In New Orleans and elsewhere, many — including numerous physicians and the AMA — sighed in relief, hoping to put the nightmare — which many regarded as a gross injustice against heroic health care workers in unimaginably difficult circumstances — behind them.

But CNN is reporting that the issue may not be put to bed quite so easily:

A New Orleans grand jury that declined to indict a doctor on charges that she murdered patients in the chaotic days after Hurricane Katrina never heard testimony from five medical experts brought in by the state to analyze the deaths.

All five concluded that as many as nine patients were victims of homicide.

In detailed, written statements, the five specialists — whose expertise includes forensic medicine, medical ethics and palliative care — determined that patients at Memorial Medical Center had been deliberately killed with overdoses of drugs after Katrina struck New Orleans in 2005.

The grand jury had been asked to consider second-degree murder charges against a doctor and two nurses in four deaths. But in July, the grand jury decided that no one should be indicted…

In a decision that puzzled the five experts hired by the state, New Orleans District Attorney Eddie Jordan never called them to testify before the grand jury.

The experts themselves were puzzled and frustrated to have their evidence ignored:

“They weren’t interested in presenting those facts to the grand jury,” said Dr. Cyril Wecht, the former coroner of Allegheny County, Pennsylvania, and a past president of the American Academy of Forensic Scientists.

“The hard scientific facts are those from five leading experts, [the patients died] from massive lethal doses of morphine and Versed. As far as I know the toxicological findings were not presented to the grand jury and certainly not with quantitative analysis.” …

“I was never called to the grand jury,” said Caplan. “As far as I know, the grand jury never saw my reports. As far as I know, none of the reports prepared by these experts, who looked at all the cases, who were independent, and came to the conclusion that massive amounts of drugs were used as the cause of death and that they couldn’t have been requested [by the patients], they had to be given involuntarily. That’s evidence that I think a grand jury would want to be familiar with before it made its decision as to whether or not to proceed with an indictment.

“Now you can still get into a dispute about the evidence,” Caplan added. “You can get into a dispute about the circumstances and all the rest of it, but at face value there is no other conclusion I think that’s possible, other than these people — or someone — killed them.”

Dr. Pou testified that she had sedated patients to keep them comfortable in the intolerable conditions; the forensics experts found this an implausible explanation:

“The primary and immediate cause of death for each of these patients was acute combined drug toxicity, specifically morphine and Versed,” wrote Wecht. “The manner of death would be classified as homicide.”

“Large doses of these drugs were present in patients and the administration of the drug was not documented,” wrote James Young, the former chief coroner of the province of Ontario, Canada, who, like Wecht, once served as president of the American Academy of Forensic Sciences.

“Accidental overdoses would need to have occurred nine times between 12 noon and 3:30 p.m., all on one floor, to every patient who was left on the floor,” Young wrote. ” Again, it is noted that morphine was not ordered for seven of the patients and Versed was not ordered for any. Therefore it seems highly unlikely that nine patients died on the same floor on the same afternoon of accidental overdose.”

Caplan wrote that there was no evidence any patient asked to be given assistance in dying, and no evidence that any consented to be given an overdose of medication to end their lives.

“In reviewing the facts and opinions, my conclusion is that the deaths of the nine persons at Memorial Medical Center in New Orleans are all cases of active euthanasia,” Caplan wrote. “Each person died with massive doses of narcotic drugs in their bodies.”

The grand jury’s findings remain secret, although there are legal challenges to disclose them. The experts’ summary, however, also includes some chilling testimony, although the witnesses are not identified:

In its executive summary report included with the forensic experts’ findings, the attorney general’s office paints a chilling picture of what its investigators say happened four days after the hurricane hit New Orleans.

The summary cites a number of people — whose names are blacked out in the report — as having offered statements through their attorneys and having sought immunity from prosecution.

The summary states that Pou told the nurse executive of Lifecare, the acute care facility on the seventh floor of the hospital that housed the nine patients, that “a decision had been made to administer lethal doses of morphine to Lifecare patients.”

According to the report, none of the nine was a patient of Pou’s and there was no indication she had talked to their doctors before seeing them on the day they died.

The attorney general’s report also said that other medical personnel told Pou that one of the patients, Emmett Everett Sr., was conscious and alert. Everett was 61 years old, weighed almost 400 pounds and was confined to a wheelchair.

“Dr. Pou decided (patient name blacked out) could not be evacuated. He could not be taken out by boat because he was not ambulatory and Dr. Pou felt he was too heavy to be evacuated by helicopter,” according to the report.”

While we may never know the exact details of what happened at Memorial Hospital, the ghosts of that tragedy may continue to haunt us for years to come.

It was not the district attorney who had these people arrested. It was attorney general of the State, Charles Foti, who had them arrested despite that they were not charged. He made a big grandstand about it saying they were murderers, much like Mike Nifong said the Duke lacrosses players were rapists. The atty. general can investigate pursuant to his powers under the Medicaid Fraud Act. Then he has to turn things over to the local district attorney. Now the district attorney has convened a grand jury to see if he can charge the nurses and doc. that the atty. general arrested. The local coroner says he cannot determine cause of death. May I suggest heat, lack of medical equipment, stress and failure of government. But not lack of care from those who chose to stay behind to help patients and did not leave until all patients were evacuated.

I stand corrected on referring to Charles Foti as district attorney, rather than Louisiana Attorney General. And I wholeheartedly agree that he may well have used the Memorial death case opportunistically for personal political gain: the shadow of Mike Nifong looms long, and politically ambitious prosecutors can destroy lives by abusing the power of their office.

In fact, almost everything about this case begs for dismissal — it is fraught with extraordinary circumstances which solicit quick judgment and counsel hasty condemnation. A raging storm roars through a fragile city long known for its vulnerability, frail aging levies its sole defense against certain disaster. A city flooded, its weakest citizens trapped in a hospital-turned-hellhole. Heroic doctors and desperate nurses battling impossible circumstances, tending to the sick and dying, utterly abandoned by corrupt, inept civil servants and emergency services overwhelmed and overtaxed. An Attorney General exploiting public horror at the trapped and hopeless, sacrificing valiant healers to the gods of political ambition and self-aggrandizement. We desperately want to avert our eyes in disgust, having witnessed yet another example of corrupt politicians and cynical civil servants. The news is old; heap scorn and hurry along; judge harshly and hastily dismiss; feel that self-righteous contempt which comforts the mind while killing the spirit.

Yet pause we must. This perfect storm of pathos and perfidy masks a simple question which we ignore at our peril:
(more…)

The arrests were widely decried in the medical community — most of whom clearly had read none of the rather compelling and chilling testimony of other physicians and nurses who were present at the hospital. The case quickly became mired in charges of political grandstanding by the DA, who was considering running for governor and using the publicity around the case to raise money for his campaign. It subsequently went to a grand jury, which has used deliberate — some would say glacial — speed in investigating the case.

CNN today reports an update on the grand jury proceedings, where two of the involved nurses have been offered immunity to testify against the physician accused, Dr. Anna Pou.

The CNN update mentions this previously-unknown side story:

Craig Nelson, a New Orleans lawyer who is convinced his mother was killed by a lethal dose of morphine, has taken steps to file a civil lawsuit.

Nelson had an autopsy performed on the body of his mother, Elaine Nelson. The 90-year-old Jefferson Parish resident died inside Memorial Medical Center during the aftermath of the hurricane. Nelson said her death is not part of the murder investigation because his mother was elderly, frail and sick.

She was a patient of LifeCare, a long-term care facility run inside Memorial Medical Center’s seventh floor. Nelson said his sister was helping to care for his mother during Katrina, but was asked to leave. It was after his sister was evacuated that he was told his mother had died.

Test results conducted by a private lab hired by the lawyer indicate high levels of morphine in Elaine Nelson’s liver, muscle tissue and brain, Nelson said. He said his mother should have had no morphine in her system, since none had been prescribed to her in the week and a half before she died.

My prior discussion of this event may be found here, along with a substantial list of links for more information.

NEW ORLEANS, Louisiana (CNN) — In the desperate days after hurricane Katrina struck, a doctor and two nurses at a flooded New Orleans hospital allegedly killed four patients by giving them a lethal drug cocktail, Louisiana’s top law enforcement official said Tuesday.

“We’re talking about people that pretended that maybe they were God,” Attorney General Charles C. Foti Jr. said, announcing second-degree murder charges against Dr. Anna Pou, Lori L. Budo and Cheri Landry.

“This is not euthanasia. It’s homicide,” Foti said.

The charges stem from the post-Katrina deaths of some patients at New Orleans Memorial Medical Center.

An affidavit said tests determined that a lethal amount of morphine was administered on September 1 to four patients ages 62, 66, 89 and 90. Hurricane Katrina swamped the city on August 29.

According to the court document, the morphine was paired with midazolam hydrochloride, known by its brand name Versed. Both drugs are central nervous system depressants. Taken together, Foti said, they become “a lethal cocktail that guarantees that you die.”

The doctor and nurses were taken into custody late Monday, following a 10-month investigation that continues. Each was charged with four counts of being a principal to second-degree murder and released on $100,000 bond.

The original reports showed up in a British tabloid not known for its reliability, and this sourcing, as well as some of the details therein, led to widespread scepticism about their reliability. However, interviews with physicians and health care workers at Memorial Hospital raised troubling questions as well, and a formal investigation was launched. The investigation was delayed by the reluctance of the involved hospital personal to testify, as well as the difficulty of obtaining autopsy evidence on the badly decomposed bodies after the fact.

What struck me the most, at the time I first posted it, was the vehemence of some commenters about how ridiculous this report was. One suspects there will be no humble pie eaten by those who sarcastically castigated me for posting on such obviously fictitious urban legends.

But sometimes the truth can be more frightening than fiction.

UPDATE: Here’s some earlier media links filling in some detals of the investigation as it unfolded (I’ll keep this updated as more becomes available):

• CNN: Katrina Investigation Focuses on more than one person
• CNN: New Orleans doctor recalls dire scene
• CNN: New Orleans hospital operator has checkered past
• CNN: Staff at hospital debated euthanizing patients
• LifeSite: Court documents show hospital gave lethal injections
• AP: Bodies of Katrina patients to be tested for euthanasia drugs
• NPR: Euthanasia probe continuing in NO
• NOLA: Doctor, 2 Nurses charged in killing patients
• NOLA: Ethicists: Any deliberate killing crosses the line
• Disability group statement on NPR report
• AP: Doctor, 2 nurses charged
• Post-Courier: Charges over mercy killing
• Scholars say case won’t be easy
• Doctor, nurses used lethal injections to kill patients
• Arrest warrants and details of accusations from Louisiana DA
• Ethics discussion of Memorial Hospital events
• NOLA: Accused doctors calls get scrutiny
• Ethicists: No way to justify mercy deaths

In the aftermath of hurricane Katrina, there were some scattered reports–in an admittedly questionable media source (a British tabloid)–of euthanasia of patients trapped in a New Orleans hospital. I discussed the initial media report here, and did a follow up post here which expanded on the questionable nature of the sources and some of the comments in response. In brief, there was widespread skepticism from some commenters on the veracity of this report, which was, in their opinion, pure urban legend–and I was castigated for lending credence to such an outrageous myth.

Apparently they never got the word to the Louisiana Attorney General.

CNN is now reporting that a very active investigation is currently underway of Memorial Hospital–where 45 patients were found dead–by the Attorney General’s office. This investigation to date has uncovered additional testimony that euthanasia was actively discussed and may well have been performed:

The Louisiana attorney general’s office is investigating allegations that mercy killings occurred and has requested that autopsies be performed on all 45 bodies taken from the hospital after the storm.Orleans Parish coroner Frank Minyard said investigators have told him they think euthanasia may have been committed.

“They thought someone was going around injecting people with some sort of lethal medication,” Minyard said.

A nurse manager, Fran Butler, is quoted as saying:

“My nurses wanted to know what was the plan? 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.

Butler also told CNN that a doctor approached her at one point and discussed the subject of putting patients to sleep, and “made the comment to me on how she was totally against it and wouldn’t do it.”

Dr. Bryant King, a physician who was present at the hospital, was also interviewed by the AG’s office, and recounts his story:

But King said he is convinced the discussion of euthanasia was more than talk. He said another doctor came to him at 9 a.m. Thursday and recounted a conversation with a hospital administrator and a third doctor who suggested patients be put out of their misery.

King said that the second physician — who opposed mercy killing — told him that “this other [third] doctor said she’d be willing to do it.”

About three hours later, King said, the second-floor triage area where he was working was cleared of everyone except patients, a second hospital administrator and two doctors, including the physician who had first raised the question of mercy killing…

One of the physicians then produced a handful of syringes, King said.

“I don’t know what’s in the syringes. … The only thing I heard the physician say was, ‘I’m going to give you something to make you feel better,’ ” King said….

King said he decided he would have no part of what he believed was about to happen.

Time will tell how this investigation turns out–and it may ultimately be very difficult to prove what happened at Memorial Hospital, given the poor condition of the bodies and the difficulty in distinguishing therapeutic pain management and sedation versus the same drugs used in doses sufficient to kill. One suspects that those involved in such actions–if they occurred–will be loath to admit it–and likely would have been careful to avoid witnesses, if at all possible.

And I’m sure those who so vehemently argued the absurdity of this story will belly up to the bar and confess they may have overreacted just a bit–but I’m not holding my breath waiting.

Update 10-27-2005: CNN is reporting that dozens of subpoenas have been issued to find out what happened at Memorial:

The subpoenas were served on employees of all levels at Memorial Medical Center, which is owned by Tenet Healthcare, because “cooperation, lately, has not been as good as I had hoped,” Foti said.

The subpoenas require that people appear before investigators for questioning.

“Some people were not coming forward. We learned Tenet sent out a letter that had a chilling effect,” Foti said. “We had no choice but to issue these subpoenas.”

“They [Tenet] seem to be in a position of protecting themselves, while we are just trying to get to the facts of what happened at the hospital,” the attorney general said.

Stay tuned–this may begin to get very interesting…