A Case of Death

May 25, 2007
Surgical Rounds®, October 2006, Volume 0, Issue 0

Bernard M. Jaffe, Professor of Surgery, Tulane University School of Medicine, New Orleans, LA

Bernard M. Jaffe, MD

Professor of Surgery

Department of Surgery

Tulane University

School of Medicine

New Orleans, LA

The announcement in the press shocked the world: a physician and two nurses were arrested for the murder of four patients in a flooded and nonfunctional New Orleans hospital shortly after Hurricane Katrina. While there is still a great deal the public doesn't (and shouldn't) know, the allegation is that Dr. Anna Pou and nurses Lori Budo and Cheri Landry deliberately administered lethal doses of morphine and a sedative intravenously to four incapacitated patients in a long-term, acute care facility run by Lifecare Hospital within the Memorial Hospital complex. Overall, 24 patients died at Memorial within those first few post-Katrina days. The arrests have fueled an incredible furor within New Orleans and beyond. One reason is that the protagonists are all exceptional individuals.

Attorney General Charles Foti has dedicated his life to public service. Initially a prosecutor, he became Criminal Sheriff of Orleans Parish (New Orleans) in 1973. He served in this role for 31 years before he was elected to his current statewide office. A dedicated professional, Mr. Foti was recognized for his generosity for serving holiday meals to hundreds of elderly and infirm New Orleans residents during his time as sheriff. At his direction, the Orleans Parish prison was always highly decorated, and the then-sheriff often used the building to convey public messages. As attorney general, Mr. Foti has never taken the easy road. His office has convicted a nurse in northern Louisiana for elder abuse, and he has charged the owners of a nursing home in New Orleans with negligent homicide for the drowning deaths of 34 patients during Hurricane Katrina. As an avowed 'right-to-lifer,' his statement that "This is homicide, it is not euthanasia"1 is consistent with his personal and religious beliefs.

The Times Picayune

Dr. Anna Pou is an equally impressive individual. An experienced head and neck oncologist, she joined the full-time faculty at Louisiana State University (LSU) Medical School with a track record of superb training, investigative prowess, and superior clinical skills. Dr. Pou was beloved by her patients and had an impeccable reputation in New Orleans. There has been an unbelievable outpouring of support for her, but none more meaningful than that expressed in a letter to by her residents at the LSU Department of Otolaryngology. Their touching note records that "Once we began working hand in hand with Dr. Pou, we realized her greatness as a physician. No doctor in our experience surpasses her compassion, attentiveness, and quality of care. Her patients uniformly express their gratitude not only for their cure of cancer but also for her intensely personal and often emotional support throughout their treatment."2 Particularly relevant to the current situation, the letter also notes that "Pain and end-of-life care issues are a significant part of this and all cancer subspecialties. Dr. Pou has dedicated her career to helping these seriously ill patients regain health and restore functions often taken for granted."2 It is hard to imagine that she stayed in the hospital during this desperate situation to hurt rather than help patients. Dr. Pou, who has not been formally charged with a crime, denies all the accusations and is currently working for LSU but is not involved in patient care.

The two nurses who have been accused, Lisa Budo and Chris Landry, were similarly well regarded. Both women were born at Memorial Hospital and have worked there for the duration of their professional careers. Being senior, Ms. Landry helped train Ms. Budo when she started working in the intensive care unit. The two nurses are known to be best friends. Accolades have been heaped on both women. Dr. Mo Bethea, a recently retired cardiac surgeon who trained at Tulane and practiced at Memorial, wrote that, "Their performance has always been exemplary. There is no doubt that they have saved the lives of a lot of my patients over the years."1 Dr. Glenn Casey, chief of anesthesia at Memorial, has stated, "I hope I can practice the rest of my career with nurses who are as dedicated as they are."1 Both nurses were reported as being able to identify subtle signs of distress often not apparent to their colleagues. Like Dr. Pou, both women have denied the accusations.

Fortunately, I know none of the facts other than those aired in the press. My wife Marlene and I were occupied evacuating patients from Tulane University Hospital. From what I have heard, the situation at Memorial was far worse than that at Tulane, and their evacuation efforts were much less successful. It is worth noting that neither Lifecare's chief executive officer or medical director were in the hospital during and after the storm, in sharp contrast to the leadership at our hospital.

It is difficult to predict the ultimate outcome of this potential criminal situation. Eddie Jordan, the District Attorney of Orleans Parish, has to decide whether it is appropriate to prosecute the three health care professionals and, if so, what the charges should be. He has declared that he will convene a grand jury to aid in that decision. Even if the women are tried for criminal offenses, conviction is far from assured. The eyewitness accounts are contradictory; the reports of the sedative allegedly used (lorazepam versus midazolam) are inconsistent; the toxicology was performed on tissue rather than blood. Independent of the facts, the overwhelming sentiment in New Orleans is that all three capable professionals were victims, not perpetrators.

case of death

Now to the . There is no question that the 4"--"indeed 24"--"patients died at Memorial. But that is only the beginning of the deaths. Even if the accused are exonerated, the allegations of murder have killed the careers of the three enormously able clinicians. While Attorney General Foti plans to run for office again, his seemingly grandstanding public announcement and insistence on arresting these three individuals at work after they had agreed to submit voluntarily has badly tarnished his image, even if he ultimately prevails. Right or wrong, the overwhelming majority of Louisianans, all of whom suffered during Katrina, sympathize with the surgeon and two nurses and realize how desperate their patients' plight was. Future evacuations have also been dealt a mortal blow. The arrests have so outraged the medical community that physicians and nurses are no longer willing to voluntarily stay in hospitals during hurricanes (as I did during Katrina), and, for the first time ever, institutions have had to issue assignments for such emergencies.

And yes, all of medicine has taken a big hit. Three health care professionals have been painted as killers rather than saviors. The only hope for salvation in this case is if it acts as a catalyst for our nation to face reality and open a serious and long-overdue dialogue about euthanasia, end-of-life issues, and physicians' roles and responsibilities to the dying.

References

1. Meltrodt J. Katrina nurses are called victims of justice. The Times Picayune. July 23, 2006:1.

2. Pero CD. Residents know Dr. Pou as caring, skilled physician. The Times Picayune. August 2, 2006:B6.