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http://www.nola.com/news/t-p/frontpage/index.ssf?/base/news-6/115606061389400.xml&coll=1&thispage=1
FOR DEAR LIFE: How hope turned to despair at Memorial Medical Center
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

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 10 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.

-------------------------------Part 2

FOR DEAR LIFE: How hope turned to despair at Memorial Medical Center
Hurricane Katrina finally departed, and Memorial's patients and staff emerged mostly OK.
For a fleeting moment, it seemed a normal life soon could resume.
Monday, August 21, 2006
By Jeffrey Meitrodt

About 2 a.m. that fateful Monday, four hours before Hurricane Katrina barreled ashore at Buras, nurse Julie Campbell was shaken awake by her co-workers at Memorial Medical Center and told it was time to abandon the intensive care unit in the surgical building.

Patients had been moved out during the weekend, just in case the unit got cut off from the rest of the hospital, a colossus that sprawls over three city blocks, its parts linked by elevated, glass-walled crosswalks.

Their 10 post-surgical patients having been relocated to the main building's eighth floor, the nurses had bunked down Sunday night in the emptied ICU, with its quiet rooms and cots. No such amenities remained on the eighth floor of the hospital, where about 20 ICU patients from all parts of the complex were sharing space with dozens of relatives, some dozing in chairs, some sprawled on the floor.

As Campbell, nine months pregnant, was roused from her slumber, wind gusts already were starting to blow out windows all across the city, including those in the crosswalk connecting the core hospital to an office building.

Campbell and her fellow nurses were told to grab a single bag and then, one at a time, to sprint across the swaying walkway from the surgery building. Campbell grabbed her maternity bag.

"It was terrifying," recalled Cathy Green, one of the nurses who made the run with Campbell. "You're standing there, waiting for your turn, thinking: Are the windows going to break on me? Is it going to fall down? For us, that was the beginning of the bad times."

The group made it to what they thought was safety and hunkered down on the eighth floor to ride out Katrina.

Landfall had tamed some of Katrina's fury. Category 5 wind gusts above 215 miles an hour a day earlier had fallen to 120 mph, Category 3 strength, as the storm hit shore.

Plywood nailed to the interior surfaces of Memorial's windows controlled flying glass as the storm neared the city, but soon sheets of horizontal rain began savaging the hospital, nowhere more mercilessly than on the eighth floor.

"You could hear a bing, bing, bing as each window was breaking, and after that the water started coming in," said ICU nurse Melissa St. Amant, who was on duty that morning. "The wind was so loud and so strong that the boards were bending inward. We were terrified that the boards were going to blow in." 

Though some ICU patients managed to sleep through the storm, their relatives peppered the nurses with questions.

"They were frantic," St. Amant said. "They wanted to know where we were going to move the patients."

Some couldn't be moved because they were hooked up to oxygen or immovable life-support machines. But nurses wheeled as many patients as they could into windowless halls and common areas, where the beeping of pumps and other portable units woke any family members who had somehow managed to stay asleep.

'Set back 50 years'

By dawn, the driving rain had taken a toll on Memorial's roof. Water had puddled on the linoleum and saturated carpeting throughout the hospital.

About 5 a.m., the electrical power failed, and the hospital's back-up generators kicked in. Essential medical equipment kept working, but the outage killed a pneumatic tube system that was used to move drugs and other supplies from one part of the hospital to another. Most of the elevators and some of the phones were out, too.

"Everything had to be done the hard way," St. Amant said. "Without all of our modern conveniences, you were suddenly set back 50 years."

A major concern was the loss of air conditioning. By the end of the day, the interior temperature -- usually kept at 70 degrees -- was topping 90.

As he walked through the rapidly warming hospital lobby that morning, Dr. John Kokemor noticed that the floors were already wet with condensation. In the streets outside, he could see whitecap-flecked floodwater two feet deep. Trees and power lines were down everywhere.

On the eighth floor, where Kokemor had several patients to visit, he could hear the metal skeleton of the building creaking in the strong wind.

"It sounded like a scene from 'Titanic,' where the ship is ready to go down," Kokemor said.

Despite the day's rough start, head chef Scott Perry and the kitchen staff pulled off a minor miracle.

By 7:30 a.m. Monday, hundreds of people lined up on the fourth floor for sausage, muffins, grits and eggs -- a breakfast that had been painstakingly hauled upstairs Sunday because administrators feared the basement kitchen would flood. Monday's dinner menu called for red beans and rice.

"Scott was phenomenal," said Dr. Richard Deichmann, Memorial's chief of medicine. "He mustered meals out of practically nothing."

About 10 a.m., with the storm continuing to rage, the hospital's crisis management team met for a status update and discussion of how to handle patient care.

Most cell phones weren't working and nurses were having trouble getting in touch with doctors, whether for routine drug prescription or a medical emergency.

To deal with the problem, Deichmann assigned a staff physician to each of the hospital's 12 nursing units. Each doctor would be responsible for the patients in that unit, Deichmann said, even if not officially a patient's attending physician.

Deichmann's deployment of physicians covered the entire hospital, with one glaring exception: the LifeCare unit on the seventh floor. Though there were 55 patients on the unit, including 19 chronically ill people who had been shipped in Saturday from LifeCare's facility in Chalmette, Deichmann decided against assigning any of Memorial's physicians to the leased LifeCare floor, essentially a separate hospital within a hospital.

"They had their own medical staff," Deichmann said recently. "I didn't have the authority to put anybody up there."

But LifeCare's medical director did not show up for the hurricane, LifeCare officials have acknowledged. That didn't impair patient care on the floor, they contended, because there were at least seven physicians available at Memorial during the crisis to treat their long-term residents.

A deceptive calm

Later that afternoon, LifeCare nurses called a "code blue" on one of their patients, hospital lingo indicating a life-threatening situation and the need for immediate care. The doctor who answered the call was Anna Maria Pou, who had privileges to treat patients in the unit, even though she typically wasn't their attending physician. Instead, Pou, a surgeon, was sometimes called in to consult on a specific case.

On Monday, Pou's efforts were unsuccessful, and the 73-year-old patient died. It was the first of 24 deaths on the unit during the three days after the hurricane.

LifeCare officials declined to speculate on the high death rate in their unit beyond pointing out that their patients typically are suffering from life-threatening conditions.

"These are people who were facing some very complex system failures," LifeCare spokeswoman Rosemary Plorin said. "I won't attribute the deaths to that, but these were extreme circumstances."

Though the storm hit Memorial hard, most hospital workers felt a sense of relief Monday afternoon. Kokemor said he wasn't disturbed when the Internet began carrying reports about 3 p.m. suggesting that some neighborhoods were taking on water from breaches in the levee system.

"I figured certain areas of Lakeview would flood, but I didn't think it was going to push water all the way to Napoleon Avenue," he said. "At that point, we didn't know about the breaches on the London Avenue canal."

By 6 p.m., the streets surrounding the facility were clear of water. Some hospital workers went outside to walk the dogs. Others decided to drive home.

The skies were turning blue and it looked like the worst was over.

"Everybody thought we had dodged a bullet," St. Amant said. "I remember telling one of the nurses, 'We are going to be able to go home tomorrow.' Everything seemed fine."

-------------------------------Part 3

FOR DEAR LIFE: How hope turned to despair at Memorial Medical Center - Part 3
As Katrina passed, the staff felt they had dodged a bullet.
But their situation was about to get worse as water began rushing into the city from levee breaches.
Tuesday, August 22, 2006 By Jeffrey Meitrodt

For Dr. Richard Deichmann, the toughest moment came the morning after Hurricane Katrina, when a wrenching decision was forced upon him: whether to evacuate Memorial Medical Center with his wife and daughters or stay to face the deadly crisis engulfing the hospital.

It all came to a head for him Tuesday, Aug. 30, at about 9 a.m. The sense of relief that the hurricane had passed was giving way to a sense of gathering catastrophe. Water rushing through a series of levee breaches across the city was rising in the streets around the hospital. Other doctors and nurses had cleared out after struggling through the power outages and turmoil that surrounded the hurricane's assault the day before. Now the window of opportunity to evacuate was slamming shut, Deichmann sensed, and though he was the hospital's chief of medicine, nothing in his long years of training had prepared the 49-year-old physician for a decision such as this.

"I felt a moral obligation to stay," Deichmann said. "I also felt a strong moral obligation to go with my family. I don't know if I made the right decision, but I know I did a lot of good there."

Deichmann had no idea he would face such a dilemma when he awoke that morning. Like most people who weathered the storm at the hospital, he thought the worst was over.

At sunrise, Memorial was high and dry. There were reports of flooding in other parts of the city, but most hospital workers were unconcerned. Administrators were trying to figure out how to restore power and air conditioning. Doctors made their rounds, nurses changed the sheets, and head chef Scott Perry doled out hundreds of plastic foam cups full of grits, scrambled eggs and bacon: a concoction he dubbed "the breakfast parfait."

Breakfast was not served to everyone. With limited food supplies, it was mostly reserved for hospital workers and patients. And after 24 hours of splitting meals with his wife, Stella, who had undergone a Caesarean section and given birth to a baby girl at Memorial on the previous Friday, Jeffrey Eisenman had had enough.

At 6:30 a.m., Eisenman said goodbye to Stella and his newborn daughter, Jenna, climbed into his Ford Explorer and headed for the family's home in Belle Chasse. He intended to clean out the pantry and bring back enough supplies to get them through the week. He also wanted to collect an ice chest full of drinks, a flashlight and a battery-operated fan for their baby, who was suffering in the 100-degree heat.

The trip, usually 30 minutes each way, wound up taking almost three hours. After navigating miles of downed branches and power lines, Eisenman had to wade through knee-deep water to reach his house. On his way back, he discovered that many of the streets that were dry when he left were now covered with several inches of water. In some parts of New Orleans, he had to drive on the wrong side of the street to avoid flooding his engine.

By the time he returned to Memorial, Stella was frantic. In a few hours the mood at the hospital had changed drastically. News of uncontrolled flooding was spreading fast, and Memorial sits in one of the lowest parts of the city.

Doctors were trying to discharge as many healthy patients as they could, thrusting five-day supplies of prescription drugs into their hands and urging them to leave as soon as possible to avoid being trapped, according to one doctor in the hospital.

Refusing to leave

Medical workers were joining the exodus. Dr. Anna Maria Pou, a surgeon, was urged to leave by her husband, who had made his way to the hospital Monday night. But like Deichmann and most of the other doctors and nurses still on hand, she refused to go.

"She felt there was a need for her," said Rick Simmons, a criminal defense attorney who represents Pou, who stands accused of second-degree murder in the deaths of four elderly patients.

Deichmann's family got out in time. Others were forced back into the medical center by high water. The Eisenmans never made it out of the obstetrics unit.

"They said they were never going to let me leave the hospital with a baby, not with that much water in the streets," Stella Eisenman said. "That is when I lost it. I thought I was going to die. I had no idea how I was going to get my daughter out."

As administrators realized the magnitude of their predicament, they asked the Rev. John Marse, the hospital's chaplain, to conduct a 10:30 a.m. prayer service for those who needed comfort. About 50 people attended for the impromptu gathering, held in a second-floor lobby because the dark chapel was deemed too depressing.

By the time the service was over, Memorial was an island. Within hours the rapidly rising urban lake in which it stood would be more than 8 feet deep.

Memorial's situation was being closely monitored in Dallas by executives with Tenet Healthcare Corp., the hospital's owner. But Tenet was having trouble communicating with Memorial administrators. Phone lines went out sometime Tuesday morning, and cell phones were increasingly unreliable.

At 11:30 a.m., Tenet executives sent an e-mail to Memorial's chief executive, Rene Goux, instructing him to close the hospital immediately and prepare for a general evacuation. Tenet also turned to state official Cynthia Matherne, who was in City Hall as the regional coordinator for emergency management in New Orleans and three surrounding parishes. Tenet officials asked Matherne to coordinate the evacuation of its hospital with government resources such as boats and helicopters.

Matherne wanted to help. Two of her grandchildren were stuck at Memorial with their stepmother, a nurse at the hospital. But she wasn't optimistic. Matherne had been overwhelmed by thousands of requests for emergency assistance, pleas that she passed on to emergency operations headquarters in Baton Rouge. There just weren't enough boats and helicopters to rescue everyone right away.

At that point, she said, neither Memorial nor any other hospital in the city was a high priority. With thousands of local residents trapped on their roofs and in their attics, the government was directing the bulk of its resources toward saving those people.

"I was pretty much told that the hospital people were considered to be in a safe environment, as opposed to those people who were out on their rooftops," Matherne said. "You have to remember, this was Tuesday, and there were still not a lot of (rescue) assets in the area."

As the day wore on, conditions in the hospital deteriorated. Sinks and faucets ran dry. Toilets stopped working and later overflowed, spilling feces and filth throughout the hospital. The overhead paging system, used to summon doctors for emergencies, crashed. The last working elevators shut down.

Heat takes its toll

Worst of all was the heat. Though maintenance workers smashed out windows to improve circulation, the muggy August air provided no relief.

Patients baked in their rooms, and nurses stood over them for hours, waving large pieces of torn cardboard over their heads in an attempt to create a breeze. Dehydration was rampant. With water low, one patient said she received no more than a teaspoon of water every hour. Nurses wore cut-up sheets that they doused regularly with bottled water.

"It was horrible," said Dr. Roy Culotta, who spent much of the day hovering over a seventh-floor acute-care ward operated by LifeCare in space leased from Tenet.

"To see these debilitated patients struggling for their lives in this heat was just really nauseating," said Culotta, who had brought his mother from her nursing home and placed her among the elderly and chronically ill patients in the unit.

The stress and heat were too much for nurse Julie Campbell, who was nine months pregnant when she reported for hurricane duty. She felt contractions Monday but ignored them until midday Tuesday, when her supervisor on the eighth floor noticed her rubbing her belly.

"At that point the contractions were three to five minutes apart," said Campbell, whose baby boy wasn't due for three weeks, on Sept. 20. "They wanted to evacuate me to another hospital and stop the contractions. But they wouldn't let me take my grandma and my aunt with me, so I decided to stay."

The decision to separate patients from their relatives and evacuate each group individually had been made by the crisis team at its afternoon meeting.

First to go, Deichmann and the others decided, were the sickest patients. That group included 18 sick and premature babies who were sweltering in the neonatal unit. It also included about two dozen dialysis patients, who typically received treatment every other day but had now gone as long as four days without having their kidneys flushed. Also on the high-risk list were a half-dozen critically ill patients in intensive care.

Other patients would be evacuated as appropriate means of transport became available. For instance, patients who could walk could leave on boats, while bedridden individuals and those with more serious problems would be taken out by helicopter.

Last on the list were elderly patients with "do-not-resuscitate" orders, indicating that the patient -- or someone authorized to make decisions on their behalf -- wished to forego drastic medical intervention if they went into cardiac or respiratory arrest. Many of the frail and elderly residents in the LifeCare unit had DNR orders.

"There was no intent to leave the DNRs or give them less attention," said Dr. John Kokemor, who attended the meeting. "We wanted to get everybody out, but the people with the highest needs had to go first."

Journey to the heliport

The first rescuers showed up about 3 p.m., when a National Guard truck pulled up to the emergency room ramp. Kokemor and several other doctors quickly loaded a dozen dialysis patients into the truck. By the time the truck returned an hour later for a second load, it almost stalled as it pushed through the floodwaters. Though the driver made it out, that was the last time anyone sent a truck.

Within minutes, however, hospital workers heard the welcome sound of a helicopter approaching Memorial's heliport, on top of an adjacent parking garage. Deichmann, who took charge of the helicopter evacuations, was a little worried. The heliport hadn't been used in about five years and was not fully functional.

"We weren't sure it wouldn't collapse," he said.

The helicopter landed without incident. It took the first of several loads of babies. But reinforcements were slow to arrive. Sometimes, nurses said, nearly an hour would pass before another helicopter showed up.

Even worse, on at least two occasions helicopters left empty because no one was waiting there for a ride.

"These pilots and medics had strict instructions," said Acadian Ambulance Service executive Michael Sonnier, who coordinated a fleet of 28 rescue helicopters in New Orleans in the wake of Katrina. "When you hit the pad, you had to load. We'd give them at least 10 minutes, but if they weren't ready at that point, we'd have to move on to another facility."

Deichmann, who had never prepared for such a responsibility, climbed a learning curve as the day wore on. At first he tried using a walkie-talkie to alert the nurses whenever he thought a helicopter was about to touch down.

Without elevators, it often took 45 minutes to move a patient from a hospital bed to the heliport. Though some could walk, most of the intensive-care patients had to be carried down six flights of stairs by nurses and family members, while other volunteers lit the darkened stairwells with flashlights. From a second-floor boiler room, patients were passed through a 3-foot hole in the wall into the parking garage where a pickup or flatbed truck ferried them to the top of the nine-level garage. Another two flights of stairs had to be scaled to reach the heliport.

"It was exhausting," said Melissa St. Amant, a nurse who helped bring down all 20 patients in Memorial's ICU on Tuesday. "At the end of the day, I felt, like, 'Wow. We got some things done today.' "

Moving patients wasn't the only challenge. Doctors had to calm family members as they learned at the last minute that they could not accompany the ailing relative aboard the helicopter. Marse helped console one mother who had begun to sob uncontrollably as she watched a helicopter carry off her baby. Just a few days before, Marse had performed an emergency baptism when the sickly infant's condition turned critical.

By 11 p.m., when the last helicopter left for the day, about 25 patients had been evacuated -- and at least five had died since Katrina.

Late that night, as Marse walked the hospital hallways, he found a corpse on a gurney. The third-floor morgue was full, and hospital workers didn't know where else to put the bodies.

Marse tracked down a hospital administrator.

"Let's put the deceased in the chapel," Marse told her. "It is a sacred space. And it is better than just having them in the hallway."

Overnight, several more bodies were taken to the chapel.

A frantic plea

Miles away in Metairie, at a triage station on the corner of Interstate 10 and Causeway Boulevard, Mark and Sandy LeBlanc were afraid that their mother, who was recuperating from surgery in the LifeCare unit on Memorial's seventh floor, was in danger of dying. In a race against rising floodwaters, they had spent most of Tuesday working their way back to New Orleans from Ferriday, where they had evacuated.

At 3 a.m. they were sleeping in their pickup truck when their cell phone rang. It was the sitter they had hired to stay with Mark LeBlanc's mother.

His wife took the call. The sitter told her that five LifeCare patients had died and that the nurses were getting frightened. The sitter was crying and nearly hysterical.

"She was screaming at me, 'You have to come get me! You have to come get me!' " Sandy LeBlanc recalled.

Within six hours the LeBlancs had commandeered three airboats and were skimming over the drowned city, uncertain what they would find at Memorial, but convinced they at least had to give it a try.

Tomorrow: Private citizens make a rescue effort as emergency power is lost and life support fails.

--------------------Part 4

FOR DEAR LIFE: How hope turned to despair at Memorial Medical Center
The water is rising and no official evacuation is in sight.
Then the power goes out and life support systems fail.
But private citizens in boats show up and get about 500 people to safety.
Wednesday, August 23, 2006
By Jeffrey Meitrodt

The bad news reached Tenet Healthcare's Dallas headquarters at 9 a.m. on Wednesday, two days after Katrina hit.

Bob Smith, a senior executive with the hospital chain, was told that the government would be sending no helicopters or boats to evacuate Memorial Medical Center that day.

"I can't tell you when they will be able to go in and rescue your people," said Cynthia Matherne, the New Orleans emergency management official who was trying to arrange the evacuation of eight local hospitals.

"Are you telling me we have to use private assets to evacuate?" asked Smith, a senior vice president with Tenet.

"I'm telling you to use private assets if you want it done quickly," Matherne responded.

The call terrified Smith. At that point, Tenet officials hadn't even considered organizing an evacuation of Memorial. They figured the government would take care of that. They had no boats or helicopters lined up. Smith didn't know where to start.

"What in the world are we going to do?" he wondered.

Smith didn't know it, but in a parking lot 500 miles away, a furniture maker named Mark LeBlanc was already on the job.

LeBlanc, who had grown increasingly worried about the health of his mother since leaving her at the hospital on Sunday, had driven back to New Orleans the day before. He and his wife, Sandy, had spent the night sleeping in their truck at the triage center at Interstate 10 and Causeway Boulevard in Metairie, where scores of flood victims had congregated on both sides of the empty highway. Someone, the LeBlancs do not recall who, told them that rescue boats would be massing the following morning outside an unflooded Sam's Club store on Airline Drive.

At 8 a.m., when they showed up at the parking lot, they saw more than 100 boats. None of them had been assigned to Memorial. LeBlanc found someone in charge and passed on the news from his mother's sitter, who had called several times to report a rash of deaths in an acute-care ward and increasingly dire reports about conditions at the hospital.

LeBlanc was offered three airboats. After a quick scouting expedition, he and the pilots decided to launch near the railroad tracks on Jefferson Highway, just down the road from Ochsner Foundation Hospital, about three miles from Memorial. LeBlanc's wife, Sandy, an emergency medical technician, came with them.

At about 10 a.m., the rescuers arrived at Memorial. Dozens of patients already were lined up on the emergency room ramp, where they had been for two hours. Memorial administrators were having trouble communicating with their bosses in Dallas and mistakenly believed that an armada of boats -- sent by the government -- were on the way.

High fives

Dr. Glenn Casey, head of anesthesia, heard the engines coming from blocks away. He caught sight of the three boats as they rounded a corner near the hospital.

"When they made that turn, there was a big loud cheer on the emergency room ramp. Everybody was screaming and yelling and high-fiving everybody," said Casey, who volunteered to help lead the boat evacuation.

It had been a long night. Though the hospital's back-up generators were high and dry on the second floor, water had damaged the hospital's electrical grid and the generators started to fail about 1 a.m. By 5 a.m., the hospital had lost all power, cutting off vital life support equipment. By dawn, doctors had responded to five or six "code blue" emergencies, signaling that a patient was on the verge of death, and the second-floor chapel, now in use as an overflow morgue, was filling up with corpses.

The loss of power also made it almost impossible to communicate with the outside world. Computers no longer worked, and most cell phones were dead or inoperable.

But hospital workers remained hopeful. Considering the number of helicopters that made it to Memorial on Tuesday to remove 25 patients, administrators predicted that this would be the day when help arrived in force.

At the 8 a.m. meeting, the crisis team decided to prepare the hospital for a mass evacuation, ordering the staff to move the 200 or so remaining Memorial patients to the first and second floors. The only exceptions were those who were dying or were considered too sick to move.

Anxious to avoid the blunders of Tuesday, when at least two helicopters took off without taking any patients, administrators wanted people lined up and ready to go at both the emergency room ramp and the heliport.

'You came back'

Mark LeBlanc's mother, Vera, was still on the seventh floor when he arrived at the hospital.

"She said, 'Hello. You came back.' I said, 'Yeah, Mom. I promised I'd come back. How are you doing? She said, 'I'm hanging in there.' "

LeBlanc said his mother was badly dehydrated. He said he couldn't tell when she had last been fed or received fluids because her vital signs hadn't been updated since Monday, when someone scrawled "Disaster Mode" across her chart.

After finding an administrator with LifeCare, which leased the seventh floor from Tenet and operated it as an acute-care unit, LeBlanc got out his cell phone and told the manager to call the company's corporate office in Plano, Texas. The administrator managed to connect and found out that LifeCare had made arrangements with private transportation companies. Helicopters were expected to start arriving soon.

Relieved that he wouldn't have to put his frail mother on a boat, LeBlanc went back downstairs and started evacuating other, more mobile patients.

"We knew we had a monumental task on our hands, so we started rolling people out immediately," LeBlanc said.

Getting out

One of the first people to leave was Julie Campbell, an intensive-care nurse who was nine months pregnant and had gone into labor the day before. Campbell was distraught. Administrators were still making family members stay behind, and she couldn't imagine leaving her grandmother and her great-aunt at Memorial. But her supervisor and several other ICU nurses talked her into getting out. Among those who persuaded her were Lori Budo and Cheri Landry, two nurses who along with Dr. Anna Marie Pou stand accused of second-degree murder by allegedly delivering lethal injections to four elderly patients.

"They convinced me that I couldn't risk having the baby at Memorial," Campbell said. "And they said they'd look after Grandma and Aunt Mildred. Lori and Cheri made sure they took their medicine."

Campbell made it out with another nurse who was five months pregnant. The boat dropped them near Ochsner, where an ambulance took the women to a Baton Rouge hospital, where doctors were able to stop Campbell's contractions. She gave birth to her son, John Luke, on her original due date of Sept. 20, with no complications. But her grandmother suffered a minor stroke the day after Campbell left Memorial, and died Jan. 5.

Soon after Campbell left, Stella Eisenman and her 5-day-old baby girl were loaded onto a flatboat with four other new mothers and their babies. A nurse accompanied them to the railroad tracks less than a mile from Ochsner where the airboats mustered by LeBlanc had been launched. An ambulance was waiting there to take them to Baton Rouge.

The ride through the flooded city was a strange one.

"There were people on the neutral grounds begging for food and water," Eisenman said. "We had heard about the lootings and the shootings and I was scared that someone was going to take the boat away from us. We had no protection. I had a diaper bag full of formula. That is what the nurse kept saying: 'All we have is formula.' Fortunately, nobody tried to approach us."

Waiting and waiting

Though hugely relieved to be moving patients out of Memorial, Casey and the other doctors in charge of the boat rescue weren't satisfied with the pace of the evacuation. It was taking an hour or more for boats to make the six-mile round trip to the railroad tracks, and the supply of ambulances had dried up. At this rate, it would take a week to evacuate the hospital.

"Some of the elderly people were becoming delirious," said the Rev. John Marse, the hospital's chaplain. "There was one old lady in her wheelchair. She was crying. She wanted to go home. I said, 'You can't go home. Look at all the water.' She said, 'You can put me on your back and swim.' I told her, 'Honey, I can't swim.' She more or less cried herself to sleep."

After talking to the pilots, the doctors found a more convenient landing spot near the junction of Napoleon and St. Charles avenues, less than 12 blocks away. Casey figured there would be ambulances standing by.

There were none.

By Wednesday, the police -- many of them on rescue missions in devastated parts of the city -- were unable to control looting in parts of Uptown. On Tchoupitoulas Street, thieves had swarmed a Wal-Mart and a Winn-Dixie supermarket. Near Memorial, nurses saw looters try to crash a boat into a credit union and sack a nearby drug store. Gunshots could be heard at all hours of the day.

Hospital administrators were concerned that the violence could spread to their facility, so they told security guards to prevent anyone from entering Memorial unless they were in need of medical care.

The policy angered a young contract doctor named Bryant King, who had just started working at Memorial. He confronted hospital CEO Rene Goux in the lobby.

"What are you doing, man? You have 400 animals in this hospital and you are turning human beings away," said King, according to Dr. John Kokemor, who witnessed the exchange.

Goux told King that the issue wasn't pets versus people. It was security. "We don't have food, we don't have water, we aren't functioning as a hospital -- we aren't going to take care of people we aren't responsible for," Goux said, according to Kokemor, whose account was confirmed by officials with Tenet.

A hero from Hope

Despite the mayhem that morning, James Pafford, an ambulance company operator from Hope, Ark., managed to find a clear route and respond to an emergency call on Tchoupitoulas Street. He and his crew, who came to New Orleans after federal officials started pleading for rescue vehicles of every type, were hauling four boats and a cargo trailer full of fuel and water. But when his caravan showed up on Tchoupitoulas, Pafford discovered the house where the call originated was in an unflooded part of town and a rescue wasn't needed.

Pafford was trying to find a way out of the neighborhood when he stumbled across the group of Memorial evacuees at Napoleon and St. Charles. He put his boats in the water and got on his cell phone and called his son, Greg Pafford, who had eight ambulances parked on the Crescent City Connection.

But Pafford's son couldn't get through. The first time he tried, he ran into a gunfight between looters and cops on Tchoupitoulas. He took his units back to the bridge and waited for things to cool down, but authorities wouldn't let him try again.

"They thought it was unsafe, and I pretty much agreed," Greg Pafford said. "It was a mess down there."

As the afternoon wore on, the crowd at Napoleon and St. Charles grew larger and larger. Besides helping at the hospital, Pafford's crew was working the neighborhood, rescuing people who were stranded on their roofs and porches. By 3 p.m., there were more than 2,000 people at the intersection, waiting for a ride out of the city.

Authorities were aware of the situation. Several police officers had shown up but seemed unable to do more than monitor the evacuation.

"We had all these people at that intersection with nowhere to go," Pafford said. "They were getting very restless."

Frustrated, Pafford started looking for someone who knew how to hot-wire a car. He had spotted two school buses in the neighborhood that looked ripe for the taking. He also found two reluctant young volunteers.

"I had to get a preacher to tell them it was OK, because the guy said he had never hot-wired a vehicle with the police watching," Pafford said.

Pafford's crew also commandeered a van and several other vehicles. Finally, the police brought a shuttle from the Audubon Zoo.

Most evacuees were taken to the triage center at Causeway and I-10, where they were loaded onto buses and taken out of the city, usually within a few hours. But at least 15 hospital evacuees wound up at the Ernest N. Morial Convention Center, which had become a lawless zone with no food, no water and no working toilets. They didn't make it out of the city until Saturday.

"It was really hell," said Olga de la Vega, a Memorial evacuee who was stranded on Convention Center Boulevard with her elderly parents. "We had to sleep outside the Convention Center because things got so violent there. We had to go to the bathroom outside. It was humiliating."

Death toll climbs

Back at the hospital, nurses and volunteers -- including Eisenman's husband -- spent the day hauling patients down the stairs. Some weighed more than 400 pounds; others had to be moved in their wheelchairs.

"I stopped after a while," said Eisenman, a beefy, blue-collar worker who flips switches at an oil and gas plant in Belle Chasse. "I just couldn't lift anyone anymore."

The death toll began increasing. One patient had a heart attack in a stairwell. Another died in his wheelchair. Marse spent much of the day delivering last rites.

"There was a sense of despair," he said.

By day's end, Memorial's second floor housed more than 100 people on wall-to-wall cots. Pou, who had few of her own patients in the hospital, hovered over the dangerously frail patients from the LifeCare unit, checking glucose levels, dispensing medicine and tending to basic needs.

"I remember thinking, 'Here is Anna Pou, who does these complicated, 12-hour neck surgeries, and she's down here taking care of these debilitated medical patients,' " said Dr. Roy Culotta, whose grandmother was treated by Pou. "It was kind of out of her area, but she wasn't complaining. I was really impressed."

Elena Hagstette said her husband was in agony until Pou told a nurse to let him have four pills of Percocet, a narcotic painkiller.

"They told me he could only take them one at a time, because that was all I was going to get," said Hagstette, whose husband was recovering from heart surgery. "I am grateful to her."

By late afternoon, when police shut down the evacuations for fear that boats would have trouble negotiating the tree-filled streets in the dark, about 500 people had been taken out of Memorial, including dozens of patients.

"Those guys were unbelievable, tremendous heroes," said Casey, referring to LeBlanc, Pafford and other volunteers. "Without those efforts, we could not have succeeded in evacuating the hospital."

It was a different story on the heliport. Overwhelmed by the scope of the rescue work, state and federal officials had deployed helicopters to evacuate stranded residents as well as babies and high-risk patients from other hospitals. Just two or three copters landed at Memorial that day, one of them only dropping off some water and a case of Vienna sausages.

About 4 p.m. LeBlanc ran out of patience. He went inside the hospital, found his mother lying on a cot and put her on a boat with her sitter. LifeCare's rescue vehicles never did show up.

The death toll began increasing. One patient had a heart attack in a stairwell. Another died in his wheelchair. Marse spent much of the day delivering last rites.

"There was a sense of despair," he said.

By day's end, Memorial's second floor housed more than 100 people on wall-to-wall cots. Pou, who had few of her own patients in the hospital, hovered over the dangerously frail patients from the LifeCare unit, checking glucose levels, dispensing medicine and tending to basic needs.

"I remember thinking, 'Here is Anna Pou, who does these complicated, 12-hour neck surgeries, and she's down here taking care of these debilitated medical patients,' " said Dr. Roy Culotta, whose grandmother was treated by Pou. "It was kind of out of her area, but she wasn't complaining. I was really impressed."

Elena Hagstette said her husband was in agony until Pou told a nurse to let him have four pills of Percocet, a narcotic painkiller.

"They told me he could only take them one at a time, because that was all I was going to get," said Hagstette, whose husband was recovering from heart surgery. "I am grateful to her."

By late afternoon, when police shut down the evacuations for fear that boats would have trouble negotiating the tree-filled streets in the dark, about 500 people had been taken out of Memorial, including dozens of patients.

"Those guys were unbelievable, tremendous heroes," said Casey, referring to LeBlanc, Pafford and other volunteers. "Without those efforts, we could not have succeeded in evacuating the hospital."

It was a different story on the heliport. Overwhelmed by the scope of the rescue work, state and federal officials had deployed helicopters to evacuate stranded residents as well as babies and high-risk patients from other hospitals. Just two or three copters landed at Memorial that day, one of them only dropping off some water and a case of Vienna sausages.

About 4 p.m. LeBlanc ran out of patience. He went inside the hospital, found his mother lying on a cot and put her on a boat with her sitter. LifeCare's rescue vehicles never did show up.

---------------------Part 5

FOR DEAR LIFE: How hope turned to despair at Memorial Medical Center Finally, help arrives. But four deaths on the seventh floor raise questions. Thursday, August 24, 2006 By Jeffrey Meitrodt

Jerry Forstater slept fitfully until about 3 a.m. that Thursday, when the man in the next hospital bed died.

Forstater knew it was coming. The elderly patient had been wheezing and coughing for four hours. When the pain got too bad, he'd let loose a scream. Forstater had no idea who the man was or what was hurting him. He had first laid eyes on him the previous day, when all the remaining patients at Memorial Medical Center had been brought downstairs for evacuation.

"The commotion woke me up," said Forstater, 62, whose colon had been removed at Memorial on Aug. 20. "They gave him a shot, they tried CPR. They did everything they could for this poor fellow, but it didn't help. He just died. They all walked away with their heads down."

Forstater said he never got back to sleep that night.

Neither did many of the doctors and nurses who spent those dark hours at Memorial. Between sundown Wednesday and sunrise Thursday, at least 10 patients died at the hospital, compared to one on a normal day. The temporary morgue in the second-floor chapel held 16 corpses, none of them in body bags, and the smell was beginning to make people sick. Other patients would be left in the rooms where they died because the regular morgue on the third floor was also full.

"Conditions at the hospital were horrible at that time," said Dr. Richard Deichmann, Memorial's chief of medicine. "Patients were dying of dehydration. I think a lot of them just gave up hope. We knew we had to evacuate that death trap."

As dawn broke at Memorial that Thursday, three days after Katrina, nobody had any idea that help was finally on the way for the more than 1,000 people still trapped in the hospital. At 6:30 a.m., the first of five helicopters chartered by Tenet Healthcare Corp., Memorial's owner, took off from a landing pad at a Tenet-owned hospital in Slidell and started for New Orleans, company officials said.

The helicopter showed up a little after 7 a.m. Even though the helicopter came back once or twice during the next two hours, most hospital workers weren't aware that the cavalry had finally landed until about 9 a.m., when a fleet of Coast Guard helicopters arrived.

By that time, according to state Attorney General Charles Foti, Dr. Anna Maria Pou and two nurses had decided to end the lives of at least four of the most critically ill patients remaining at Memorial.

According to an affidavit Foti filed in July to support second-degree murder allegations against Pou and nurses Lori Budo and Cheri Landry, the criminal conspiracy clicked into gear shortly after a 7 a.m. crisis meeting on the hospital's emergency room dock.

At that meeting, crisis manager Susan Mulderick shocked the assembled doctors and nurses, who did not know about that first helicopter, by telling them that they could expect no rescue that day. No one on the dock is sure how she came by such appallingly incorrect information. Mulderick declined a request for an interview through her attorney, Bruce Whittaker.

Mulderick's announcement was the last straw for some staff members, who had been hoping she would be able to break the communications blackout and get some good news from Tenet's headquarters in Dallas.

"It was a phenomenal blow to hear that nobody was coming to get us," Deichmann said. "The worst thing for us was always waiting for someone to come and get us and then never showing up. There was this feeling of betrayal all the time. That freezes your ability to do things. And that's what happened Wednesday and Thursday."

Death on the seventh floor

After the meeting, Mulderick was approached by two administrators of the seventh-floor LifeCare unit, which treated chronically ill patients with severe health problems.

They wanted to know how Memorial planned to evacuate their surviving patients, most of whom had been brought down to the second floor on Wednesday. Mulderick told the administrators that she knew there were still nine critically ill patients on the seventh floor, and that "we don't expect them to make it," according to Foti's affidavit. Even when help eventually arrived, she told LifeCare's pharmacy director, she didn't expect those patients to be evacuated with the rest of the hospital.

She also told the LifeCare administrators that some decisions had been made regarding the LifeCare patients, and she advised them to seek out Pou, according to the affidavit. Pou had been treating some of the LifeCare patients.

According to Foti's affidavit, which lays out the state's case, two of the administrators went to the seventh floor, where they found Pou and the two nurses in the medicine charting room. Pou allegedly told the two administrators that a decision had been made to administer lethal doses to the nine patients because they were too sick to survive. Pou made a similar statement to LifeCare's nurse leader, according to the affidavit.

Instead of trying to stop Pou, the LifeCare administrators fell into stride and helped her, according to the affidavit. The pharmacy director brought her a bunch of syringes, and the director of physical medicine showed Pou where each of the nine patients was located in the 82-bed wing.

When the pharmacy director asked Pou what she was going to use, she allegedly displayed a pack of 25 vials of morphine and an additional handful of loose vials. According to the affidavit, the lead nurse also asked what Pou was going to use, and she recalls that Pou's answer was morphine and ativan, a combination that is typically used to relax agitated patients and relieve severe pain. Medical experts say morphine and ativan is an extremely unreliable way to induce death.

Pou 'appeared nervous'

The first room Pou entered, according to the affidavit, was that of Emmett Everett Sr., 61, who weighed 380 pounds and was paralyzed. Pou allegedly told the LifeCare administrators that Everett was unaware of what was happening, but the assistant administrator disagreed, saying Everett was conscious and alert.

As Pou approached the door, she "appeared nervous," according to one of the LifeCare administrators. She allegedly told the director of physical medicine that she was going to give Everett something to help with his dizziness. She then entered the room and closed the door, according to the affidavit.

Next, the director of physical medicine accompanied nurse Lori Budo into the room of Hollis Alford, 66, and Rose Savoie, 90. The LifeCare administrator allegedly watched as Budo injected Savoie, and heard Savoie complain, "That burns," according to the affidavit. Savoie was suffering from kidney failure, asthma and bronchitis, according to attorney Michael Samanie, who represents Savoie's family in a pending civil case over her death.

Several of the alleged murder victims had do-not-resuscitate orders, which means they wished to forgo drastic medical intervention if they went into cardiac or respiratory arrest.

The affidavit doesn't provide any details about the fourth death, that of Ireatha Watson, 89, but LifeCare administrators said Pou asked for a list of the unit's nine remaining patients so she could come back later and make sure she didn't miss anyone. She then told the administrators they could evacuate. Pou's parting words, according to the affidavit: "I want y'all to know I take full responsibility and y'all did a great job taking care of the patients."

A lethal cocktail?

Though the affidavit suggests that Pou gave lethal doses to all nine patients on the seventh floor, Foti's forensic expert concluded that a lethal dose of morphine was administered to just four of the patients. In two cases, the dead patients also had an elevated level of Versed, a sedative typically used during surgery.

"When you use both of those drugs together -- either one of them can kill you -- but when you use them both together it becomes a lethal cocktail that guarantees they are going to die," Foti said at a July news conference to announce the arrests of Pou and the nurses.

Medical experts, however, said conditions at Memorial were so extreme that it is difficult to draw conclusions from the mere presence of the drugs in someone's system. They said it is just as plausible that the drugs were being used to help comfort dying patients or help prepare them for a painful evacuation.

Moreover, Dr. Roy Culotta, a critical care specialist who helped treat LifeCare patients in the wake of Katrina, said he administered morphine and Versed to two or three of his patients that week. Each of the patients was in severe pain because they had to be taken off their ventilators when the power went out, he said. All survived, he said.

"Did I use it to try and speed up their death? Absolutely not," Culotta said. "Did I use it to help them not to suffer? To relieve their sense of anxiety? To relieve their gasping? Absolutely. I use it that way all the time. If you don't do that, I don't think you are a good doctor . . . To say that is a lethal cocktail is just irresponsible."

'Shouldn't have happened'

Pou's accusers are not all LifeCare employees. Dr. Bryant King, a contract physician who had been working at Memorial for about a month before the storm, was the first person to publicly claim that hospital administrators were searching for a doctor that Thursday morning who would be willing to put sick patients "out of their misery."

In several interviews with CNN, King acknowledged that he did not witness any acts of euthanasia, but he said "most people know something happened that shouldn't have happened."

At about 9 a.m. that day, King said, he saw Pou walking around the second floor with a handful of syringes. "And the words I heard her say were, 'I'm going to give you something to make you feel better,' " King told the television network.

King said he thought it was "strange" that Pou was administering the same medication to so many people. "Nobody walks around with a handful of syringes and goes and gives the same thing to each patient," King told CNN. "It's not how we do it."

Through his sister, King declined repeated requests for interviews for this newspaper.

Mulderick's attorney said his client was not involved in any conspiracy to commit euthanasia. Mulderick has not been accused of any crime.

"Miss Mulderick denies any criminal wrongdoing whatsoever and denies witnessing any criminal wrongdoing," Whittaker said. "Her efforts and the efforts of other medical staff, to her knowledge, were nothing but professional and heroic beyond the call of duty."

Other doctors who were trapped at Memorial dispute King's account. First, they note, King said he saw Pou giving shots on the second floor, not the seventh floor, making his version of events inconsistent with that of LifeCare administrators.

Culotta doesn't think King was even at Memorial that Thursday morning. Culotta, whose grandmother was in the LifeCare unit, said he spent a lot of time visiting LifeCare's patients Wednesday and Thursday, and he didn't see King once.

Thomas Martin, 52, a New Orleans resident who took shelter at the hospital during the hurricane, said he put King on a boat Wednesday afternoon, shortly after King confronted hospital CEO Rene Goux about the hospital denying shelter to local residents. Martin said he had met King earlier that morning.

"I came to the hurricane in a pair of flip-flops, and he was concerned about the condition of my feet with the kind of filthy water that was around the hospital," said Martin, who said he spent most of Wednesday helping load patients and other evacuees into boats.

Through his sister, King maintained that he was at the hospital that Thursday morning.

To Culotta, one of the biggest problems with building a criminal case against Pou and the nurses is a lack of motive. Foti hasn't offered one, saying that is not his job. "It is my job and duty to find probable cause that people acted illegally," Foti said at the July news conference.

The case is now being reviewed by New Orleans District Attorney Eddie Jordan, who is expected to bring it to a grand jury in September.

"The idea that there would have been patients who were too tough to evacuate or would have been so difficult that they were just put out of their misery, that is just ridiculous," Culotta said.

Attempts were made to evacuate patients so fragile that three of them died while being transported to helicopters that Thursday or while waiting in line for a ride, according to Tenet and several doctors who assisted in the evacuation.

"By that time, people were so weak it was unbelievable," Deichmann said.

Seeking a way out

Like most doctors and nurses who attended Mulderick's briefing Thursday morning, Dr. John Kokemor was dumbfounded by the announcement that no help would be coming that day. For 15 or 20 minutes, he said, the medical staff was paralyzed.

Several doctors decided it was time to take matters into their own hands. Dr. Glenn Casey, the hospital's head of anesthesia, and Dr. John Walsh, a surgeon, volunteered to go on a scouting mission in a small hospital boat and look for other rescue vehicles. They were gone about an hour and a half, but they returned with a major catch: a 25-seat pleasure boat owned by one of Memorial's doctors and parked in a nearby lot.

"It took three guys from maintenance to figure out how to hot-wire the outboard motor," Kokemor said. "We probably made 10 runs with the boat that day. It should get an award. It should be in the D-Day Museum."

By the time the boat was in the water, rescue helicopters had finally arrived in force. This time, there was no waiting. Beginning at 9 a.m. and continuing through the rest of Thursday, the sky above Memorial was thick with helicopters. Sometimes, there would be two on the pad and three or four circling above, said Acadian Ambulance executive Michael Sonnier, who coordinated a fleet of 28 rescue helicopters in New Orleans after Katrina.

"We had a lot more assets by then," Sonnier said. "There were probably 50 to 100 helicopters in the area."

At first, the hospital wasn't prepared for the massive influx of help. At 7 a.m., there were just a handful of workers on the helipad. The first load consisted of a pregnant nurse, her husband and their 1-year-old son.

But word started to spread when the Coast Guard landed about 9 a.m. During the next hour, the Coast Guard's fleet flew about two dozen missions, evacuating more than 100 people, Deichmann said.

A flood of relief

Two more Tenet helicopters landed between 9:30 and 10 a.m., and the final pair showed up later in the day, including a 19-seat Puma that came all the way from Montana. Company spokesman Steve Campanini said the helicopters had gotten to Slidell the previous night but didn't come to the hospital because it was so late.

Altogether, Tenet's helicopters flew a total of 15 missions. Campanini said he doesn't know how many people were evacuated on the aircraft, but doctors estimate that the chartered helicopters took out about 150 patients, family members and medical personnel on Thursday.

Campanini acknowledged that the company made no effort to bring ambulances, buses or boats to Memorial. He said Tenet decided to bring all of its other rescue equipment -- including 50 buses and 26 ambulances -- to its hospital in Slidell, where Tenet established its regional command center.

"We couldn't get into the area," Campanini said. "Logically, it didn't make sense. . . . To send assets willy-nilly into a market that is totally destabilized is not prudent."

That explanation doesn't satisfy Mark LeBlanc, who organized a boat rescue that helped deliver several hundred people to safety on Wednesday. "If we could do it, why couldn't they do it?" he asked.

Though he got his mother out of the hospital Wednesday, LeBlanc returned Thursday morning. This time, he was leading a group of six ambulances from Arkansas, which he had arranged through a friend who had evacuated to Little Rock.

They had plenty of work. By about 1 p.m., when the State Police showed up to help, Arkansas ambulance operator James Pafford had returned with his four boats, and Memorial's medical staff had scrounged up several others. Altogether, Deichmann said, they had about 10 boats moving people up Napoleon to St. Charles Avenue and the hospital was being evacuated quickly.

End of an ordeal

One of the first people out was Forstater.

"They wanted to fly me out, but I said no -- I'm Navy, I'll sail out," said Forstater, who evacuated on his 62nd birthday. "It was a wonderful birthday present."

The Rev. John Marse, the hospital's chaplain, left about noon. Before getting into a boat, he stepped inside the chapel and blessed the 16 corpses being left behind.

Though he spent the entire day with the hospital's doctors and nurses, Marse said none of them ever talked to him about euthanizing patients. "One of the women I evacuated with asked a doctor to euthanize her two cats, and it tore the doctor up to do that," he said.

Nurse Melissa St. Amant said she was preparing to leave her cat in the parking garage with a bedpan full of food and another full of water when she heard administrators were finally letting people evacuate with their pets. Cat in hand, she departed about 2 p.m., leaving behind several suitcases of clothing. She said there were probably 100 pets in line with her.

After spending three hours at the triage center at Interstate 10 and Causeway Boulevard in Metairie, St. Amant boarded a bus to Baton Rouge with about 40 co-workers, including Budo, who had gotten out with her 19-year-old daughter.

"There was nothing different from her than anybody else," St. Amant said. "I remember her joking when we were close to Baton Rouge. She said, 'Maybe we could rent some of these places,' because most of us had lost our houses. It was small talk really. We didn't talk about the hospital much."

Culotta got his grandmother on a helicopter at about 3 p.m. "It was the biggest weight off my shoulders, because my mother was counting on me to take care of her," he said.

Kokemor got on a boat about 4 p.m. He couldn't get over how empty the hospital felt then. Nurses and volunteers had conducted several room-to-room sweeps to make sure no one was left behind.

Operation shut down

"It was amazing," he said. "In a few hours, we went from thinking we were going to be there for several more days to realizing we might be able to get everybody out on Thursday."

By 5 p.m., there were just two or three dozen patients left in Memorial. But the State Police wanted to shut down the boat evacuation because they "couldn't guarantee the safety" of evacuees in the dark, Deichmann said.

"I said, 'We've got patients dying. And more people are going to die if you close us down,' " Deichmann said.

The trooper refused to budge, so Deichmann and Walsh abandoned the emergency room ramp but quietly kept funneling patients to the other side of the hospital, where they had a second boat operation working out of the parking garage.

They eluded detection for 45 minutes, until a state trooper got into one of their boats with a shotgun and said, "You're stopping now," Deichmann recalled.

At that point, the only way out for the remaining 20 patients was the heliport, which workers had rigged with flashlights so copters could find it in the dark. Some of the patients had been waiting for hours, parked on their mattresses inside the garage. Nurses fanned them with cardboard, poured bottled water on their necks and held their hands.

About 8:30 p.m., as the light from the flashlights was dying, six hospital workers lifted the last patient to the top of the helipad. Mr. Rodney weighed 450 pounds, couldn't get out of his wheelchair and was suffering from lung disease. As the crew lifted the enormous man, nurse Charles Jarreau was smashed between the wheelchair and the helicopter's door and collapsed on the asphalt.

'Out of it'

"Everybody was high-fiving each other, saying, 'We did it!' when we realized Charles was in severe pain," said Culotta, who was helping with the evacuation. "We didn't have any equipment so we couldn't examine him. He wasn't responding to us. He was out of it."

Another helicopter showed up 20 minutes later and took Jarreau and Culotta to Baton Rouge General hospital, where Jarreau spent three days recovering from a bruised spleen, internal bleeding and severe dehydration.

The other 70 hospital workers had to wait until Friday morning for evacuation because federal officials stopped letting helicopter pilots fly at night.

"Nothing was lit up, so we couldn't get our bearings," Sonnier said. "We had nothing to steer by."

It was a long night on the helipad. Staff members watched as looters with flashlights roamed the abandoned hospital. About 5 a.m., a huge fire on the other side of the French Quarter lit the sky. As the sun came up, a wave of helicopters descended on the city. The last people at Memorial were airlifted to safety about 8:30 a.m. on Friday, four days after the hurricane had passed.

Pou was not among them. She had gotten out on a helicopter late Thursday and spent the night with her mother and relatives in Baton Rouge. Jeanette Pou said it was late when her daughter arrived with a black eye that she never explained.

"She was dirty. She was tired. She was crying," said Jeanette Pou, who had not been able to get through to her daughter's cell phone since before the storm. "She said it was just horrible but she just didn't want to talk about it. Then she went to bed."

. . . . . . .

Staff writer Michelle Krupa contributed to this report.

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