Instruction Against Cardiopulmonary Resuscitation

The Instruction Against Cardiopulmonary Resuscitation is a medical directive concerning resuscitation, but the accounts of Hurricane Katrina show how a DNR designation could acquire a broader and more disputed meaning inside a hospital under extreme pressure. At Memorial Medical Center, testimony described patients being called DNR in conversations about whether they could survive or be evacuated; other evidence shows that staff disagreed over the meaning of comfort care, evacuation priorities, and the responsibilities attached to a patient’s status. The distinction matters: a resuscitation instruction was not, by itself, proof that a patient should be denied rescue or that hastening death was intended.

Function and Meaning in the Crisis

During the emergency at Memorial Medical Center, decisions were being made amid flood threat, failing power, and a scramble to move patients. In the command room, Susan Mulderick presented the crisis as an urgent operation before power failed. The account of that meeting describes a plan to evacuate the sickest patients first, including people dependent on life support, newborns, high-risk pregnant patients, and dialysis patients. This context shows that grave illness and dependence on medical support could make someone a priority for evacuation, rather than automatically excluding that person from it.

The DNR designation became more contentious when it was recalled in relation to the remaining patients on LifeCare Hospitals’ seventh floor. In an interview, nurse Cindy Chatelain described a tall, thin, light-haired doctor, whom she thought was named Skinner, arriving with another man on Thursday morning. She recalled being told that the remaining nine patients were not going to make it and were DNR. Chatelain corrected the doctor: at least one patient was not DNR but extremely obese. The doctor reportedly cited the helicopter’s capacity, although the account notes that some air-ambulance stretchers had weight limits while military aircraft could carry more.

Disputed Application and Authority

Chatelain’s account linked a DNR label to a prediction of futility and to the practical question of whether patients could be transported. She further recalled the doctor saying that only the strong would survive and that nature’s course would have to be hastened. The identity and wording were not established as fact: investigators found it difficult to determine whether Chatelain had identified Skinner correctly, and Skinner later denied speaking to a LifeCare nurse or making those remarks. He said the description did not sound like him. The testimony therefore documents a disputed report, not a verified order or settled account of what occurred.

Other scenes at Memorial show that authority over evacuation and patient care was contested. On the helipad, a nurse with Air Force experience took charge of the flight line after a dispute with a Coast Guard pilot over how many patients his helicopter could carry. Later, when a helicopter’s flight plan pointed to a hospital different from the Baton Rouge destination expected for a group of critically ill babies, the neonatal nursing director refused to let them leave unless the pilot changed the plan. These episodes do not concern DNR orders directly, but they make clear that emergency decisions involved competing judgments about patients’ safety and who had authority to make those judgments.

DNR, Comfort Care, and Medication

In her interview, Mulderick said discussions about palliative care concerned making patients comfortable, not speeding their deaths. She gave Ativan as an example of a medication that might relax patients. But records seized from the pharmacy showed that Ativan and other drugs ordinarily used for comfort had already been prescribed for patients by Anna Pou and other doctors during the disaster. That evidence complicates any account in which comfort medication, a DNR designation, and an intention to hasten death are treated as interchangeable. They were distinct questions, even as the crisis brought them into the same retrospective scrutiny.

The distinction also appears in the later criticism of hospital leadership. Horace Baltz argued that true valor would have meant opposing euthanasia, securing narcotics and sedatives, erasing DNR orders, and preventing nurses from carrying out orders that would ordinarily have been rejected. His letter treated the removal of DNR orders as one proposed safeguard among several, alongside confirming evacuees’ destinations and holding executives accountable. It records Baltz’s judgment about what should have been done; it does not establish that the orders were in fact erased or that every DNR instruction at the hospital had been misused.

Investigation and Aftermath

The deaths at Memorial prompted investigation into what had happened to patients after rescue efforts began. Michael Morales, a homicide prosecutor in the Orleans Parish District Attorney’s Office, realized that the case would demand substantial work after following pleadings involving Pou’s post-storm conversations with a Tenet attorney. The investigation was institutionally divided: the attorney general’s office had not kept the district attorney’s office involved in the yearlong inquiry, and prosecutors there ordinarily joined investigations only when asked by the investigative agency. Toxicology results later showed drugs in the tested remains of patients who died after helicopters and boats arrived, including all nine patients on the LifeCare floor. Those results intensified questions about treatment and deaths, but they do not by themselves establish what any DNR instruction said or what it authorized.

The book’s accounts also trace the human cost of the disaster and its investigation without making DNR status a complete explanation for patients’ deaths. Gina Isbell continued to see her Katrina patients’ faces in nightmares and remained angry that help had come too slowly. Karen Wynn described the difficulty of preparing to testify: discussing the events could make her feel as though she were living them again, and sometimes it took weeks to recover her footing after meetings with her lawyer. Their recollections place disputes over orders within a longer aftermath of loss, scrutiny, and distress. The central issue is not simply whether a chart carried a DNR designation, but how that instruction was understood—and whether it was allowed to stand in for a separate judgment about a patient’s right to care and rescue.