by Sheri Fink
Pou considered herself harassed by the reporters, “terrorized,” she called it. One day a resident at her hospital summoned her to see a visitor, a woman who claimed to represent a pharmaceutical company. “I don’t think she’s a drug rep,” the resident said.
Pou assumed the woman was a reporter. “Tell her to quit interfering with the care of my patients,” she told the resident. Pou could not abide this. Simmons, too, was worried. Imagine an operation went poorly: “You’re that doctor.” It was a bad environment for her to practice in, and she needed to let it cool.
Simmons, Pou, and the head of her department at Louisiana State University all drew the same conclusion. Days earlier it would have been unthinkable. She had to stop performing surgery.
Notifying her patients, some with advanced cancer, was heartbreaking. Pou called one of them, James O’Bryant, to tell him and his wife, Brenda, he would need to see someone else for an upcoming operation, the third she would have performed on him.
From the first time Pou met him, that January, she had worried about him. James O’Bryant was a busy working father of two who lived on a bayou off the Pearl River, far from a big city. Months earlier, thinking the pain in his mouth was from bad teeth, he’d put off going to see a doctor. He wasn’t a smoker or a drinker like most of Pou’s other patients with disfiguring facial cancers.
Pou gave the terrified couple her cell-phone number with instructions to call anytime, day or night, to talk about anything at all. They used it frequently.
Before the first surgery Pou had come into the hospital room and enveloped O’Bryant’s family members—including his children, James Lawrence and Tabatha—in kisses and embraces. “We’re all going to pray and we’re not going to stop praying,” she’d said. She rehearsed each step of the surgery with them, describing how she would remove the large tumor from the sinus above O’Bryant’s teeth and reconstruct his face. She hugged and kissed them again and disappeared through a door to scrub for the surgery, leaving O’Bryant’s brother-in-law in tears. He cried at Pou’s tenderness. He had a history of health problems and had never had a doctor treat him this way. The operation lasted more than twenty hours.
At follow-up appointments over months of radiation therapy, the O’Bryants would wait three or four hours to see Pou. Once they were in, she checked James “up one side and down the other,” Brenda would joke. The couple stayed as long as they needed, asked any questions they liked.
The month before the storm, Pou had lifted a flap of skin from O’Bryant’s forehead and swung it on a pedicle across his nose to fill in a hole under his right eye where the skin broke down after radiation therapy.
The flap took root in its new location, and a new surgery was planned to sever the stalklike connection. But with Katrina bearing down, Pou had decided to delay it. She told the O’Bryants she didn’t want to put James in the hospital with the storm coming at them.
She had promised always to be there for him. Now she said she couldn’t practice and needed some time away; there were questions about what had gone on during the hurricane. She told Brenda her experiences had been horrifying, that anyone who was not there could never, ever understand. That words could never explain it.
BY DECEMBER, Rider, Schafer, and their small team of coworkers had gathered all the pieces of information—detailed toxicology reports, medical records, and autopsies—that an expert would need to determine causes of death for four of the LifeCare patients on the seventh floor. The New Orleans coroner, Frank Minyard, was a gynecologist, not trained to interpret these results to a level of certainty that could verify the prosecutors’ suspicions, so he recommended a forensic pathologist, Cyril Wecht, a longtime friend and colleague who had worked on the John F. Kennedy assassination case and the O.J. Simpson murder trial.
The fast-talking coroner of Allegheny County, Pennsylvania, was a media fixture and had commented on the Memorial investigation on CNN weeks before he was hired. “If you find any morphine in a patient for whom morphine had never been ordered, now, in my opinion, from a forensic, scientific, legal, investigative standpoint, that’s enough, because what are they doing with morphine?”
Wecht reported back to Butch Schafer by phone in early December. “Mr. Schafer, I have reviewed the four cases you sent to me,” he said. All four patients had been found with drugs in their bodies that had not been prescribed for them in the medical records. “I believe that they can be said to have caused or to have substantially contributed to the deaths of the individuals.”
Schafer asked if the drug levels found by the laboratory were abnormally high. Wecht said that didn’t matter.
“When you talk about morphine and you talk about Demerol, any amount when it is not prescribed is significant.”
“Yes sir.”
“Especially with somebody who was severely compromised to begin with…”
“Oh, I agree with you.”
“Morphine is a central nervous system depressant drug that slows down respiration, slows down GI motility, slow down heart rate, lower blood pressure. That is the last thing in the world that they need.”
Still, Schafer homed in on a potential defense. Could the drugs at the levels detected have been given with the intention of relieving pain and not of causing death?
“I see your point,” Wecht said, as if the possibility hadn’t occurred to him. “Let me do this. Let me go back to the levels and deal with that. That is a very good question and yeah, right, absolutely. Let me do that and then I will get back to you on that, whether or not they could be said to be present in therapeutic doses.”
Wecht supplied his answer by fax two days before Christmas. He had found, in a respected textbook, Randall C. Baselt’s Disposition of Toxic Drugs and Chemicals in Man, a range of morphine concentrations associated with previous fatalities. Wecht compared them with the drug levels found in the tissues of the four LifeCare patients. “In all four of the cases it appears that a lethal amount of morphine was administered,” he wrote.
Wecht’s findings seemed to supply the probable cause needed to prosecute Pou and two of the Memorial nurses who the prosecutors believed had first accompanied her on the seventh floor, Cheri Landry and Lori Budo. Rider and Schafer had not accumulated enough evidence on a third ICU nurse they were investigating. Rider and her colleagues began preparing arrest warrants.
In January, Wecht sent a $7,500 bill to the attorney general’s office for fifteen hours of work at $500 an hour on the Memorial case. The same day a federal grand jury indicted him on eighty-four counts of alleged wrongdoing, including mixing expenses from his public office and private consulting work. Some argued that the charges were politically motivated, elements of a wave of prosecutions of outspoken Democratic elected officials under the Justice Department of Republican president George W. Bush.
USA Today quoted the Louisiana attorney general’s spokesperson saying that another expert would probably be appointed to review toxicology reports related to more than two hundred hospital and nursing-home deaths across the state. Wecht interpreted that to mean he would no longer be used as a consultant. Famously thin-skinned, he shot Butch Schafer—who had been as effusive with him as with toxicologist Middleberg—an excoriating letter. “I recall that when I informed you about my conclusions, you stated that you ‘would like to give me a big hug and a kiss.’ Instead, you have quite unnecessarily and callously thrust a dagger into my heart.”
THE CHARGES against Wecht concerned his business ethics, not his competency as a forensic pathologist. For now, as toxicology reports on other patients continued to arrive from the laboratory, Rider and Schafer’s team relied on his determinations in the first four cases.
What they were missing was an eyewitness who had seen these patients being injected on the seventh floor. LifeCare pharmacist Steven Harris, reinterviewed in December, said he had seen Pou standing by Emmett Everett’s bed. His attorney had also said, in a secret proffer, that Harris had supplied Pou with additional morphine and mida
zolam.
Prosecutor Schafer and Special Agent Rider needed more to seal their case. They and their colleagues did another round of interviews with the key LifeCare witnesses and with others. As a prosecutor, Schafer was thinking ahead to the possibility of taking his witnesses to court. He wanted to make sure their testimony would be credible and believable, and part of that was seeing whether they were consistent from interview to interview.
Over time he also came to suspect that some of the witnesses had held back in their original interviews. He confronted the LifeCare attorneys, offering an example. “Butch, you didn’t ask that question,” one responded. In the first stages of the investigation, the witnesses had dutifully answered the questions that were asked of them, but had not volunteered more. Now that trust had grown between Schafer and LifeCare, the lawyers advised the witnesses to tell the whole story. In these next interviews, the questioners focused more on what had happened to Emmett Everett, and they coaxed out more than the witnesses had originally recalled or been willing to share.
A new witness, LifeCare respiratory therapist Terence Stahelin, offered compelling details. He said that he had spoken with Everett when volunteers came up to help carry LifeCare patients downstairs for evacuation. “He called me into his room and shook my hand and thanked me for all that we—not me personally—but what we had all done for him.” Stahelin said the volunteers then told him they weren’t going to carry Everett downstairs because he was too heavy. “I find that really hard to believe,” he told Rider and her colleagues. “There’s a big flat roof next to the seventh floor. They could have knocked a window out and passed him through a window and then across to the helicopter pad.” Stahelin did not say, and the investigators did not ask, whether he had suggested this to anyone. Why did Stahelin think some of the smaller patients weren’t carried downstairs? “Because they were little old ladies who were either Alzheimer’s patients, senile dementia,” he said. “These were the ‘expendable’ patients. The ones who someone decided that”—he paused—“had no quality of life.”
Stahelin said he had left the LifeCare floor on Thursday, September 1, after an armed, uniformed man he believed was a National Guardsman came to the respiratory lounge and told everyone they had to leave. At the boat drop-off point, Stahelin said, he saw the infectious diseases doctor who had come to LifeCare the previous evening. He asked her what she thought would happen to the patients left on the seventh floor. “She broke down and cried and said, ‘Terry, they’re going to help them find their way to heaven.’” (She later said they never had this conversation.)
The investigators spoke again with LifeCare’s incident commander, assistant administrator Diane Robichaux, who had now had her baby. She recalled that on the morning of Thursday, September 1, 2005, she and physical medicine director Kristy Johnson had tried to figure out how they could get Everett, who was so heavy, out of the hospital.
“Let’s go talk to him,” Johnson had told Robichaux that morning, “see how he’s doing.” They went into Room 7307 and asked Everett how he was. He said he felt a little dizzy. “I might need some oxygen or something,” he told the women.
“Well, you are already hooked up to the oxygen,” Robichaux said. “We got your window open.” The air was blowing through and it was loud with the sounds from outside. They spoke about the noise.
“So are we ready to rock and roll?” Everett asked.
“We are working on it,” Robichaux told him.
Later that morning, Anna Pou came upstairs and they discussed Everett’s prospects in the physical therapy charting room. One of Everett’s nurses, Andre Gremillion, joined the discussion and was asked to sedate him. He backed out of the room crying.
Rider, Schafer, and their colleagues had interviewed Gremillion several times early in the investigation. In another interview in late December, Gremillion said he remembered one of the main reasons he was so upset by the request to sedate Everett. A recent chat with his nursing director, Gina Isbell, had sparked his memory.
He recalled Pou had turned to him in the physical therapy charting room after asking him to medicate Everett and said something like: “If you don’t feel comfortable, don’t do it, because it will come back and haunt you. The first time I did it, I wasn’t ready and it haunted me for two years.”
Gremillion had left the room and walked past Isbell, who saw he was upset and tried to put her arm around him. He kept going down the hallway to a nursing station in an alcove. He walked up to the corner of a wall and hit it to try to get a handle on himself. Pou’s comment, Gremillion told the investigators, had made him think “they were going to give Mr. Everett something to let him go.”
Still, Schafer and Rider were missing a true eyewitness who could link Pou’s words directly to the injections of LifeCare patients. In January, an attorney for LifeCare called Butch Schafer to say that physical medicine director Kristy Johnson had remembered something more, something she wanted to share. Schafer got on the phone with her on a Thursday evening. When he told Rider what he’d learned, she arranged to talk with Johnson, too. What Johnson had come forward to say was so potentially important to the case, so revelatory, that Rider needed to hear it for herself.
With both Rider and Schafer, Johnson began by talking about Mr. Everett. She said she had accompanied Pou to the entrance of Everett’s room. Johnson couldn’t remember if Pou was holding syringes then. Johnson said she had never seen a physician look as nervous as Pou did. As they walked, Pou said to Johnson that she planned to tell Everett she would give him something “to help him with his dizziness.”
“What do you think?” Pou had asked, Johnson recalled.
“I don’t know,” Johnson had said. “I guess.”
They reached Room 7307. One of the nurses from Memorial was outside. “Are you going to be OK?” the nurse asked Pou. “Do you need me to go in with you?”
“No, I am OK,” Pou said.
Pou disappeared into Everett’s room and shut the door.
Johnson mentioned several other important details she had not yet told the attorney general’s team. She had witnessed Pou drawing fluid from vials into syringes. She had seen Pou and nurses from Memorial carrying syringes in their hands. She had escorted the health professionals to each of the patients’ bedsides and, most crucial of all, had been present for some of the injections. Johnson held some of the patients’ hands and said a prayer.
Johnson stood across from Pou at Wilda McManus’s bedside after Wilda’s daughter Angela had been ordered to leave. Johnson had walked her downstairs and reassured her they would do everything for her mother.
“I am going to give you something to make you feel better,” Pou told Wilda, according to Johnson. It was the same phrase Bryant King had mentioned hearing Pou say on CNN. Johnson said she didn’t glance down at what Pou was doing to McManus on the opposite side of her bed. Instead, Johnson looked right into McManus’s eyes and spoke to her.
“Mrs. McManus, I just want you to know, your daughter got out safely and she’s going to be OK,” Johnson had said.
The seventy-year-old woman, who had been feverish and drifting in and out of consciousness, didn’t say anything in reply. “She is really fighting,” Johnson thought she recalled Pou telling her later. “I had to give her three doses.” (Pou’s attorney Rick Simmons would later emphatically deny Pou ever said something like this.)
Johnson accompanied the taller of the Memorial nurses into Room 7305. “This is Ms. Hutzler,” Johnson said, touching the woman’s hand and saying a “little prayer.” Johnson tried not to look down at what the nurse was doing, but she saw the nurse inject Hutzler’s remaining roommate, Rose Savoie, a ninety-year-old woman who had a case of acute bronchitis and a history of kidney problems. A LifeCare nurse later told the investigators that both women were alert and stable as of late that morning. “That burns,” Savoie murmured. Johnson looked down and saw her arm was puffy.
By that afternoon, Savoie was dead, as were the rest of the nine r
emaining LifeCare patients. Rider and Schafer had their eyewitness.
They had another one in Memorial pathologist Dr. John Skinner. He, and his lab director David Heikamp, had some of the answers as to what happened on the seventh floor after Johnson and her LifeCare colleagues had left. On Thursday afternoon, Skinner and Heikamp walked through the hospital to ensure everyone was gone and to write down the names of the dead and their locations. Medicine chairman Richard Deichmann and CEO René Goux had asked Skinner earlier in the week to keep track of any deaths.
The notes the men took and their recollections were now important evidence in establishing the timing of the deaths.
On the seventh floor the two encountered Anna Pou and a nurse manager Heikamp knew well, Mary Jo D’Amico, with a patient, a heavyset black woman lying on a bed in the hallway near a nursing station. Skinner and Heikamp didn’t name her, but by location and description she was likely to have been Wilda McManus. The woman appeared unconscious and was taking occasional, labored breaths.
The sight and sound of her upset Heikamp. His mother had breathed like that for hours before she died the previous year. Skinner explained that it was agonal breathing, assuring him that patients like that had so little brain function they didn’t experience pain.
It looked to Skinner like Pou was trying to get the woman’s IV to work, toggling the valve and readjusting the catheter in her vein. Unsuccessful, she took a syringe and tried to inject medicine into the woman’s thigh.
Skinner asked to speak with Pou privately, away from Heikamp and the nurse. “I told her that I thought this patient was still living and that we should evacuate this patient. And that I would like to go and get appropriate help; find someone to help us carry her.”
Skinner’s assistant Heikamp remembered Pou asking if one of them could go to the helipad and tell the doctor in charge that there was one more patient who needed to be evacuated. Heikamp left to do that.