Natural disaster, unnatural deaths: the killings on the life care floors at Tenet's Memorial Medical Center after Hurricane Katrina.

• Author: Lugosi, Charles I.

ABSTRACT: This article examines the meaning of the killing of four patients with disabilities on the Life Care ward of Tenet's Memorial Medical Center in New Orleans in anticipation of hurricane Katrina. None were terminally ill. None were in pain. None knew their lives were about to end. None were evacuated. The victims had one thing in common: they all had chosen to be designated as Do Not Resuscitate (DNR) patients.

All were killed with overdoses of medications that had not been prescribed for them. Dr. Daniel Nuss of the Louisiana State University School of Medicine and Dr. Floyd Burras, President of the Louisiana Medical Society defend the doctor's actions as involuntary euthanasia or mercy killing. Was this euthanasia, or homicide? At Memorial, the term DNR took on a new meaning--Do Not Rescue. In this new Memorial model, patient autonomy to control and choose one's medical treatment, yields to the physician's unilateral power to arbitrarily decide who lives and who dies. The author concludes that doctors and hospitals must observe the rule of law, even in times of natural disaster.

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On July 18, 2006, Louisiana Attorney General Charles Foti announced the arrests of three white females, Dr. Anna Pou and Nurses Lori Budo and Cheri Landry, who are accused of murdering four black patients on the Life Care ward on the seventh floor of Tenet's Memorial Medical Center in New Orleans (herein called "Memorial"), by injecting them with lethal doses of morphine and midazolam (the generic form of Versed). (1) The victims were Emmett Everett Sr. (age 61); Hoffis Alford (age 66); Ireatha Watson (age 89); and Rose Savoie (age 91). (2)

All of these victims were expected to live, as none were in danger of imminent death from natural causes. (3) Rose was ill from bronchitis, but otherwise in good health. (4) Her daughter, Jennie Crabtree said, "She didn't act like a 90 year-old; she was all there. She knew where she was. She knew who she was." (5) Emmett "could have lived for years. All he wanted was to live to be with his grandkids." (6) Ireatha was ill from gangrene in both legs and dementia, but she was in stable condition when last visited by her daughter, two days before Katrina hit. (7) She was scheduled to have her legs amputated on August 29, the day the hurricane arrived. (8)

None of the victims were in pain, and thus did not require any medication like morphine or Versed. (9) There were no orders on the victims' medical charts for the prescription of either morphine or Versed. (10) These drugs had not been given previously to these patients as part of their routine care. (11) None of the victims knew their lives were about to end.

No consent was sought or given for these lethal drugs. (12) It seems as though the victims were lied to. Pou told Everett she was going to give him something for his dizziness, even though he was conscious and alert. (13) Rose complained, "That burns," when injected with the deadly drugs. (14) None of these victims were under the care of Pou or nurses Budo and Landry. (15) One witness observed that Pou did not appear familiar with the condition of the Life Care patients. (16) Pou was heard to say "a decision was made to administer lethal doses" to patients on the seventh floor of the hospital. (17) She did not identify the decision maker, but did say the Life Care staff was not involved at all. (18) Dr. Pou further stated "there is no telling how far this would go," and "I want y'all to know I take full responsibility and ya'll did a great job taking care of the patients." (19)

The killings occurred on September 1, 2005, two days after hurricane Katrina left the hospital with no electricity and water from broken levees flooded the surrounding streets. (20) There was no air conditioning and windows were broken by nurses to seek relief from temperatures that peaked at 110 degrees. (21) With the heat came the stench of human waste. There was no water. The telephones did not work. Food was limited. At night it was pitch black. Nurses fanned patients. Ventilators did not work. Patients were at risk of dying from dehydration and there was confusion over evacuation plans for those who were difficult to move, like Everett who was paralyzed and weighed 380 lbs. (22) A rumor spread that no organized rescue was coming, and the medical team became demoralized. (23)

Similarly, very difficult conditions were faced by all the hospitals in New Orleans, yet at one, the Memorial Hospital, the bodies of 45 patients were discovered in its morgue on September 11, 2005 by the Disaster Mortuary Operations Team. (24) Twenty five of the deaths appeared to be suspicious, not caused by natural causes. No other hospital in the New Orleans area had apparently authorized the unnatural killings of its patients as a response to a natural disaster. (25)

The victims did have one thing in common: they had all chosen to be designated as Do Not Resuscitate (DNR) patients. (26) This meant that in case of catastrophic change in health, such as a heart attack or stroke, there was a standing order to medical staff to abstain from heroic measures, like a Code Blue, which is a special team response that is designed to save life in exigent circumstances. (27) No one had warned these victims that in case of a natural disaster, hospital administrators would interpret DNR to mean "Do Not Rescue." (28) Angela McManus, a black woman, worried that her mother Wilda would not be evacuated. (29) Wilda was critically ill on the seventh floor. (30) Angela overheard nurses openly discussing who would be evacuated and who would not. (31) Apparently a decision was made not to evacuate the DNR patients. (32)

Rather than participate in this plan, Dr. Bryant King, a contract physician Employed by Memorial, chose to abandon his patients rather than to do them harm. (33) Just before the killings, an unnamed physician told King that a hospital Administrator had decided that some patients would be "put out of their misery." (34) The physician then told King that another physician volunteered that "she'd be willing to do it." After this conversation, King noticed a marked change: "there were no more fanners, there were no more nurses checking blood sugars or blood pressures ... It didn't make sense that we were stopping what we had been doing." (35) King observed Pou with a handful of syringes talking with patients, saying, "I'm going to give you something to make you feel better." (36) This was a strange departure from protocol because physicians didn't give medications unless there was a critical need for the physician to give the medication) (37) King left the hospital and passed on this information to the media and to law enforcement officials. (38) Pou herself evacuated the hospital and gave a statement to a Baton Rouge television station "There were some patients there who were critically ill who, regardless of the storm, had the orders of "do not resuscitate. We all did everything in our power to give the best treatment that we could to the patients in the hospital to make them comfortable." (39)

The autopsy results showed that none of these four victims were terminally ill. (40) The forensic pathologist concluded that all four had lethal doses of morphine in their bodies that far exceeded any dose consistent with "comfort care" for the dying. (41) While all four victims also had midazolam in their bodies, two of them had a concentration of this drug that exceeded normal therapeutic doses. (42)

The same day the bodies were recovered, the British newspaper, the Daily Mail ran a sensational story about its interview with an unidentified New Orleans doctor who admitted to killing patients. (43) The doctor (presumably Pou) Reportedly stated:

I didn't know if I was doing the right thing. But I did not have time. I had to make snap decisions, under the most appalling circumstances, and I did what I thought was right.... I injected morphine into those patients who were dying and in agony. If the first dose was not enough, I gave a double dose. And at night I prayed to God to have mercy on my soul ... This was not murder, this was compassion. They would have been dead within hours, if not days. We did not put people down. What we did was give comfort to the end. (44) When interviewed by Morley Safer on 60 Minutes on September 24, 2006, Dr. Pou denied that she was guilty of murder: "No, I did not murder those patients ... I do not believe in euthanasia. I don't think it's anyone's decision to make when a patient dies. However, what I do believe is comfort care. And that means that we ensure that they do not suffer pain." (45)

The granddaughter of one of the victims, Rose Savoie writes: "We were told she [Rose] would be taken care of and safer with the care she was under. She was still very much alive and had her mind. She was probably weak, so were all who were fighting for their lives, but MURDER was not the answer." (46)

Is Dr. Pou "a hero," as viewed by Dr. Daniel Nuss, who hired Dr. Pou at the Louisiana State University School of Medicine and is raising money to pay for her legal defense? Dr. Floyd Burras, President of the Louisiana Medical Society defended Dr. Pou, claiming she worked under battlefield conditions, that she put her patients first, and kept with the highest principles of the medical society. (47) The American Medical Association called Dr. Pou's actions heroic and opposed any attempt to characterize her medical judgments as criminal. (48)

Or is she a murderer, "who took the law into her own hands," as portrayed by Attorney General Charles Foti, who authorized the arrests of Pou, Budo and Landry? (49) Foti stated: "This is not euthanasia. This is homicide. We're...