Identifying the Dead: New Orleans Mortuary Response
After Hurricane Katrina's assault on the gulf Coast in August, the horror of the storm's destruction was televised to the world. Day after day, searing images of the bodies of people who wouldn'tor couldn'tevacuate the area were seen floating in sewage-filled waters.
Now, a little more than three months later, the water has receded and New Orleans is taking its first steps toward recovery. But the suffering continues for the families and friends of the more than 5,800 dead and missing. A total of 1,086 bodies have been recovered in New Orleans, and of those, at least 270 remain unidentified as of Nov. 28. Most of the unidentified bodies are located at the temporary morgue set up after the hurricane in
St. Gabriel, La., about 70 miles west of New Orleans:
The state's medical examiner, Dr. Louis Cataldie, is using a database called the Victim Identification Profile (VIP) to help identify bodies. VIP was built by the Disaster Mortuary Operational Response Team (Dmort), a network of 10 regional teams of 1,200 medical, forensic and mortuary professionals that operate under the Federal Emergency Management Agency (FEMA). VIP, designed to help medical examiners identify bodies after disasters such as plane crashes and building collapses, was used in New York after the Sept. 11, 2001, terrorist attack on the World Trade Center. It is a repository for detailed physical characteristics of the dead and post-mortem medical exam results.
The VIP database, however, was not designed to handle anything on the scale of Katrina, where more than 4,700 people are still reported missing, out of the original total of 10,633.
In many other cases where VIP was used, there were passenger manifests and building-occupancy lists to populate an initial VIP worksheet. From there, other identifiersbody descriptions, personal effects, etc.were entered and then sorted to match names and victims.
But the fallout from Katrina was widespread.
There is no single, complete list of missing people; bodies are being recovered across a wide area; and those remains are being found weeks or even months after death. Analysis of the database records is hampered by limited search capabilities and the inability to easily flag incomplete or inaccurate data, among other problems, according to those working to identify bodies at the morgue.
"We've got people scattered over an area the size of Great Britain," Cataldie says. "There's no manifest. All we've got are 16,000 phone calls of people reporting people missing."
Besides the information-management challenges, other factors contribute to the protracted identification process in Louisiana, according to state officials and others.
Many bodies are severely decomposed, making DNA matching one of the few options available to medical examiners. And there was a delay in matching the DNA of recovered bodies with genetic samples provided by victims' family and friends due to a reported squabble between state and federal authorities over who would foot the bill.
The obstacles in Louisiana underscore the importance for organizationsfrom governments to businesses to nonprofit agenciesto be able to collect, analyze and disseminate up-to-date information in times of crisis.
Cataldie says he and his team are committed to their task, but concedes that "it absolutely takes longer" to identify bodies with the information systems in use at the morgue. In fact, he wanted to identify all of the bodies before the end of September.
At the St. Gabriel morgue, a body usually arrives in a body bag. It's assigned a case number by a staff person, who writes the number on a label and affixes it to the bag. Bodies are kept in a refrigerated truck except when the remains are being examined. The case number and the body's location in the morgue are recorded on paper and then entered into the VIP database by a state-hired clerk.
The VIP program, built on a customized FileMaker Pro relational database, mirrors an eight-page paper form filled out by Dmort and other forensic workers during a multi-step post-mortem exam. Those pages include space to record information such as physical characteristicsheight and weight, race and complexion, and the presence of birthmarks and prosthetics. Other items found on the body, including jewelry, clothing and personal effects such as a notebook or wallet, are also input.
In addition, unless a body is severely decomposed, fingerprints are taken. Other steps include full-body and dental X-rays, dental examination, DNA sampling and an autopsy.
With VIP, all of this datasometimes hundreds of pieces of information about one personcan be input into database tables. Then, if a corpse has a rose tattoo on its left forearm, a forensic investigator can search the "tattoo" field in another database that contains information on missing people.
A single tidbit could provide a breakthrough. One Katrina victim was identified based on his discount card from a Piggly Wiggly grocery store; others from jewelry and tattoos.
Because so many people fled the citya reported 400,000collecting information from phone conversations with victims' families, doctors, dentists and other medical professionals has taken on added complexity.
VIP wasn't initially designed as a contact management system to maintain summaries of phone conversations, lists of people and phone numbers, and call-back reminders. As a result, for the first month following Katrina, conversations were not recorded into VIP because there weren't fields for that. If a morgue worker contacted dentists, for example, to obtain dental records to help identify remains, that information was recorded on paper, according to Don Bloom, who developed VIP in 1994 and works on-call as a technical specialist for Dmort.
Without a single log of the numerous phone calls placed early on from the morgue, Cataldie says that Dmort workers, who rotate through the morgue every two weeks, take their knowledge with them. "All the history is gone," he says.
By late September, Bloom programmed a feature into the VIP database that allows Dmort workers to make a notation after requesting dental records or contacting someone who reported a missing person.
But that's not enough for Cataldie, whose staff would benefit from reminders to check in with people who could be related to victims. Cataldie's office may call to clarify personal information or to see whether a missing family member has been found alive.
"I would like to have some database tell me that today is Sept. 29," Cataldie says. "That these people have to be called for their weekly follow-up."
Bloom says that adding an alert system to VIP would be "an easy fix," but that Cataldie and others at the morgue hadn't requested the feature.
Tracking missing people is yet another challenge. After Katrina, state and federal officials set up a family assistance center in Baton Rouge, La. There, family members and others can report a missing person, his or her name and address, what he or she looks like, and clothing worn when last seen. To capture or record that information, family-
assistance center technicians adapted the morgue's VIP database, which has some fields to track missing-person data, for their own use.
While separate, the VIP databases at the morgue and at the Baton Rouge call center can be viewed and searched simultaneously via a T1 connectiona fast link that can transmit 1.5 megabits of information a secondprovided by the state. That morgue worker searching for a tattoo would first try the missing person's VIP file for a match.
VIP was originally designed to match dates and physical characteristics, according to Bob Shank, a deputy commander of Dmort's upper Midwest region who is responsible for Dmort's information systems and mobile morgue unit. But, Shank says, VIP was not intended to be a tool to track reports of missing persons or coordinate lists of displaced people.
To wit, IBM in November was retained at no cost to analyze lists of missing people from nine different federal and charity-owned databases and Web sites to search for duplicate names and other conflicts. For example, if someone listed in the missing-persons' VIP has requested housing assistance from FEMA, an investigator would follow up and close out the case. IBM sends daily reports to the technology staff at the Baton Rouge call center.
Shawn Romero, a database administrator and analyst from the Louisiana Department of Health and Hospitals, knows all too well the limitations of the two databases, especially their insufficient analytics and reporting capabilities.
He devotes several hours a day to extracting records from both VIP databases and uploads them into a Microsoft SQL Server database where he cleanses the records of duplicates, anomalies and misspellings. SAS analytical software corrects data entry errors, such as ZIP codes that staffers accidentally keyed into address fields.
Romero can write queries to find instances of dates that appear more than once in the two VIPs. An analysis of the duplicates could lead to a positive identification based on a birth or wedding date.
But misspellings and multiple spellings of the same name are common in VIP, particularly when more than one person reports that an individual is missing, but the consequences of those typos are significant.
Cataldie uses his own name as an example: "If they were looking for 'Louis Cataldie,' and he were dead in the morgue but they spelled it with a 'y' instead of an 'ie', they wouldn't match me and it wouldn't automatically pull up a list of 'Do you mean this?' or 'Here are some possible matches.'" The VIP database's search is not designed to recognize close but not exact matches, according to Kevin Mallon, a spokesman for FileMaker, a Santa Clara, Calif.-based software developer.
Tom Brondolo, former deputy commissioner at New York City's chief medical examiner's office, says he recognized VIP's limitations shortly after the bodies of victims from the World Trade Center attack arrived at his agency's morgue. There would be 20,000 fragmented remains recovered at the disaster site; VIP had no easy way to electronically link numerous records for body fragments brought to the morgue, Brondolo says.
There were other disadvantages to the database. "VIP's [missing-persons] form was very important," Brondolo says. "But we needed one place to pull all the information together." VIP couldn't be used to track the movement of remains through the morgue, as well as family visits, phone calls, dental and DNA records, death certificates, visitor passes, and other aspects of the identification process.
FEMA counters that VIP has been used successfully for every event in the U.S. with mass fatalities since 1994. "VIP was capable of being used at 9/11 and is continually reviewed," says Debbie Wing, a FEMA spokeswoman. She adds that FEMA was not aware of the Louisiana medical examiner's criticism of the VIP system.
For Cataldie and the hundreds of others working around the clock to identify the dead and return them to their families, the frustration is rising. When asked what his goal is for identifying the remaining bodies at the morgue, the state medical examiner replies, "Yesterday. A month ago. Two months ago.
I want to get that goal done now."
Headquarters: 500 C St. SW, Suite 713, Washington, DC 20472
Phone: (202) 646-4580
Incident Commander: Charles Smith
Business: The Disaster Mortuary Operational Response Team, or Dmort, is made up of 10 regional teams. Each consists of medical, forensic and mortuary professionals. It is deployed when disaster strikes to identify the deceased and determine their cause of death.
Challenge: Assist in the rapid recovery and identification of 1,086 people who died in New Orleans due to Hurricane Katrina.
- Set up a temporary morgue, staffed by medical, forensic and mortuary professionals from a five-state area, within one week after the hurricane hit.
- Identity 100% of the 1,086 bodies at New Orleans' morgues. Goal not met; more than 270 bodies remain unidentified as of Nov. 28.
- Determine the whereabouts of 4,748 people who were reported missing by family and friends, down from 10,633 as of early September.