Investigation begins on allegations of euthanasia

Did hospitals fail to follow evacuation plans?

The criminal investigation of hospitals and health care providers in New Orleans has cast an unusual light on a group whose primary mission is to heal. The attorney general for Louisiana has described allegations that hospital workers, including at least one physician, euthanized patients trapped by floodwaters following Hurricane Katrina in August 2005 as "credible."

A spokeswoman for Attorney General Charles Foti told Medical Ethics Advisor in April that investigators are awaiting a state Supreme Court ruling on access to witnesses before announcing whether — or, more likely, what — founded allegations have been uncovered, and if charges may arise from what occurred in three hospitals and a handful of nursing homes in the four to six days following Hurricane Katrina.

Kris Wartelle, spokeswoman for Foti, acknowledges that a criminal investigation has been ongoing since September into allegations that hospitals, doctors, and administrators may have played a role in the deaths of more than 200 patients at Tenet Healthcare Corp.’s Memorial Medical Center, at Lindy Boggs and Touro hospitals, and at five nursing homes in the New Orleans area.

Most of the allegations that have been disclosed in court records center around the actions of the Tenet hospital, Memorial, which included an independently owned long-term acute-care facility, LifeCare Hospital. The 317-bed Memorial hospital had 260 patients when the hurricane struck, with another 82 mostly frail patients in the LifeCare facility. At least 45 patients died at Memorial, Tenet said in prepared statements released in late 2005.

The allegations that staff at Memorial euthanized patients several days after the hurricane struck — after enduring days without electricity or clean water in temperatures in excess of 100 degrees Fahrenheit and with little or no medicine or operational equipment — began appearing within days after the hurricane hit.

No official details were disclosed by Foti’s office, which announced a criminal investigation within weeks of the storm. But because of the actions of Tenet, the allegations against the Memorial Medical Center recently were unsealed in federal court. Allegations involving other hospitals and nursing homes had not been made public at presstime.

Foti’s office issued more than 70 subpoenas to Tenet employees and officers in December, after Tenet issued a statement to its employees saying that they did not have to talk with investigators.

An announcement in the case was delayed in March and April by a petition filed in the state Supreme Court by the lawyer for one Memorial doctor, Anna Pou, asking that Pou’s conversations with Tenet attorneys and other hospital officials in the days after the storm be protected under attorney-client privilege. If successful, it would mean investigators could not ask the lawyers what Pou told them about patient deaths at Memorial.

Pou is alleged to have been seen carrying several syringes. While witness descriptions in court records don’t specify what was in the syringes or whether they saw Pou administer injections, Pou’s attorney says in filings with the court that she is a suspect in allegations of patient euthanasia.

Hospital employees and Tenet have described the harrowing days after the storm — patients dying of natural causes or due to lack of supplies, looters threatening the hospital campus, and hospital staff being torn between wanting to evacuate and being told to stay behind with patients.

Scrutiny on evacuation failure

Wartelle says the investigation is focused not only on individuals and hospitals, but on whether the hospitals and nursing homes failed to follow evacuation plans, which might have saved more patients.

"We are looking at every death in every hospital and nursing home during and after Katrina," says Wartelle. "We’re looking at specific allegations as to whether euthanasia occurred, whether the circumstances warranted it or not, because regardless, euthanasia is illegal in the state of Louisiana."

Throughout the investigation, she says, there has always been more than one "person of interest," and not all were doctors and nurses.

"As part of this whole umbrella of an investigation, we were charged with looking at everything," she explains. "The attorney general wanted to come up with a report to give to the governor, to the department of human services, and to elected officials, to talk specifically in terms of what should have been done in evacuation."

One outcome likely will be to close a loophole in state law that requires hospitals and nursing homes to have evacuation plans, but does not specifically require that they follow those plans.

"That’s what we’re looking at — they have to have a plan, but they don’t have to follow it, and we want to see what they did to make sure patients got out of harm’s way," says Wartelle. "We want to find out what went wrong in all regards, and how to make it better."

The only criminal charges filed as of early April relating to patient care or abandonment during and after the hurricane are those filed 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, were charged in September with 34 counts of negligent homicide for abandoning nursing home residents who later drowned in the flooding that followed the hurricane.

Tenet Healthcare, based in Dallas, issued a statement several months ago stating that it was not a target of the investigation by Foti’s office. Wartelle says that after Foti issued the 73 subpoenas to Tenet employees, the hospital corporation cooperated with investigators.