Fury Meets Katrina Hospital Arrests

This 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 doctors saw the accusations leveled by Louisiana Atty. Gen. Charles C. Foti Jr. on Tuesday as brash, misguided moves that permanently smeared the reputation of three respected colleagues.

Others were disgusted that suspicion was being heaped on a small cadre of healthcare 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.”

Nuss said he was confident the suspects -- all veteran caregivers with unblemished professional records -- would be found not guilty.

Pou, 50, and nurses Lori L. Budo, 43, and Cheri A. Landry, 49, were booked Monday on suspicion of second-degree murder for allegedly injecting patients with lethal drugs at Memorial Medical Center on Sept. 1. It was three days after Katrina struck New Orleans, leaving the city in chaos and deep water. There was no electricity, water or phone service at the hospital, and only a few rescue boats were available for evacuations.

Pou, a head and neck cancer specialist, was given the opportunity to evacuate the hospital with others, but chose to stay and help patients, Nuss said. He believes her work in the days that followed was just as honorable.

“By personal accounts from nurses, doctors, administrators, and support personnel who knew Dr. Pou and had worked with her closely in the months before Katrina, her work during the crisis was ‘heroic,’ ‘selfless’ and ‘distinguished,’ ” Nuss said in a prepared statement. “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.

“Apparently there were individuals in the hospital who could not understand why so many people were dying,” Nuss’ statement continued. “Allegations were made, egregiously accusing Dr. Pou and the others of giving too much narcotic pain medication, and even using the word ‘euthanasia.’ This attracted national news coverage, which became absurdly sensationalistic.”

Pou, who was released on bail this week, has been reassigned to nonclinical research duties pending the outcome of her case.

The criticism of the criminal case is not limited to doctors who know Pou personally. Some other New Orleans doctors accused Foti, who plans to run for reelection in 2008, of grandstanding.

“Where the hell was he?” asked Dr. L. Lee Hamm of Tulane University School of Medicine, 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 Ali, a pulmonary-critical care doctor, stayed through the flood at Memorial’s sister hospital, Lindy Boggs Medical Center, across town. Like Memorial, the hospital was surrounded by deep water and had lost electricity.

“We had no help -- no help was in sight. And we felt abandoned. We didn’t know what we were dealing with,” he said.

Ali 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 healthcare workers as to whether it’s fair to project them as murderers.”

Investigators allege the suspects killed four patients -- all residents of a long-term care ward -- with a drug cocktail of morphine and midazolam, which is commonly used to relieve pain and anxiety among long-term-care patients.

In an affidavit, a witness alleges that Pou said “lethal” doses of the drugs would be given to a number of patients on the ward.

Among the patients was a 380-pound paralyzed man who was “aware, conscious and alive,” according to the affidavit.

Orleans Parish Dist. Atty. Eddie Jordan said Thursday that he would refer the cases to a grand jury, which would determine whether the suspects should be indicted. Foti’s office has said more arrests and more victims will probably be announced.

Also on Thursday, a source close to the investigation who was unauthorized to talk about the specifics of the case said evidence could include testimony from one or more witnesses who participated in administering the drugs.

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.

For instance, the affidavit noted that the bodies of the victims contained a “lethal amount” of morphine, and levels of midazolam that were “greater than expected from normal therapeutic doses.”

But Ben deBoisblanc, a Louisiana State University medical professor and a doctor at Charity Hospital, said those kinds of quantifications could be tricky, because the amount of drugs needed to treat pain and anxiety could vary significantly from patient to patient.

“The attorney general can’t tell from a [corpse’s] drug level what’s an appropriate dose,” he said.

David Magnus, director of Stanford University’s Center for Biomedical Ethics, defended a physician’s right to help ease a patient’s pain.

“Physicians are always allowed, and arguably obligated, to relieve the pain and suffering of their patients,” he said, even when it risks killing them.

But Magnus said there was an impregnable ethical line defined by “the intention of the act.” A doctor, he said, may administer drugs and view death as “a foreseeable and unintentional consequence.” But a doctor may not intentionally kill a patient.

“I feel for the medical personnel, who were faced with this horrible situation,” he said. “The patients can’t be evacuated. You can’t abandon them. You can treat them. These patients will probably die.... But to euthanize them against their will is ethically not an acceptable solution.”

Some legal experts have criticized Foti, the attorney general, saying he crossed ethical boundaries in his news conference.

Harry Connick Sr., the Orleans Parish district attorney from 1974 to 2003, noted that Foti’s office said the suspects had been charged when in fact they had not been charged or indicted. In Louisiana, the attorney general can make an arrest on suspicion of a crime, but the district attorney must file the formal charge.

“All that occurred is an arrest,” Connick said.

Timothy Meche, a New Orleans defense attorney who comments on legal issues for local media, said 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.

Foti spokeswoman Kris Wartelle said her office was within its rights as the investigating agency to call the news conference.

She said her office was “absolutely certain” that crimes occurred -- and that they took extra care to be well prepared.

“This is a possible homicide committed by doctors who were highly esteemed professionals, who everybody thinks are gods -- and in some cases they think they’re gods,” she said. “You don’t waltz into these kinds of cases lightly.”