up on the offer. The jury was told that 64-year-old Mabel Mangano stayed, despite not knowing how to swim. (Family members evacuated about 10 residents before the storm.)
“A lot of mistakes were made, but they should not be blamed on just two people,” reasoned juror Kim Maxwell, a 46-year-old secretary. “How could you punish these two people for doing what they thought was right?”
Maxwell and other jurors asked to meet with the Manganos after the verdicts were announced, not long after dinnertime on Sept. 7, a Friday night little more than two years after Katrina struck. “I just wanted to hug them,” Maxwell said.
Sixty-seven-year-old Sal Mangano hugged his wife as the verdicts were read, later telling reporters they really didn’t want to hear what he thought about the trial. It was no secret the couple and their attorneys felt they had been victims of an attorney general’s rush to judgment, the only individuals charged with criminal negligence after Katrina.
The state’s criminal negligence statute requires a “gross deviation below the standard of care expected to be maintained by a reasonably careful person.” Jurors asked Judge Jerome Winsberg, who was brought out of retirement to hear the case, to re-read that definition before beginning deliberations. Their first vote was 5-1 to acquit, demonstrating just how powerfully the defense had made its case.
Defense attorneys repeatedly hammered home the point that government-designed and maintained levees had caused the fatal flooding, and how no mandatory evacuation order had been given. Government personnel and agencies were to blame, not the Manganos, they stressed.
“We were a 28-point underdog in the eyes of the public and the media,” defense attorney James Cobb told McKnight’s. “We only needed one (dissenting juror) to hang it up. We could have had a verdict in 10 minutes. It was a severe butt-whipping.”
Cobb said the trial was good for the nursing home industry, though terrible for the Manganos, who lost their home, business and reputations.
He also chided the greater nursing home community for not giving more public backing to his clients.
“I wish we had gotten more national industry support,” he said. “We had a Mangano legal defense fund, and we didn’t collect a lot of money for that, frankly.”
Although he felt prosecutors attempted to intimidate nursing home officials during the case, Cobb said he still had hoped the Manganos’ peers would have come more to their aid, as doctors and nurses professional associations had vocally defended a physician and nurse who were ultimately not charged after assisting patients’ deaths in the aftermath of Katrina.
“They rejected this attack on caregivers, and you would think the nursing home industry would be helping the same,” Cobb said.
Joe Donchess, executive director of the Louisiana Nursing Home Association, one of just a handful of defense witnesses, said he thought the trial was good for nursing homes for two reasons.
“It clarified that what nursing home operators were doing before Hurricane Katrina was basically correct – leaving the professional judgment up to the people operating the facilities. They know the residents best. There should not be second-guessing after the fact by government agencies,” Donchess said.
Second, it brought issues to light that led to legislation and clearer regulations, he said.
Primary responsibility is now in the hands of providers, though they must evacuate if ordered by the governor or parish (county) president, Donchess explained. Operators also can look for back-up from the state if they think they need it, he added.
A lawyer who has presented cases before the state supreme court, Donchess said he was unsure how the jury would handle the emotional testimony the prosecution packed into its case. During their 40-witness, two-and-a-half week case, prosecutors called victims’ relatives and fought to show televised weather warnings to the jury. Interestingly, the jurors themselves had not felt the brunt of Katrina because the case was moved about 100 miles away from St. Rita’s out of concerns that there wouldn’t be a big enough, impartial jury pool available to start a trial in St. Bernard Parish.
“When I looked in (jurors’) faces, I saw compassion,” Donchess said. “They were very attentive.”
Hopefully, providers also were paying attention, he said.
“They have to be prepared for any type of emergency. Know what your emergency plan is and be prepared to activate it, not just have it on paper. Don’t be complacent. Take this part of the business very seriously,” he advised. “I think for the next couple of years at least people will be gun-shy and ready to pull that trigger (to evacuate) very quickly.”
Providers truly better have their priorities in order, said Larry Minnix, president and CEO of the American Association of Homes and Services for the Aging. One prosecution witness told how Mabel Mangano had rejected the notion of evacuating, reportedly saying, “Unless a hurricane’s coming up my back door, I’m not putting people through an evacuation and wasting money on it.”
Again, jurors apparently took notice of the concern about moving and harming residents before wondering about the financial motivations.
“The wake-up call for everyone was that the prosecution was trying to say that the decision was made because of money. They didn’t make that point in a convincing way,” Minnix said. “But I think a lesson of all of this is if money is your primary consideration, that’s when the public will … if that could have been proven, it might have been a different story.
“In the final analysis, whether you’re a for-profit or not-for-profit and you’re responsible for vulnerable lives and using taxpayer money to do it, your bottom line better be you have acted in the best interest of the people being served. There can’t be any other criteria.”
Minnix said the verdict showed good intentions do matter.
“In the case of St. Rita’s, and the case of the physician (who was not prosecuted), to me, that reflects the public is willing to be forgiving, as long as the intent is noble, even though conflicted.”

From the October 01, 2007 Issue of McKnight's Long-Term Care News