Steven Karch

Steven Karch entered the investigation into deaths at Memorial and LifeCare at a point when forensic evidence seemed to promise answers but could not straightforwardly provide them. Consulted by Orleans Parish coroner Frank Minyard, Karch argued that prolonged heat and decomposition made it impossible to determine the causes of death reliably from the bodies. His opinion gave Minyard a serious alternative to the conclusions advanced by other experts, and became part of the unresolved dispute over what the toxicology evidence could prove.

Role in the Investigation

The investigation faced a basic evidentiary problem: patients’ bodies had remained in extreme heat for days before recovery, making blood testing unavailable and raising questions about whether postmortem drug concentrations represented what had been present before death. A volunteer pathologist had told investigator Virginia Rider that drugs might still be detected in more durable tissues, including liver, brain, and muscle, or in fluid pooled in the abdomen. Investigators consequently arranged for tissue samples from Memorial patients to be tested. In an early report, nine of eighteen cases were positive for morphine, while roughly five or six more showed midazolam.

The results widened the inquiry but did not settle its central question. Later, laboratory director Robert Middleberg told a group of experts that twenty-three of forty-one analyzed bodies from Memorial and LifeCare had tested positive for morphine, midazolam, or both. He considered many of the concentrations unusually high. Yet the bodies’ exposure to heat could have altered the measurements, so he urged the group to compare laboratory results with each patient’s medical history. The question was not simply whether a drug could be detected, but whether the evidence established when and how much had been given, whether it caused or hastened a death, and what could be inferred about the person who administered it.

Expertise and Consultation

Minyard sought another opinion while deciding what to tell the grand jury. Karch had built his career around the argument that drug levels measured in a cadaver might bear no relation to the levels in the body shortly before death. Minyard knew him through his work as the author of a well-known textbook on signs of drug-induced deaths; he had also received a recommendation from John Kokemor, a former assistant to Minyard and a vocal supporter of Anna Pou.

Karch had a prior connection to New Orleans: he had studied medicine there and, as a student, had attended a party at Minyard’s home. He flew to the city to examine the evidence. After doing so, he concluded that determining causes of death in bodies exposed to temperatures of about one hundred degrees for ten days was untenable. His advice was that the medical cause of death should remain undetermined in every case. The breadth of that conclusion mattered: it offered Minyard not merely a qualification to particular toxicology findings but a reason to withhold cause-of-death determinations across the cases.

Dispute Over the Evidence

Karch’s position challenged the inferences other specialists drew from the same evidence, but it did not erase the fact that drugs had been detected. Forensic pathologist Michael Baden considered the uncertainty about exact postmortem levels beside the finding that morphine and Versed were present and the absence of another competing cause of death. That distinction kept two propositions separate: the difficulty of reconstructing a dose after decomposition, and the significance of finding drugs in a patient’s tissues.

Cyril Wecht offered a further challenge. He described concentrations in some bodies as far above borderline levels and conducted a small experiment comparing samples from overdose deaths that had been refrigerated with samples exposed to hot, humid conditions. He found no significant differences in the measured drug levels. The experiment was limited: it was not definitive, had not been reviewed by other scientists, and was never published. It nevertheless supplied another piece of evidence against treating heat-related redistribution as a complete explanation. The experts’ disagreement therefore concerned not only the interpretation of particular results but also the degree of certainty that forensic evidence could support.

Influence and Limits

Minyard appeared persuaded by Karch in nearly all the cases, perhaps with one exception, and gave substantial weight to his opinion. That influence mattered because Minyard still had to decide how to present the deaths to the grand jury. He imagined a trial in which the experts would contest the meaning of the postmortem findings and worried that reasonable doubt could defeat the case. His judgment involved both the scientific dispute and his concern about the consequences of a failed prosecution for New Orleans’s recovery.

Karch’s position did not resolve whether the patients had received drugs in amounts that caused or accelerated their deaths, and it did not establish the intentions behind any administration. In the later account of Minyard’s deliberation, drug redistribution remained a reason murder could be difficult to prove, while the presence of the drugs and the absence of a competing cause remained arguments on the other side. Karch’s importance lies in the narrower but consequential role he played: he made uncertainty about decomposed tissue central to the coroner’s assessment, while the disagreement among specialists left the meaning of the evidence—and the deaths themselves—contested.