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Tenet and Hurricane Katrina


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In the dreadful conditions following Hurricane Katrina hundreds of patients were trapped under dreadful conditions in one of Tenet Healthcare's hospitals. Forty five bodies were found a week later. A doctor and two nurses were accused of murdering four of these patients. The story is interesting because of the situation, the ethical issues and the way the matter was mishandled.




Tenet Healthcare was caught up in a contentious matter in Florida after Hurricane Katrina struck New Orleans. Some including CNN attempted to blame Tenet for what happened in one of its hospitals. Tenet's New Orleans hospitals were among those being investigated for a number of questionabloe practices but these seem unrelated to what happened.

When the reports are examined it seems that, although still behaving like Tenet, for once it seems to have done the right thing. When the government’s emergency response failed dramatically Tenet chartered helicopters to fly out the patients trapped under dreadful conditions in its hospital. At the worst its preparedness for a disaster was suboptimal and it was slower (than for example HCA in evacuating its hospitals)

What happened in its Memorial hospital is interesting not because of Tenet but because of the ethical issues raised and because of the way the US legal system and the grandstanding self interest of one of its officers created a situation in which everyone suffered. The important social and personal issues could not be effectively and sympathetically addressed. It all makes interesting and revealing reading.

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Following Hurricane Katrina Tenet’s 300 bed Memorial hospital, was isolated, flooded and deprived of all services. It was filled with patients, as well as many hundreds seeking shelter. There was no lighting, no fresh water and no sewage. In the dark, intense heat and putrid air many frail patients died. Evacuation was delayed and those involved believed that it would not arrive. Some of the very ill were given doses of sedatives and subsequently died. Allegations were made that a doctor and two nurses had deliberately killed them to spare them suffering. What actually happened is far from clear.

Mr Foti, the attorney general, investigated. Nine months after the flooding, when about to seek re-election, he charged a respected member of the medical profession and two well liked nurses with murder.

They were cooperating and had indicated to police that they would do whatever was required. Instead the police dealing with them received a directive and without warning apprehended the three. They were hand cuffed and dragged off to be acccused but not formally charged.

This was followed by a dramatic press conference in which accusations of murder were made. In fact it had not been confirmed that the patients had died from unnatural causes. This was trial by media.

This tactic backfired as the doctor and nurses’ peers rallied to their support; and as the community examined what had happened.

As the coroner waited and waited for evidence that there had been a homicide, support for those accused increased. The criticism turned against the attorney general. The medical profession, the legal profession and even the attorney general’s colleagues turned against him.

Seven months later the coroner was unable to support the homicide claim. The attorney general indicated he still planned to prosecute.

A grand jury was to be called but 11 months after the arrest there is still no sign of a grand jury. No charges have been laid and there are no press reports of any activity. Those accused have spoken out about their ordeal. An election is due and an alternative candidate is campaigning on Foti’s incompetence. This will likely resolve the matter.

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Tenet’s involvement

Tenet Healthcare owned 5 hospitals in or near New Orleans when Hurricane Katrina struck. Only one was able to continue operating normally. Its Memorial Medical Center became the focus of media attention when a large number of bodies were found in the abandoned facility. Rumours of mercy killings were soon heard.

While its emergency planning was criticised Tenet can’t be blamed for what its doctors did - if in fact they did what they are accused of and if this was unacceptable. While it claimed that it cooperated there are suggestions that it did not do so and this would be in character.

Sep 12 The deaths
Harry Anderson, a Tenet spokesman, said they were patients who had died and were tagged after Katrina hit but before the hospital was evacuated. They were awaiting removal by the coroner and were guarded by a security detail, he said. - - - - - Anderson also noted. "No living patient was left behind," he said. "We evacuated every living patient before the staff left on Friday..
Bodies found in La. hospital were awaiting coroner Modern Healthcare Alert September 12, 2005

Sep 14 Tenet to the rescue
Dr. Louis Cataldie, the state's emergency medical director, said he did not fault the management for the deaths. "I don't think it's any reflection on that hospital," he said. "They did all the right things. They ultimately got their own helicopters to come in."
The telephones had died, and Mr. Goux began sending frantic e-mail messages to Tenet's headquarters in Dallas, requesting assistance. Company officials began calling the Coast Guard, the National Guard and even H. Ross Perot, the investor and former presidential candidate, who is a friend of Tenet's chief executive, Trevor Fetter.
By Thursday morning, doctors were in crisis mode. "We said we had to find a way to get these people out faster," Dr. Allen said. "We could just sense what was coming. It was so hot. We were down to one meal a day. There was no running water or sewage." At 9 a.m., six helicopters chartered by Tenet finally started arriving, carrying away wave after wave of patients and evacuees. The last living patient left that evening. For others, help had come too late.

"As people died, they were wrapped into blankets," said Dr. Glenn A. Casey, the chief anesthesiologist and one of three doctors who left on the final flight. "We didn't have body bags to put them in."
Hurricane and Floods Overwhelmed Hospitals The New York Times September 14, 2005

In true Tenet style Tenet sought to distance itself from any of its doctors who were in trouble. It was in the midst of its own scandals. Tenet of course knows exactly what happened. Tenet officials and lawyers had long conversations with the doctor soon after the flood.

Mar 2006 The earliest allegations
Allegations of euthanasia at Memorial first surfaced a week after the hurricane. A week later, on September 13, Memorial CEO Rene Goux sat down with CNN and denied any knowledge of the allegations even though he was inside the hospital and coordinating the evacuation.
New Orleans hospital operator has checkered past CNN March 9, 2006

Jul 2006 Tenet shifts blame
"If the allegations are proven true, the doctor and nurses named by the attorney general made these decisions without the knowledge, approval or acquiescence of the hospital or their key physician leaders," the Tenet statement said.
3 Arrested in Hospital Deaths After Katrina THE NEW YORK TIMES July 18, 2006

Sep 2006 Tenet knew
She (the doctor) got a return call the same day from Steven Campanini, a Tenet public relations official, who was on the line with Audrey Andrews, a Tenet lawyer.
Doctor's phone calls ruled private ; Tenet advice to Pou shielded, court rules Times-Picayune September 21, 2006

The attorney general accused Tenet of discouraging witnesses and obstructing the investigation.

Oct 2005 Tenet denies
Memorial Hospital said it has not tried to keep employees from talking to investigators.

In a memo dated Oct. 14 and obtained by The Associated Press on Wednesday, Tenet's assistant general counsel, Audrey Andrews, told Memorial employees it was their decision whether to talk to investigators.

The memo advised employees to speak first to a lawyer and listed the phone number for the hospital's lawyer.
La. AG Subpoenas 73 in Hospital Deaths The New York Times October 26, 2005

Jul 2006 Foti angered by Tenet
He was apparently angered by what he (Foti) saw as a lack of cooperation by the management of the medical center.
The Tenet statement said that the corporation had assisted the attorney general in „all aspects of his investigation."

Ms. Wartelle said last year when the subpoenas were issued that an Oct. 14 memorandum issued by Tenet had "changed the climate" of the investigation. It said that employees were not compelled to give interviews to the government and that if they chose to be interviewed they had the right to have both a lawyer and a hospital representative present.
3 Arrested in Hospital Deaths After Katrina THE NEW YORK TIMES July 18, 2006

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The situation in the hospital

Memorial Medical Center was surrounded by sewage soiled and offensive water. All its services (eg electricity, running water, air conditioning, sewage) broke down. The hospital was isolated and cut off. Electricity and all support systems, including phones failed. Conditions were truly horrendous. Many sick, frail and terminal patients were dieing. The failure of the emergency response and the political reasons for this are now history. There was no relief and evacuation services failed to materialise. Staff did not know that helicopters were coming and thought they had been abandoned.

Sep 12 Bodies found
Forty-five bodies have been found at a hospital (Tenet’s Memorial Medical Center) that was abandoned more than a week ago after it was surrounded by floodwaters unleashed by Hurricane Katrina, a state health official said Monday.
45 Bodies Found at New Orleans Hospital The New York Times September 12, 2005

Sep 14 Conditions inthe hospital
Confusion and desperation permeated the New Orleans hospital system as floodwaters rose, emergency generators failed and dozens of patients died in the three chaotic days after the levees broke, doctors and other witnesses said on Tuesday.

While all of the city's major hospitals had detailed evacuation and emergency plans, officials said, none were prepared for a catastrophic flood. And each responded differently when disaster struck.

At Memorial Medical Center, where 45 bodies were discovered this week, staff members said they could do little more than try to comfort dying patients.

Frightened and exhausted nurses and doctors squeezed hand-held ventilators for patients who could not breathe. The cook reduced the daily meal ration from three to two to one. Doctors ranked patients for evacuation by helicopter, taping a number to each patient, with 3 for the sickest and 1 for the least critical.
Dr. Walsh compared the scene to the railyard hospital for wounded soldiers in "Gone With the Wind," saying: "The nurses were basically standing, and giving them food or water. There were some medications we could give, but nothing like modern medicine. We were back to the 1800's."
Dr. Timothy Allen, an anesthesiologist, was astonished. "We were told and we believed that our generators would last six days, and of course they died after two and one-half days, whether because they shorted out or were flooded," he said.
William P. Quigley, a law professor at Loyola University who was at Memorial until that afternoon with his wife, Debbie, an oncology nurse, said: "They didn't have enough food. One night, I remember one of the doctors saying, 'If you've eaten food today, we can't feed you tonight.' Then they passed out little tin cans of Vienna sausage."
Hurricane and Floods Overwhelmed Hospitals The New York Times September 14, 2005

Mar 2006 Abandoned
The staff at Memorial Hospital have said that after the storm they felt abandoned, that they worried about the sporadic evacuations and that they feared looters, some of whom they watched break into a nearby credit union.
New Orleans hospital operator has checkered past CNN March 9, 2006

Jul 2006 Hospital packed
As many as 300 patients and 1,500 other people were trapped for four days at the medical center in temperatures of more than 100 degrees and without generators, food or water, as early evacuation efforts failed.
3 face charges in mercy killings ; Katrina-trapped patients drugged The Washington Times July 19, 2006

Jul 2006 Conditions
Staff members and hundreds of patients were stranded inside the sweltering building awaiting rescue. The power was out, the toilets were backing up, and 10 feet of putrid floodwaters filled the neighborhood. Some patients watched from their beds as people broke into nearby buildings in the lawless streets outside.
Doctor, 2 nurses accused of killing patients with drug injections Corpus Christi, TX --- KRISTV.COM July 20, 2006

Sep 2006 Conditions
By late Tuesday, the hospital was flooded with ten feet of water and completely without power. Ventilators stopped. There were no telephones, limited food, and perhaps worst of all the 110 degree heat.

POU: I don’t know if there’s any way for me to describe to you how intense the heat was. It was relentless. It was suffocating. It made it extremely difficult to breathe. And with the heat came the terrible smell from all of the human waste and the fact that we didn’t have water.
SAFER (voice-over): Patients lay soaking in squalor. Nurses broke windows for air and fanned patients. The seventh floor was most critical. A separate company called Lifecare ran an acute care facility for the severely ill. Their doctor didn’t show, so Dr. Pou and a handful of other doctors and nurses did what they could.
POU: The hospital, you have to remember, was pitch black. We couldn’t see our hands in front of our face. We had to examine patients using flashlights. The patients realized there wasn’t a whole lot that we could do for them, except to provide the most basic care and they were worried, you know. You know, "I don’t feel well. When am I going to get out of here?"
POU: You have to understand that there were very sick people in the hospital. You had this intense heat. We had the lack of all the tools that we normally used. And so people were dying from the horrible conditions because they were not strong enough to tolerate them.

SAFER (voice-over): Bodies were piling up. The chapel became a morgue. Then, gunshots were heard. There was fear that looters might break in.
DR. JOHN KOKEMOR: That was actually what was told us that help was not on the way that we would be on our own. At that point, we were dumbfounded and in a bit of shock.
Euthanasia or Murder? CBS News: 60 Minutes September 24, 2006

One of the major problems was getting very sick patients to the helicopters - down seven flights of stairs in extreme heat and then up more to the pad. A number died on the way.

Jul 2006 Evacuation route
Mr. Simmons said that evacuating patients from the hospital had been far more difficult than the state's attorney general, Charles C. Foti Jr., has indicated, and he disputed Mr. Foti's assertion that the patients would have survived if they had been evacuated. He said the sickest patients could not have been evacuated on the inflatable boats being used. And he said that to take patients to the roof for helicopter rescues, orderlies had to squeeze them through a 3-foot-by-3-foot hole in a hospital wall and push them on gurneys up the ramps of the parking garage before carrying them onto the roof.

Mr. Simmons said some patients also died while being transported under those conditions.
Accused Doctor Said to Have Faced Chaos at New Orleans Hospital The New York Times July 20, 2006

Sep 2006 Deaths on the stairs
Throughout the day, McManus said, four LifeCare patients died in the brutally hot stairwells, where temperatures reached 110 degrees. When McManus asked a LifeCare staff member what was going on, she was told: "Their bodies couldn't handle being transported."
Woman is convinced her mom was killed at hospital ; She stayed with her through the hurricane Times-Picayune September 3, 2006

Sep 2006 Evacuation route
SAFER (voice-over):
- - - - There were sporadic evacuations, but it took tremendous effort. Patients had to be carried down as many as seven flights of stairs, then back up again to a helipad on a garage. It was a battlefield. Several died in the process. By nightfall Wednesday, Memorial was a hellhole.
Euthanasia or Murder? CBS News: 60 Minutes September 24, 2006

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The allegations relate to what happened on the 7th floor which was leased to a company caring for very sick terminal patients. While Tenet doctors volunteered and stayed to look after patients, LifeCare’s doctors did not show. Dr Pou and the two nurses did what they could for these patients. It has never been suggested that they did not believe that they were doing their best.

Jul 2006 Lifecare's patients
Now, the attorney general’s investigation has really centered around the seventh floor of Memorial Hospital, and that was leased to a long-term care facility known as LifeCare. The attorney general today stressed that these three employees did not work for LifeCare, yet they took over the patient’s care of LifeCare. I just want to also say I’ve spoken to lawyers for the doctor and one of the nurses. They say they will vigorously fight these charges, adamantly deny any wrongdoing, saying that their clients worked under horrendous conditions, tirelessly on behalf of their patients.

New Orleans Doctor, Nurses Charged with Murder NPR News, - ALL THINGS CONSIDERED July 18, 2006

Jul 2006 Patients not going to survive
The victims were actually patients of Lifecare Hospital, an intensive-care unit that leased space from Memorial and had a separate staff. With chaotic evacuations taking place, many by boat, Dr. Pou and a Memorial official who has not been charged by Mr. Foti told witnesses that the Lifecare patients ''were probably not going to survive,'' according to the affidavit.
Patient Deaths In New Orleans Bring Arrests The New York Times July 19, 2006

Sep 2006 Additional patients
As Katrina approached, life on the usually quiet unit got much noisier. Nineteen patients from LifeCare's low-lying hospital in Chalmette were moved in, and family members began to fill the 82- bed seventh-floor unit. At least one nurse brought a dog and a cat, which wound up in the room next to her mother, McManus said.

Despite the increased workload, LifeCare's medical director, Dr. John Wise, elected to evacuate. Wise, an internist with several patients in the hospital, said nobody from LifeCare asked him to change his plans.
Woman is convinced her mom was killed at hospital ; She stayed with her through the hurricane Times-Picayune September 3, 2006

Nov 2006 Not Lfecare employees
Pou, Landry and Budo were not LifeCare employees; they ended up working on the seventh floor because LifeCare had no physician present.
Foti's Crusade The Greater Baton Rouge Business Report November 7, 2006

It was LifeCare’s staff who made the allegations to the attorney general.

Aug 2006 Lifecare complained
According to an affidavit released by Mr. Foti's office, the arrests grew out of accusations by four supervisors for LifeCare Hospitals that ran an acute-care ward in the hospital. As hopes for a full rescue seemed to fade on the third day after the storm, three of the LifeCare employees say that Dr. Pou told them she was going to inject a ''lethal dose'' into patients who seemed unlikely to survive, the affidavit states.
Arrest of Nurses and Doctor Puts Attorney General In Louisiana on Defensive The New York Times August 1, 2006

Dec 2006 Doctor who was not there complained
Bryant King, a contract physician who first came forward with the story, painted a troubling picture in that update.

Physician Anna Pou "had a handful of syringes," King told CNN. "That was strange on a lot of levels. Number one, we don't give medications; nurses give medications. We almost never give medications ourselves unless it's something critical. Nobody walks around with a handful of syringes and goes and gives the same thing to each patient. It's not how we do it."

Pou has stopped commenting to CNN and hired an attorney to defend her. Her attorney, Rick Simmons, portrayed the conditions at Memorial as horrific -- and the actions by its physicians as heroic -- but stopped short of denying the mercy killings in a statement supplied to CNN.
New Tests for Tenet The (Melissa Davis) December 22, 2005

Lifecare too claimed that it had tried to independently evacuate its patients but that these efforts had been blocked by authorities. Authorities denied this and the person mentioned by Lifecare as blocking their plan was not employed by the authorities. It is not clear if he existed.

Sep 2003 Lifecare's claims
LifeCare officials declined to comment on McManus' allegations, but Plorin, its spokeswoman, said the company tried to mount its own evacuation effort. That effort was blocked by federal officials who insisted on controlling all evacuations, according to affidavits filed in court by two LifeCare executives.

"We experienced significant obstacles in both our ground and air efforts," Plorin said.
FEMA spokesman Ronnie Simpson said the agency did not block any hospital from organizing its own evacuation.
"I'm not a big Tenet fan, but they get a bad rap when people say they abandoned Memorial," said Dr. John Kokemor, who treated patients at both Memorial and LifeCare. "If any administrators abandoned anybody, it was LifeCare who abandoned their patients. Their own medical director did not show up."

Altogether, 24 of the 55 patients in the LifeCare unit died in the days following the hurricane, compared with 10 Memorial patients.
Woman is convinced her mom was killed at hospital ; She stayed with her through the hurricane Times-Picayune September 3, 2006

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What actually happened probably only Tenet and the parties involved know. The patients were sedated but whether this was to relieve suffering or to kill is not known. If we assume that it was to kill then the question arises as to whether the conduct was morally or ethically wrong, and perhaps more importantly was it justified under these extreme circumstances? Was it a reasonable error of professional judgement made under extreme pressure? Was it a deliberate killing of patients, who could not be evacuated, so that the doctors and nurses could evacuate themselves? No one considered the last possibility likely given the dedication of the people involved.

We need to know the truth, debate and then make plans for the next time this happens. Perhaps the doctors and nurses should have been censored. Unfortunately the law would not allow this to happen. Instead they were treated as criminals, arrested, handcuffed and accused of murder without being formally charged.

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Ethical background

There are groups whose beliefs would lead to the condemnation of the actions of anyone who gives any sort of treatment that shortens a patients life or terminates it. With more emphasis on quality of life there are hopefully fewer of these groups.

There can be few doctors whose religious beliefs are so strong that they will not give a patient dieing in agony pain relief even when they know that the patient will not survive this. Ethicists acknowledge this.

It is now possible to keep people alive on life support when they have no prospect of recovery or meaningful life. It is normal practice to discuss this with relatives and then withdraw support.

While no individual wants to play god situations do arise where someone has to make a decision one way or another and play god. This can happen in medicine, particularly in 3rd world countries. Decisions must be made in the best interests of all parties and someone makes them - rightly or wrongly - ethically or not.

Euthanasia is now a world wide debate. There are community groups and some doctors who assert the patient’s right to be assisted in departing this life when it has become intolerable and there is no prospect of relief or recovery. In some countries this is now legal.

What may be illegal and anathema in one situation may be acceptable in other or in exceptional circumstances. In war killing the enemy is desirable and praised - even heroic. At other times it is murder.

A parallel can be drawn with another exceptional situation which occurred during a plane crash. Cannibalism, like murder, is taboo and a crime in most societies. Some years ago a plane crashed in the snow capped Andes. Those still living were able to survive until they were found by cooking and eating the frozen bodies of the dead. The matter was kept confidential and they were not prosecuted. It was only years later that the matter was exposed to the public and given some legitimacy. Their exceptional situation was understood and the response was sensible.

One ethicist spelled some of this out

Jul 2006 Current practices
"There are quite a number of studies that say upwards of 70 percent of deaths in hospitals involved explicit decisions to limit treatment," he (Tom Murray, president of the Hastings Center, a bioethics think tank in Garrison, N.Y) said. "And those figures are old. Most people believe it's higher than that now."

Doctors and patients have become familiar with managing death, he said.

Patients with advanced cancer often refuse another harsh treatment that might mean a few more weeks or months of life. Or the parents of a patient with brain damage might agree to withdraw life support.

Or a family might request higher doses of narcotic for a terminal patient suffering pain, even if the higher dose may depress breathing and hasten death by a few hours.

The key is not the outcome, but the intention, ethicists said.

"Intention is the single most important element" in judging the ethical appropriateness of such decisions, Murray said.

"In normal circumstances, we have a clear, bright line between relieving pain and hastening death," said David Magnus, president of Stanford University's Center for Biomedical Ethics. "You are allowed to relieve pain even if it has a foreseeable but unintended consequence of hastening death.

"If morphine will help relieve pain, even if it brings on respiratory distress and brings on death, that's well understood in every state. It's accepted medical practice."
Ethicists: Any deliberate killing crosses the line Times-Picayune July 19, 2006

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The ethical debate

The doctors in New Orleans were not afforded the dignity nor was consideration given to the extraordinary situation in which they found themselves. What they did under pressure may have been wrong. We can all make mistakes under pressure.

Alternately their actions may be debatable. The issues may need public debate and the doctor was initially prepared to be quite open about it. It may need to be tested in law but it is a situation that has not arisen before. The way it was handled is appalling and hopefully if it comes tp trial the judge will be more discerning. Th response to this could only happen in countries dominated by fundamentalist religions - extremist Moslem countries and the USA!

Ethicists in their academic castles soon entered the debate and generally condemned mercy killings. Most would agree that they are right but they were not there. As some acknowledge, this does happen and rigid enforcement of ethical regulations in every situation would not really help patients or their families. In most instances where patients are helped it sensibly stays below the radar. The question is whether this was one of them. The situation probably did need attention and even a legal resolution but it should certainly have been handled more sensitively.

Jul 2006 Yes its wrong BUT
Conditions were hellish beyond expectation: Electrical power knocked out by Hurricane Katrina. The hospital isolated; its medical staff exhausted, anxious and largely helpless. Profoundly sick patients deteriorating in unbearable heat. But if a doctor and two nurses at Memorial Medical Center purposely injected patients with a lethal dose of painkillers, as the state alleged Tuesday, even if it was end their suffering, they crossed a legal and ethical boundary, several medical ethicists said Tuesday.
After the allegations of killings at the hospital surfaced in October, and as Foti's investigation quietly advanced, one widespread belief was that because of the unprecedented misery that engulfed Memorial, if doctors and nurses hastened patients' deaths, they were motivated by humanitarian motives.

If so, such humanitarianism is misplaced on several counts, several ethicists said Tuesday.
By contrast, it is clearly unethical to end a patient's misery by intentionally killing, Magnus, Murray and other ethicists said.

In practice, however, it sometimes happens, even outside extraordinary public emergencies such as Katrina, Murray said.

"In American law, the rule in every jurisdiction is you don't do that," Murray said. "It's homicide.

"Does it happen? Yeah, it probably does happen. No one knows how frequently."

He said intentional killings usually happen only in cases in which a trusted doctor knows a family or a suffering patient well.

"It happens quietly. It's rarely prosecuted. . . . But the majority of doctors who do ethics say you should never do that," Murray said.

'I can't even imagine'

Some ethicists said they sympathized with the staff at the besieged hospital and were impressed by the fact that they faced almost intolerable conditions.

"I can't even imagine what they must have gone through trying to do what was best for their patients," Magnus said. "But we draw that bright line we don't want doctors and nurses to cross. They had an obligation to patients to do everything possible to relieve their suffering -- but to intentionally euthanize, if that's in fact what took place, crosses that bright line."

Moreover, there is another complication, ethicists said: consent.

"What if all those patients didn't want that?" Magnus said. "I doubt they knew just what each of those patients wanted, what each of their surrogates wanted. I doubt they talked to each of the surrogates.

"If it's that they decided to intentionally euthanize patients . . . the lack of consent makes it worse, even under those horrible circumstances."
Ethicists: Any deliberate killing crosses the line Times-Picayune July 19, 2006

Some stressed that such situations might well become more common and as a society we needed to develop guidelines. There was another more serious ethical issue that was being overlooked. This related to discrimination.

Jul 2006 Disaster planning and ethics
Would doctors, who took a professional pledge to "first do no harm," break their oath when their backs were to the wall and they thought the only merciful thing to do was to help end the life of a patient?
And in this age of weapons of mass destruction and an increase in the severity of natural disasters, such as hurricanes, society needs to rethink how it will respond to mass casualties when medical care may be limited, according to medical ethicists.

"These are situations we better start discussing way in advance if such an event would ever happen in a nation where our social welfare net can fray under extreme conditions," said Laurie Zoloth, director of the center for bioethics, science and society at Northwestern University Feinberg School of Medicine.
"What do you do if you had no way to treat people, and they were ill, and there was no power, and the ventilation had gone down, and the machines that had kept them alive were failing?" asked Ms. Zoloth. "That is an astonishingly important ethical problem, given the realties we face with disaster planning."

She said society may have to face ethical quandaries like this in the event of massive casualties from a terrorist attack with nuclear or biological weapons, or from a flu epidemic, like the one in 1918 that killed millions of people worldwide. In such cases, as in war on the battlefield, doctors may be forced to triage patients when resources are limited, selecting for treatment those most likely to survive while leaving the most seriously injured to die, Ms. Zoloth said.
An even broader ethical question arises over why it took so long to rescue the public hospital patients, Ms. Zoloth said. "The patients in the poor, public hospital faced a far worse fate than the private hospital, and that was not only unethical, it was unconscionable," she said.

Aug 2006 Events stimulate ethical debate
Foti's decision to arrest Pou, a specialist in ear, nose and throat cancer surgery, and the nurses has ignited a furious debate in New Orleans and elsewhere about whether sharp ethical boundaries can be drawn around decisions on patient comfort made in a crisis. The arrests also have played into the ongoing national debate about euthanasia and the decisions medical professionals and families face every day when caring for gravely ill people.
Doctor's drug mix not ideal killer ; Evidence in Memorial case called unreliable Times-Picayune August 6, 2006

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The Investigation

The attorney general

The attorney general had risen to his position by managing and reforming the New Orleans goal system, and by advocating aggressively for the aged.

Nov 2006 Foti's career
Foti built a political empire at Parish Prison. In his 29 years as sheriff, the prison expanded from a decaying jail that held 800 inmates into a sprawling physical plant along Interstate 10 with space for more than 8,000 prisoners, an increase of 1000% during a generation in which the population of the city declined by 18%. Foti turned the prison into a powerful patronage base, with 1,200 employees not governed by Civil Service.

In fairness to Foti, he inherited a nightmare and quickly turned it into a tightly run urban jail. In his first term, he won praise locally and from across the country, including The New York Times.
Foti's Crusade The Greater Baton Rouge Business Report November 7, 2006

Aug 2006 An advocate for the elderly
During his 30 years as the sheriff here, Charles C. Foti Jr. was known for treating thousands of elderly people to free Thanksgiving dinners, complete with jazz and blues bands. And when he was sworn in as the state's attorney general in 2004, he made cracking down on the abuse of the elderly one of his top priorities.

His support for the state's older residents helped make him one of Louisiana's most popular politicians. But now it has led Mr. Foti, a normally cautious lawyer, into a firestorm, as many people question his decision to order the arrests of a doctor and two nurses, whom he accused of killing four hospital patients with drug injections in the desperate days after Hurricane Katrina.
Arrest of Nurses and Doctor Puts Attorney General In Louisiana on Defensive The New York Times August 1, 2006

Foti was politically ambitious and due for re-election in 2008. He was accused of using the case as a publicity stunt to promote his own political career. Those in question were cooperating and had offered to turn themselves in. The police received instructions from above to arrest, handcuff and arraign them without any prior warning. He then grandstanded in a press release using evocative language. As the details were unearthed the public and the media turned against Foti.

Jul 2006 Dr. Pou's account
In December, Dr. Pou had told Baton Rouge TV station WBRZ: "There were some patients there who were critically ill who, regardless of the storm, had the orders of do not resuscitate. In other words, if they died, to allow them to die naturally, and to not use heroic methods to resuscitate them."
"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," Pou said then.
Doctor, 2 nurses accused of killing patients with drug injections Corpus Christi, TX --- KRISTV.COM July 20, 2006

Mar 2006 Credible allegations
Louisiana Attorney General Charles Foti is investigating what he calls "credible" allegations that patients at Memorial Medical Center were euthanized in the frantic days following the storm. Foti has told CNN he has "a very good case."
New Orleans hospital operator has checkered past CNN March 9, 2006

Jul 2006 Arrested
A doctor and two nurses have been arrested on suspicion of giving deadly drug injections to four patients at a medical center in New Orleans after Hurricane Katrina, the Louisiana attorney general said today.

The doctor, Anna Pou, and two nurses, Cheri Landry and Lori Budo, were arrested on Monday on four counts of principal second-degree murder, the attorney general, Charles C. Foti Jr., said at a news conference today.
"This is not euthanasia," Mr. Foti said. "This is a homicide." Prosecutors said they would seek indictments from a grand jury.
Mr. Foti said that the patients were injected with what he described as a "lethal cocktail" of morphine and midazolam hydrochloride that "guarantees they are going to die."

"It is not my job or duty to say what the motive was," Mr. Foti said.
3 Arrested in Hospital Deaths After Katrina THE NEW YORK TIMES July 18, 2006

Jul 2006 Homicide
''This is not euthanasia; this is plain and simple homicide,'' Mr. Foti said several times at a news conference here, although he declined to ascribe a motive to the killings.
Patient Deaths In New Orleans Bring Arrests The New York Times July 19, 2006

Jul 2006 Lethal doses of drugs found
The tests revealed morphine and another powerful sedative, Versed, in what Mr. Foti said was a lethal combination. According to the affidavit, medical records showed that none of the four patients had been receiving either drug in their regular medical treatment.

He said the doctor and two nurses had decided who would live and who would die.

''They took the law in their own hands,'' Mr. Foti said. ''They're not the lawgiver.''
Patient Deaths In New Orleans Bring Arrests The New York Times July 19, 2006

Jul 2006 Playing God
"We're talking about people that pretended that maybe they were God," Louisiana Attorney General Charles Foti said. "And they made that decision."

The defendants were booked on charges of being "principals to second-degree murder," which carries a mandatory sentence of life in prison.
Dr. Anna Pou, a cancer and ear, nose and throat specialist, and the two nurses were accused of deliberately killing four patients, ages 62 to 90, with a "lethal cocktail" of morphine and the sedative Versed. The patients' names were not released.

"There may be more arrests and victims that cannot be mentioned at this time," Foti said. "This case is not over yet." He planned to turn the case over to the New Orleans district attorney, who will decide whether to ask a grand jury to bring charges.
In court papers, state investigators said Pou told a nurse executive three days after the hurricane that the patients still awaiting evacuation would probably not survive and that a "decision had been made to administer lethal doses" to them. Overdoses of morphine or Versed can stop the heart and lungs.

Foti, however, said he believed the patients would have lived through the storm's aftermath.
Doctor, 2 nurses accused of killing patients with drug injections Corpus Christi, TX --- KRISTV.COM July 20, 2006

Jul 2006 Criticism of the case
The criticism of the criminal case is not limited to doctors who know Pou personally. A number of other New Orleans doctors accused Foti, who plans to run for re-election in 2008, of grandstanding.

"Where the hell was he?" said L. Lee Hamm, chairman of medicine at Tulane University School of Medicine, and a doctor who helped care for stranded patients there after Katrina. "Where the hell was the law enforcement? Where the hell was anybody until Friday?" -- Sept. 2, the day large-scale evacuations began in many areas. "If you want to prosecute, if you want to know who is responsible for people dying, it's the people who were not here," Hamm said. "It's not the people who were here."
Juzar said he was "disturbed" by the attorney general's allegations, "because we don't really know the actual circumstances in which clinical decisions were made. ... So as a peer, it makes you feel for the physicians and the health-care workers as to whether it's fair to project them as murderers," he said.
Some doctors interviewed acknowledged that they were not aware of all of the facts in the case. They also warned that prosecutors could find themselves treading on complicated legal and ethical terrain
Katrina doctor, nurses backed Los Angeles Times July 21, 2006

Aug 2006 A big PR stunt
But John E. DiGiulio, a lawyer for one of the nurses, said it was a ''big P.R. stunt'' for Mr. Foti to arrest the three women before the case had been reviewed by a grand jury.
Arrest of Nurses and Doctor Puts Attorney General In Louisiana on Defensive The New York Times August 1, 2006

Note that the text of the Foti Affidavit can be viewed in the archives of Tenet ShareHolder Committee's web site. Go to

The press started to examine Foti’s public statements more critically. The contradictions and misstatements he had made were noted. People who knew Foti and his failings spoke out.

Nov 2006 Foti criticised
Foti kept the spotlight on himself instead. The orchestration of events gave Foti a bonanza of free publicity leading into a splashy political fundraiser just two days after the arrests.
In fact, euthanasia is a form of homicide under the law. That legal tenet was lost on CNN anchors and TV coverage in general, which repeated the mistake in endless recapitulations of the briefing.

Foti's misstatement was one in a sequence of blunders that led critics to call his competence and ethics into question.
Now, even one of Foti's oldest allies, an attorney who did work for his office when he was the Orleans Parish criminal sheriff, is attacking the attorney general's motives on the arrests of the three women.
Now, 14 months after the storm and three months after the arrests, many are wondering why the attorney general made such high-profile arrests without the most basic evidence needed-lab reports and a coroner's classification of the deaths-to ensure an immediate indictment.
"Arresting those women was a clear abuse of power in [Foti's] office, and it blew up in his face," declares New Orleans attorney Allen Usry, who defended Orleans Parish Prison against civil lawsuits during Foti's 29 years as the city's criminal sheriff, until his election as attorney general in 2003.

"He should have turned the information over to [New Orleans District Attorney] Eddie Jordan, without arrests, and let Jordan decide whether to take it to a grand jury," says Usry.

Why did Foti arrest the suspects?

"He thought it would be good political PR," states Usry.
On July 20 - two nights after the press conference announcing the arrests-the attorney general spoke to a $500-a-plate fund-raising dinner held in his honor at the Windsor Court Hotel in New Orleans. The room was packed with lawyers and political heavy-hitters in response to letters sent weeks earlier, signed by the attorney general, asking them to serve on his campaign "finance committee." Foti, once the popular and politically untouchable criminal sheriff of Orleans Parish, was on a roll, chomping a cigar, pumped up from the recent new coverage.

"Some people say I should run for governor," he said to several guests. "What do you think?"
"I've known Charlie 32 years, and there are some personal issues," concedes Usry. "My problem with Foti is that he's not reliable. Time and again I'd introduce him to people, and they'd call back and say he doesn't keep his word. He's got a lot of personality flaws. ...

"What's bothering me is not personal. I was born and raised here. We're in a hell of a mess after Katrina," Usry continues. "Memorial Hospital was like a M.A.S.H. unit. Foti should have known better after running that jail with [prisoners'] suits over medical treatment."

Usry defended a line of civil lawsuits against Orleans Parish Prison during Foti's long tenure. "Most of those suits were without merit, criticizing decent medical staff working under adverse conditions-with criminals trying to manipulate the system," says Usry. "Foti had experience with baseless accusations. This is the same situation. Here's a doctor [Pou] with an impeccable record, volunteering for something she didn't have to do, in conditions even worse than a jail. Foti's the last person in the world who should be second-guessing someone in a medical situation like that."
Harking back to the week after Katrina, he said: "As we started this case, the attorneys for Lakeside came to our office and self-reported. And that's how euthanasia got in, that euthanasia happened." Then he made his famous comment, "This is not euthanasia. This is a homicide."

"Lakeside" is a Metairie hospital. LifeCare is the health care company whose representatives went to Foti's office to report what had happened at Memorial. Foti made the "Lakeside" mistake three times in the press conference, never saying "LifeCare."
Foti's Crusade The Greater Baton Rouge Business Report November 7, 2006

The press went back to interview those accused and learned of the way in which they had been arrested. The police had clearly been unhappy and had treated them sympathetically.

Jul 2006 Handcuffed
Pou's lawyer complained that she was arrested and handcuffed at her house late Monday night.

"I told them that she is not a flight risk. I told them that she would surrender herself. Instead, they chose to arrest her in her scrubs so that they could present her scalp to the media," Simmons said.
Doctor, 2 nurses accused of killing patients with drug injections Corpus Christi, TX --- KRISTV.COM July 20, 2006

Nov 2006 Similar arrest stories
The attorneys, from different law firms, spoke in separate interviews of having had communication with Foti's staff during the long investigation. "It was always understood we would self-surrender our clients," says Castaing (nurse Budo’s lawyer).

All three lawyers believe that understanding was superceded by orders from Foti.
At 9:30 p.m., she (nurse Landry) was in a patient's room, when her supervisor told her "some people need to see you." Out in the hallway she saw several people with the words "Attorney General's Staff" emblazoned on their jackets.
They read Landry her constitutional rights. A female officer padded her down, checking for weapons, then handcuffed her behind the back. By then, the head of nursing had called the facility's CEO, who arrived just as the officers were walking Landry to a law enforcement vehicle.
At Central Lockup the handcuffs were removed. Someone handed her an orange prison suit and ordered her into a holding cell. She recalls "about 15 women in there. A lot of them were talking. One was sleeping on the floor. One woke up and said she'd been there since Friday. ...One lady was walking around in pants and a bra. It was hot, extremely hot. I didn't feel comfortable changing into prison clothes, so I just stayed in my scrubs."
Meanwhile, Foti's agents arrived at Budo's Harahan home. Budo was in the kitchen, cleaning up after dinner. Her daughter, an LSU student, was taking a shower. Her son, a UNO student, was elsewhere in the house when a hard knock hit the door. Her husband Mike opened it. Budo heard voices asking for her. "She's not available," said her husband. "May I help you?"

Agents pushed past him, as others forced her husband to the street.

Confronted in the kitchen, Budo was read her constitutional rights and ordered into the bedroom to change into long pants; a female agent stood in the room as she changed. Shaken, Budo asked if she was going to be handcuffed. "Yes," said the agent. "Can you wait till I'm outside so my children don't see that?" said Budo. The agent agreed to her request.

The officers had her son and daughter sequestered in the kitchen as they escorted her out of the house. Budo was handcuffed and put into the car that took her first to the Harahan jail for initial processing then driven to Central Lockup in New Orleans.

Mike Budo immediately called Castaing (Budo’s lawyer)

Castaing by then had gotten word from an attorney on Foti's staff. "I pleaded with him to let me self-surrender Lori," Castaing said. "He said he had his instructions."

"The same attorney called me," says DiGuilio (nurse Landry’ lawyer), "and basically apologized. He said he had instructions from above."
On the morning of Monday, July 17, she (Dr Pou) was in the middle of an eight-hour surgery when a call came from a reporter in Baton Rouge. She had an assistant refer the message to Simmons (her lawyer). At 3:30 p.m., she finished the procedure. After making rounds, she arrived home at 7:30 p.m.

Simmons had received calls from other reporters asking about an arrest.
He was troubled because he, too, had "an understanding" with Foti's staff to self-surrender his client. Three days earlier, the attorney general's office called LSU, seeking Pou's address. Simmons called Foti's office that Friday and was told they needed to complete documentation to provide to New Orleans District Attorney Jordan.
About 9 p.m., Pou was at her house in Baton Rouge, still in her scrubs from the operating room, eating a salad when she heard a knock. She opened the door and met four agents in uniforms-two men, two women.

"You're under arrest."

She asked if she could use her cell phone to arrange for another physician to care for the patient on whom she had operated that afternoon.

The officers looked at each other.

"I was not going to leave that house with my patient hanging in the breeze," says Pou. "Think of what you would do [after surgery] if you learned your doctor was abandoning you."

The officers demanded her driver's license, and allowed her to make the call - but then she'd have to leave the cell phone.
The officers read her the constitutional rights of an accused, padded her for weapons, allowed her to put on shoes, handcuffed her, put her in the back seat and drove to the East Baton Rouge Parish jail for initial processing.
"I was talking to God, asking for strength and courage, saying Hail Marys," says Pou.

The Baton Rouge jail was "surreal," says Pou. "The people in charge were very kind. Someone said, 'Can you look at the camera?' Praying helped me remain composed. I did not cry."

Two officers drove her to New Orleans. She sat alone in the back seat, handcuffed. At one point someone in front asked, "You okay back there?"
At Central Lockup, she was struck by the politeness of people working on the intake procedures. One of them told her the judge wanted her released immediately. She was not put in a holding cell.
"What made me angry is the effect this had on my patients," Pou adds, her voice rising slightly. "Can you imagine your spouse, or you, watching on the news that the doctor who has operated - or is about to-gets arrested for murder? I think if Foti truly cared about the people of Louisiana he would have been more considerate in the manner in which he handled this. They were lying in bed, sick. Had I known about the arrest, I would have told them, 'I'm going to selfsurrender and set your treatment with Dr. So-and-So.' "

Pou paused.

"I think what Foti did was cruel to my patients."
Foti's Crusade The Greater Baton Rouge Business Report November 7, 2006

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CNN reporting

While much of the press reported on this sympathetically and responsibly, CNN Television took a different tack interviewing the witnesses and backing Foti. They attempted to drag Tenet into what had happened. The Tenet Shareholder committee, a group that had been fighting with Tenet’s management for years encouraged this.

Dec 2005 Tenet cops it
For Tenet, the coverage by CNN just keeps getting worse.
The cable news giant has, by now, spent months investigating allegations that hospital workers euthanized patients at Tenet's Memorial Medical Center in New Orleans during the aftermath of Hurricane Katrina. It continued to build on that story -- offering increasingly damaging testimony -- in an update this week.
"We believe ... that as more details become available about events at Memorial, the nation will again be reminded of the Terri Schiavo tragedy," the group (Tenet Shareholder Committee) stated on its Web site last month. "That case centered on a single instance of so-called 'mercy killing.' At Memorial, there may be more than a dozen."
New Tests for Tenet The (Melissa Davis) December 22, 2005

Mar 2006 More critics
But those familiar with the company's checkered history say they aren't surprised it is a Tenet hospital that is under scrutiny.
Cripe (author of a book about Tenet) and Caplan say it has been Tenet's practice over the years to deny knowledge by management of allegations of wrongdoing by hospital doctors and staff. That, they say, appears to be the case in New Orleans.
New Orleans hospital operator has checkered past CNN March 9, 2006

Jul 2006 CNN and the evidence
In October, CNN broadcast interviews with a doctor and a nurse manager at the hospital, who said that staff members had repeated discussions about euthanizing patients they thought might not survive the crisis.

Dr. Bryant King, who was working at Memorial, told CNN that while he did not witness any acts of euthanasia, "most people know something happened that shouldn‚t have happened.

A nurse manager, Fran Butler, told the network that she did not see anyone euthanizing patients, but at one point a doctor approached her and discussed the subject, saying "how she was totally against it and wouldn‚t do it," Ms. Butler said.

"My nurses wanted to know, what was the plan?" she said. "Did they say to put people out of their misery? Yes. They wanted to know how to get them out of their misery," she said, according to CNN.
3 Arrested in Hospital Deaths After Katrina THE NEW YORK TIMES July 18, 2006

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Foti targeted others as well

A husband and wife owning a nursing home unwisely elected not to accept advice (note not orders) to evacuate their nursing home. They were flooded and many died. Both were charged by Foti. While they were certainly at fault, the way it was handled looked like an attempt to direct the community’s anger at those involved rather than the authorities who knew what was happening and arguably should have ordered an evacuation.

Jul 2006 Nursing home owners charged
Last September, the husband-and-wife owners of a New Orleans-area nursing home where patients died in Hurricane Katrina's floodwaters were charged last September with negligent homicide.

The owners of St. Rita's Nursing Home in the town of Chalmette "were asked if they wanted to move (the patients). They did not. They were warned repeatedly that this storm was coming. In effect, their inaction resulted in the deaths of these patients," Louisiana Attorney General Charles Foti said at that time.
3 Arrested In Katrina Hospital Deaths : Doctor, 2 Nurses Booked On Second-Degree Murder For Patient Deaths
CBS News July 18, 2006

Nov 2006 The story - Foti an avenging angel!
As attorney general, Foti made elderly issues a priority, focusing on Medicaid fraud and medical standards of care.

In the traumatic days after Katrina, Foti moved swiftly to arrest Sal and Mabel Mangano, who had for many years operated St. Rita's nursing home in St. Bernard Parish-"the best nursing home in the parish," Dr. Bryan Bertucci, the coroner, testified in a civil deposition. Thirty-five people died in the flooding at St. Rita; Bertucci had offered the Manganos the use of two busses to evacuate residents. The Manganos declined the offer.

When the Manganos' mug shots were flashed across TV screens, the media narrative of Katrina found a criminal strand. Millions of Americans were outraged at FEMA's incompetence, the failure of elected officials from President Bush to Gov. Blanco to Mayor Nagin, and images of New Orleans like a third world backwater. The Manganos had been in a shelter before they were arrested, with all the implications of abandonment.

Few people realized the Manganos had actually stayed at St. Rita!s during Katrina, believing-as many did - they would ride out the storm. The levees had held in the past. When the place flooded, the couple and their son ended up on the roof with 50 people. "We saved 58 people with six people in tow boats," the Manganos' son, Sal Jr., is quoted in the September issue of Esquire.

Sal and Mabel Mangano were indicted in St. Bernard, though the judges in that parish, where many people had relatives or friends at St. Rita's, recused themselves. Retired New Orleans judge Jerome Winsberg has been appointed to preside over the case.

A key factor in the St. Rita's case is whether the Manganos were criminally culpable. Civil lawsuits against them need not prove intent, only damages to those who lost their loved ones as a result of the Manganos' alleged negligence. Their attorney, Jim Cobb, has counter-charged that state officials are at fault, particularly the Department of Transportation and Development, which did not provide an evacuation plan. Cobb also argues that Foti's office should be disqualified because the attorney general was a party to the state evacuation plan. The DOTD secretary has admitted to Congress that his office failed to deliver on its plan. In arresting the Manganos so soon after the storm, Foti positioned himself as an avenging angel righting the wrongs inflicted upon the helpless elderly.
Foti's Crusade The Greater Baton Rouge Business Report November 7, 2006

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The Memorial investigation unfolds

The investigation started soon after the flood when a doctor (who had not been there for the patients) and nurses from Lifecare went to the attorney general.

Oct 2005 Records removed
Tenet Healthcare Corp. said Sunday that the Louisiana attorney general removed medical records from the company's Memorial Medical Center in New Orleans over the weekend, following a warrant from a parish judge.

The company said it was told by the attorney general's office that the search was one of many the state planned to make in a probe of hospitals and nursing homes where deaths occurred during or after Hurricane Katrina.
Tenet Says Records Are Removed Bloomberg News October 3, 2005

Oct 2005 Employees subpoenaed
The Louisiana attorney general's office subpoenaed 73 employees of Memorial Hospital on Wednesday as part of its investigation of deaths at hospitals and nursing homes in the New Orleans area during and after Hurricane Katrina.
La. AG Subpoenas 73 in Hospital Deaths The New York Times October 26, 2005

Jul 2006 Witnesses
An exchange of dialogue quoted in the affidavit between Dr. Pou and an unidentified nurse executive said Dr. Pou told her: "decisions had been made to administer lethal doses" to patients remaining on the seventh floor of the unit who would not survive.
3 Arrested In Katrina Hospital Deaths : Doctor, 2 Nurses Booked On Second-Degree Murder For Patient Deaths
CBS News July 18, 2006

Jul 2006 Tssue samples
According to court papers, tissue samples taken from the dead at Memorial Medical tested positive for morphine and Versed, and the amount of Versed present was found to be higher than the usual therapeutic dose. Medical records reviewed by investigators also showed that none of the four patients were taking either of the two drugs as part of their routine care.

Foti said the combination of morphine and Versed "guarantees they are going to die."
Doctor, 2 nurses accused of killing patients with drug injections Corpus Christi, TX --- KRISTV.COM July 20, 2006

Jul 2006 Witness accounts and syringes
There’s some of the chilling details that they’ve given us, that there are eyewitness accounts of LifeCare employees, and they say that they observed Dr. Pou and the two nurses drawing something up from vials into syringes. One witness also said Dr. Pou told them that a decision had been made to administer lethal doses. And one more point that I wanted to tell you about - reading straight from the affidavit - was Dr. Pou was witnessed, and the two nurses together were witnessed walking in and out of LifeCare patient rooms. And they gave instructions to these employees to check on all the LifeCare patients and pull the sheets over the heads of those who were now deceased.
New Orleans Doctor, Nurses Charged with Murder NPR News, - ALL THINGS CONSIDERED July 18, 2006

Jul 2006 Lethal doses
''A decision had been made to administer lethal doses,'' Dr. Pou told a witness, according to the affidavit, released by the office of the attorney general, Charles C. Foti. Then, the authorities said, a witness saw Dr. Pou and the nurses filling syringes.

A 61-year-old patient identified only as E. E. was chosen. ''She was going to tell patient E.E. that she was going to give him something to help with his dizziness,'' the affidavit said. Dr. Pou entered E. E.'s room, it said, and closed the door.
But the patient identified as E. E. -- the only one whose case is discussed in detail -- was described as ''aware, conscious and alert.'' He also weighed 380 pounds and was paralyzed.

A nurse close to E. E. was asked by Dr. Pou to sedate him, but the nurse refused. ''I take full responsibility,'' a witness quotes Dr. Pou as saying.

One of the witnesses said she saw a nurse, later identified as Ms. Budo, give an injection to the oldest of the victims, identified as 92-year-old R.S., and then heard R.S. say, ''That burns.''

The affidavit suggests that many staff members at the hospital were familiar with Dr. Pou's plan, and that it was openly discussed. At the very least, there was widespread knowledge that ''we're not going to leave any living patients behind,'' as Susan Mulderick, described as ''incident commander'' for Memorial Medical Center, is quoted as saying in the affidavit.
Patient Deaths In New Orleans Bring Arrests The New York Times July 19, 2006

Jul 2006 Not possible to evacuate
"Dr. Pou decided E.E. could not be evacuated," the affidavit said. "Dr. Pou asked if one of (LifeCare's) staff members would sedate him. . . . They briefly discussed the matter with the nurse, but (a LifeCare administrator) decided that she did not want LifeCare staff involved."
Mr. Foti quoted Dr. Pou as telling others, "We'll take care of it," and then she and the two nurses then went to the bedsides of the four patients.
MD, nurses accused of killing patients after Katrina The Star-Ledger July 19, 2006

Sep 2006 A patients relative as witness
McManus said she spent the morning using a large piece of cardboard to fan her mother and a male LifeCare patient. She was still on the ward between 9 a.m. and noon, when LifeCare administrators claimed Dr. Pou and the nurses walked around with a tray full of syringes, going from room to room administering lethal injections to as many as nine critically ill patients.

"I didn't see anything like that," McManus said.
Woman is convinced her mom was killed at hospital ; She stayed with her through the hurricane Times-Picayune September 3, 2006

Sep 2006 Dr Pou's discussion with Tenet
The 2-1 ruling by Louisiana's 4th Circuit Court of Appeals means that, for now, a lengthy telephone conversation Dr. Anna Maria Pou had with a public relations officer and a lawyer with Tenet Health Care is protected by attorney-client privilege. Consequently, the eight pages of notes a Tenet lawyer took during the conversation are off limits to prosecutors, and neither Tenet employee can be interviewed by investigators, court papers indicate.

The second aspect is particularly damaging to the state's case, Assistant Attorney General Arthur Schaeffer said. Prosecutors think the two Tenet employees have "vital information to the ongoing investigation" and that removing them from the witness list "has a potentially major impact on the investigation."
Doctor's phone calls ruled private ; Tenet advice to Pou shielded, court rules Times-Picayune September 21, 2006

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The impact on families

One of the consequences of all this was that the families of the people involved were not told how their relative had died by the hospital or the doctors. The very least they could expect was to be told sympathetically. With all parties represented by lawyers and Mr Foti beating the bushes this was almost impossible. Their confusion and distress is obvious and predictable.

Jul 2006 The families
Like many others who lost family members during Hurricane Katrina, Ms. Jacob went through the agony of not knowing what had befallen her mother, when and where she had died or when her body would be returned. But the agony was made worse by the knowledge that Ms. Savoie, whose family members regularly lived into their 90's, had been recovering well.

''I kind of suspected that she was euthanized because I saw her on the 28th of August in the hospital,'' the day before the storm, Ms. Jacob said. ''She was sitting up, talking to us, no IV's; her blood was good.''

Asked if she would consider the death of her mother a homicide, Ms. Jacob hesitated.

''In a way I don't blame those nurses,'' she said. ''It was a terrible thing they went through. They made a decision, and maybe it was wrong, maybe it was right. I don't know. I was not there. But I know I would have liked my mother to pass in a different way.''
However, Ms. Jacob said, ''I don't think they should have euthanized all those people. I think maybe some of them could have come through.''

Paulette Watson Harris, a daughter of another of the four patients, Ireatha Butler Watson, was interviewed by The New York Times several months ago and said she thought her mother, who had dementia and gangrene that prevented her from walking, might have died of heat exhaustion.

On Tuesday, she said she was shocked to hear that her mother's death at age 90 might have been a homicide, although she said she had been suspicious because of the lack of information from the hospital.

''I think it was a selfish move on the doctor's and the nurses' part if they decided to do this,'' said Ms. Harris, who lives in Jefferson, La. ''I have never been in that situation before, but I don't think the choice would be mine to end someone else's life just because I think they're miserable."

Ms. Watson said she had hired a lawyer and called the arrests ''a step in the right direction.''
Patient Deaths In New Orleans Bring Arrests The New York Times July 19, 2006

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Dr Pou

The case centres around the doctor and the decisions she made.

Dr Pou’s background and record showed that she was a dedicated and highly respected doctor. Foti’s aggressive response jarred with her supporters and colleagues.

Jul 2006 University staff
Dr. Pou, who has been practicing medicine for 16 years, is on the staff of the Louisiana State University Health Sciences Center in New Orleans. Her biography on the L.S.U. Web site said she is an associate professor.
Patient Deaths In New Orleans Bring Arrests The New York Times July 19, 2006

Jul 2006 Praise and testimony from colleagues
Calling Dr. Anna Maria Pou "one of the greatest doctors I've ever worked with," a Louisiana State University Health Sciences Center department chairman said Wednesday that the ear, nose and throat specialist arrested in connection with the post-Hurricane Katrina deaths of four patients at Memorial Medical Center will continue to teach and conduct research -- but not treat patients -- at LSU.

"Anna Pou is one of those rare people who has devoted her life to the care of her patients and the practice of medicine," said Dr. Daniel Nuss, chairman of the LSU department dealing with ear, nose and throat problems.

Nuss was one of several friends and colleagues who extolled Pou's professionalism and concern for her patients less than two days after Pou, a cancer specialist, and two nurses, Lori Budo and Cheri Landry, were arrested and booked with four counts of second-degree murder.
On Wednesday afternoon, LSU announced that Pou, an associate professor of otorhinolaryngology, has been reassigned to nonclinical duties until her case has been resolved.

Pou, "like all citizens, is entitled to the presumption of innocence," the LSU statement said.

"She's a valuable member of our medical team and faculty," Zewe said.
But others spoke for her, describing her as a devout, deeply spiritual Catholic who always put her patients first.

"We're talking about an extremely dedicated doctor, the kind you'd want to take care of your own family," Nuss said. "That's why I think these accusations are very uncharacteristic of the doctor I know."
Dr. Isabel Ochsner, a longtime friend of Pou's, said her specialty of attempting delicate surgeries and helping people live with what can be disfiguring consequences is very difficult. "It takes a big heart to do that job," Ochsner said.

Blase McCarthy, a New Orleans lawyer who first met Pou in high school, agreed.

"She's a very nice lady," he said. "Regardless of what happened, she was put in a bad situation at a bad time, and I'm sure she did the best she could. I can't imagine she'd have done anything else."
Pou, the seventh of 11 children, graduated from Mercy Academy and earned undergraduate and medical degrees from LSU. She had residencies at the University of Tennessee and the University of Pittsburgh and a fellowship at Methodist Hospital of Indiana in Indianapolis.

From 1999 until she returned to New Orleans in September 2004, Pou was at the University of Texas Medical Branch in Galveston.
"I'm so ashamed of what someone has put her through," Ochsner said. "For someone of her caliber to be wrongfully accused of killing is a sin."
Doctor's colleagues rush to her defense ; Friend says Pou 'has devoted her life to the care of her patients' Times-Picayune July 20, 2006

Jul 2006 Dr Pou's ackground
Dr. Pou was known among fellow doctors as a fierce advocate for her patients and a prominent specialist in the difficult field of endocrine surgery. Her father was a doctor, as were two of her uncles, and she was so devoted to medicine that a resume listing her continuing education courses, scholarly publications and teaching activities stretches for 21 pages.
Accused Doctor Said to Have Faced Chaos at New Orleans Hospital The New York Times July 20, 2006

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Trial by Media

Mr Foti had decided to promote his career by using the media to drive the case. The accusation of second degree murder carried a mandatory life sentence.

Jul 2006 A life sentence
In Louisiana, anyone convicted of second-degree murder is sentenced to life in prison without parole. A grand jury is expected to review the case and decide whether enough evidence exists to bring criminal charges.
MD, nurses accused of killing patients after Katrina The Star-Ledger July 19, 2006

Dr Pou’s supporters had no choice but to accept that this was a trial by media and they did it successfully. Foti’s strategy backfired badly when the medical profession and the public rallied behind the popular and dedicated doctor who they saw as being publicly humiliated and falsely accused of murder.

One of the consequences of Foti’s witch hunt was that doctors would not volunteer to work in situations like this in the future.

Jul 2006 Looking for an explanation
Dr. Steven Miles, a professor of medicine at the University of Minnesota's bioethics center, said that instead of trying to kill, it is more likely that those charged were trying to relieve patients' pain "in a resource-poor environment and were doing the best they could."

He said that there are documented cases where patients have required seemingly lethal morphine doses to relieve extreme pain, and that he doubts the charges will be proven.
Doctor, 2 nurses accused of killing patients with drug injections Corpus Christi, TX --- KRISTV.COM July 20, 2006

Jul 2006 What went on?
Ms. Zoloth said it's hard to second guess what really went on in the hospital without more information, but the fact that the medical staff stayed on the job indicates that they were concerned about their patients.

Jul 2006 Stayed to care for patients - no one will next tme
She arrived at Memorial Medical Center to treat several patients as Hurricane Katrina's winds were gathering and did not leave until days later, when the water and the temperature and the body count had risen beyond endurance.

By the time the ordeal ended, her friends and supporters say, Dr. Anna M. Pou was one of the few doctors left in a hospital that had become a nightmare.
Her supporters, though, say there is another explanation: she was using drugs to try to calm and comfort patients who had nearly reached their limit.

Eugene Myers, a professor at the University of Pittsburgh who helped train Dr. Pou, said that what she had told him shortly after the hurricane sounded heroic.

He said Dr. Pou had told him that she and Lori Budo and Cheri Landry, two nurses who have also been arrested in the case either helped evacuate the last patients or tried to make them comfortable with pain medications.
Others who went through the storm cited the extreme circumstances of Hurricane Katrina in defending Dr. Pou and said they were unhappy with the attorney general's recommendation of criminal charges.

''There are a lot of doctors who have a lot of problems with this,'' said Dr. Richard Vinroot, who was at Touro Infirmary during the storm. ''It's going to have an impact on a lot of people, because nobody is going to want to stay for a storm again.''
Accused Doctor Said to Have Faced Chaos at New Orleans Hospital The New York Times July 20, 2006

Jul 2006 A lot of sympathy
We've yet to be shown evidence that Dr. Anna Maria Pou and nurses Lori Budo and Cheri Landry killed four patients at Memorial Hospital the Thursday after Hurricane Katrina, but even if it's proved that they willfully killed the four, there might exist a fair amount of sympathy for them.

Conditions in New Orleans were barely tolerable for the hale and hearty after the hurricane, and many will empathize with a doctor and nurses who they believe were trying to spare their painfully ill patients more suffering.
And there are those who want desperately to support them. They want to believe that if the patients were injected with lethal drugs, the ones depressing the plunger did so out of love. They can expect, though, to be challenged by those who argue that not even love grants anybody that right.
Debating our right to end suffering Times-Picayune July 21, 2006

Jul 2006 Vilifying the heroes
Others were disgusted that so much suspicion was being heaped on a small cadre of health care workers who stayed, at great personal risk, to tend to the sick -- and in conditions that most American doctors have experienced only in wartime.

"This is vilifying the heroes," said Dr. Daniel Nuss, who supervises the accused doctor, Anna Pou, at the Louisiana State University Health Sciences Center. "I think it's presumptuous for the attorney general or anyone else to try to assign blame for what happened under such desperate circumstances."
Pou, an accomplished head and neck cancer specialist, was given the opportunity to evacuate with others leaving the hospital, but she chose to stay and help patients, Nuss said. He said he believes her work in the days that followed was just as honorable.
Nuss said in a prepared statement Thursday. "With other dedicated doctors and nurses, she worked without sleep and without nourishment. ... At great self- sacrifice, she prevented further loss of life and has been credited with saving multiple people from dying."
Katrina doctor, nurses backed Los Angeles Times July 21, 2006

Jul 2006 Medical and legal backlash
This past week's arrest of a doctor and two nurses who stayed through Hurricane Katrina to care for stranded hospital patients -- but are now accused of killing four of them -- has prompted a strong backlash in the medical and legal communities here.
Some legal experts, meanwhile, have criticized Mr. Foti for crossing ethical boundaries himself in his news conference. Harry Connick Sr., the Orleans Parish district attorney from 1974 to 2003, noted that Mr. Foti's office said the suspects had been "charged," when, in fact, they have not yet been charged or indicted.

"All that occurred is an arrest," Mr. Connick said.

Timothy Meche, a New Orleans defense attorney who comments on legal issues for local media, said Mr. Foti's assertion that a homicide occurred appeared to violate Louisiana's rules of professional conduct for lawyers, which prohibit them from making public statements that would have the "substantial likelihood" of prejudicing a jury pool.

Jul 2006 Dedication rewarded with the worst
And now, in a perverse twist of fate, Pou and two nurses stand accused of murder for decisions they made trying to take care of their patients --and everyone else's -- as civil society collapsed around them. This story has electrified the medical world, and for good reason, Oregon doctors say:
Pou and the nurses chose to stay at Memorial Medical and help hundreds of sick people stuck in the stifling heat while the power failed, toilets overflowed and bodies floated in the lobby. They helped patients evacuate from the roof, and they apparently gave medicine --including painkillers and sedatives --to those who couldn't be moved.

They likely made mistakes, which seems forgivable under the circumstances. But their behavior failed the standards of the Louisiana attorney general, who accused them this month of killing four patients with lethal doses of drugs.
But it's reasonable to assume they stayed out of duty and love, the two best feelings in medicine. And now, as their reward, they face the worst.

UNDER THE MICROSCOPE Was it murder? The doctor is in, but she's hiding The Oregonian July 30, 2006

Aug 2006 Delicate issues trampled
Angry doctors say Mr. Foti's accusations have trampled delicate issues about end-of-life care and have made the doctor, Anna M. Pou, a scapegoat for the delays in evacuating a flooded hospital.

More than 200 local residents and evacuees have rallied to her defense on a community Web site, calling her a hero for working through the storm and accusing Mr. Foti of grandstanding. Even some of his former law enforcement colleagues criticize Mr. Foti's handling of the case and question whether his accusations will hold up.

The vehemence of the criticism has been striking, as the case has quickly become a flashpoint for the sense of abandonment and rage that many people here still feel for being left to navigate the storm's dire aftermath as best they could. And even some who have long been fans of Mr. Foti argue that whatever the doctor and the nurses did, it should not be viewed as criminal given how horrific the situation was.
Some defense lawyers said they would question the credibility of LifeCare and its employees. The company has acknowledged that 24 of its 55 patients died, and that its top administrator and medical director were not at the hospital during these days.

And while Mr. Foti's affidavit says that LifeCare's employees refused to help Dr. Pou give the injections, it does not indicate that they did much to stop her before evacuating.
Arrest of Nurses and Doctor Puts Attorney General In Louisiana on Defensive The New York Times August 1, 2006

Aug 2006 Dr Pou's family
Dr. Pou’s entire family is speaking out, too. Peggy Perino is her younger sister.

Mr. PEGGY PERINO (Younger Sister of Dr. Anna Pou): It’s crazy. I mean, it’s just totally absurd. Everyone who has ever known her and doesn’t know her just thinks it’s absolutely ridiculous.
Doctors Still Uncharged in Katrina Hospital Deaths NPR: All Things Considered August 31, 2006

Aug 2006 Community support
But after making those allegations, authorities have been moving slowly, and in New Orleans the three suspects are getting support from a sympathetic and outspoken segment of the community.
Doctors Still Uncharged in Katrina Hospital Deaths NPR: All Things Considered August 31, 2006

Sep 2006 Dr Pou's public denial
No, I did not murder those patients. Mr. Safer, I`ve spent my entire life taking care of patients. I have no history of doing anything other than good for my patients. I do the best of my ability. Why would I suddenly start murdering people? It doesn`t make sense.
SAFER (voice-over): Murder or not, the alleged crimes took place when help was actually on the way but no one in the hospital knew that. The owners of Memorial had chartered five helicopters. Within hours hundreds of people were evacuated, 34 people lay dead.
Euthanasia or Murder? CBS News: 60 Minutes September 24, 2006

Sep 2006 The AMA speaks up
"The American Medical Association continues to monitor closely the situation of Louisiana physician Dr. Anna Pou. Dr. Pou is an AMA member in good standing.

"The facts of this case appear complex, remain under investigation, and based on media reports, are sharply contested. Dr. Pou and others under investigation are entitled to due process and the AMA expects that they will receive full and fair treatment by our judicial system.
AMA Monitors New Orleans Case, Calls for Fair Investigation U.S. Newswire September 25, 2006

Sep Lousiana Medical society spaks out
Praising Dr. Anna Pou's performance in "horrific conditions" at Memorial Medical Center in the days after Hurricane Katrina, the Louisiana State Medical Society issued a strong statement of support on Wednesday, saying she acted "in the best interest of her patients."
But in its statement, the 6,116-member state medical society said it is "confident that Dr. Pou performed courageously under the most challenging and horrific conditions and made decisions in the best interest of her patients."
Group stands behind Memorial doctor ; Medical society gives vote of confidence Times-Picayune September 28, 2006

Jan 2007 American College of Surgeons criticises
In the aftermath of Hurricane Katrina, the American College of Surgeons remains concerned about the arrest more than five months ago of Anna Maria Pou, MD, FACS, and two nurses from Memorial Hospital in New Orleans. These individuals volunteered to remain at the hospital in order to provide care for patients, many of whom were terminally ill. Some of the patients were on ventilators, and there was no evacuation plan in place. Their acts were those of heroism. Medical and health care professionals should continue to be free to render appropriate medical care without fear of criminal charges regarding their emergency medical judgment being rendered by politicians and newspersons.
The College believes that the arrest of Dr. Pou and lack of due process in her case will have a chilling effect on volunteerism provided by physicians and health care professionals during emergency situations.
American College of Surgeons Calls for Fair Investigation in New Orleans Case PR Newswire (U.S.) January 11, 2007

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The nurses' colleagues rally
The nurses colleagues rallied. Unable to work the two nurses were destitute. Colleagues set up a fund and accepted donations to support them during this period.

Aug 2006 Dedicated nurses
KAHN: She (Green, a nurse colleague) says Budo and Landry never complained and stayed through the entire ordeal. Green says the two nurses were born at Memorial Hospital and have worked there together as a team for more than two decades. Green and other colleagues are now rallying to Budo and Landry’s side.

Ms. GREEN: They’re the best nurses that I know. I cannot think of any other nurse that could surpass them in skill and compassion. They are the best of the best, absolutely.
KAHN: Foti said the investigation isn’t over and suggested that other health care providers may be involved. That’s outraged New Orleans’ medical community, which has responded with angry letters to the editor and full page ads supporting the three suspects.
Doctors Still Uncharged in Katrina Hospital Deaths NPR: All Things Considered August 31, 2006

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The prosecutions case drags on and on and on!

The case dragged on without any charges being laid and with doubts about the evidence. When the coroner was unable to confirm that this was murder Foti insisted he still planned to prosecute. At the time of writing (June 2007), 11 months after the accusations were made, no charges have been laid and there are no more press reports. All the indications are that this will die a death by attrition but meanwhile the doctor and the nurses are barred from working and have suffered enormous stress and hardship.

Jul 2006 The blame game
"There is no motivation, and there is no homicide," Simmons said at a news conference. "It's a year later, and the blame game has shifted to this doctor and two nurses and maybe to others."
None of the three women has been charged with any crime. The course of the case is up to Jordan because the deaths occurred in his jurisdiction. Jordan's office said yesterday it had not received all of the findings from Foti's investigation, but will begin its review upon receipt.
MD, nurses accused of killing patients after Katrina The Star-Ledger July 19, 2006

Aug 2006 District attornet waiting for evidence
Orleans Parish District Attorney Eddie Jordan, to whom Foti turned over the case, said he still has not received a complete coroner's report. Jordan has decided to present the case to a grand jury, but that won't happen for at least another month, his spokeswoman said last week.
But close scrutiny of the medical evidence suggests the deaths at Memorial will be anything but an open-and-shut case.
The narcotic blends are potentially toxic, several doctors said, but they are not invariably so. And morphine and Ativan -- a brand name for lorazepam -- are so commonly administered in acute-care settings that they are almost routine pain-control treatments.
Doctor's drug mix not ideal killer ; Evidence in Memorial case called unreliable Times-Picayune August 6, 2006

Aug 2006 Waiting for autopsy reports
The D.A. says he can’t convene a grand jury until he gets the final autopsy reports from the coroner. Until then, Dr. Anna Pou and nurses Laurie Budo and Sherrie Landry wait. Landry’s lawyer, Eddie Castaing, says the wait is unbearable.
Doctors Still Uncharged in Katrina Hospital Deaths NPR: All Things Considered August 31, 2006

Nov 2006 Toxicology critical
Jordan needs evidence to present to a grand jury. A pivotal factor for Jordan is how Orleans Parish Coroner Dr. Frank Minyard decides to classify toxicology data from lab specimens of the four deceased seniors. Samples have gone to out-of-state labs, with toxicology consultants yet to render opinions. Police can arrest and prosecutors can charge or seek indictments, but only a coroner can classify a death as a homicide. Without that classification, there can be no murder case.
Foti's Crusade The Greater Baton Rouge Business Report November 7, 2006

Feb 2007 Seven months and waiting
More than seven months after Louisiana's attorney general recommended that a doctor and two nurses be prosecuted for putting patients to death in Hurricane Katrina's aftermath, the coroner here said Thursday that he had not yet found evidence that would show that the cases were homicides.

New Orleans Coroner Sees No Evidence Yet For Indictments The New York Times February 2, 2007

Feb 2007 Coroner can't support homicide
But now, the coroner has told 'The Times-Picayune" newspaper that toxicology and expert analysis cannot support that homicide claim and the cause of death is undetermined, which could prevent a formal indictment.


Feb 2007 But Foti plans to go ahead
Louisiana Attorney General Charles Foti is going to pursue homicide charges against Dr. Anna Pou and nurses Lori Budo and Cheri Landry, despite negative autopsy findings.

The grand jury is set for February. Suggestions: Sequester the jurors. Turn out the lights. Turn up the heat; 100-110 will be fine. Turn off the water, which includes the toilets. Don't feed them. Don't communicate with them. Wait four days.

When Mr. Foti goes in to have them render their decision, he may want to wear riot gear.
A suggestion for attorney general The Baton Rouge Advocate February 15, 2007

If Foti won’t back down voters may make the decision for him. He is being challenged at the 2008 election and it seems likely that if successful his successor will drop the case.

Apr 2007 Foti to be challenged
"Poor planning and poor administration by the attorney general's office are the hallmarks of the Foti regime, not to mention the politics-based decision-making process that seems to turn up at every corner," Alexander said in a written statement that launched his campaign. "We can't afford another four years of 'Keystone Cops' style leadership."

Alexander, 40, no relation to his former boss, did not cite specific cases he believes Foti has mishandled.
Candidate says he'll target Foti ; Lawyer announces attorney general bid Times-Picayune April 20, 2007

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Rebuilding New Orleans

It is now widely acknowledged that President Bush had appointed an incompetent associate to run emergency services in the USA. Government strategies had emasculated emergency services.

The failure of US emergency services to respond to warnings and to the acute situation is well documented. Local services were also unprepared. The inability of a country operated as a market rather than a social system to respond in situations where people and not profitability are at risk is revealed.

The town needed to be rebuilt and the returning residents needed hospitals. Very few had the money or insurance to pay for care. A market system would not provide needed services unless they were profitable.

Tenet itself came out of it all quite well. Its insurers paid up and it sold two hospitals to a local not for profit group which government could fund and which would provide the services. A third went to a company which is likely to redevelop the site.

Sep 2005 Economic forces vs Community planning
The New Orleans medical system has been devastated by Hurricane Katrina, and no one can say how many hospitals will ever reopen.

Although some local officials are calling for a central plan, decisions are likely to be based mainly on economic forces - not necessarily on the city's health care needs. Deregulation at the state and federal level over the last few decades has meant that the main force in the hospital industry now is the invisible hand of the marketplace.
Of the 16 hospitals in the immediate area of New Orleans, at least 13 were closed because of the storm or concerns about looting, according to the state hospital association. Mr. Arrick said that individual hospitals would decide, based on whether they had the wherewithal to rebuild and on their assumptions about whether there would be enough paying patients.

"I really think the economy drives everything," he (a bond analyst) said.
But many other New Orleans hospitals have not yet made decisions. These include two for-profit hospitals owned by Tenet Healthcare - the Lindy Boggs Medical Center and Memorial Medical Center - both heavily damaged by flooding.
The notion of health care planning has been out of fashion in this country, especially in states like Louisiana, where any health care oversight tends to be an exercise in local politics. Even after a disaster of Katrina's magnitude, many experts say that a coordinated government approach to rebuilding hospitals there is unlikely.

"I think Louisiana would be the last place for regional planning," said Mark V. Pauly, a health economics professor at the Wharton School of the University of Pennsylvania.

But some New Orleans hospital officials say it may now be time for a coordinated approach. "It's not really up to the hospitals to decide what the health care delivery system should be," said Donald R. Smithburg, chief executive of Louisiana State University's health care services division, which ran the state's two public hospitals in New Orleans - Charity and University, which had about 600 beds in total and are situated next to each other. With the water receding, the facilities are now being cleaned up.
It is not only a matter of how many people return, experts say, but also whether they have jobs and health insurance. If a large number of people have no insurance or are dependent on public programs like Medicaid to pay for their care, private hospitals may not have enough paying patients to warrant staying open.
The state's public hospitals, run by the state university system, are likely to get significant amounts of rebuilding money from the Federal Emergency Management Agency, just as the University of California, Los Angeles did after the earthquake in 1994 that damaged its medical center. Charity, one of the state hospitals in New Orleans, was badly in need of renovation even before Hurricane Katrina.
But any decisions about how much FEMA money will be available will not be made until the hospitals apply for reconstruction assistance, an agency spokeswoman said. Only government-run or nonprofit hospitals are eligible for this help.
Stuart Altman, a professor at Brandeis University, who was involved in regional health care planning for the federal government in the 1970's, said he would favor a regional rebuilding approach with any government money shared by all the city's hospitals.

"I would hope that they would move health care from a private service to a public service, regardless of the ownership of the facility," Mr. Altman said.
Can Hospitals Reopen? It's a Matter of Money The New York Times September 14, 2005

Nov 2005 Tenet's losses
Tenet said it slashed the accounting value of hospitals and imaging centers affected by Katrina by $201 million pre-tax. It also incurred $40 million in Katrina-related costs during the quarter, including $27 million in employee salaries and $2 million for evacuations.
Tenet's loss soars with hurricanes, drop in volume Modern Healthcare Daily Dose November 1, 2005

Jul 2006 Tenet's insurers pay up
Tenet Healthcare Corp. (THC.N) on Thursday said its property insurers paid the company $340 million to settle claims after half a dozen of its hospitals sustained severe damage and business interruption caused by Hurricane Katrina.
Insurers pay Tenet $340 mln for hurricane claims The Washington Post (Reuters) July 6, 2006

Jul 2006 A not-for-profit buys Tenet hospitals
Ochsner Health System, the largest private employer in the New Orleans area and the operator of one of the few local hospitals that never closed after Hurricane Katrina, announced Tuesday it would expand its reach by acquiring three underperforming hospitals owned by Tenet Healthcare Corp. of Dallas.

Ochsner executives said the deal for Memorial Medical Center in New Orleans, Meadowcrest Hospital in Gretna and Kenner Regional Medical Center should help bring stability to a medical community unglued by an exodus of doctors, a rise in indigent patients and a dearth of available hospital beds since the storm.
"Decisions will be made in our community rather than 1,000 miles away. That is the core of this transaction," Finn said. "Our community is going to have these facilities."
But Ochsner executives are banking that its position as a nonprofit with a community focus will help restock the supply of doctors. By recruiting doctors and nurses and making technology upgrades at the adopted facilities, Ochsner might be able to steady the wobbling health care market, Quinlan said.
Ochsner buying 3 hospitals ; Tenet selling its Memorial, Meadowcrest, and Kenner medical centers Times-Picayune July 19, 2006

May 2007 Sells one to developer
Tenet Healthcare Corp. said today that it has completed its sale of the former Lindy Boggs Medical Center in New Orleans to Victory Real Estate Investments LLC of Columbus, Ga.
Former Lindy Boggs Medical Center changes hands May 04, 2007

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Update August 2008

I have not done an extensive search because a recent article in the New England Journal of Medicine on Jan 3rd 2008 describes what has happened since I wrote this. It shows that there is no new information about what actually happened. It also discusses the ethical dilemmas, the implications for doctors, and the adverse impact on doctors conduct in volunteering in future disasters. It is worth reading as is Pou's letter criticising the article and pointing out that many of the claims made in the article are based on Foti's charges (also available on the www) have never been established in court.

In summary toxicology revealed traces of morphine and midazalam in the bodies but the concentration was insufficient to show that it was given with lethal rather than palliative intent as claimed by Pou. Foti, the attorney general agreed not to charge the nurses in return for their giving evidence against Pou, but a grand jury in August 2007 refused to indict her so the charges were dropped. The proceedings were behind closed doors so no details are available. With a pending election Foti refused to back down but he was not re-elected. A number of the patients' relatives have continued civil actions against the doctors and nurses. As a consequence they have not been prepared to give an account of what actually happened.

There is additional information on the "Official Site Dr Pou Defence Fund", the community group that formed to support Dr Pou and raise money for her defence. Dr Pou and others were active in pressing for a change to the legislation so that medical staff who voluntarily gave medical care in a disaster were better protected from similar prosecution - and from civil law suits. These measures were passed by the Louisiana state government in June 2008 as an extension of the good Samaritan act . A July 15 2008 article by Mary Foster from AP press describing these developments is reproduced on the Defence fund web site.

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Web Page History
This page created June 2007 by
Michael Wynne
Update August 2008