Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (38 page)

IN ATLANTA, GEORGIA, a tall, slender man with graying hair watched the interview and felt a swell of emotion. Arthur “Butch” Schafer lived and worked in Louisiana and was crushed by the vast wasteland he saw on television. This nurse was a hero.

The death and devastation mirrored a personal tragedy. He and his wife were in Georgia with family because one of their daughters, Shelly—a thirty-one-year-old with a sweet smile and a giving nature—had recently died.

Schafer interrupted his mourning to return to Louisiana where he was also needed. In his professional life, he fought to protect the lives of elderly and disabled hospital patients and nursing-home residents. Schafer worked as an assistant attorney general in the state’s Medicaid Fraud Control Unit, charged not only with rooting out fraud but also investigating abuse, neglect, and exploitation of Louisiana’s most vulnerable—a population now displaced by the thousands and scattered across the state.

LIKE MANY RELATIVES of hospital and nursing home patients, Carrie Everett could not locate her husband, Emmett, the heavyset paraplegic patient in LifeCare. Carrie had spent Katrina in the Ninth Ward of New Orleans, trapped in a house as the waters rose. A boat pilot rescued her, and she ended up in Houston. Everyone she reached by phone to ask about Emmett passed her to someone else. Day after day she worried.

Carrie had cared for Emmett ever since a freak spinal cord stroke had disabled the Honduran-born, blue-collar laborer a decade earlier at the
age of fifty. She was a small woman, but every day she had dutifully helped transfer Emmett to a wheelchair so that he could sit in their yard, read the Bible, play with their dog, and clown around with his seven-year-old granddaughter, his “eyes,” riding on his knees.

Emmett had been in LifeCare awaiting colostomy surgery to ease chronic bowel obstruction. Carrie had visited him in the hospital every day, but she’d been told to stay at home when the LifeCare patients on the Chalmette campus were transferred to Memorial Medical Center. Emmett had called her to let her know that he had made it there with no problems, brought a photograph of his granddaughter with him, and was safe. That was the last she had heard from him.

LINETTE BURGESS GUIDI searched the Internet for news of her mother, Jannie Burgess, the licensed practical nurse with advanced uterine cancer whom she had flown in from Europe to visit in the ICU as the storm approached. Burgess Guidi and her mother’s caring niece enlisted every relative from Louisiana, Chicago, Holland, and Italy to make calls, comb missing persons listings, and try to find her.

AS FAMILIES SEARCHED FOR loved ones, bodies lay decomposing in the flooded city. Days passed as government officials argued about whose responsibility it was to recover them. On Tuesday, September 6, MSNBC cameraman Tony Zumbado paddled to Memorial Medical Center in a kayak and followed the overpowering smell of death to the Myron C. Madden Chapel. A small piece of yellow lined paper reading
DO NOT ENTER
was duct-taped to the wooden door. Inside, Zumbado’s camera panned to take in more than a dozen bodies lying on low
cots and on the ground, shrouded in white sheets. Here, a wisp of gray hair peeked out. There, a knee was flung akimbo. A pallid hand reached across a blue gown.

For days more, Memorial’s deceased underwent a sort of wake—a viewing attended by, among others, a passing battalion of
National Guardsmen from San Diego assigned to aid and secure the neighborhood, Tenet-contracted DynCorp security guards recently returned from Iraq and Afghanistan, a
Christianity Today
magazine reporter, and a relief worker who vomited from the stench.

A chaplain who came to search for survivors compared what he saw when he entered Memorial’s chapel with Dante’s
The Divine Comedy
.
“It was like a picture of hell,” he said on CNN. When members of a disaster mortuary team finally arrived on Sunday, September 11, more than a week after the last living patients and staff members had departed, they recovered forty-five bodies from the chapel, morgues, hallways, LifeCare floor, and the emergency room.

It was the largest number of bodies found at any Katrina-struck hospital or nursing home. Major news outlets covered the shocking discovery. Dr. Anna Pou agreed to an interview with a Baton Rouge television reporter. Pou put on a simple white V-neck blouse. Her cinnamon-colored hair was well coiffed, but the camera showed shadows under her eyes and a hollowness beneath her cheekbones. She struggled to explain why so many at Memorial had died.

“There were some patients there that, who were critically ill, and regardless of the storm were, uh, had the orders of Do Not Resuscitate, in other words that if they died to allow them to die naturally, and not to, um, use any heroic methods to resuscitate them.” As she spoke, she nodded emphatically, as if to bring along her interviewer or her audience, or perhaps to convince herself. “We all did everything in our power to give the best treatment that we could to the patients in the hospital, to make them comfortable.”

WHILE MORE PATIENTS had died on the grounds of Memorial than anywhere else, horrible stories were beginning to emerge from health facilities around the flooded region. At
St. Rita’s, a single-story nursing home near failed levees in St. Bernard Parish, more than thirty residents had apparently drowned. The owners, a married couple who had been urged to evacuate their facility before the storm, were nowhere to be found. It began to appear that people in hospitals and nursing homes accounted for a significant proportion of all deaths from the massive disaster.

As the outlines of this medical tragedy sharpened, there was an urgent need to understand its causes before the next catastrophe occurred in New Orleans or elsewhere in the country. Were deaths at hospitals and nursing homes regrettable results of an act of nature, a chaotic government response, and poorly constructed flood protection overlaid on a degraded environment? Or had lax oversight allowed individual or corporate greed to play a role? Did some hospital and nursing home leaders decide not to evacuate before the storm primarily to avoid the substantial costs of emptying and closing health facilities? Were emergency plans not followed, important pre-storm investments not made, and health workers not properly prepared?

These were questions Butch Schafer, returning home from mourning his daughter’s death, began to probe. He was an experienced criminal prosecutor who specialized in complex cases. His boss, first-term Louisiana attorney general Charles Foti, had served for thirty years as elected sheriff of Orleans Parish and had a strong constituency among the elderly. White-haired himself, Foti had taken care of his own father until he died that May at ninety-two, driving him out of the predicted path of several hurricanes. Foti pledged in public to investigate fully what he called a horrific tragedy at St. Rita’s, and his Medicaid Fraud Control
Unit opened investigations into every one of the hospitals and nursing homes where patients had died.

The unit, supported by state and federal funds, had jurisdiction over hospitals and other health facilities that participated in Medicaid, one of the programs that Southern Baptist Hospital’s leaders had, four decades earlier, resisted joining in part to avoid government meddling. Now Memorial Medical Center’s current corporate owners received a request by phone from a government investigator for a list of deceased patients and a copy of the hospital’s disaster plan.

If the company could show the disaster plan had been followed, there was every reason to expect the case could quickly be closed and the locus of blame for the deaths could be pursued elsewhere. New Orleans mayor Ray Nagin’s pre-storm evacuation order had not applied to hospitals, which had been ordered to stay open and staffed.

Almost immediately, however, suspicious signs emerged. A Tenet attorney responded to the phoned-in questions defensively, by requesting them in writing. He faxed a corporate summary of events, copies of newspaper articles highlighting the heroism of Memorial’s employees, and a set of press releases blaming the deaths on forces beyond the hospital’s control:

During more than four days with poor sanitation, without power, air-conditioning and running water, and with temperatures in the building approaching 110 degrees, some patients simply did not survive despite the heroic efforts of our physicians and nurses. […] By Sept. 2, we were able to evacuate every living patient from the hospital, often using private helicopters hired by Tenet after government rescue efforts were overwhelmed.

A day later, a fax came into the unit from an attorney for LifeCare Hospitals of New Orleans. It reported that nine LifeCare patients on the seventh floor at Memorial had died under suspicious circumstances.

Although we are just beginning to collect the relevant facts, we have information that the patients involved were administered morphine by a physician (Dr. Poe, whom we believe is not an employee of LifeCare) at a time when it appeared that the patients could not be successfully evacuated.

Allegations of intentional killings at health facilities were almost unheard of in the unit. Even deaths as a result of abuse emerged only rarely. Of all the potential crimes Schafer and his coworkers were planning to pursue, this one was completely unexpected and seemed, at first, almost outlandish.

Schafer and his new partner, Special Agent Virginia Rider, knew that the allegations needed to be investigated. Rider was a ten-year veteran of the unit, where prosecutor-investigator teams worked cases. Rider had a top-notch reputation: thorough, diligent, and smart. Fact-gathering and public service ran in her blood—her father, a mapmaker, had served in army intelligence in the Korean War and then worked for decades on the interstate highway system. Rider had followed her mother in becoming an accountant.

Rider loved poring through financial transactions—a case that left her buried in paper bank records made her “as happy as a pig in mud”—but she hadn’t been satisfied keeping the books at a real estate development firm, her first job. Only a few months after starting, she netted an embezzler and discovered she had a knack for lifting the numerical fingerprints of fraud. The employee had stolen $400,000 from the small company over a period of years and nobody noticed. Rider had found her passion—pursuing fraudsters. What had led her to her current, hazardous duty investigator position, which had required police-academy training, was a passion and talent for helping bring wrongdoers who harmed others to justice.