During the evacuation of Memorial Medical Center, doctors made an exception to the plan to prioritize the sickest patients and those dependent on machines: patients with Do Not Resuscitate orders would go last. The order was meant to govern whether a patient should be revived after breathing or a heartbeat stopped, not whether that patient should be rescued. In practice, the distinction blurred under pressure, and the evacuation rule placed four ICU patients—including Helen Breckenridge and Jannie Burgess—at the back of the line.

Background and Meaning of a DNR Order

The decision took shape amid a hurried evacuation in a hospital where a single elevator was taking so long to arrive that staff and relatives began carrying patients down stairwells on blankets. The patients being moved could be critically ill, dependent on ventilators or medication pumps, and difficult to transport. In that setting, a rule for sorting patients could determine who received an early chance to leave and who remained inside.

A DNR order had a narrower meaning than the evacuation plan gave it. A doctor signed the order, almost always with informed consent from the patient or a health-care proxy. It instructed medical staff not to revive someone whose heartbeat or breathing had stopped. It did not, by itself, establish that a patient was terminal or that life-sustaining treatment should be withdrawn. Louisiana’s living-will law addressed a different matter, allowing a patient with a terminal and irreversible condition to request in advance that life-sustaining procedures be withheld or withdrawn.

The distinction mattered especially for Jannie Burgess, one of the four DNR patients in the ICU. Burgess was a licensed practical nurse who had worked for thirty-five years in New Orleans hospitals and nursing homes. She had entered nursing to support her children, after working as a taxi dispatcher and secretary to a mortician. Because of racial segregation, she could care for patients at private hospitals while being barred from receiving care at them. Memorial had opened in 1926 as Southern Baptist Hospital, only months before Burgess was born; more than four decades would pass before she could be a patient there. Her presence among those assigned last place connected the evacuation rule to a longer history of unequal access to care, though the immediate decision was framed in terms of DNR status.

The Rule and Its Rationale

Medical chairman Richard Deichmann later said he believed the law required patients with DNR orders to have a certified terminal or irreversible condition. He also believed those patients should go last because they would have the “least to lose” if catastrophe struck. That understanding treated the order as a broader statement about the value of continued treatment and rescue than the order itself contained. Other doctors agreed with his plan. Bill Armington later said he thought patients who did not want their lives prolonged by extraordinary measures would not want to be saved at the expense of others, although neither the orders nor Memorial’s disaster plans said that DNR patients should be evacuated last.

The decision was passed down through the hospital’s management. Nurse manager Karen Wynn learned of it from Ewing Cook and Roy Culotta and shared it with Susan Mulderick. A nurse transporting Breckenridge was told that “the most salvageable had to go.” The phrase turned an interpretation of patient wishes into an operational sorting rule: DNR status, which concerned what to do after cardiac or respiratory arrest, now affected whether patients would be taken out in the first evacuation sweep.

Breckenridge’s transfer showed the rule in action. The seventy-seven-year-old had lung and heart disease and diabetes, and had been receiving hospice care focused on comfort rather than extending life. Her brother, a physician, believed she had been forced into hospice and did not want to remain there; after going to court, he had her transferred to Memorial for aggressive ICU treatment. During the evacuation, staff worked to move her from the eighth floor while one person squeezed air into her lungs by hand and others monitored battery-powered pumps delivering medication. When she reached the floor below, a doctor ordered, “Bring her back up,” adding, “She can’t go in the first sweep.”

Back in the ICU, staff reconnected Breckenridge’s pumps and drips to emergency outlets and restored her mechanical ventilator, but she soon died. Her death may have been imminent; the account describes it as seemingly the first in the hospital to have been hastened by Katrina. Dr. Horace Baltz was summoned to pronounce her dead and hurried up the staircase. The evacuation rule did not establish that the decision caused her death, but her removal from the first sweep and her return to intensive care made its consequences immediate and visible.

Patients and Families Confront the Rule

The policy’s meaning became clearer to families when they saw what it did on the floors. In the Clara Wing, transporters stopped and maneuvered other patients around a bed-bound woman after seeing her DNR order. Nurses were instructed not to tell her daughter that this was why her mother had been left behind. The daughter had agreed to the DNR when her ninety-three-year-old, oxygen-dependent mother was admitted before the storm. She had understood it to mean that staff should not resuscitate her mother if her heart stopped—not that they should leave her behind during an evacuation. When the distinction became apparent, she said, “When I made my mother a DNR, I did not know it meant ‘do not rescue.’”

The daughter asked to cancel the order. Nurses who had been told to leave the floor stayed with the patient, and someone went to find a doctor to remove the DNR order. The woman was moved downstairs and taken toward the helipad, surviving that immediate ordeal. On LifeCare’s seventh floor, Angela McManus likewise tried to rescind the DNR order for her frail seventy-year-old mother, Wilda, after learning that patients with such orders were being deferred. Staff told her that no doctors were available. These episodes exposed the practical gap between a directive made for one clinical circumstance and a blanket evacuation ranking applied during another.

Aftermath and Significance

The consequences of the crisis continued after the evacuation. Gina Isbell, who had worked with LifeCare patients, later described poor sleep, nightmares in which she saw her patients’ faces, and guilt about the staff she had chosen to work the storm and the patients who had died. After the special grand jury’s 2007 decision, she celebrated with another former LifeCare nurse, but still wore a hurricane-shaped pendant and remained angry that help had come too slowly. Her account reflects the lasting distress among staff involved in the larger evacuation; it does not establish that the DNR rule alone caused that distress.

Memorial’s decisions can also be set beside the response at public Charity Hospital, where patients continued to receive care in their rooms until the end despite flooding, loss of power and functioning facilities, and severe threats to staff and patients. Charity took until September 2 to transfer everyone, a day later than Memorial, and had roughly twice as many patients across its two campuses, yet fewer than ten patients died. The circumstances were not identical, but the comparison makes clear that danger and scarcity did not dictate one universal response. At Memorial, the DNR-last rule converted a limited instruction about resuscitation into a ranking of evacuation claims. The families’ efforts to reverse that ranking showed what the order could not say on its own: choosing not to be revived is not the same as choosing not to be rescued.