Five Days at Memorial Read online

  Five Days at Memorial

  Sheri Fink

  Pulitzer Prize winner Sheri Fink’s landmark investigation of patient deaths at a New Orleans hospital ravaged by Hurricane Katrina—and her suspenseful portrayal of the quest for truth and justice

  In the tradition of the best investigative journalism, physician and reporter Sheri Fink reconstructs 5 days at Memorial Medical Center and draws the reader into the lives of those who struggled mightily to survive and to maintain life amid chaos.

  After Katrina struck and the floodwaters rose, the power failed, and the heat climbed, exhausted caregivers chose to designate certain patients last for rescue. Months later, several health professionals faced criminal allegations that they deliberately injected numerous patients with drugs to hasten their deaths.

  Five Days at Memorial, the culmination of six years of reporting, unspools the mystery of what happened in those days, bringing the reader into a hospital fighting for its life and into a conversation about the most terrifying form of health care rationing.

  In a voice at once involving and fair, masterful and intimate, Fink exposes the hidden dilemmas of end-of-life care and reveals just how ill-prepared we are in America for the impact of large-scale disasters—and how we can do better. A remarkable book, engrossing from start to finish, Five Days at Memorial radically transforms your understanding of human nature in crisis.

  Sheri Fink

  FIVE DAYS AT MEMORIAL

  Life and Death in a Storm-Ravaged Hospital

  For Mary Fink,

  every living moment

  PHOTO

  MAP

  SELECTED INDIVIDUALS

  Affiliations listed as at the time of the events in the book.

  Relatives listed only if they appear in the book.

  Doctors (many on staff at both Memorial and LifeCare)

  Dr. Bill Armington—Neuroradiologist

  Dr. Horace Baltz—Internal medicine specialist, one of the longest-serving medical staff members present for storm

  Dr. Reuben Chrestman—Medical staff president; on vacation

  Dr. Ewing Cook—Chief medical officer, retired pulmonologist experienced in critical care medicine

  • Minnie Cook, wife, former surgical intensive care unit nurse

  • Stephanie Meibaum, daughter, current surgical intensive care unit nurse

  Dr. Roy Culotta—Pulmonologist and critical care specialist; grandmother sheltering at LifeCare

  Dr. Richard E. Deichmann—Chairman, Department of Medical Services

  Dr. Kathleen Fournier—Internal medicine specialist

  Dr. Juan Jorge Gershanik—Neonatologist

  Dr. Bryant King—Internal medicine specialist

  Dr. John Kokemor—Internal medicine specialist; former coroner assistant under Dr. Frank Minyard

  Dr. Anna Maria Pou—Otolaryngologist; head and neck surgeon, specialist in cancer surgery

  • Vincent Panepinto, husband

  • Peggy Perino, sister

  • Dr. Frederick Pou, father

  • Frederick Pou Jr., brother

  • Jeanette Pou, mother

  • Jeannie Pou, sister

  • Michael Pou, brother

  Dr. Paul Primeaux—Anesthesiologist

  Dr. John Skinner—Pathologist

  Dr. John Thiele—Pulmonologist experienced in critical care medicine

  Dr. John J. Walsh Jr.—Chairman, Department of Surgical Services

  Memorial Medical Center

  Nurses

  Lori Budo—Surgical intensive care unit nurse

  Cathy Green—Surgical intensive care unit nurse

  Thao Lam—Medical intensive care unit nurse Cheri

  Landry—Surgical intensive care unit nurse

  Patients and Their Family Members (ages and locations as of time of storm)

  Helen Breckenridge—77, intensive care unit, eighth floor

  Jannie Burgess—79, intensive care unit, eighth floor

  • Linette Burgess Guidi, daughter

  • Johnny Clark, brother

  • Gladys Clark Smith, sister

  • Bertha Mitchell, niece

  Essie Cavalier—79, fourth-floor medical ward

  Donna Cotham—41, fourth-floor medical ward

  Tesfalidet Ewale—66, intensive care unit, eighth floor

  Merle Lagasse—76, fourth-floor medical ward Karen Lagasse, daughter

  Rodney Scott—63, intensive care unit, eighth floor

  Hospital Administrators, Managers, and Nonclinical Staff

  Fran Butler—Nurse manager of fourth-floor west and south medical and surgical units

  Sandra Cordray—Community relations manager; designated communication leader for Hurricane Katrina

  Mary Jo D’Amico—Operating-room nurse manager

  Curtis Dosch—Chief financial officer Sean

  Fowler—Chief operating officer

  L. René Goux—Chief executive officer

  David Heikamp—Laboratory director

  Father John Marse—Chaplain

  Susan Mulderick—Nursing director, head of emergency preparedness committee, designated incident commander for Hurricane Katrina

  Karen Wynn—Nurse manager of the intensive care units; head of hospital ethics committee

  Eric Yancovich—Plant operations director and part of emergency leadership team

  Tenet Corporate Officials

  Michael Arvin—Business development director for Texas–Gulf Coast region

  Trevor Fetter—President and chief executive officer

  Bob Smith—Senior vice president for operations in the Texas–Gulf Coast region

  LifeCare

  Seventh Floor

  Patients and Their Family Members

  Hollis Alford—66

  Wilmer Cooley—82

  Emmett Everett—61

  • Carrie Everett, wife

  Carrie (Ma’Dear) Hall—78

  George Huard—91

  Alice Hutzler—90

  Elvira LeBlanc—82

  • Mark and Sandra LeBlanc, son and daughter-in-law

  Wilda McManus—70

  • Angela McManus, daughter

  Elaine Nelson—90

  • Craig Nelson, son

  • Kathryn Nelson, daughter

  John Russell—80

  Rose Savoie—90

  • Doug Savoie, grandson

  • Lou Anne Savoie Jacob, daughter

  Ireatha Watson—89

  LifeCare Nurses and Therapists

  Cindy Chatelain—Registered nurse

  Andre Gremillion—Registered nurse

  Terence Stahelin—Respiratory therapist

  Hospital Administrators, Directors, and Nonclinical Staff

  Tim Burke—Administrator for LifeCare Hospitals of New Orleans; not present at hospital for the storm

  Steven Harris—Pharmacist

  Gina Isbell—Nursing director, LifeCare Chalmette campus, relocated to Baptist (Memorial) before the storm

  Kristy Johnson—Physical medicine director

  Therese Mendez—Nurse executive

  Diane Robichaux—Assistant administrator, incident commander

  Dr. John Wise—Medical director; absent for the storm

  LifeCare Corporate Officials

  Robbye Dubois—Corporate senior vice president for clinical services; in Shreveport, LA

  People Involved in the Investigation

  Louisiana Attorney General’s Office

  Attorney General Charles Foti

  Julie Cullen—Assistant attorney general, head of criminal division

  Virginia Rider—Special agent, Medicaid Fraud Control Unit; lead investigator, Memorial case

  Arthur “Butch” Schafer—Assistant at
torney general, Medicaid Fraud Control Unit; lead prosecutor, Memorial case

  Kris Wartelle—Public information director

  US Department of Health and Human Services, Office of the Inspector General

  Artie Delaneuville—Special agent

  Orleans Parish District Attorney’s Office

  Eddie J. Jordan Jr.—District attorney

  Michael Morales—Assistant district attorney; lead prosecutor, Memorial case

  Craig Famularo—Assistant district attorney, senior to Morales

  Orleans Parish Coroner’s Office

  Dr. Frank Minyard—Coroner

  Forensic Consultants

  Dr. Michael Baden—Forensic pathologist, New York City

  Dr. Frank Brescia—Oncologist, palliative care specialist, Medical University of South Carolina

  Arthur Caplan—Bioethicist; chairman, Department of Medical Ethics, and director of the Center for Bioethics at the University of Pennsylvania (until 2012; now at New York University)

  Dr. Steven B. Karch—Cardiac pathologist; former assistant medical examiner, San Francisco, CA Dr. Robert Middleberg—Laboratory director, National Medical Services, Inc.

  Dr. Cyril Wecht—Forensic pathologist; coroner, Allegheny County, PA (until 2006)

  Dr. James Young—Special advisor to the Government of Canada on emergency management; president, American Academy of Forensic Sciences (2006–2007); former chief coroner of Ontario, Canada

  Others

  Government Officials

  Louisiana governor Kathleen Babineaux Blanco (2004–2008)

  US senator Mary Landrieu (since 1997)

  Mayor Ray C. Nagin, City of New Orleans (2002–2010)

  Emergency Responders and Experts

  Knox Andress—Health resources services administration district regional coordinator for part of northwest Louisiana, based in Shreveport; registered nurse at CHRISTUS Schumpert Health System; communicated with LifeCare corporate officials during the disaster

  LTJG Shelley Decker, US Coast Guard (now LT); at emergency command center, Alexandria, Louisiana

  Cynthia Matherne—Health resources services administration district regional coordinator for part of southeast Louisiana, including New Orleans; based at the emergency operations center in New Orleans City Hall; communicated with Tenet Healthcare officials during the disaster

  Michael Richard, US Coast Guard Auxiliary; at emergency command center, Alexandria, Louisiana

  Dr. Robert Wise—Vice president, division of standards and survey methods, Joint Commission on Accreditation of Healthcare Organizations, JCAHO (now medical advisor, division of healthcare quality evaluation at the organization, renamed the Joint Commission)

  Colleagues and Patients of Dr. Anna Pou

  Dr. Daniel Nuss—Chairman, Department of Otolaryngology; head and neck surgery, Louisiana State University Health Science Center

  James O’Bryant—53, patient of Dr. Anna Pou

  • Brenda O’Bryant, wife

  • James Lawrence O’Bryant, son

  • Tabatha O’Bryant, daughter

  Defense Attorneys

  Eddie Castaing—Attorney for Lori Budo

  Richard T. Simmons Jr.—Attorney for Dr. Anna Pou

  NOTE TO THE READER

  THIS BOOK RECOUNTS what happened at Memorial Medical Center during and after Hurricane Katrina in August 2005 and follows events through the aftermath of the crisis, when medical professionals were arrested and accused of having hastened the deaths of their patients. Many people held a piece of this story, and I conducted more than five hundred interviews with hundreds of them: doctors, nurses, staff members, hospital executives, patients, family members, government officials, ethicists, attorneys, researchers, and others. I was not at the hospital to witness the events. I began researching them in February 2007 and wrote an account of them in 2009, copublished on the investigative news site ProPublica and in the New York Times Magazine: “The Deadly Choices at Memorial.”

  Because memories often fade and change, source materials dating from the time of the disaster and its immediate aftermath were particularly valuable, including photographs, videotapes, e-mails, notes, diaries, Internet postings, articles, and the transcripts of interviews by other reporters or investigators. The narrative was also informed by weather reports, architectural floor plans, electrical diagrams, and reports prepared by plaintiff and defense experts in the course of civil litigation; and I visited the hospital and other sites depicted in the book.

  Dialogue rendered in quotation marks is reproduced exactly as it was recalled in interviews, or is taken directly from transcripts and other primary sources. If one person recounted an important conversation, I generally attempted to contact all participants, but some declined to speak, and at times memories were at odds. The main text and Notes highlight areas of significant dispute and indicate the sources of quotes when they do not derive from interviews with me. Typographical mistakes are preserved in quoted e-mails to give the reader a sense of the urgency involved in their production.

  This book relates the thoughts, impressions, and opinions of the people in it, perhaps the most fraught aspect of narrative journalism. Attributed thoughts or feelings reflect those that a person shared in an interview, wrote down in notes, a diary, or a manuscript, or, less commonly, expressed to others whom I interviewed. As any book reflects the interwoven interpretations and insights of its author, I have tried to make these distinct. All errors are mine.

  PART I

  DEADLY CHOICES

  Blindness was spreading, not like a sudden tide flooding everything and carrying all before it, but like an insidious infiltration of a thousand and one turbulent rivulets which, having slowly drenched the earth, suddenly submerge it completely.

  —José Saramago, Blindness

  PROLOGUE

  AT LAST THROUGH the broken windows, the pulse of helicopter rotors and airboat propellers set the summer morning air throbbing with the promise of rescue. Floodwaters unleashed by Hurricane Katrina had marooned hundreds of people at the hospital, where they had now spent four days. Doctors and nurses milled in the foul-smelling second-floor lobby. Since the storm, they had barely slept, surviving on catnaps, bottled water, and rumors. Before them lay a dozen or so mostly elderly patients on soiled, sweat-soaked stretchers.

  In preparation for evacuation, these men and women had been lifted by their hospital sheets, carried down flights of stairs from their rooms, and placed in a corner near an ATM and a planter with wilting greenery. Now staff and volunteers—mostly children and spouses of medical workers who had sought shelter at the hospital—hunched over the infirm, dispensing sips of water and fanning the miasma with bits of cardboard.

  Supply cartons, used gloves, and empty packaging littered the floor. The languishing patients were receiving little medical care, and their skin felt hot to the touch. Some had the rapid, thready pulse of dehydration. Others had blood pressures so low their pulses weren’t palpable, their breathing the only evidence of life. Hand-scrawled evacuation priority tags were taped to their gowns or cots. The tags indicated that doctors had decided that these sickest individuals in the hospital were to be evacuated last.

  Among them was a divorced mother of four with a failing liver who was engaged to be remarried; a retired church janitor and father of six who had absorbed the impact of a car; a WYES public television volunteer with mesothelioma, whose name had recently disappeared from screen credits; a World War II “Rosie Riveter” who had trouble speaking because of a stroke; and an ailing matriarch with long, braided hair, “Ma’Dear,” renowned for her cooking and the strict but loving way she raised twelve children, multiple grandchildren, and the nonrelatives she took into her home.

  In the early afternoon a doctor, John Thiele, stood regarding them. Thiele had taken responsibility for a unit of twenty-four patients after Katrina struck on Monday, but by this day, Thursday, the last of them were gone, presumably on their way to safety. Two had died before they we
re rescued, and their bodies lay a few steps down the hallway in the hospital chapel, now a makeshift morgue.

  Thiele specialized in critical care and diseases of the lungs. A stocky man with a round face and belly, and skinny legs revealed beneath his shorts, he answered often to “Dr. T” or, among friends, “Johnny,” and when he smiled, his eyes crinkled nearly shut. He was a native New Orleanian, married at twenty, with three children. He was a golfer and a Saints football fan. He liked to smoke a good cigar while listening to Elvis.

  Like many of the hospital staff around him, his professional association with what was now Memorial Medical Center stretched back decades, in his case to 1977, when he had rotated at the hospital as a Louisiana State University medical student. A classmate would later say that Johnny Thiele had turned into the sort of doctor they all wished to be: kind, gentle, and understanding, perhaps all the more so for having struggled over the years with alcohol and his moods. When Dr. T passed a female nurse, he would greet her by name with a pat on the back and sometimes call her “kiddo.”

  Thiele had undergone part of his training at big, public Charity Hospital, one of the busiest trauma centers in the nation, where he learned, when several paramedics burst into the emergency room in close succession, to attend to the most critical patients first. It was strange to see the sickest here at Memorial prioritized last for rescue. At a meeting Thiele had not attended, a small group of doctors had made this decision without consulting patients or their families, hoping to ensure that those with a greater chance of long-term survival were saved. The doctors at Memorial had drilled for disasters, but for scenarios like a sarin gas attack, where multiple pretend patients arrived at the hospital at once. Not in all his years of practice had Thiele drilled for the loss of backup power, running water, and transportation. Life was about learning to solve problems by experience. If he had a flat tire, he knew how to fix it. If somebody had a pulmonary embolism, he knew how to treat it. There was little in his personal history or education that had prepared him for what he was seeing and doing now. He had no repertoire for this.