by Sheri Fink
Mendez had seen this on TV once and had a name for it, a “bug out,” a decision to retreat at once in the face of the enemy, leaving everything—and potentially everyone less fortunate—behind. Saigon.
Mendez’s account seemed, to her interviewers, consistent with Robichaux’s in every important way. It was remarkable. It had enough minor differences to be credible; a fabricated story was more likely to sound identical. What was surprising was that the alleged plan was put into action not when the staff was desperately awaiting rescue, but rather when the evacuation was at last under way.
Days after the interview with Mendez, more misery visited Louisiana. Hurricane Rita plowed into the western part of the state and Texas on September 24. This time widespread pre-storm evacuations took place. Roads clogged in the storm’s projected path. A charter bus with an illegal license, driven by an undocumented Mexican national, caught fire on its way from Brighton Gardens of Bellaire, a nursing home near Houston, Texas, to a sister facility in Dallas. Oxygen tanks in the luggage bays exploded. Twenty-three of the thirty-eight elderly people aboard the bus burned to death. In the end, the storm spared Houston.
“I told you so,” James A. Cobb Jr., the attorney for the owners of St. Rita’s nursing home, wrote in an e-mail to the producers of a network news show. Days earlier he had gone on air to defend his clients’ choice not to evacuate for Katrina when all three other nursing homes in St. Bernard Parish had moved patients ahead of the storm. The Texas deaths made his clients’ bad decision look a little more reasonable. St. Rita’s owners Sal and Mabel Mangano and their family had, contrary to popular assumption, stayed at St. Rita’s and tried to save their residents. Before a planned meeting between Medicaid fraud investigators and the married couple, the attorney general issued a warrant for the arrests of the pair on thirty-four counts each of negligent homicide for failing to evacuate prior to Katrina. The Manganos surrendered to authorities and Attorney General Foti took to the media, condemning them. Cobb fired back, savaging Foti for acting before he knew the whole story. He called his clients heroes.
Cobb’s point was that moving residents before a storm also carried risks. Investigators were looking into transportation-related deaths that had occurred prior to Katrina, too, but been quickly forgotten by the public. Ferncrest Manor Living Center was the unnamed subject of the brief WWL radio report about three deaths that occurred en route to Baton Rouge before Katrina. The residents had apparently died of complications from heat exposure in the course of evacuating on buses that lacked functioning air-conditioning, drinking water, and, in some cases, nurses. They had spent up to four hours boarding and six hours traveling the clogged route from New Orleans to Baton Rouge. Many survivors were treated in a hospital for dehydration.
Mayor Nagin had mandated evacuations of nursing homes because many homes occupied single-story buildings with marginal electrical backup. However, his order was not enforced. Many homes were not prepared and did not receive needed support to relocate in the less than a day between his order and predicted landfall. About two-thirds of the affected nursing homes had kept residents in place. In Jefferson Parish at Chateau Living Center, the home where the contracted tour company had refused to provide buses before the storm, thirteen died in the heat after power failed.
In another extreme case, nineteen residents perished in an inundated nursing home, Lafon, run by the Sisters of the Holy Family, a New Orleans congregation of African American Catholic Sisters. The congregation had transported its members, including residents of the nursing home, out of the city in advance of Katrina, but left the nursing-home residents who were not congregants, and the staff of sisters and non-sisters who cared for them, in place.
All of the resident rooms were on the first floor, but their occupants had not drowned. The valiant staff had carried everyone who could not walk up to the second floor out of the floodwaters, only to watch many die in the heat and darkness despite the fact that the water had quickly receded. First responders had rolled by on the highway, ignoring roadside entreaties from the staff. The administrator went out dressed in her religious habit to seek help, but rescue came too late.
THE WEEK AFTER Hurricane Rita, Special Agent Virginia Rider interviewed another witness, LifeCare physical medicine director Kristy Johnson, who had supervised the hospital’s rehabilitation-therapy programs. Despite Rider’s preference, as an accountant, for interrogating numerical databases over questioning people, she often conducted interviews; her colleagues were out for the day and she spoke with the thirty-one-year-old physical therapist alone.
Johnson’s memory for detail at first seemed excellent. She, too, recounted the ways the LifeCare staff labored Wednesday night to hydrate and cool patients, including pouring Kentwood mineral water onto cut-up blankets to wet their skin, helping keep all of them alive. Johnson said on Thursday morning she heard Susan Mulderick say at a meeting that she didn’t think the LifeCare patients would make it. Along with Diane Robichaux and LifeCare pharmacist Steven Harris, Johnson spoke with Mulderick after the meeting to ask about the plan. “She’s like, ‘We need to talk to Dr. Pou.’” Johnson recalled Mulderick saying: “The plan is that we’re not going to leave any living patients behind.” It was the same phrase Robichaux had remembered.
Johnson painted the chaos on the first floor as rescuers arrived and called for women and children to evacuate, and she told of how she ran back up to LifeCare and guided Wilda McManus’s tearful daughter Angela down to the first-floor ER ramp to get on a boat. She heard Therese Mendez calling for her through the crowds.
“I just heard ‘LifeCare, Kristy Johnson.’ She’s screaming my name and, you know, I’m like, ‘Here I am!’ And I’m way down the hall and she’s like, grabbed me, she’s like, ‘Come on, we got to go.’ So, we’re running up the stairs, I’m like, ‘What’s wrong, what’s going on?’ And that’s when she told me, um, that our patients were going to be given a lethal dose and, I mean, I just stopped and, I was like, ‘What?!’ And I knew the day before that, you know, a physician had told Therese we were under martial law, so I just was thinking, I can’t believe it’s come to this, that they’re ordering, you know, that our patients are going to be given a lethal dose.”
Johnson was in the room for the discussion with Pou about evacuating Emmett Everett. “She was saying, ‘There’s no way; he couldn’t fit through the hole.’ He was triaged to three. I knew he was sick, he was either a quadriplegic or paraplegic, but um, you know, he could talk and everything. So, she wanted someone to sedate him and Diane told her that—”
Rider interrupted Johnson. This was a key point. “OK, you heard, you heard Dr. Pou ask for someone to sedate him?” Johnson admitted that she wasn’t sure whether she had heard Pou say it or had heard this particular detail from her colleagues while they waited in the evacuation line. “I did hear this part, I mean, she, she said you know, ‘Y’all need to evacuate. The patients are going to be in our care now.’
“I did see Dr. Pou, like, as she was walking down the hall. She was nervous, and she had two nurses with her.” Johnson described the two women, saying they were familiar faces from the seven years she had worked at the hospital.
Agent Rider named twenty-three deceased LifeCare patients one by one, and Johnson was able to tell her either when they had died or where they were—on the first, second, or seventh floor—when she had last seen them alive.
The day after the interview, Schafer, Rider, and their partners spoke with LifeCare pharmacist Steven Harris. He told a similar story: he had heard Mulderick say at the Thursday morning emergency meeting that she didn’t expect the LifeCare patients would be evacuated. He approached her with Johnson and Robichaux after the meeting to discuss what the plan was. She said they needed to talk with Pou. He and Robichaux found Pou on the seventh floor, and, he said, Pou told them “lethal doses” would be given to the patients. Robichaux told Pou that Emmett Everett was oriented and aware of what was happening at the hospital. Pou requested someone to
talk with him or sedate him, but a nurse who was asked to do it refused.
Robichaux in her interview hadn’t remembered hearing the phrase “lethal doses” directly from Pou. Harris offered other distinct recollections. When he had asked Pou what medications she was going to give the patients, she had shown him a large package of morphine vials and some loose vials. She requested supplies including syringes and vials of sterile saltwater used to chase a drug through an intravenous catheter and into a patient’s bloodstream. Harris had provided these supplies.
Pou and the two nurses who accompanied her prepared to draw up morphine into the syringes. Harris didn’t know the names of the nurses, but he thought he might be able to identify them. Later, he saw them entering the rooms of the remaining patients, and after that he saw Pou and the two nurses heading for a staircase carrying one or more translucent garbage bags. They had said they would return. Johnson told him that Pou had asked them to check on the patients and pull up sheets over those who had died.
Harris went downstairs with the other LifeCare administrative staff. They were prevented from walking through the area where the patients were lying on the second floor. He caught a glimpse of Pou and the same two nurses in the blocked-off area when he was allowed to pass quickly to the parking garage with antianxiety medicines for a LifeCare nurse who “was kind of losing it.”
Harris’s attorney suggested his client might have something more to add to the story. The attorney wanted to meet with prosecutor Schafer first. They made plans to do so later in the week.
The LifeCare witnesses had confirmed one another’s stories. They all alleged that Dr. Pou had come up to the seventh floor to end the lives of the nine surviving patients, and two recalled that Pou had told them directly that “lethal” was her intention. The patients had all indeed died. But had the plan actually been carried out? Why, and who was involved besides Pou? Who were the unnamed nurses? What Rider and Schafer needed to see was whether physical evidence corroborated the allegations. Rider drew up a wish list, including items she had requested and Tenet had not yet supplied: medical records for all the deceased patients; evacuation plans; computer hard drives; names and contact details of hospital employees; pharmacy records; and medical waste, which might contain discarded drug vials and syringes.
They needed to search the hospital. Given the unwelcome response to their previous appearance, it was unlikely to be a consensual search. To get a warrant, they had to convince an Orleans Parish District Court judge that a crime was likely to have occurred there. Schafer discussed potential charges with his bosses, and Rider pulled up the Louisiana statute, because she wasn’t used to dealing with alleged murders. In the state, the difference between first- and second-degree murder had to do with the nature of the victims, not premeditation. She wrote up an affidavit summarizing the key events described by Robichaux, Mendez, Johnson, and Harris. She submitted it with an application for a warrant to search for items “necessary in order to prove the crime of second-degree murder.” Louisiana’s legal definition of second-degree murder included murder with the specific intent to kill. Everyone seemed to agree, in light of the circumstances of Katrina, that they weren’t going to seek the death penalty and thus there was no need to charge first-degree murder. Lesser charges of manslaughter or negligent homicide could always be brought.
The judge granted the search warrant. The next day, Saturday, October 1, Rider and Schafer joined twenty-two special agents, including nearly every agent from the Medicaid Fraud Control Unit and many others from the US Department of Health and Human Services Office of the Inspector General. Accompanying them were two crime-scene investigators from the Louisiana State Police. They drove an hour from Baton Rouge, descending on the hospital at around nine a.m. Rider participated in searches about once a month. This was the largest search team in which she had ever participated.
The agents approached with their badges on display, and Rider handed Memorial’s security supervisor a copy of the search warrant. Infectious diseases experts from the US Centers for Disease Control and Prevention evaluated the air and determined it was safe for the agents to enter.
The hospital spanned two city blocks and still had no electricity. It would be a challenge to search. Rider carried a duty belt around her waist laden with flashlights, a radio, handcuffs, pepper spray, and firearms with extra magazines—her typical search-warrant raid gear. Some colleagues wore blue gloves and breathed in the faintly medical smell of a respirator mask that covered their noses and mouths and made each breath feel somewhat suffocating. It was hard to walk, let alone climb stairs in the heat, and Rider and Schafer left their masks around their necks. Rider had high blood pressure and was out of shape, so she left the seventh floor for the others to search. Schafer and others were clamoring to go there, and they clomped upstairs in their heavy boots. When everyone else wanted to do something, Rider was inclined to do something different.
She trekked through a maze of rooms on several floors. Once she stepped into what appeared to be a nursery. Blooms of black mold spread like creepers over the cheerily painted walls.
The security guard’s passkey opened most doors, but it took a battering ram to breach the Memorial and LifeCare pharmacies. A forensic scientist prepared an inventory of morphine. Agents seized pharmacy records, including the three prescriptions for large amounts of morphine dated September 1, 2005, and signed by Dr. Anna Pou.
What struck Schafer the most was the smell of death. It was everywhere in the hospital; if you’d smelled it, you could never forget it.
Some news stories had suggested the hospital had run out of food and water. It astounded Schafer to see water bottles stacked to the ceiling. There were canned goods in the kitchen and food and beverages stashed and scattered throughout the hospital. After hearing the stories of looting in New Orleans, it shocked him to see that nobody had even been desperate enough to clean out a vending machine. Those sheltering at Memorial had come supplied like good south Louisianans, with more to eat than they could possibly consume.
Search-team members traced the paths used to rescue patients. Later, putting together the pieces, they would have a hard time understanding why the staff had used the hole in the second-floor machine room wall exclusively when there seemed to be other ways to reach the parking garage, including the route over the rooftop directly from the seventh floor.
It amazed Rider to see the hospital’s main generators sitting well above flood level. She assumed they were functional. Why hadn’t the staff figured out how to bypass the submerged parts of the electrical system and drive power to important patient-care areas and equipment? She couldn’t help thinking her self-reliant family of South Central Louisianans would have figured out a way. Some people depended too much on the government to help them.
The search team found plenty of medical records, but not the particular ones Rider had requested and not yet received from the Tenet attorneys. Schafer wondered if the company was hiding them out of fear of criminal culpability. Perhaps company officials, not only a rogue doctor, had a hand in what had happened.
While the absence of the medical records was disappointing, other evidence appeared to back up the witnesses’ stories. The agents seized boxes of morphine ampoules from the nursing station on the west side of LifeCare, a desk that sat beneath windows facing the helipad. The controlled drug was sitting out in the open instead of locked away. Elsewhere on the seventh floor, in the garbage can of Room 7305, the room Rose Savoie and Alice Hutzler had shared, they found a translucent bag like the one pharmacist Harris had described, full of syringes. Next door in what was Emmett Everett’s room, the agents seized a saline push syringe from a bedside table next to a box fan. Near it, a cafeteria meal tray still had its plate, mug, and bowl. In the second-floor lobby, multiple morphine vials and boxes sat in the open on a blue tray.
Computers and a server were removed and would go to the state’s High Technology Crimes Unit in the hopes that important records might be found. T
he agents documented the search with photographs and videotape.
That evening, Rider turned the seized medical items over to the state police crime laboratory to analyze for fingerprints and traces of controlled drugs. On the official request form, under the line marked “Subject,” she wrote Anna Pou’s name, birth date, and driver’s license number. She scribbled: “Suspect may have euthanised multiple patients in Memorial Medical Center (MMC) following Hurricane Katrina.”
Rider and several others returned to the hospital four days later, this time with permission from Tenet officials, accompanied by a Tenet attorney. They went to the seventh floor and found more syringes and medical waste in the LifeCare therapy charting room, where the witnesses had described sitting and speaking with Pou about Emmett Everett. Elsewhere at Memorial they located Pou’s employment agreement, a staff roster, and a set of the hospital’s emergency policies and procedures.
In the days after the searches, Rider and Schafer interviewed family members of three of the deceased LifeCare patients. Doug Savoie was the grandson of Rose Savoie, Alice Hutzler’s roommate. Both women had been aware enough on Wednesday night to tell the infectious diseases doctor who visited LifeCare that they were not in pain or anxious. A daughter of Savoie’s, Lou Ann Savoie Jacob, had come to New Orleans to visit her and had been with her until the storm approached. Rose was sitting up and talking, with no IVs, recovering well, it seemed to her. Learning of her death, after a difficult search, had surprised the family.
Wilda McManus’s daughter Angela, and Elaine Nelson’s daughter, Kathryn—the two who had stayed with their mothers on the LifeCare floor until Thursday, September 1—were also eager to assist the investigators. Kathryn Nelson, who had blurted out, “I’m dying too,” when she was forced from her mother’s bedside, had waited downstairs as long as possible before leaving Memorial. When she finally climbed into a boat, a young woman behind her asked who she was and told her that her gravely ill mother, Elaine, had died.