Katrina Aftermath: The Deadly Choices at Memorial - Part Three
Sheri Fink | , ProPublica | 5/5/2010, 8:39 p.m.
Originally Published in the New York Times Magazine
Part three in a Five-part series
Mendez heard that Pou was looking for her. They sat down in an office with an open window. Pou looked distraught and told her that the LifeCare patients probably were not going to survive. Mendez told investigators that she responded, ''I think you're right.''
Mendez said she watched Pou struggle with what she was saying, telling investigators that Pou told her that ''the decision had been made to administer lethal doses'' of morphine and other drugs. (Pou, through her lawyer, Richard Simmons Jr., denied mentioning ''lethal doses.'') Were the LifeCare patients being singled out? Mendez asked. She knew there were other sick patients at Memorial. Mendez recalled that Pou said ''no'' and that there was ''no telling how far'' it would go.
According to Mendez, Pou told her that she and other Memorial staff members were assuming responsibility for the patients on the seventh floor; the LifeCare nursing staff wasn't involved and should leave.
(Pou, through her lawyer, disputes Mendez's account.) Mendez later said she had assumed that the hospital was under martial law, which was not the case, and that Pou was acting under military orders. Mendez left to dismiss her employees, she said, because she feared they would be forced downstairs by authorities.
Diane Robichaux, the senior leader on the LifeCare floor, later walked into the office, she recalled in interviews with investigators. (She declined to talk to me.) She and other LifeCare workers had gone downstairs at around 9:30 a.m. to ask Susan Mulderick when the LifeCare patients on the seventh floor would be evacuated.
According to Robichaux, Mulderick said, ''The plan is not to leave any living patients behind,'' and told her to see Pou. In Robichaux's interview with investigators, she could not recall exactly what Pou told her, but she said that she understood that patients ''were not going to be making it out of there.'' She said that Pou did not use the word ''euthanize.'' Prompted by investigators, she said she thought Pou might have used the word ''comfortable'' in describing what she was trying to do for the patients.
Robichaux remembered Pou saying that the LifeCare patients were ''not aware or not alert or something along those lines.'' Robichaux recounted to investigators that she told Pou that that wasn't true and said that one of LifeCare's patients -- Emmett Everett, a 380-pound man -- was ''very aware'' of his surroundings. He had fed himself breakfast that morning and asked Robichaux, ''So are we ready to rock and roll?''
The 61-year-old Honduran-born manual laborer was at LifeCare awaiting colostomy surgery to ease chronic bowel obstruction, according to his medical records. Despite a freakish spinal-cord stroke that left him a paraplegic at age 50, his wife and nurses who worked with him say he maintained a good sense of humor and a rich family life, and he rarely complained. He, along with three of the other LifeCare patients on the floor, had no D.N.R. order.
Everett's roommates had already been taken downstairs on their way to the helicopters, whose loud propellers sent a breeze through the windows on his side of the LifeCare floor. Several times he appealed to his nurse, ''Don't let them leave me behind.'' His only complaint that morning was dizziness, a LifeCare worker told Pou.
''Oh, my goodness,'' a LifeCare employee recalled Pou replying.
Two Memorial nurses -- identified as Cheri Landry and Lori Budo from the I.C.U. to investigators by a LifeCare pharmacist, Steven Harris -- joined the discussion along with other LifeCare workers. (Through their lawyers, Landry and Budo declined to be interviewed. Harris never returned my calls.) They talked about how Everett was paralyzed and had complex medical problems and had been designated a ''3'' on the triage scale. According to Robichaux, the group concluded that Everett was too heavy to be maneuvered down the stairs, through the machine-room wall and onto a helicopter.
Several medical staff members who helped lead boat and helicopter transport that day say they would certainly have found a way to evacuate Everett. They say they were never made aware of his presence.
In his interviews with investigators, Andre Gremillion, a LifeCare nurse, said that the female physician in the office (he didn't know Pou's name) asked if someone who knew Everett could explain to him that because he was so big they did not think they would be able to evacuate him. They asked Gremillion whether he could ''give him something to help him relax and explain the situation.'' Gremillion told investigators that he didn't want to be the one who told Everett that ''we would probably be leaving and he would be staying.'' At that point, Gremillion said, he lost his composure.
Gremillion's supervisor and friend, a LifeCare nursing director, Gina Isbell, told me she walked into the room around 11 a.m. and saw Gremillion crying and shaking his head. He brushed past her into the hallway, and Isbell followed, grabbing his arm and guiding him to an empty room. ''I can't do this,'' he kept saying.
''Do what?'' Isbell asked. When Gremillion wouldn't answer, Isbell tried to comfort him. ''It's going to be O.K.,'' she said. ''Everything's going to be all right.''
Isbell searched for Robichaux, her boss. ''What is going on?'' she asked, frantic. ''Are they going to do something to our patients?''
''Yes, they are,'' Isbell remembers Robichaux, in tears, saying. ''Our patients aren't going to be evacuated. They aren't going to leave.'' As the LifeCare administrators cleared the floor of all but a few senior staff members, Robichaux sent Isbell to the back staircase to make sure nobody re-entered. It was quiet there, and Isbell sat alone, drained and upset.
Isbell said she thought about her patients, remembering with guilt a promise she made to the daughter of one of her favorites, Alice Hutzler, a 90-year-old woman who came to LifeCare for treatment of bedsores and pneumonia. Isbell fondly called her Miss Alice and had told Hutzler's daughter that she would take good care of her mother. Now Isbell prayed that help would come before Hutzler and her other patients died.
According to statements made to investigators by Steven Harris, the LifeCare pharmacist, Pou brought numerous vials of morphine to the seventh floor. According to investigators, a proffer from Harris's lawyer said that Harris gave her additional morphine and midazolam -- a fast-acting drug used to induce anesthesia before surgery or to sedate patients for medical procedures. Like morphine, midazolam depresses breathing; doctors are warned to be extremely careful when combining the two drugs.
Kristy Johnson, LifeCare's director of physical medicine, said she saw what happened next. She told Justice Department investigators that she watched Pou and two nurses draw fluid from vials into syringes. Then Johnson guided them to Emmett Everett in Room 7307. Johnson said she had never seen a physician look as nervous as Pou did. As they walked, she told investigators, she heard Pou say that she was going to give him something ''to help him with his dizziness.'' Pou disappeared into Everett's room and shut the door.
As they worked their way down the seventh-floor hallway, Johnson held some of the patients' hands and said a prayer as Pou or a Memorial nurse gave injections. Wilda McManus, whose daughter Angela had tried in vain to rescind her mother's D.N.R. order, had a serious blood infection. (Earlier, Angela was ordered to leave her mother and go downstairs to evacuate.) ''I am going to give you something to make you feel better,'' Pou told Wilda, according to Johnson.
Johnson took one of the Memorial nurses into Room 7305. ''This is Ms. Hutzler,'' Johnson said, touching the woman's hand and saying a ''little prayer.'' Johnson tried not to look down at what the nurse was doing, but she saw the nurse inject Hutzler's roommate, Rose Savoie, a 90-year-old woman with acute bronchitis and a history of kidney problems. A LifeCare nurse later told investigators that both women were alert and stable as of late that morning. ''That burns,'' Savoie murmured.
According to Memorial workers on the second floor, about a dozen patients who were designated as ''3's'' remained in the lobby by the A.T.M. Other Memorial patients were being evacuated with help from volunteers and medical staff, including Bryant King. Around noon, King told me, he saw Anna Pou holding a handful of syringes and telling a patient near the A.T.M., ''I'm going to give you something to make you feel better.''
King remembered an earlier conversation with a colleague who, after speaking with Mulderick and Pou, asked him what he thought of hastening patients' deaths. That was not a doctor's job, he replied. Patients were hot and uncomfortable, and a few might be terminally ill, but he didn't think they were in the kind of pain that calls for sedation, let alone mercy killing. When he saw Pou with the syringes, he assumed she was doing just that and said to anyone within earshot: ''I'm getting out of here. This is crazy!'' King grabbed his bag and stormed downstairs to get on a boat.
Bill Armington, the neuroradiologist, watched King go and was upset at him for leaving. Armington suspected that euthanasia might occur, in part, he told me, because Cook told him earlier that there had been a discussion of ''things that only doctors talk about.'' Armington headed for the helipad, "stirred up,'' as he recalls, ''to intensify my efforts to get people off the roof.'' Neither Armington nor King intervened directly, though King had earlier sent out text messages to friends and family asking them to tell the media that doctors were discussing giving medication to dying patients to help accelerate their deaths.
King told me that he didn't think his opinion, which hadn't mattered when he argued against turning away the hospital's neighbors, would have mattered. Only a few nurses and three doctors remained on the second floor: Pou; a young internist named Kathleen Fournier; and John Thiele, a 53-year-old pulmonologist, who had never before spoken publicly about his Katrina experiences until we had two lengthy interviews in the last year.
Thiele told me that on Thursday morning, he saw Susan Mulderick walking out of the emergency room. ''John, everybody has to be out of here tonight,'' he said she told him. He said Rene Goux told him the same thing. Mulderick, through her lawyer, and Goux both say that they were not given a deadline to empty the hospital and that their goal was to focus their exhausted colleagues on the evacuation. ''We'd experienced the helicopters' stopping flying to us,'' Goux told me, ''and I didn't want that to occur again.''
Around a corner from where the patients lay on the second floor, Thiele and Fournier struggled to euthanize two cats whose owners brought them to the hospital and were forced to leave them behind. Thiele trained a needle toward the heart of a clawing cat held by Fournier, he told me later. While they were working, Thiele recalls Fournier telling him that Mulderick had spoken with her about something to the effect of putting patients ''out of their misery'' and that she did not want to participate. (Fournier declined to talk with me.)
Thiele told her that he understood, and that he and others would handle it. Mulderick's lawyer says that Mulderick did ask a physician about giving something to patients to ''make them more comfortable,'' but that, however, was not ''code for euthanasia.''
Thiele didn't know Pou by name, but she looked to him like the physician in charge on the second floor. He told me that Pou told him that the Category 3 patients were not going to be moved. He said he thought they appeared close to death and would not have survived an evacuation. He was terrified, he said, of what would happen to them if they were left behind. He expected that the people firing guns into the chaos of New Orleans -- ''the animals,'' he called them -- would storm the hospital, looking for drugs after everyone else was gone.
''I figured, What would they do, these crazy black people who think they've been oppressed for all these years by white people? I mean if they're capable of shooting at somebody, why are they not capable of raping them or, or, you know, dismembering them? What's to prevent them from doing things like that?''
The laws of man had broken down, Thiele concluded, and only the laws of God applied.
''Can I help you?'' he says he asked Pou several times.
''No,'' she said, according to Thiele. ''You don't have to be here.''
''I want to be here,'' Thiele insisted. ''I want to help you.''
Thiele practiced palliative-care medicine and was certified to teach it. He told me that he knew that what they were about to do, though it seemed right to him, was technically ''a crime.'' He said that ''the goal was death; our goal was to let these people die.''
Thiele saw that morphine, midazolam and syringes had been set up on a table near the A.T.M. There were about a dozen patients, and he took charge of the four closest to the windows -- three elderly white women and a heavyset African-American man -- starting IVs on those who didn't have one. Apart from their breathing and the soft moans of one, the patients appeared ''lifeless'' and did not respond to him. Thiele saw Pou and several nurses working on patients lying near the hallway.
Thiele wavered for a moment. He turned to Karen Wynn, the I.C.U. nurse manager at Memorial who led the hospital's ethics committee. ''Can we do this?'' he remembers asking the highly respected nurse.
Wynn felt that they needed to medicate the patients, she said when she described her experiences publicly for the first time in interviews with me over the past year. She acknowledged having heard rumors that patients were being euthanized, but she said no one had told her that that was what was happening to these patients and that her only aim was to make patients comfortable by sedating them. Wynn said she did not fear staying in the hospital after the 5 p.m. curfew announced by the State Police -- she had already decided to ignore the evacuation deadline and stay at the hospital until everyone alive had been taken out. Instead, she said, she was motivated by how bad the patients looked.
Wynn described turning to an elderly woman who was unconscious with labored breathing. She then prepared a syringe with morphine and midazolam, pushed it slowly into the woman's IV line and watched her breathing ease. The woman died a short time later, which didn't disturb Wynn because she had appeared to be close to death. Wynn told me that at that point all the staff could offer was ''comfort, peace and dignity.'' She said: ''We did the best we could do. It was the right thing to do under the circumstances.''
She added: "But even if it had been euthanasia, it's not something we don't really do every day -- it just goes under a different name.''
Thiele gave other patients a shot of morphine and midazolam at doses he said were higher than what he normally used in the I.C.U. He held their hands and reassured them, ''It's all right to go.'' Most patients, Thiele told me, died within minutes of being medicated. But the heavyset African-American man didn't.
His mouth was open, his breathing was labored and everyone could hear his awful death rattle. Thiele tried more morphine. He tried prayer. He put his hand on the man's forehead; Wynn and another nurse manager took the man's hands in theirs. Together they chanted: ''Hail Mary, full of grace. The Lord is with thee.'' They recited the Lord's Prayer. They prayed for the man to die.
The man kept breathing, and Wynn says she and her colleagues took that as a sign. ''God said, 'O.K., but I'm not ready for him.' Or he wasn't ready.'' She remembers passing him through the hole in the machine-room wall on his way to the evacuation helicopters.
Thiele has a different memory of what happened. ''We covered his face with a towel'' until he stopped breathing, Thiele told me. He says that it took less than a minute for the man to die and that he didn't suffer. ''This was totally against every fiber in my body,'' Thiele told me, but he also said he knew what he did was right. ''We were abandoned by the government, we were abandoned by Tenet, and clearly nobody was going to take care of these people in their dying moments.'' He added, ''I did what I would have wanted done to me if the roles were reversed.''
Both Thiele and Wynn recall that they, Pou and the other nurses covered the bodies of the dead and carried them into the chapel, filling it. Thiele said the remaining bodies were wrapped in sheets and placed on the floor in the corridor and in a nearby room.
''It was very respectful,'' Thiele told me. ''It's not like you would think.''
That afternoon, Memorial's pathologist and laboratory director walked though the hospital, floor by floor, to record the locations of the dead and make sure that nobody alive was left behind. They found Pou on the seventh floor with a nurse. Pou was working on the IV of a patient who seemed barely alive. The laboratory director told investigators that Pou asked for help moving the patient; the pathologist remembered it differently and said in a deposition that he offered Pou help with evacuating the patient, but Pou did not respond, and later, when he asked her again, she said she needed to speak with an anesthesiologist first.
Dr. John Walsh, a surgeon, told me that he was sitting on a bench, too tired to move, when Pou and the pathologist came downstairs. Pou looked upset. She sat down beside him. ''What's wrong?'' he asked. He said she mentioned something about a patient, or patients, dying and about someone, or some people, questioning her.
Walsh had known Pou for about only a year, but he knew, he told me, that she was compassionate and dedicated to her patients. ''I'm sure you did the right thing,'' he remembers telling her. ''It'll work itself out. It'll all turn out O.K.''
End of Part Three