Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (40 page)

Tenet’s corporate communications director, Steven Campanini, called Pou back on her cell phone. He asked if she was somewhere near a landline. She assumed he wanted a more secure connection. When he called Pou again, he had Tenet assistant general counsel Audrey Andrews on the line.

Pou spoke with them for more than an hour. Andrews clarified during the conversation that she worked for the corporation and not individuals. She advised Pou to get her own attorney, and Campanini suggested she draw up a general statement for the media. Pou called him the next day to go over it, and he phoned back with Andrews. They advised Pou, in fact, not to send it to the media. Andrews started to ask more questions, but Pou said she wanted to get her own lawyer before answering.

Richard T. Simmons Jr., a criminal and civil defense lawyer who specialized in white-collar offenses, worked in a wealthy suburb of New Orleans at Hailey, McNamara, Hall, Larmann & Papale. Formerly an
assistant US attorney in New Orleans and a US Army JAG Corps officer during and after the Vietnam War, Simmons was well connected. He had helped represent commanding officer Lt. William Calley on an appeal in the My Lai massacre case and successfully helped defend a business partner of one of Louisiana’s most corrupt recent governors, Edwin Edwards, in a racketeering case. Simmons was turning sixty that month. He wore a few long strands of shoe-polish-black hair stretched over his balding pate. Pou hired him on the advice of her employer, the Louisiana State University Healthcare Network, which had used Simmons’s services in another matter.
The network agreed to pay Simmons at the same rate, $275 an hour, to defend Pou.

One of the first things Simmons did was to contact one of Tenet’s attorneys and insist that whatever Pou had told Andrews and Campanini be treated in confidence, as if Andrews had actually been Pou’s attorney, not Tenet’s, and the conversations had been covered by attorney-client privilege. Simmons wanted to ensure that nobody else had the chance to discover what Pou had confided. There would be no more unrestricted discussions with people aside from him, no more unmediated forays into the media. Even Pou’s husband would be kept, to a certain extent, in the dark.

Protecting Pou would mean marshaling the facts and safeguarding them until the time was appropriate to release them. Simmons began constructing what he would refer to as her “defense camp,” and Pou retreated into it. Lines were being drawn.

Those seeking to discover and expose the truth were on the other side.

ON THE SAME day that Pou called Mulderick, Prosecutor Butch Schafer and Special Agent Virginia Rider sat down to interview the first of four LifeCare witnesses about their allegations of suspicious deaths
on the seventh floor of the hospital. A lawyer for LifeCare scheduled the interviews at Rider’s request. Joining Schafer and Rider was a friend of Rider’s from the police academy, Artie Delaneuville, a federal investigator with the US Department of Health and Human Services who had previously been employed in the Medicaid Fraud Control Unit. He often worked cases with Rider.
The US attorney for southeast Louisiana had opened concurrent investigations into the hospital and nursing-home deaths as potential criminal violations of the federal health-care fraud statute.

The witness was LifeCare’s pregnant assistant administrator Diane Robichaux, who joined them by phone with two LifeCare attorneys. She recounted her experiences during the storm, how by Wednesday the smells of the unrefrigerated morgue on the eighth floor had drifted down the staircase in the furnace-hot air, the way the staff labored all night with rubbing alcohol and gravity-drip IVs—not commonly used elsewhere in the hospital—to cool the patients and keep them alive, and finally what she said had happened the morning of Thursday, September 1. Robichaux had gone downstairs with two colleagues to speak with Susan Mulderick, who had told them, Robichaux recalled, “The plan is not to leave any living patients behind.”

Robichaux found Pou on the seventh floor when she returned to LifeCare. “We said, ‘Are you Dr. Pou?’ And she says, ‘Yeah, I’m Dr. Pou.’ And I said, ‘Ms. Susan told us we need to talk with you.’ Robichaux introduced herself and Pou said she had already spoken with LifeCare’s nurse leader and had some nurses coming up to meet her. “I’m trying my hardest to remember the exact words she said to me, but she, she just, she said that, ah, ‘We, we’re here, these patients,’ ah, you know, ‘are not gonna survive,’ or, or something like that.” Pou had asked Robichaux to make a choice. “ ‘You need to make a decision whether you want your, your staff on the unit or not.’ And at that point I mean, just things are going through your mind and, and I just, I remember saying, ‘Well, absolutely not I, I don’t want my staff on the unit.’ Now, she was a little bit
more specific with Therese, ah, when she spoke with her, you know, in terms of.”

“Let me ask you,” Delaneuville interrupted her. “What did Therese relate to you that Dr. Pou told her?”

“She said that, ah, Dr. Pou said that, she came up and said, ‘These patients aren’t going to survive,’ or you know, ‘these patients aren’t going to survive,’ something like that. And, ah, ‘a decision has been made to administer lethal doses to these patients.’ ”

It was a harrowing story, but a confusing one. Robichaux hadn’t directly heard Pou say she was going to give the patients “lethal doses.” She had only heard that from her colleague, Therese Mendez, LifeCare’s nurse executive. Perhaps Pou had been misheard and her intentions misjudged. (Pou’s lawyer would later strongly deny that she had used those words.)

The interview continued. Robichaux said she told Pou about sixty-one-year-old Emmett Everett, who was aware of his surroundings, but weighed 380 pounds and was paralyzed. Pou replied she hadn’t known that any of the patients were “aware”—that is, conscious. Two Memorial nurses joined Pou on the seventh floor. Robichaux didn’t know their names. Together, they discussed the situation.

“We kind of went back and forth with scenarios if, ah, of whether or not he’ll be able to be evacuated in terms of, whether someone could physically or people could physically get him down the stairs and lift him through that hole to get on the helicopter and, ah, and you know, it, it was said that they, they didn’t think that, that was possible and, ah, then she said, ‘Will one of your staff members be willing,’ you know, ‘somebody that, that he feels comfortable with, to go in and, and, and sedate him,’ and ah, at the time, you know, we said, ‘We, we have one very strong nurse here and, ah, his name is Andre,’ and we, we pulled Andre in at that point, but something just at that point clicked in, ah, I just see Andre hearing this and, ah, I said, ‘No, Andre is not going to do it.’ ”

Robichaux had gathered her staff and left the floor. She remembered
Pou coming to speak with her before they went downstairs. “And she said to me, ‘I know this is hard for y’all, I don’t want anybody to feel responsible, this is nothing to do with LifeCare,’ ah, she said, something like, ‘I take full responsibility for, I don’t want anybody to worry about their license,’ or, you know, something along those lines.”

After being airlifted to another Tenet hospital on Thursday afternoon, Robichaux and several colleagues took a Tenet-hired bus to Baton Rouge, where LifeCare senior vice president Robbye Dubois helped arrange a flight for them to Shreveport.

Robichaux stayed overnight at Dubois’s home. The next morning they sat together in the kitchen and cried as Robichaux described what had happened. This was how corporate officials learned of the events. From there Robichaux and other senior LifeCare leaders were called to the company’s headquarters in Plano, Texas, where they received support and counseling over the weekend. After Labor Day, the company’s lawyers discussed the situation and decided the best approach would be to self-report the potentially criminal events to government officials and offer full cooperation. Getting to the government quickly and disclosing all that was known was the best insurance against criminal charges for the corporation, it was thought.

The attorneys interviewed Robichaux and other witnesses and counseled them that they had little to fear in terms of their own exposure to criminal prosecution. They told them to be honest when they spoke with law enforcement officials. However, they advised them not to answer anything they weren’t asked.

In Plano, Robichaux happened to be in the room when a call came in from Memorial pathologist Dr. John Skinner. He shared the names of patients he had documented as deceased before leaving the hospital. He was calling in case any of them were LifeCare patients. The names Skinner mentioned included all nine patients on the seventh floor and some additional patients who the LifeCare staff hadn’t been aware had died. Robichaux’s colleague took the information from Skinner. Robichaux
passed her a note with a question for him: “Does he know cause of death?” She wanted to know, were these natural deaths? Or something else? Skinner said he didn’t know.

Robichaux’s interviewers remained skeptical that something illegal had happened at Memorial. It could all be a case of misunderstanding. Two days later the three colleagues interviewed LifeCare nurse executive Therese Mendez, who joined them by cell phone from an evacuated house. She had crawled through a window and was squatting in a back room until she could reenter her home. Mendez had left a hotel room and driven eight hours only to discover, nearing New Orleans, that the mayor had changed his mind and residents would not yet be allowed back into her neighborhood. Meanwhile a new Category Five hurricane, Rita, was mustering in the Gulf. One of the strongest ever recorded, it had a bead on Louisiana, and Mendez, spooked by hysterical television news reports, worried she’d be forced to evacuate again.

To save Mendez time, the investigators asked her to begin her account with the morning of Thursday, September 1, her last day at the hospital. Mendez said she had worked overnight on the first floor. After daybreak she heard the sound of helicopters. “We’re just getting one right after the other. The air was just filled with helicopters.” It made her think of the rush to the evacuation helicopters on the American embassy rooftop during the 1975 North Vietnamese capture of Saigon. She returned to the seventh floor at around eight or nine a.m. and walked along a corridor of LifeCare, overpowered by the smell of diesel fumes from the helipad washing into the unit. The patients she saw looked bad. Several were unconscious, frothing at the mouth, and breathing in an irregular way that often heralds death. Still, while two patients had died on the LifeCare floor on Wednesday, the others had lived through the night against the expectations of the infectious diseases doctor who had come upstairs on Wednesday night and examined them. Only a few were given small doses of morphine or the sedative Ativan for comfort.

Mendez said she heard her colleagues hollering for her through the
ducts. “I got up and came down the hall and Dr. Pou was coming up toward the north side.” Mendez sat down with Pou in a back office with an open window. “She said that, um, the patients that I had left on the floor will probably not survive or were not going to survive. And having seen what I had just seen when I looked around, well, you know, ‘I think you’re right.’ ” Mendez was amazed that her staff had been able to keep these sickest patients, relegated to be rescued last, alive this long.

Mendez paused. HHS special agent Delaneuville asked what happened next. “The patients that I had seen, you know, when I was looking at them, I was wondering how much longer it was going to go on because they, it was just so horrible. And, um, in the meantime you have the helicopters and the gunshots and windows crashing and people screaming and, you know, it’s just like total chaos.”

Mendez stopped talking again. A long time passed. Delaneuville asked her, “Well, what did she say next after she says they’re not going to, probably not going to survive?”

“She said the decision had been made to administer lethal doses.” Mendez paused again.

“Of what?” Delaneuville asked.

Mendez said she had asked Pou that question “and she listed off the drugs and I asked her to repeat it and she repeated it,” but now Mendez couldn’t remember exactly what drugs Pou had mentioned. “Morphine was one of them, Ativan, um, I don’t know. I’m—I’m guessing after that.”

Mendez had asked Pou if the plan applied only to LifeCare patients “because, you know, why would they just do that to our patients?” Pou said no. Staff members from another part of the hospital were coming to assist, and LifeCare employees should pack up their belongings and leave. Mendez, in tears, went to gather her colleagues. After having worked so hard to keep their patients alive to be rescued, the floor nurses and aides could not be allowed to see what was going to take place; she felt they would never recover.

Hearing the word
lethal
had given Mendez the sensation of stepping off a curb the wrong way. The investigators did not press her on why she—a smart, forceful advocate for her patients—had not challenged Pou. Nurses had the duty as professionals, no less as humans, to refuse to implement doctors’ orders that they considered wrong. Mendez explained how her perception of the nexus of control had guided her actions.