by Sheri Fink
That backing was reflected in the letters that arrived in a post office box for Cheri Landry and Lori Budo, full of kind words: I wasn’t there, but I’m a nurse, too; or my relative’s a nurse; or I’m a former patient or coworker or doctor, and I know you did the best you could. On the nurses’ support fund website, ICU nurse Cathy Green solicited not only money for Budo and Landry, but also “cards, letters and words of encouragement” to help cheer the nurses.
The accused women also uplifted each other. When Landry’s house had to be demolished due to flood damage, Budo went to pick a few items out of the putrid muck, taking them home, washing and sterilizing them for her friend—a couple of boxes’ worth salvaged from the belongings of a lifetime.
Far worse than losing everything she owned, Landry told Green, was losing her job. Landry questioned whether they would ever be able to be nurses again.
Not working was difficult both professionally and existentially. Tenet continued to pay the nurses’ legal fees, but in many ways, their position after the arrests was more difficult than Anna Pou’s. Unlike Pou, Landry and Budo did not have a university job to fall back on when they could not practice clinically. Landry had lost her home to Katrina and was the primary caregiver for her ailing mother. Budo was the major breadwinner in her family with two children in college. The nurses were middle class, with mortgages, rent, and car loans to pay.
Colleagues from the Memorial ICU sold plastic bracelets and car magnets to raise money for the two nurses. They organized a committee to deliver food and perform “other acts of kindness” for them. At the request of their friends, Landry and Budo drew up itemized budgets and received a monthly allowance from the support fund to cover bills, food, and clothing. Landry told a reporter for the local Gambit Weekly that she was grateful, but having her bills paid this way was very humbling and weird. “It’s like someone else’s life.” The reporter wrote that Budo wept during the joint interview.
The women’s supporters worked to keep a three-month cushion of funds in the bank. One particularly generous donor said that if the treasury ever fell short, he would pick up the slack. The medical staff of the hospital gave each of the two nurses a gift of $10,000.
Getting together with Budo or Landry reminded Green of being at a funeral. They could be talking calmly one moment, and someone would start crying the next. They asked, “Why me?” Green felt terrible knowing that her friend Lori awoke every morning thinking, I could lose my husband and my children. I could go to jail for the rest of my life for staying at the hospital. Green believed the nurses’ lives would never be all right again. She saw the toll their plight was taking on their families.
Anna Pou, in contrast, had kept her job and quietly returned to operating again, although her PR force did nothing to dispel the public’s perception that the arrest had stilled the hands of one of Louisiana’s great surgeons. She restricted her clinical work to the public hospital in Baton Rouge, Earl K. Long (named after Gov. Huey Long’s younger brother, who also served as governor), a limping structure with two aluminum-clad cylindrical towers some doctors referred to as the “twin trash cans.” Among other things, Rick Simmons feared the potential for “frivolous lawsuits” lodged by private pay patients. Some attorneys in New Orleans believed that poor patients had less wherewithal to sue their doctors.
LSU had not reopened Charity Hospital in New Orleans after Katrina, lobbying instead for state and federal support to build a long-hoped-for new hospital, and Earl K. Long was picking up some of the slack. The air-conditioner in the operating room didn’t work reliably, and Pou operated sometimes under the light of hunting headlamps. Pou questioned her surgical academy’s practice of sending surgeons overseas when Louisiana was, to her mind, “as Third World as any place you want to visit.”
The state medical board had not sanctioned or investigated Pou. She even received something of a promotion, being named director of Louisiana State University’s residency training program for her specialty, which required the approval of national medical organizations.
ON MAY 19, 2007, secretaries, nurses, and doctors who had once worked with Pou in Texas spent hours dressing up a windowless exhibit room in the basement of the Hyatt Regency in Houston, covering concrete walls with cardboard cutouts in the shape of the New Orleans symbol, the fleur-de-lis, slipping black polyester sheaths over dozens of ugly metal chairs, and placing tall candles into hurricane glasses. They had organized a disaster-preparedness seminar and dinner dance fund-raiser for Pou far from New Orleans, where a fancy celebration to raise money for her defense might seem inappropriate.
As her friends worked, Pou paid a visit to her old hairdresser, Raoul, who created a poufy shag for the occasion. Another stylist tended to her eighty-three-year-old mother, who had ridden in with her for the event along with many of her brothers and sisters. They were staying at the hotel, some sharing beds.
Before the disaster seminar, well-wishers crowded around to ask about her ongoing legal travails. Pou compared them to purgatory. “Now I know what the nuns were talking about in Catholic School,” she said, and laughed bitterly. “I know exactly what it feels like.” She recalled the little white snowmen the nuns had said represented the soul and had marked in black to symbolize sins. Pou had thought her soul was white. “Apparently not,” she said to her admirers. “I have a feeling I must have had some black marks I didn’t know about.”
She stood with a phalanx of siblings, and many attendees remarked on the diminutive women’s striking resemblance. Pou and her sisters even finished one another’s stories. When the subject of conversation drifted to the hurricane, the sisters stopped themselves lightly. “We won’t even go back there,” Pou said. Her older sister Jeannie—the dialysis nurse whose phone conversation with Pou had cut out after the Seventeenth Street drainage canal split open and began filling her Lakeview neighborhood with Katrina’s floodwaters—picked up the riff. “We can’t, we’re not goin’ back there,” she agreed.
As they discussed disaster preparedness that afternoon, Rick Simmons argued that Katrina showed what worked best was a central, top-to-bottom command. He gave the example of the Coast Guard, perhaps not knowing that many in the Guard attributed their Katrina successes, conversely, to the initiative of ground-level crew members who were empowered to solve problems impromptu and worked with great autonomy.
“Well, there was a problem with the Coast Guard,” Pou asserted. “The Coast Guard do not fly at night. When you have a disaster, you need people who can fly at night. That’s absurd that that can’t happen, in my opinion.”
Of course the contention wasn’t true. In the days after Katrina, Coast Guard air crews had donned night-vision equipment and risked tangling themselves in power lines to land on rooftops, hack into attics, and rescue people, including patients at Memorial. The Coast Guard had specific policies and procedures for flying at night.
Pou could fix on an idea and be absolutely convinced of it, and convince others of it, even without all the evidence. “Trust me, they don’t fly at night,” she said to the audience. “Ask Vince.” Her husband, a pharmacist who was a recreational pilot, had heard this.
What “really rescued people in Katrina” was “the military,” she said, as if discounting the Coast Guard as part of the military. “It was the Night Hawks,” she said, meaning Black Hawks, “those big, giant Black Hawk military helicopters that came in and got everybody.”
“It was dangerous to fly at night because there were so many unlit towers,” Vince Panepinto said. He had become a legend among Pou’s friends for having reportedly made his way north to Hammond, Louisiana, after Katrina’s floodwaters rose, and from there flown helicopters to rescue people.
One of the seminar presenters, Dr. Neil Ward, gently cited a report suggesting the Coast Guard had in fact flown at night. “They make the point that they did, with night-vision goggles, make some rescues.”
Pou expressed similarly unshaded, Manichaean views on other matters. The LSU Medical Cen
ter employees working with her to serve the poor at the rundown public hospital in Baton Rouge were heroic. “I tell you, the courage. They are so courageous,” she said. “I’ve never seen such altruism.”
By contrast, those at the rival medical school, Tulane, had “abandoned all indigent care” for the uninsured poor, she said, even as a system of clinics set up by Tulane doctors in New Orleans after Katrina was continuing to treat thousands of residents for free.
Pou had told many friends she would never return to practicing in New Orleans after what had happened to her, but at the seminar she said she hoped other doctors would stay there, despite conditions she compared to “Civil War Reconstruction,” to help bring back the city.
“We just have to give people a shot of hope,” she said without irony.
Before the seminar ended, Pou’s former chairman from Galveston complimented her. “There’s never been a stronger patient advocate in our department than Anna Pou,” he said. He lauded the work she was doing now at Louisiana State University to reorganize its residency program. “All of us are praying for you,” he said.
Pou thanked her friends at the seminar for helping her through her ordeal. “I know that phenomenal good is going to come of this. I’ve been through some very dark places in my mind. I wouldn’t be here without all of you. The courage and strength all of you have given me are a gift from God.”
A FEW HOURS later in the transformed hotel basement ballroom, a former colleague of Pou’s welcomed around two hundred guests who had donated up to $2,000 per couple to attend and support her. “Doing the right thing sometimes isn’t the most popular thing to do,” he said into a microphone. “But it certainly is not a crime. And so I think all of us are here today to celebrate doing the right thing. So that’s what I want the emphasis of this evening to be, is to be a celebration.”
Pou took the microphone in tears. “If it would not be for you,” she told her supporters, “I would not be standing here today.” She thanked them from the bottom of her heart and told them their love and support got her out of bed every day. “I consider myself one of the luckiest people that I’ve known because people have been so wonderful.”
The organizers kicked off the entertainment with a country ditty about Pou, sung raspy and gravelly to an untuned guitar, written and recorded by a patient whose voice box Pou had reconstructed. Waiters served steak and poured wine. A local band, the DarDans, played Creedence Clearwater Revival’s “Born on the Bayou” and invited the “bayou folks” to dance. Pou and around a dozen others obliged, drinking and dominating the dance floor throughout the night.
Pou wore a diaphanous gown with a deep V-neck that disappeared into a high empire waist, exposing a broad expanse of pink chest. The look, Southern Lady, Prêt-à-Party, was enhanced by a small gold cross dangling from a strand of pearls.
Even Rick Simmons let loose on the dance floor in a sweat-soaked dress shirt and tie; the heavyset lawyer had a dripping comb-over plastered to his scalp. One of Pou’s friends thought it improper for “Disco Dick” to be enjoying himself so visibly—after all, the purpose of the dinner was to raise money to pay him. “I’m telling her to get a new lawyer,” she said.
Pou let her girlish side take over, donning a fake grass skirt for “Margaritaville,” erupting in chirpy whoops, and pushing her hair back, Vogue style, with jerks of alternating arms.
Pou’s husband, Vince Panepinto, stood watching as his wife danced with her former colleagues and Simmons. “I wish I knew all the things he knows,” he mused. Pou and her lawyer were speaking every day as the case progressed, but Panepinto said that he didn’t ask her for details of their conversations. “Attorney-client privilege; they take it seriously.”
Panepinto had tried to walk back to Memorial after the city began flooding. But the sight of two menacing men on his way there had made him turn around. Without a gun, he felt vulnerable. While he had not been at the hospital to witness what happened there, he knew his wife would never kill anyone, and he was convinced Foti had arrested her and accused her of killing elderly patients to impress other seniors, a constituency Foti had long courted. Now Panepinto said he didn’t know what his and Pou’s future would be.
From the dance floor, Pou summoned her tall, handsome husband. He gestured no and stayed to the side, watching. She didn’t press him.
Attendees browsed auction tables laden with treats of a distinctly high-low flavor. A Chanel purse, a spa package, a hunting vacation… a hooked rug by a friend’s mother, an awkward metal wall hanging, an enormous wooden cross hewn by a sick little girl, according to its auction tag. Peggy Perino, one of Pou’s sisters, bid on and won a giant basket filled with supplies for making margaritas, then had trouble fitting it into the family’s car the next day. “Peggy did this to us,” Pou sighed.
THE EVENT RAISED close to $100,000 and Pou emerged from it enriched in more than one way. During the seminar on disaster preparedness, she jotted occasional notes on the record pages of her checkbook, having forgotten a notepad. A presenter read a quote from the World Medical Association, an organization founded after World War II to set ethical guidelines for doctors. In a disaster, “patients whose condition exceeds the available therapeutic resources,” the organization said, “may be classified as ‘beyond emergency care.’” Rather than maintaining their lives at all costs, “the physician must show such patients compassion and respect for their dignity, for example by separating them from others and administering appropriate pain relief and sedatives.”
Pou scrounged in her purse for more paper to record the quote. After the event, she went on the Internet to find the full WMA policy on disaster medical ethics and e-mailed it to Rick Simmons.
Simmons was thrilled. They had found a respected medical organization stating that a disaster doctor could ethically designate a class of patients as not savable and treat them only with painkillers and sedatives. It sounded exactly like the decision Anna Pou had made.
There were, in fact, crucial differences. The policy defined “beyond emergency care” as applying to patients who had “extremely severe injuries” such as radiation burns that were not survivable, or who would require a long operation that would oblige a surgeon to choose between them and other patients. It also said that if any patient was categorized in this way, the decision had to be “regularly reassessed” in case the resources available—such as the helicopters that began arriving in force at Memorial Medical Center on Thursday morning—or the patient’s condition changed.
Still, Simmons thought, this is something I can use. He met with WMA representatives in Chicago. A jury, he felt, could readily understand the concept of “beyond emergency care,” and from now on he and Pou would refer to this in all publicity materials and public statements.
If the case went to trial, he and Pou might also need to justify one of the more controversial choices made at Memorial, that the healthier patients should be helped before the sicker ones. He and Pou adopted the term “battlefield triage.” That would say it all to a layperson, portray the conditions as Pou had perceived them, regardless of the fact that this method of triage was not typical practice on the battlefield.
They also took to calling the concept “reverse triage,” as in the reverse of what a layperson would expect. The term was used, albeit rarely, to refer to theoretical wartime situations where treating the most able-bodied first to get them back on the battlefield could help ensure the group’s survival.
Simmons was devoting nearly his entire practice to the goal of preventing the grand jury from indicting Pou, mounting what he called a “proactive defense.” He taught himself about triage and end-of-life issues, interviewed or obtained statements from more than one hundred potential witnesses, oversaw the preparation of exhibits on government abandonment, and filed motions to protect evidence and keep her conversations with Tenet officials confidential. He was still working by the hour, and although Pou’s university and her support fund were covering what had already amounted
to several hundred thousand dollars in legal fees, he was prepared to sue the state to repay them if Pou, technically a state employee of the public university, was not indicted. He drew up a legal motion to wipe away all traces of her arrest—mug shots, fingerprint cards, rap sheets—from every agency’s records in the event that the charges were dropped or refused.
Simmons took pride in having written statements of support for Anna Pou adopted by and released in the name of several professional organizations. He also collaborated with the attorney for the owners of St. Rita’s Nursing Home, James Cobb, in a public relations campaign to undermine the image of the man who’d had their clients arrested—an accusation AG Foti would lob, referring to their efforts as a “nefarious conspiracy,” one to which Cobb would later happily admit. Cobb was impressed by the Pou team members’ “deep pockets” and took turns with them feeding the media negative stories about Foti. The nursing home’s owners were months away from standing trial for negligent homicide in the drowning deaths of their residents at the home, which had been named for Mabel Mangano’s grandmother Rita, who was named for St. Rita of Cascia, the patron saint of lost and impossible causes.
Cobb and his colleagues planned to call Gov. Kathleen Babineaux Blanco to the stand and lay the blame on the government for failed levees and failed evacuation plans for the most vulnerable residents. How could the state scapegoat his clients at the same time it was attempting to hold the Army Corps of Engineers and its deficient levees responsible for an estimated $200 billion in damages, using the same language of negligence—willful, wanton, and reckless—that Foti was using against the Manganos?