Orleans Parish is the principal local setting for the investigation into deaths at hospitals and nursing homes after Hurricane Katrina. The parish’s significance lies not only in the concentration of deaths there, but also in the institutional history and jurisdictional conflicts that shaped how those deaths were examined. A state inquiry reached across multiple facilities, while the evidence from Memorial Medical Center became a contested test of what could be established from patient records, witness accounts, and bodies recovered after prolonged exposure to heat.

Hospitals and a history of unequal care

The history of Memorial Medical Center reaches back to its opening in 1926 as Southern Baptist Hospital. Jannie Burgess, born only months after the hospital opened, worked for decades as a licensed practical nurse in New Orleans hospitals and nursing homes. Her experience exposed a contradiction in the city’s medical system: because she was Black, she could care for patients at many private hospitals but could not receive care at them. It was more than four decades before she could be a patient at the hospital where she had once been excluded.

Southern Baptist Hospital was among the last hospitals in the South to integrate. In the mid-1960s, as Medicare and other federal programs made reimbursement conditional on nondiscrimination, the hospital refused to join. Its leaders framed federal requirements as governmental interference, and some New Orleanians wrote in support of the hospital’s position. That history gives Burgess’s presence as a patient during the later evacuation crisis a particular weight: the institution’s earlier division between those permitted to work and those permitted to receive care had shaped her life before she returned there as a patient.

A parish-wide investigation

After deaths at Memorial and other facilities began to emerge, Louisiana Attorney General Charles Foti publicly pledged a full investigation of what he called a horrific tragedy at St. Rita’s Nursing Home. His Medicaid Fraud Control Unit opened investigations into every hospital and nursing home in Orleans Parish where patients had died. The unit’s state and federal funding gave it jurisdiction over health facilities participating in Medicaid, including institutions whose predecessors had once resisted federal programs in the name of freedom from government oversight.

The investigation began with basic requests to Memorial’s corporate owners for a list of deceased patients and the hospital’s disaster plan. If investigators could establish that the plan had been followed, they might be able to close the case and look elsewhere for responsibility. But New Orleans Mayor Ray Nagin’s pre-storm evacuation order had not applied to hospitals; they had instead been ordered to remain open and staffed. The question of what happened inside individual facilities therefore sat alongside broader questions about emergency planning, oversight, preparation, and the choices made before the storm.

Butch Schafer, an experienced prosecutor returning to work after mourning his daughter’s death, helped lead the inquiry. The local criminal-prosecution structure complicated the investigation: decisions about prosecution generally rested with Orleans Parish District Attorney Eddie Jordan, who would have to recuse himself before the attorney general’s office could take over. Because it was uncertain who would ultimately prosecute, investigators could not offer potential witnesses full immunity. Information obtained through a legal proffer risked becoming unusable against the witnesses unless investigators could show they had found it independently.

Recovering evidence from the dead

The condition of the recovered bodies initially appeared to limit what forensic examination could establish. Orleans Parish Coroner Frank Minyard first told Virginia Rider that autopsies would be of little use because the bodies from Memorial had decomposed in the heat for more than a week, making blood sampling impossible. A volunteer pathologist pointed out that drugs might remain detectable in more resilient tissues or in abdominal fluid. At the attorney general’s request, Minyard agreed to ask a federal disaster mortuary team to perform autopsies and collect tissue samples from patients who had died in Orleans Parish after Katrina—about one hundred people in the first estimate, including deaths at several facilities under investigation.

On September 22, investigators flew tissue samples from eighteen Memorial bodies to National Medical Services, Inc., in Willow Grove, Pennsylvania. On October 6, laboratory director Robert Middleberg reported preliminary results to Rider, Schafer, and another agent: nine of the eighteen cases tested positive for morphine, and roughly five or six more were positive for midazolam. The early findings gave investigators evidence of drug exposure, but did not by themselves settle how the drugs had been administered or whether they had caused particular deaths.

The scope of testing later expanded. Of forty-one Memorial and LifeCare bodies analyzed by Middleberg’s laboratory, twenty-three tested positive for morphine, midazolam, or both. At a later review, experts cautioned that interpreting drugs in postmortem tissue was more difficult than interpreting blood from living patients: prolonged heat could affect concentrations, and each result had to be considered alongside the patient’s clinical history. They examined whether drugs had been given in a single large dose or accumulated through repeated doses, how kidney or liver disease might affect processing, and whether the drugs’ effects on breathing and blood pressure matched the known timing of death.

The experts disagreed about what those findings could prove. Steven Karch argued that after bodies had spent days in extreme heat, drug concentrations could not reliably establish causes of death and should leave the medical causes undetermined. Michael Baden countered that uncertainty about the original dose did not erase the fact that morphine and Versed were present, and argued that there was no competing cause of death in the cases he discussed with Minyard. Cyril Wecht likewise challenged Karch’s interpretation, describing some detected levels as very high and reporting a small experiment in which hot, humid storage produced no significant difference from refrigerated samples. The experiment was limited and unpublished; it added evidence to a dispute rather than resolving it.

Jurisdiction, memory, and the account

The investigation also had to contend with the fragility of witness recollection. As reports appeared in the media, Schafer and Rider worried both that coverage might prompt people to remember relevant events and that it might influence or contaminate those memories. Several LifeCare witnesses had discussed their experiences after the evacuation and consulted on a written timeline. Investigators therefore sought additional interviews without leading questions and gathered physical and written records that originated closer to the events.

Orleans Parish is also the geographic center of the book’s reconstruction, not a location the author claims to have witnessed firsthand. The account draws on more than five hundred interviews, alongside photographs, videos, emails, notes, diaries, contemporary reporting, weather reports, building plans, electrical diagrams, and expert reports prepared for civil litigation. The author describes attempts to contact participants in important conversations and notes that memories sometimes conflicted or that people declined to speak. In this setting, the parish is more than a backdrop: it is where institutional history, local prosecutorial authority, emergency-care decisions, and the limits of forensic and testimonial evidence converge.