Dr. Anna Maria Pou
The Louisiana healthcare community is reeling from the July 18 arrests of Dr. Anna Maria Pou and registered nurses Lori Budo and Cheri Landry, who are accused of second-degree murder for "mercy killings," giving four patients that were either too ill or too incapacitated to be transported too much narcotic pain medication, which reportedly resulted in their deaths.
This action occurred during the four-day period following Hurricane Katrina at Memorial Medical Center in New Orleans when there was no electricity, no running water, overflowing toilets, no communication between floors in rising triple-digit-temperature heat in the eight-story, 317-bed hospital in New Orleans overrun with evacuees and when bodies were floating in the flooded lobby.
If convicted of second-degree murder, Pou, a 50-year-old specialist in otolaryngolical cancer surgery, and an associate professor of otolaryngology at the Louisiana State University (LSU) School of Medicine, faces life in prison.
Two weeks after Hurricane Katrina, some 40 bodies were recovered from the hospital. Autopsies revealed that four bodies contained traces of a deadly combination of morphine and the sedative Versed. None of the four patients — Hollis Alford, 66; Emmett Everett Sr., 61; Rose Savoie, 90; and Ireatha Watson, 89 — were reportedly taking either of the two drugs as routine care.
"Apparently, there were a few individuals in the hospital who could not understand why so many people were dying," said Dr. Daniel W. Nuss, professor and chairman of the LSU Department of Otolaryngology. "Allegations were made, egregiously accusing Dr. Pou and the others of giving too much narcotic pain medication, even using the word 'euthanasia.' This attracted national news coverage, which became absurdly sensationalistic. Because of the widespread news coverage, an official investigation was launched."
The Louisiana State Medical Society expressed concern about the controversial accusations, adding that the judicial system "should be allowed to ultimately determine what actually took place at the hospital in the days following Hurricane Katrina."
The American Medical Association would only state its policy: "euthanasia is fundamentally incompatible with the physician's role as a healer."
At the conclusion of the 10-month investigation, Louisiana Attorney General Charles C. Foti clearly stated: "This is not euthanasia. This is homicide."
Some physicians have rallied support for Pou, considered a "brilliant, kind" doctor who "would never harm anyone intentionally."
"No one in their right mind would believe that these good citizens and proven healthcare providers would suddenly decide to use the circumstances of a natural disaster as cover to satisfy an urge to commit a murder," said Dr. Ricardo Febry of New Orleans.
New Orleans resident Louis Shepard criticized finger-pointing out-of-state medical ethicists who are "sitting in their air-conditioned offices, knowing that their families are safe, that their houses are fine, that they can sleep in their own beds and come to work at the same place tomorrow.
"If the government wants to place blame for what happened, they need look no further than the government's failure to come to the aid of its most vulnerable constituents in a timely manner," he said.
Dr. Ben deBoisblanc, director of critical care at Charity Hospital, called "this doctor and these nurses" heroes who "had an opportunity to leave and chose not to." He said morphine and Versed are commonly given to relieve suffering and anxiety and "the very fact that you found these drugs means nothing."
Dr. Steven Miles, a bioethicist at the University of Minnesota Medical School, said the drugs are routinely used in palliative medicine, both individually and in combination, and that there's no reliable lethal use of these drugs. "That's why they're not used, for example, in executions," he said.
Some legal and healthcare experts view Pou's high-profile arrest as fodder for the slew of civil lawsuits popping up citing corporate negligence, such as the hospital not having an adequate backup power source in place. The first wrongful-death suit was filed on Oct. 14 against Tenet, the Texas company that owned Memorial Medical at the time of the storm. Plano, Texas-based LifeCare Holdings, Inc., which leases space at Memorial Medical and operates 21 long-term acute care hospitals at facilities located in Colorado, Michigan, Nevada, North Carolina, Ohio, Pennsylvania, Texas and Wisconsin, was later added to the suit. LifeCare Holdings, Inc. is owned by the Carlyle Group, based in Washington, DC, a $41 Billion private equity firm with venture capital investments in real estate, energy and healthcare.
LifeCare has gone on record supporting the efforts of the Louisiana Attorney General's Office, stating "our company reported its concerns about incidents at Memorial Medical Center following Hurricane Katrina, and our employees have cooperated fully with the AG's office since the inception of the investigation."
However, LifeCare argues in court documents that once the Federal Emergency Management Agency (FEMA) and the U.S. Coast Guard assumed control of evacuations and other emergency procedures in New Orleans during the flood, it was no longer responsible for the patients at Memorial.
Pou's case has created ripple effects in the healthcare industry. Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University, a state that allows physician-assisted suicide, said physicians practicing pain management "are afraid they'll be similarly accused."
Pou's lifelong friend Marc Charbonnet of New York, who described her as "deeply Catholic," said if he had been left behind in New Orleans "during this horrendous experience, I would've hoped to have Dr. Pou at my bedside."
The evidence gathered during the investigation has been turned over to Orleans Parish District Attorney Eddie Jordan, who, at press time, had not tipped his hand about charges that may be filed against the trio. Kris Wartelle, a spokesperson for the AG's office, hinted that more arrests might be made.
Nuss has established the Anna Pou MD Defense Fund to help offset legal costs.
Foti would only say: "This case is not over yet."