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The Deadl Choices at Memorial

AUG. 1 2009 Fo ea af e Ka ina heelchai

and e i men li e a alk a o he heli ad a he
fo me Memo ial Medical Cen e a of hich
ha e no eo ened
Paolo Pelleg in Magn m fo The Ne Yo k Time

By SHERI FINK

A g

See h hi a icle a ea ed he i a igi all bli hed

NYTime .c m.

The smell of death as o erpo ering the moment a relief orker cracked open one of the
hospital chapel s ooden doors. Inside, more than a do en bodies la motionless on lo cots
and on the gro nd, shro ded in hite sheets. Here, a isp of gra hair peeked o t. There, a
knee as ng akimbo. A pallid hand reached across a bl e go n.

Within da s, the grisl tablea became the foc s of an in estigation into hat happened
hen the ood aters of H rricane Katrina marooned Memorial Medical Center in Upto n
Ne Orleans. The h rricane knocked o t po er and r nning ater and sent the
temperat res inside abo e 100 degrees. Still, in estigators ere s rprised at the n mber of
bodies in the makeshift morg e and ere st nned hen health care orkers charged that a
ell-regarded doctor and t o respected n rses had hastened the deaths of some patients b
injecting them ith lethal doses of dr gs. Mort ar orkers e ent all carried 45 corpses
from Memorial, more than from an comparable-si e hospital in the dro ned cit .

In estigators pored o er the e idence, and in J l 2006, nearl a ear after Katrina,
Lo isiana Department of J stice agents arrested the doctor and the n rses in connection
ith the deaths of fo r patients. The ph sician, Anna Po , defended herself on national

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tele ision, sa ing her role as to help patients thro gh their pain, a position she
maintains toda . After a Ne Orleans grand j r declined to indict her on second-degree
m rder charges, the case faded from ie .

In the fo r ears since Katrina, Po has helped rite and pass three la s in Lo isiana that
offer imm nit to health care professionals from most ci il la s its tho gh not in cases of
illf l miscond ct for their ork in f t re disasters, from h rricanes to terrorist attacks
to pandemic in en a. The la s also enco rage prosec tors to a ait the ndings of a
medical panel before deciding hether to prosec te medical professionals. Po has also
been ad ising state and national medical organi ations on disaster preparedness and legal
reform; she has lect red on medicine and ethics at national conferences and addressed
militar medical trainees. In her ad ocac , she arg es for changing the standards of medical
care in emergencies. She has said that informed consent is impossible d ring disasters and
that doctors need to be able to e ac ate the sickest or most se erel inj red patients last
along ith those ho ha e Do Not Res scitate orders an approach that she and her
colleag es sed as conditions orsened after Katrina.

Po and others cite hat happened at Memorial and Po s s bseq ent arrest hich she
has referred to as a personal traged to j stif changing the standards of care d ring
crises. B t the stor of hat happened in the frantic da s hen Memorial as c t off from
the orld has not been f ll told. O er the past t o and a half ears, I ha e obtained
pre io sl na ailable records and inter ie ed do ens of people ho ere in ol ed in the
e ents at Memorial and the in estigation that follo ed.

The inter ie s and doc ments cast the stor of Po and her colleag es in a ne light. It is
no e ident that more medical professionals ere in ol ed in the decision to inject patients
and far more patients ere injected than as pre io sl nderstood. When the names
on to icolog reports and a topsies are matched ith recollections and doc mentation from
the da s after Katrina, it appears that at least 17 patients ere injected ith morphine or the
sedati e mida olam, or both, after a long-a aited resc e effort as at last empt ing the
hospital. A n mber of these patients ere e tremel ill and might not ha e s r i ed the
e ac ation. Se eral ere almost certainl not near death hen the ere injected,
according to medical professionals ho treated them at Memorial and an internist s re ie
of their charts and a topsies that as commissioned b in estigators b t ne er made
p blic.

In the co rse of m reporting, I ent to se eral e ents in ol ing Po , incl ding t o f nd-
raisers on her behalf, a conference and se eral of her appearances before the Lo isiana
Legislat re. Po also sat do n ith me for a long inter ie last ear, b t she has repeatedl
declined to disc ss an details related to patient deaths, citing three ongoing rongf l-death
s its and the need for sensiti it in the cases of those ho ha e not s ed. She has pre ented
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jo rnalists from attending her lect res abo t Katrina and led a brief ith the Lo isiana
S preme Co rt opposing the release of a 50,000-page le assembled b in estigators on
deaths at Memorial.

The f ll details of hat Po did, and h , ma ne er be kno n. B t the arg ments she is
making abo t disaster preparedness that medical orkers sho ld be irt all imm ne
from prosec tion for good-faith ork d ring de astating e ents and that lifesa ing
inter entions, incl ding e ac ation, sho ldn t necessaril go to the sickest rst deser e
closer attention. This is partic larl important as health of cials are no eighing, ith
little p blic disc ssion and ins f cient scienti c e idence, protocols for making the kind of
agoni ing decisions that ill, no do bt, arise again.

At a recent national conference for hospital disaster planners, Po asked a q estion: Ho

long sho ld health care orkers ha e to be ith patients ho ma not s r i e? The stor
of Memorial Medical Center raises other q estions: Which patients sho ld get a share of
limited reso rces, and ho decides? What does it mean to do the greatest good for the
greatest n mber, and does that end j stif all means? Where is the line bet een appropriate
comfort care and merc killing? Ho , if at all, sho ld doctors and n rses be held
acco ntable for their actions in the most desperate of circ mstances, especiall hen their
go ernment fails them?

A HEL E F M HE M

Memorial Medical Center as sit ated on one of the lo points in the bo l that is Ne
Orleans, three miles so th est of the cit s French Q arter and three feet belo sea le el.
The esteemed comm nit hospital spra led across a neighborhood of do ble-shotg n
ho ses. Se eral blocks from a ho sing project b t a short alk to the genteel mansions of
Upto n, it ser ed a di erse clientele. B ilt in 1926 and kno n for decades as So thern
Baptist, the hospital as renamed after being p rchased in 1995 b Tenet Healthcare, a
Dallas-based commercial chain. For generations, the hospital s st rd alls ser ed as a
shelter hen h rricanes threatened: emplo ees o ld bring their families and pets, as ell
as coolers packed ith m ff lettas.

B the time Katrina began lashing Ne Orleans in the earl ho rs of Monda , A g. 29, some
2,000 people ere b nking in the hospital, incl ding more than 200 patients and 600
orkers. When the storm hit, patients screamed as indo s shattered nder a hail of rocks
from nearb rooftops. The hospital groaned and shook iolentl .

At 4:55 a.m., the s ppl of cit po er to the hospital failed. Tele isions in patient rooms
icked off. B t Memorial s a iliar generators had alread th mped to life and ere
h mming reass ringl . The s stem as designed to po er onl emergenc lights, certain
critical eq ipment and a handf l of o tlets on each oor; the air-conditioning s stem sh t
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do n. B that night, the ooding receded from the s rro nding streets. Memorial had
s stained damage b t remained f nctional. The hospital seemed to ha e eathered one
more storm.

HE E AC A I N BEGIN

Anna Po as a 49- ear-old head- and neck-cancer s rgeon hose strong ork ethic earned
respect from doctors and n rses alike. Tin and passionate, ith coiffed cinnamon hair and
a penchant for pearls, Po as f nn and sociable, and she had p t her patients at the
center of her life.

DR. ANNA POU JULY 19 2006 Pho og a hed o

da af e he a e in he dea h of fo a ien A
g and j did no indic he he face ongf l
dea h i
Lee Celano

The morning after Katrina hit, T esda , A g. 30, a n rse called to Po : Look o tside!
What Po sa from the indo as hard to belie e: ater g shing from the se er grates.
Other staff members gaped at the dark pool of ater rimmed ith garbage cra ling p
So th Claiborne A en e in the direction of the hospital.

Senior administrators q ickl grasped the danger posed b the ad ancing aters and
co nseled L. Ren Go , the chief e ec ti e of Memorial, to close the hospital. As at man
American hospitals in ood ones, Memorial s main emergenc -po er transfer s itches
ere located onl a fe feet abo e gro nd le el, lea ing the electrical s stem lnerable. It
on t take m ch ater in height to disable the majorit of the medical center, facilities
personnel had arned after H rricane I an in 2004. Fi ing the problem o ld be costl ; a
fe less-e pensi e impro ements ere made.

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S san M lderick, a tall, no-nonsense 54- ear-old n rsing director, as the rotating
emergenc -incident commander designated for Katrina and as in charge in
cons ltation ith the hospital s top e ec ti es of directing hospital operations d ring the
crisis. The longtime chair oman of the hospital s emergenc -preparedness committee,
M lderick had helped draft Memorial s emergenc plan. B t the 246-page doc ment offered
no g idance for dealing ith a complete po er fail re or for ho to e ac ate the hospital if
the streets ere ooded. Beca se Memorial s chief of medical staff as a a , Richard
Deichmann, the hospital s soft-spoken medical-department chairman, organi ed the
ph sicians.

At 12:28 p.m., a Memorial administrator t ped HELP!!!! and e-mailed colleag es at other
Tenet hospitals o tside Ne Orleans, arning that Memorial o ld ha e to e ac ate more
than 180 patients. Aro nd the same time, Deichmann met ith man of the ro ghl t o
do en doctors at Memorial and se eral n rse managers in a sti ing n rse-training room on
the fo rth oor, hich became the hospital s command center. The con ersation t rned to
ho the hospital sho ld be emptied. The doctors q ickl agreed that babies in the neonatal
intensi e-care nit, pregnant mothers and criticall ill ad lt I.C.U. patients o ld be at great
risk from the heat and sho ld get rst priorit . Then Deichmann broached an idea that as
no here in the hospital s disaster plans. He s ggested that all patients ith Do Not
Res scitate orders sho ld go last.

A D.N.R. order is signed b a doctor, almost al a s ith the informed consent of a patient or
health care pro , and means one thing: A patient hose heartbeat or breathing has
stopped sho ld not be re i ed. A D.N.R. order is different from a li ing ill, hich nder
Lo isiana la allo s patients ith a terminal and irre ersible condition to req est in
ad ance that life-s staining proced res be ithheld or ithdra n.

B t Deichmann had a different nderstanding, he told me not long ago. He said that patients
ith D.N.R. orders had terminal or irre ersible conditions, and at Memorial he belie ed the
sho ld go last beca se the o ld ha e had the least to lose compared ith other patients
if calamit str ck. Other doctors at the meeting agreed ith Deichmann s plan. Bill
Armington, a ne roradiologist, told me he tho ght that patients ho did not ish their li es
to be prolonged b e traordinar meas res o ldn t ant to be sa ed at the e pense of
others tho gh there as nothing in the orders that stated this. At the time, those
attending the meeting didn t see it as a momento s decision, since resc ers ere e pected
to e ac ate e er one in the hospital ithin a fe ho rs.

There as an important part missing from the con ersation. For ears, a health care
compan kno n as LifeCare Hospitals of Ne Orleans had been leasing the se enth oor at
Memorial. LifeCare operated a hospital ithin a hospital for criticall ill or inj red patients
in need of 24-ho r care and intensi e therap o er a long period. LifeCare as kno n for
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helping to rehabilitate patients on entilators ntil the co ld breathe on their o n.

LifeCare s goal as to assist patients ntil the impro ed eno gh to ret rn home or to
n rsing facilities; it as not a hospice.

The 82-bed nit credentialed its o n doctors, most of hom also orked at Memorial. It had
its o n administrators, n rses, pharmacists and s ppl chain. It also had its o n
philosoph : LifeCare deplo ed the f ll arra of modern technolog to keep ali e its often
elderl and debilitated patients. Horace Balt , one of the longest-ser ing doctors at
Memorial, told me of spirited debates among doctors o er coffee abo t hat some of his
colleag es considered to be e cessi e reso rces being po red into hopeless cases. We
spend too m ch on these t rke s, he said some o ld sa . We o ght to let them go.

Man of the 52 patients at LifeCare ere bedbo nd or req ired electric entilators to
breathe, and clearl , the o ld be at signi cant risk if the hospital lost po er in its
ele ators. The doctors I spoke to ho attended the meeting ith Deichmann did not recall
disc ssing e ac ating LifeCare patients speci call , despite the fact that some of the
doctors at the meeting orked ith both Memorial and LifeCare patients.

In the afternoon, helicopters from the Coast G ard and pri ate amb lance companies began
landing on a long- n sed helipad atop an eight-stor parking garage adjacent to the
hospital. The pilots ere impatient tho sands of people needed help across the cit . The
intensi e-care nit on the eighth oor rang o t ith sho ts for patients: We need some
more! Helicopters are aiting!

A cre of doctors, n rses and famil members carried Memorial patients do n ights of
stairs and heeled them to the hospital ing here the last orking ele ator bro ght them
to the second oor. Each patient as then mane ered onto a stretcher and passed thro gh
a ro ghl three-b -three-foot opening in the machine-room all that offered a shortc t to
the parking garage. Man patients ere placed in the back of a pick p tr ck, hich dro e to
the top of the garage. T o ights of metal steps led to the helipad.

At LifeCare that afternoon, conf sion reigned. The compan had its o n incident
commander, Diane Robicha , an assistant administrator ho as se en months pregnant.
At rst e er thing seemed ne; Robicha established comp ter comm nications ith
LifeCare s corporate of ces in Te as and as ass red that LifeCare patients o ld be
incl ded in an FEMA e ac ation of Memorial. B t as the da ore on, the te ts bet een
LifeCare staff members and headq arters gre frantic as it became clear that the
go ernment s resc e efforts and comm nications ere in chaos.

According to the messages, Robicha asked Memorial administrators to add her 52

patients to transport plans being organi ed ith the Coast G ard. An e ec ti e at the
hospital told Robicha that permission o ld be req ested from Memorial s corporate
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o ner, Tenet Healthcare. I hope and pra this is not a long process for getting their
appro al, Robicha said in an e-mail message to her colleag es at headq arters. (A Tenet
spokesman, Da id Matthe s, rote me in an e-mail message that LifeCare staff members
t rned do n se eral offers of e ac ation assistance from Memorial staff members on
T esda afternoon.)

TWO FLIGHTS OF METAL STEPS TO THE HELIPAD

AUG. 1 2009 The final leg of an e ac a ion ha
incl ded being a ed h o gh a hole in he all
in o he a king deck
Paolo Pelleg in Magn m fo The Ne Yo k Time

The doctors had no spent da s on d t , nder stress and sleeping little. E ing Cook, one of
the hospital s most senior ph sicians, told me that he decided that in order to lessen the
b rden on n rses, all b t the most critical treatments and care sho ld be discontin ed.
When Br ant King, a 35- ear-old internist ho as ne to Memorial, came to check on one
of his patients on the fo rth oor, he canceled the senior doctor s order to t rn off his
patient s heart monitor. When Cook fo nd o t, he as f rio s and tho ght that the j nior
doctor did not nderstand the circ mstances. He directed the n rse to reinstate his
instr ctions.

It as dark hen the last of the Memorial patients ho had been chosen for immediate
e ac ation ere nall gone. Later that night, the Coast G ard offered to e ac ate more
patients, b t those in charge at Memorial declined. The helipad had minimal lighting and no
g ard rail, and the staff needed rest.

Memorial had sha ed its patient cens s from 187 to abo t 130. On the se enth oor, all 52
LifeCare patients remained, incl ding se en on entilators. Been on the phone ith Tenet,
a LifeCare representati e o tside the hospital rote to Robicha . Will e ent all be to o r
patients. Ma be in the morning.

FA EF L IAGE DECI I N

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At abo t 2 a.m. on Wednesda , A g. 31 nearl 48 ho rs after Katrina made landfall near

Ne Orleans Memorial s back p generators sp ttered and stopped. E ing Cook later
described the s dden silence as the sickest so nd of his life. In LifeCare on the se enth
oor, criticall ill patients began s ffering the conseq ences. Alarm bells clanged as life-
s pport monitors and entilators s itched to brief batter reser es hile contin ing to
force air into the l ngs of se en patients. In abo t a half-ho r, the batteries failed and the
reg lar hiss of mechanical breaths ceased. A Memorial n rse appeared and anno nced that
the Coast G ard co ld e ac ate some critical patients if the ere bro ght to the helipad
immediatel . Vol nteers began carr ing the LifeCare patients ho relied on entilators
do n e ights of stairs in the dark.

A LifeCare n rse na igated the staircase alongside an 80- ear-old man on a stretcher,
man all sq ee ing air into his l ngs ith an Amb bag. As he aited for e ac ation on the
second oor, she bagged him for nearl an ho r. Finall a ph sician stopped b the stretcher
and told her that there as no o gen for the patient and that he as alread too far gone.
She h gged the man and stroked his hair as he died.

Anna Po began bagging another patient on the second oor to relie e a n rse hose hands
ere gro ing tired. That patient, along ith t o other LifeCare patients ho relied on
entilators, also died earl that morning, b t the others ere e ac ated b helicopter. The
hospital chaplain opened a do ble door ith stained-glass indo s do n the hall a , and
the staff began heeling bodies into the chapel. Distra ght n rses cried, and the chaplain
held them and pra ed ith them.

The s n rose and ith it the s ltr Ne Orleans temperat re, hich as on its a to the
mid-90s. The hospital as sti ing, its alls s eating. Water had stopped o ing from taps,
toilets ere backed p and the stench of se age mi ed ith the odor of h ndreds of
n ashed bodies.

Visitors ho had come to the hospital for safet felt so desperate that the cheered hen
t o airboats dri en b ol nteers from the Lo isiana s amplands roared p to the ooded
emergenc -room ramp. The otilla s organi ers, Mark and Sandra LeBlanc, had a special
reason to come to Memorial: Vera LeBlanc, Mark s 82- ear-old mother, as at LifeCare,
reco ering from colon-cancer s rger . Sandra, an E.M.T., kne that her mother-in-la
co ldn t s allo , so she as s rprised hen she sa that Vera and other patients ho
needed IVs to keep h drated ere no longer getting them. When her h sband asked a
Memorial administrator h , the administrator told him that the hospital as in s r i al
mode, not treating mode. F rio s, Mark LeBlanc asked, Do o j st ip a s itch and o re
not a hospital an more?

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THAT MORNING, doctors and n rses decided that the more than 100 remaining Memorial
and LifeCare patients sho ld be bro ght do nstairs and di ided into three gro ps to help
speed the e ac ation. Those ho ere in fairl good health and co ld sit p or alk o ld
be categori ed 1 s and prioriti ed rst for e ac ation. Those ho ere sicker and o ld
need more assistance ere 2 s. A nal gro p of patients ere assigned 3 s and ere
slated to be e ac ated last. That gro p incl ded those hom doctors j dged to be er ill
and also, as doctors agreed the da before, those ith D.N.R. orders.

Tho gh there as no single doctor of ciall in charge of categori ing the patients, Po as
energetic and j mped into the center of the action, according to t o n rses ho orked ith
her. Thro gho t the morning, makeshift teams of medical staff and famil members carried
man of the remaining patients to the second- oor lobb here Po , the slee es of her
scr bs rolled p, stood read to recei e them.

In the dim light, n rses opened each chart and read the diagnoses; Po and the n rses
assigned a categor to each patient. A n rse rote 1, 2 or 3 on a sheet of paper ith a
Marks-A-Lot pen and taped it to the clothing o er a patient s chest. (Other patients had
n mbers ritten on their hospital go ns.) Man of the 1 s ere taken to the emergenc -
room ramp, here boats ere arri ing. The 2 s ere generall placed along the corridor
leading to the hole in the machine-room all that as a shortc t to the helipad. The 3 s ere
mo ed to a corner of the second- oor lobb near an A.T.M. and a planter lled ith
greener . Patients a aiting e ac ation o ld contin e to be cared for their diapers o ld
be changed, the o ld be fanned and gi en sips of ater if the co ld drink b t most
medical inter entions like IVs or o gen ere limited.

Po and her co- orkers ere performing triage, a ord once sed b the French in
reference to the sorting of coffee beans and applied to the battle eld b Napoleon s chief
s rgeon, Baron Dominiq e-Jean Larre . Toda triage is sed in accidents and disasters
hen the n mber of inj red e ceeds a ailable reso rces. S rprisingl , perhaps, there is no
consens s on ho best to do this. T picall , medical orkers tr to di p care to achie e
the greatest good for the greatest n mber of people. There is an ongoing debate abo t ho
to do this and hat the greatest good means. Is it the n mber of li es sa ed? Years of life
sa ed? Best q alit ears of life sa ed? Or something else?

At least nine ell-recogni ed triage s stems e ist. Most call for people ith relati el minor
inj ries to ait hile patients in the orst shape are e ac ated or treated. Se eral call for
medical orkers to sort the inj red into another categor : patients ho are seen as ha ing
little chance of s r i al gi en the reso rces on hand. That categor is most commonl
created d ring a de astating e ent like a ar- one tr ck bombing in hich there are far
more se erel inj red ictims than amb lances or medics.

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MARK AND SANDRA LEBLANC AUG. 5 2009 A
home in Ne O lean The led a flo illa of boa o
he ho i al o a e hi mo he among o he
Paolo Pelleg in Magn m fo The Ne Yo k Time

Po and her colleag es had little if an training in triage s stems and ere not g ided b
an partic lar triage protocol. Po o ld later sa she as tr ing to do the most good ith a
limited pool of reso rces. The decision that certain sicker patients sho ld go last has its
risks. Predicting ho a patient ill fare is ine act and s bject to biases. In one st d of
triage, e perienced resc ers ere asked to categori e the same patients and came p ith
idel different ans ers. And patients conditions change; more reso rces can become
a ailable to help those hose sit ations at rst appear hopeless. The importance of
reassessing each person is eas to forget once a ranking is assigned.

After se eral helicopters arri ed and resc ed some of the LifeCare patients, Air Force One
e o er Ne Orleans hile President B sh s r e ed the de astation. Fe helicopters
arri ed after that. Po told me she heard that the Coast G ard as foc sing on sa ing
people stranded on rooftops aro nd the cit . Mean hile do ens of patients s eltered on the
lo er t o oors of Memorial and in the parking garage as the aited to lea e.

Man of the doctors and n rses had shifted from caring for patients to carr ing them and
ere loading people onto helicopters and atercraft. Vera LeBlanc, the LifeCare patient
hose son arranged the airboat otilla that had arri ed ho rs earlier, as among the
patients massed on the second oor. Her chart read Do Not Res scitate, as it had d ring
se eral hospital admissions for more than a decade, so that her heart o ld not be restarted
if it ere to stop. Mark LeBlanc decided he as going to p t his mother on one of the
airboats he and his ife had directed to the hospital. When the LeBlancs tried to enter the
patient area on the second oor, a staff member blocked them, and se eral doctors told them
the co ldn t lea e ith Vera. The hell e can t, Sandra said. The co ple ignored the
doctors, and Vera smiled and chatted as Mark and se eral others picked her p and carried
her onto an airboat.

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On a se enth- oor hall a at LifeCare, Angela McMan s, a da ghter of a patient, panicked

hen she o erheard orkers disc ssing the decision to defer e ac ation for D.N.R. patients.
She had e pected her frail 70- ear-old mother, Wilda, o ld soon be resc ed, b t her mother
had a D.N.R. order. I e got to rescind that order, Angela begged the LifeCare staff. She
sa s the told her that there ere no doctors a ailable to do it.

B Wednesda afternoon, Dr. E ing Cook as ph sicall and mentall e ha sted, lth and
forlorn. A 61- ear-old p lmonar specialist, he d had his semi-a tomatic Beretta strapped to
him since he heard on Monda that a n rse as raped hile alking her dog near the
hospital (a hospital of cial denies that this happened). Cook had had t o heart attacks and
co ld not help transport patients in the heat.

That afternoon, Cook stood on the emergenc -room ramp and ca ght sight of a mattress
oating p Napoleon A en e. On it la an emaciated black oman, ith se eral o ng men
propelling her thro gh the fetid ater. The hospital is closed, someone sho ted. We re not
accepting an bod .

Ren Go , the hospital s chief e ec ti e, told me he had decided, for reasons of safet , that
people oating p to Memorial sho ld generall be directed to dr gro nd abo t nine blocks
so th. Medical orkers nall insisted that the oman and her h sband be allo ed to enter,
b t the men ho s am in the to ic so p to resc e her ere told to lea e. When a co ple
ith small children ro ed p and ere told to go a a , Br ant King, ho as one of
Memorial s fe African-American ph sicians, lost his temper.

Yo can t do this! King sho ted at Go . Yo gotta help people! B t the famil as
t rned a a .

King as o t of to ch ith realit , Cook told me he tho ght at the time. Memorial asn t so
m ch a hospital an more b t a shelter that as r nning o t of s pplies and needed to be
emptied. Cook also orried that intr ders from the neighborhood might ransack the hospital
for dr gs and people s al ables.

Recentl retired from clinical practice, Cook became a Memorial administrator a eek
before Katrina hit, b t he had spent man ears orking on the eighth oor in the I.C.U.
That afternoon, he climbed slo l pstairs to check hat as happening there. Most of the
patients had been e ac ated on T esda , b t a fe ith D.N.R. orders had not.

What s going on here? he asked the fo r n rses in the nit. Whadd a ha e left? The
n rses said the ere do n to one patient: Jannie B rgess, a 79- ear-old oman ith
ad anced terine cancer and kidne fail re. She as being treated for comfort onl and had
been sedated to the point of nconscio sness ith morphine. She as so eighted do n b
id from her diseases that Cook si ed her p at 350 po nds.

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Cook later told me he belie ed se eral things: 1. Gi en ho dif c lt it had been for him to
climb the steps in the heat, there as no a he co ld make it back to the I.C.U. again. 2.
Gi en ho e ha sted e er one as and ho m ch this oman eighed, it o ld be
impossible to drag her do n si ights of stairs. 3. E en in the best of circ mstances, the
patient probabl had a da or so to li e. And frankl , the fo r n rses taking care of her ere
needed else here.

To Cook, a dr g that had been dripping into B rgess s IV for da s pro ided an ans er.
Morphine, a po erf l narcotic, is freq entl sed to control se ere pain or discomfort. B t
the dr g can also slo breathing, and s ddenl introd cing m ch higher doses can lead to
death.

Doctors, n rses and clinical researchers ho speciali e in treating patients near the ends of
their li es sa that this do ble effect poses little danger hen dr gs are administered
properl . Cook sa s it s not so simple. If o don t think that b gi ing a person a lot of
morphine o re not premat rel sending them to their gra e, then o re a er na e
doctor, Cook told me hen e spoke for the rst time, in December 2007. We kill em.

DR. EWING COOK AUG. 2 2009 A hi home nea

Lafa e e La He a he did he igh hing fo a
e ill oman hen he ha ened he demi e
Paolo Pelleg in Magn m fo The Ne Yo k Time

In fact, the distinction bet een m rder and medical care often comes do n to the intent of
the person administering the dr g. Cook alked this line often as a p lmonologist, he told
me, and he prided himself as the go-to man for dif c lt end-of-life sit ations. When a er
sick patient or the patient s famil made the decision to disconnect a entilator, for e ample,
Cook o ld prescribe morphine to make s re the patient asn t gasping for breath as the
machine as ithdra n.

Often Cook fo nd that achie ing this le el of comfort req ired eno gh morphine that the
dr g markedl s ppressed the patient s breathing. The intent as to pro ide comfort, b t
the res lt as to hasten death, and Cook kne it. To Cook, the difference bet een something
ethical and something illegal is so ne as to be impercei able.
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B rgess s sit ation as a little different, as Cook described it. Being comatose and on
painkillers, she asn t ncomfortable. B t the orst thing Cook co ld imagine o ld be for
the dr gs to ear off and for B rgess to ake p and nd herself in her ra aged condition
as she as being mo ed. Do o mind j st increasing the morphine and gi ing her eno gh
ntil she goes? Cook told me he asked B rgess s n rse.

Cook scribbled prono nced dead at in B rgess s chart, left the time blank and signed the
note ith a large sq iggle. Then he alked back do nstairs, belie ing that he had done the
right thing for B rgess. To me, it as a no-brainer, and to this da I don t feel bad abo t
hat I did, he told me. I ga e her medicine so I co ld get rid of her faster, get the n rses off
the oor. He added, There s no q estion I hastened her demise.

The q estion of hat to do ith the hospital s sickest patients as also being raised b
others. B the afternoon, ith fe helicopters landing, these patients ere lang ishing.
S san M lderick, the incident commander ho had orked ith Cook for decades, shared
her o n concerns ith him. According to Cook, M lderick told him, We gotta do something
abo t this. M lderick, ho declined to be formall inter ie ed abo t the da s after
Katrina, did tell me: We ere ell prepared. We managed that sit ation ell.

Cook sat on the emergenc -room ramp smoking cigars ith another doctor. Help as
coming too slo l . There ere too man people ho needed to lea e and eren t going to
make it, Cook said, describing for me his thinking at the time. It as a desperate sit ation
and he sa onl t o choices: q icken their deaths or abandon them. It as act all to the
point here o ere considering that o co ldn t j st lea e them; the h mane thing
o ld be to p t em o t.

Cook ent to the staging area on the second oor here Anna Po and t o other doctors
ere directing care. Cots and stretchers seemed to co er e er inch of oor space. Rodne
Scott, an obese I.C.U. patient ho as reco ering from heart problems and se eral
operations, la motionless on a stretcher, co ered in s eat and almost nothing else. A doctor
had decided that he sho ld be the last patient to lea e the hospital beca se he eighed more
than 300 po nds and might get st ck in the machine-room hole, backing p the e ac ation
line. Cook tho ght Scott as dead, and he to ched him to make s re. B t Scott t rned o er
and looked at him.

I m O.K., Doc, Scott said. Go take care of somebod else.

Despite ho miserable the patients looked, Cook said, he felt there as no a , in this
cro ded room, to do hat he had been thinking abo t. We didn t do it beca se e had too
man itnesses, he told me. That s the honest-to-God tr th.

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Richard Deichmann, Memorial s medical-department chairman, also remembers being

stopped b M lderick for a q ick con ersation that afternoon, an episode he rote abo t in
Code Bl e, a memoir he p blished in 2006 abo t the da s after Katrina. He as startled,
he rote, hen M lderick asked him his tho ghts abo t hether it o ld be h mane to
e thani e the hospital s D.N.R. patients. E thanasia s illegal, he said he told her. There s
not an need to e thani e an one. I don t think e sho ld be doing an thing like that. He
had g red the D.N.R. patients sho ld go last, b t the plan, he told M lderick, as still to
e ac ate them e ent all . Thro gh her la er, M lderick denied that she disc ssed
e thanasia of patients ith Deichmann or an one else at Memorial.

As darkness fell, r mor spread that e ac ations o ld halt for the night beca se people
ere shooting at resc ers. In the adjacent parking garage, Go distrib ted g ns to sec rit
and maintenance staff, ho cordoned off the hospital s entrances. That night, do ens of
LifeCare and Memorial patients la on soiled and s eat cots in the second- oor lobb . Po ,
se eral doctors and cre s of n rses orked in the dim light of a fe lamps po ered b a
portable generator. For the third night in a ro , Po as orking ith scarcel an ho r s
sleep, changing patients diapers, gi ing o t ater, comforting and pra ing ith n rses.

Kamel Bo ghrara, a LifeCare n rsing director, alked past the A.T.M. area on the second
oor here some of the sickest patients most of hom had been gi en 3 s la . Carrie
Hall, a 78- ear-old LifeCare patient ith long, braided hair hose ast famil called her Ma-
Dear, managed to grab him and indicate that she needed her tracheostom cleared. The
n rse as s rprised at ho ercel Hall as battling to sta ali e. He s ctioned her ith a
portable machine and told her to ght hard.

C MF CA E ME C KILLING?

Soon after s nrise on Th rsda , Sept. 1 more than 72 ho rs into the crisis Memorial s
chief nancial of cer, C rtis Dosch, deli ered good ne s to hospital staff gathered on the
emergenc -room ramp. He had reached a Tenet representati e in Dallas and as told that
Tenet as dispatching a eet of pri atel hired helicopters that da . Dosch later said that
the dejected staff as skeptical. B t soon the hospital s oice chain began echoing ith
sho ts for omen and children to e ac ate. Boats ere arri ing, incl ding shing essels
that had been parked on trailers in the neighborhood and ere no commandeered b
hospital orkers. Helicopters at last con erged on the hospital ithin a co ple of ho rs of
da light, according to a Memorial n rse from the Air Force Reser e ho o ersa helipad
operations. The Tenet spokesman and testimon b M lderick in a 2008 deposition also
con rm this. The hospital lled ith the cacophon of militar and pri ate crafts ho ering
and landing. Do n on the emergenc -room ramp that morning, stone-faced State Police
of cers ielding shotg ns barked that e er one had to be o t of the hospital b 5 p.m.
beca se of ci il nrest in Ne Orleans; the o ld not sta later to protect the hospital.
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Mean hile, Cook strapped on his g n again and prepared to lea e the hospital b boat to
resc e his son, ho had been trapped at his ho se since T esda s ooding. He told me that
M lderick asked him before he left to talk to Po .

DR. BRYANT KING AUG. 9 2009 A hi home in

Indiana oli He a ange ed b he a a ien
and o he ci i en e e ea ed b he ho i al
Paolo Pelleg in Magn m fo The Ne Yo k Time

On the second oor, Cook sa s, he and Po , both ear , disc ssed the Categor 3 patients,
incl ding nine ho had ne er been bro ght do n from the se enth oor. According to Cook,
Po as orried that the o ldn t be able to get them o t. Cook hadn t been on the se enth
oor since Katrina str ck, b t he told me that he tho ght LifeCare patients ere
chronicall deathbo nd at the best of times and o ld ha e been horribl affected b the
heat. Cook co ldn t imagine ho the e ha sted Memorial staff o ld carr nine patients
do n e ights of stairs before the end of the da . Nobod from o tside had arri ed to help
ith that task. If there ere other a s to e ac ate these patients, he didn t see them.

Cook said he told Po ho to administer a combination of morphine and a ben odia epine
sedati e. The effect, he told me, as that patients o ld go to sleep and die. He e plained
that it c ts do n o r respiration so o grad all stop breathing and go o t. He said he
belie ed that Po nderstood that he as telling her ho to achie e this. He said that he
ie ed it as a a to ease the patients o t of a terrible sit ation.

In an inter ie ith Ne s eek in 2007, Po ackno ledged that after disc ssions ith other
doctors, she did inject some Categor 3 patients. B t she said her intention as onl to help
the patients that ere ha ing pain and sedate the patients ho ere an io s beca se e
kne the ere going to be there another da , that the o ld go thro gh at least another
da of hell. Be ond that, Po has not talked abo t the details of hat happened on that
Th rsda , citing the pending legal cases and sensiti it to patients and their families. What
follo s is based on the recollections of others, some of hich ere reco nted in inter ie s
ith Lo isiana J stice Department in estigators, as ell as in inter ie s ith me.

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Therese Mende , a LifeCare n rse e ec ti e, had orked o ernight on the rst oor, she
later told in estigators. (She declined to speak ith me.) After da break, she heard the
so nd of helicopters and atched the e ac ation line begin to mo e. According to Mende ,
she ret rned at aro nd 8 or 9 a.m. to the se enth oor and alked along a corridor. The
patients she sa looked bad. Se eral ere nconscio s, frothing at the mo th and breathing
in an irreg lar a that often heralds death. Still, hile t o patients died on the LifeCare s
se enth oor on Wednesda , the others had li ed thro gh the night, ith onl a fe gi en
small doses of morphine or the sedati e lora epam for comfort.

Mende heard that Po as looking for her. The sat do n in an of ce ith an open indo .
Po looked distra ght and told her that the LifeCare patients probabl ere not going to
s r i e. Mende told in estigators that she responded, I think o re right.

Mende said she atched Po str ggle ith hat she as sa ing, telling in estigators that
Po told her that the decision had been made to administer lethal doses of morphine and
other dr gs. (Po , thro gh her la er, Richard Simmons Jr., denied mentioning lethal
doses. ) Were the LifeCare patients being singled o t? Mende asked. She kne there ere
other sick patients at Memorial. Mende recalled that Po said no and that there as no
telling ho far it o ld go.

According to Mende , Po told her that she and other Memorial staff members ere
ass ming responsibilit for the patients on the se enth oor; the LifeCare n rsing staff
asn t in ol ed and sho ld lea e. (Po , thro gh her la er, disp tes Mende s acco nt.)
Mende later said she had ass med that the hospital as nder martial la , hich as not
the case, and that Po as acting nder militar orders. Mende left to dismiss her
emplo ees, she said, beca se she feared the o ld be forced do nstairs b a thorities.

Diane Robicha , the senior leader on the LifeCare oor, later alked into the of ce, she
recalled in inter ie s ith in estigators. (She declined to talk to me.) She and other
LifeCare orkers had gone do nstairs at aro nd 9:30 a.m. to ask S san M lderick hen the
LifeCare patients on the se enth oor o ld be e ac ated. According to Robicha ,
M lderick said, The plan is not to lea e an li ing patients behind, and told her to see Po .

In Robicha s inter ie ith in estigators, she co ld not recall e actl hat Po told her,
b t she said that she nderstood that patients ere not going to be making it o t of there.
She said that Po did not se the ord e thani e. Prompted b in estigators, she said she
tho ght Po might ha e sed the ord comfortable in describing hat she as tr ing to
do for the patients.

Robicha remembered Po sa ing that the LifeCare patients ere not a are or not alert
or something along those lines. Robicha reco nted to in estigators that she told Po that
that asn t tr e and said that one of LifeCare s patients Emmett E erett, a 380-po nd
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man as er a are of his s rro ndings. He had fed himself breakfast that morning
and asked Robicha , So are e read to rock and roll?

The 61- ear-old Hond ran-born man al laborer as at LifeCare a aiting colostom s rger
to ease chronic bo el obstr ction, according to his medical records. Despite a freakish
spinal-cord stroke that left him a paraplegic at age 50, his ife and n rses ho orked ith
him sa he maintained a good sense of h mor and a rich famil life, and he rarel
complained. He, along ith three of the other LifeCare patients on the oor, had no D.N.R.
order.

E erett s roommates had alread been taken do nstairs on their a to the helicopters,
hose lo d propellers sent a bree e thro gh the indo s on his side of the LifeCare oor.
Se eral times he appealed to his n rse, Don t let them lea e me behind. His onl complaint
that morning as di iness, a LifeCare orker told Po .

Oh, m goodness, a LifeCare emplo ee recalled Po repl ing.

T o Memorial n rses identi ed as Cheri Landr and Lori B do from the I.C.U. to
in estigators b a LifeCare pharmacist, Ste en Harris joined the disc ssion along ith
other LifeCare orkers. (Thro gh their la ers, Landr and B do declined to be
inter ie ed. Harris ne er ret rned m calls.) The talked abo t ho E erett as paral ed
and had comple medical problems and had been designated a 3 on the triage scale.
According to Robicha , the gro p concl ded that E erett as too hea to be mane ered
do n the stairs, thro gh the machine-room all and onto a helicopter. Se eral medical staff
members ho helped lead boat and helicopter transport that da sa the o ld certainl
ha e fo nd a a to e ac ate E erett. The sa the ere ne er made a are of his
presence.

THE FAMILY OF EMMETT EVERETT AUG. 4 2009

In LaPlace La Ca ie E e e econd f om lef
a ked Who ga e hem he igh o la God
Paolo Pelleg in Magn m fo The Ne Yo k Time

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In his inter ie s ith in estigators, Andre Gremillion, a LifeCare n rse, said that the female
ph sician in the of ce (he didn t kno Po s name) asked if someone ho kne E erett
co ld e plain to him that beca se he as so big the did not think the o ld be able to
e ac ate him. The asked Gremillion hether he co ld gi e him something to help him
rela and e plain the sit ation. Gremillion told in estigators that he didn t ant to be the
one ho told E erett that e o ld probabl be lea ing and he o ld be sta ing. At that
point, Gremillion said, he lost his compos re.

Gremillion s s per isor and friend, a LifeCare n rsing director, Gina Isbell, told me she
alked into the room aro nd 11 a.m. and sa Gremillion cr ing and shaking his head. He
br shed past her into the hall a , and Isbell follo ed, grabbing his arm and g iding him to
an empt room. I can t do this, he kept sa ing.

Do hat? Isbell asked. When Gremillion o ldn t ans er, Isbell tried to comfort him. It s
going to be O.K., she said. E er thing s going to be all right.

Isbell searched for Robicha , her boss. What is going on? she asked, frantic. Are the
going to do something to o r patients?

Yes, the are, Isbell remembers Robicha , in tears, sa ing. O r patients aren t going to
be e ac ated. The aren t going to lea e. As the LifeCare administrators cleared the oor of
all b t a fe senior staff members, Robicha sent Isbell to the back staircase to make s re
nobod re-entered. It as q iet there, and Isbell sat alone, drained and pset. Isbell said she
tho ght abo t her patients, remembering ith g ilt a promise she made to the da ghter of
one of her fa orites, Alice H t ler, a 90- ear-old oman ho came to LifeCare for treatment
of bedsores and pne monia. Isbell fondl called her Miss Alice and had told H t ler s
da ghter that she o ld take good care of her mother. No Isbell pra ed that help o ld
come before H t ler and her other patients died.

ACCORDING TO STATEMENTS made to in estigators b Ste en Harris, the LifeCare

pharmacist, Po bro ght n mero s ials of morphine to the se enth oor. According to
in estigators, a proffer from Harris s la er said that Harris ga e her additional morphine
and mida olam a fast-acting dr g sed to ind ce anesthesia before s rger or to sedate
patients for medical proced res. Like morphine, mida olam depresses breathing; doctors
are arned to be e tremel caref l hen combining the t o dr gs.

Krist Johnson, LifeCare s director of ph sical medicine, said she sa hat happened ne t.
She told J stice Department in estigators that she atched Po and t o n rses dra id
from ials into s ringes. Then Johnson g ided them to Emmett E erett in Room 7307.
Johnson said she had ne er seen a ph sician look as ner o s as Po did. As the alked,
she told in estigators, she heard Po sa that she as going to gi e him something to help
him ith his di iness. Po disappeared into E erett s room and sh t the door.
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As the orked their a do n the se enth- oor hall a , Johnson held some of the
patients hands and said a pra er as Po or a Memorial n rse ga e injections. Wilda
McMan s, hose da ghter Angela had tried in ain to rescind her mother s D.N.R. order,
had a serio s blood infection. (Earlier, Angela as ordered to lea e her mother and go
do nstairs to e ac ate.) I am going to gi e o something to make o feel better, Po
told Wilda, according to Johnson.

Johnson took one of the Memorial n rses into Room 7305. This is Ms. H t ler, Johnson
said, to ching the oman s hand and sa ing a little pra er. Johnson tried not to look do n
at hat the n rse as doing, b t she sa the n rse inject H t ler s roommate, Rose Sa oie,
a 90- ear-old oman ith ac te bronchitis and a histor of kidne problems. A LifeCare
n rse later told in estigators that both omen ere alert and stable as of late that morning.
That b rns, Sa oie m rm red.

According to Memorial orkers on the second oor, abo t a do en patients ho ere

designated as 3 s remained in the lobb b the A.T.M. Other Memorial patients ere being
e ac ated ith help from ol nteers and medical staff, incl ding Br ant King. Aro nd noon,
King told me, he sa Anna Po holding a handf l of s ringes and telling a patient near the
A.T.M., I m going to gi e o something to make o feel better. King remembered an
earlier con ersation ith a colleag e ho, after speaking ith M lderick and Po , asked
him hat he tho ght of hastening patients deaths. That as not a doctor s job, he replied.
Patients ere hot and ncomfortable, and a fe might be terminall ill, b t he didn t think
the ere in the kind of pain that calls for sedation, let alone merc killing. When he sa
Po ith the s ringes, he ass med she as doing j st that and said to an one ithin
earshot: I m getting o t of here. This is cra ! King grabbed his bag and stormed
do nstairs to get on a boat.

Bill Armington, the ne roradiologist, atched King go and as pset at him for lea ing.
Armington s spected that e thanasia might occ r, in part, he told me, beca se Cook told
him earlier that there had been a disc ssion of things that onl doctors talk abo t.
Armington headed for the helipad, stirred p, as he recalls, to intensif m efforts to get
people off the roof. Neither Armington nor King inter ened directl , tho gh King had
earlier sent o t te t messages to friends and famil asking them to tell the media that
doctors ere disc ssing gi ing medication to d ing patients to help accelerate their deaths.
King told me that he didn t think his opinion, hich hadn t mattered hen he arg ed against
t rning a a the hospital s neighbors, o ld ha e mattered.

ONLY A FEW n rses and three doctors remained on the second oor: Po ; a o ng
internist named Kathleen Fo rnier; and John Thiele, a 53- ear-old p lmonologist, ho had
ne er before spoken p blicl abo t his Katrina e periences ntil e had t o length
inter ie s in the last ear. Thiele told me that on Th rsda morning, he sa S san
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M lderick alking o t of the emergenc room. John, e er bod has to be o t of here

tonight, he said she told him. He said Ren Go told him the same thing. M lderick,
thro gh her la er, and Go both sa that the ere not gi en a deadline to empt the
hospital and that their goal as to foc s their e ha sted colleag es on the e ac ation. We d
e perienced the helicopters stopping ing to s, Go told me, and I didn t ant that to
occ r again.

Aro nd a corner from here the patients la on the second oor, Thiele and Fo rnier
str ggled to e thani e t o cats hose o ners bro ght them to the hospital and ere forced
to lea e them behind. Thiele trained a needle to ard the heart of a cla ing cat held b
Fo rnier, he told me later. While the ere orking, Thiele recalls Fo rnier telling him that
M lderick had spoken ith her abo t something to the effect of p tting patients o t of their
miser and that she did not ant to participate. (Fo rnier declined to talk ith me.) Thiele
told her that he nderstood, and that he and others o ld handle it. M lderick s la er sa s
that M lderick did ask a ph sician abo t gi ing something to patients to make them more
comfortable, b t that, ho e er, as not code for e thanasia.

THE HELIPAD AUG. 1 2009 Man a ien ee

e ac a ed b helico e off he o of he eigh
o a king deck ne o he ho i al
Paolo Pelleg in Magn m fo The Ne Yo k Time

Thiele didn t kno Po b name, b t she looked to him like the ph sician in charge on the
second oor. He told me that Po told him that the Categor 3 patients ere not going to be
mo ed. He said he tho ght the appeared close to death and o ld not ha e s r i ed an
e ac ation. He as terri ed, he said, of hat o ld happen to them if the ere left behind.
He e pected that the people ring g ns into the chaos of Ne Orleans the animals, he
called them o ld storm the hospital, looking for dr gs after e er one else as gone. I
g red, What o ld the do, these cra black people ho think the e been oppressed for
all these ears b hite people? I mean if the re capable of shooting at somebod , h are
the not capable of raping them or, or, o kno , dismembering them? What s to pre ent
them from doing things like that?

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The la s of man had broken do n, Thiele concl ded, and onl the la s of God applied.

Can I help o ? he sa s he asked Po se eral times.

No, she said, according to Thiele. Yo don t ha e to be here.

I ant to be here, Thiele insisted. I ant to help o .

Thiele practiced palliati e-care medicine and as certi ed to teach it. He told me that he
kne that hat the ere abo t to do, tho gh it seemed right to him, as technicall a
crime. He said that the goal as death; o r goal as to let these people die.

Thiele sa that morphine, mida olam and s ringes had been set p on a table near the
A.T.M. There ere abo t a do en patients, and he took charge of the fo r closest to the
indo s three elderl hite omen and a hea set African-American man starting
IVs on those ho didn t ha e one. Apart from their breathing and the soft moans of one, the
patients appeared lifeless and did not respond to him. Thiele sa Po and se eral n rses
orking on patients l ing near the hall a .

Thiele a ered for a moment. He t rned to Karen W nn, the I.C.U. n rse manager at
Memorial ho led the hospital s ethics committee. Can e do this? he remembers asking
the highl respected n rse.

W nn felt that the eeded to medicate the patients, she said hen she described her
e periences p blicl for the rst time in inter ie s ith me o er the past ear. She
ackno ledged ha ing heard r mors that patients ere being e thani ed, b t she said no
one had told her that that as hat as happening to these patients and that her onl aim
as to make patients comfortable b sedating them. W nn said she did not fear sta ing in
the hospital after the 5 p.m. c rfe anno nced b the State Police she had alread
decided to ignore the e ac ation deadline and sta at the hospital ntil e er one ali e had
been taken o t. Instead, she said, she as moti ated b ho bad the patients looked.

W nn described t rning to an elderl oman ho as nconscio s ith labored breathing.

She then prepared a s ringe ith morphine and mida olam, p shed it slo l into the
oman s IV line and atched her breathing ease. The oman died a short time later, hich
didn t dist rb W nn beca se she had appeared to be close to death. W nn told me that at
that point all the staff co ld offer as comfort, peace and dignit . She said: We did the
best e co ld do. It as the right thing to do nder the circ mstances.

She added: B t e en if it had been e thanasia, it s not something e don t reall do e er

da it j st goes nder a different name.

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Thiele ga e other patients a shot of morphine and mida olam at doses he said ere higher
than hat he normall sed in the I.C.U. He held their hands and reass red them, It s all
right to go. Most patients, Thiele told me, died ithin min tes of being medicated. B t the
hea set African-American man didn t.

His mo th as open, his breathing as labored and e er one co ld hear his a f l death
rattle. Thiele tried more morphine. He tried pra er. He p t his hand on the man s forehead;
W nn and another n rse manager took the man s hands in theirs. Together the chanted:
Hail Mar , f ll of grace. The Lord is ith thee. The recited the Lord s Pra er. The pra ed
for the man to die.

The man kept breathing, and W nn sa s she and her colleag es took that as a sign. God
said, O.K., b t I m not read for him. Or he asn t read . She remembers passing him
thro gh the hole in the machine-room all on his a to the e ac ation helicopters.

Thiele has a different memor of hat happened. We co ered his face ith a to el ntil he
stopped breathing, Thiele told me.

RODNEY SCOTT AUG. 4 2009 In Pea l Ri e La

He a almo aken fo dead and a he la
a ien o lea e he ho i al in he e ac a ion
Paolo Pelleg in Magn m fo The Ne Yo k Time

He sa s that it took less than a min te for the man to die and that he didn t s ffer. This as
totall against e er ber in m bod , Thiele told me, b t he also said he kne hat he did
as right. We ere abandoned b the go ernment, e ere abandoned b Tenet, and
clearl nobod as going to take care of these people in their d ing moments. He added, I
did hat I o ld ha e anted done to me if the roles ere re ersed.

Both Thiele and W nn recall that the , Po and the other n rses co ered the bodies of the
dead and carried them into the chapel, lling it. Thiele said the remaining bodies ere
rapped in sheets and placed on the oor in the corridor and in a nearb room.

It as er respectf l, Thiele told me. It s not like o o ld think.

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THAT AFTERNOON, Memorial s pathologist and laborator director alked tho gh the
hospital, oor b oor, to record the locations of the dead and make s re that nobod ali e
as left behind. The fo nd Po on the se enth oor ith a n rse. Po as orking on the
IV of a patient ho seemed barel ali e. The laborator director told in estigators that Po
asked for help mo ing the patient; the pathologist remembered it differentl and said in a
deposition that he offered Po help ith e ac ating the patient, b t Po did not respond,
and later, hen he asked her again, she said she needed to speak ith an anesthesiologist
rst.

Dr. John Walsh, a s rgeon, told me that he as sitting on a bench, too tired to mo e, hen
Po and the pathologist came do nstairs. Po looked pset. She sat do n beside him.
What s rong? he asked. He said she mentioned something abo t a patient, or patients,
d ing and abo t someone, or some people, q estioning her.

Walsh had kno n Po for abo t onl a ear, b t he kne , he told me, that she as
compassionate and dedicated to her patients. I m s re o did the right thing, he
remembers telling her. It ll ork itself o t. It ll all t rn o t O.K.

Thro gho t the da , boats and helicopters drained the hospital of nearl all of its patients
and isitors. At aro nd 9 p.m., Rodne Scott, the obese I.C.U. patient ho as reco ering
from s rger and heart tro ble, at last felt himself being hoisted p the open metal steps to
the helipad. Weighing more than 300 po nds and nable to alk, Scott as the last li ing
patient to lea e the hospital gro nds. He felt relief. The fo r men s rro nding him sho ted,
P sh! P sh! and rolled his hea heelchair into a Coast G ard helicopter. E ac ating
someone as large as Scott had a cost a n rse as brie pinned against the helicopter,
br ising his ribs and spleen b t it had been done.

Scott, Thiele and W nn ere o n separatel to Lo is Armstrong Ne Orleans

International Airport, here their ordeals contin ed. H ndreds of hospital and n rsing-
home patients had been dropped there from across the disaster one; the ere met b
federal disaster-management teams that ere so nderstaffed and nders pplied that the
co ldn t pro ide e en basic n rsing care to man patients. Re ecting on the scene at the
airport, Thiele told me that if the patients he injected ith dr gs had made it there, The
o ldn t ha e s r i ed.

HE C NE DILEMMA

On S nda , Sept. 11, 2005, 13 da s after the storm hit, mort ar orkers reco ered 45
decomposing bodies from Memorial Medical Center. The ne t da the Lo isiana attorne
general, Charles Foti Jr., opened in estigations into hospital and n rsing-home deaths
d ring H rricane Katrina. The J stice Department s phones ere soon ringing ith
allegations of patient abandonment and e thanasia.
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One of the people ho called as a LifeCare la er ho rela ed a report that nine of the
compan s patients ma ha e been gi en lethal doses of medicines b a Memorial doctor
and n rses. State and federal in estigators inter ie ed LifeCare itnesses and descended
on the mold-ridden hospital to search for e idence. Separatel , Foti s staff asked the Orleans
Parish coroner, Dr. Frank Min ard, to perform a topsies and dr g tests on appro imatel
100 bodies that ere reco ered from more than a half-do en hospitals and n rsing homes in
Ne Orleans.

The b rden as n elcome for Min ard, a 76- ear-old obstetrician-g necologist ho as
alread str ggling to o ersee the a topsies and identi cation of h ndreds of h rricane
ictims. Min ard as inspired b a Catholic n n to de ote his life to p blic ser ice. For 31
ears as the cit s elected coroner, he peered into bodies in the basement of ce of the
colonnaded criminal co rtho se, emerging in co bo boots and hite s its to pla ja
tr mpet at cit charit e ents. As Ne Orleans ooded, Min ard sa s, he got o t of his car
and s am to ork. He as trapped there for fo r da s.

After a topsies ere done and specimens remo ed, orkers at National Medical Ser ices, a
pri ate laborator in Penns l ania, q ickl detected morphine in nine bodies the same
nine patients LifeCare staff identi ed as potential ictims.

The attorne general s of ce hired a forensic pathologist, C ril Wecht, ho orked on the
John F. Kenned assassination case and the O. J. Simpson m rder trial, to re ie e idence
in the deaths of fo r patients hose f ll to icolog reports and medical records the
obtained rst: Emmett E erett, Rose Sa oie and t o other LifeCare patients. Wecht
concl ded that all fo r deaths ere homicides, ca sed b h man inter ention.

After months of cond cting inter ie s and collecting doc ments, in estigators came to
belie e, the said, that doctors and n rses e thani ed as man as t o do en patients at
Memorial. B t medical records ere needed to s bstantiate the ndings, and according to
in estigators, Tenet s la ers said that man of those belonging to Memorial patients ere
na ailable. (The Tenet spokesman said ia e-mail that Tenet prod ced all records in its
possession.) Armed ith the testimon of LifeCare orkers and the medical records of the
fo r patients on the se enth oor, state prosec tors decided their strongest case as against
Anna Po , Cheri Landr and Lori B do for those deaths.

DR. FRANK MINYARD AUG. 6 2009 The co one

in hi office in Ne O lean He ggled i h
mi ed feeling hile leading an in e iga ion
Paolo Pelleg in Magn m fo The Ne Yo k Time

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AT ABOUT 9 P.M. on J l 17, 2006 nearl a ear after ood aters from Katrina s amped
Memorial hospital Po opened the door of her home to nd state and federal agents, clad
in bod armor and carr ing eapons. The told her the had a arrant for her arrest on
fo r co nts of principal to second-degree m rder.

Po as earing r mpled s rgical scr bs from se eral ho rs of s rger she performed

earlier in the da . She kne she as a target of the in estigation, b t her la er tho ght he
had ass rance that she co ld s rrender ol ntaril . What abo t m patients? she asked
re e i el . An agent s ggested that Po call a colleag e to take o er their care. She as
allo ed to freshen p and then as read her rights, handc ffed and ltimatel dri en to the
Orleans Parish jail. On the a , she pra ed silentl . (Landr and B do ere arrested the
same night.)

Po as booked and released after midnight. The ne t da the attorne general, Foti, held a
ne s conference carried on CNN, hich had broken some of the initial reports of the
in estigation and the possible e thanasia at Memorial. This is not e thanasia, Foti said
emphaticall . This is plain and simple homicide.

At a ne s conference later that da , Po s la er blamed the storm not Po for the

deaths. He said his client as innocent and acc sed Foti, ho as abo t to r n for re-
election, of orchestrating a media e ent ith the arrests. He anno nced his intention to
bring the res lts of his o n in estigation to the Orleans Parish district attorne , hose of ce
had j risdiction o er the case after the arrests and o ld bring it before a grand j r .

As the go ernment in estigation progressed, Carrie E erett, Emmett E erett s ido ,

spoke o t on CNN. After Katrina she searched for her h sband for t o eeks before
learning that he as dead. She led rongf l death la s its against Tenet, LifeCare, Po ,
Landr and B do.

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Who ga e them the right to pla God? Mrs. E erett demanded. Who ga e them the
right?

A SUCCESSFUL MURDER prosec tion in Orleans Parish t picall req ires a coroner s
medical determination of homicide that a death as ca sed b the actions of another
h man being itho t regard to fa lt or legal responsibilit . It is a step to ard a criminal
nding of homicide, in hich a Lo isiana co rt assigns fa lt for a killing.

Min ard, the coroner, bro ght together C ril Wecht, Michael Baden another ell-kno n
forensic pathologist and Robert Middleberg, the director of the to icolog laborator
here the a tops samples ere tested, to disc ss the to icolog ndings. Min ard s ood-
ra aged of ces still hadn t been repaired, so the met for three da s in his temporar
q arters in a acant f neral home.

Records sho ed that more than half of the 41 bodies from Memorial that ere anal ed b
Middleberg s lab tested positi e for morphine or mida olam, or both. Middleberg had
handled tho sands of cases in his career, and the high dr g concentrations fo nd in man of
the patients st ck o t like a sore th mb, he told me.

The gro p considered the 90- ear-old pne monia patient Alice H t ler, hom the LifeCare
n rse Gina Isbell had promised to care for d ring the h rricane. Morphine and mida olam
ere fo nd in her li er, brain and m scle tiss e, b t neither dr g had been prescribed,
according to her chart, hich contained notes ntil the night before her death on Sept. 1.
That chart sho ed that she as resting calml the pre io s afternoon, and d ring the
e ening her n rses did not doc ment an complaints of pain or distress that indicated she
needed the dr gs.

H t ler as one of the nine LifeCare patients fo nd on the se enth oor ith one or both
dr gs in their s stems. All ere seen ali e the morning of Sept. 1, and all ere listed as dead
b Memorial s pathologist that afternoon.

Homicide, Wecht rote on a sheet of paper ith H t ler s name on top, nderlining it
t ice. Homicide, he rote for se en of the eight other se enth- oor patients, incl ding
Emmett E erett, Wilda McMan s and Rose Sa oie. The last patient, hose records
indicated she as close to death, he marked as ndetermined. Baden said he tho ght all
nine ere homicides.

The gro p considered one death on the eighth oor in the I.C.U.: Jannie B rgess as the
comatose patient ho as fo nd b E ing Cook hen he climbed the stairs in the heat on
Wednesda , A g. 31. B rgess s medical chart sho ed that she as gi en 15 milligrams of
morphine se en times on Wednesda bet een 2:10 p.m. and 3:35 p.m. on spoken orders
from Cook. This as more than se en times the ma im m dose she as recei ing for

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comfort care. B t beca se she had alread been recei ing morphine and beca se of her
ad anced cancer, she as not a clear, strong case, Wecht rote in his notes. He marked
her death as ndetermined.

Besides the nine patients ho remained on the LifeCare oor and B rgess, the gro p also
re ie ed 13 Memorial and LifeCare patients hose deaths ere recorded b Memorial s
pathologist on the second- oor lobb near the A.T.M. and else here. (Other deaths str ck
in estigators as s spicio s, b t beca se not all bodies ere tested for dr gs after a tops ,
the ere not considered.) Of those 13, 9 tested positi e for mida olam and 4 for morphine,
too. In estigators searching the hospital fo nd prescriptions for large amo nts of morphine
for three of them, incl ding Carrie Hall, the oman ho fo ght hard to s r i e on
Wednesda night. The prescriptions ere dated Th rsda , Sept. 1, and ere signed b Dr.
Anna Po .

Ca ie E e e h band Emme died a Memo ial

Medical Cen e af e H icane Ka ina
Paolo Pelleg in Magn m fo The Ne Yo k Time

Despite Wecht and Baden s strong opinions that the LifeCare deaths ere the res lt of dr g
injections, Min ard anted additional information to help him make his decision. He sent
the patients medical, a tops and to icolog records to three other e perts for an
independent re ie .

Homicide, Dr. Frank Brescia, an oncologist and specialist in palliati e care, concl ded in
each of the nine cases. Homicide, rote Dr. James Yo ng, the former chief coroner of
Ontario, Canada, ho as then president of the American Academ of Forensic Sciences.
All these patients s r i ed the ad erse e ents of the pre io s da s, and for e er patient
on a oor to ha e died in one three-and-a-half-ho r period ith dr g to icit is be ond
coincidence.

A local internal-medicine specialist concl ded that hile medical records and a topsies for
se eral of the patients re ealed medical iss es that co ld reasonabl ha e led to their
deaths, most of the patients records did not. In his report to Min ard, he rote that it as
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e ident that Emmett E erett as in stable medical stat s ith no clear e idence that
death as imminent or impending. (Po s la er sa s that E erett almost certainl died of
an enlarged heart, not an o erdose of medication.)

As Min ard deliberated, he contin ed his o n inq ir , in iting se eral LifeCare

administrators to his of ce for inter ie s. Their stories foc sed on Anna Po . Min ard had
ne er met Po , b t t o months after her arrest he atched her defend herself and her n rse
colleag es ith passion on 60 Min tes. I ant e er bod to kno that I am not a
m rderer, she told Morle Safer. I do not belie e in e thanasia.

After the 60 Min tes stor , some of Min ard s longtime colleag es q estioned h he as
e en in estigating the case. The da after the CBS broadcast, the American Medical
Association released a statement: The A.M.A. is er pro d of the man heroic ph sicians
and other health care professionals ho sacri ced and disting ished themsel es in the
aftermath of H rricane Katrina.

Min ard told me that after Po appeared on national tele ision, he had an rge to meet her,
to chat o er a c p of coffee and tr to get a handle on her. He had done this before ith
people acc sed of crimes. Science is great, b t there is a point here o ha e to go be ond
science; o ha e to go b o r g t feeling, hate er o do. He in ited Po s la er to
bring her to his of ce for a isit.

Po sat across from Min ard, a er lad like lad , real So thern charming lad . On his
desk as a Bible, on his all a cr ci , and all aro nd them ere framed pict res of life in
their nati e cit . Soon the ere disco ering m t al friends and chatting abo t se eral
members of Po s large Catholic famil ith hom Min ard as close. The reminisced
abo t Po s deceased father, a famil doctor ho had been especiall kind to Min ard and
had referred patients to him hen Min ard opened his ob-g n practice.

The talked for abo t an ho r. She told him that she had been tr ing to alle iate pain and
s ffering. Gi en that Po s la er as there, Min ard as caref l not to p t her on the spot
ith direct q estions abo t hat she had done. The conditions she described at Memorial
took him back to the da s he spent trapped in the co rtho se after Katrina. Ho precio s
food and ater had seemed. Ho impossible it as to sleep at night ith g nshots echoing
all aro nd.

Min ard told me that his feelings ere less s mpathetic than he let Po kno . He belie ed
he o ld ha e at least tried to sa e Emmett E erett. There m st ha e been a a to get the
380-po nd man do nstairs, he said he tho ght. It also bothered Min ard that
doc mentation s ggested that fe of the elderl patients ho died ere being treated for
pain.

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Min ard reached o t to the noted Uni ersit of Penns l ania bioethicist Arth r Caplan for
more ad ice. Caplan re ie ed the records and concl ded that all nine LifeCare patients on
the se enth oor ere e thani ed, and that the a the dr gs ere gi en as not
consistent ith the ethical standards of palliati e care that pre ail in the United States.
Those standards are clear, Caplan rote, in that the death of a patient cannot be the goal of a
doctor s treatment.

Despite all the e pert determinations of homicide, Min ard as still str ggling ith hat to
tell the grand j r . He cons lted one more pathologist, Dr. Ste en Karch. Karch had staked
his career on ad ancing the arg ment that the le el of dr gs fo nd in a cada er ma ha e
no relationship to the le els j st before death.

Karch e to Ne Orleans, e amined the e idence and concl ded that it as abs rd to tr
to determine ca ses of death in bodies that had sat at 100 degrees for 10 da s. In all of the
cases, he ad ised, the medical ca se of death sho ld remain ndetermined.

The coroner said he belie ed that if the case ent to trial, the defense o ld bring in
someone like Karch to pro ide reasonable do bt. We d lose the case, Min ard told me. It
o ld not be good for the cit , for the reco er . It s j st a bigger pict re that I had to
consider than j st that p re basic scienti c thing.

Min ard agoni ed. Willf ll taking a life as a er bad, bad thing, he tho ght. Onl God
kno s hen o re going to die. The case occ pied Min ard s life, his tho ghts and the
dreams that a oke him in the middle of the night. He called his e perts again and again for
s pport and ad ice.

HE G AND J DECI I N

In March 2007, the grand j rors ho o ld consider Anna Po s fate ere s orn in. That
spring, the began meeting abo t once a eek at a secret location. Normall prosec tors
are ad ocates for indictment, calling their strongest itnesses to testif and granting
imm nit in e change for critical information. B t the assistant district attorne , Michael
Morales, hose of ce recei ed condemnator letters e er da for bringing a case against
Po , told me that he and the Orleans Parish district attorne , Eddie Jordan, eren t g ng-
ho abo t prosec ting the case. We ere going to gi e some deference to the defendant, he
said, beca se Po asn t the s al career criminal acc sed of m rder. At the same time,
beca se a j dge had signed a arrant to arrest Po and m ltiple itnesses ere illing to
testif , e eren t going to shirk o r d ties and tank it. He said that he personall didn t
care one a or the other abo t the o tcome.

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Rather than presenting the e idence to the j rors and seeking an indictment, as he t picall
did, he said he in ited the j rors, in conj nction ith the district attorne s of ce, to act as
in estigators and decide hat e idence the anted to consider. This didn t sit ell ith the
attorne general and his staff. Foti told me that he repeatedl asked the district attorne s
of ce to present all the e idence and the e perts.

Grand-j r hearings are cond cted in secret, making it dif c lt to kno e actl hat j rors
hear. Min ard told me that in the end, he decided that fo r of the nine deaths on the se enth
oor ere homicides, incl ding Emmett E erett and Rose Sa oie. Until no , he has ne er
p blicl re ealed that concl sion. He also said of Po , I strongl do not belie e she planned
to kill an bod , b t it looks like she did.

The j r heard from Min ard b t not from an of his forensic e perts; nor from t o famil
members ho ere present on the LifeCare oor d ring most of the ordeal; nor the main
J stice Department in estigator, ho orked the case for a ear and helped collect 50,000
pages of e idence. Onl t o of the main LifeCare itnesses ere bro ght before the j r
late in the process. B do and Landr , ho ere compelled to testif after the district
attorne decided not to prosec te them, had p blicl e pressed their s pport for Po .

The grand j rors li ed among the general p blic, hich as rml in Po s corner. Po had
one of Ne Orleans s premier p blic-relations agencies representing her. A poll
commissioned b her la er s of ce to assess the potential j r pool fo nd that fe Ne
Orleanians fa ored indictment.

An grand j rors ho might ha e t rned on their radios or TVs, or opened The Times-
Pica ne, or s rfed the Web o ld ha e heard samples of the comm nit s dr mbeat of
s pport. Nearl e er da , Ne Orleans s most pop lar talk-radio host, Garland Robinette,
raised his bass oice on WWLs Think Tank in o trage at hat s being done to these three
. . . for tr ing to sa e li es. On J l 17, 2007, a s pport rall to mark the rst anni ersar of
Po s arrest garnered top billing on Robinette s sho and on e er local ne s program.
H ndreds gathered in Cit Park. Speakers aimed their comments directl at the grand j r ,
arning that medical professionals, hose ranks had alread been depleted b Katrina,
o ld ee Lo isiana in dro es if a doctor as indicted after ser ing in a disaster.

The eek of the rall , the grand j rors stopped hearing e idence. The district attorne s
of ce prepared a 10-co nt bill of indictment against Po for the grand j r to consider one
co nt of second-degree m rder in Emmett E erett s case and nine co nts of the lesser
conspirac to commit second-degree m rder, one for each of the LifeCare patients on the
se enth oor.

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This meant that the grand j rors ere being asked to decide hether the e idence the
heard pers aded them that Po had a speci c intent to kill part of Lo isiana s de nition
of second-degree m rder.

On J l 24, 2007, the j rors led into Section E of Orleans Parish Criminal District Co rt, the
b ilding here Min ard s r i ed Katrina. J dge Cal in Johnson read alo d the 10 co nts of
indictment. The grand j r did not indict Po on an of them.

FOUR YEARS AFTER Katrina, it s s mmer again in Ne Orleans, and the m rtle trees are
in bloom. Rodne Scott, the patient hom E ing Cook once took for dead, is still ali e.

Scott is gratef l to be ith his famil . A former n rse, he sa s he does not kno hether
e thanasia occ rred at Memorial; b t if it had, he onders hat the doctors and n rses
co ld ha e been thinking. Ho can o sa e thanasia is better than e ac ation? he
asked me not long ago. If the ha e ital signs, he said, get em o t. Let God make that
decision.

The debate among medical professionals abo t ho to handle disasters is intensif ing, ith
Po and her ersion of the Memorial narrati e often at the center. At a conference for
hospital e ec ti es and state disaster planners a fe months ago in Chicago, she did not
mention that she injected patients, sa ing that helicopters arri ed in the afternoon of
Th rsda , Sept. 1, and e ere able to e ac ate the rest.

Po projected the booking photo from her arrest onto the screen as she arg ed for la s to
shield health orkers from ci il and criminal liabilit in disasters.

Before deli ering the ke note address, Po participated in a panel on the moral and ethical
iss es that co ld arise if standards of care ere altered in disasters. At one point, one of the
panelists, Father John F. T ohe , regional director of the Pro idence Center for Health Care
Ethics in Portland, Ore., said that there are dangers hene er r les are set that o ld den
or remo e certain gro ps of patients from access to lifesa ing reso rces. The implication
as that if people o tside the medical comm nit don t kno hat the r les are or feel
e cl ded from the process of making them or don t nderstand h some people recei e
essential care and some don t, their con dence in the people ho care for them risks being
eroded. As bad as disasters are, he said, e en orse is s r i ors ho don t tr st each
other.

Sheri Fink, an M.D., is a staff reporter at ProP blica, the independent nonpro t in estigati e organi ation. She is the a thor of
War Hospital: A Tr e Stor of S rger and S r i al and is a senior fello at the Har ard H manitarian Initiati e.

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