Anna Pou—Rick Simmons

Anna Pou—Rick Simmons describes an attorney-client relationship that became both an intensive private lifeline and a public defense campaign. As Pou faced the possibility of indictment over patient deaths at Memorial Medical Center, Simmons advised her, managed approaches from the media, and built arguments about disaster care for a potential grand jury and broader audiences. Their partnership did not merely answer accusations: it helped frame the ethical questions that the case brought into public view.

Counsel and Personal Support

Pou spoke with Simmons nearly every day, often in lengthy, tearful conversations. She shared her anxiety and matters she felt unable to discuss with others. Following his advice, she avoided watching the news and left him to handle media inquiries and a stack of interview and book proposals. Simmons had not committed to those offers; instead, he advised her to consider how she might market her story if she were indicted, when the legal costs could become enormous. His role thus reached beyond courtroom preparation to the management of what Pou would say publicly, and when.

Simmons also assessed the local climate surrounding the case. He commissioned a poll of potential jurors as he considered whether to seek a change of venue. The poll found that 76 percent of Orleans Parish residents supported the health professionals and opposed indictment, while 8 percent wanted an indictment and the remainder were undecided. Support for Pou and the nurses was also visible in letters sent to Cheri Landry and Lori Budo, and in a support-fund website where ICU nurse Cathy Green asked for messages of encouragement as well as donations. Those details formed part of the public environment in which Simmons was making strategic decisions; they did not, by themselves, settle the legal or ethical questions at issue.

Building a Defense Around Disaster Care

Simmons considered whether palliative sedation might provide a defense if Memorial’s health professionals were indicted. For the time being, however, he chose not to have Pou publicly enter a debate about end-of-life care. He regarded the subject as especially risky in Louisiana, which he considered too fundamentally Christian for the discussion he anticipated. His caution reflected a strategic judgment about public argument, not a resolution of whether the practice applied to what had happened at Memorial.

He was frustrated that the American Medical Association offered no useful guidelines for comfort care under disaster conditions. Its palliative-care guidance called for consulting family members and documenting medications—steps Simmons said Pou had not taken. He pressed the organization on how a doctor could follow those expectations when records could not be documented and relatives could not be reached. Ethicist Arthur Caplan, however, argued that the absence of those safeguards was precisely why the Memorial episode did not fit within the guidelines for palliative sedation. He pointed to the possibility of keeping handwritten medication orders, the rapid use of substantial amounts of drugs known to be lethal, and the fact that at least some patients did not appear terminally ill. The disagreement exposed a central tension in Simmons’s defense: the difficulty of applying ordinary standards during a disaster did not establish that the actions taken met those standards.

A disaster-preparedness seminar gave the defense a more favorable point of reference. Pou took notes on the record pages of her checkbook when she had no notepad, then found the full World Medical Association disaster-ethics policy online and emailed it to Simmons. The policy said that patients whose conditions exceeded available therapeutic resources could be classified as beyond emergency care and receive pain relief and sedatives. Simmons saw language that seemed to correspond to Pou’s decision and began using the concept in public statements and publicity materials. But the policy’s scope was narrower than the defense’s use suggested: it described cases such as unsurvivable injuries or operations that would force a choice between patients, and required regular reassessment if resources or a patient’s condition changed. Simmons’s strategy drew rhetorical force from the policy while the differences between its criteria and the Memorial circumstances remained consequential.

A Proactive Legal and Public Campaign

Simmons devoted nearly his entire practice to preventing a grand jury from indicting Pou, calling the effort a proactive defense. He taught himself about triage and end-of-life issues, interviewed or obtained statements from more than one hundred potential witnesses, prepared exhibits concerning government abandonment, and filed motions to protect evidence and keep Pou’s conversations with Tenet officials confidential. The work had already generated several hundred thousand dollars in legal fees, covered by Pou’s university and support fund. Simmons was prepared to sue the state to recover those costs if Pou, technically a state employee of the public university, was not indicted. He also prepared a motion to remove arrest-related records, including mug shots, fingerprint cards, and rap sheets, if charges were dropped or refused.

The defense developed a vocabulary for explaining the choices made at Memorial. Simmons and Pou adopted battlefield triage to describe helping healthier patients before sicker ones, presenting the phrase as a way to make the conditions Pou had perceived intelligible to a lay audience. The book notes that this was not typical battlefield practice. They also used reverse triage, a term associated, albeit rarely, with theoretical wartime situations in which treating able-bodied people first could help preserve a group’s survival. These labels did more than summarize a medical procedure: they situated a disputed hospital decision within the language of catastrophe and collective survival.

Taking the Argument to the Medical Profession

At the American Medical Association’s annual meeting in Chicago, Simmons carried the defense into a national debate. In a dark suit, sapphire tie, matching handkerchief, and cufflinks, he spoke beneath the chandeliers of the hotel ballroom in favor of changing disaster-care standards and supporting proposed state laws granting doctors broad immunity from liability in disasters unless they acted maliciously, even when their care was grossly negligent. He argued that overwhelmed systems would leave some patients untreated and that physicians might make decisions based on factors including DNR orders and fears for their own safety. Because families might sue, he said, doctors needed protection if they were to respond to emergencies caused by nature or terrorism. He also invoked the American Medical Association’s longstanding opposition to criminalizing medical judgment.

Simmons argued that ordinary end-of-life protections, including obtaining consent from patients or proxies and documenting decisions, might be unavailable during catastrophe, leaving doctors to exercise good-faith judgment. He again cited the World Medical Association’s beyond-emergency-care guidance as support for separating and sedating patients considered unsavable. His advocacy connected Pou’s individual case to proposed changes in professional standards and law, while making the case itself a prominent example in arguments over disaster medicine. The relationship therefore carried two intertwined stakes: Simmons’s effort to protect his client from indictment, and his attempt to persuade medical institutions and lawmakers that disaster conditions required different rules.