Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (51 page)

Rider didn’t ask Skinner about the Mother Nature comment. It was
difficult to tell whether Nurse Chatelain had identified the right doctor.
Years later in an interview, Skinner would say the nurse was not referring to him. He did not recall having spoken with a LifeCare nurse on the seventh floor or having conveyed a message of that sort. He felt he would not have referred to patients as “little people” or said that Mother Nature’s course would have to be hastened. It didn’t sound at all like him.

Rider later learned Chatelain had a troubled history and had been put on probation by the nursing board shortly before the storm. Skinner fit the physical description Chatelain had provided, and he was head of the hospital’s infection control committee. But Chatelain said he had introduced himself as “Dr. Skinner with the CDC,” the federal infectious diseases center.

The interviews with hospital workers were full of such small, important, and maddening inconsistencies, memory’s transmogrifications. Rider’s job was as impossible as collecting fragments of a fractured mirror and then, somehow, inferring what image had once appeared there.

SUSAN MULDERICK had a sense of what the attorney general’s investigators might ask at her interview with them in early January 2006. She knew there were things others had heard her say at the hospital that were being interpreted as suspicious or incriminating. She knew this from the copy of the secret search-warrant affidavit that had been sent to Tenet attorney Harry Rosenberg, which set out the allegations.

At the interview, a short investigator with dark blond hair asked Mulderick about her conversations with LifeCare employees the morning of Thursday, September 1, 2005.

“Did you make a statement to them to the effect that no living patients would be left behind?” Virginia Rider asked.

Mulderick said she might have. “I’m sure I said it to dozens of people,”
she said. Staff and family members were concerned they would never get out of the hospital, that they would die there. Many stopped her to ask whether and how they would ever get all the patients and themselves to safety.

“So, I was always trying to reinforce with everyone that we are all going. Everybody’s going, every patient is going. We will get out of here.” Mulderick said she viewed Anna Pou as the primary doctor on the second floor. She had several discussions with Pou on Thursday morning. “What was the substance of those discussions?” Rider asked.

“Um … One of those discussions had to do with um, asking her if some of these patients could be given something for, what I considered was their suffering, their anxiety, their pain.” Mulderick said that Pou had agreed and said, “I’m not sure what to give them.” That was when Mulderick had said she would ask Dr. Cook to talk with Pou, which Mulderick had done. Mulderick said she had not seen the medications being given. “I don’t even know if she followed up on it. I just left it at that.”

“Did you have any discussions with anybody regarding euthanasia of the patients?” Rider asked later.

“Specifically euthanizing patients? No.”

“What about discussions of giving them palliative care that might result in their deaths?” Rider asked, and then clarified the question when Mulderick seemed to hesitate. “Something that would ease their pain, but might also speed up the dying process?”

“No,” Mulderick said. “My discussions with, well, had to do with palliative care. Comfort patients, certainly not to speed up a process like that.”

Mulderick’s interview revealed that the idea of medicating patients at Memorial that Thursday came from her. She portrayed her intentions as having wanted to provide comfort. “You give them some Ativan or something,” she offered as an example, to relax patients. However the prescriptions seized from the pharmacy during the search had shown that Ativan and other normal drugs for comfort were already being prescribed
for these patients by Pou and other doctors throughout the disaster. The idea that Pou would need Cook to tell her about them made little sense.

Mulderick appeared extremely well prepared for her interview. But at least she presented herself as knowledgeable and involved in leading the response to the disaster. That wasn’t the case for all of the “uppity-ups,” as Butch Schafer referred to the hospital’s major players. CEO René Goux, whom Rider and a colleague had interviewed in November, claimed to have known almost nothing about what had gone on in his hospital after the storm, even though he had stayed there the entire time. Months later, interviews with two of the CEO’s fellow uppity-ups, Memorial CFO Curtis Dosch and Memorial COO Sean Fowler, stunned Schafer and Rider when the men casually mentioned that the cancer institute connected to Memorial via sky bridges had a working generator and electricity throughout the disaster. Hospital executives went there to make phone calls and coffee, and their interviews revealed something of the executive mind-set. “We sat there and watched TV for a little bit,” Fowler said. Dosch described discovering that the place had power and going back to get the rabbit-ear antenna. “I’m feeling pretty good, ’cause I got a fan, I got a recliner, and I got TV, and I rummaged around and found a can of chicken noodle soup.” He said he hooked up a microwave and had a hot meal. “I want to tell you, it tasted pretty good!”

Dosch had not kept all the goodies for himself. He made coffee for the nurses and brought the fans to the hospital’s second-floor lobby, where they could be powered by the small generators and positioned to blow on patients. The investigators were left to wonder why, however, the patients weren’t lifted onto gurneys and rolled into the more comfortable cancer center (or to air-conditioned cars and trucks).

Dosch had recently been promoted to interim CEO of Memorial in advance of its reopening. He spoke benignly to Schafer and Rider about Susan Mulderick’s expression of concern regarding the patients’ ability to survive. Mulderick had told him that they were being made comfortable,
he said. Schafer and Rider did not press him hard for specifics, and Dosch did not volunteer that he had seen a doctor inject a patient on the second floor, had asked CEO Goux if he knew what was happening, or had seen the chief nursing officer crying.

In fact, until Dosch returned home one day to find two CNN employees on his porch, he hadn’t realized “what a big deal it might become,” he’d later say. Dosch had confronted Susan Mulderick after the disaster, and she had denied having spoken of medicating the patients. People from Memorial shunned conversation about the events of Thursday, September 1, and he felt they were trying to protect themselves. He wondered whether the patients might have lived if they had gotten out. And was it someone else’s right to decide for them that they wouldn’t make it?

Dosch was not the only person to notice and be disturbed by a general refusal to acknowledge and discuss what had occurred. Nurses referred to it as a Code of Silence, which was adopted almost immediately upon departure from the hospital. “We’re not talking about it.… And by the way, nothing happened,” was how one would describe it. Circle the wagons. Don’t get anyone in trouble.

Whereas the LifeCare attorneys had eventually advised their clients to be open in their interviews about what happened, even to volunteer facts that the investigators might not know or ask about, other lawyers had a different take on the wisdom of being more forthcoming than the law required.

Pou’s attorney called another lawyer involved in the events and said, as the other lawyer would remember it: “It’s in nobody’s interest for these things to see the light of day.”

THE INVESTIGATORS turned increasingly to the corporation that owned the hospital and employed these executives. What had Pou meant
when she had allegedly told Therese Mendez that “the decision had been made” to give lethal doses to the patients? Who was behind that? Rider and Schafer had not yet interviewed anybody who would admit to being a decision maker.

The grudging cooperation of Tenet’s attorneys, the delays, and the failure to produce certain pieces of potential evidence raised Schafer’s suspicions in particular. Tenet attorneys insisted that copies of all medical records in the company’s possession had been provided to the attorney general’s office, but Schafer and Rider believed some were still missing.

Tenet had also refused to allow LifeCare representatives to enter the hospital in the first weeks after the storm. In the interim, certain patient records, computer servers, and computer tapes had gone missing and LifeCare nurses’ lockers were cut open, their property removed. LifeCare had filed a restraining order and injunction against Tenet seeking the return of the materials.

Schafer’s suspicions had only grown stronger as
interviewees intimated that when a “decision was made” about giving the injections, it appeared to have come from a higher place. He wondered
whether Tenet corporate officials might have been aware of or even issued an order to euthanize the sickest patients and quickly clear the remaining workers on Thursday, September 1, to protect them from the feared, rampaging mobs, or, as far-fetched as it sounded, even to avoid having to pay for another day of staff overtime and leased helicopters. After all, this was a corporation that had, the year before Katrina,
paid nearly $400 million to settle claims that doctors at one of its hospitals performed unnecessary heart surgeries and procedures on healthy patients. That didn’t speak well of corporate ethics.

Higher-ups in the Medicaid Fraud Control Unit did not encourage Rider to go to Tenet’s corporate headquarters in Dallas to interview officials there. At least, not now. One of the most important interviews she could do in Dallas was with Steven Campanini, Tenet’s media chief, who
had received Pou’s urgent call for advice days after she left Memorial and spoken with her extensively. Pou’s attorney, Rick Simmons, had gone to court to block the attorney general’s staff from interviewing Campanini. Because Tenet’s attorney, Audrey Andrews, had been involved in some of the phone conversations, and she did not immediately warn Pou that she did not represent her, Simmons argued, all the information should be protected as attorney-client privileged and confidential. Campanini could not speak to it.

Assistant Attorney General Schafer fought back against Simmons’s motion, arguing that Pou couldn’t have possibly thought a Tenet lawyer represented her. The evidence was right there in the employment contract she had inked a year before the storm. While the hospital had supported her recruitment and first year’s salary, she was an employee of Louisiana State University—not Memorial, not Tenet.

A ruling by the district court pleased neither side, and the motion was now with the Louisiana Supreme Court on expedited appeal. Lawyers for Dr. John Thiele and nurse Cheri Landry also asked Schafer to await the court’s decision before seeking to learn what their clients had told Tenet personnel. As there was no official case against Pou yet, and perhaps because both sides wished to avoid alerting the media to the dispute, the motion was entitled “IN RE: A MATTER OF AN OFFENSE UNDER INVESTIGATION.”

Rider and Schafer wanted to interview others at Tenet headquarters, including those who had staffed the hastily established command center and communicated for some time by e-mail and cell phone with the panicked Memorial employees as the waters rose. But higher officials at the AG’s office told Schafer that it would probably be a waste of time now that the company was lawyered-up—if they went to Dallas, they would presumably only get to speak with lawyers. And besides, Tenet’s attorneys had said they would fully cooperate and send whatever materials were requested.

An observer might have wondered whether politics and high-level personal relationships were at play in lightening the pressure on the corporation. “
Tenet is a major health-care provider in our state and has contributed to campaigns of most of our federal elected officials,” a spokesman for US senator Mary Landrieu of Louisiana was quoted as saying in the
Baton Rouge Advocate
in March. The quote seemed aimed at reassuring the company that it was valued in Louisiana. A minor group of dissident Tenet shareholders led by a doctor with a personal grudge hoped, the article reported, to pressure the company to reform. Toward that end, the group was demanding that Senator Landrieu donate to charity the $29,000 she had received from Tenet in campaign contributions. The shareholders cited the AG’s investigation of events at Memorial as evidence against a company with a trail of fraud and abuse suits and settlements. The group pointed out that Landrieu’s aunt had received nearly a million dollars for lobbying on behalf of the company. Tenet’s Steven Campanini was quoted in the article saying that the company was not a target of the AG’s investigation. “Euthanasia is never permissible under any circumstances.”