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.