Dr. Pou’s Hurricane Katrina Case: Charges, Grand Jury, Lawsuits

Dr. Anna Pou was a head and neck surgeon at Memorial Medical Center in New Orleans when Hurricane Katrina struck in August 2005, and the Dr. Pou Hurricane Katrina case refers to the criminal and civil proceedings that followed the deaths of forty-five patients at that hospital. Louisiana’s attorney general arrested her in 2006 on a second-degree murder charge, alleging she injected critically ill patients with lethal doses of morphine and midazolam during the crisis. A New Orleans grand jury declined to indict her in July 2007. She was never tried, later settled civil claims from patients’ families, and went on to help write Louisiana laws that shield medical workers who provide care during declared disasters.¹²

What Happened Inside Memorial

Memorial Medical Center, then owned by Tenet Healthcare, lost power and running water almost immediately when Katrina made landfall on August 29, 2005. Staff began helicopter evacuations and reduced the census from about 183 patients to roughly 130 by the end of the first day. About forty-eight hours after landfall, the backup generators failed, taking out elevators, ventilators, and other life-sustaining equipment. Internal temperatures climbed above 100 degrees, sewage systems failed, and staff worked by flashlight.³⁴

A separate long-term acute care unit called LifeCare Hospitals of New Orleans leased the seventh floor and had about fifty-two patients, most elderly and critically ill. LifeCare had its own staff, and its patients were not initially part of Memorial’s evacuation plan. A Coast Guard helicopter offered to evacuate LifeCare patients on Tuesday, August 30, but the offer was declined because the helipad lacked lighting and guardrails and staff were exhausted.²⁴

Physicians led by Dr. Richard Deichmann set up a triage system on Tuesday morning. Patients were sorted into three categories: “1s” were the healthiest and would leave first, “2s” were sicker, and “3s” — the most critically ill, including patients with Do Not Resuscitate orders — would go last. Pou and several nurses assigned the categories in the second-floor lobby. Staff had to carry patients up dark stairwells to the rooftop helipad. Many LifeCare patients were too heavy or too sick to move easily.²

What Pou Was Accused of Doing

By the fourth day, September 1, 2005, investigators later alleged, Pou and two nurses administered injections of morphine and midazolam — both central nervous system depressants — to patients they believed would not survive evacuation. Pou said her intent was to relieve pain and sedate anxious patients because she “knew they were going to be there another day, that they would go through at least another day of hell.”⁵³

Several LifeCare patients drew the most scrutiny. Emmett Everett, a sixty-one-year-old paraplegic awaiting colostomy surgery, was described as alert and stable before receiving an injection. Rose Savoie, ninety, had acute bronchitis and kidney problems. Alice Hutzler, also ninety, was being treated for pneumonia. Carrie Hall, seventy-eight, had a tracheostomy and was observed actively struggling to live. On the Memorial side, Jannie Burgess, a seventy-nine-year-old ICU patient with advanced uterine cancer and kidney failure, received increased morphine on August 31.⁶⁷

Forty-five bodies were recovered from Memorial after the crisis ended. A Louisiana coroner detected morphine in nine of them. A forensic pathologist retained by the attorney general reviewed toxicology on four patients and concluded their deaths were homicides caused by human intervention. Later reporting indicated at least seventeen patients had been injected with morphine, midazolam, or both after rescue operations began.³²

Dr. Bryant King, a contract internist at Memorial, told investigators he saw Pou carrying a “handful of syringes” and telling patients she would give them “something to make you feel better.” He said another physician had told him a hospital administrator decided certain patients would be “put out of their misery.” King chose to leave rather than participate, and later reported what he saw.⁸

Dr. Ewing Cook, a pulmonary specialist at Memorial, gave his own account to the New York Times and ProPublica about Jannie Burgess: “I gave her medicine so I could get rid of her faster, get the nurses off the floor.” He added, “There’s no question I hastened her demise.” Cook was never charged. Orleans Parish Coroner Frank Minyard classified Burgess’s manner of death as “undetermined,” citing her advanced cancer, kidney failure, and sepsis.⁷⁹

The Arrest and Charges

On July 18, 2006, nearly a year after Katrina, Louisiana Attorney General Charles Foti Jr. announced the arrest of Pou and two nurses, Cheri Landry and Lori Budo, in connection with the deaths of four patients. Pou was booked on one count of second-degree murder and nine counts of conspiracy to commit second-degree murder. The nurses were booked on four counts each of being a principal to second-degree murder.⁵¹⁰

Foti was blunt. At a press conference he said, “This is a homicide; it is not euthanasia,” and told reporters the accused had been “maybe pretending they were God.” Pou’s defense attorney accused Foti of trying the case in the media, and critics noted the attorney general was running for reelection. The Louisiana State Medical Society and the American Medical Association both issued statements questioning the murder characterization and defending due process for the accused.¹⁰¹¹

Why the Grand Jury Declined to Indict

Foti’s office had no authority to prosecute directly, so the case went to Orleans Parish District Attorney Eddie Jordan. Charges against nurses Landry and Budo were dropped, and both testified before the grand jury under immunity. On July 24, 2007, the grand jury declined to indict Pou. Jordan then declared the criminal investigation closed.¹²¹

The no-bill produced a bitter public dispute between Jordan and Foti. The attorney general’s office had hired five independent medical experts, including forensic pathologist Cyril Wecht and bioethicist Arthur Caplan, all of whom concluded the deaths were homicides. None were called to testify before the grand jury. Wecht called the evidence “overwhelming.” Caplan said it was “inconceivable” the case would not go to trial. Jordan’s office cited grand jury secrecy laws and said only that the panel found “insufficient evidence to indict.”¹³

In October 2007, Foti became the first Louisiana attorney general in more than thirty-five years to lose a primary election, finishing last in a three-way race.¹¹

Pou called the grand jury’s decision a “personal triumph” and a “tribute to all of those who stayed at their post.” Her attorney, Rick Simmons, framed the deaths as a result of “government abandonment.” The AMA commended her. Reaction was not universal: family members of deceased patients expressed anger, with one widow asking, “Who gave them the right to play God?” Leon Cannizzaro Jr., who succeeded Jordan as Orleans Parish district attorney, testified in 2010 that he believed “human beings were killed as a result of actions by doctors,” though he acknowledged whether a successful prosecution could be brought was a separate question.¹³¹⁴¹⁵

Civil Lawsuits and Settlements

The end of the criminal case was not the end of the litigation. Families of deceased patients pursued civil claims, and a class action was filed against Tenet Healthcare on behalf of approximately 187 patients and 800 visitors who were at Memorial during the crisis. In July 2011, Orleans Parish Civil District Court Judge Rosemary Ledet granted preliminary approval to a $25 million settlement. Tenet denied the allegations but agreed to pay. The money was to be distributed to injured patients and visitors and to the survivors of those who died.¹⁶¹⁷

Survivors of some LifeCare patients pursued a separate action against LifeCare Holdings. At least one survivor disclosed in a deposition receiving more than $200,000 as part of that settlement, though the full terms were not made public. Some relatives opted out of the class action to bring individual claims. Pou herself settled civil claims from families of the deceased. Those settlements included clauses requiring the families to give up their right to speak publicly about their beliefs regarding what happened.¹⁷¹⁴

The Louisiana Laws Pou Helped Pass

After the grand jury cleared her, Pou became an advocate for legal protections for healthcare workers who serve during disasters. She helped write and pass three Louisiana laws granting medical professionals immunity from most civil lawsuits for actions taken during declared emergencies, with an exception for willful misconduct. The legislation also encourages prosecutors to wait for the findings of a medical review panel before initiating criminal proceedings against healthcare workers for disaster-related care.²

Louisiana already had a Health Emergency Powers Act, enacted in 2003, that shielded providers from civil liability during declared public health emergencies unless they acted with gross negligence or willful misconduct. Neither that law nor federal protections such as the Volunteer Protection Act applied neatly to Pou’s situation, because she was an on-duty staff physician rather than a volunteer or an outside responder. The new statutes she championed were designed to close that gap.³

Where Pou Is Now, and Whether Charges Could Return

After fourteen years on the LSU Health Sciences Center faculty in New Orleans, where she was promoted to full professor and served as program director for otolaryngology, Pou moved to Ochsner Health System in Covington, Louisiana. She continues to practice as a head and neck oncologic surgeon there.¹⁸¹⁹

Under Louisiana law there is no statute of limitations on murder. Criminal charges could in theory be brought again, but no prosecutor has moved to do so, and Jordan closed the investigation after the grand jury’s no-bill in 2007.¹⁴

The Unresolved Ethical Dispute

The Memorial deaths remain contested on the ethics as much as the law. Pou and her supporters have invoked the doctrine of double effect, arguing that medications given to relieve suffering may permissibly hasten death as a secondary consequence. Cook’s own account of giving Burgess morphine to “get rid of her faster” is difficult to square with that framework. Dr. Deichmann, who led the triage meeting, later said euthanasia at Memorial was “illegal and unnecessary” and that patients could have been treated and evacuated. No professional consensus exists on a universal triage standard for conditions as extreme as those at Memorial, which is why the case is still taught in bioethics and disaster-medicine programs rather than treated as closed.²⁰²¹

1
NPR. New Orleans Doctor Not Indicted for Mercy Killings
2
ProPublica. The Deadly Choices at Memorial
3
American Medical Association Journal of Ethics. The Case of Dr. Anna Pou: Physician Liability in Emergency Situations
4
The Guardian. Hurricane Katrina: After the Flood
5
CNN. Hospital Deaths
6
ProPublica. On the Frontlines at Memorial Medical Center
7
CNN. Katrina Hospital Deaths
8
Suffolk University Law Review. Natural Disaster, Unnatural Deaths
9
Courthouse News Service. Coroner Clears New Orleans Doctor Again
10
American Medical Association Journal of Ethics. Accusation of Murder in New Orleans and Media Response
11
ABC News. Doctor Not Indicted for Mercy Killings
12
CBC News. Doctor Accused of Deaths After Hurricane Katrina Won’t Be Indicted
13
CNN. Hospital Grand Jury
14
Sheri Fink. Dr. Anna Pou
15
NOLA.com. Orleans DA Testifies That He Believes Patients Were Killed at Memorial Medical Center After Katrina
16
The New York Times. Hospital Settles Katrina Deaths Class Action
17
ProPublica. Class Action Suit Filed After Katrina Hospital Deaths Settled for $25 Million
18
LSU Health Sciences Center. CV – Pou AM
19
Memorial Hospital Truth. About Dr. Anna Pou
20
NYU Gallatin. Unveiling Disaster
21
ProPublica. The Deadly Choices at Memorial