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Report probes New Orleans hospital deaths

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  • CNN obtains report into post-Katrina hospital deaths
  • Report: "Might have to hasten Mother Nature along," doc says
  • 11 months of investigators' work covered in report
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By Drew Griffin and Kathleen Johnston
CNN
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NEW ORLEANS, Louisiana (CNN) -- A state law enforcement investigators' report -- obtained by CNN from a confidential source close to the investigation -- into the deaths of patients at a New Orleans hospital in the aftermath of Hurricane Katrina provides new details about the events that occurred at Memorial Medical Center.

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Among those who died at Memorial were, clockwise from bottom left: Emmett Everett, Elaine Nelson, Wilda McManus and Rose Savoie.

Sources familiar with the investigation tell CNN that the 68-page report was prepared by investigators from the Louisiana attorney general's office and given to the Orleans Parish district attorney who took charge of the case but did not gain any indictments. CNN has been told that the report was also distributed to other agencies familiar with the probe.

The document is a summary of more than 11 months of interviews, forensic analysis and collection of evidence. The period covered by the report is from September 2005, shortly after 45 bodies were removed from the hospital, through August 2006, when forensic pathologists retained by the state determined that eight, and possibly nine, of the deaths were the result of homicides.

The report -- titled "Memorial Medical Center -- Case #59-2652" -- was obtained by CNN from the confidential source four months after a New Orleans grand jury declined in July to indict a doctor, Anna Pou, who had been arrested in connection with four of the patient deaths that occurred in an acute care facility at the hospital. Pou, and two nurses, Lori Budo and Cheri Landry, were arrested by the state investigators prior to the case being turned over to then-District Attorney Eddie Jordan, who brought it before the grand jury. Pou, Budo and Landry all denied any wrongdoing. In June, Budo and Landry were given immunity in exchange for their testimony.

It is not known how much, if any, of the detail in the investigative report was presented to the grand jury. The report consists of investigators' summaries of more than 70 interviews with doctors, nurses and hospital administrators, as they recounted evacuation procedures and patient care in the chaotic days following the hurricane. During that time, the hospital was without electricity and plumbing, but still had food and water, the report says.

The forensic pathologists hired by the state concluded that as many as nine patients located on the seventh floor of Memorial were possible victims of homicide, though none of the pathologists were called to testify in person before the grand jury. The focus of the investigators' report is on the events that occurred on the seventh floor, in a long-term acute care facility operated by a company called Lifecare Holdings, Inc.

When they were arrested on charges including second-degree murder, Pou, Budo and Landry were charged with administering lethal doses of morphine and other drugs to Lifecare patients who they felt were immobile or too sick to be evacuated.

The investigative report obtained by CNN also ranges beyond events on the Lifecare floor to detail, for the first time, the deaths of other patients elsewhere in the building who may have been given lethal injections.

The conversations summarized in the Case #59-2652 report paint the most complete picture of the conditions inside the hospital at the time. The report is based on witness accounts, which a source close to the investigation says were taped and transcribed, and on follow-up visits to the hospital by state investigators to obtain evidence, including patient charts, pharmacy inventories and syringes that allegedly were used to provide the doses of morphine and other drugs that pathology reports indicate contributed to the deaths of many of the patients.

The summary of one interview reports that a senior hospital official said that he began making rounds at about 2:30 p.m. on Thursday, September 1. It says that "he had been told that the hospital was to be locked down by 5:00 p.m. and that everybody must be out by 5:00 p.m." The report does not say who issued that directive. The report notes that, previously, administrators had said that they were to evacuate all living patients. The deaths in question, according to investigators' accounts, occurred between noon and 4 p.m. on September 1.

Lawyers representing Pou portrayed their client as acting selflessly and heroically to care for patients as conditions inside the hospital became intolerable. Many medical professionals also rallied to Pou's defense. The American Medical Association issued a formal statement of support, saying, "The AMA is very proud of the many heroic physicians and other health care professionals who sacrificed and distinguished themselves in the aftermath of Hurricane Katrina. We believe these physicians served as bright lights during New Orleans' darkest hour.''

On the day the grand jury voted not to indict Pou, the attorney general's office released a six-page summary of its investigation of the Memorial deaths, focusing specifically on the actions of Pou, Budo and Landry. All the names of patients are redacted. The 68-page report obtained by CNN goes well beyond the detail in the six-page summary, and includes the names of patients.

In an email to CNN, Pou's attorney, Richard Simmons, said that the report is merely a summation of "witnesses and alleged statements which have never been the subject of cross-examination or verification." He also pointed out that Pou was not in charge of the seventh-floor evacuation, and that the pharmacist there, identified as Steven Harris, "readily" provided Pou with medication, not all of which was used. Simmons added, "The report reflects only a biased version of events and interviews as written by the Attorney General's staff in such a way to validate their expensive, fruitless, two year investigation."

When contacted by CNN, Harris said, "This is something I do not believe I should discuss with you."

In an interview with Newsweek magazine this past summer, after the grand jury said it would not issue an indictment, Pou said that it was a "group decision" to give patients morphine and a sedative to ease their suffering. She did not tell the magazine who else was involved in the decision. Dr. Pou said while she knew the drugs might hasten patients' deaths, she said that she did not set out to murder anyone.

Earlier, in a televised interview with Morley Safer of CBS's 60 Minutes, Pou said: "You have to understand that there were very sick people in the hospital. You have this intense heat. We have the lack of all the tools that we normally use. And so people were dying from the horrible conditions because they were not strong enough to tolerate them."

When asked directly by Safer if the attorney's general's charges against her were true, Pou replied: "I did not murder those patients."

Conditions of patients

A major point of contention evident in the report was the condition of the patients in the Lifecare ward. According to the report, Lifecare staff told investigators that Dr. Pou was not familiar with those patients' conditions, believing all of them to be near death. In fact, one patient was described by his primary care physician in the report as not in imminent danger of death, and another was alert enough to respond to being given a morphine injection.

Conversations summarized in the report include discussion about "putting patients out of their misery" in the wake of Katrina's devastation. One doctor, according to the report, told a Lifecare employee on September 1 that "only the strong would survive," and that "Mother Nature would take its course and that they might have to hasten Mother Nature along."

The report says that Pou told a Lifecare staff member that "patients remaining on the seventh floor were probably not going to survive ..." and ... "that a decision had been made to administer lethal doses to those patients." When another Lifecare employee asked Pou what she was going to use, the report says that she "showed him a big pack of vials of morphine and some loose vials, also."

In all, a source close to the investigation told CNN Pou was believed to have controlled more than 127 vials of morphine on the day the patients died, based on pharmacy inventories, toxicology reports and eyewitness accounts.

The report says that one doctor told investigators he saw Pou administer "a syringe of medicine to one of the patients in the femoral area." According to the report, another doctor, Bryant King, who was interviewed by CNN only days after Katrina tore through New Orleans, saw Pou "standing next to a patient with a handful of syringes ..." King said he found it curious, as physicians usually leave the administering of medications to nurses. Earlier, King had told CNN he left Memorial shocked at what he said he believed some of his former colleagues were about to do.

The state investigative report obtained by CNN says that, in addition to King, at least one other doctor objected to the alleged plan to euthanize patients.

The report also notes that when a nurse indicated to Pou that he did not feel comfortable sedating one of the patients, Pou reportedly said to him: "If you don't feel comfortable, or if you are not ready to do it, don't, because it will come back to haunt you. I know the first time I did it, it haunted me for two years."

The report gives the following accounts of the deaths of three patients in the Lifecare facility, who appeared, according to the report, to be conscious and responsive:

  • One Lifecare patient, Emmett Everett, was alert and aware, and, according to the summary of an interview with his primary care physician, "while Everett had a number of health issues, he was not in imminent danger of dying from those conditions and ... had expressed a desire to live." But since he weighed 380 pounds and was paralyzed, some felt he could not be evacuated. After some discussion on the seventh floor with a Lifecare administrator, the report says that Dr. Pou asked for a tray, and the Lifecare employees present left.
  • Lifecare's director of physical medicine, identified in both the six-page summary and the 68-page report as Kristy Johnson, told investigators that she "heard Dr. Pou tell patient Wilda McManus, 'I'm going to give you something that's going to make you feel better.' " The account continues: Johnson "later heard Dr. Pou say ... 'You know, I had to give her three doses, she's fighting.' "
  • Johnson told investigators she heard another patient, Rose Savoie, say, "That burns," after a nurse whom Johnson identified as Budo administered an injection.
  • Kristy Johnson did not return phone calls from CNN.

    Everett, McManus and Savoie were later found dead, and were among those whom the prosecution's medical experts believe to be possible victims of homicide.

    Investigation halted

    Less than two weeks after Katrina ravaged New Orleans, Attorney General Charles Foti's office began its investigation of the deaths at Memorial Hospital. But in August 2006, then-DA Jordan, whose office would be responsible for any prosecution, wrote a letter to Foti asking that the investigation be halted. "Upon review of the documents presented to my office, I am now of the opinion that such an investigation would not be advantageous to the case," Jordan wrote in the letter, obtained by CNN. "Therefore, I am requesting that the investigation by your office of such deaths cease until the Grand Jury investigations begins in earnest."

    CNN has been told that the directive was crushing to investigators. The lead attorney for the attorney general's office, Arthur Schafer, told CNN that Jordan's letter effectively put an end to the investigation. "Yes we got that letter and yes it told us to stop investigating," Schafer said. "And through other phone calls we already knew we were being told to stop, they didn't want any more information."

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    Jordan resigned his post due to unrelated matters last month. In spite of repeated requests from CNN, he has never commented on his handling of the Memorial case, but a spokesman for the district attorney's office told CNN: "All relevant information was presented to the Grand Jury. The Grand Jury exercised its discretion based upon its assessment of the merits."

    Neither Lifecare nor Tenet, the company that owned Memorial at the time, would comment on any aspect of the investigators' report. E-mail to a friend E-mail to a friend

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