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The case "State of Louisiana vs Anna M. Pou" arose from the deaths of patients at the Memorial Medical Center, New Orleans, five days after the landfall of Hurricane Katrina in 2005. In 2006, Louisiana Attorney General Charles Foti arrested Dr. Anna Pou and two nurses, publicly stating that "this is a homicide". The case never went to trial. The charges have now been expunged and the state of Louisiana has agreed to pay Pou's legal fees.
During Katrina
Dr. Anna Pou, an associate professor in the Department of Otorhinolaryngology at the LSU Health Sciences Center, was at Memorial Medical Center from before Katrina's landfall on Monday, August 29 until Friday, September 2. By Wednesday, the hospital was surrounded by floodwaters, without sanitation, running out of food, experiencing indoor temperatures up to 110 °F (43 °C), and had no electricity. The staff decided to evacuate the hospital. Patients on upper floors had to be carried down the stairs, and those evacuated by helicopter had to be carried up more stairs to the helipad on a separate building; several patients died while being moved. By Friday, about 2,000 patients, families and staff had been evacuated "under incredibly difficult circumstances".
The seventh floor at Memorial was leased to LifeCare Hospitals of New Orleans. LifeCare provides intensive care for severely ill patients, aiming to improve their health to the point that they no longer need hospital care. Many of LifeCare's patients at Memorial were especially affected by the loss of electric power, since they were on ventilators.
One patient in particular, Emmett Everett, was alert and in the hospital awaiting surgery to relieve a chronic bowel obstruction, a condition not acutely life-threatening. According to witnesses speaking to The New York Times, Pou is alleged to have administered a lethal cocktail of drugs to Everett with the intent of ending his life. Everett was a paraplegic and weighed approximately 380 pounds; for these reasons, Dr. Pou allegedly didn't think the staff could reasonably assist him in the evacuation.
Investigation
On September 13, mortuary workers recovered 45 bodies from the hospital. More than two dozen of the cases had large amounts of morphine present in their bodies, although few of them had been prescribed morphine for pain. In the following weeks, it was reported that staff had discussed euthanizing patients. Some reports went further. Dr. Bryant King, an internist at Memorial, told CNN that he believed that "the discussion of euthanasia was more than talk." LifeCare told the state Attorney General's office that nine of their patients might "have been given lethal doses of medicines by a Memorial doctor and nurses."
King publicly charged that one or more health care workers had killed patients, based on conversations with other health care workers. King told CNN that when he believed that a doctor was about to kill patients, he boarded a boat and left the hospital. King explained his actions in terms of his opposition to Pou's alleged actions, arguing "I'd rather be considered a person who abandoned patients than someone who aided in eliminating patients."
At the request of the Louisiana AG's office, Orleans Parish Coroner Frank Minyard investigated the cause of the deaths. Experts reported abnormal levels of morphine, midazolam (Versed), and/or Lorazepam in several bodies. In many cases, the experts said, the levels indicated homicide. Experts agreeing that the lethal levels of morphine constituted homicide in many of the deaths on the seventh floor included noted forensic pathologists Cyril Wecht and Michael Baden, along with the director of the toxicology lab where the patients' samples had been tested and three other independent pathologists, including the then-president of the American Academy of Forensics, James Young. Wecht thought eight of the nine deaths on the LifeCare floor could conclusively be ruled homicides, and Baden thought all nine constituted homicide. Young stated, “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.” A separate doctor stated that in the case of Emmett Everett, the patient had no fatal conditions or indications of imminent or impending death. University of Pennsylvania bioethicist Arthur Caplan also stated that all nine of the deaths were homicides; the administration of the drugs was "not consistent with the ethical standards of palliative care that prevail in the United States," precisely in that the death of a patient must not be the goal of a doctor's treatment; and death, in his opinion, was the goal in these in cases. The experts were unanimous that the amounts of morphine used did not constitute any level of palliative care used in the United States.
Having received these six reports indicating that that at least 8 of the 9 deaths under investigation were homicides, Minyard sought the opinion of another expert, Dr. Steven Karch. Karch specializes in disputing drug toxicology tests performed after death; according to the New York Times, Karch "had staked his career on advancing the argument that the level of drugs found in a cadaver may have no relationship to the levels just before death." The Times continues: "Karch flew to New Orleans, examined the evidence and concluded that it was absurd to try to determine causes of death in bodies that had sat at 100 degrees for 10 days. In all of the cases, he advised, the medical cause of death should remain undetermined." Having received this opinion, Minyard sought no further opinions.
Investigators believed up to two dozen patients might have been euthanized, but stated that they had difficulty acquiring the medical records needed to document the patients' conditions. Tenet Healthcare said it turned over all the patient records it had on the case. Investigators believed that of the two dozen possible cases, they had the strongest case in the deaths of four of the patients who had died on the hospital's seventh floor.
On July 17, 2006, Pou was arrested and charged with four counts of second-degree murder in connection with the deaths of four LifeCare patients; nurses Lori Budo and Cheri Landry were arrested and charged, but charges were dropped in exchange for their testimony. State Attorney General Charles Foti announced the arrests the next day, at a widely televised news conference. "This is a homicide; it is not euthanasia," he said. The affidavit says Pou and the nurses "intentionally (killed)" Emmett Everett Sr., 61; Hollis Alford, 66; Ireatha Watson, 89; and Rose Savoie, 90, by administering or causing to be administered lethal doses of morphine sulphate (morphine) and/or midazolam (Versed). According to Kristy Johnson, LifeCare's director of physical medicine, Pou told these patients that she was administering drugs to make them "feel better." The drugs injected are usually given for pain purposes, but not at the levels found in subsequent toxicology reports.
The arrests were controversial. In the words of Times-Picayune reporter James Varney, they "ignited a furious debate in New Orleans and elsewhere about whether sharp ethical boundaries can be drawn around decisions on patient comfort made in a crisis."
60 Minutes aired a report on the case in September 2006. In an interview, Pou told Morley Safer:
- "No, I did not murder those patients. Mr. Safer, I've spent my entire life taking care of patients."
In February 2007, seven months after Pou's arrest, Minyard issued his report on the deaths of the four LifeCare patients. He did not issue a determination of cause of death in any of the cases, leaving them classified as "undetermined". The case against Pou and the two nurses appeared more questionable after Minyard announced that he had classified the patient deaths at Memorial as "undetermined," which means that on available evidence he could not classify the deaths as due to homicide or natural causes. Minyard told the media that he had retained some of the nation's leading experts as consultants in the case. The New York Times reported in August 2009 that Minyard privately came to the conclusion that Pou was responsible for the deaths of four of the nine patients: “I strongly do not believe she planned to kill anybody, but it looks like she did.”
Outcome
Assistant District Attorney Michael Morales said in 2009 that he and District Attorney Jordan "weren't gung-ho" about prosecuting the case, in part due to negative public reaction. In March 2007, a state grand jury was sworn in to consider the Memorial case. Unlike a typical grand jury, this one dealt with just one case, and functioned as an investigation instead of a review of evidence. The grand jury did not hear from Minyard's experts, some witnesses who had been present, or the Department of Justice investigator who had spent a year on the case and amassed 50,000 pages of evidence. The two nurses who had been arrested with Pou testified in her defense, after being compelled to testify in return for not being charged themselves.
The grand jury was sworn in on March 6, 2007, and prosecutors took the unusual step of having its meetings at an undisclosed location (i.e. away from the courthouse), in order to prevent the media from observing the identity of witnesses coming and going. The grand jury was selected to deal solely with the Memorial case, rather than the dozens to hundreds grand juries normally hear; prosecutors stated it could hear testimony for months. The unusual moves prompted legal observers to speculate the district attorney considered the evidence ambiguous and wanted to be able to assure the public of a thorough investigation if he decided to drop the case without bringing formal charges. Loyola University Law Professor Dane Ciolono told the media, "Doing it this way certainly speaks to the ambiguity of the evidence and the prosecutor's deliberation as to whether to seek an indictment. . . . Or it could be that he's made up his mind that he does not want to bring charges and wants the grand jury to provide his cover."
After several months, the grand jury concluded its work by declining to indict any of the suspects on any of the charges.
Charles Foti lost the 2007 election for state Attorney General after criticism for prosecuting Pou and the nurses.
Since then, the charges have been expunged, the state of Louisiana has agreed to pay Pou's legal fees of over $450,000, and several Louisiana lawmakers have apologized for the accusations against her.
A class action was filed on behalf on non-Tenet employees, patients and relatives who were stranded at the Memorial facility during the hurricane. The class action, Elmire Preston et al. vs. Tenet Health Systems, Memorial Medical Center, et al., Civil District Court No. 2005-11701 c/w 2006-8861, Division "A", alleged a number of failures by Tenet Corporation, running the gamut from a failed evacuation policy to the improper location of generators in the basement of the facility, which led to the loss of power.
Tenet, while claiming no admission of liability, set up a 25 million dollar substantial settlement fund for all non-Tenet employees, patients and visitors who were trapped at Memorial during Katrina.
LifeCare was not the subject of a class action, opting early on to pay substantial amounts of money to family members of 24 deceased patients, in lieu of trials.
Three lawsuits (Alford, Everett, and Savoie) initially filed against Dr. Pou and the Memorial nurses have all been dismissed.
Aftermath
In the four years following Katrina, Pou helped write and pass three laws in Louisiana offering immunity to health care workers from most civil lawsuits (except in cases of intentional misconduct) for their efforts in future mass casualty situations.
Notes
- The Memorial Medical Center has since changed ownership, and is now called the Ochsner Baptist Medical Center.
References
- http://www.nola.com/katrina/pdf/072006_nolacharges.pdf
- ^ Kathleen Johnston (October 13, 2005). "Staff at New Orleans hospital debated euthanizing patients". CNN.
- ^ Sherry Fink (August 30, 2009). "Strained by Katrina, a Hospital Faced Deadly Choices". ProPublica and The New York Times Magazine.
- Louisiana AG Orders Autopsies of 50 Memorial Medical Patients; Susan Polk Goes on Trial CNN.com, 14 October 2005
- ^ James Varney (August 6, 2006). "Doctor's drug mix not ideal killer: Evidence in Memorial case called unreliable". The Times-Picayune.
- ^ Mary Foster (March 8, 2007). "Grand Jury to investigate hospital deaths". Associated Press.
- ^ Gwen Filosa (July 16, 2007). "Foti sued by doctor accused in Memorial Hospital deaths". The Times-Picayune.
- Daniel Schorn; Morley Safer (August 15, 2007). "Katrina Doc Denies Mercy Killings". 60 Minutes.
- Jeffrey Meitrodt (February 1, 2007). "N.O. coroner finds no evidence of homicide: Memorial doctor still faces grand jury in 4 deaths". The Times-Picayune.
- Jeffrey Meitrodt (2007-02-01). "N.O. coroner finds no evidence of homicide". The Times-Picayune.
- "Grand jury starts work in Memorial case". The Times-Picayune. March 6, 2007.
- Grand Jury to investigate hospital deaths Associated Press, 8 March 2007
- "'Dark Cloud' Lifted From Pou, Attorney Says: Grand Jury Declines To Indict Doctor In Hospital Deaths". WDSU. July 25, 2007.
- Bill Barrow (2007-10-21). "Foti out as attorney general". The Times-Picayune.
- "Gov. Jindal Signs Bill To Reimburse Anna Pou". Associated Press. July 1, 2009.
- "Strained by Katrina, a Hospital Faced Deadly Choices". New York Times.