When Doctors Kill: Who, Why, and How
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Born in 1956 into a family that included a number of physicians, Marie Anne Pou was exposed early to the challenges of medical practice. She and her siblings often accompanied their father on weekend house calls and were impressed by his J.A. Perper and S.J. Cina, When Doctors Kill: Who, Why, and How, 149
DOI 10.1007/978-1-4419-1369-2_15, © Springer Science+Business Media, LLC 2010
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skills and sensitive contact with patients. It is not difficult to understand why Pou decided quite early in her life to be a doctor. Her Katrina saga started as a routine weekend with Anna heading to work at New Orleans Memorial Hospital. Hurricane Katrina appeared heading for Florida and although warnings were issued for New Orleans there did not appear to be a real threat. Dr. Pou decided to stay with her patients and ride out the storm if it reached them. It did and the rest is history.
After the storm had passed on Monday August 29, 2005 the hospital administration prematurely congratulated itself on not having had the hospital evacuated.
While they celebrated, the levees were collapsing. By Tuesday, water was rising in the streets eventually reaching a depth of 10 ft. The hospital basement flooded and the generators failed. When nightfall came, the hospital and the city were enveloped in darkness. Water pressure dropped, toilets backed up and the temperature began to rise. The deteriorating situation had dire consequences. Pou later said the hospital staff struggled to climb stairwells, carry supplies, and spent 2-hour shifts squeezing ventilators to keep patients alive. “The heat was so terrible, it wore you down,” Pou said. “We were trying to keep the patients comfortable. The 9 year-old daughter of one of the nurses even took shifts fanning them.” Airboats evacuated some patients and babies from the nursery but most remained. About seven medical staffers, including Dr. Pou, stayed with the patients. “Tuesday night was when we realized we were going to be there for a while,” Pou said. All she could do was to keep critically ill patients comfortable. The staff gathered supplies, rationed food and water, and prayed. Under the military’s orders, the staff initiated reverse triage. Instead of addressing the needs of the sickest patients, the healthiest ones were taken out first in an effort to save the greatest number of people. Many had to be carried to the roof. It was slow, backbreaking work with as many as ten people struggling up the dark stairs with a stretcher. At least 34 people died waiting for rescuers. Pou was one of the last to leave Memorial Hospital. She returned to New Orleans – her house had not been flooded – from Baton Rouge a few months later at Thanksgiving.
In January 2006 she started working at a Baton Rouge hospital, trying to put Katrina behind her. Many felt she was a heroine.
In July 2006, she was greeted by four police officers upon her arrival home from a 13-hour day of surgery. They handcuffed her, still in her scrubs, and drove her to jail. She was booked on four counts of second-degree murder together with two of the hospital nurses. Attorney General Charles Foti accused Dr. Pou and the nurses of using a “lethal cocktail” of prescription drugs to kill four elderly patients at Memorial Hospital 3 days after Hurricane Katrina. Pou strongly contended that she killed no one during those desperate days, although she acknowledges patients were sedated for their comfort. She unequivocally stated, “I did not murder those patients. . . . I do not believe in euthanasia. I don’t think it’s anyone’s decision to make when a patient dies. However, what I do believe in is comfort care, and that means that we ensure that they do not suffer pain.” She was then released on bond. A year after her arrest, charges were still not filed by then New Orleans Parish District Attorney Eddie Jordan, and a Grand Jury that investigated the case declined to issue indictments against Dr. Pou. Two civil lawsuits related to the deaths are pending.
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While a number of details surrounding the circumstances of the deaths were murky and of a subjective nature, others were crystal clear:
– New Orleans’ Memorial Hospital, where Dr. Pou worked, had a capacity of only 200 beds. But on the eve of the storm the facility accommodated a total of 2,000
people, including medical and supportive staff, their families and neighbors who sought refuge
– Dr. Pou and the remaining medical staff had to work in extremely trying conditions
– The hospital was hit hard by the storm and lost all electrical power as the basement generators became flooded
– With the power loss the air conditioning system broke down and the health workers had to break the windows to get some relief from temperatures reaching more than 110°F
– The toilets had backed up and the air was so rancid that it was burning the throat
– The evacuation of most of the patients from the hospital was delayed for almost 4 days
– The priority order of patient to be evacuated was changed by military order from evacuating the most sickly patients first to evacuating the patients who had the best chance of survival
– Most of the physicians have been evacuated but Dr. Pou and a small number of nursing personnel chose to stay on and care for the patients
– The patients on the seventh floor which included the four alleged murder victims were the most severely ill patients in the hospital. In fact, some had DNR (do not resuscitate) orders issued prior to the storm, and
– Stories of murders, robbery, and gang rape circulated through Memorial Hospital where the people trapped inside, including more than 200 patients, feared for their lives.
Second hand information, however, and a few facts suggested that Dr. Pou may have been involved in accelerating the final hours of some patients:
– A nurse reported hearing Dr. Pou state that one of the patients on the seventh floor could not be evacuated and that no living patient was to be left behind
– A fellow physician, Dr. King, reported that before he was evacuated he observed a nervous Dr. Pou holding many syringes in her hands at the entry to the seventh floor in the company of two nurses. Dr. King stated that according to the hospital’s protocol and custom physicians never administered injections to patients (of course, customarily they didn’t work under these conditions, either)
– Nine severely ill patients on the seventh floor all died at about the same time on the fourth day after the hurricane shortly before help finally arrived
– In all nine the postmortem toxicological analysis showed elevated levels of morphine and midazolam (a sedative like Valium but stronger) even though most of them were not prescribed morphine or midazolam, and
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– Autopsies of the deceased listed the cause of death as combined drug intoxication, although the manner of death was listed by the Coroner as undetermined (i.e. impossible to determine whether the death was natural, suicide, accident or homicide).
Based on the suspicious circumstances surrounding these clustered deaths, Attorney General Charles Foti, a former sheriff of the Orleans Parish, decided to arrest Dr. Pou and the two nurses on charges of homicide. Foti allegedly made his decision based on his interpretation of the facts of the case and also relied on the opinion of Dr. Cyril Wecht, a forensic pathologist recommended by the Coroner, Dr. Maynard. Foti, who was in the process of running for re-election ordered the arrest and turned it into a media event. In 2006, during an internationally televised news conference debating the Memorial Hospital investigation, Foti categorically stated “This is a homicide; it is not euthanasia.”
By trying Dr. Pou in the media rather than Court, the Attorney General made a series of basic tactical errors which were to haunt him and, in conjunction with insufficient evidence, bring the case ignominiously down. The first error was making strident public accusations against a reputable physician with no record of supporting euthanasia, no known “God complex,” and who was one of the few doctors who chose to stay with and treat her patients while most other healthcare providers basically fled. The public often frowns upon
charging a hero or a heroine with murder especially if it seems to be politically motivated. Further, the alleged crimes occurred during a time in which the government failed to address the suffering of thousands of Katrina’s victims, yet the same government now wanted to prosecute a doctor who was doing her job. It was no wonder that hundreds of Louisiana residents supported Dr. Pou and contributed to her defense fund.
The prosecution’s case lingered for more than 2 years, raising further questions about the reliability and sufficiency of the accusatory evidence before it totally collapsed. In the aftermath of the Pou arrest, Charles Foti lost his bid for re-election and a new Attorney General was elected. The new Attorney General asked additional forensic experts (well-known forensic pathologists Drs. Cyril Wecht and Michael Baden and Dr. Steven Karch, a well-respected forensic pathologist with expertise in toxicology) as well as an ethicist (Dr. Kaplan) for their opinions. The forensic consultants, except Dr. Karch, were of the opinion that there was sufficient credible evidence to conclude that the deaths of the involved patients were homicide by drugs. For unknown reasons these experts were never called to testify before the Grand Jury which ultimately dismissed the case. Several years later, Dr.
Karch stated unequivocally: “There was no evidence to take before a Grand Jury (against Pou).” As a forensic specialist grounded in both pathology and toxicology the opinion of Dr. Karch should have carried particular weight since these cases were thought to be the result of a drug overdose.
Dr. Pou is still working as a doctor but she has also found also a new vocation, advocating laws to protect physicians and other healthcare specialists from being sued for the altruistic rendering of care during dire emergencies. She had been successful in promoting such legislation both at the federal and state levels. On July 8, The Benghazi Six
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2008 Governor Bobby Jindal of Louisiana signed the last bill in a three-piece legislation package designed to protect medical personnel and patients during future disasters. Two of the new laws limit civil lawsuits against medical professionals who work during a declared disaster. The third directs prosecutors to use a medical panel to review evidence when a doctor or nurse is suspected of euthanasia or other criminal medical actions during a disaster. These measures extend the so-called “Good Samaritan law” which protects ordinary citizens who render emergency assistance from lawsuits to health care professionals who are working during a disaster. The Pou case proves at least one thing-truly no good deed goes unpunished.
The Benghazi Six
In another less publicized case, groundless accusations of intentionally killing more than 450 children by infecting them with AIDS kept a Palestinian doctor and five Bulgarian nurses imprisoned for 8 years in Libya. They were ultimately released after widespread international outrage, diplomatic pressure, and the payment of $400 million to the families of the victims (after filtration through the Libyan government, of course) by Western countries. It is somewhat hard to understand why the free world had to pay for the mistakes and incompetency of the Libyan medical system but free nations have repeatedly made clandestine agreements with terrorists and terrorist states that often reward rather than punish them for their crimes. In this case, the freedom of the Benghazi Six was bought for about $65 million each.
The AIDS epidemic among Libyan children in Benghazi started to slowly unfold in the mid 1990s. Dr. Achris Ahmed, who headed the Benghazi HIV Committee, stated that the first case of AIDS at the Al Fateh Children’s Hospital was diagnosed in June1997, a year before a group of Bulgarian nurses even began working at the Libyan hospital. Several months later, doctors diagnosed a second AIDS case. “But we knew little about the virus because there is no HIV in Libya,” Dr. Ahmed was quoted to have said. Dris Lagha’s 8-year-old daughter, Rokaya Lagha, was the seventh case to be diagnosed back in September 1998. “The doctor was confused,”
Lagha is reported to have said, recalling the day he learned the devastating news.
“He didn’t seem to know much about the virus, and we didn’t know what to do.”
Some parents were told they could do nothing. Others were told, “This is from God.” By December 1998, the epidemic had become a social issue. “Because AIDS
is a sexually transmitted disease, many of our kids were mocked and ostracized.
Many stopped going to school,” said one concerned parent. Some children were treated like animals by their own families, “We isolated our kids, thinking they might infect their sisters and brothers or us.” Some were locked away and thrown food like dogs. “We were afraid to touch or hold them,” said another parent.
In November 1998, the Libyan “Le magazine” published an expose about the spread of AIDS at El-Fatih Children’s Hospital in Benghazi, the second largest city in Libya.
Investigation by the Libyan police revealed that over 400 children at the hospital had been diagnosed with HIV infection and 56 of them had died of AIDS. The 154
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Libyan public was enraged by this report and, even in a dictatorship, a leader has to pay attention to deep feelings that could undermine the ruler’s authority. Since admitting that its healthcare system was subpar and its knowledge of AIDS was pathetic was not an option, placing the blame on others was the self-evident solution. In February 1999, the Bulgarian embassy in Libya announced that 23
Bulgarians had gone missing and were apparently abducted by unidentified armed men. A week later the Embassy was informed by the Libyan authorities that “pre-cautionary measures” had been taken against a doctor and nurses working at the Benghazi Children’s Hospital. These measures consisted of arrest warrants for intentionally infecting Benghazi children with the HIV. The accused consisted of Dr. Ashraf al-Hajuj, a Palestinian physician, and five Bulgarian nurses who became widely known as “the Benghazi Six”. The murder conspiracy theory soon had a powerful champion in Libya’s ruler, the “brother-leader” himself, Colonel Muammar Gadhafi. He declared that either America’s CIA or the Mossad (Israel’s
“CIA”) had developed a unique strain of the killer virus and given it to the suspects to experiment on Libya’s children. Several years later, Saif al-Islam, Gadhafi’s son, challenged his father’s argument that the outbreak was a foreign plot and publicly asserted: “There is no conspiracy. There is no hand of Mossad or the CIA. This was a question of mismanagement, or negligence, or bad luck, or maybe all three.”
Nonetheless, popular belief in the foreigners’ guilt remained unshaken even when it was disclosed that their confessions followed intense torture.
The first case against the Six was brought in the People’s Court (Mahkamat al-Shàb), a body convened for crimes against the state. The trial began on February 7, 2000. The charges were intentionally “murdering with a lethal substance (Article 371 of the Penal Code), randomly killing with the aim of attacking the security of the State (Article 202), and causing an epidemic through spreading harmful virus, leading to the death of persons (Article 305).” In addition, the Bulgarians were accused of violating Libyan customs and traditions by engaging in non-marital sexual relations and drinking alcohol in public places, distilling alcohol, and illegally transacting in foreign currency. All defendants plead not guilty to all charges.
The prosecutors submitted confessions of the defendants into evidence but during the trial every one of them was recanted; the defendants maintained that they were coerced to confess by torture. Supporting this claim, the nurses had filed civil suits against ten Libyan police officers accusing them of physical abuse. The methods of interrogation employed by the authorities included forcing the nurses to undress before them, putting insects on their bodies, setting dogs on them, hanging them by their hands until the wrists and shoulders became dislocated, thrashing their feet with cables, beating them with electrical prods over the breast and genitalia, and sexual abuse. The women were also deprived of water and denied sleep in a tiny cell without a toilet and were threatened with death if they did not confess.
The prosecution asserted that the prisoners were part of a plot to subvert Libya by foreign secret service agencies stating, “To those services, child killing is nothing new. In this way they want to prevent Libya from playing an important role in the Arab World and to disturb calm in the country. The killing of the children by that virus is a means by which those secret services achieve their ends.”
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In calling for the death penalty, the prosecutor said, “These people have no moral human feelings once they have killed those children. They have sold themselves to the devil.” The defendants denied being part of any conspiracy, disclosed that some of them had never met prior to their arrest, and refuted the accusation that they had been paid to infect the children. Their defense lawyers argued that no incriminating physical evidence was submitted such as blood bottles alleged to contain contaminated plasma, syringes used to infect the children, distilling apparatus for alcohol production, or sexually compromising photographs of the Bulgarian defendants.
One of the lawyers argued that four of the defendants had been very recently hired and did not have the time or opportunity to infect the children even if they wanted to.
The employment records of the nurses supported this claim. A year after the trial began the People’s Court ruled that it did not have jurisdiction in the matter. The case was then bound over to ordinary criminal court.
The second trial took place in the Benghazi Appeals Court beginning in July 2003. Tight security measures were in place to protect the defendants from mobs outside of the courthouse. Police officers with submachine guns guarded the venue as relatives of the children gathered in front of the building. The prosecutor began by saying that the charges did not reflect the real number of children infected by the suspects – the real number of children infected was 429. The defense countered with testimony from Professor Luc Montagnier, the co-discoverer of the HIV, who testified that the virus infecting 393 Libyan children was a rare strain found mostly in Western Africa but also throughout the continent – but not in America, Bulgaria, or Israel. Montagnier told the court that an infected child admitted for treatment at the hospital probably started the outbreak. He said that injection was not the only possible means of infection and that any medical or surgical procedure involving penetration of the skin could have transmitted the virus unless sterilization practices were followed. These revelations prompted the Court to order a new expert study of the case records by a panel of appointed Libyan physicians. After an exhaustive,