Arrest of Katrina doctor, nurses stirs up strong support for the accused

Were medical staff easing pain or euthanizing patients?

If, by arresting a doctor and two nurses in the deaths of patients at a New Orleans hospital after Hurricane Katrina, Louisiana Attorney General Charles Foti anticipated being hailed as a hero of the downtrodden and helpless, no doubt the backlash surprised him.

The New Orleans community has reacted with fury toward Foti's office and sympathy for head and neck surgeon Anna Pou, MD, and nurses Lori Budo and Cheri Landry, who were arrested in July upon Foti's announcement that his office had uncovered evidence the women intentionally euthanized four patients at Memorial Medical Center in the desperate days following Katrina. Physicians have responded with questions about the evidence Foti has gathered, and laypeople have reacted to what they view as the vilification of health care professionals who didn't have to stay with patients at all and were, many bloggers, editorial letter writers, and radio talk-show callers say, merely trying to ease the suffering of their patients.

"Our community is convulsed by this," says Jeffrey Meitrodt, a reporter for the New Orleans Times-Picayune, who has covered the hurricane and its after-effects since the storm struck more than a year ago. "You generally don't see this much sympathy for people who have been accused of murder."

Louisiana law a convoluted affair

Because of the vagaries of Louisiana law, which is based on French common law, Pou, Budo, and Landry have been arrested, but weren't actually charged with any crime as of presstime in early August. Laws in that state permit arrests based on information, even before charges are lodged.

The women were released on their own recognizance. Their attorneys have stated the arrests were unnecessary, given that the women were prepared to surrender if charged.

Foti has turned over the evidence his office has gathered throughout its nearly yearlong probe to the Orleans Parish district attorney, who refused comment and is not under any obligation to pursue charges. A grand jury is expected to convene in the case in early fall, however, according to press reports in New Orleans.

While some opinions lodged via public forum (news interviews, letters to editors of Louisiana newspapers, and radio debates) have expressed sympathy for the families of those patients who died at Memorial and concern over the possibility that illegal euthanasia was carried out, the tide of public opinion, at least in the weeks immediately after the arrests, is squarely in favor of the doctor and nurses. Most say the real culprit in the deaths of anyone who died in the wake of Katrina was the federal government.

"Opinions [at the Times-Picayune's reader forum] are about 90% in support of Dr. Pou," Meitrodt told Medical Ethics Advisor.

Louisiana Medical Society President Floyd A. Buras, MD, expressed concern over the accusations, but said officially the society will allow the justice system to determine what took place at Memorial in the days after Katrina before issuing any comments about the case.

Homicide or euthanasia?

Foti accuses Pou, an associate professor of otolaryngology at the Louisiana State University School of Medicine, and the two nurses of intentionally administering lethal doses of morphine and the anxiolytic midazolam (Versed) to four patients on Sept. 1, 2005 — three days after Katrina hit New Orleans. The four were patients of Lifecare, a long-term acute-care unit located within Memorial Medical Center.

Flooding after the hurricane stranded the hospital, which had no electricity or safe water. Medical and food supplies were nearly gone, and the temperature inside was more than 100° F. Some patients had been evacuated, but most Lifecare patients were physically unable to get out on their own power, and the hospital staff were desperately trying to arrange evacuation.

Within days of the final evacuation of the hospital, rumors began spreading that an unnamed female physician had been seen entering patients' rooms carrying syringes, and that those patients later died. The four patients Foti listed in his complaint against Pou and the nurses included two men and two women, ranging in age from 61 to 90. At least one was paralyzed, two were described as extremely ill, and one was reportedly convalescing.

Foti stated in a press conference that toxicology reports showed lethal amounts of the drugs in the patients' bodies, and that Pou had allegedly told a Lifecare nurse executive that lethal doses were administered to patients too sick to be moved.

"This is a homicide. It is not euthanasia," Foti stated in announcing the case against the women.

Ethicists familiar with the case — and even some who know of it only by media reports — have come out unanimously against euthanasia as a point of law and ethics; but physicians familiar with the case and with forensic evidence say the evidence Foti has gathered may not be enough for a conviction.

Meitrodt says some in the New Orleans legal community have hinted that Foti has left the Orleans Parish district attorney's office, which will be responsible for carrying out any prosecutions, with a potentially losing case.

'Lethal cocktail' alleged

Though Foti described Versed and morphine as a "lethal cocktail guaranteed to kill," palliative care experts say the combination is not the most effective means to cause death, and both drugs could be expected to be found in the systems of patients in terminal pain. Given the shortage of supplies, one physician told the Times-Picayune, Pou's defense attorney is sure to raise the issue of the doctor using what drugs were at her disposal to ease patients' discomfort.

The case also has raised fears in New Orleans that medical staff will abandon hospitals and patients should there be similar disasters in the future, since to remain might put them in jeopardy of being where Pou finds herself now. Among health care professionals, there already has been discussion of what measures doctors and nurses should prepare for should they be called on to care for patients without the equipment and basic supplies they need. Can physicians who take an oath to "do no harm" keep that pledge in situations like those seen in the days after Katrina?

In the days after the hurricane, some health care officials were questioning this.

"Doctors and nurses who stayed behind were scrambling to find drugs for their critically ill patients," says Joseph L. Cappiello, vice president for accreditation field operations at the Joint Commission on Accreditation of Healthcare Organizations, the nation's major hospital accrediting body, who toured New Orleans in the wake of Hurricane Katrina. "[Health care providers in New Orleans] had to make choices that we ordinarily don't make in America, to help those with the greatest chance of survival."

Pou has not been available for interviews, but told Baton Rouge television station WBRZ in December 2005 that staff at Memorial did everything in their power to make patients comfortable in the days after the hurricane.

Pou's supervisor at another institution, Daniel Nuss, MD, of the Louisiana State University Health Sciences Center, noted that Pou volunteered to stay behind and care for patients.

"With other dedicated doctors and nurses, she worked without sleep and without nourishment," Nuss said in a statement he prepared after Pou's arrest. "At great self-sacrifice, she prevented further loss of life and has been credited with saving multiple people from dying."

Although Foti names only four patients in the allegations against Pou, family members of other Lifecare patients have said they welcome the prosecution as a way to find out what happened to their loved ones.

"You know, of course I don't know what God's will is," said Angela McManus in an interview with National Public Radio. McManus' mother, Wilda, died at Memorial but is not one of the patients Foti mentioned in his announcement. "I don't know when he was calling her home. If he did in fact do it, OK. But if man decided that, I want to know that. My family needs peace of mind about that."1

The only other criminal charges filed thus far relating to patient care or abandonment during and after the hurricane are those filed in 2005 against the owners of St. Rita's Nursing Home in St. Bernard Parish near New Orleans. Mable B. Mangano and Salvador A. Mangano, Sr., owners of the nursing home, are charged with 34 counts of negligent homicide for abandoning nursing home residents who later drowned in the flooding that followed the hurricane.

Reference

  1. National Public Radio, All Things Considered, Feb. 16, 2006. Transcript available at www.npr.org.

Sources/Resource

For more information:

  • Jeffrey Meitrodt, staff writer, New Orleans Times-Picayune. Phone: (504) 826-3497. E-mail: jmeitrodt@timespicayune.com.
  • Floyd A. Buras, MD, president, Louisiana State Medical Society, Baton Rouge. Phone: (225) 763-8500.
  • Joseph L. Cappiello, vice president for accreditation field operations, Joint Commission on Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5757. E-mail: jcappiello@jcaho.org.
  • Daniel Nuss, MD, professor and chairman, Louisiana State University Department of Otolaryngology, 533 Bolivar St, 5th Floor ENT Suite, New Orleans, LA 70112. Phone: (504) 717-2776.