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In the days after Hurricane Katrina struck and New Orleans's infrastructure failed, hospitals and other organizations that have custodial responsibility for human beings (such as nursing homes and jails) faced special difficulties. In some two dozen hospitals, patients had to be evacuated because of the loss of power, water, and sewage service, and many of these hospitals required external assistance, which was slow to arrive. Meanwhile, patients' needs for care continued unabated. Some hospitals evacuated all patients successfully, but by the end of that long week, some had become places of death. This paper explores what happened in New Orleans-area hospitals during and after Hurricane Katrina and why hospitals had such varied experiences. We conclude with lessons based on the Katrina experience.