by Sheri Fink
Why had the city flooded? A bad storm. The loss of a wetlands buffer. Most of all, around New Orleans, the levee and flood control system—increasingly federalized after the 1927 Mississippi River floods and managed by the US Army Corps of Engineers—was grievously and predictably faulty. The failure to address its known weaknesses had saved money in the short term and now appeared outrageous.
Why, in the end, had more than a thousand died immediately in New Orleans—many of them in medical facilities, and many others poor and elderly—and an unknown number of others suffered and died in the aftermath due to stress and disruption of health care? So many reasons. The mayor’s delayed evacuation order. The lack of buses and drivers to move people out of town who had no cars of their own. Stubborn decisions to stay by people with the means to leave. Uncoordinated rescue efforts. Confusion and turf battles between different agencies and levels of government. Poor communications, not interoperable. Hospitals and nursing homes that didn’t evacuate before the storm and had not invested in backup power systems and backup water systems robust enough to withstand a prolonged emergency. Alarm over lawlessness, which interrupted rescues. It soon became clear that the fear of violence outweighed the actual violence, and that fear itself had compounded tragedy, as when first responders, including medical workers at the Superdome, were instructed to abandon their posts and their patients out of concern for their safety. “Most of the worst crimes reported at the time never happened,” Times-Picayune reporters asserted in an investigative story, part of a group that won a Pulitzer Prize.
Although real and troubling lawlessness and several murders and violent crimes occurred, rumors of homicidal gangs and “zombies” that had swirled from WWL to the rescue boat pilots to the halls of Memorial were revealed as overblown. Looters were sometimes foragers, searching for food and water. Gunshots assumed to have been aimed at rescuers may have been gunshots aimed, however misguidedly, at alerting those rescuers to the presence of desperate survivors. In the wake of the rumors, journalists began uncovering real and troubling evidence of several white vigilante attacks on unarmed black men after the storm, and of police misconduct, questionable shootings, and a cover-up.
Underlying the official response to the crisis was a lack of situational awareness—a view of the larger picture of what was happening and what needed to be done.
All of this had occurred against the backdrop of the knowledge, for years, that exactly such a scenario could occur. The Times-Picayune had written about it. The Hurricane Pam exercises had modeled it.
The hospital was a microcosm of these larger failures, with compromised physical infrastructure, compromised operating systems, and compromised individuals. And also instances of heroism.
The scenario was familiar to every student of mass disasters around the world. Systems always failed. The official response was always unconscionably slow. Coordination and communication were particularly bad. These were truths Americans had come to accept about other people’s disasters. It was shocking to see the scenario play out at home.
Life and death in the critical first hours of a calamity typically hinged on the preparedness, resources, and abilities of those in the affected community with the power to help themselves and others in their vicinity. Those who did better were those who didn’t wait idly for help to arrive. In the end, with systems crashing and failing, what mattered most and had the greatest immediate effects were the actions and decisions made in the midst of a crisis by individuals.
E-MAILS AND CALLS of support flooded into Pou’s home and Simmons’s office. The arrests of all three women had occurred well after the evening news, but they were amply covered the next day in New Orleans and around the world, complete with pitiful black-and-white mug shots. CNN carried much of Foti’s press conference live. The online discussion threads of the Times-Picayune website filled with comments mostly favorable toward the medical professionals.
“I know if I was in a nasty hospital like that with 100 degree temperatures and I was suffering in pain, I would want them to off me too,” Timothy of Luling, Louisiana, wrote.
“To the family members whose loved ones died in Memorial, (and who I’m sure are suing the hospital), I have one question. Where were you? You obviously weren’t with your loved one while they were trapped in that hospital,” nurse Mark C. of Metairie, Louisiana, wrote.
Anonymous A of New Orleans blamed others: “Instead of arresting three women for alleged murder, we should put our Local, State and Federal Government on trial for this atrocity.”
J. Nisis of New Orleans went even further: “Enjoy your press conferences and photo-ops, Mr. Foti. I certainly won’t forget this incident the next time you’re up for re-election.”
But not everyone was sympathetic to Pou and the nurses. Writer DM Edwards of Marrero, who described having worked at another New Orleans hospital during the disaster, wondered exactly whose pain the medical workers had been trying to relieve: “Our whole purpose for being here was to aid the patients; not to kill them because we wanted them out of our misery.”
A debate on this question broke out on the medical blog KevinMD:
What were they supposed to do, let their patients suffer and die in misery?
Who are you to decide whether or not my misery is enough for you to put me out of it without my consent or permission?
As a RN I support Dr. Pou and the nurses. I have seen Drs order lethal doses of IV medications to be given every hour to utimatley cause death. Good for Dr. Pou, let the patients die with dignity and not any further suffering.
It’s really unnerving to see how many healthcare professionals have granted themselves the right to kill when they are upset.
“Might we all make questionable judgments if we were hungry, dehydrated and sleep deprived?” asked a writer who self-identified as a doctor in Kansas City.
Two of Pou’s siblings spoke with CNN in her defense, referring to her and the two arrested nurses as heroes. A sister, Peggy Perino, said Pou had told her little about what had happened in the hospital. Perino said a Memorial nurse she knew considered Pou an incredible person and had said that nobody would have made it out of the hospital without her. “She took complete control of the whole situation,” Perino said the nurse told her. “She gave orders.”
AFTER THE ARRESTS, the lawyer for Dr. Ewing Cook, the retired pulmonologist and Memorial chief medical officer, phoned to say that under no circumstances should Cook speak voluntarily with investigators. Six days before the arrests, Virginia Rider had come to Cook’s house and handed him a subpoena to appear for an interview at the attorney general’s office. Butch Schafer was waiting in the car.
Cook had told his lawyer then, “I’ll be very glad to go. I can say what I saw.”
Cook’s attorney was one of the city’s top criminal lawyers and had been appointed by Tenet. He would tell the attorney general’s office that Cook would plead his Fifth Amendment rights and not divulge anything if he was called for an interview.
Cook was sorry about that. He had wanted to paint the scenario, explain how bad the situation had been at the hospital. They’d had the feeling they might not get out alive, and that the sick had even less of a chance. They’d felt desperate.
The lawyer’s response stuck with Cook. “For God’s sake, never say that! They’ll seize in the court on the fact that desperate people do desperate things, and you’re dead!”
Cook should volunteer nothing, keep a low profile, and speak of this to no one. “You don’t want to talk to these people,” the lawyer said, even to try to defend Pou and the two nurses. “Whatever you say has no bearing. Whatever you’d say is not going to help them anyway.” If reporters showed up, he shouldn’t talk to them, either.
This discussion made Cook feel unimportant. He wanted to help defend Pou and the nurses! It could have been he who was arrested. The only difference, he was convinced, was that the nurses who worked with him to hasten Jannie Burgess’s death had protected him in their discussions
with the attorney general’s representatives.
The lawyer would tell the people seeking to interview Cook that he would be happy to testify at the grand jury. Even Cook knew no fool would bring someone to a grand jury without knowing in advance that he had something helpful to say for the prosecution.
WHEN SENIOR INTERNIST Dr. Horace Baltz saw the mug shots of Cheri Landry and Lori Budo flash across his television screen as he dressed for work, he fell forward onto his bed. He had a hard time believing they had been arrested as he slept. He adored them, knew them as principled professionals who cared for his ICU patients on the night shift with excellent judgment and skill. His heart bled especially for Budo, whose mother he’d regarded as a standard-bearer in nursing.
Baltz called her and offered to be a character witness if it ever came to that. A Memorial nurse phoned back to ask if he would be willing to speak to the press on the nurses’ behalf. He agreed, as long as he could be assured the women were being candid with the authorities. Some LifeCare employees had by their own admission facilitated the giving of “lethal doses,” and they had not engaged in cowardly obfuscation but instead bravely told the truth to law enforcement. The Memorial nurses who had any part in what happened should do the same. “Oh Dr. Baltz, we can’t do that,” the nurse who had called him said, suggesting that was because Tenet was paying for their attorneys.
Baltz felt nauseated. He prayed. His mind kept returning to the conversation he had overheard in a doctor’s office early the morning of Thursday, September 1: “Our most difficult job will be to convince the nurses…” Had one of the persuasive male physicians he’d overheard devised the evil deeds in the Stygian hospital? Had the girls, as he still thought of the middle-aged nurses, succumbed, obeying a doctor’s orders like Eves seduced by Satan in the Garden of Eden?
ANNA POU’S ARREST sickened Dr. Dan Nuss, her compassionate department chairman, who saw it as a pathetic political move by the attorney general. Nuss hadn’t been at Memorial to witness the events, and Pou hadn’t spoken much about what had happened after Katrina, but that didn’t matter. He felt he knew her so well as a dedicated, ethical doctor; there was no chance she had done anything to harm anyone.
Nuss believed the same of the nurses, with whom he had worked for many years. The idea that the three had formed a renegade team roaming the hospital bumping people off was inconsistent with their personalities and lives’ work. He viewed their accusers as disgruntled, less capable professionals who had disagreed with decisions during the disaster and ended up with an ax to grind. Pou, Landry, and Budo had his complete support.
As news of Pou’s arrest spread, Nuss was inundated with phone calls and offers to help Pou from her former colleagues and even doctors who were total strangers. They, too, seemed outraged and unwilling to believe that three health professionals who had pledged to save lives had snapped under pressure and conspired to kill.
Over the ensuing days, Nuss discussed the offers with Pou’s attorney, Simmons. Nuss believed he should use his position as a Louisiana State University medical department chairman to help generate an army of support for Pou, and he took time away from work to organize a legal defense fund through his office at the public university.
“One of our dear friends and most respected colleagues, Dr. Anna Maria Pou, is in urgent need of your support,” he wrote in an appeal.
He described how Pou had worked heroically “without sleep and without nourishment” to help others after Katrina at Memorial, where “the prevailing conditions were absolutely desperate.”
At great self-sacrifice, she prevented further loss of life and has been credited with saving multiple people from dying.
Apparently there were a few individuals at the hospital who could not understand why so many people were dying. Allegations were made, egregiously accusing Dr. Pou and the others of giving too much narcotic pain medication, even using the word “euthanasia”. This attracted national news coverage which became absurdly sensationalistic.
He surmised that news coverage had triggered the attorney general’s investigation. Nuss was confident Pou’s name would be cleared, but her defense, not covered by malpractice insurance because of the criminal allegations, would be costly.
Therefore Dr. Pou’s professional reputation AND her personal assets are at substantial risk. Remember, this kind of thing could happen to any of us who happen to be on call when a disaster strikes.
Nuss asked for donations to the Anna Pou MD Defense Fund, to be sent to him at his office. Even secretaries in the department spent their off hours spreading the word in a letter and e-mail campaign. Within a week they had collected about $30,000.
The money would be used both for Pou’s legal defense and the defense of her reputation. The effort now turned to making the allegations disappear by attracting attention to a radiant image of Pou. Her supporters would highlight the virtuous, heroic aspects of her career and personality in the public’s mind, which would carry into the DA’s office and the grand jury room. They would act as if the allegations did not exist—a sleight of hand. They would savage the reputation of the attorney general and chastise reporters who sought to learn the truth about the alleged crimes.
In large circles of New Orleans society it became impolite to discuss the events as if they had happened. It was no longer a question of whether what the women did was right or wrong. It simply could never have occurred. There was absolutely no basis in the claims that patients had been injected and died, no matter the intent.
Partners of the New Orleans public relations agency Beuerman Miller Fitzgerald (“The strength to shout; the wisdom to whisper”) took up Pou’s case. Greg Beuerman—a tall, perpetually tan veteran oil-company spokesman and former Republican Party state director—had spent Katrina volunteering at another marooned, Tenet-owned hospital, Lindy Boggs Medical Center. His colleague Virginia Miller told potential clients that one of the goals of successful crisis communications was: “Control!” For now, control meant keeping Pou herself out of the public eye in spite of an avalanche of media requests seeking her side of the story.
Nurses who had worked with Budo and Landry launched their own support fund with the help of a lawyer relative of Landry’s. Landry was single, had lost nearly all her possessions to Katrina’s floodwaters, and had an elderly mother to support. Agents had arrested her at work at a local hospital and arrested Budo at home with her husband and two teenage children.
The two nurses were just weeks away from starting jobs again at the soon-to-reopen surgical institute at Memorial when they were arrested. Tenet representatives told them that their services would no longer be needed, although the company was covering their legal expenses.
Tenet released a statement after the arrests disclaiming responsibility for the alleged crimes. “We have assisted the Louisiana attorney general in all aspects of his investigation,” it said. “If the allegations are proven true, the doctor and nurses named by the attorney general made these decisions without the knowledge, approval, or acquiescence of the hospital or their key physician leaders.”
Hours before Foti’s press conference, Tenet had announced it would be selling Memorial to a local nonprofit hospital system, a deal that had been in process for months. The sale of Memorial and other Tenet New Orleans hospitals for $56.8 million was to be used to help fund a nearly billion-dollar settlement to end investigations for overcharging Medicare in Louisiana and other states. The hospital system also disclosed that its insurers had agreed to pay the company $340 million for Katrina-related damage and business interruption at five of the company’s hospitals.
The nurses’ coworkers received the news of their arrests with pain and disbelief. Fear spread through the tight community. Who would the witch hunt bring down next? They rallied, sent e-mails, compiled call lists, and sought doctors and hospital leaders willing to talk to the media. They aimed high, leveraging connections to oil-business executives who had plenty of money and experience with crises.
IC
U 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.