How hope turned to despair at Memorial Medical Center

Part one of a five-day series:
FOR DEAR LIFE: When Katrina threatened, patients, nurses, doctors and loved ones trusted they would be safe at Memorial Medical Center. But over the next five days, it seemed all hope was lost.
Sunday, August 20, 2006
By Jeffrey Meitrodt
Staff writer

As they gathered that morning on the emergency room ramp, three days after Hurricane Katrina, John Kokemor looked more like a vagrant than a successful doctor. His shorts and LSU T-shirt were stained with sweat. He hadn't showered for the better part of a week. Despite the grim conditions, he felt more hopeful than he had in days.
More than 1,000 people were still trapped inside Memorial Medical Center, and food and water were running low, but Kokemor and the other sleep-deprived doctors and nurses believed they were finally going to get some good news as they huddled for the 7 a.m. briefing on Thursday, Sept. 1.

Within a day of the storm, helicopters had rescued 18 babies and a few critically ill patients, and hundreds more patients were ferried to higher ground on Wednesday by seven boats that showed up unexpectedly. But Kokemor and other doctors worried that time was running out for the most vulnerable patients at a hospital still surrounded by at least eight feet of water. Ten patients had died overnight, and a makeshift morgue in the second-floor chapel was full.

Everyone knew that Tenet Healthcare Corp., the hospital's owner, had been trying to mount a private rescue operation. Those in the meeting with Kokemor on Thursday morning figured the company would deliver within hours.

They expected confirmation from head nurse Susan Mulderick, the hospital crisis manager who had been passing along fragmentary updates from the company.

Mulderick offered no comfort.

"We don't know when the boats will be back," she told the small crowd of doctors and nurses. "We don't know if the boats will be back."

What about the helicopters?

"We're on our own."

The announcement was met with stunned silence. For many staff members, this was the nadir in a week that, for many, would constitute the low point in their years of professional service, the moment when hope turned to despair. The Rev. John Marse, the hospital's chaplain, saw some people break under the strain. One doctor sobbed as she clung to him.

"It really was doomsday, almost," Marse said. "At that point, we were beginning to ration the food because we didn't have much left. Some staff members started losing it. The big question was: When are we going to get some help?"

Kokemor was equally concerned: "People started thinking, 'We might not get out of this at all.' "

The bad news spread quickly, as staff members returned to their duties. Like most members of the hospital's medical team, Dr. Anna Maria Pou, an ear, nose and throat surgeon, missed the briefing.

But about two hours later, Pou allegedly went to the seventh floor, where a medical service called LifeCare Hospitals of New Orleans operated an acute-care unit in space leased from Tenet. On that floor, according to Attorney General Charles Foti, she and two nurses systematically snuffed out the lives of four frail and elderly patients.

In July, Foti ordered the arrest of Pou and the two nurses and accused them of second-degree murder, though they have not been formally charged. According to an affidavit made public at the time of the arrests, the four killings were orchestrated in plain sight, with virtually no effort at concealment. The mode of death, according to Foti: injected overdoses of painkillers.

Attorneys for Pou and nurses Lori Budo and Cheri Landry have declined to comment on Foti's accusations beyond insisting that their clients are innocent. But the arrests have triggered a raucous debate. Defenders of the women are outraged that officials of a government that failed so miserably to bring prompt relief to a beleaguered hospital would now attack medical professionals who stayed on the job in hellish conditions.

Pathologists studying the evidence arrayed in Foti's affidavit suggest that the drugs -- morphine and Versed -- found in the four patients who died were routine palliatives given to calm patients facing the trauma of evacuation.

Or had the women, as Foti alleges, purposely delivered overdoses, with intent to kill rather than comfort? Had they decided to play God and eliminate four lives they had deemed too far gone to be worth the trouble of evacuating?

To find out what it was like to practice medicine at Memorial in the grueling days after Katrina, The Times-Picayune interviewed more than three dozen people who survived the storm at the medical center, including doctors, nurses, patients and family members.

Altogether, 34 patients died at the hospital in the days after Katrina struck, 24 of them in the LifeCare unit.

For some of those interviewed, the entire post-storm period is a blur; others differed on the exact moment one event or another took place. But overall, the interviews yielded a general consensus on key events that transpired between Sunday, the day before Katrina struck, and Thursday, when the last patients were evacuated.

Father Marse, for one, has no doubt when he was summoned. As he lay in bed Saturday at 11:45 p.m., the chaplain heard a voice he'd never heard before.

"I was dead asleep when I heard this voice say, 'I need you to be at the hospital for this hurricane,' " said Marse, who still hadn't decided whether to evacuate. "It was the voice of God. I said, 'OK, I'll do it.' You may negotiate with your superiors, but not when it is God."

The 51-year-old Catholic priest got up, packed a bag with three days of clothes and other hurricane gear, and then went back to sleep for six hours.

"That voice gave me a lot of courage, a lot of peace and a lot of stamina," said Marse, who spent 25 years as a parish priest before becoming the hospital's chaplain two years ago. "So when things started happening, I had a perspective: 'This is why I'm here.' "

Marse is no stranger to tragedy. In 1987, his 6-year-old niece and her mother died in a drowning accident. In 1999, he presided over the funeral of his aunt and uncle, victims in the infamous Mother's Day bus accident that claimed 22 lives.

"Maybe God was preparing me for Katrina in some ways," Marse said.


Day before the storm

Marse was one of the first people to arrive at the hospital Sunday. He got there at 7 a.m., just as the day shift for nurses was starting. Though Katrina was less than 24 hours away, the hospital was quieter than he expected. Just three or four people were on hand for the Sunday Mass he celebrated at 8 a.m., compared with the usual 30.

Julie Campbell was another early arrival. A nurse in the surgical intensive care unit, Campbell was scheduled to start her 12-hour shift at 7 a.m. She was one of about 75 nurses who showed up for hurricane duty.

Her husband wasn't happy she was there. Campbell was nine months pregnant and had only recently returned to work after taking nine months off in 2004 to deal with Hodgkin's disease, a cancer of the lymph system.

Her husband wanted her at home with him in St. Gabriel, a small town near Baton Rouge. But Julie Campbell knew the price of not reporting for duty during a hurricane: automatic termination.

"I had to show up," she said. "I didn't ask for any special treatment."

Campbell didn't come alone. She brought her 87-year-old grandmother and her 80-year-old great-aunt, both residents of New Orleans. Campbell typically stayed with her grandmother when she commuted into the city for weekend shifts at the hospital.

Campbell had planned to take her relatives to St. Gabriel, so they could ride out the hurricane with her husband. She scratched those plans when the state initiated the contraflow evacuation plan Saturday afternoon, turning all lanes of local interstates into one-way arteries leading out of the city.

"I could leave, but that meant I wouldn't be able to get back to work," Campbell said. "I feel bad that I put my grandmother through all this, and my great-aunt and my child."

Campbell wasn't the only staff member to show up with relatives. Over the course of the day, as hundreds of thousands of residents packed up and fled the city, Memorial became the shelter of choice for anybody with relatives who worked there or was being treated at the facility. Staff members brought their kids, their parents, their pets. Ultimately, the center's population swelled to about 2,000, including 260 patients and about 500 hospital workers.


Informal rotation

Though nurses had to report to duty, doctors were another story. The only physicians required to show up Sunday were the hospital's six department heads -- among them Dr. Richard Deichmann, chief of medicine -- and the handful of doctors who worked the emergency room.

Other physicians were free to make their own arrangements, provided they had lined up colleagues to take charge of any patients they might have in the facility. An informal rotation assured that there would be at least a few physicians on hand for hurricane duty.

For Katrina, it was Pou's turn. Before reporting to the hospital that Sunday, she swung by her mother's house on Fontainebleau Drive. It was 9:30 a.m., and Jeanette Pou was drinking coffee with her grandson when she heard her daughter knocking on the door.

"I said I wasn't leaving," said Jeanette Pou, 83, who suffers from arthritis and has heart problems. "So she dragged me out of the house. She said, 'This time it's the real thing.' I said, 'That's what they always say.' "

Anna Pou had to be equally firm in 2004, when Ivan threatened New Orleans. That time, she was able to drive her mother out of town because another doctor had hurricane duty.

"We spent 10½ hours in an automobile," Jeanette Pou recalled. "I said I'd never go again."

Ivan, which veered east and came ashore in Alabama, was Dr. Pou's first hurricane since moving back to New Orleans from Galveston to look after her mother. The return from Texas meant a cut in her pay.

Pou's specialty is reconstructive surgery, often for people whose faces have been disfigured by cancer. Among her colleagues, she is famous for giving her personal cell phone number to her patients.

Though her father, Frederick Pou, was a physician for more than 50 years, Jeanette Pou never dreamed her little girl -- the seventh of her 11 children -- would grow up to be a doctor. "Too tenderhearted," she thought.

In medical school, Anna Maria Pou seemed to confirm her mother's suspicions. When she was told to kill a guinea pig as part of a laboratory test, she refused.

"That's why this is just so out of character," said Jeanette Pou, referring to the criminal charges. "Maybe one of my other children could have done something like this, but not this one. Not Mrs. Soft Heart."

Jeanette Pou said her daughter was in good spirits when she left on Sunday morning.

"She said, 'I'm working at the hospital. I'll be safe there.' "

Days would pass before she again heard from her daughter.


Waiting for Katrina

By the time Pou got to the hospital, employees were making their final preparations for the storm. Workers slapped plywood over dozens of windows, especially those on the highest floors, those most vulnerable to a hurricane's cyclonic winds. Others were busy hauling several tons of food and water from the basement kitchen to the fourth floor, where they hoped it would be safe from flooding.

"We used anything we could find -- stretchers, wheelchairs, hospital beds," said Deichmann, who spent an hour helping the food service department transfer the goods.

Kokemor, whose wife and children left for Gulf Shores, Ala., two days before the storm, showed up at 4 p.m. After parking in one of the last empty slots in the parking garage, he checked in at the command center, where administrators took down his cell phone number and room assignment. Like everyone else in the facility, he got a wristband that told security guards he was authorized to be present. By the end of the day, an estimated 25 to 40 doctors had shown up for duty.

As he walked around the hospital, Kokemor was stunned by the noise coming out of the medical records office, which had been turned into a kennel. Hundreds of dogs and cats were stacked in their carriers. There was even a ferret.

"It was hard to sleep that night because of the nonstop barking," said Kokemor, who wound up sleeping in a doctor's lounge near the kennel.

As more and more people arrived, the anxiety level started to increase, said Father Marse, who spent the day walking the floors and visiting with patients and their family members. By the end of the day, the hallways were overflowing with people. Most spent the day glued to their televisions, watching as Katrina's satellite image filled the entire Gulf and tracked toward New Orleans.

Despite the crowding, Dr. Roy Culotta managed to find room for Nathalie Andree, his 89-year-old grandmother, on the seventh floor of the hospital, the one leased by LifeCare.

LifeCare looks after chronically ill patients who have been involved in catastrophic accidents or ailments that require long-term care.

"It's basically a hospital full of chronically ill nursing home patients who are very, very sick," said Culotta, an internist who often treated patients in the long-term unit. "These are patients who are more or less nearing the end of their lives."

Culotta's grandmother had been doing fine in a Metairie nursing home, but her family was anxious about leaving her there for the storm. Culotta picked her up Sunday morning and brought her to the LifeCare unit, figuring LifeCare's nurses would be glad to make room for her.

"It was great, because all the nurses knew she was my grandmother so they took wonderful care of her," said Culotta, whose wife and kids evacuated to Lake Providence. "But they also knew I'd be coming up to see her, and if they needed anything, I'd be there to help . . . I think I spent more time up there than the other physicians."

Over the weekend, LifeCare transferred 19 patients to Memorial from its long-term care facility in Chalmette. Counting Culotta's grandmother, 55 of the unit's 82 beds were filled as Katrina approached.

Like other doctors, Culotta figured the big brick hospital would be the perfect place to ride out the coming storm. After all, the facility -- still known to many local residents as Baptist Hospital -- had been around since 1926 and had survived many a hurricane. It had never been evacuated.

Still, Katrina had lots of people spooked. Mark LeBlanc, for one, knew floodwaters would never reach his 82-year-old mother on the seventh floor, but he couldn't leave town Sunday without stopping by the LifeCare unit for a visit. Vera LeBlanc, an 82-year-old with Parkinson's disease and cancer, had been on the LifeCare floor only a few days following surgery to remove her colon.

A day earlier, Mark LeBlanc hired a seasoned nurse assistant, Jill Wilson, to stay with his mother for the duration of the storm. On Sunday afternoon, LeBlanc and his wife, Sandy, brought the sitter a cooler filled with food, a flashlight, batteries and a cell phone.

Though the floor was fully staffed with 40 nurses and four administrators, LeBlanc was worried about his mother. He grew even more concerned when he discovered that Dr. John Wise, his mother's doctor and director of the LifeCare unit, had evacuated. Wise did not return several phone calls.

Sandy LeBlanc wondered aloud if the prudent thing would be to move her mother-in-law out of Memorial altogether. "Do we need to be concerned?" she asked a nurse.

The nurse tried to reassure them, saying there were plenty of doctors around to tend to LifeCare's patients. The nurse also said an evacuation would be extremely risky, considering Vera LeBlanc's fragile condition.

Feeling somewhat better, the LeBlancs left the hospital. The next time they saw the facility would be from a boat plying the waters of a drowned city.

. . . . . . .

Staff writer Michelle Krupa contributed to this report.

Jeffrey Meitrodt can be reached at jmeitrodt@timespicayune.com or (504) 826-3497.