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Hurricane Katrina and the Deadly Choices at Memorial Medical Center
On September 1, 2005, inside a flooded New Orleans hospital, doctors and nurses made a choice that ended in homicide charges: they injected dying patients wit…
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On September 1, 2005, inside a flooded New Orleans hospital, doctors and nurses made a choice that ended in homicide charges: they injected dying patients with morphine and midazolam to hasten their deaths. This is what happened at Memorial Medical Center, and why nurses still argue about it.
It started the morning of August 31. The generators failed, the lights died, and the ventilators and monitors switched to battery reserves that would not last. Floodwater had drowned the lower floor where the power source sat, cutting the building off completely. Nearly 2,000 people, patients, staff, and families, were trapped inside with at least 180 patients to evacuate and no clear way out.
Half an hour after the lights went, the ventilators fell silent. Patients were carried to the second floor to wait for the Coast Guard while nurses hand-ventilated them with Ambu bags for hours and fanned them with cardboard. Some patients lay on soiled stretchers on the floor of the parking garage. Patients who could still move volunteered to bag the ones who could not. The chapel became a makeshift morgue, and exhausted nurses cried in the corners.
By the fourth day, clean water was scarce and medications were running low. Staff opened charts and triaged: patients were marked 1, 2, or 3 on paper taped to their chests. The 1's, who could still walk, went first. The 2's, sicker and needing help, waited in the corridors. The 3's were the critically ill, most of them already on DNR orders before the storm.
That afternoon, Dr. Ewing Cook, a 61-year-old pulmonary specialist newly moved into hospital administration, surveyed the third-floor ICU. He asked a nurse to increase the morphine for Jannie Burgess in a way that would slow her breathing and let her go faster. Burgess was already on DNR and was getting morphine for comfort.
Outside, helicopters took 45 minutes per run, lifting patients up flights of stairs in the dark, through a three-by-three-foot opening to a parking garage, onto a truck, then up two more flights to the helipad. People on the floodwater begged to get inside, but the staff could not let them in without breaking what little supply they had. The air conditioning was dead, the temperature inside topped 110 degrees, and the smell of the dead, as one staffer put it, would burn the back of your throat.
Four nurses stayed with Jannie Burgess, the last patient in the ICU. She was 79, swollen with fluid from her condition, and weighed about 240 pounds. Cook looked at her and decided he would not drag someone that heavy to the evacuation point and tie up nurses the floor needed. "Give her enough morphine till she goes," he said. He opened her chart, wrote "pronounced dead at," left the time blank, signed it, and left.
This was 48 hours after a category 3 hurricane named Katrina hit. Memorial was supposed to be a shelter. Instead, some of its doctors and nurses agreed to hasten the deaths of critically ill patients on DNR to thin the list of people they had to evacuate.
The death of the laws of man
Of the 45 bodies recovered from the hospital, 41 were tested in toxicology, and 23 came back positive for morphine, the sedative midazolam (Versed), or both. Several showed higher than normal levels, which is what drew investigators. Most were on DNR status, though the patients' records and diagnoses were never released publicly to confirm it.
Memorial held about 187 patients, roughly 600 medical staff, 500 family members, and the pets the families brought in. It also housed LifeCare, a "hospital within a hospital" on the seventh floor that cared for the very sick, many on long-term ventilation. LifeCare had 52 patients waiting to evacuate and few DNR cases, since its patients were not under hospice care. When the disaster hit, medical-department chairman Richard Deichmann decided the DNR patients had the least to lose and ordered them evacuated last.
A DNR order means a patient is not to be resuscitated if the heart or breathing stops. Inducing death with a medication overdose is a different thing entirely.
"This was totally against every fiber in my body," recalled Dr. John Thiele, who helped administer the high morphine doses to category 3 patients. "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."
Coast Guard and private helicopters were landing on an unused helipad atop an eight-story garage next to the hospital. Martial law was in effect, gunshots cracked through the city, and pilots pushed everyone to move faster. Thiele was certain the people firing guns outside would eventually break in.
The Coast Guard ordered everyone still alive evacuated by 5:00 on the afternoon of September 1, 2005. It was the final rescue attempt, and anyone left behind would be on their own. After a doctor euthanized the pets, Dr. Susan Mulderick decided the same logic could apply to the patients who would not survive the wait. She took the plan to Dr. Anna Pou, a head and neck surgeon respected by staff, and it was carried out.
Cook had already worked out the mix with Pou: 10 mg morphine and 5 mg midazolam to cut respiration so patients would gradually stop breathing. Thiele, managing about 24 patients on the second floor, watched Pou arrive with two nurses, Cheri Landry and Lori Budo, carrying vials and syringes. Pou moved among the category 3 patients, injecting their IVs.
"I will give you something for the pain," she told one. "I have something to make you feel better," she said to another. Patients who had struggled to breathe for hours went quiet. Pou flipped through charts, checking diagnoses, deciding who was a candidate.
"Can we do this?" Thiele asked Karen Wynn, the ICU nurse manager who also chaired the hospital's bioethics committee. "Do we really have to do this?" Wynn had spent her career in the ICU. She believed the outcome was already set, that these patients would not make it, so she saw no reason to prolong it. She mixed saline with 10 mg morphine and some midazolam, pushed it into the IV of an elderly woman in labored breathing, and half an hour later the patient died.
Thiele offered to help. Pou refused at first, but he insisted. "I want to be here," he said. He took a syringe and pushed the medication into a patient's IV, telling himself he had eased their suffering. Some nurses watched and protested, one weeping as she gave a patient a last hug. Others let their silence speak.
Not everyone agreed. Bryant King, an internal medicine specialist, refused. "I disagree 100%. The idea was stupidity itself," he said. Two days after the flood, he argued, most patients were hydrated and managed on small doses of painkillers, and hastening their deaths was a wild overreaction.
Wait for divine intervention, or become the instrument of it?
"Who are they to play God?" some asked. No one can reliably predict how a patient will do, and recovery is always on the table. Who looks like a candidate for impending death is a subjective call, and triage in disasters is still imperfect. There are guidelines, but plenty of gray area, and what one clinician decides another might not. What unsettled people most was that a handful of staff decided who would die without consulting families or reaching any broad consensus. The intent may have been good. The what-ifs never close: what if they had waited a little longer, and what if rescue had arrived in time?
Hospitals plan for storms, floods, supply shortages, and civil unrest. Memorial showed there was no plan for all of them hitting at once. The case exposed the gaps so they could be fixed, and it was a hard reminder that no one is ever 100 percent ready for every disaster.
Medically ethical or mass murder?
In fairness to the staff, they worked around the clock through the evacuation and delivered the best care they could under the conditions, saving all 16 critically ill infants in the neonatal unit and most of the pregnant patients along with elderly patients who needed oxygen and intervention. By the end of day five, everyone still alive at Memorial, patients and staff, was rescued. A week later, when the mortuary team recovered the bodies, the count of 45 stood out: the highest hospital death toll in Louisiana from the storm, and enough to raise suspicion about what had happened.
Immunity against prosecution
Nearly a year later, in July 2006, Dr. Anna Pou, Cheri Landry, and Lori Budo were arrested on four counts of being principal to second-degree murder. Louisiana attorney general Charles Foti called it bluntly: "This is not euthanasia. This is plain-and-simple homicide. I would probably say there will be more arrests." Pou went on national television to say she was not a murderer and had given the drugs only to provide comfort.
The case gripped the country, and public support swung behind Pou. Speakers worried that prosecuting workers who had served through a disaster would drive doctors and nurses out of the state. Dr. James Young, president of the American Academy of Forensic Sciences, wrote: "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."
One case stood out: Emmett Everett, a 61-year-old LifeCare patient found with both drugs in his system. Witnesses said he had fed himself breakfast that Thursday and asked his nurses whether they were "ready to rock and roll." He weighed 380 pounds and was partially paralyzed. Staff reportedly decided he was too heavy to move, though Pou's attorney argued he died of a heart attack from cardiomegaly, not the injection. The coroner, Frank Minyard, came to believe the women had not intended murder but had acted out of desperation and goodwill.
The prosecutor dropped the charges and sent the matter to a grand jury, which declined to indict. One juror reasoned that no one had testified to seeing Pou inject a patient and the evidence was thin, though the jury concluded a crime had been committed that September 1. After her release, Pou campaigned to reform the laws on immunity for medical workers acting under disaster protocol, and Louisiana passed legislation protecting them.
People work in medicine and still get bombarded by situations no oath prepared them for. The staff at Memorial acted on what they had left in an impossible week: a read on who would survive, and the intent to spare suffering. Whether that read was theirs to make is the question that has never gone away.
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