The tragic deaths at New Orleans's Memorial Medical Center after Hurricane Katrina are among the most notorious examples of the vast human suffering that resulted from the destruction of the levees and the flooding of the city—and the government's incompetent response to the disaster. As many as 34 people died in the hospital awaiting evacuation and it wasn't long before dark rumors began circulating that some of them were helped along by lethal doses of morphine or other pain medication. Almost a year after the storm, in July 2006, authorities arrested Dr. Anna Pou, a well-known head and neck surgeon. She was eventually accused of murdering nine patients who were in a long-term acute care unit on the seventh floor run by LifeCare Hospital of New Orleans. (Two nurses were also arrested but their charges were later dropped.)
Late last month, a Louisiana grand jury refused to indict Pou and the highly controversial criminal case came to a close. Pou still faces several civil lawsuits brought by relatives of patients who died while at LifeCare. In her most extensive comments yet on the events surrounding those deaths, Pou tells NEWSWEEK's Julie Scelfo that she did indeed administer morphine to the nine patients and she knew that the medication might hasten their deaths. But, she says, killing them was not her intention. In the desperate calculation Pou and other medical professionals were forced to make in the chaos and madness that engulfed the hospital, she says some patients could be saved and others were certain to die. It was their suffering Pou says she sought to alleviate. Excerpts:
NEWSWEEK: What was it like after the levees broke?
Dr. Anna Pou: Monday after the storm passed, we figured, 'OK, minimal damage; we began organizing how we were going to evacuate the hospital.' We didn't have full power so we needed to move patients. Tuesday morning we were planning our day and one of the nurses called me to the window and said you've got to come see this. Water was gushing from the street. So we all kind of looked in disbelief. What is this? We could tell the city was flooding, you could see water down Claiborne Street. It was rising about a foot an hour. Then the whole mood at the hospital changed and what we were doing changed. We were in hurricane mode and we had to go into survival mode because we knew we had to be there for some time.
Who organized patient care?
The chief of staff organized physicians. He got us all together and said we have a lot of patients in the hospital so we are going to assign physicians to different units and you can triage and decide how well patients can do with the evacuation.
How did you determine who was fit to be evacuated?
On Tuesday, the categories were: 'Is the patient well enough to be discharged home, or since they couldn't go home, [released] into general population?' The second group were those who needed to be discharged to a nursing-care facility. The third group were patients who were acutely ill who needed to go to an acute-care facility.
What was the hospital like? I know the hospital allowed those who worked there and their extended families to use it as a shelter.
It made the situation much, much more difficult because we had people who shouldn't have been there—physicians, nurses, employees, extended families, pets. That really comes into play because instead of a few hundred people to take care of there were 2,000 people. That [policy] was one of those errs in human judgment.
So who was evacuated Tuesday?
The patients who were the sickest, babies in the nursery. We got the sickest people out that we could. There were very few helicopters. It was not like a fleet of helicopters came to take away a fleet of patients. They were very sporadic and …after dark, they don't fly.
How did things change on Wednesday?
Tuesday night, we lost generator power, and that changed things a lot. 'Til then we were on generator power so we did have some lights, and we did have some water. Water wasn't clean, but it was running. But then we didn't have water, we didn't have any electricity, commodes were backing up everywhere. Conditions in the hospital started to deteriorate Tuesday night and early Wednesday. When that happens it makes care a lot more difficult. I was called to help suction a patient who had a tracheotomy but we had no suction running. We were going down to very, very basic care. You try every old-time method you can … [P]eople in charge were trying to get helicopters to come, [but] at that time we were told we were low priority. There were people on rooftops [who were going to get rescued first]. They said … there's not going to be a lot of help coming, [so] what we decided [was] if helicopters were going to show up sporadically, we have to have patients ready and waiting to go.
How many people had died at this point?
I can't tell you the number. The morgue was full and patients were already in the chapel, people were asking for body bags and "What do we do with bodies?"
In normal triage situations, the sickest people are treated first. But my understanding is that conditions were so bad, you and the other medical staff switched to a reverse triage or battlefield approach. Tell me about this.
The conditions were unbearable. Inside the hospital it was pitch black, with odors, smell, human waste everywhere. It was very rancid. You would take a breath in and it would burn the back of your throat. The patients were very sick. That's when we had to go from triage to reverse triage because we came to realize if patients aren't being evacuated, [we had to deal with what we had]. Basically it was a general consensus that we're not going to be able to save everybody. We hope that we can, but we realize everybody may not make it out.
What were the categories?
We divided patients into groups one, two and three. Patients in category one are able to sit up and walk and are not very sick. Patients in three are critically ill, "Do Not Resuscitate." The ones in category two were sick, but doing much [better than those in category three]. The triage system was very crude—we'd write the number 1, 2 or 3 on a sheet of paper and tape it across the patient's chest with their hospital records. There was limited use of flashlights. There were limited batteries. [Parts of the hospital] were pitch black. I'm talking jet black. Very dangerous. It was pitch dark in inner rooms.
What is the reverse triage process like?
Let me tell you, for a patient to be triaged—typical triage isn't that difficult. Reverse triage is heart wrenching. Absolutely heart wrenching. You place patients into categories. With boats coming and going we could evacuate patients who could sit. There were elderly couples—how do you make that decision who can go when one was sick and the spouse wasn't? Do you let elderly couples go together as husband and wife? Some of these couples had been married 50 years.
When was the first time you were on the seventh floor LifeCare acute unit? How did you come to be there?
On Monday, mid afternoon around 2 p.m. or 3 p.m, the intercom system was still working then. I was with nurses, doing things like setting up emergency operating rooms. We heard a code, a code in LifeCare. The nurse next to me said, "Anna, I think you better go. I don't think there's anybody up there." So I ran up the stairs and when I got there, there was a patient who had arrested and some nurses in room. I intubated the patient, put an endotracheal tube in. The nurses had already started the code. Then another physician came up from the emergency room. The patient didn't survive. What was interesting to me was that my friend said, "You better go there, I don't think there's any doctor there." The nurses said it's rare we get a doctor there on LifeCare.
Tell me about conditions from Wednesday night until Thursday.
By the time Wednesday evening came around, if you can imagine in our mind, there is a central area that is a sea of people. A lot of very sick patients in that central triage area. It's grossly backed up. Few patients had been evacuated. So there was just enough space to walk between the stretchers. It is extremely dark. We're having to care for patients by flashlight. There were patients that were moaning, patients that are crying. We're trying to cool them off. We had some dirty water we could use, some ice. We were sponging them down, giving them sips of bottled water, those who could drink. The heat was—there is no way to describe that heat. I was in it and I can't believe how hot it was. There are people fanning patients with cardboard, nurses everywhere, a few doctors and wall-to-wall patients. Patients are so frightened and we're saying prayers with them. We kind of looked around at each other and said, "You know there's not a whole lot we can really do for those people." We're waiting [for help]. The people in that area could have [been evacuated] by boat but no boats were coming. I would do what I could with the nurses: changing diapers, cooling patients down with fanning. It wasn't like, "I'm a doctor, you're a nurse." We were all human beings trying to help another human being, whatever it took.
Were people still dying at this point?
Every now and then a nurse would say, "Dr. Pou, this patient isn't breathing any more." Or I would be fanning patients and watch them take their last breath. So that's basically what it was like Wednesday night: kind of a feeling of helplessness, frustration, sadness. It's sad. You look around and think we live in the greatest country in the world and yet the sick could basically be abandoned like this.
What happened Thursday?
On Thursday morning we were told nobody was coming and we had to fend for ourselves. Everybody was kind of like at a loss here. What is plan B? Or plan C?
At what point did it become clear some patients wouldn't make it out alive?
I think when we went to reverse triage. It was always everybody's hope that every single person would make it out of the hospital. Everybody did everything to make that happen. What you have to do when resources are limited, you have to save the people you know that you can save. And not everybody is going to survive those kind of conditions. And we knew that. People were dying. People were dying in the hospital. Not through lack of effort. Healthy people were getting sick. Employees' family members were getting sick. People from the neighborhood came in getting sick. We were trying to find insulin for people. It was a mass of people—very chaotic. You have to realize there were people everywhere, not only patients, but 2,000 people in the hospital. That is a lot of people.
Tell me about the decision to administer painkillers to the nine people on the seventh floor?
There were patients, all of us knew, still remaining in the LifeCare unit. They were category three [in the reverse triage system]. We all believed eventually everybody was going to leave the hospital. We just didn't know when or what was the time frame. So we knew that patients were going to be there for long time. We knew they were going to be there another day. That they would go through at least another day of hell. Basically it was decided to give the patients sedation.
Who exactly made the decision?
It was basically a group decision. I was asked to go check on patients on LifeCare.
So who was the doctor in charge on the LifeCare's acute unit on the seventh floor?
To my knowledge nobody was there. The medical director was not there.
Who sent you to seventh floor?
It was a group decision. I didn't really volunteer for anything.
How did you come to be the one administering the injections? Louisiana Attorney General Charles Foti made a point of saying you had administered medication to people who were not your patients.
This was an emergency situation. There were no LifeCare doctors. In an emergency situation, the patients become everybody's patients. What are you supposed to do if a patient needs to be cleaned and have IV fluids, say, "You're not my patient, good luck"? That's absurd. If that's the case I dare say three-fourths of the population of Memorial Hospital would have been left without a doctor. We're in medicine because we care about people. This is what we do. We don't run around murdering people. That's why what he said is so ludicrous.
What was your intention when you administered injections to the nine patients in the acute unit?
The intention was to help the patients that were having pain and sedate the patients who were anxious. That was it. Reverse triage meant the sickest would be the last to be triaged. We didn't know how much longer they would be there. I take care of patients with cancer, so if I was a murderer, it would really be an interesting combination, very incongruous.
Did you consider when giving the injections that they might hasten these patients' deaths?
I guess the thought crossed my mind. Any time you give medicine it crosses your mind. There's always a risk of hastening death. There is a risk with every single thing we do in medicine. Every time you give antibiotics there's a risk.
Did that factor into your decision to administer these painkillers and sedatives?
Basically what we're trying to do is help the patients. Let me tell you—God strike me dead—what we were trying to do was help the patients. Everything was done with their best interest in mind. First and foremost. Any medicines given were for comfort. If in doing so it hastened their deaths, then that's what happened. But, this was not, "I'm going to go to the seventh floor and murder some people." We're here to help patients.
How uncomfortable were the patients on the seventh floor?
I don't want to be disrespectful to the dead [and give any specifics]. In general, LifeCare patients are very sick people, extremely ill or chronically ill. [And the harsh environment] took a toll on patients. Patients were dying.
As a physician how do you balance risk and the need for palliative care?
Any physician cannot practice medicine if we could not give painkillers. It would be barbaric. "Oh you're dying of metastatic lung cancer, but if we give you morphine for pain, you may die a day earlier?" What do you do, not give the medicine? So it is usually disease and illness that is responsible for a patient's death. The intention is to alleviate pain and give the patient the best quality of life. That is part of the Hippocratic oath, that I'm not going to let you die in misery and agony. It was a very, very helpless, helpless experience. All you could do is make them comfortable. And I shouldn't downplay that.
When did you leave the hospital and who was still there when you left?
I left Thursday around 6 p.m. in a helicopter. When I left no one was in the hospital. There were a handful of patients on the helipad. I went to [another hospital and then] on a bus to Baton Rouge because my family was there.
How did you feel?
I was tired but I was more in total disbelief that the sick and the poor could be abandoned the way that they were in the United States of America. I never thought I would ever live to see that day. I was sad, heartbroken, kind of amazed and shocked at the lack of organization—the fact that there was no type of coordination. I have friends who practice in the third world and this was less than third world.
What was it like to be arrested in 2006?
I had [performed] surgery that Monday. It was bedlam in the medical community after Katrina. I had surgery Monday, Tuesday, Wednesday, Thursday and clinic on Friday. And the attorney general's office knew that. I was taking care of indigent patients. He put my patients at risk. I am still angry about that. And then I was basically sitting by myself eating a salad, still in scrubs. I was starving and really dehydrated because I had been on call the weekend and been up 48 hours before. There was a knock on the door. It was four agents from the attorney general's office.
The whole way [to jail] I was asking God to help my family get through this. I have nieces and nephews, and my hospitalized patients, who found out about this on the 10 o'clock news, which was heinous. Had I known [about the arrest], I could have spoken to my patients. Instead I just don't show up and they see me on the news. There were cancer surgeries that had to be rescheduled. These patients' treatments were delayed because of what happened. I am still furious about it. It just really makes me mad.
How did the ordeal affect your mom, who is 84, and your family? And husband?
For my family there's been a lot of highs and lows. Good days, bad days. My mother is a really remarkable person. My mother is an extremely religious person who has a lot of faith. She told me to put myself in the hands of Jesus and everything will be OK, and to hope and to trust. I never fully realized the power of prayer before this.
So when did you start practicing medicine again?
I started practicing again in February. I don't have to tell you about the shortage of physicians in the state. There aren't a lot physicians in our state with head and neck cancer [as a specialty].
How did you feel when the grand jury declined to indict you?
I really fell to my knees. I was home with my husband. I was so grateful for their fairness and grateful to God. I couldn't believe it had happened. I was pretty much in shock for a couple of days, going, "Is it really over?" For two years it's the most effective form of torture—the uncertainty and the waiting and waiting and having everybody take a shot at you.
What did you think when the attorney general said he still believes you committed murder?
I actually felt sorry for Mr. Foti. What he did was so unprecedented and is typically not done. I know he had his reasons for doing it, but I just felt sorry that he feels that he has to continue his actions. I'm not going to dwell on that. I'm really going to move forward with my life. I'm not going to focus on Mr. Foti. I don't want to go backwards.
How has this affected your feelings about practicing medicine?
I love the practice of medicine. Fortunately or unfortunately it really defines who I am. I'm not going to let this make me bitter. I will always do what's in the best interest of my patients. As a physician who makes hard choices regarding treatments, I'll always continue to do what's in my heart the right thing to do. I'm not going to let this taint what I do. I know the type of life I've lived.
Do you feel this will always be hanging over your head?
Professionally, the patients I've taken care of in the past still call me every day—I had one this morning—who say they still want me to be [their] doctor. People say we know what you've been through and we're so sorry. They know I'm sincere, they know my reputation as a caregiver. I don't think this will be as big an issue as you think. People who know me, know me. In another sense, will this ever be over for me? No. Even though I've had some legal victories, nobody's won here. There will always be the sadness of what happened at Memorial Hospital, of what happened to the city. I think everybody who lived though Katrina will carry the memories with them for the rest of their lives. How can that ever be over for anybody?