Morphine

Morphine has a double role in the account of Memorial Medical Center during Hurricane Katrina: it was among the few medicines staff could use to relieve suffering during the evacuation crisis, and later became a key piece of evidence in an investigation into whether drugs contributed to patients’ deaths. The book distinguishes the drug’s presence in a patient from the harder questions of dose, effect, intention, and criminal responsibility. Those questions remain contested even as investigators find patterns they regard as significant.

Use During the Evacuation Crisis

In a group of patients lying near a corridor, Karen Wynn noticed an elderly woman breathing with difficulty. At a nearby supply table, Wynn saw morphine and Midazolam, a combination she knew from intensive-care practice. In that setting, the medicines could sedate patients and reduce their drive to breathe while a ventilator supported them; they were also used to lessen pain and distress before withdrawal of life support. Many patients at Memorial lacked intravenous lines. Anna Pou and Wynn requested IV catheters, but not the fluids and tubing that would have been needed to hydrate patients unable to drink adequately. Pou began an IV with a nurse holding a flashlight.

Wynn believed the patients she observed were already dying and that morphine with Midazolam might hasten their deaths without changing the eventual outcome. She also considered the physical demands of moving severely ill patients through the evacuation route: in her judgment, transport itself could worsen their condition, and sedation might be used for that journey as well. This was her assessment, not a finding that the patients had all been examined or that their outcomes were certain.

For the elderly woman, Wynn diluted what she later recalled as a 10-milligram vial of morphine with a small amount of Midazolam in saline, administered the mixture through the woman’s IV, and flushed the line. The woman appeared to struggle less with breathing and died about half an hour later. The account records both the immediate relief Wynn observed and the short interval before death, without treating that sequence alone as proof of what caused the death.

Merle Lagasse and a Separate Treatment Decision

Morphine also figures in the care of Merle Lagasse, who waited for rescue after being separated from her daughter during evacuation. Lagasse had advanced cancer and emphysema and had received narcotics for weeks to manage pain and anxiety. When Roy Culotta saw her 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 the hospital.

The nurse returned with morphine, Midazolam, and Ativan, which Culotta assumed had come from an intensive-care lockbox. Because he knew Lagasse’s tolerance was high, he believed a large amount of morphine would be needed to ease her breathing and suffering; he also believed it would hasten her death. Lagasse and her daughter had not agreed to a do-not-resuscitate order. Culotta’s decision therefore appears in a context of an existing treatment relationship, limited therapeutic options, and an established aim of controlling pain and anxiety—not as a simple repetition of the circumstances on another floor.

From Pharmacy Records to Toxicology

During the later search of Memorial and LifeCare, investigators had to force entry into both pharmacies. They seized pharmacy records that included three prescriptions for large amounts of morphine, dated September 1, 2005, and signed by Anna Pou. The prescriptions became a concrete investigative lead, while the hospital search also exposed the limits of relying on any single kind of evidence. The hospital had no electricity, and its size made the search difficult; the records had to be considered alongside witness accounts, drug containers, patient histories, and forensic testing.

The condition of the bodies complicated that testing. Frank Minyard initially told Virginia Rider that decomposition after more than a week in the heat made autopsies seem unhelpful, including because blood samples could not be used to check drug levels. A pathologist advised that drugs might still be detectable in more durable tissues or in fluid accumulated after death. At the attorney general’s request, Minyard agreed to seek autopsies and tissue samples from roughly one hundred people who had died at hospitals and nursing homes in Orleans Parish after Katrina. On September 22, investigators sent samples from eighteen Memorial bodies to National Medical Services, Inc., a forensic toxicology laboratory in Willow Grove, Pennsylvania.

The first results appeared to align closely with the investigators’ concerns. In a call with Rider and Butch Schafer, laboratory director Robert Middleberg reported morphine in nine of the eighteen cases and Midazolam in several more. The identified morphine-positive cases included Harold Dupas, Hollis Alford, Wilda McManus, Elaine Nelson, Emmett Everett, Alice Hutzler, Rose Savoie, Ireatha Watson, and George Huard. The results for the two drugs matched the names on the attorney’s list of suspicious deaths, although the laboratory had not been given that list. Middleberg described some morphine concentrations as high; the alignment strengthened the investigators’ case, but did not by itself establish the amount administered, the reason for administration, or the drug’s role in each death.

Disputed Meaning of the Findings

The investigation later expanded beyond the initial eighteen samples. Of forty-one Memorial and LifeCare bodies analyzed by Middleberg’s laboratory, twenty-three tested positive for morphine, Midazolam, or both. The experts cautioned that postmortem tissue results were not as straightforward to interpret as blood tests from living patients. Heat and the time before sampling could affect measured concentrations, so Middleberg urged investigators to consider each patient’s clinical history alongside the laboratory figures.

The resulting review asked whether a finding reflected one large dose shortly before death or repeated doses that had accumulated; whether kidney or liver disease affected how a patient processed the drugs; whether the combination was medically unsuitable in particular cases; and whether its effects on breathing and blood pressure fit the known timing of death. Alice Hutzler’s case illustrated the importance of those questions: she was ninety, had been treated for pneumonia, and had morphine and Midazolam detected in liver, brain, and muscle tissue, but neither drug appeared as prescribed in her chart, which was current until a few hours before her death was recorded. Her record described her as resting comfortably the previous afternoon and did not document pain or distress that night requiring those medicines.

Expert disagreement prevented the toxicology from yielding a simple verdict. Steven Karch argued that drug levels in bodies exposed to prolonged heat could not reliably establish the levels present before death, and advised that the medical cause of death remain undetermined. Michael Baden countered that uncertainty about exact dosage did not erase the finding that morphine and Midazolam were present shortly before death, and he saw no competing cause in the cases he discussed with Minyard. Cyril Wecht likewise considered some detected levels extremely high; he tested the effect of hot, humid conditions on samples from overdose deaths and found no significant difference from refrigerated samples, while acknowledging that the small study was not definitive or independently vetted. Morphine thus functions in the narrative as both a means of comfort and an evidentiary trace: its use and detection matter, but neither alone resolves whether a particular death was hastened or whether an act was criminal.