Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (41 page)

“I’m under the impression here that, you know, that she [had], you know, gotten her orders from a higher authority and she’s acting under these military orders. OK?” Pou said the doctors were having a hard time with the decision to medicate the patients. “I mean, I’ve been told that this is, uh, martial law and the military is making all the decisions now and, you know, we’re having one helicopter after another just, you know, taking out hundreds of people.”

Mendez had seen this on TV once and had a name for it, a “bug out,” a decision to retreat at once in the face of the enemy, leaving everything—and potentially everyone less fortunate—behind. Saigon.

Mendez’s account seemed, to her interviewers, consistent with Robichaux’s in every important way. It was remarkable. It had enough minor differences to be credible; a fabricated story was more likely to sound identical. What was surprising was that the alleged plan was put into action not when the staff was desperately awaiting rescue, but rather when the evacuation was at last under way.

Days after the interview with Mendez, more misery visited Louisiana. Hurricane Rita plowed into the western part of the state and Texas on September 24. This time widespread pre-storm evacuations took place. Roads clogged in the storm’s projected path. A charter bus with an illegal license, driven by an undocumented Mexican national, caught fire on its way from Brighton Gardens of Bellaire, a nursing home near Houston, Texas, to a sister facility in Dallas. Oxygen tanks in the luggage bays exploded. Twenty-three of the thirty-eight elderly people aboard the bus burned to death. In the end, the storm spared Houston.

“
I told you so,” James A. Cobb Jr., the attorney for the owners of St. Rita’s nursing home, wrote in an e-mail to the producers of a network news show. Days earlier he had gone on air to defend his clients’ choice not to evacuate for Katrina when all three other nursing homes in St. Bernard Parish had moved patients ahead of the storm. The Texas deaths made his clients’ bad decision look a little more reasonable. St. Rita’s owners Sal and Mabel Mangano and their family had, contrary to popular assumption, stayed at St. Rita’s and tried to save their residents. Before a planned meeting between Medicaid fraud investigators and the married couple, the attorney general issued a warrant for the arrests of the pair on thirty-four counts each of negligent homicide for failing to evacuate prior to Katrina. The Manganos surrendered to authorities and Attorney General Foti took to the media, condemning them. Cobb fired back, savaging Foti for acting before he knew the whole story. He called his clients heroes.

Cobb’s point was that moving residents before a storm also carried risks. Investigators were looking into transportation-related deaths that had occurred prior to Katrina, too, but been quickly forgotten by the public.
Ferncrest Manor Living Center was the unnamed subject of the brief WWL radio report about three deaths that occurred en route to Baton Rouge before Katrina. The residents had apparently died of complications from heat exposure in the course of evacuating on buses that lacked functioning air-conditioning, drinking water, and, in some cases, nurses. They had spent up to four hours boarding and six hours traveling the clogged route from New Orleans to Baton Rouge. Many survivors were treated in a hospital for dehydration.

Mayor Nagin had
mandated evacuations of nursing homes because many homes occupied single-story buildings with marginal electrical backup. However, his order was not enforced. Many homes were not prepared and did not receive needed support to relocate in the less than a day between his order and predicted landfall.
About two-thirds of the affected nursing homes had kept residents in place. In Jefferson Parish
at
Chateau Living Center, the home where the contracted tour company had refused to provide buses before the storm, thirteen died in the heat after power failed.

In another extreme case, nineteen residents perished in an inundated nursing home, Lafon, run by the Sisters of the Holy Family, a New Orleans congregation of African American Catholic Sisters. The congregation had transported its members, including residents of the nursing home, out of the city in advance of Katrina, but left the nursing-home residents who were not congregants, and the staff of sisters and non-sisters who cared for them, in place.

All of the resident rooms were on the first floor, but their occupants had not drowned. The valiant staff had carried everyone who could not walk up to the second floor out of the floodwaters, only to watch many die in the heat and darkness despite the fact that the water had quickly receded. First responders had rolled by on the highway, ignoring roadside entreaties from the staff. The administrator went out dressed in her religious habit to seek help, but rescue came too late.

THE WEEK AFTER Hurricane Rita, Special Agent Virginia Rider interviewed another witness, LifeCare physical medicine director Kristy Johnson, who had supervised the hospital’s rehabilitation-therapy programs. Despite Rider’s preference, as an accountant, for interrogating numerical databases over questioning people, she often conducted interviews; her colleagues were out for the day and she spoke with the thirty-one-year-old physical therapist alone.

Johnson’s memory for detail at first seemed excellent. She, too, recounted the ways the LifeCare staff labored Wednesday night to hydrate and cool patients, including pouring Kentwood mineral water onto cut-up blankets to wet their skin, helping keep all of them alive. Johnson said on Thursday morning she heard Susan Mulderick say at a meeting that
she didn’t think the LifeCare patients would make it. Along with Diane Robichaux and LifeCare pharmacist Steven Harris, Johnson spoke with Mulderick after the meeting to ask about the plan. “She’s like, ‘We need to talk to Dr. Pou.’ ” Johnson recalled Mulderick saying: “The plan is that we’re not going to leave any living patients behind.” It was the same phrase Robichaux had remembered.

Johnson painted the chaos on the first floor as rescuers arrived and called for women and children to evacuate, and she told of how she ran back up to LifeCare and guided Wilda McManus’s tearful daughter Angela down to the first-floor ER ramp to get on a boat. She heard Therese Mendez calling for her through the crowds.

“I just heard ‘LifeCare, Kristy Johnson.’ She’s screaming my name and, you know, I’m like, ‘Here I am!’ And I’m way down the hall and she’s like, grabbed me, she’s like, ‘Come on, we got to go.’ So, we’re running up the stairs, I’m like, ‘What’s wrong, what’s going on?’ And that’s when she told me, um, that our patients were going to be given a lethal dose and, I mean, I just stopped and, I was like, ‘What?!’ And I knew the day before that, you know, a physician had told Therese we were under martial law, so I just was thinking, I can’t believe it’s come to this, that they’re ordering, you know, that our patients are going to be given a lethal dose.”

Johnson was in the room for the discussion with Pou about evacuating Emmett Everett. “She was saying, ‘There’s no way; he couldn’t fit through the hole.’ He was triaged to three. I knew he was sick, he was either a quadriplegic or paraplegic, but um, you know, he could talk and everything. So, she wanted someone to sedate him and Diane told her that—”

Rider interrupted Johnson. This was a key point. “OK, you heard, you heard Dr. Pou ask for someone to sedate him?” Johnson admitted that she wasn’t sure whether she had heard Pou say it or had heard this particular detail from her colleagues while they waited in the evacuation
line. “I did hear this part, I mean, she, she said you know, ‘Y’all need to evacuate. The patients are going to be in our care now.’

“I did see Dr. Pou, like, as she was walking down the hall. She was nervous, and she had two nurses with her.” Johnson described the two women, saying they were familiar faces from the seven years she had worked at the hospital.

Agent Rider named twenty-three deceased LifeCare patients one by one, and Johnson was able to tell her either when they had died or where they were—on the first, second, or seventh floor—when she had last seen them alive.

The day after the interview, Schafer, Rider, and their partners spoke with LifeCare pharmacist Steven Harris. He told a similar story: he had heard Mulderick say at the Thursday morning emergency meeting that she didn’t expect the LifeCare patients would be evacuated. He approached her with Johnson and Robichaux after the meeting to discuss what the plan was. She said they needed to talk with Pou. He and Robichaux found Pou on the seventh floor, and, he said, Pou told them “lethal doses” would be given to the patients. Robichaux told Pou that Emmett Everett was oriented and aware of what was happening at the hospital. Pou requested someone to talk with him or sedate him, but a nurse who was asked to do it refused.

Robichaux in her interview hadn’t remembered hearing the phrase “lethal doses” directly from Pou. Harris offered other distinct recollections. When he had asked Pou what medications she was going to give the patients, she had shown him a large package of morphine vials and some loose vials. She requested supplies including syringes and vials of sterile saltwater used to chase a drug through an intravenous catheter and into a patient’s bloodstream. Harris had provided these supplies.

Pou and the two nurses who accompanied her prepared to draw up morphine into the syringes. Harris didn’t know the names of the nurses, but he thought he might be able to identify them. Later, he saw them
entering the rooms of the remaining patients, and after that he saw Pou and the two nurses heading for a staircase carrying one or more translucent garbage bags. They had said they would return. Johnson told him that Pou had asked them to check on the patients and pull up sheets over those who had died.

Harris went downstairs with the other LifeCare administrative staff. They were prevented from walking through the area where the patients were lying on the second floor. He caught a glimpse of Pou and the same two nurses in the blocked-off area when he was allowed to pass quickly to the parking garage with antianxiety medicines for a LifeCare nurse who “was kind of losing it.”

Harris’s attorney suggested his client might have something more to add to the story. The attorney wanted to meet with prosecutor Schafer first. They made plans to do so later in the week.

The LifeCare witnesses had confirmed one another’s stories. They all alleged that Dr. Pou had come up to the seventh floor to end the lives of the nine surviving patients, and two recalled that Pou had told them directly that “lethal” was her intention. The patients had all indeed died. But had the plan actually been carried out? Why, and who was involved besides Pou? Who were the unnamed nurses? What Rider and Schafer needed to see was whether physical evidence corroborated the allegations. Rider drew up a wish list, including items she had requested and Tenet had not yet supplied: medical records for all the deceased patients; evacuation plans; computer hard drives; names and contact details of hospital employees; pharmacy records; and medical waste, which might contain discarded drug vials and syringes.

They needed to search the hospital. Given the unwelcome response to their previous appearance, it was unlikely to be a consensual search. To get a warrant, they had to convince an Orleans Parish District Court judge that a crime was likely to have occurred there. Schafer discussed potential charges with his bosses, and Rider pulled up the Louisiana statute, because she wasn’t used to dealing with alleged murders. In the state,
the difference between first- and second-degree murder had to do with the nature of the victims, not premeditation. She wrote up an affidavit summarizing the key events described by Robichaux, Mendez, Johnson, and Harris. She submitted it with an application for a warrant to search for items “necessary in order to prove the crime of second-degree murder.” Louisiana’s legal definition of second-degree murder included murder with the specific intent to kill. Everyone seemed to agree, in light of the circumstances of Katrina, that they weren’t going to seek the death penalty and thus there was no need to charge first-degree murder.
Lesser charges of manslaughter or negligent homicide could always be brought.

The judge granted the search warrant. The next day, Saturday, October 1, Rider and Schafer joined twenty-two special agents, including nearly every agent from the Medicaid Fraud Control Unit and many others from the US Department of Health and Human Services Office of the Inspector General. Accompanying them were two crime-scene investigators from the Louisiana State Police. They drove an hour from Baton Rouge, descending on the hospital at around nine a.m. Rider participated in searches about once a month. This was the largest search team in which she had ever participated.

The agents approached with their badges on display, and Rider handed Memorial’s security supervisor a copy of the search warrant. Infectious diseases experts from the US Centers for Disease Control and Prevention evaluated the air and determined it was safe for the agents to enter.

The hospital spanned two city blocks and still had no electricity. It would be a challenge to search. Rider carried a duty belt around her waist laden with flashlights, a radio, handcuffs, pepper spray, and firearms with extra magazines—her typical search-warrant raid gear. Some colleagues wore blue gloves and breathed in the faintly medical smell of a respirator mask that covered their noses and mouths and made each breath feel somewhat suffocating. It was hard to walk, let alone climb stairs in the heat, and Rider and Schafer left their masks around their necks. Rider had high blood pressure and was out of shape, so she left the
seventh floor for the others to search. Schafer and others were clamoring to go there, and they clomped upstairs in their heavy boots. When everyone else wanted to do something, Rider was inclined to do something different.