by Sheri Fink
The reporter asked whether she had any regrets for having stayed at Memorial for the hurricane. “No regrets whatsoever,” the nursing director replied. “I don’t regret it at all because I’m a nurse, and that’s what nurses do.”
IN ATLANTA, GEORGIA, a tall, slender man with graying hair watched the interview and felt a swell of emotion. Arthur “Butch” Schafer lived and worked in Louisiana and was crushed by the vast wasteland he saw on television. This nurse was a hero.
The death and devastation mirrored a personal tragedy. He and his wife were in Georgia with family because one of their daughters, Shelly—a thirty-one-year-old with a sweet smile and a giving nature—had recently died.
Schafer interrupted his mourning to return to Louisiana where he was also needed. In his professional life, he fought to protect the lives of elderly and disabled hospital patients and nursing-home residents. Schafer worked as an assistant attorney general in the state’s Medicaid Fraud Control Unit, charged not only with rooting out fraud but also investigating abuse, neglect, and exploitation of Louisiana’s most vulnerable—a population now displaced by the thousands and scattered across the state.
LIKE MANY RELATIVES of hospital and nursing home patients, Carrie Everett could not locate her husband, Emmett, the heavyset paraplegic patient in LifeCare. Carrie had spent Katrina in the Ninth Ward of New Orleans, trapped in a house as the waters rose. A boat pilot rescued her, and she ended up in Houston. Everyone she reached by phone to ask about Emmett passed her to someone else. Day after day she worried.
Carrie had cared for Emmett ever since a freak spinal cord stroke had disabled the Honduran-born, blue-collar laborer a decade earlier at the age of fifty. She was a small woman, but every day she had dutifully helped transfer Emmett to a wheelchair so that he could sit in their yard, read the Bible, play with their dog, and clown around with his seven-year-old granddaughter, his “eyes,” riding on his knees.
Emmett had been in LifeCare awaiting colostomy surgery to ease chronic bowel obstruction. Carrie had visited him in the hospital every day, but she’d been told to stay at home when the LifeCare patients on the Chalmette campus were transferred to Memorial Medical Center. Emmett had called her to let her know that he had made it there with no problems, brought a photograph of his granddaughter with him, and was safe. That was the last she had heard from him.
LINETTE BURGESS GUIDI searched the Internet for news of her mother, Jannie Burgess, the licensed practical nurse with advanced uterine cancer whom she had flown in from Europe to visit in the ICU as the storm approached. Burgess Guidi and her mother’s caring niece enlisted every relative from Louisiana, Chicago, Holland, and Italy to make calls, comb missing persons listings, and try to find her.
AS FAMILIES SEARCHED FOR loved ones, bodies lay decomposing in the flooded city. Days passed as government officials argued about whose responsibility it was to recover them. On Tuesday, September 6, MSNBC cameraman Tony Zumbado paddled to Memorial Medical Center in a kayak and followed the overpowering smell of death to the Myron C. Madden Chapel. A small piece of yellow lined paper reading DO NOT ENTER was duct-taped to the wooden door. Inside, Zumbado’s camera panned to take in more than a dozen bodies lying on low cots and on the ground, shrouded in white sheets. Here, a wisp of gray hair peeked out. There, a knee was flung akimbo. A pallid hand reached across a blue gown.
For days more, Memorial’s deceased underwent a sort of wake—a viewing attended by, among others, a passing battalion of National Guardsmen from San Diego assigned to aid and secure the neighborhood, Tenet-contracted DynCorp security guards recently returned from Iraq and Afghanistan, a Christianity Today magazine reporter, and a relief worker who vomited from the stench.
A chaplain who came to search for survivors compared what he saw when he entered Memorial’s chapel with Dante’s The Divine Comedy. “It was like a picture of hell,” he said on CNN. When members of a disaster mortuary team finally arrived on Sunday, September 11, more than a week after the last living patients and staff members had departed, they recovered forty-five bodies from the chapel, morgues, hallways, LifeCare floor, and the emergency room.
It was the largest number of bodies found at any Katrina-struck hospital or nursing home. Major news outlets covered the shocking discovery. Dr. Anna Pou agreed to an interview with a Baton Rouge television reporter. Pou put on a simple white V-neck blouse. Her cinnamon-colored hair was well coiffed, but the camera showed shadows under her eyes and a hollowness beneath her cheekbones. She struggled to explain why so many at Memorial had died.
“There were some patients there that, who were critically ill, and regardless of the storm were, uh, had the orders of Do Not Resuscitate, in other words that if they died to allow them to die naturally, and not to, um, use any heroic methods to resuscitate them.” As she spoke, she nodded emphatically, as if to bring along her interviewer or her audience, or perhaps to convince herself. “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.”
WHILE MORE PATIENTS had died on the grounds of Memorial than anywhere else, horrible stories were beginning to emerge from health facilities around the flooded region. At St. Rita’s, a single-story nursing home near failed levees in St. Bernard Parish, more than thirty residents had apparently drowned. The owners, a married couple who had been urged to evacuate their facility before the storm, were nowhere to be found. It began to appear that people in hospitals and nursing homes accounted for a significant proportion of all deaths from the massive disaster.
As the outlines of this medical tragedy sharpened, there was an urgent need to understand its causes before the next catastrophe occurred in New Orleans or elsewhere in the country. Were deaths at hospitals and nursing homes regrettable results of an act of nature, a chaotic government response, and poorly constructed flood protection overlaid on a degraded environment? Or had lax oversight allowed individual or corporate greed to play a role? Did some hospital and nursing home leaders decide not to evacuate before the storm primarily to avoid the substantial costs of emptying and closing health facilities? Were emergency plans not followed, important pre-storm investments not made, and health workers not properly prepared?
These were questions Butch Schafer, returning home from mourning his daughter’s death, began to probe. He was an experienced criminal prosecutor who specialized in complex cases. His boss, first-term Louisiana attorney general Charles Foti, had served for thirty years as elected sheriff of Orleans Parish and had a strong constituency among the elderly. White-haired himself, Foti had taken care of his own father until he died that May at ninety-two, driving him out of the predicted path of several hurricanes. Foti pledged in public to investigate fully what he called a horrific tragedy at St. Rita’s, and his Medicaid Fraud Control Unit opened investigations into every one of the hospitals and nursing homes where patients had died.
The unit, supported by state and federal funds, had jurisdiction over hospitals and other health facilities that participated in Medicaid, one of the programs that Southern Baptist Hospital’s leaders had, four decades earlier, resisted joining in part to avoid government meddling. Now Memorial Medical Center’s current corporate owners received a request by phone from a government investigator for a list of deceased patients and a copy of the hospital’s disaster plan.
If the company could show the disaster plan had been followed, there was every reason to expect the case could quickly be closed and the locus of blame for the deaths could be pursued elsewhere. New Orleans mayor Ray Nagin’s pre-storm evacuation order had not applied to hospitals, which had been ordered to stay open and staffed.
Almost immediately, however, suspicious signs emerged. A Tenet attorney responded to the phoned-in questions defensively, by requesting them in writing. He faxed a corporate summary of events, copies of newspaper articles highlighting the heroism of Memorial’s employees, and a set of press releases blaming the deaths on forces beyond the hospital’s c
ontrol:
During more than four days with poor sanitation, without power, air-conditioning and running water, and with temperatures in the building approaching 110 degrees, some patients simply did not survive despite the heroic efforts of our physicians and nurses. […] By Sept. 2, we were able to evacuate every living patient from the hospital, often using private helicopters hired by Tenet after government rescue efforts were overwhelmed.
A day later, a fax came into the unit from an attorney for LifeCare Hospitals of New Orleans. It reported that nine LifeCare patients on the seventh floor at Memorial had died under suspicious circumstances.
Although we are just beginning to collect the relevant facts, we have information that the patients involved were administered morphine by a physician (Dr. Poe, whom we believe is not an employee of LifeCare) at a time when it appeared that the patients could not be successfully evacuated.
Allegations of intentional killings at health facilities were almost unheard of in the unit. Even deaths as a result of abuse emerged only rarely. Of all the potential crimes Schafer and his coworkers were planning to pursue, this one was completely unexpected and seemed, at first, almost outlandish.
Schafer and his new partner, Special Agent Virginia Rider, knew that the allegations needed to be investigated. Rider was a ten-year veteran of the unit, where prosecutor-investigator teams worked cases. Rider had a top-notch reputation: thorough, diligent, and smart. Fact-gathering and public service ran in her blood—her father, a mapmaker, had served in army intelligence in the Korean War and then worked for decades on the interstate highway system. Rider had followed her mother in becoming an accountant.
Rider loved poring through financial transactions—a case that left her buried in paper bank records made her “as happy as a pig in mud”—but she hadn’t been satisfied keeping the books at a real estate development firm, her first job. Only a few months after starting, she netted an embezzler and discovered she had a knack for lifting the numerical fingerprints of fraud. The employee had stolen $400,000 from the small company over a period of years and nobody noticed. Rider had found her passion—pursuing fraudsters. What had led her to her current, hazardous duty investigator position, which had required police-academy training, was a passion and talent for helping bring wrongdoers who harmed others to justice.
Rider was a tenacious worker who loved her job just north of the Louisiana state capitol complex, where a fraud investigator could work surrounded by reminders of the unbroken strain of patronage running through Louisiana political history. Legendary governor Huey P. Long, known as “Kingfish,” both convinced legislators to build the limestone and marble capitol during the Depression and was assassinated there in 1935. Thirty-four stories high and Art Deco in its details, it remained the nation’s tallest state capitol. Both Rider and Schafer lived about an hour away from Baton Rouge and made the drive to work in state-issued Impalas. Rider kept an ancient blue Thunderbird at home.
Rider was twenty-four years younger and a foot shorter than Schafer. He was newer to the unit and had had only one previous interaction with her, a year earlier, when she led an investigation of combined money laundering and Medicaid fraud and came to testify at trial. She had dimples when she smiled, but she cultivated the conservative look of someone dedicated to a life behind the scenes, with a medium build, gray-blue eyes, and natural hair she called dishwater blond. It was the first time she had ever been called before a jury, and she was nervous about going onstage. Schafer, by contrast, was a frustrated actor who loved the sanctioned confrontation of the courtroom; it was practically the reason he had gone to law school. He’d advised Rider to hold on to a pen in her lap and fidget with it to avoid telegraphing insecurity to the jury. She did well, and Schafer saw that Rider worked hard because she believed in what she did, not out of a desire to get out in front of others and be recognized for it.
Upon receiving the fax from LifeCare, Rider immediately requested copies of the patients’ medical records from Tenet, which controlled access to Memorial, where the records were still likely to be. Tenet officials were vague about the location of the records. They might have been removed with the bodies to the coroner’s office or might still be in the hospital. Rider, Schafer, and several colleagues drove to New Orleans with subpoenas to attempt to retrieve them. Security guards denied them entry to the hospital, insisting they needed protective gear. Federal investigators accompanying the group located two hazardous-materials suits and went into Memorial, but found little in the way of records for the nine patients.
Butch Schafer had visited many hospitals in his life. He had never heard of one that lacked current records. That struck him as curious. Interesting, too, was the presence of heavily armed guards intent on blocking the group.
The number of complaints arriving at the attorney general’s office about other hospitals and nursing homes was also surprising. The CEO of Touro Infirmary in New Orleans, Les Hirsch, bragged after the storm about his hospital’s performance. In an essay for Modern Healthcare, he wrote that even after a fire department superintendent gave Touro’s staff an hour to leave the hospital because violence was breaking out in the city, there was “no way” they would leave patients behind. His employees stayed until the last patient was safely evacuated.
An anonymous letter writer took issue with Hirsch’s story and copied the attorney general. A patient at Touro had been found “alive and abandoned” on Friday, September 2, 2005, by workers from a nearby hospital.
One of the nurses helping with the hospital evacuation came upon 16 bodies in your building. It was reported that numerous morphine vials were found littering the floor. One of these bodies was still alive and is currently receiving treatment in another hospital. Why were these patients left to die? Were they euthanized? How did you decide which ones to leave, based it on ability to pay? I find the actions of this hospital deplorable. No patient should be left to die or euthanized.
“Someday,” the letter writer warned, “the truth will be told.”
MEMORIAL PATHOLOGIST Dr. John Skinner had recorded the names, birth dates, and locations of the dead before leaving Memorial. He had faxed the handwritten scraps of paper to Tenet officials in Texas, who entrusted them to the company’s regional chief medical officer, the man who had worked from vacation in Oregon as the disaster unfolded. During the week and a half that the bodies of the dead remained in the hospital and were not yet in the hands of the coroner, little was done with this information. Tenet telephone operators took down messages from dozens of frantic families, and these were entered into a database. If a patient’s relatives somehow reached the medical officer directly, he told them what he knew. Not until after the bodies were retrieved and the attorney general’s office launched an investigation did Tenet officials print out medical chart “face sheets” with names, addresses, and family contacts of the dead, and assign various employees to notify them. The callers received a set of instructions:
1. Speak in general terms.
2. Never give opinions!
3. May be first time family has had contact with anyone about loved one.
4. The loved ones know nothing except news media information.
5. Loved ones are usually angry.
6. Tell truth, i.e., Patient may have died due to lack of electricity or high temperatures, etc.
The employee was to introduce himself or herself, verify the family member’s relationship with the patient, and: “Reveal information: patient expired between the hurricane and evacuation of patients from the facility.”
The document included guidance for handling tough questions, including why notification was occurring more than two weeks after the deaths: “All information electronic; however, computer server stored in New Orleans. Did not ever plan for a whole city to shut down.”
The employee was to tell each family: “Your loved one was cared for throughout. Your loved one was identified and shrouded and placed in our chapel area. Your loved one was treated with dignit
y.”
If a family member questioned the decision not to evacuate before the hurricane, it was based on “risk to the patient.” The decision to evacuate after Katrina had been mandated by government officials: “In situations like this disaster, the government takes control. The state retrieved your loved one and brought to the parish’s coroner office. Eventually, all deceased will be taken to St. Gabriel, LA (southwest of Baton Rouge), where a thorough medical exam will be performed and a cause of death will be identified. A death certificate will be available. Once a cause of death has been determined, state officials will contact the family.”
The eight members of the call team included ICU nurse manager Karen Wynn and incident commander Susan Mulderick. Both women had spent the night of Thursday, September 1, on Memorial’s open helipad with about fifty other staff and family members, including Mulderick’s aged mother, still wearing her housedress. Rescue helicopters had stopped coming after dark, and the group did not reenter the hospital for fear of encountering looters. Armed staff members blockaded the staircases. When a group of people appeared at a hospital window, including wide-eyed children, the armed employees threatened to shoot “the looters” if they came closer.
The next morning, Wynn flew out on a helicopter to the New Orleans airport. It angered and disheartened her to see Mr. Rodney Scott sitting on the concourse in his wheelchair, shivering in a paper gown, without a soul taking care of him. Many of the last push of Memorial patients from the previous evening had not gone far after leaving the hospital. Her injured ICU nurse, however, had been flown directly to a Baton Rouge hospital at the insistence of Dr. Roy Culotta and another accompanying doctor, with a Coast Guard pilot’s knife at the ready for one of them to extemporize the insertion of a chest tube. Fortunately it was not necessary, and X-rays showed the nurse had sustained only severe bruises to his ribs and the area around his spleen. He spent three nights at the hospital being treated for dehydration developed over days of moving patients in the heat.