Cyril Wecht and Butch Schafer

Cyril Wecht and Butch Schafer’s relationship in the Memorial investigation was that of forensic consultant and prosecutor: Wecht interpreted postmortem findings, while Schafer tested what those findings could establish about cause of death and criminal responsibility. Their exchanges helped move the inquiry from the difficult recovery of evidence toward a prosecutorial case, but they also exposed the limits of conclusions drawn from bodies affected by heat and delay. The central distinction was consequential: evidence that a drug was present was not, by itself, the same as proof of how it had been administered, whether it caused a death, or what the person administering it intended.

The Evidence They Had to Reconstruct

The collaboration began against a serious forensic obstacle. More than a week after the patients had died, the remains recovered from Memorial had decomposed in the heat. Frank Minyard, the Orleans Parish coroner, initially told Virginia Rider that autopsies would be of little use: investigators could not rely on blood samples to establish lethal drug levels. A volunteer pathologist, however, advised that drugs might still be detectable in more resilient tissues or in fluid in the abdomen. At the attorney general’s request, Minyard agreed to seek autopsies and tissue samples from about one hundred patients who had died at hospitals and nursing homes in Orleans Parish after Hurricane Katrina.

On September 22, investigators took samples from eighteen Memorial Medical Center bodies to National Medical Services, Inc., a forensic toxicology laboratory in Pennsylvania. An early report found morphine in nine of the eighteen cases and midazolam in roughly five or six others. Those preliminary results established drug exposure in some of the remains, but did not settle the separate questions of dosage, timing, medical indication, or causation. The distinction shaped Schafer and Wecht’s work together: their task was not merely to notice a laboratory result, but to determine how far it could responsibly support an inference about a particular death.

By December, Rider, Schafer, and their colleagues had assembled toxicology reports, medical records, and autopsy materials for four LifeCare patients on Memorial’s seventh floor. Minyard, whose medical training was in gynecology, recommended Wecht, a forensic pathologist and longtime colleague, to interpret the material. Wecht had already commented publicly on the investigation before being hired, arguing that morphine found in a patient for whom it had not been ordered would be significant evidence. His prior public view made his later conclusions consequential, while also placing them within an investigation whose claims were already attracting attention.

The Four Cases and Wecht’s Opinion

In an early-December phone call, Wecht told Schafer that all four patients he had reviewed had drugs in their bodies that were not prescribed in their medical records. He believed the drugs had caused or substantially contributed to the patients’ deaths. Schafer then asked whether the measured levels were abnormally high. Wecht initially emphasized that, for drugs such as morphine and Demerol, an amount not prescribed to the patient was significant. He explained that morphine depresses the central nervous system and can slow respiration, heart rate, and blood pressure—effects that could matter greatly in already vulnerable patients.

Schafer did not stop at the presence of unprescribed medication. He raised a possible defense: the drugs might have been administered to relieve pain rather than to cause death. Wecht agreed to revisit the concentrations and consider whether they could be consistent with therapeutic dosing. That exchange marks an important feature of their working relationship. Schafer pressed the expert to consider an alternative interpretation relevant to intent; Wecht undertook further analysis rather than treating the first inference as the only possible one.

Two days before Christmas, Wecht sent Schafer a written assessment. Comparing tissue concentrations from the four patients with fatality ranges in Randall C. Baselt’s toxicology reference, he concluded that each appeared to have received a lethal amount of morphine. The findings supplied what prosecutors considered probable cause to prepare arrest warrants for Anna Pou, Cheri Landry, and Lori Budo, whom prosecutors believed had accompanied Pou on the seventh floor. Investigators had not, at that point, accumulated enough evidence against a third intensive-care nurse they were examining. Wecht’s opinion therefore informed a specific prosecutorial step, but did not itself determine every person’s role or establish the full circumstances of the deaths.

Scrutiny, Disagreement, and the Limits of the Opinion

The toxicology remained open to challenge. When experts later reviewed results from forty-one bodies from Memorial and LifeCare, twenty-three had tested positive for morphine, midazolam, or both. Robert Middleberg, the laboratory director, considered many of the concentrations unusually high, but cautioned that postmortem tissue results were not as straightforward as blood tests from living patients. Heat exposure could have altered measured concentrations, he advised, and each result needed to be assessed alongside the patient’s clinical history. The experts considered whether drugs might have accumulated in patients with kidney or liver disease, whether the combination could suppress breathing in patients not on respirators, and whether the timing of administration fit the known times of death.

Minyard later consulted Steven Karch, who argued that after ten days in temperatures around 100 degrees, drug concentrations in remains could not reliably establish the concentrations before death. Minyard gave considerable weight to Karch’s position. Wecht, by contrast, maintained that uncertainty about the original dose did not erase the significance of detecting drugs shortly before death where there was no competing cause. He also tested the decomposition argument by exposing samples from people who had died of overdoses to hot, humid conditions and comparing them with refrigerated samples. He found no significant difference in drug levels. The study was small, not definitive, and neither independently vetted nor published; it added evidence to the dispute, not a final resolution.

Professional Confidence and a Complicated Aftermath

Schafer’s exchanges with Wecht were marked by professional warmth. The book describes Schafer as having been effusive with him, as he had been with toxicologist Robert Middleberg. That rapport did not eliminate scrutiny: Schafer’s questions about therapeutic intent and drug levels show him probing the limits of the expert conclusion, while Wecht’s follow-up gave their working relationship a concrete investigative function.

The arrangement became strained when a spokesperson for the Louisiana attorney general’s office said another expert would probably review toxicology reports from more than two hundred hospital and nursing-home deaths statewide. Wecht understood this to mean he would no longer be retained. In a sharp letter to Schafer, he recalled Schafer’s earlier expression of affection and described the change as a personal betrayal. The rupture was not presented as a dispute over the four patients’ test results. Wecht was later indicted on eighty-four counts concerning alleged misconduct in his business ethics, including the handling of public and private consulting expenses; those charges concerned his ethics, not his competence as a forensic pathologist. While other toxicology reports continued to arrive, Rider and Schafer’s team relied on his conclusions in the first four cases.

Their collaboration thus produced both a usable prosecutorial assessment and a record of unresolved scientific and legal questions. Wecht’s opinion linked unprescribed drugs to four deaths and helped investigators prepare warrants; Schafer’s questioning brought the distinction between relief of suffering and intent to cause death directly into the analysis. Subsequent experts disputed how much could be inferred from postmortem concentrations, and the evidence required case-by-case interpretation. The relationship matters not as a simple alliance that settled the case, but as a point where forensic judgment, prosecutorial needs, and uncertainty met.