Do-not-resuscitate status

Do-not-resuscitate status (DNR) was an instruction against resuscitation after breathing or heartbeat stopped, not a general refusal of treatment or rescue. During the crisis at Memorial Medical Center, that narrow instruction acquired a much wider force: doctors made DNR patients the last priority for evacuation, turning a decision about resuscitation into a decision about whose life would be carried to safety first.

Meaning and Legal Scope

A DNR order was signed by a doctor and was usually made with the informed consent of the patient or a health-care proxy. Informed consent, established in the United States beginning in the 1950s in response to historical abuses, was meant to protect patients’ authority over medical decisions by requiring disclosure of an intervention’s nature, risks, benefits, and alternatives. A DNR order addressed a specific circumstance: if a patient’s breathing or heartbeat stopped, staff should not attempt to revive them.

That instruction differed from a living will under Louisiana law. A living will could allow a patient with a terminal and irreversible condition to request in advance that life-sustaining procedures be withheld or withdrawn. The distinction mattered during the evacuation: having a DNR order did not, by itself, mean that a patient had declined ongoing care or should not be rescued.

From Medical Instruction to Evacuation Priority

Earlier in the crisis, Memorial’s doctors established an exception to the protocol that otherwise prioritized the sickest patients and those dependent on machines. All patients with DNR orders were to be evacuated last. Four DNR patients were in the intensive care unit, including Helen Breckenridge and Jannie Burgess. Richard Deichmann, the hospital’s medical chairman, later said he had thought the law required DNR patients to have a certified terminal or irreversible condition. He believed they had the least to lose if disaster struck—a rationale that blurred the difference between a DNR order and a living will.

The policy’s meaning became visible in the movement of patients through the hospital. On a fifth-floor hallway, transporters stopped a bed-bound woman’s evacuation when they saw her DNR order, repeatedly maneuvering other patients around her. Nurses were instructed not to tell her daughter that the order was the reason. They said only that her mother was not the sole patient left on the floor; the other patient there was dead.

The daughter had approved the order for her oxygen-dependent, ninety-three-year-old mother because she did not want her resuscitated after cardiac arrest. She understood that choice as applying to resuscitation, not abandonment. Once she learned what was happening, she asked for the order to be canceled. A doctor was found to remove it, and the patient was taken downstairs toward the helipad, surviving that immediate ordeal. Her protest exposed the practical difference between declining CPR and being denied a chance to escape.

Uneven Application and Patient Histories

The evacuation rule also reached LifeCare Hospitals of New Orleans. Angela McManus, expecting that her frail seventy-year-old mother, Wilda, would soon be rescued, heard staff discussing the decision to defer evacuation for DNR patients. She begged to rescind her mother’s order, but staff told her no doctors were available to do so. The account thus shows how a medical instruction could become difficult to reverse precisely when its consequences changed, and when the patient’s advocate needed access to a physician.

The status did not determine every patient’s fate in a uniform way. Two nurses cared overnight for the two surviving patients with DNR orders. Later accounts also describe variation in how patients were classified: some doctors recalled using a fourth category for DNR patients, while other patients were rated on wards and sometimes re-triaged. Those ad hoc systems were similar but not identical. The record presents a consequential policy, but also an unstable practice whose categories and applications could shift across the hospital.

Jannie Burgess’s presence among the ICU patients placed the evacuation decision against a longer history of unequal access to care. She had worked for thirty-five years as a nurse in New Orleans hospitals and nursing homes, yet, because she was African American, she could care for patients at many private hospitals without being eligible to receive care there. Born only months after Memorial opened in 1926 as Southern Baptist Hospital, she waited more than four decades before she could be a patient there. The account does not establish that race determined the DNR rule; it does set the rule’s treatment of Burgess beside the history of exclusion that had shaped her access to the hospital.

Consequences and Significance

For one patient’s daughter, the phrase DNR had meant that resuscitation should not be attempted if her mother’s heart stopped. In the evacuation, the same status was treated as a reason to defer rescue. That gap was not merely semantic: it altered where patients stood in line, what families were told, and whether they could ask a doctor to change an instruction before it affected their safety.

The episode makes the scope of a medical order a central issue in disaster care. A patient’s limited refusal of one intervention could be treated as a broader judgment about the value or priority of that patient’s life. The daughter’s insistence that she had not meant for her mother to be left behind, and the nurses’ decision to stay with patients despite an order to leave a floor, show the human consequences of that conversion without making DNR status itself equivalent to refusing care.