Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (57 page)

ICU nurse Cathy Green took action as soon as Budo’s daughter called her about the arrests. Green was appalled and panic-stricken for her friends. She mustered her colleagues—“We have to do something about this!”—arguing that Foti had attacked the integrity of every one of them who had worked during the storm. And where had his helicopters and boats been when they needed help?

Green went on an errand with Budo and met her lawyer, Eddie Castaing. A criminal lawyer. It was unbelievable. She sat down beside him and looked him in the eyes. She asked him if he had any idea who he
was representing. “These are not ordinary people, these are
great
people. Truly, I will not live long enough to be as good a nurse as they are.”

Most of the other nurses now shied from the media, but Green went on the record with reporters, unafraid of sounding hyperbolic: “They are, bar none, the best nurses we have. If my daughter had been in that storm and needed care, those are the nurses I would have handpicked to take care of her. And had she died in the storm, I would never have looked at them and said, ‘You did the wrong thing,’ ever.”

The nurses’ supporters filled an Internet home page with testimonials to their exemplary careers and a description of the horrors of Katrina at Memorial and the personal sacrifices made.

“Tragically, the rescue helicopters and boats that finally arrived were too few in number and far too late to save some of our patients—and THAT is the crime that happened in our hospital,” the website said. “Please join us as we offer our full support and love to Cheri and Lori. They are not criminals, they are battlefield heroes!”

ONE DOCTOR who was certainly not on the support team was Cyril Wecht, the well-known forensic pathologist from Pittsburgh whose determinations of homicide had cinched the arrests. About a month after they occurred, on a Sunday evening in August, Virginia Rider picked him up at the airport for
a three-day meeting with Orleans Parish coroner Frank Minyard.

Wecht came to assist Minyard in classifying the cause and manner of all of the suspicious Memorial and LifeCare deaths, and Minyard promised in return to leaven his New Orleans nights with wine and oysters. Minyard, a loyal friend, kept Wecht involved in the case even as the pathologist awaited trial on the federal charges of public corruption brought against him months earlier (years later all charges would be dropped). Perhaps in part because of this cloud over Wecht’s reputation,
Minyard had also invited to the meeting and oysterfest Dr. Michael Baden, another prominent forensic pathologist.

The men gathered that Monday morning in Minyard’s new quarters at the vacant Good Citizens Rhodes Funeral Home, a single-story concrete building with boarded-up row houses and a wig shop as neighbors. Minyard’s ruined offices in the basement of the stately criminal courts building had not been repaired.

The importance of the meeting was clear. Attorney General Foti was not in charge of prosecuting the cases, District Attorney Jordan was, and he had made it plain that he wanted the coroner’s classification of the deaths before bringing the cases to a grand jury for possible indictments. As of that moment, Minyard and his assistants had kept most of the patient death certificates from LifeCare and Memorial “Pending Investigation” or, less commonly, “Accident” by a tick in a checkbox. “Hurr. Katrina Related Death,” some said.

The experts sat around a large table and began considering evidence. Rider and two nurses who had worked the case in the fraud unit with her had prepared charts and tables depicting the drugs found in each body. Robert Middleberg, the director of the Pennsylvania toxicology laboratory where the autopsy samples were tested for drugs, joined them to present his results.

Pou, Budo, and Landry had been arrested on the basis of four deaths, but twenty-three of the forty-one bodies from Memorial and LifeCare analyzed by Middleberg’s lab had tested positive for morphine or midazolam, or both. Middleberg had handled thousands of cases in his career, and the drug concentrations found in many of these patients seemed high to him, made him say to himself, “These numbers are sticking out, sort of like a sore thumb.”

Still, interpreting toxicology results from tests on postmortem tissues was not as straightforward as interpreting blood tests in living patients. The fact that the bodies had sat out in the heat for so long before being sampled could have changed the concentrations of the drugs. Middlebelrg
advised his colleagues to consider each patient’s clinical history in conjunction with the lab numbers. The group began poring through the available medical records, case by case.

There were many questions to consider. Did the findings suggest that the patients received a single massive dose of the drugs shortly before death, or repeated doses that allowed the drugs to accumulate, particularly in patients with problems like kidney failure or liver disease, which would have made it difficult for their bodies to process certain drugs? Would the morphine-midazolam drug combination have been contra-indicated in patients with these medical problems? Would large doses of these drugs, known to suppress breathing, be dangerous to any patient not on a respirator? How long would it take for the drugs to decrease the breathing rate and blood pressure, and did this match up with the times of the deaths, to the extent these were known?

The experts went over evidence related to LifeCare patient “Miss Alice” Hutzler, the ninety-year-old nursing-home resident who was being treated for pneumonia. Morphine and midazolam were found in her liver, brain, and muscle tissue, but neither drug had been prescribed, according to her chart, which was kept current until a few hours before her death was recorded on Thursday, September 1, by pathologist Skinner. She had been “resting comfortably” on Wednesday afternoon, and that night her nurses didn’t document any complaints of pain or distress that indicated a need for 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 September 1, and all were listed as dead by Memorial’s pathologist that afternoon.

“Homicide,” Wecht wrote on a sheet of paper under Hutzler’s name, 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, Kathryn Nelson’s mother, Elaine, whose
records indicated she was close to death on Thursday morning, he marked as “Undetermined.” Baden thought all nine were homicides.

The group also considered the deaths on the eighth floor in the ICU. Jannie Burgess was the seventy-nine-year-old nurse with advanced metastatic uterine cancer who had been found by Dr. Ewing Cook when he climbed the stairs in the heat on Wednesday, August 31. Burgess’s medical chart showed that a nurse gave her 15 mg of morphine seven times on Wednesday between 2:10 p.m. and 3:35 p.m., based on spoken orders from Cook. This amount—105 mg over one and a half hours—was more than five times the maximum she had ever received in an entire day during her hospitalization, according to her chart. She had received morphine only irregularly in small doses as needed for pain, at most once an hour and typically only two to four times a day. The largest dose a nurse had ever documented giving her at once was 6 mg. From seven that morning until Cook’s arrival that afternoon, a nurse had only seen the need to give her a single injection of 4 mg. But because she had already been receiving some amount of 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 and recommended that she not be included in any legal case. The bodies of two of the three other ICU patients who were left behind with Burgess after the other ICU patients were airlifted also tested positive for morphine, but at lower concentrations, and Wecht did not consider these homicides.

Besides the nine patients who remained on the LifeCare floor and Burgess, the group also reviewed nine Memorial and LifeCare patients whose deaths were recorded by pathologist Skinner on the second-floor lobby during the evacuation on Thursday, September 1. Every one of them, plus a tenth, Merle Lagasse, tested positive for midazolam and five of them for morphine, too. Among the dead were the three patients whose prescriptions for large amounts of morphine were signed by Anna Pou and found during the search warrant, including Carrie “Ma’Dear” Hall,
former truck driver Wilmer Cooley, and forty-one-year-old engaged mother of four Donna Cotham. (Despite their morphine prescriptions, two of the three tested positive for midazolam only, not morphine.) On the autopsy report the experts reviewed, Cotham had a recent needle-puncture wound in the crook of her left arm, but her decomposed body revealed little evidence of her severe liver disease.

Essie Cavalier, the stroke patient who said “Mama” and whose former nurse had been upset by what she saw being done to her on the second floor, had also died and had what Wecht considered high levels of morphine and midazolam in her tissues. Wecht marked her death and many of the other second-floor patients’ deaths as likely homicides, too, pending review of hospital records. But Rider and her colleagues still had not managed to obtain many of those records. Tenet had turned over most of the LifeCare charts but, according to
correspondence from one of its attorneys, had been “unable to locate” records of many of the Memorial patients who died on the second floor “despite diligent efforts.” He suggested the charts might have been removed with the patients’ remains. Rider had checked with a mortuary worker who had helped remove the bodies and was told the records were not taken.

Dr. Horace Baltz’s longtime patient was found not to have had morphine or midazolam in her system. Only traces of Tylenol and her anti-Parkinson’s drug were found, suggesting that her death had been a natural, if unexpected, one. About five of the forty-five bodies found at the hospital had, available evidence suggested, been of patients whose deaths occurred just before the disaster. In addition to the forty-five adult bodies, seven apparently stillborn specimens had been recovered from the hospital—they did not consider them.

Five patient bodies did not have toxicology test results. At least one of those, a Memorial patient, had been found deceased on the second floor by the ATM on Thursday afternoon, September 1, after having been seen alive there by the infectious diseases doctor that morning. She had
an IV catheter in her right forearm at autopsy. It was frustrating to think they might never know whether she, too, had received the drugs.

The first day of the meeting passed with no participation from the district attorney’s office. Hearing firsthand from the experts was apparently not a priority for those who might be presenting the case to the grand jury. On the second day, two assistant district attorneys finally showed up. The lead prosecutor on the Memorial case was a young, dark-haired man with slightly crossed eyes, Assistant District Attorney Michael Morales. He had prosecuted homicides for only about two years and arrived at the coroner’s office with his boss, ADA Craig Famularo.

“Whaddya have?” one of them asked.

Their manner—particularly the short, testy Famularo’s—struck Rider and the two forensic pathologists as unusually hostile. The experts were accustomed to ass-kissing from prosecutors, but these attorneys acted suspicious, skeptical, and uninterested. The lawyers left after about half an hour. “Obviously these guys don’t want to do anything,” pathologist Baden commented to coroner Minyard. Minyard, in contrast, seemed to agree with the experts that many deaths at Memorial were homicides. What was striking was the pattern. Almost every patient who died after the helicopters and boats arrived on Thursday morning and whose bodies were tested—including all nine patients on the LifeCare floor, nine on the second-floor lobby, and Merle Lagasse—were positive for the drugs.

MICHAEL MORALES HAD been following the pleadings in the case for his boss, District Attorney Eddie Jordan, since the previous fall when Pou’s attorney, Simmons, had sued to keep her post-storm conversations with the Tenet attorney private. While Simmons sent Morales courtesy copies of his filings in the case as it proceeded, the attorney
general’s office usually did not. Unlike in the Medicaid fraud unit, where investigators and prosecutors worked in teams, at the district attorney’s office, prosecutors typically did not get involved in the investigation of a case—usually conducted by police—unless specifically requested to do so by the investigative agency. The attorney general’s office had not sought to involve Morales in the Memorial investigation. Now he was realizing what a big job lay ahead of him.