Memorial patient toxicology results

The Memorial patient toxicology results became a central, contested part of the investigation into deaths at Memorial Medical Center during Hurricane Katrina. They established that morphine and midazolam were present in many of the tested bodies, including patients whose deaths investigators had considered suspicious. But the results could not, by themselves, settle when or how the drugs had been given, whether they caused a death, or what anyone intended. Their importance lay both in what laboratory analysis detected and in the limits that investigators and experts placed on what those findings could prove.

Why the Bodies Were Tested

When Special Agent Virginia Rider first discussed autopsies with Orleans Parish coroner Frank Minyard, he warned that testing might be useless. The bodies from Memorial Medical Center had remained in the heat for more than a week before recovery, and decomposition made it impossible to collect blood for a straightforward measurement of drug levels. For Rider and prosecutor Butch Schafer, that limitation threatened to leave the case dependent on witness accounts and empty morphine vials.

A volunteer pathologist offered another route: drugs could leave detectable traces in tissues more resilient than blood, including liver, brain, and muscle, as well as in fluid that accumulates in the abdomen after death. At the attorney general’s request, Minyard agreed to seek help from a federal disaster mortuary team. The proposed examination extended beyond Memorial Medical Center: investigators were initially considering about one hundred people who had died at hospitals and nursing homes in Orleans Parish after Katrina, amid allegations of wrongdoing at several facilities.

On September 22, 2005, state and federal investigators flew tissue samples from eighteen Memorial Medical Center bodies to National Medical Services, Inc., in Willow Grove, Pennsylvania. Laboratory technicians prepared the samples for analysis by gas chromatography and mass spectrometry. The process turned tissue recovered from badly decomposed bodies into material that could still be examined for drug traces, even though the loss of blood and the conditions before recovery meant the findings would require careful qualification.

The Preliminary Findings

On October 6, 2005, laboratory director Robert Middleberg called the attorney general’s office with an update. He emphasized that the samples were less than ideal because of decomposition and that the laboratory’s work was not complete. Rider placed the call on speakerphone so Schafer and another special agent could hear the preliminary findings directly.

Of the eighteen cases discussed, nine tested positive for morphine. Middleberg also reported that about five or six additional samples were positive for midazolam. When Schafer asked what midazolam was, Middleberg began to explain the drug rather than assuming the investigators knew its medical use. The exchange underscored the distinction between a laboratory result and the clinical or legal meaning investigators would need to establish from it.

Middleberg identified the nine patients whose samples were positive for morphine: Harold Dupas, Hollis Alford, Wilda McManus, Elaine Nelson, Emmett Everett, Alice Hutzler, Rose Savoie, Ireatha Watson, and George Huard. Dupas was among the patients LifeCare staff believed had been injected by Anna Pou or by the two Memorial nurses who came to the seventh floor on September 1. The significance of the list was not simply that drugs had been detected: the positive results coincided exactly with the names on the attorney’s list of suspicious deaths, although the laboratory had not been told which patients were on that list. Middleberg also characterized the morphine concentrations as high, a description Rider and Schafer retained in their understanding of the emerging evidence.

A Larger Review, and Its Limits

The preliminary call concerned eighteen bodies, but the later review covered a larger group. Pou, Lori Budo, and Cheri Landry had been arrested in connection with four deaths; Middleberg’s laboratory ultimately analyzed forty-one bodies from Memorial Medical Center and LifeCare. Twenty-three tested positive for morphine, midazolam, or both. In a meeting of experts, Middleberg presented his findings alongside charts and tables prepared by Rider and two nurses who had worked with her in the fraud unit. The wider analysis expanded the scope of the evidence beyond the four deaths underlying the arrests, without making every positive result equivalent in meaning.

Middleberg cautioned that toxicology in postmortem tissue was not as direct as testing blood from a living patient. Prolonged exposure to heat could have altered drug concentrations, so the laboratory numbers needed to be considered alongside each patient’s clinical history. The experts therefore examined cases individually, asking whether a finding might reflect a large dose shortly before death or repeated doses that accumulated over time. They also considered whether kidney failure or liver disease could affect how a patient processed drugs, whether combining morphine and midazolam was medically appropriate for a particular patient, and whether doses capable of suppressing breathing would be especially dangerous for someone not on a respirator. Where the timing of death was known, they considered whether the expected effects on breathing and blood pressure aligned with it.

Alice Hutzler’s case illustrated why the records mattered. Hutzler, a ninety-year-old nursing-home resident being treated for pneumonia, had morphine and midazolam detected in her liver, brain, and muscle tissue. Her chart, which remained current until a few hours before her death was recorded on September 1, showed that neither drug had been prescribed. She had been described as resting comfortably on the preceding Wednesday afternoon, and her nurses had not documented pain or distress that night indicating a need for either medication. The combination of tissue findings and chart history raised questions about the drugs’ use, but the postmortem result still had to be assessed alongside what the records did—and did not—show.

Conflicting Interpretations

The experts did not agree on how far toxicology could take the investigation. Minyard consulted Steven Karch, who argued that drug concentrations measured in a cadaver might not correspond to levels before death. After examining the evidence, Karch considered it impossible to determine medical causes of death from bodies that had remained at about one hundred degrees for ten days; he advised leaving the causes undetermined. Minyard gave substantial weight to that view, which was also shared by a local toxicologist retained by Pou’s attorney.

Michael Baden challenged the reach of that argument. In his view, uncertainty about the dose did not erase the finding that the drugs were present; he maintained that morphine and Versed had been given shortly before the patients died and that there was no competing cause of death. Cyril Wecht disputed Karch’s concern about changes in decomposed tissue by comparing samples from overdose deaths that had been kept under hot, humid conditions with refrigerated samples. He found no significant difference in drug levels. The test was small, had not been independently vetted or published, and could not resolve the issue conclusively, but it offered another piece of evidence against treating decomposition as a complete explanation for the results.

The toxicology therefore became a point of convergence and disagreement at once. The early match between positive samples and the suspicious-death list strengthened investigators’ concern; the larger analysis showed that drug traces appeared in more than the four cases that had led to arrests. Yet questions about decomposition, dosing, patient conditions, records, and causation remained. Minyard worried that a trial would become a battle among forensic experts and that reasonable doubt could defeat the case, with consequences he believed could affect the city’s recovery. The results did not end the debate over the deaths: they gave it measurable evidence, while leaving its interpretation contested.