Merle Lagasse

Merle Lagasse was a 76-year-old woman with emphysema and advanced lung cancer whose evacuation from Memorial Medical Center during Hurricane Katrina became a wrenching separation from her daughter, Karen. At the hospital, the failure of equipment and the improvised movement of patients left Merle gasping for air; after she was taken from the evacuation line and treated with painkillers and sedatives, she died with her physician beside her. Her daughter did not learn what had happened for months. The account of Merle’s life and death turns the hospital’s disaster decisions into a particular family’s experience of care, fear, loss, and unanswered questions.

Life Before the Evacuation

Until the months before the storm, Merle had been vivacious. She had volunteered in schools, worked reception at a beauty salon, and loved, rescued, and collected feral cats. Her presentation was part of the vivid portrait remembered by her family: she dressed up for medical appointments, with arched brows, mascara around her richly lined eyes, and bright lipstick. Her emphysema physician, Ewing Cook, greeted her warmly and joked, “you’re gonna make a beautiful corpse.” The remark irritated Karen, while Merle heard the compliment in it. That contrast stayed with Karen, becoming painful again after her mother’s death.

Cook was frank that Merle’s emphysema could not be cured. He prescribed a home oxygen machine, and Merle chose the longest cord so she could move through the house; sometimes she went out with a portable tank. Karen wished that more could be done, including physical therapy, but her mother’s illness weakened her. Later, Merle learned she had lung cancer that was not curable. A little more than a week before Hurricane Katrina, her new physician, Roy Culotta, admitted her to Memorial after she reacted badly to a pain-medication patch.

During that hospitalization, Culotta worked to relieve her pain, shortness of breath, and the anxiety of living with an ongoing hunger for air. Before the hurricane, he prescribed a Vapotherm machine, which delivered high-flow oxygen from the hospital’s wall supply through a nasal device. He also planned a thoracentesis: fluid on the left side of Merle’s chest was constricting a lung, and draining it with a sterile needle and flexible tube might allow the lung to expand, temporarily relieving her breathing difficulty. Culotta ordered the kit to be placed at her bedside, but the procedure had not been performed. After the storm’s intermittent wind and rain subsided, Karen encountered him in the parking garage on Monday; he said he was going home to shower. She did not see him again before the evacuation, and the thoracentesis kit remained unopened beside Merle’s bed.

Equipment Failure and Evacuation

After the air-conditioning stopped on Monday, Karen put a box fan beside her mother’s bed and covered her with ice packs. She also went down to the dark, empty chapel to pray for Merle and for the cats she had left at home with food and water, afraid that the animals might have drowned. Overnight on Tuesday, the alarm on Merle’s high-flow oxygen machine began ringing. The respiratory therapist had stopped making rounds, and Karen felt it took the fourth-floor nurses a long time to identify the cause: the power loss. Staff removed the failing Vapotherm machine and substituted a less effective mask connected to the hospital’s bulk oxygen supply, which was still flowing through the walls. Merle seemed to be working harder to breathe. Karen tried to cool and fan her with a piece of cardboard printed with the hospital company logo.

The nurses initially told Karen that Merle would be among the first patients to leave because she depended on breathing equipment. Then a doctor asked whether she could sit in a wheelchair. Karen did not think she could. As patients able to walk or sit in wheelchairs were taken out first, she realized the plan had changed. When Merle’s turn came, a nurse moved her oxygen tubing from a wall nozzle to a regulator on a green metal cylinder. Karen noticed that the thoracentesis kit was still at the bedside and asked whether it should go with them. The nurse answered, “Oh, they’re not going to do that now.”

Volunteers lifted Merle by the corners of her bed sheet and carried her toward a stairwell, with Karen and a nurse following and carrying the oxygen cylinder and the single bag Karen had packed. The carriers first started down with Merle’s head facing forward, then backed up and turned her feet-first when they recognized the danger of that position. Two flights below, they laid her in a line of patients leading to the second-floor machine room. Flat on the floor, Merle found breathing still harder. A nurse recognized her, called, “She’s got to go now!” and turned up the oxygen regulator.

Staff then began moving Merle toward the heliport and told Karen to leave the area. As Karen started away, she heard her mother gulp, “Karen,” and say, “I can’t breathe.” Karen turned and saw that the oxygen tank had been disconnected as Merle was about to be passed through a narrow opening in the wall leading to the parking garage. She shouted that her mother could not breathe without oxygen and demanded that it be put back. A woman in scrubs who appeared to be in charge replied, “You don’t know what’s going on.” Karen was assured that Merle would receive oxygen on the other side of the opening, but she was again told to go. Furious and frightened, Karen left for the emergency-room ramp in the hope of finding a boat and searching for wherever her mother would be taken. She did not want Merle to be alone.

Death on the Garage Level

By the waning daylight, Merle was still waiting for rescue at the top of the garage. A day had passed since she and Karen were separated at the machine-room opening. After days in the heat, with advanced cancer and emphysema, Merle was gasping. A nurse recognized the breathing pattern as one that often heralds death and asked Culotta to provide medication to ease it. Culotta assessed her as being in respiratory distress and believed she was actively dying. He removed her from the evacuation line and asked an intensive-care nurse to retrieve painkillers and sedatives from inside the hospital.

The nurse returned by a makeshift route: a wooden pallet bridged the garage and the roof of an intervening building, with a hose serving as a handhold on the way to a seventh-floor hospital window. The medications included morphine, Versed, and Ativan. Culotta had treated Merle with narcotics for weeks for pain and anxiety caused by her spreading cancer, and believed she had developed a high tolerance. He thought a large amount of morphine would be needed to relieve her gasping and suffering, while also believing that it would undoubtedly hasten her death. Merle and Karen had not agreed to a do-not-resuscitate order. Culotta had nevertheless regarded her treatment options as limited and had made control of her pain and anxiety a central goal of her care.

Without electricity, the nurse could not use the intravenous pump Culotta described as the normal way to deliver and adjust medication gradually. Instead, the drugs were injected as a bolus. Culotta did not remember the precise dose he ordered for Merle, only that it was high; her prior narcotic use had made her tolerant. After the nurse administered the medication, Merle was put in the back of a truck. Culotta drove her back down and brought her into the hospital, where he remained with her when she died.

In a later interview with state investigators, Culotta described Merle as one of two patients he knew of who developed respiratory distress while waiting for helicopters on the parking garage. He recalled that he had been trying to get her evacuated, recognized her Cheyne-Stokes breathing as a pattern associated with the approach of death, and ordered morphine and other drugs to make her comfortable. He acknowledged that morphine hastens death, while explaining that his intention was to relieve suffering. Investigators later considered that this breathing pattern can also occur in other circumstances, including sleep in some people with heart failure or brain damage; its presence alone did not establish that a patient was about to die. That distinction became important to questions about what Culotta had inferred from Merle’s condition and what the medication did.

The Search and the Lawsuit

Karen made it out of Memorial by boat and reached the overcrowded New Orleans Convention Center, where she slept outside on the street, afraid for her own safety. Someone there told her that her mother had died at the hospital, but she refused to accept the report. For ten frantic days, she recruited friends to call emergency rooms across Louisiana and Texas. At last, a Tenet official told her that Merle was on a list of people believed to have died during the evacuation. Months later, Karen was allowed to return to the hospital garage and search through debris for her mother’s personal effects, remnants of the life they had shared in the Lakeview District, which had been lost to flooding.

Karen’s lawsuit described an unknown health-care worker, identified as Jane Doe, removing Merle’s oxygen mask before she was passed through the machine-room wall. The petition said that Merle yelled that she could not breathe and that both mother and daughter pleaded for the mask to be replaced, but that Jane Doe refused. This account put the disputed moment of disconnection into legal language, but it could not answer Karen’s larger uncertainty about the hours afterward: whether her mother had continued to receive oxygen, how long she had suffered in the heat, and what care she had received before her death.

Karen buried Merle on Valentine’s Day in a metal coffin sealed by funeral-home workers with a rubber gasket to contain the odor of decomposition. She argued that the body bag should be removed before her mother was placed in the coffin; the workers refused. The indignity upset her, as did the thought that Merle had not, at least, become the “beautiful corpse” of Cook’s dark joke. A year after the storm, Karen still had not been told what happened after the separation. Investigators’ interview with Culotta had not been shared with her. She believed her mother died because of Culotta’s negligence and the hospital’s failure to prepare for disaster.

Karen sued Culotta, Memorial Medical Center, its chief executive René Goux, Jane Doe, and Richard Deichmann, the director of internal medicine. Deichmann was also Karen’s own internist; she was initially surprised to learn that her lawyer had named him in the suit. The case joined the question of Merle’s individual care to broader allegations concerning the hospital’s preparedness and evacuation. The family’s account did not erase the uncertainty about the exact course of treatment, but it preserved the events Karen witnessed and the questions she continued to ask.

A Death Revisited

Merle was among the patients whose remains were included in the later review of deaths at the hospital. Toxicology testing found midazolam in Merle and the nine other patients discussed in that group; five of the ten, including Merle, were not individually specified as positive for morphine in the account of the results. The report therefore does not establish a particular toxicology result for Merle beyond the stated midazolam finding. The distinction matters in a case where the physician’s recollection of medication, the physical evidence, and the family’s incomplete access to information were all part of the reckoning.

Karen’s suit on her mother’s behalf eventually settled for $270,000 before attorney-fee deductions. The settlement, reached through mediation, left her angry: she believed the amount did not deliver justice or compel the hospital and physicians to change their practices. In January 2013, she objected to the idea that doctors could decide who was worthy to live, who would be evacuated, and who would be left behind, warning that the same decisions could affect anyone’s wife or child. Merle’s story thus ends not with a settled explanation of every choice made in the hospital, but with her daughter’s insistence that the questions of care, evacuation, and responsibility remain public questions.