by Sheri Fink
In order to receive money, those eligible had to submit a notarized claim form indicating whether physical or emotional injuries were suffered. Funds were divided among three categories: patients who died, patients who survived, and non-patients. Each claim effectively reduced the payout to other claimants in the same category.
Anna Pou opted in for a share of the settlement. According to the guidelines, she qualified for $2,090.37 for each day she was at Memorial.
THE SPECIAL GRAND jury’s decision in 2007 raised spirits in unexpected quarters. Some LifeCare nurses rejoiced, perhaps because lifting a cloud on Pou lifted a cloud on them, too. If she was not guilty of murder, then they were not guilty for having entrusted their patients to her.
A friend from nursing school called Gina Isbell with the news. She was at work with another former LifeCare nurse. They screamed, hollered, and jumped up and down in celebration.
Isbell wore a necklace with a pendant in the shape of a hurricane symbol. She still saw the faces of her Katrina patients in nightmares and was angry and bitter—not at Pou but at the thought that help came too slowly. She considered herself a different person after the storm, forever changed by the trauma of those days and how they had ended.
Sometimes she took comfort in a memory from her last hours on the helipad at Memorial. Dr. Roy Culotta’s eighty-seven-year-old grandmother reached out and grabbed her arm. “If I’m alive tomorrow,” the woman told Isbell, “it’s because of you.”
Isbell clung to the belief that she and her LifeCare and Memorial colleagues had done the best they could. She would serve again in a storm if she was asked. It was her job, her oath.
CATHY GREEN was still a true believer. Nothing could shake the ICU nurse’s faith in her accused colleagues and her pride in Baptist Hospital and the nursing and medical professions. The grand jury’s decision pleased her, but it was not enough. She wished she could erase the idea Foti had implanted in the public that health-care workers would willingly do harm to their patients.
Memorial staff had been criticized for playing God. Green knew they were asked to play God every day in the ICU. She didn’t believe in killing people, but she saw no valor in prolonging death by not giving painkillers. At Memorial’s ICU, doctors like Ewing Cook wrote orders that gave nurses like her a great deal of leeway with “a whole arsenal of stuff.” That was the culture, and she embraced it, having seen, early in her career, a woman die a “lingering death.” When Memorial’s long closure forced Green to work in other hospitals, she noticed that the approach was different. Patients weren’t given as much sedation.
It pained Green to watch the sharp contractions of agonal breathing. When a young doctor reassured her once that patients at that point weren’t themselves in pain, she told him to try breathing like that himself and see how comfortable it was. The doctor’s point was that the patients had too little brain function to be uncomfortable, but Green thought “young mind doctors” and “young mind nurses” didn’t get it.
Green didn’t want a protracted ending for herself. She told her daughter that if that time came, “You just take me to Holland.”
What was it about death in the United States? Why did it seem like Americans were so unprepared for it when it occurred? She had seen it again and again working in the ICU. People often did not want to talk about death with the dying, or be there with a relative when it happened.
Why did we celebrate every milestone in life except this one? she wondered. Everyone wanted to be there to witness the beginning of life, but the ratio of birth to death was one to one. We all had to learn to say good-bye and give our loved ones the dignity to acknowledge we knew they were going. She would ask, “If your best one got on the slow boat to China, you would not be at the dock saying good-bye?”
Green had once been extremely sick on a ventilator in an ICU. She knew that the softness provided by a caring nurse like her was meaningful. But what she did not like about her job was the way she and her colleagues, with their drugs and machines, forced some suffering people to be alive for many months. People who chose ICU care did not realize this could happen, she believed. Death was not always the enemy, she felt, especially when somebody was elderly. She thought that most of her patients did not want the high-tech care that their families wanted for them. The effect of ICU treatment on quality of life should be considered. She knew what her next battle was, now that the one for her colleagues was won.
“We’re so frightened of ‘euthanasia,’” she would say. “It’s the race card of medicine. It’s like the word ‘lynching.’” She wanted that to change.
FRANK MINYARD would later say he felt a little betrayed, a little hurt. It wasn’t often that he called a death a homicide and the grand jury failed to indict. Their decision had stemmed, he concluded, from the harsh way that Attorney General Foti had treated the women, as well as the persuasive power of the media. He did not consider the role of his own media statements.
He thought someone would pick up the case again, perhaps a federal prosecutor. He didn’t believe the story was over. It would lie dormant and come back roaring.
FORENSIC EXPERT Cyril Wecht did not care if Pou was punished. What he cared about was the truth and what could be learned from it. For heaven’s sake, he thought, Memorial wasn’t on a goddamn battlefield with enemy shells coming in. This was New Orleans, and there were helicopters and boats. And really, were they saying they couldn’t get patients off the seventh floor? Given a choice, would someone rather die a painless death or live after being lowered, however uncomfortably, from a window? A great disservice was being done to the field of medicine, because the events were covered up and medical leaders reacted emotionally, without knowledge about what had happened. For now the lessons seemed to be that in a disaster if you’re a doctor, you’re in charge. If you feel giving large doses of morphine and Versed are appropriate, go ahead. It’s your call. “Is this what we want young doctors to learn?” he asked. “It’s a goddamn precedent, a very dangerous, bad precedent.”
ARTHUR CAPLAN, the ethicist, worried that without formal analysis, the case would remain “an unsettled moral toothache.” Bioethicists, not usually shrinking violets, had generally shied from sharing their opinions on this case. Perhaps some thought there was an underground practice of assisted suicide and euthanasia in America that seemed to be working and nobody wanted to shine a big spotlight on it. Many ethicists felt the conditions at Memorial were so horrible that moral judgments could not be made about what happened there.
Caplan felt differently. “Why not there?” he would ask. He never received a satisfactory answer.
VIRGINIA RIDER and Butch Schafer did not believe justice had reached its end in the case. Justice did not require, ultimately, a conviction. It could be served in a retelling through the court process.
Pou, Budo, and Landry symbolized the people in whose hands everyone places their lives in times of sickness. It was imperative to know how they would react under pressure, to learn that simply because people were medical professionals did not mean they would always act in the interest of their patients, whether from a self-serving motive or muddled thinking.
This case had changed the way Rider looked at the world more than almost anything in her life besides her children. It had led her to set out her own end-of-life preferences very clearly in an advance directive: for example, that she should be removed from life support only if two doctors and a sister she had designated as her health-care proxy agreed; that she would want pain medicines, yes, but no more than necessary for pain, and not in an amount that would carry a great risk of killing her. Members of the public deserved to know the story, so that they, too, could use its lessons to make informed choices.
Most of all, the victims deserved to have their stories told. Rider’s position on Pou herself would soften slightly after the surgeon performed a daylong operation on a relative with cancer. Perhaps God was telling her she shouldn’t be so quick to judge people.
Schafer co
uld understand Rider’s feelings about the case, but he was more sanguine. He knew what had really happened at Memorial. Whether anyone else knew it was not his concern. As a prosecutor, you learned that many of the people you brought to trial wouldn’t be found guilty. You couldn’t spend your life sulking about it.
Years later, Dr. Ewing Cook would walk into a room at a small, rural hospital where Schafer had been admitted for the treatment of a possible lung infection. As Schafer lay helpless on the bed, hooked up to monitors and drug infusions, he marveled at the irony of the situation—his life now in Cook’s hands. To his relief, the doctor did not seem to recognize him from the day he had sat outside Cook’s door in the car while Rider handed him a subpoena. In the hospital, Cook was nice, cordial, with a dry sense of humor—a great guy, Schafer thought. Cook told Schafer there was nothing wrong with him. Schafer recovered.
Schafer believed the small, underresourced Medicaid fraud team had done the best they possibly could with the resources that they had. He was proud of the whole unit. They did not cheat. They had nothing to be ashamed of, contrary to public opinion. They’d been good. He would always have that.
ANGELA MCMANUS spent the entire day of the grand jury return crying. She phoned family members to let them know. “Now what?” they asked. McManus had no answer. She wished the grand jury had called her to testify. She still believed Pou was her mother’s murderer.
KATHRYN NELSON, Elaine’s daughter, didn’t feel angry; she didn’t necessarily want to see Pou in prison, but she didn’t believe she should keep her medical license. She had broken her primary oath. The nurses had too. What was to stop them from doing it again?
She thought of the wars going on across the ocean in Iraq and Afghanistan. Americans didn’t leave their dead troops behind, no matter how intolerable the situation. But here at home a war against nature had been lost because some people were killed and left behind.
Her brother Craig moved forward aggressively with his civil case.
CARRIE EVERETT wanted to see justice done, to see Pou accept responsibility for her actions. Even though her husband, Emmett, had lost the use of his legs and the control of his bladder, and had depended on her care for nine years, she would still rather be bathing him, putting a diaper on him, laughing and clowning and arguing like every couple did—she would still rather have him there.
She wanted to know, what was the reason, what was the purpose? She didn’t know what happened; she wasn’t there to see Pou, to place her hands on the woman and say, “Don’t do this.” If she had been there, instead of trapped with her children and grandchildren in the flooded Ninth Ward, she was sure Pou would never have come into the room. Whatever had happened would not have happened. She would still have her husband.
RODNEY SCOTT, the patient whom Ewing Cook once took for dead, had made it home. He had suffered during the disaster, designated to go last because he weighed more than 300 pounds. He was frightened and hot and uncomfortable. He had hit his head in the helicopter, and had been left for two days in a paper gown at the New Orleans airport, in his feces, in pain. The trauma had lasted: the next time he’d had to be in a hospital, he refused to remove his street clothes. Still—and despite lingering medical problems that kept him from getting around much, that put him squarely in the camp of “the disabled”—there was no question in his mind that it was worth going through all of that to survive and reunite with his family.
If nothing else was learned, what he hoped people took from Memorial’s misfortune was simple: “Every time you can save a life, save it.” If they could get him out, they could get everyone out. What had happened need not have happened. “There’s a way for everything,” he would say. Every option should have been explored.
When he was younger and healthier, he had worked as a nurse. He did not know whether euthanasia had occurred at Memorial, but if it had, he wondered what the doctors and nurses could have been thinking in deciding who would die that day. “How can you say euthanasia is better than evacuation? If they had vital signs, you could evacuate them… get ’em out. Let God make that decision.”
FATHER JOHN MARSE, as hospital chaplain, was careful to tell people that he was not present when the alleged acts occurred. And he was not a bioethicist. What he would say was that people faced with bad choices should make choices that are in the best interests of patients and family members, not their own egos. He believed in comfort and felt that the staff at Memorial did the best they could to offer that. He believed that God was merciful and forgiving.
DR. BRYANT KING had stayed far away from New Orleans, turning down later CNN interview requests out of concerns for his safety. A friend warned him that the moneyed people who were trying to discredit him could sweep him under the rug and get rid of him. “Don’t say a word,” the friend said. “Go somewhere. If you’ve got shade, go in it.” Keep it low. You don’t want anyone hunting you down.
King had worked closely with Anna Pou throughout the disaster, switching off caring for patients on the second floor. He’d thought she was doing a yeoman’s job. What troubled him later was how easily someone with whom he’d had a cordial relationship could be turned to do something so horrible. No matter how tired a doctor was, the initial reaction to the proposal should have been to take a step back and say, “Are you kidding me? Oh no, that just doesn’t sound right.” He wondered what words someone could possibly have used to make Pou and others say instead, in essence, “We know this is not how we usually function, but today we’re going to do it and pretend it never happened.” He could not wrap his mind around it. And he could not believe that Pou was allowed to continue practicing medicine.
DR. HORACE BALTZ shook his head when he heard Pou’s remarks from the press conference. He was still violently upset over the euthanasia, considered it totally unethical and unnecessary. It haunted him. Pou’s alleged actions, he felt, destroyed the trust in the medical profession that is a foundation of society. That trust was further eroded by the lockstep defense of the medical community.
Pou had genuflected to thank God that she wasn’t going to prison? He longed to hear that she had taken to her knees to do something different: beg forgiveness for having violated the commandment “Thou shalt not kill.”
Just after Katrina, Britain’s Mail on Sunday tabloid newspaper had reported that a doctor had done exactly this. The doctor had been quoted anonymously. She was, in fact, a more repentant-sounding Anna Pou:
I did not know if I was doing the right thing. But I did not have time. I had to make snap decisions, under the most appalling circumstances, and I did what I thought was right. I injected morphine into those patients who were dying and in agony. If the first dose was not enough, I gave a double dose. And at night I prayed to God to have mercy on my soul.
“DOES ANYONE FEEL that they’re making a mistake?” a man on the special grand jury had asked his fellow jurors before they took their final vote in July 2007. None of them said they did. The Memorial nurses had been very sad and cried throughout their testimony. The coroner struck one juror as a “cute old man” who spoke calmly and whose opinion in large part contradicted those of his experts.
What that juror couldn’t understand was where the LifeCare staff members had been on Thursday, September 1, 2005, when the patients were medicated. It was only at the final meeting of the grand jury that two LifeCare leaders—assistant administrator Diane Robichaux and nurse executive Therese Mendez—were called to testify. The prosecutor did not ask the women very detailed questions. Mendez described how Pou came upstairs to LifeCare and said that she was assuming responsibility for the patients and that they would be given a lethal dose of drugs. Neither Mendez nor Robichaux, however, had seen what happened next, because they had gone to clear staff off the floor.
There was, of course, a witness, who had stood at the bedsides of the patients as Pou and the nurses injected them. Kristy Johnson. Two people close to Johnson would later recall that she was scheduled to appear before the special grand
jury the same day as her colleagues—perhaps later in the day, because of a work schedule conflict. She was not, however, called by the prosecutors when she was available.
What sank the case in the one juror’s mind was that nobody stood before the jury and testified to seeing Anna Pou actually inject a patient. The fundamental evidence needed to pin the deaths on the woman whose name was on the indictment papers was, in this juror’s opinion, lacking.
The juror was a devotee of forensic pathologist Michael Baden’s documentary television series Autopsy. What particularly struck her was the fact that so many patients who had been alive in the morning were dead by the afternoon. And Emmett Everett, he would stay with her. She would recall, years later, the vision of him eating his breakfast that Thursday morning and asking the staff when they were going to rock and roll. She believed the experts’ reports that concluded that the deaths at Memorial were homicides.