Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (88 page)

 
17
Lesser charges of manslaughter
: Arthur Schafer sworn witness examination, mandamus hearing,
John and Jane Does v. Charles Foti, et al
, 19th Judicial District Court, Parish of East Baton Rouge, State of Louisiana, case 558,055, August 28, 2007. Schafer said a decision on what charges might be applicable had not been reached.

 
18
Lou Ann Savoie Jacob
: Nossiter, Adam and Shaila Dewan, “Patient Deaths in New Orleans Bring Arrests,”
New York Times
, July 19, 2006;
http://www.nytimes.com/2006/07/19/us/19patients.html
. Ms. Savoie Jacob’s recollections are supported by Rose Savoie’s medical records: “Actually doing better” (August, 25, 2005) and “No new medical complaints” (August 27, 2005, the last physician progress note).

 
19
Kathryn Nelson
: Ms. Nelson and her brother Craig’s recollections in interviews with the author were supplemented by a handwritten account of the events she prepared for state investigators, dated October 26, 2006, and her July 8, 2008, deposition in
Elaine Nelson, et al v. Memorial Medical Center, et al
, Orleans Parish Civil District Court.

 
20
massive temporary morgue
: Described in Wecht, Cyril H. and Dawna Kaufmann.
A Question of Murder
(New York: Prometheus Books, 2008), pp. 248, 271–2.

 
21
In an acidic-smelling
: Description based on author’s visit in July 2008.

 
22
Chalmette Medical Center
: This brief description of what happened at Chalmette Medical Center is based on the recollections of Dr. Bong Mui in an interview with the author, August 3, 2011, and in a translated partial transcript of his interview in Vietnamese with son Nguyen dated September 10, 2006, for the oral history project “Surviving Hurricanes Katrina and Rita in Houston Collection” (AFC 2008/006), Archive of Folk Culture, American Folklife Center, Library of Congress, Washington, DC (interview SR05, accession no. SKR-SNU-SR05). Lightly redacted Louisiana Medicaid Fraud Control Unit investigative memoranda on Chalmette Medical Center obtained through a public information request suggest that hospital leaders had decided to keep the hospital open and staffed (not only because ambulances did not return to transfer more patients). Some patients who were transferred out of Chalmette Medical Center prior to the storm were moved to that hospital’s sister campus in the New Orleans area (Pendleton Memorial Methodist Hospital), which was also subsequently severely disabled by floodwaters and generator failures.

 
23
Tulane was also dark
: Hamm, L. Lee, “Personal Observations and Lessons from Katrina.”
The American Journal of the Medical Sciences
, vol. 332, no. 5 (2006): 245–50; Tulane commissioned a book on its hospital experiences during Katrina: Carey, Bill.
Leave No One Behind
:
Hurricane Katrina and the Rescue of Tulane Hospital
(Nashville, TN: Clearbrook Press, 2006). New employees of the Hospital Corporation of America (HCA, Tulane Hospital’s owner) are sometimes presented with a copy of the praise-filled account.

 
24
had not supplied with food, water
:
Hurricane Katrina
:
A Nation Still Unprepared
, p. 11.

 
25
authorized the lieutenant to land
: LTJG Sean Moore was riding in a Coast Guard–chartered commercial helicopter, aiding a marine salvage crew surveying the local waterways for sunk and disabled vessels. He said in an interview with the author (June 3, 2013) that the pilot, on learning Moore’s wife, Stephanie, was in the hospital, said, “Let’s get her the ‘f’ out of there.” The commander of Sector NOLA, Captain Frank Paskewich, said in a US Coast Guard Oral History interview (October 18, 2005) that he readily approved the request. “I said, ‘Absolutely, go rescue your wife, please.’ ”
http://www.uscg.mil/history/katrina/oralhistories/PaskewichFrankoralhistory.asp
.

 
26
Anderson Cooper said
: “Euthanasia Performed in Aftermath of Hurricane Katrina?,” CNN,
Newsnight with Aaron Brown
, October 12, 2005, ten p.m.;
http://transcripts.cnn.com/TRANSCRIPTS/0510/12/asb.01.html
.

 
27
“Why weren’t there plans”
: “Accusations of Mercy Killing in New Orleans,” CNN,
Newsnight with Aaron Brown
, October 12, 2005, eleven p.m.;
http://transcripts.cnn.com/TRANSCRIPTS/0510/12/asb.02.html
.

 
28
“The culture that we live in”
: ibid.

 
29
“Did an angel of death”
: “Louisiana AG Orders Autopsies of 50 Memorial Medical Patients,” CNN,
Nancy Grace
, October 14, 2005;
http://transcripts.cnn.com/TRANSCRIPTS/0510/14/ng.01.html
.

 
30
“There was no way”
: “In Depth: Officials Are Looking Into Allegations of Euthanasia in a New Orleans Hospital for Gravely Ill Patients as Hurricane Katrina’s Floodwaters Rose,” NBC News, October 17, 2005;
http://www.nbcuniversalarchives.com/nbcuni/clip/5117065625_s09.do
.

 
31
“I didn’t know if I was doing the right thing”
: Graham, Caroline and Jo Knowsley, “We Had to Kill Our Patients,”
Mail on Sunday
, September 11, 2005;
http://www.dailymail.co.uk/news/article-361980/We-kill-patients.html
.

 
32
Nearly three out of four convictions
: Innocence Project, Inc., “Reevaluating Lineups: Why Witnesses Make Mistakes and How to Reduce the Chance of a Misidentification,” (Benjamin N. Cardozo School of Law, Yeshiva University, July 16, 2009);
http://www.innocenceproject.org/docs/Eyewitness_ID_Report.pdf
.

 
33
they were far from complete
: Tenet Healthcare Corporation provided the following response on August 18, 2009: “This is not correct. Tenet has produced all requested medical records in its possession—both hard copies and electronic—to the Louisiana Attorney General’s office. On numerous occasions, Memorial Medical Center made available all records in its possession and provided investigators full access to the facility when requested.”

 
34
CNN reported on the subpoenas
: Griffin, Drew and Kathleen Johnston, “Dozens Subpoenaed in Hospital Deaths,” CNN, October 26, 2005;
http://www.cnn.com/2005/US/10/26/katrina.hospital
.

 
35
Castaing would, years later
: Castaing said this during fact checking for
Deadly Choices
in 2009. He repeated it in two phone calls with the author in 2013 and an e-mail. He said the meeting’s purpose was to organize logistics for interviews of Memorial employees and that he requested either a blanket non-prosecution or immunity agreement for all the nurses from
Memorial, which he did not obtain. When Castaing was told that notes were made within days of the meeting by the investigator, he said he, too, had taken notes “religiously.” However after the author asked to see them, he checked and said he had taken no notes.

 
36
Jim Letten
: Letten’s position had previously been held by Orleans Parish District Attorney Eddie Jordan Jr. Letten was reportedly the longest-serving US attorney when he resigned from his position in December 2012, after senior prosecutors in his office were discovered to have commented on active criminal issues on the website of the
Times-Picayune
, using aliases. Robertson, Campbell, “Crusading New Orleans Prosecutor to Quit, Facing Staff Misconduct,”
New York Times
, December 6, 2012;
http://www.nytimes.com/2012/12/07/us/jim-letten-new-orleans-us-attorney-resigns.html
.

 
37
federal jurisdiction over them was limited
: Williams, C. J., “Making a Federal Case out of a Death Investigation,”
United States Attorneys’ Bulletin
, vol. 60, no. 1 (January 2012);
http://www.justice.gov/usao/eousa/foia_reading_room/usab6001.pdf
.

 
38
“John, everybody has to be out of here”
: Susan Mulderick, through her attorney, and L. René Goux both said that they were not given a deadline to empty the hospital and that their goal was to focus their exhausted colleagues on the evacuation. “We’d experienced the helicopters’ stopping flying to us, and I didn’t want that to occur again,” Goux said in an interview with the author (August 17, 2009).

 
39
DMATs
: Sanford, Christopher. “Nine Days at the Airport” (unpublished manuscript). Sanford, Christopher, Jonathan Jui, Helen C. Miller, and Kathleen A. Jobe, “Medical Treatment at Louis Armstrong New Orleans International Airport After Hurricane Katrina: The Experience of Disaster Medical Assistance Teams WA-1 and OR-2,”
Travel Medicine and Infectious Disease
5 (2007): 230–235; Klein, Kelly R. and Nanci E. Nagel, “Mass Medical Evacuation: Hurricane Katrina and Nursing Experiences at the New Orleans Airport,”
Disaster Management and Response
vol. 5, no. 2 (2007): 56–61; “Hurricane Katrina—After Action Report: OR-2 DMAT,” September 25, 2005; Dentzer, Susan, “Hurricane Hospital Challenges,”
PBS NewsHour
, September 8, 2005;
http://www.pbs.org/newshour/bb/weather/july-dec05/hospitals_9-8.html
; Barringer, Felicity and Donald G. McNeil Jr., “Grim Triage for Ailing and Dying at a Makeshift Airport Hospital,”
New York Times
, September 2, 2005;
http://www.nytimes.com/2005/09/03/national/nationalspecial/03hospitals.html
; Smith, Stephen, “Patients Evacuated in Massive Airlift: LA Airport Used as Field Hospital,”
Boston Globe
, September 4, 2005; Allison, Cody, “Untitled,” Hurricane Digital Memory Bank, object no. 39470;
http://www.hurricanearchive.org/items/show/39470
. The US House of Representatives report on Hurricane Katrina (
A Failure of Initiative
:
The Final Report of the Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina
, February 15, 2006, p. 269;
www.c-span.org/pdf/Katrinareport.pdf
) noted the “confusion” that resulted over the command structure of the medical teams. Prior to Katrina, the National Disaster Medical System, of which the DMATs are a part, was removed from HHS and placed under FEMA and the Department of Homeland Security as part of a massive governmental redesign after the September 11, 2001, attacks. After Katrina, the NDMS was placed back under the Department of Health and Human Services, which coordinates federal health care resources in emergencies (“Emergency Support Function-8”), according to the National Response Framework. The medical section of the House of Representatives report (pp. 267–309) criticized the failures of the federal medical response in particular. It described the medical effort at the airport as “chaotic,” with many people dying while doctors who weren’t members of the federal teams, like Thiele, were turned away. Personnel “black tagged” the sickest and
moved them away from others “so they could die in a separate area,” one doctor quoted in the report said (p. 288). Despite the post-Katrina “lessons learned,” supply chain problems and rigid procurement policies again encumbered the NDMS’s lifesaving work in response to the 2010 Haiti earthquake (albeit in a much more logistically challenging environment); some supply caches arrived with heaters, for example, instead of air-conditioners; and bottled oxygen, fuel, and certain equipment for performing operations ran short. One case is discussed in the Epilogue. NDMS in recent years “significantly revamped its supply, resupply and logistics processes” including the warehousing of supplies around the country for use by any team, and anticipating specific needs, such as special bariatric beds for very obese patients, according to Gretchen Michael, director of communications, HHS Office of the Assistant Secretary for Preparedness and Response (e-mail, August 2013). DMATs used smaller strike teams to respond more flexibly to Superstorm Sandy in 2012, and HHS behavioral health teams supported first responders and American communities affected by mass shootings and bombings in 2012 and 2013.

 
40
Baltz searched his memory
: Baltz, Horace.
The Kat’s Paw
:
Memorial Medical Center—Katrina
(unpublished manuscript), and interviews with the author.

 
41
death of one of his longtime patients
: Baltz disagreed entirely with Kokemor’s assessment of his motivation for seeking the truth about his patient’s death.

 
42
She had promised
: Chatelain’s husband, Alfred Lee Moses, and daughter, Catherine Chatelain, attributed her increasing use of alcohol and narcotics—resulting in the loss of her nursing license, and her untimely death in her early fifties from acute pancreatitis—to her distress over the circumstances of her patient Emmett Everett’s death. “I think that’s the major reason my mom isn’t here today, because she just spiraled into depression after that,” Catherine Chatelain said in an interview in 2013.

 
43
one of the investigators researched
: She shared these articles with her colleagues: Perkin, R. M. and D. B. Resnik, “The Agony of Agonal Respiration: Is the Last Gasp Necessary?,”
Journal of Medical Ethics
, 28 (2002): 164–169, retrieved by the investigator on November 28, 2005, from
http://jme.bmjjournals.com/cgi/content/full/28/3/164
;
Whonamedit? A Dictionary of Medical Eponyms
, “Cheyne-Stokes Respiration,” retrieved by investigator November 29, 2005, from
http://www.whonamedit.com/synd.cfm/1159.html
; “Central Sleep Apnea: Details,” retrieved by investigator on November 29, 2005, from
www.apneos.com/csa.html
.