Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (72 page)

Away from the reporters, she called Brenda O’Bryant to share the news. James was still hanging on, sleeping all the time, no longer visibly conscious. The medical people had said there was no reason he should still be alive. Brenda took to calling him “the bionic man.”

“Be sure to tell him right in his ear,” Pou said, “so he’ll know.”

She thanked Brenda for all the prayers James had said for her. “Tell him I’m praying for him.”

Pou continued to practice surgery and went on to become a
popular national lecturer on “ethical considerations” in disaster medicine. In her talks, she rewrote history. “FEMA called us and said we’re taking the airboats at noon,” she said as the keynote speaker at a conference registering nearly a thousand California hospital executives and health professionals, who gave her a long ovation. “So whatever you can get out of the hospital get out because they can no longer stay.” In all the months Virginia Rider and Butch Schafer had investigated events at Memorial, and in all the years of stories journalists had written about the disaster, nobody had made that claim.

Standing on stage, her voice booming through the large hall, Pou said that in addition to no running water there was “no clean water” at Memorial—though investigators found a large amount of bottled water left over after the evacuation—and she asked audience members to put themselves in the position of deciding who should get the last bottle of
drinking water—an employee or a patient, “Who gets it? Who gets the one bottle of water?”—a decision that was never necessary at Memorial.

“The Coast Guard helicopters did arrive,” she said, “late Thursday afternoon.” She spoke as if helicopters had not arrived early on Thursday morning—documented by the pilots, cacophonous, and later recalled by LifeCare staff members present as Pou gathered drugs and supplies to inject the patients (Pou’s attorney, Rick Simmons, counters in a letter: “
The obvious effect of that type of contention would be that the helicopters were awaiting right outside and ready to evacuate patients. This is just not so. […] We flatly deny this new contention of ‘loud helicopters’ during the morning hours”). Pou also did not say that the Coast Guard came to rescue patients on Tuesday afternoon, the day the floodwaters rose, and throughout Tuesday night, and into Wednesday morning—despite Memorial employees having tried repeatedly to send the helicopters away after deciding it was too dangerous to conduct the evacuation in the dark and that staff needed rest. “I should note that, something I didn’t know: Helicopters cannot fly at night,” Pou told the audience, years after a colleague at her Houston fund-raiser had gently tried to relieve her of this mumpsimus.

Embellishing the profound hardships she experienced might have been inconsequential except for the fact that as Pou lectured to medical groups around the country, she used these stories—juxtaposed with the fact of her arrest—to convince her audiences of the need to crusade for immunity laws that would prevent people from suing and prosecuting medical professionals in future emergencies. In her talks, Pou sometimes flashed her mug shot on the screen, but she did not say that she was arrested for having allegedly murdered patients, not for having made the challenging and controversial triage decisions she discussed. In fact, she left out mention of injecting patients entirely. In lectures to hospital executives in Sacramento, disaster preparedness planners in Chicago, doctors in Texas, and attorneys in New Orleans, she did not discuss or explain the decision she and her colleagues made to medicate at least
nineteen patients on Thursday, September 1, all of whom died as helicopters and boats emptied Memorial.

Pou took issue with the AMA’s ethical directive for doctors to serve in emergencies “even in the face of greater than usual risk.” Pou said, “The duty to care sounds easy, great. It’s not always so; it’s more romantic on paper.” Pou concluded her Sacramento talk by sharing her views on handling the media in disasters: “Restrict them and use them to the best of your ability.”

After Attorney General Charles Foti released the forensic experts’ findings to the media, litigation ensued, with dozens of hospital employees fighting—as “Jane Does” and “John Does”—to protect the balance of the Medicaid Fraud Control Unit’s thousands of pages of investigative case records from public disclosure. The
Times-Picayune
and CNN led a multiyear effort to force the state to produce what the organizations viewed as public records. Anna Pou filed a brief supporting the Does’ position that the records should be kept secret. A lower court’s ruling that the records should be released was reversed on appeal, and—after numerous actions that led the Louisiana Supreme Court to consider the issues—in 2012, the Does prevailed. The files remain sealed because courts ruled the case was not over and more prosecutions were possible.

In fiscal year 2009–2010, at Anna Pou’s request, the general fund of the
state of Louisiana paid $456,979.41 in legal fees and expenses for her successful defense, reimbursing the LSU Health Network and the Dr. Anna Pou Defense Fund.

Claims brought against Tenet Healthcare and Memorial Medical Center for deaths and personal injuries as a result of insufficiencies in Memorial’s electrical systems, preparedness, and evacuation plans were certified as a class action and reached jury selection in 2011. (LifeCare settled years earlier with families that sued.) Post-Katrina suits against hospitals, numbering about two hundred, had been allowed to proceed as general negligence actions, as opposed to medical malpractice actions that would have capped damages. The class action suit against Memorial and Tenet was settled before trial for $25 million with
no admission of wrongdoing. The settlement was to be divided among patients, visitors, family members, and others at the hospital during and after Katrina who wished to take part, including LifeCare staff (Memorial employees were excluded according to provisions of Louisiana workers’ compensation law). It took until 2013 for the checks to be distributed—more than seven years after Katrina, in a case some referred to as a “full employment act” for disaster-struck New Orleans attorneys. Many families objected in court to what they considered meager compensation for the suffering they and their loved ones endured.

In order to receive money, those eligible had to submit a notarized claim form indicating whether physical or emotional injuries were suffered. Funds were divided among three categories: patients who died, patients who survived, and non-patients. Each claim effectively reduced the payout to other claimants in the same category.

Anna Pou opted in for a share of the settlement.
According to the guidelines, she qualified for $2,090.37 for each day she was at Memorial.

THE SPECIAL GRAND jury’s decision in 2007 raised spirits in unexpected quarters. Some LifeCare nurses rejoiced, perhaps because lifting a cloud on Pou lifted a cloud on them, too. If she was not guilty of murder, then they were not guilty for having entrusted their patients to her.

A friend from nursing school called Gina Isbell with the news. She was at work with another former LifeCare nurse. They screamed, hollered, and jumped up and down in celebration.

Isbell wore a necklace with a pendant in the shape of a hurricane symbol. She still saw the faces of her Katrina patients in nightmares and was angry and bitter—not at Pou but at the thought that help came too slowly. She considered herself a different person after the storm, forever changed by the trauma of those days and how they had ended.

Sometimes she took comfort in a memory from her last hours on the helipad at Memorial. Dr. Roy Culotta’s eighty-seven-year-old grandmother reached out and grabbed her arm. “If I’m alive tomorrow,” the woman told Isbell, “it’s because of you.”

Isbell clung to the belief that she and her LifeCare and Memorial colleagues had done the best they could. She would serve again in a storm if she was asked. It was her job, her oath.

CATHY GREEN was still a true believer. Nothing could shake the ICU nurse’s faith in her accused colleagues and her pride in Baptist Hospital and the nursing and medical professions. The grand jury’s decision pleased her, but it was not enough. She wished she could erase the idea Foti had implanted in the public that health-care workers would willingly do harm to their patients.

Memorial staff had been criticized for playing God. Green knew they were asked to play God every day in the ICU. She didn’t believe in killing people, but she saw no valor in prolonging death by not giving painkillers. At Memorial’s ICU, doctors like Ewing Cook wrote orders that gave nurses like her a great deal of leeway with “a whole arsenal of stuff.” That was the culture, and she embraced it, having seen, early in her career, a woman die a “lingering death.” When Memorial’s long closure forced Green to work in other hospitals, she noticed that the approach was different. Patients weren’t given as much sedation.

It pained Green to watch the sharp contractions of agonal breathing. When a young doctor reassured her once that patients at that point weren’t themselves in pain, she told him to try breathing like that himself and see how comfortable it was. The doctor’s point was that the patients had too little brain function to be uncomfortable, but Green thought “young mind doctors” and “young mind nurses” didn’t get it.

Green didn’t want a protracted ending for herself. She told her daughter that if that time came, “You just take me to Holland.”

What was it about death in the United States? Why did it seem like Americans were so unprepared for it when it occurred? She had seen it again and again working in the ICU. People often did not want to talk about death with the dying, or be there with a relative when it happened.

Why did we celebrate every milestone in life except this one? she wondered. Everyone wanted to be there to witness the beginning of life, but the ratio of birth to death was one to one. We all had to learn to say good-bye and give our loved ones the dignity to acknowledge we knew they were going. She would ask, “If your best one got on the slow boat to China, you would not be at the dock saying good-bye?”

Green had once been extremely sick on a ventilator in an ICU. She knew that the softness provided by a caring nurse like her was meaningful. But what she did not like about her job was the way she and her colleagues, with their drugs and machines, forced some suffering people to be alive for many months. People who chose ICU care did not realize this could happen, she believed. Death was not always the enemy, she felt, especially when somebody was elderly. She thought that most of her patients did not want the high-tech care that their families wanted for them. The effect of ICU treatment on quality of life should be considered. She knew what her next battle was, now that the one for her colleagues was won.

“We’re so frightened of ‘euthanasia,’ ” she would say. “It’s the race card of medicine. It’s like the word ‘lynching.’ ” She wanted that to change.

FRANK MINYARD would later say he felt a little betrayed, a little hurt. It wasn’t often that he called a death a homicide and the grand jury failed to indict. Their decision had stemmed, he concluded, from the
harsh way that Attorney General Foti had treated the women, as well as the persuasive power of the media. He did not consider the role of his own media statements.