by Sheri Fink
Bias recalled, contradictorily, that Riopelle said she should put her daughter to sleep and demonstrated how to inject the morphine into her IV line. Bias refused. Her reaction was colored by an earlier conversation, she told investigators. She had learned from a staff member after an administrative meeting that certain patients were not going to be evacuated. The woman allegedly told her, “They will give them morphine to put them to sleep.”
Jessie Lynn LaSalle, the wife of another young patient, one who had just undergone a liver transplant, also recalled being offered morphine by Riopelle repeatedly, something Riopelle later said he did not recall. She said he had told her nobody was coming to rescue her husband and she should let Riopelle give him morphine so he could “go at ease.” Furious, she sent Riopelle out of the room. She said he told her if she changed her mind she could find him upstairs with the animals.
LaSalle’s husband was on a ventilator rigged to operate pneumatically on the hospital’s supply of oxygen now that the power was out. Because of this, Riopelle later pointed out, morphine—even if he had offered it—would not have depressed the man’s breathing or posed a danger to him.
Riopelle denied having euthanized any patients or given any morphine, and he told investigators that Bias and LaSalle might have misunderstood his intentions because they were feeling abandoned. Several of the patients who remained in the hospital were on life support, breathing with the help of ventilators powered by compressed gas. Bias alleged that she saw these being turned off and patients without accompanying family members being injected with what she believed was morphine, then dying.
Approximately twenty-seven bodies were recovered at Lindy Boggs, including many from a separately owned long-term acute care hospital, Genesis Specialty (a few patients had died before the storm). While the total number of deaths in the building was lower than at Memorial, the proportion was similar, as there were fewer patients overall. Toxicology tests revealed the presence of morphine in nearly a quarter of twenty-one bodies tested; however, only one had levels that appeared to be unusually high.
Both of the young transplant patients went out by boat the next day, but they died weeks later of infections that their families believed stemmed from the abandonment and lack of care. They filed medical malpractice claims against Riopelle and the transplant doctor—both of which were later dismissed—as well as the hospital and its owner, Tenet. The claims mentioned the “strong suggestion” that the patients be euthanized.
THE ATTORNEY GENERAL’S staff had also continued to look into the case of the patient who had been abandoned for dead and later found alive at Touro Infirmary. This was the patient mentioned in a letter to Touro’s CEO, copied to the attorney general’s office, predicting: “Someday the truth will be told.” The patient in question was Odun Arechaga, a seventy-year-old man with a regal face who had suffered a heart attack before the hurricane, falling unconscious and sustaining brain damage while awaiting rescuers who had difficulty finding his house. Neurologists had advised his daughter to “let him die.” She refused, and in the days before the storm, he regained the ability to breathe on his own and became somewhat more responsive.
In the 1960s Arechaga had founded the occult Sabaean Religious Order in Chicago. He imbued its practices with ancient philosophies and mysteries and referred to himself as a priest of the Am’n, the hidden and deep. In her book Drawing Down the Moon, NPR reporter Margot Adler compared a fantastic Sabaean marriage feast at his temple in 1975 with Fellini’s Satyricon, which, Arechaga playfully reminded her, was “merely a movie.” He had been a brilliant storyteller fascinated by disasters. He wrote and produced elaborate plays for holiday festivals where the children of his order would reenact cities being destroyed by Sumerian earthquakes and the eruption of Mt. Vesuvius.
Witnesses told investigators they had found Arechaga on a soiled gurney on Touro’s third floor on Friday, September 2, with small Styrofoam coffee cups inexplicably taped over his ears, and his medical record at his feet. National Guardsmen wheeled him out of Touro and summoned medical staff from a smaller hospital across the street, screaming that they had a patient who needed help. When rescuers examined him, they found his airway nearly completely blocked and the tracheotomy collar around his neck saturated with dried, crusted green-and-yellow sputum. His heart was beating slowly, his extremities were cold, and his oxygen level was low, his body failing.
The rescuers suctioned his airway, changed the collar, and removed his soiled clothing. Arechaga opened his eyes as he was loaded into an ambulance.
Touro Infirmary’s staff, not knowing how high the waters would rise, or how quickly, had carried eighteen critical patients like Arechaga in the heat from the ground floor, which still had backup power, to the third floor, which had lost power when the hospital’s generators—some of them decades-old—began failing. They had not been tested to work for such a long period, were running on possibly tainted fuel from the government, and were not configured in many areas to support the air-conditioning system (which also relied on the crippled city water system for its chillers). When the battery backups on ventilators were exhausted, patients were bagged by hand, but many didn’t tolerate being off the machines, and died.
Some staff later described a unique and horrifying triage system: those patients who could not say their names were not given IVs—an allegation that haunted the family members of a man with advanced Parkinson’s disease who could not speak and had died unexpectedly at the hospital. A number of patients were tagged “black”—too sick to move—and were not taken to the helipad.
Touro Infirmary had remained reachable by land after Katrina, unlike Memorial and Lindy Boggs, but its workers had been similarly frightened by reports that violence was breaking out in the city. Medical workers from Touro and a separately owned long-term acute care unit within it, Specialty Hospital of New Orleans, told the investigators that while many of their colleagues worked heroically and tirelessly to rescue patients, even returning to the hospital to do so, some units’ entire staff had driven out of the hospital garage, leaving their patients behind. After the storm, some nurses were fired and were reported to the nursing board for abandonment.
A Touro emergency room nurse who was put in charge of triage later said that members of the National Guard arrived at the end and commanded the last remaining staff to leave for their safety, reassuring them that soldiers would stay behind to protect the remaining two dozen or so patients. Cars lined up with snipers at the lead. “At some point you just have to save yourself,” the nurse, Brent Becnel said. Although the professionals were upset and didn’t want to leave, they resigned themselves to the situation. “If you get hurt, when the hospital can open again and you’re not there, what good are you?”
A Touro doctor, writing anonymously to the attorney general’s office, described being told by a military commander who had supervised Touro’s evacuation that Arechaga was among fourteen patients considered “too critical.” Medical workers “shot them full of morphine and left them behind.”
Toxicology tests on some of the bodies found at Touro and at Specialty Hospital of New Orleans revealed high levels of morphine and midazolam, the same drug combination used at Memorial.
THE STORIES from Memorial, Lindy Boggs, and Touro hospitals stood in contrast to the reaction of staff at New Orleans’s public Charity Hospital. Charity had flooded; lost power, functioning plumbing, computers, telephones, and elevators; lacked a helipad; and had no corporate overseers to assist, however belatedly. It had taken until Friday afternoon, September 2, to transfer all the patients from there, compared with Thursday, September 1, at Memorial. Approximately twice as many patients were present at the public hospital’s two campuses as compared with Memorial, with a lower ratio of staff to patients. However, fewer than ten patients died.
Doctors said that staff continued to provide medical care to patients in their rooms until the end, despite similar or even worse conditions of existential threat, including a gunm
an reported to be on a nearby roof, disrupting the evacuation, and the presence of more than a hundred psychiatric patients inside. People urinated on stair landings. Convoys attempting to reach the hospital over water were reportedly shot at and looted. News reports suggested the hospital had been evacuated when it hadn’t. Soldiers had brought additional ventilator-dependent patients to the hospital.
In articles and conversations, hospital workers chalked up their resilience to a number of factors, including morale-building—leaders held meetings every four hours in the lobby for everyone from doctors to janitorial staff. They put on a talent show by flashlight. They painted and laughed.
Hospital officials had drilled for a Category Three hurricane and levee failure and purchased, with the help of federal preparedness funds made available after the 9/11 attacks, several portable generators, oxygen-powered ventilators, and a ham radio system. Special disaster training had been provided to hospital security officers.
The Charity staff was populated by crusty characters accustomed to the comparatively Spartan, chaotic, and occasionally threatening conditions of an inner-city government hospital. Workers included Vietnam War–era ER doctors known for their bravado and machismo. Nearly everyone had experience getting creative with all-too-common resource limitations.
At Charity, workers siphoned gas from cars to fuel ten small portable generators. These were used to power ventilators and cardiac monitors in the ICUs, keeping critically ill people alive, including a very premature baby. This contrasted with Memorial, where patients were ventilated by hand with Ambu-bags after the power failed, as two similar generators were only later put to use for powering lights and fans in common areas and the helipad, not medical equipment.
Charity staff also kept up the hospital routine despite the bizarre conditions, continuing to provide services like physical and occupational therapy and encouraging workers to maintain shifts and a regular sleep schedule. This signaled that the situation was under some degree of control and kept panic to a minimum. There was an active effort to stem rumors. “You can only say it if you’ve seen it,” staff were told.
Perhaps most important, Charity’s leaders avoided categorizing a group of patients as too ill to rescue. The sickest were taken out first instead of last.
RICK SIMMONS’S EFFORTS to construct a defense for Anna Pou were unflagging but handicapped by a deficit of evidence from the prosecution. In mid-September he wrote Assistant District Attorney Michael Morales, asking for the umpteenth time for copies of the forensic test results performed on the bodies. Simmons referred to it as an exchange: in return for being given the laboratory and autopsy results, he would offer his own experts’ input on the case.
ADA Morales declined the offer, reminding Simmons that Pou had not yet been indicted. When and if she was, her attorney could move under Louisiana law to gain access to certain evidence that the DA had amassed. But they were not yet at this point in the process. Morales was happy to look at Simmons’s hand if he wanted to show it, but he wasn’t prepared to show his.
Simmons repeatedly reminded Morales that the DA’s office had “absolute discretion” in the case, could reject it out of hand, could simply send it back to the attorney general as a refusal. As Morales underwent a crash course in medical care under crisis, Simmons seemed always at the ready to supplement his information, sharing the defense’s concepts of the case.
Morales was learning so many new terms, he began to keep a glossary: Agonal Breathing; Double Effect; Euthanasia; Palliative Care; Triage. Special prosecutors, division chiefs, and the attorney general had the glossary at hand for reference whenever they met to discuss the evidence and what remained to be done. In a normal case, one charging conference would be held. The Memorial case was on its way to five.
As hard as Morales found it to apply civilian criminal law to a “war zone,” he was impressed at how well the medical ethical concept of the double effect tracked with the legal concept of specific criminal intent, which was required to prove murder in Louisiana. Were the injections intended to harm and kill, or to palliate? He began to view the case from this perspective.
Simmons continued to fight to ensure that what Pou said to the Tenet attorney and media relations chief after Katrina would not be revealed. At the end of September, a Louisiana appeals court sided with him. The information remained protected as Butch Schafer petitioned the state’s Supreme Court to hear the case again.
Simmons also guided Pou, who now harbored great enmity for the media, through an interview with the influential CBS television magazine show 60 Minutes. The camera crew and producer arrived to film Pou twice. Nervous, she changed her mind and refused to see them the first time.
Simmons arranged for an audio recording of her entire interview with Morley Safer so that nothing could later be taken out of context in court should 60 Minutes be served with a subpoena. As the broadcast date approached, he was confident the segment would show her in a good light, and he helped orchestrate a chorus of support from professional medical organizations to appear in the days after it aired. Befitting his role as mastermind of Pou’s defense, Simmons even took issue with a plan by the American Medical Association—an influential membership organization of doctors—to release a statement the day after Sunday night’s show, arguing that a much-anticipated Monday Night Football broadcast marking the return of the New Orleans Saints to the restored Superdome would draw local news attention away from it.
Meanwhile, Attorney General Foti’s public information director, Kris Wartelle, had also helped organize an interview with her boss, confident that the broadcast would be a hard-hitting investigative work that would fairly present his side of the story. She had been impressed by 60 Minutes reporter Ed Bradley’s work with her office on a story examining why police in the majority white suburb of Gretna prevented a largely black crowd of New Orleans residents from crossing a bridge to relative safety there after Katrina. It took Wartelle by surprise to learn that Morley Safer, not Bradley, would be reporting the Memorial story after what she believed to have been an internal fight. Safer’s young producer assured Wartelle the story would still portray Foti as a hero.
Safer arrived to conduct the interview. “Morley’s in a bad mood,” the producer warned Wartelle.
When Safer began questioning the attorney general under the klieg lights, it became apparent the story would be critical toward him. Foti was angry at Wartelle, who argued with Safer for about an hour after the interview and sent a scathing e-mail to a top CBS network official. She felt she had been lied to about the reporter’s intentions.
The segment aired Sunday night, September 24, 2006. Pou’s appearance was a sensation.
The camera closed in on her attractive face. Her lips trembled slightly, their corners turned down in a pained grimace as she stared intently at Safer. “I want everybody to know that I am not a murderer,” she told him, speaking slowly and nodding her head to emphasize her words, as if the American public were a child whom she needed to make understand something vital.
Safer’s face showed pity and sympathy. He asked what it was like going from being a respected surgeon to an accused criminal. “It completely ripped my heart out,” she said, on the verge of tears. “My entire life I have tried to do good.” She argued that she had done the best she could under dreadful conditions that resulted from being abandoned. She didn’t believe in euthanasia, she said, but in comfort care—ensuring that patients don’t suffer pain. Asked by Safer if she ever lost hope, Pou was indignant. As a cancer specialist, she said, “I am hope.”
The attorney general, meanwhile, appeared stiff and distant behind thick glasses, his face shiny and lit from the side, highlighting his wrinkles. Safer asked him, “Would you not think that in case of murder, the perpetrators would try to conceal their actions?”
“Maybe they just didn’t think that anybody would ever find out,” Foti replied, crooked teeth showing between chapped lips.
Doctors from around the country w
ere incensed. “Your Attorney General, Mr. Foti, is a complete buffoon for prosecuting these professionals,” a doctor from Virginia, John M. Kellum, wrote to the webmaster of the attorney general’s website during the broadcast.
Spokeswoman Wartelle filed a complaint with Kellum’s medical school dean, describing his e-mail as “rude and unprofessional,” and she sent a message back to Kellum. “If you don’t want allegations of wrong doing investigated, then maybe you should contact the hundreds of eyewitnesses we interviewed […] We cannot comment on the evidence which puts us at a disadvantage when viewers lash out without one inkling of the evidence in this case.”
As Simmons had helped orchestrate (albeit on the Monday) the American Medical Association released a statement describing Pou as a member in good standing and the case against her as complex and sharply contested. One of the organization’s top executives was a head and neck surgeon like Pou and worked on her behalf behind the scenes. “The AMA is very proud of the many heroic physicians and other health care professionals who sacrificed and distinguished themselves in the aftermath of Hurricane Katrina,” the statement said.
Meanwhile, a doctor on the board of the Louisiana State Medical Society who had known Pou since childhood lobbied for her within that organization. Members pressured the group to donate to Pou’s support fund, and when legal strictures precluded that, employees posted information about Pou’s defense fund on the organization’s website, which carried a statement suggesting that the strength of Pou’s television performance be used to gauge her innocence.