Doctor, nurses arrested in Katrina deaths

A physician and two nurses who worked through the chaos of Hurricane Katrina and its aftermath in New Orleans were arrested last month and accused of second-degree murder in the deaths of four hospital patients.

Louisiana Attorney General Charles C. Foti Jr. accused Anna Maria Pou, MD, an associate professor of otolaryngology at the Louisiana State University School of Medicine, and two nurses, Lori Budo and Cheri Landry, of intentionally administering lethal doses of morphine and the anxiolytic midazolam, the latter marketed as Versed, to four Lifecare Hospitals patients on Sept. 1, 2005. Lifecare is a long-term acute-care unit that leased space from Memorial Medical Center.

Toxicology reports showed apparently lethal amounts of the drugs in the patients' bodies, according to an affidavit accompanying the arrest warrants. The physician allegedly told an unidentified Lifecare nurse executive that "a decision had been made to administer lethal doses" to patients too sick to be moved to the hospital's roof for evacuation by helicopter, according to the affidavit.

"This is a homicide. It is not euthanasia," Foti said during a news conference, according to The Times-Picayune.

The investigation is ongoing and may result in more arrests, according to Kris Wartelle, a spokeswoman for the attorney general's office.

Dr. Pou, Budo and Landry were released on their own recognizance and at press time were in legal limbo because no formal charges were filed. The evidence gathered during the 11-month investigation was turned over to Orleans Parish District Attorney Eddie Jordan, who will present the case to a grand jury and may adjust charges as he sees fit. The DA's office refused to comment on the case.

Dr. Pou did not grant interviews on the advice of her lawyer, Richard T. Simmons. According to local news accounts, through their attorneys, the physician and two nurses have all proclaimed their innocence.

In a statement, the Louisiana State Medical Society expressed concern about the accusations, but added, "We believe the judicial system should be allowed to ultimately determine what actually took place at the hospital in the days following Hurricane Katrina."

The AMA did not comment on the case but cited policy stating, "Euthanasia is fundamentally incompatible with the physician's role as healer."

Steven Miles, MD, a bioethicist at the University of Minnesota Medical School said it's wrong to think of the case in terms of "euthanasia."

"The claim made in this case is that this was a lethal combination of drugs," Dr. Miles said. "These are standard drugs that are used in palliative medicine, both individually and in combination. There's no reliable lethal use of these drugs. That's why they're not used, for example, in executions."

Dr. Miles added that the horrific circumstances -- no food, running water or electricity, 100-degree temperatures and a hospital overrun by Katrina refugees -- must be considered.

"In a situation where FEMA was missing for days, this lady goes to work and stays at her post and they pick her as culpable for the deaths in New Orleans? It just doesn't make sense," he said.

Friends and colleagues rushed to defend the accused.

"I am convinced, because I know these individuals, that there was no intent to harm anyone, and I have tremendous faith in these three ladies," said Daniel Nuss, MD, chair of the LSU otorhinolaryngology department, who hired Dr. Pou. Dr. Nuss left for Houston with his family and received desperate calls from Dr. Pou asking for help in getting the National Guard to evacuate patients.

"Dr. Pou is one of the heroes of the storm," said Michael S. Ellis, MD, a Louisiana otolaryngologist who worked with Dr. Pou's father. Dr. Ellis, a member of the AMA's Council on Long Range Planning, described the family of 11 brothers and sisters as deeply Catholic.

"I can't, frankly, conceive of Anna Maria going around killing people," Dr. Ellis said. "It's not what her religious or ethical background and training is. She has spent her life trying to keep people alive."