Memorial Medical Center medication and hastened-death controversy

The Memorial Medical Center medication and hastened-death controversy centers on the boundary between relieving suffering and intentionally hastening death during an evacuation crisis. As patients remained in an overheated, failing hospital and outside help came slowly, physicians faced decisions about comfort, transport, and who might survive. Ewing Cook’s treatment of Jannie Burgess and his later advice to Anna Pou became central to the dispute; prescriptions for other patients, a colleague’s objection, and contested forensic evidence ensured that the question did not end when the hospital was evacuated.

A crisis of care and evacuation

By Tuesday, most patients from the intensive care unit had been airlifted, but four patients with do-not-resuscitate orders had been left behind. At about two in the afternoon, Cook climbed to the eighth-floor unit where he had worked for years. One patient remained: Jannie Burgess, a seventy-nine-year-old with advanced uterine cancer who had worked as a nurse in segregated New Orleans. Plans to transfer her to a general medical ward for comfort care had been interrupted by the disaster.

Her chart recorded that she had been agitated on Monday night, but that her surgeon found stable vital signs and a response to speech on Tuesday. On Wednesday, the emergency power failure disabled her electronic monitors. Pumps continued delivering fluids and medication for about two hours, then nurses regulated the intravenous flow by gravity. Burgess’s eyes remained closed, and her breathing was shallow and irregular, sometimes separated by pauses of ten to fifteen seconds. Cook judged her heavily fluid-retained and estimated that she weighed more than three hundred pounds. The hot stair climb had left him doubtful he could return to the unit; he also thought that moving her six flights down would be impracticable and that she probably had only a day or so to live.

Cook considered morphine, already on Burgess’s medication list. The drug could relieve severe pain, but a sudden increase could suppress breathing and cause death. Cook had long treated patients being withdrawn from ventilators, prescribing morphine to prevent breathlessness and anxiety. In those cases, he understood that medication intended to provide comfort could also hasten death. Burgess, he recognized, presented a different circumstance: she appeared comfortable and was already receiving occasional pain relief. His concern was that medication might wear off and she might awaken during a move in her condition.

Cook asked her nurse to increase the morphine and give enough for Burgess to die. He then wrote in the chart that there was no respiration or cardiac activity, added that she had been pronounced dead but left the time blank, and signed the entry. He went back downstairs believing he had acted rightly. Later, he described his choice as a way to clear the floor and free nurses for other work, while acknowledging that he had hastened her death. The episode made the central tension unusually explicit: Cook’s experience in end-of-life care had accustomed him to medication that could shorten life, but here he believed the practical need to move patients and staff was also part of the decision.

Advice, prescriptions, and dissent

By the afternoon, few helicopters were landing and patients awaiting evacuation were languishing. Incident commander Susan Mulderick worried that they would not get the patients out. She spoke with Pou, who had been directing care on the second floor and had earlier told Mulderick that the chapel had become a morgue for LifeCare ventilator-dependent patients who died after the Coast Guard evacuation was halted. Mulderick described the difficulty of deciding what to do for patients who could not be moved and thought of them as resembling some of Pou’s cancer patients, for whom comfort might be the remaining aim.

Mulderick asked Cook to advise Pou before he left by boat to try to rescue his son, who had been trapped since the flooding. Cook spoke with Pou about the most critically ill patients, including patients in the staging areas and nine who had not been brought down from LifeCare. He had not visited LifeCare since the storm. He believed moving its patients down five flights of stairs would be beyond the exhausted staff, and he saw no other way to evacuate or care for them. He later said he understood his advice as instructions for helping patients sleep and die, rather than simply treating pain or anxiety.

Cook described a combination of morphine and a benzodiazepine sedative, which he understood would progressively suppress breathing. Pou then wrote prescriptions for three patients in the second-floor lobby: Wilmer Cooley, an eighty-two-year-old LifeCare patient with heart problems, a serious infection, dialysis needs, and a do-not-resuscitate order; Carrie Mae Hall, known as Ma’Dear, a LifeCare patient with a tracheostomy; and Donna Cotham, a forty-one-year-old Memorial patient with liver disease whose condition had worsened. Pou prescribed nine vials of concentrated intravenous morphine for each patient, totaling 90 milligrams per person, and wrote only that it should be given as directed. The dose was nine times the highest amount she had recently prescribed for pain to a colleague’s patient who was already taking morphine. A pharmacist filled the prescriptions.

Kathleen Fournier, who had been present for Mulderick and Pou’s conversation, said she disagreed with the plan. Mulderick told her not to order or administer the medication if she did not want to. Fournier later explained the conversation to King, who rejected hastening death as a physician’s role. He had visited each patient on LifeCare’s seventh floor to assign triage categories and believed that, although the patients were hot and uncomfortable and some were terminally ill, they were not experiencing pain that warranted sedation or mercy killing. His objection established that the proposed approach was not a settled or unanimous interpretation of comfort care.

Forensic evidence and uncertainty

The controversy became an investigative question after the deaths. Because the bodies had remained in the heat for more than a week, Orleans Parish coroner Frank Minyard initially doubted that autopsies could establish drug levels in blood. A volunteer pathologist told investigators that other tissues, including liver, brain, and muscle, or fluid in the abdomen might retain detectable traces. Minyard eventually agreed to have a federal disaster mortuary team collect samples from roughly one hundred people who had died at hospitals and nursing homes in the parish. On September 22, investigators took tissue samples from eighteen Memorial bodies to National Medical Services, Inc., a forensic toxicology laboratory in Pennsylvania.

The initial findings were consequential but not self-interpreting. In a review of forty-one bodies from Memorial and LifeCare, twenty-three tested positive for morphine or midazolam, or both. The laboratory director, Robert Middleberg, considered many of the concentrations notably high, while warning that postmortem tissue results were harder to interpret than blood tests from living patients. Heat and decomposition might have altered concentrations. The experts therefore examined clinical records alongside laboratory findings, asking whether drugs had been given in a single large dose or accumulated through repeated doses, whether disease affecting the liver or kidneys changed how patients processed them, and whether the timing fit the recorded deaths.

The case of Alice Hutzler illustrated why detection alone did not settle the matter. Morphine and midazolam were found in her liver, brain, and muscle, but her chart did not show prescriptions for either drug and had been maintained until a few hours before her death was recorded. Her care notes described her as resting comfortably and did not record pain or distress that would indicate a need for the drugs. Such discrepancies intensified scrutiny while leaving questions about timing, administration, and cause to be assessed case by case.

Minyard sought further opinions. Steven Karch argued that drug concentrations in bodies exposed to intense heat for ten days could not reliably establish causes of death and advised that the medical causes remain undetermined. Michael Baden countered that uncertainty about the precise dose did not erase the significance of finding the drugs, especially when no competing cause of death was apparent in some cases. Cyril Wecht argued that certain measured levels were extremely high and conducted a small comparison of drug-overdose samples kept refrigerated or exposed to hot, humid conditions; he found no significant difference. The study was not definitive, independently vetted, or published, so it added evidence without resolving the dispute.

The controversy’s unresolved questions

The investigation had to distinguish several claims that could easily be collapsed into one: whether a patient had received a drug, whether the drug contributed to death, what the person administering it intended, and whether the evidence met a criminal standard. Toxicology could establish drug presence, but postmortem conditions complicated the interpretation of concentration and timing. Medical records could illuminate a patient’s condition and prescribed treatment, but they did not automatically answer what happened in every instance. The dispute over Cook’s advice and Pou’s prescriptions therefore involved both clinical judgment under emergency conditions and the evidentiary limits of reconstructing deaths afterward.

Minyard imagined a trial becoming a battle among forensic experts, with reasonable doubt, in his view, likely to defeat the case. He also weighed the possible effects on the city’s recovery. His judgment did not remove the scientific disagreements: it showed how the controversy extended beyond laboratory results into decisions about prosecution and public consequences. The episode remains defined by that unsettled boundary—between comfort and hastened death, between evidence of exposure and proof of cause, and between an emergency rationale and the intent the law would need to establish.