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The Curious Case of Dr. Anna Pou: Hell and High Water

Saturday, Oct 23rd

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The Curious Case of Dr. Anna Pou: Hell and High Water

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New Orleans is known for its sizzling jazz clubs, world-class restaurants and winning sports teams. But in the aftermath of Hurricane Katrina in the summer of 2005, the Big Easy became the site of a mass murder at the hands of a doctor who "involuntarily euthanized" dozens of patients, most of whom were black.

How did this happen, and why hasn't there been justice for the victims?

The picturesque city of New Orleans sits in a bowl, eight to 12 feet below sea level in some places, with Lake Pontchartrain to the north and Lake Borgne to the east and buoyed by a levee system that had seen better days. When Katrina pummeled southeast Louisiana on Monday, August 29, 2005, those levees breached in 50 places, causing severe flooding in 80 percent of the city and its neighboring parishes.

After the storm moved on, area residents thought the worst was over. The sun came out, and people began moving about the city again. But as the wind stopped pushing the water out of the lakes, the returning tidal surges caused those levees to fail, one by one. Temperatures spiked to 110° and stayed that way for a week. Looting and violence on the streets were rampant. Evacuation warnings were issued and news coverage showed an endless parade of cars on roads heading out of town.

In preparation for the hurricane, many people gravitated to a local hospital at 2700 Napoleon Avenue in the Uptown/Broadmoor part of town and remained there for several days. First built in 1926, and owned by a succession of groups until it was acquired by Tenet Healthcare Corporation in 1996, it was known as Memorial Medical Center. Its six-block campus had undergone a recent $100 million facelift, with the main building boasting a red brick façade, eight stories tall. The facility had stood its ground against hurricanes in the past, without there ever being an evacuation. With waters eight feet deep around it, Memorial seemed impenetrable, like an island in the middle of an ocean.

About two thousand people were in residence when Katrina hit, including 265 patients, their visitors, 500 hospital workers and between 25 and 40 doctors. Many employees brought their relatives to wait out the storm in safety, and there were also hundreds of pets in cages. There was plenty of fresh water in five gallon bottles, and the fourth floor kitchen staff served up eggs, grits, sausage, rice, beans, and muffins in Styrofoam cups. Doctors continued making their rounds, while nurses kept patients comfortable with fresh bedding and medication.

Within hours, the metal skeleton of the building began creaking, sounding like the ship in the movie Titanic, right before it sank. The roof on Memorial's eighth floor started buckling and leaking, creating puddles on the linoleum and carpets. Memorial and Tenet executives agreed to move the floor's intensive care patients, many of whom were on life-support machines and hooked up to oxygen, to a triage area on the second floor. As those moves were being made, the electricity faltered, ending elevator transport.

Things got worse. Toilets overflowed, spilling feces and filth down the hallways, and there was no running water and scant communication between floors. Backup generators took over for a while, but by early Wednesday morning, the electrical grids in the basement that kept the generators going, also failed. The total blackout meant computers fell silent, cell phones could not be recharged and patients' life-support systems were useless. People who didn't have flashlights would have to slowly stumble down the hallways or stairs, hoping not to trip over a sleeping or dead body. And there was no escaping the fetid smell that hung in the air.

One of the last communications from Tenet's Dallas-based brass was for Memorial's chief executive to close the facility and begin evacuation at once. But boats and helicopters were in short supply and the priority was to get citizens off roofs, not to take care of hospitals, which were considered secure environments. Still, the goal was to evacuate staffers by boat and take every patient to Memorial's roof where helicopters would pick them up and fly them to another facility. No one would be left behind, although it was understood that the healthiest patients would be the first ones to leave and staff volunteers would be the last.

The going was slow, with each patient having to be carried on a stretcher down flights of pitch-black stairs, then passed through a three-foot hole in the wall to the parking garage where a vehicle would ferry the person up the nine levels to the top of the structure, and then there would be another two flights of stairs before reaching the helipad. In the first full day, only 25 patients had been flown out. Another handful had died.

Much of Memorial's seventh floor was leased to a long-term acute care operation called LifeCare Holdings, Inc., that was based in Plano, Texas. LifeCare's patients were chronically ill or suffering from calamitous accidents or ailments, requiring full-time care until they were healed enough to be discharged to their homes, a nursing home, or wherever they came from. LifeCare had 55 patients on the seventh floor, some of whom had already been moved down to the evacuation queue.

One of the doctors from LifeCare was Anna Maria Pou, then 49, a New Orleans' native and cancer surgeon whose father had also been a doctor in the community. According to an affidavit filed by Louisiana's then-Attorney General Charles Foti, Memorial's mission had changed: The remaining nine LifeCare patients would be euthanized by being given a lethal dose of a drug cocktail. Staffers who didn't approve were told to leave. Dr. Pou, accompanied by two nurses, Lori L. Budo and Cheri A. Landry, drew liquids from vials into syringes, then went into each room, told the patient he or she was getting an injection to help them rest and, as each expired, a sheet would be placed over the patient's head.

Angela McManus had been with her cancer-stricken mother Wilda for two weeks before Katrina, and was pleased with her mom's progress as a LifeCare patient. Wilda was alert and wanted to be evacuated with Angela, who was told to join the evacuation group downstairs and that her mom would soon follow. Reluctantly, Angela did so, but returned to find no arrangements were being made to move Wilda. Then three police officers arrived, pointed their guns at Angela, and forced her to leave. After the LifeCare patients were dead, Pou and her team moved down to the second floor triage area.

On Thursday morning, September 1, a young black internist named Dr. Bryant King was told that the triage patients needed to be "put out of their misery." King exploded in protest and was told he didn't have to participate; there was a doctor willing to perform the task. Three hours later, all relatives were told to leave and King saw Pou with a handful of syringes. That caught his attention since doctors never administered injections, nurses did. But while he didn't know what medications were in the syringes, he saw Pou go from one patient to another, telling each, "This is going to make you feel better."

King wanted no part of this and, although he had been willing to stay until the final evacuation, he left the building and got in a boat. Later, as he told a CNN reporter, he regretted not physically restraining Pou and stopping the killings.

In all, 34 patients at Memorial were euthanized. Foti's office began a top-secret probe with the goal of presenting his findings to Eddie Jordan, the district attorney for New Orleans who would prosecute the case. Foti believed Pou felt confident no one would get back in the building for weeks, by which time the bodies would be skeletonized, leaving no tissues to sample. But, in fact, his investigators entered the hospital within days of the deaths, and took samples of the deceased, sending them to a toxicology lab, and comparing the drugs that were present to what was in each patient's typical regimen.

It was a laborious process but on July 1, 2006, Pou, Budo, and Landry were arrested for second degree murder of four patients. Each had been injected with a fatal cocktail of the pain reliever, morphine, and a sedative called midazolam (Versed). Some patients who took too long to die received more than one injection. Foti planned to add more counts as lab results on other patients came in. At a press conference, he announced: "This is not euthanasia. This is homicide. We're talking about people who pretended that maybe they were God." All three women pleaded not guilty and were released on bail. Eventually, the two nurses agreed to testify against Pou, in exchange for immunity from prosecution.

Foti had great backup in his pursuit of justice. He assembled an A-team of "forensic all-stars," beginning with top medical examiners Drs. Cyril H. Wecht of Pittsburgh, Michael Baden of New York City, and James Young of Ontario, Canada, along with medical ethicist Arthur L. Caplan Ph.D., of Philadelphia, and Dr. Frank Brescia, a Charleston, South Carolina, authority on end-of-life issues. Wecht also performed additional scientific experiments that proved the drugs in every patient were not from some natural means, like decomposition. Each expert reviewed the medical and pharmacological reports independently and arrived at the same conclusion: Without question, the patients were murdered. The five doctors prepared separate affidavits that Foti handed over to the district attorney who had agreed to convene a grand jury on the matter.

District attorneys present prosecution evidence and witnesses to a specially convened grand jury to determine whether probable cause exists to indict anyone for a crime. If a "true bill" is handed down, the criminal case goes to trial before a jury of twelve citizens; if the grand jury finds "no true bill," the case is dismissed. Most states have safeguards whereby criminal cases a district attorney refuses or is unable to prosecute can be bumped up to a higher official, like an attorney general, who will take the case to court. But Louisiana law favors the local jurisdiction as the final stop for justice. The attorney general has the power to investigate and arrest, but the D.A. of any parish takes over the case, unless there is a recusal or an assist is requested. For reasons known to only himself, D.A. Jordan declined to show his grand jury the affidavits of, or call as witnesses, the five experts who declared the deaths were homicides. In the absence of a complete picture, the grand jury ruled that no crime had been committed. Dr. Pou would not face trial.

From the time of her arrest, Dr. Pou campaigned hard to win public support, giving many interviews, including with CBS's 60 Minutes, where she admitted administering the fatal injections, but stating that she had no choice due to the extreme conditions during that week. It was "compassion," she argued, not murder. Of course, it is her right to state the facts as she sees them; no one can deprive her of that.

In 2007, I wrote a book with Dr. Wecht entitled "A Question of Murder," in which we offer lengthy and precise details about what happened at Memorial Medical Center. The book was released the next year to wide acclaim. I was lucky enough to speak to several family members about their deceased loved ones before they signed settlement agreements that would seal their lips forever. I also spoke to Dr. King, whose honesty and humanity were heroic.

Dr. Cyril Wecht is perhaps the best known forensic pathologist in the world today, having performed autopsies on more than 17,000 people, and consulting on another 37,000+ death cases. He is also a lawyer and frequent television commentator on suspicious or high-profile deaths. His files include President John F. Kennedy, Senator Robert F. Kennedy, Nicole Brown Simpson and Ron Goldman, Laci Peterson and her unborn son, JonBenét Ramsey, Anna Nicole Smith and her son Daniel, Michael Jackson, Casey Anthony, and many others. He has testified at thousands of trials, and his professional opinion can send someone to death row or keep them out of jail.

About Anna Maria Pou, Wecht states: "She committed an act of involuntary euthanasia on these helpless patients. Despite the miserable conditions at Memorial, and the general ill health of the victims, they were all viable and should have been evacuated. Dr. Pou, perhaps with input from management or Tenet, decided to cut and run and betray her medical principles. The patients didn't ask to have their lives ended, and some even begged for evacuation, yet she systematically and callously administered drugs that killed them."

He adds: "New Orleans' mayor and district attorney, and the state's attorney general have all changed since the Memorial deaths, and if a new D.A., now or in the future, decides a jury should hear this case, I'm prepared to testify, and so are the other forensic experts. While that's a long shot, there is no statute of limitations on murder.

"I think it's fitting that a jury hears all the evidence against Dr. Pou, and if one does and acquits her, so be it. At least then the victims, and their loved ones, will get their day in court."

Dawna Kaufmann is a true crime reporter in Los Angeles. Her most recent book, also written with Dr. Cyril Wecht and about famous death cases, is "From Crime Scene to Courtroom."

Photo Credit: (Alex Brandon/AP Photo)

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