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

by Sheri Fink

Dosch was not the only person to notice and be disturbed by a general refusal to acknowledge and discuss what had occurred. Nurses referred to it as a Code of Silence, which was adopted almost immediately upon departure from the hospital. “We’re not talking about it….And by the way, nothing happened,” was how one would describe it. Circle the wagons. Don’t get anyone in trouble.

this was a corporation that had, the year before Katrina, paid nearly $400 million to settle claims that doctors at one of its hospitals performed unnecessary heart surgeries and procedures on healthy patients. That didn’t speak well of corporate ethics.

“The only way the staff could evacuate was if they could report there were no more living patients to take care of. This was not about compassion or mercy. It was about throwing someone else over the side of the lifeboat in order to save themselves.”

The lawyer was writing to Schafer because—nearly a year later—Russell’s wife of forty-two years and her daughter had learned nothing about his final moments. They had received a death certificate from the coroner’s office, but had not been given any conclusive proof as to what date Russell died and how he died. “He appeared to be in relatively good health and lucid shortly before the Hurricane,”

The urge to learn what had become of a loved one who perished in a large disaster or crisis was so essentially human that it had led to the development of a special field of DNA identification focused on mass casualties.

before. Simmons would deliver Pou to be booked in order to avoid the indignity of a surprise arrest.

They alleged that the women had violated the state’s second-degree murder statute by intentionally killing the four patients.

Simmons held up a copy of the affidavit. “It’s just a piece of paper with allegations on it,” he said. “Like every piece of paper, it has two sides.”

Why had the city flooded? A bad storm. The loss of a wetlands buffer. Most of all, around New Orleans, the levee and flood control system—increasingly federalized after the 1927 Mississippi River floods and managed by the US Army Corps of Engineers—was grievously and predictably faulty. The failure to address its known weaknesses had saved money in the short term and now appeared outrageous.

Why, in the end, had more than a thousand died immediately in New Orleans—many of them in medical facilities, and many others poor and elderly—and an unknown number of others suffered and died in the aftermath due to stress and disruption of health care? So many reasons. The mayor’s delayed evacuation order. The lack of buses and drivers to move people out of town who had no cars of their own. Stubborn decisions to stay by people with the means to leave. Uncoordinated rescue efforts. Confusion and turf battles between different agencies and levels of government. Poor communications, not interoperable. Hospitals and nursing homes that didn’t evacuate before the storm and had not invested in backup power systems and backup water systems robust enough to withstand a prolonged emergency. Alarm over lawlessness, which interrupted rescues. It soon became clear that the fear of violence outweighed the actual violence, and that fear itself had compounded tragedy, as when first responders, including medical workers at the Superdome, were instructed to abandon their posts and their patients out of concern for their own safety.

Underlying the official response to the crisis was a lack of situational awareness—a view of the larger picture of what was happening and what needed to be done. All of this had occurred against the backdrop of the knowledge, for years, that exactly such a scenario could occur. The Times-Picayune had written about it. The Hurricane Pam exercises had modeled it. The hospital was a microcosm of these larger failures, with compromised physical infrastructure, compromised operating systems, and compromised individuals. And also instances of heroism.

to accept about other people’s disasters. It was shocking to see the scenario play out at home.

Life and death in the critical first hours of a calamity typically hinged on the preparedness, resources, and abilities of those in the affected community with the power to help themselves and others in their vicinity. Those who did better were those who didn’t wait idly for help to arrive. In the end, with systems crashing and failing, what mattered most and had the greatest immediate effects were the actions and decisions made in the midst of a crisis by individuals.

wondered exactly whose pain the medical workers had been trying to relieve: “Our whole purpose for being here was to aid the patients; not to kill them because we wanted them out of our misery.”

Did the findings suggest that the patients received a single massive dose of the drugs shortly before death, or repeated doses that allowed the drugs to accumulate, particularly in patients with problems like kidney failure or liver disease, which would have made it difficult for their bodies to process certain drugs?

The experts were accustomed to ass-kissing from prosecutors, but these attorneys acted suspicious, skeptical, and uninterested. The lawyers left after about half an hour. “Obviously these guys don’t want to do anything,” pathologist Baden commented to coroner Minyard.

Minyard, in contrast, seemed to agree with the experts that many deaths at Memorial were homicides. What was striking was the pattern. Almost every patient who died after the helicopters and boats arrived on Thursday morning and whose bodies were tested—including all nine patients on the LifeCare floor, nine on the second-floor lobby, and Merle Lagasse—were positive for the drugs.

Good people, Morales thought, shouldn’t necessarily be charged for the bad things they did in a crisis.

Schafer also wanted to probe a potential corporate thread of responsibility for the deaths, even a conspiracy. He and Rider hoped the DA would grant immunity to some of the health workers who had proffered potentially critical testimony.

Baltz opposed the idea of a cover-up. He felt that his value systems and ethics were no longer in step with those of his colleagues. There was a new aroma in the air, and he disliked it.

The indignity of this upset her, as did the thought that her mother had not, at the very least, become the “beautiful corpse” of Ewing Cook’s morbid imagination.

medical malpractice attorney, became depressed after obtaining Cavalier’s toxicology results. She wondered aloud how someone could have decided for her mother that she wasn’t going to make it. Where were the checks and balances?

They were outraged that after living an upstanding life and doing so much to help others, she had apparently died as if her remaining moments had no value.

Kathryn’s brother Craig was an experienced white-collar and health-care attorney nearing retirement who had the knowhow, resources, time, and motivation to find out exactly what had happened to his mother—and make someone pay.

She was outraged at suggestions that the health workers were relieving suffering in the last moments of life—who told them it was the patients’ last moments, patients they had never even treated?

She felt her family and her mother had been violated even though her mother might not have had much time left. Family members had been deprived of the chance to be with her when she died, to see her body and sit vigil over it at a wake—it was so badly decayed, the family had decided to have it cremated. Wilda McManus did not have the kind of funeral she merited,

“Euthanasia is something you do to a horse, or to an animal. When you do it to people, it’s called murder.”

The suit alleged that the hospital had been negligent in preparing for and responding to the storm, a premises liability claim that one uninvolved insurance attorney described as “a new theory of liability against health-care institutions—lack of emergency preparedness.”

what had happened after nearly all of the 175 staff members escaped. At the fire officials’ suggestion, they had put on gowns and drawn the triage symbol “C” on themselves to look like patients so they could be evacuated by military helicopter. Some took pictures of one another grinning, patient gowns tied loosely over their scrubs, bright-red triage letters marking their chests, hands, and foreheads.

them.” An anesthesiologist, James Riopelle, was approached about euthanizing patients and said the idea was crazy. This isn’t the Titanic, he thought, Lindy Boggs isn’t going down. We’re only a mile from dry ground, with plenty of drinking water.

He’d made a pledge to himself years earlier, after touring the Holocaust concentration camp Dachau, to refuse to comply with misdirection.

It had never occurred to Riopelle that the rescuers wouldn’t take all the patients, but he and his two colleagues found themselves alone with the pets and roughly twenty-five patients who were extremely fragile, many with DNR orders. Riopelle saw some patients die, and he dragged three bodies to the hospital’s entrance to deter looters.

Charity staff also kept up the hospital routine despite the bizarre conditions. They kept patients in their rooms, continued to provide services like physical and occupational therapy, and encouraged workers to maintain shifts and a regular sleep schedule. This signaled that the situation was under some degree of control and kept panic to a minimum. There was an active effort to stem rumors. “You can only say it if you’ve seen it,” staff were told. Perhaps most important, Charity’s leaders avoided categorizing a group of patients as too ill to rescue. The sickest were taken out first instead of last.

By the rule of double effect, an act that could foreseeably cause both good and bad effects was morally permissible if solely the good effect was intended (and did not result from the harmful one), and the act, itself good or neutral, was undertaken in a proportionally grave situation.

“Homicide,” Dr. Frank Brescia, an oncologist and specialist in palliative care, concluded in each of the nine cases. “Homicide,” wrote Dr. James Young, the former chief coroner of Ontario, Canada, who was then president of the American Academy of Forensic Sciences. “All these patients survived the adverse events of the previous days, and for every patient on a floor to have died in one three-and-a-half-hour period with drug toxicity is beyond coincidence.”

True valor would have been to oppose euthanasia; to lock all narcotics and sedatives securely; to erase all orders “DNR”; to dissuade naive nurses enlisted to execute orders that ordinarily would have been rejected; to assure that evacuees have secure destinations before being dispatched; to adhere to professional ethics at all times; to guard against aberrant behavior of staff members; to demand the Chief Executive Officer and staff be held responsible and visible; and to pray that Devine guidance grace us with sound judgement, serenity, and composure.

The scenario at Memorial, he wrote, was a horror, but an instance of the horror others faced throughout the Central Gulf Coast region. “Our situation was not unique, but somehow our reactions and responses regrettably were,” he wrote. “Other hospitals with similar stress had more success than we. Was there some inherent flaw in our leadership? Look to ourselves and our behavior. Don’t indict government abandonment, while ignoring corporate neglect. Don’t cite the dread of lawlessness surrounding the hospital, when internally dreadful disregard for law and ethics may have become endorsed policy.”

In 2006 the city had the highest murder rate in the nation at 72.6 per 100,000. Gary, Indiana, was a distant number two, with 48.3 per 100,000. Of the 162 willful killings that year, only a third were followed by arrests, which had thus far led to very few convictions. Nearly 3,000 suspected felons were released automatically by state law simply because the district attorney and his overburdened assistants had not charged them within the allotted sixty days, sometimes for lack of evidence from the police.

Serving two months in prison for allegedly committing a serious offense in New Orleans was common: “Sixty days and I’m out,” the saying went. There was even the very occasional “misdemeanor murder.”

District Attorney Jordan had reportedly never tried a criminal case before taking office. His homicide unit was struggling to get a handle on the murder problem as it...

It frustrated the chief prosecutor in the Memorial case, Michael Morales, to think about how much effort and attention were going into prosecuting the doctor and nurses from Memorial when so many violent criminals were menacing the public.

WHILE FRANK MINYARD had commissioned many forensic reports on the Memorial dead, he lacked the views of an ethicist, someone who could situate the alleged acts of the health professionals in a panorama of history, philosophy, theology, law, and ever-changing societal norms.

Now Caplan reviewed the records of the nine LifeCare patients on the seventh floor and concluded that all were euthanized, and that the way the drugs were given was “not consistent with the ethical standards of palliative care that prevail in the United States.”

the death of a patient cannot be the goal of a doctor’s treatment.

Whether killing someone who wished to be killed was an act of mercy or an act of murder was a question that had divided humanity from ancient times, millennia before the advent of critical care medicine focused the modern mind on

In a story related in the Bible, King Saul, injured in battle, asked his armor bearer to finish him off. He refused, “for he was sore afraid.” Saul then fell on his own sword and called out to a passing young man, “Stand over me and kill me! I am in the throes of death, but I’m still alive.” The young man did so and later told the story to King David, saying, “I knew that after he had fallen he could not survive.” David condemned the young man to death for his actions.

In an effort to save money and resources during wartime in the early 1940s, the Nazis took the ideas to their logical extreme and implemented programs of involuntary “euthanasia” of these populations. By some counts up to 200,000 people with mental illnesses or physical disabilities were executed, the Darwinian notion of survival of the fittest employed to justify the murders.

Doctor and nurse mass murderers of more recent ilk, some who have killed many dozens of patients before being stopped—Harold Shipman, Michael Swango, and Arnfinn Nesset among them—have similarly targeted the very sick and elderly, as well as those unable to communicate and neglected by their families. On arrest, some have invoked similar justifications, claiming to have euthanized suffering patients to put them out of their misery.

Psychiatrists have profiled these killers, identifying them as grandiose narcissists who tend to bristle at criticism, or to see themselves as saviors or gods unable to do wrong, or who get a thrill out of ending suffering and deciding when somebody should die.

involuntary, active euthanasia was, at the time Caplan made his review of the LifeCare deaths, not legal anywhere. Taking the life of someone who had not expressed the wish to die would contravene the principle that people have a right to decide what doctors can do to their bodies.