Katrina Aftermath: The Deadly Choices at Memorial - Part Four
Sheri Fink | , ProPublica | 5/9/2010, 11:22 a.m.
Originally Published in the New York Times Magazine
Part Four in a Five-Part Series
Throughout the day, boats and helicopters drained the hospital of nearly all of its patients and visitors. At around 9 p.m., Rodney Scott, the obese I.C.U. patient who was recovering from surgery and heart trouble, at last felt himself being hoisted up the open metal steps to the helipad. Weighing more than 300 pounds and unable to walk, Scott was the last living patient to leave the hospital grounds. He felt relief.
The four men surrounding him shouted, ''Push! Push!'' and rolled his heavy wheelchair into a Coast Guard helicopter. Evacuating someone as large as Scott had a cost -- a nurse was briefly pinned against the helicopter, bruising his ribs and spleen -- but it had been done.
Scott, Thiele and Wynn were flown separately to Louis Armstrong New Orleans International Airport, where their ordeals continued. Hundreds of hospital and nursing-home patients had been dropped there from across the disaster zone; they were met by federal disaster-management teams that were so understaffed and undersupplied that they couldn't provide even basic nursing care to many patients. Reflecting on the scene at the airport, Thiele told me that if the patients he injected with drugs had made it there, ''They wouldn't have survived.''
The Coroner's Dilemma
On Sunday, Sept. 11, 2005, 13 days after the storm hit, mortuary workers recovered 45 decomposing bodies from Memorial Medical Center. The next day the Louisiana attorney general, Charles Foti Jr., opened investigations into hospital and nursing-home deaths during Hurricane Katrina. The Justice Department's phones were soon ringing with allegations of patient abandonment and euthanasia.
One of the people who called was a LifeCare lawyer who relayed a report that nine of the company's patients may have been given lethal doses of medicines by a Memorial doctor and nurses. State and federal investigators interviewed LifeCare witnesses and descended on the mold-ridden hospital to search for evidence. Separately, Foti's staff asked the Orleans Parish coroner, Dr. Frank Minyard, to perform autopsies and drug tests on approximately 100 bodies that were recovered from more than a half-dozen hospitals and nursing homes in New Orleans.
The burden was unwelcome for Minyard, a 76-year-old obstetrician-gynecologist who was already struggling to oversee the autopsies and identification of hundreds of hurricane victims. Minyard was inspired by a Catholic nun to devote his life to public service. For 31 years as the city's elected coroner, he peered into bodies in the basement office of the colonnaded criminal courthouse, emerging in cowboy boots and white suits to play jazz trumpet at city charity events. As New Orleans flooded, Minyard says, he got out of his car and swam to work. He was trapped there for four days.
After autopsies were done and specimens removed, workers at National Medical Services, a private laboratory in Pennsylvania, quickly detected morphine in nine bodies -- the same nine patients LifeCare staff identified as potential victims.
The attorney general's office hired a forensic pathologist, Cyril Wecht, who worked on the John F. Kennedy assassination case and the O.J. Simpson murder trial, to review evidence in the deaths of four patients whose full toxicology reports and medical records they obtained first: Emmett Everett, Rose Savoie and two other LifeCare patients. Wecht concluded that all four deaths were homicides, caused by human intervention.
After months of conducting interviews and collecting documents, investigators came to believe, they said, that doctors and nurses euthanized as many as two dozen patients at Memorial. But medical records were needed to substantiate the findings, and according to investigators, Tenet's lawyers said that many of those belonging to Memorial patients were unavailable.
(The Tenet spokesman said via e-mail that Tenet produced all records in its possession.) Armed with the testimony of LifeCare workers and the medical records of the four patients on the seventh floor, state prosecutors decided their strongest case was against Anna Pou, Cheri Landry and Lori Budo for those deaths.
At about 9 p.m. on July 17, 2006 -- nearly a year after floodwaters from Katrina swamped Memorial hospital -- Pou opened the door of her home to find state and federal agents, clad in body armor and carrying weapons. They told her they had a warrant for her arrest on four counts of principal to second-degree murder.
Pou was wearing rumpled surgical scrubs from several hours of surgery she performed earlier in the day. She knew she was a target of the investigation, but her lawyer thought he had assurance that she could surrender voluntarily. ''What about my patients?'' she asked reflexively. An agent suggested that Pou call a colleague to take over their care. She was allowed to freshen up and then was read her rights, handcuffed and ultimately driven to the Orleans Parish jail. On the way, she prayed silently. (Landry and Budo were arrested the same night.)
Pou was booked and released after midnight. The next day the attorney general, Foti, held a news conference carried on CNN, which had broken some of the initial reports of the investigation and the possible euthanasia at Memorial. ''This is not euthanasia,'' Foti said emphatically. ''This is plain and simple homicide.''
At a news conference later that day, Pou's lawyer blamed the storm -- not Pou -- for the deaths. He said his client was innocent and accused Foti, who was about to run for re-election, of orchestrating a media event with the arrests. He announced his intention to bring the results of his own investigation to the Orleans Parish district attorney, whose office had jurisdiction over the case after the arrests and would bring it before a grand jury.
As the government investigation progressed, Carrie Everett, Emmett Everett's widow, spoke out on CNN. After Katrina she searched for her husband for two weeks before learning that he was dead. She filed wrongful death lawsuits against Tenet, LifeCare, Pou, Landry and Budo.
''Who gave them the right to play God?'' Mrs. Everett demanded. ''Who gave them the right?''
A successful murder prosecution in Orleans Parish typically requires a coroner's medical determination of homicide -- that a death was caused by the actions of another human being -- without regard to fault or legal responsibility. It is a step toward a criminal finding of homicide, in which a Louisiana court assigns fault for a killing.
Minyard, the coroner, brought together Cyril Wecht, Michael Baden -- another well-known forensic pathologist -- and Robert Middleberg, the director of the toxicology laboratory where the autopsy samples were tested, to discuss the toxicology findings. Minyard's flood-ravaged offices still hadn't been repaired, so they met for three days in his temporary quarters in a vacant funeral home.
Records showed that more than half of the 41 bodies from Memorial that were analyzed by Middleberg's lab tested positive for morphine or midazolam, or both. Middleberg had handled thousands of cases in his career, and the high drug concentrations found in many of the patients stuck out ''like a sore thumb,'' he told me.
The group considered the 90-year-old pneumonia patient Alice Hutzler, whom the LifeCare nurse Gina Isbell had promised to care for during the hurricane. Morphine and midazolam were found in her liver, brain and muscle tissue, but neither drug had been prescribed, according to her chart, which contained notes until the night before her death on Sept. 1. That chart showed that she was ''resting calmly'' the previous afternoon, and during the evening her nurses did not document any complaints of pain or distress that indicated she needed the drugs.
Hutzler was one of the nine LifeCare patients found on the seventh floor with one or both drugs in their systems. All were seen alive the morning of Sept. 1, and all were listed as dead by Memorial's pathologist that afternoon.
''Homicide,'' Wecht wrote on a sheet of paper with Hutzler's name on top, underlining it twice. ''Homicide,'' he wrote for seven of the eight other seventh-floor patients, including Emmett Everett, Wilda McManus and Rose Savoie. The last patient, whose records indicated she was close to death, he marked as undetermined. Baden said he thought all nine were homicides.
The group considered one death on the eighth floor in the I.C.U.: Jannie Burgess was the comatose patient who was found by Ewing Cook when he climbed the stairs in the heat on Wednesday, Aug. 31. Burgess's medical chart showed that she was given 15 milligrams of morphine seven times on Wednesday between 2:10 p.m. and 3:35 p.m. on spoken orders from Cook. This was more than seven times the maximum dose she was receiving for comfort care. But because she had already been receiving morphine and because of her advanced cancer, she was ''not a clear, strong case,'' Wecht wrote in his notes. He marked her death as undetermined.
Besides the nine patients who remained on the LifeCare floor and Burgess, the group also reviewed 13 Memorial and LifeCare patients whose deaths were recorded by Memorial's pathologist on the second-floor lobby near the A.T.M. and elsewhere. (Other deaths struck investigators as suspicious, but because not all bodies were tested for drugs after autopsy, they were not considered.)
Of those 13, 9 tested positive for midazolam and 4 for morphine, too. Investigators searching the hospital found prescriptions for large amounts of morphine for three of them, including Carrie Hall, the woman who fought hard to survive on Wednesday night. The prescriptions were dated Thursday, Sept. 1, and were signed by Dr. Anna Pou.
Despite Wecht and Baden's strong opinions that the LifeCare deaths were the result of drug injections, Minyard wanted additional information to help him make his decision. He sent the patients' medical, autopsy and toxicology records to three other experts for an independent review.
''Homicide,'' Dr. Frank Brescia, an oncologist and specialist in palliative care, concluded in each of the nine cases. ''Homicide,'' wrote Dr. James Young, the former chief coroner of Ontario, Canada, who was then president of the American Academy of Forensic Sciences. ''All these patients survived the adverse events of the previous days, and for every patient on a floor to have died in one three-and-a-half-hour period with drug toxicity is beyond coincidence.''
A local internal-medicine specialist concluded that while medical records and autopsies for several of the patients revealed medical issues that could reasonably have led to their deaths, most of the patients' records did not. In his report to Minyard, he wrote that it was "evident" that Emmett Everett was "in stable medical status with no clear evidence that death was imminent or impending." (Pou's lawyer says that Everett almost certainly died of an enlarged heart, not an overdose of medication.)
As Minyard deliberated, he continued his own inquiry, inviting several LifeCare administrators to his office for interviews. Their stories focused on Anna Pou. Minyard had never met Pou, but two months after her arrest he watched her defend herself and her nurse colleagues with passion on "60 Minutes." "I want everybody to know that I am not a murderer," she told Morley Safer. "I do not believe in euthanasia."
After the "60 Minutes" story, some of Minyard's longtime colleagues questioned why he was even investigating the case. The day after the CBS broadcast, the American Medical Association released a statement: "The A.M.A. is very proud of the many heroic physicians and other health care professionals who sacrificed and distinguished themselves in the aftermath of Hurricane Katrina."
Minyard told me that after Pou appeared on national television, he had an urge to meet her, to chat over a cup of coffee and try to ''get a handle on her.'' He had done this before with people accused of crimes. ''Science is great, but there is a point where you have to go beyond science; you have to go by your gut feeling, whatever you do.'' He invited Pou's lawyer to bring her to his office for a visit.
Pou sat across from Minyard, ''a very ladylike lady, real Southern charming lady.'' On his desk was a Bible, on his wall a crucifix, and all around them were framed pictures of life in their native city. Soon they were discovering mutual friends and chatting about several members of Pou's large Catholic family with whom Minyard was close. They reminisced about Pou's deceased father, a family doctor who had been especially kind to Minyard and had referred patients to him when Minyard opened his ob-gyn practice.
They talked for about an hour. She told him that she had been trying to alleviate pain and suffering. Given that Pou's lawyer was there, Minyard was careful not to put her on the spot with direct questions about what she had done. The conditions she described at Memorial took him back to the days he spent trapped in the courthouse after Katrina. How precious food and water had seemed. How impossible it was to sleep at night with gunshots echoing all around.
Minyard told me that his feelings were less sympathetic than he let Pou know. He believed he would have at least tried to save Emmett Everett. There must have been a way to get the 380-pound man downstairs, he said he thought. It also bothered Minyard that documentation suggested that few of the elderly patients who died were being treated for pain.
Minyard reached out to the noted University of Pennsylvania bioethicist Arthur Caplan for more advice. Caplan reviewed the records and concluded that all nine LifeCare patients on the seventh floor were euthanized, and that the way the drugs were given was ''not consistent with the ethical standards of palliative care that prevail in the United States.'' Those standards are clear, Caplan wrote, in that the death of a patient cannot be the goal of a doctor's treatment.
Despite all the expert determinations of homicide, Minyard was still struggling with what to tell the grand jury. He consulted one more pathologist, Dr. Steven Karch. Karch had staked his career on advancing the argument that the level of drugs found in a cadaver may have no relationship to the levels just before death.
Karch flew to New Orleans, examined the evidence and concluded that it was absurd to try to determine causes of death in bodies that had sat at 100 degrees for 10 days. In all of the cases, he advised, the medical cause of death should remain undetermined. The coroner said he believed that if the case went to trial, the defense would bring in someone like Karch to provide reasonable doubt.
''We'd lose the case,'' Minyard told me. ''It would not be good for the city, for the recovery. It's just a bigger picture that I had to consider than just that pure basic scientific thing.''
Minyard agonized. Willfully taking a life was ''a very bad, bad thing,'' he thought. ''Only God knows when you're going to die.'' The case occupied Minyard's life, his thoughts and the dreams that awoke him in the middle of the night. He called his experts again and again for support and advice.
End of Part Four