Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital

by Sheri Fink

King had contacted the attorney general’s office after seeing television coverage of mortuary workers recovering bodies from Memorial. He was disturbed by the number of bodies found in Memorial’s chapel. He told them about the man he had pronounced dead early Thursday morning and carried to the chapel. “That person made the sixth patient. I’m willing to go to my grave on that because I was counting in my head,” he said. “After that, nobody else died on my second-floor area before I left the hospital. I left the hospital between twelve thirty and one thirty.”

There’s no way that that many people died in the time frame in between the time I left and the following day because…” He paused. “They were sick, they were really sick, but they weren’t sick enough that, well, they weren’t sick enough collectively, that twenty of them would die in a day. I mean, come on! What hospital loses twenty patients in a day? I mean, really! If you lose twenty patients in a day, somebody is coming to investigate because there is something abnormal going on.”

you know, kind of conduct what happened, but he didn’t.” Instead it was a tall woman with striking red hair. “She conducted every meeting. I mean, that was strange to me, for someone that I’d never seen before.”

He hadn’t thought his opinion would make a difference. Whereas some people had been scared of the people outside of the hospital, King was wary of the people in it.

King said he had sent messages to his best friend telling him that “evil entities” were planning to euthanize patients. “You were talking about ‘evil entities’?” “Because I couldn’t call them people anymore. When you talk about killing people you’re—talk about killing people who’ve done nothing wrong—you’re not…to me that’s not really a ‘person.’ Humans don’t do that. We don’t do that to each other. So, I was like…These…these…these…the correct word would have been, ‘These motherfuckers are talking about killing people!’ ”

King’s best friend had taken the messages to National Public Radio, and reporter Joanne Silberner had described the texts on air on the program All Things Considered the very afternoon the injections were taking place: “King said some of the staff was starting to panic, even talking about helping some of the long-term acute care patients, those close to death, die.”

King said he looked around and saw Anna Pou standing on the other side of the walkway by the bathrooms and the ATM. “She had a handful of 10 cc syringes with the pink needle—which is our eighteen- to twenty-one gauges—she had a handful of them and she said verbatim to a patient, ‘I’m going to give you something to make you feel better.’ ” King said it was highly unusual for a doctor to be handling syringes.

A doctor’s order was checked by a pharmacist and checked again by a nurse. Even those trappings of medical formality and quality control hadn’t broken down at Memorial until that moment.

occurred, and I don’t know how, why, or who decided it, but they need to answer to the family members, because somebody lost family members because of whatever decisions were made.”

King said the only other people he’d spoken with about events in the hospital were his girlfriend, best friend, sister, and a producer from CNN, with whom he’d had an on-camera interview several weeks earlier. It hadn’t yet aired. He said he was telling Schafer and Rider the same things he had told the producer.

The attorney was furious and thought what the Tenet lawyer had done—milking Mulderick for information, then telling her to get an attorney—was unethical.

Another sister described how St. Bernard’s Chalmette Medical Center, where ambulances had failed to return to complete a pre-storm evacuation, had flooded in a matter of hours to the ceiling of its first floor.

Another sister had worked at Tulane Hospital in downtown New Orleans. Tulane was also dark, hot, and surrounded by water, but officials at its parent corporation, HCA, had been proactive about arranging for private helicopters and buses to rescue patients, employees, and their families, betting correctly that government assets would prove insufficient. The process of an orderly if slow evacuation had kept panic at bay. She knew of no patients who had died at Tulane. This sister was able to laugh and joke about her experiences.

I recall as we picked up one patient to move him along the line to the helicopters and told him that he would be leaving soon he screamed out “Oh God—are you throwing me away??!!!” He said he had been told for so long that he was going to get out that he just knew we were throwing him away. This memory will be with me forever.

how dare you give this nation the impression that you were providing for these patients and for your employees.

during Hurricane Katrina to protect employees such as me and failed to fulfill its obligation,” one ICU nurse, Dawn Marie Gieck, wrote to Fetter. “When I consider how others and I put ourselves in harm’s way for Tenet, I feel a sense of indignation that the company wasn’t there to take care of those taking care of its patients.”

“Why weren’t there plans to cope with these patients when you knew a storm was coming? Sometimes the ethical—the most important ethical question sometimes is the one you ask not at the moment of crisis, but the duty you have to anticipate certain kinds of crises and avoid them.”

Bioethicist Arthur Caplan, then at the University of Pennsylvania, said American juries rarely sent doctors to jail for hastening deaths. “The culture that we live in does not want doctors killing, to be very clear about that. But it will listen closely and you might be able to make a defense of a mercy killing, if you will, under very, very extenuating circumstances. Whether New Orleans meets that, we’ll have to see.”

She heard enough to know she did not want to hear more. She refused to believe her mother was one of the patients injected. Who would want to believe that?

At the same time Schafer saw how strategic it was for Tenet to offer to represent its employees. What company, facing potential lawsuits, wouldn’t want to know what its workers had to say about it?

a situation Isbell compared to being simultaneously on the Titanic and in war.

Her roommate was worried—Isbell always looked sad; a force had gone out of her. She had left Memorial in a small flat boat, with a weeping heat rash, mentally and physically drained, only to discover she had lost her home and her entire community in devastated St. Bernard Parish. She felt guilty about every staff member she had picked to work the hurricane with her. She felt terrible about the patients who had died.

investigation were public and Rider began conversations with a legal disclaimer, most potential witnesses were wary and uncooperative.

When employees did agree to interviews, Schafer, drawing on more than three decades of legal practice, sensed in their guarded responses that their attorneys had schooled them on what they could and could not say. There wasn’t a lot he and Rider could do when an interview subject answered, “I can’t recall,” even when the question concerned an event it would seem that no one could ever forget.

Schafer was familiar with what attorneys did when they represented defense witnesses, and he had to admire the good lawyering of the competition. Their work energized him, made him play his “A” game, even as he saw that it only angered Rider, who seemed to see it as a form of withholding evidence.

The subpoenas could serve another purpose, flushing out people who invoked their Fifth Amendment right not to incriminate themselves—the people who might have something to hide.

Rider and Schafer now believed they had the names of two of the nurses who had come to the seventh floor with Pou; their lawyer’s opinion that injecting the patients was intended to kill them; and new details about what had occurred on the second floor, including the possibility that another doctor had played a key role.

Flying away from Memorial at sunset, a sense of relief had settled over him as he realized that he had in fact survived what he’d been sure he wouldn’t.

It was a stroke. He was only fifty-three. The doctor could find no reason. “It just had to be the stress of the storm.”

Thiele had spent nearly every hurricane at Baptist. He stayed even though he wasn’t a hospital-based doctor and didn’t need to do so. He had practiced for twenty-one years, but there was nothing in his experience, nothing in anyone’s experience there at Memorial, to prepare them to solve the problems they were facing. They were, he thought, in a war zone.

Daylight, Thursday morning, had refocused him. Susan Mulderick, taller, more confident than he, walked toward him from the emergency room. “John, everybody has to be out of here tonight.” He heard the same from CEO Goux. Their words suggested the possibility of survival. He felt encouraged.

Moral clarity was easier to maintain in concept than in execution. When the moment of truth came, he wavered. That’s when he turned to nurse manager Karen Wynn, trusting her experience in the ICU and her leadership of the hospital’s ethics committee. “Can we do this?” he asked. He was grateful for her assent.

Thiele gave patients a shot of morphine and midazolam at doses higher than what he normally used in the ICU. He held their hands and reassured them, “It’s all right to go.”

of being medicated. But the heavyset black man with the labored breathing hadn’t. Thiele gave additional shots of morphine, he thought perhaps 100 mg. He chanted Hail Marys with Karen Wynn. The man kept breathing. Perhaps his circulation was so poor that the drug wasn’t getting into him. Thiele covered his face with a towel. He remembered it took less than a minute for t...

Though he’d felt what he had done was right, immediately afterward the question of whether it was indeed right continued to play in his mind. Can we do this? If the man was unaware of what was going on, if he would have died in an hour anyway, how cruel was it to have suffocated him?

airport turned away Thiele and other doctors and nurses, even as their members were utterly overwhelmed.

As hard as it was, Baltz had to believe that King was reporting events as he had seen them, events that he’d thought were wrong.

The death of Baltz’s patient had surprised him. Her vocal cords were paralyzed. She couldn’t speak for herself. Could she have been euthanized? He resolved to find out what had happened and who was responsible. He resolved not to be silent about it.

The difference was that they had requested his services. The doctors at Memorial, as far as Rider knew, had acted without consent.

“Cindy, don’t let them leave me behind,” she remembered him saying. She had promised him she wouldn’t. She lived now with a heavy burden of guilt and leaned harder on alcohol and prescription painkillers.

Schafer had developed the famous “Katrina cough” that seemed to strike everyone who spent time in New Orleans. He traced it to their tours of Memorial without wearing masks; God knew what had come up from the sewers and drains.

She, tenacious and idealistic in the pursuit of truth. He, a wily plotter who knows he needs her. Both addicted to their callings—two opinionated people who got along best when they were focused on their work—finishing each other’s sentences, lighting each other’s cigarettes (well, Rider didn’t smoke), knowing what the other was thinking.

“I remember being in the respiratory area,” he said. This was on the second floor. “We all took oxygen tubing from the wall and just…had it just blowing all over me because it was so hot.” Did he realize how terrible this could sound when Dr. Bryant King and others had spoken of running out of oxygen for patients in the second-floor lobby? Why weren’t patients who needed oxygen carried to wherever it was, on the same floor, that oxygen could so easily be had?

“When we went to give her morphine, it ended her life.” Culotta’s matter-of-factness surprised his interviewers. Was it standard practice to administer high doses of narcotics and sedatives when a patient developed the irregular breathing pattern Culotta had described?

Moral and legal culpability for the deaths rested on the wisps of contrast between wanting, foreseeing, and intending death.

“When you talk about morphine and you talk about Demerol, any amount when it is not prescribed is significant.”

“In all four of the cases it appears that a lethal amount of morphine was administered,”

CEO René Goux, whom Rider and a colleague had interviewed in November, claimed to have known almost nothing about what had gone on in his hospital after the storm, even though he had stayed there the entire time.

Memorial CFO Curtis Dosch and Memorial COO Sean Fowler, stunned Schafer and Rider when the men casually mentioned that the cancer institute connected to Memorial via sky bridges had a working generator and electricity throughout the disaster. Hospital executives went there to make phone calls and coffee, and their interviews revealed something of the executive mind-set.

The investigators were left to wonder why, however, the patients weren’t lifted onto gurneys and rolled into the more comfortable cancer center (or to air-conditioned cars and trucks).