LifeCare Hospital, New Orleans, occupied space inside Memorial Medical Center and operated a unit whose patients became central to the controversy over the hospital’s evacuation during Hurricane Katrina. Its seventh-floor rooms were both a site of disputed patient care and, later, a focus of forensic and grand-jury scrutiny. The accounts of what happened there depended on evidence that did not always align: patient charts and tissue samples, witness recollections, and testimony that investigators and families said the grand jury never heard.

Setting Within Memorial Medical Center

LifeCare operated inside Memorial Medical Center rather than in a separate building. The seventh floor housed LifeCare patients, including people whose conditions, evacuation prospects, and medication histories later became crucial to reconstructing the final days. On Thursday, September 1, Memorial pathologist John Skinner and laboratory director David Heikamp walked through the hospital to record the dead and their locations. Their notes and recollections were considered important to establishing when deaths had occurred. On the seventh floor, they encountered Anna Pou and nurse manager Mary Jo D’Amico beside a woman lying near a nursing station, apparently unconscious and breathing laboriously. The woman was not identified in their account, though her description and location suggested she may have been Wilda McManus.

Patients, Medication, and the Evacuation

Accounts from the seventh floor put specific patients and rooms at the center of the investigation. In Room 7305, nurse Kristy Johnson accompanied a Memorial nurse into the room and saw her inject Rose Savoie, a ninety-year-old LifeCare patient with acute bronchitis and a history of kidney problems. A LifeCare nurse later told investigators that Savoie and her roommate, Alice Hutzler, had been alert and stable late that morning. Savoie complained that the injection burned; by that afternoon she and the other remaining LifeCare patients were dead. Johnson’s account became a significant eyewitness account of events on the floor.

The medical record for Hutzler, a ninety-year-old patient being treated for pneumonia, provided a separate line of evidence. Morphine and midazolam were detected in her liver, brain, and muscle tissue, although neither drug appeared as prescribed in her chart, which had been kept current until a few hours before her death was recorded on September 1. The notes described her as resting comfortably on Wednesday afternoon, and her nurses recorded no overnight pain or distress that indicated a need for either drug. These findings raised questions about the circumstances and timing of medication, while the broader toxicology evidence could not by itself settle every question of dose or cause.

Forensic Evidence and Its Limits

The condition of the recovered bodies complicated the investigation. Orleans Parish coroner Frank Minyard initially told investigators that examining the Memorial bodies would be of little use after they had decomposed in the heat for more than a week; blood samples, for example, could not be taken to test for lethal drug levels. A volunteer pathologist pointed out that drugs might remain detectable in more resilient tissues or in abdominal fluid. At the attorney general’s request, a federal disaster mortuary team undertook autopsies and tissue sampling in a broader group of deaths at hospitals and nursing homes across Orleans Parish. On September 22, investigators took samples from eighteen Memorial bodies to National Medical Services, Inc., for testing. In an initial report on those cases, the laboratory director said nine were positive for morphine and roughly five or six for midazolam.

Later, toxicology results covered forty-one bodies from Memorial and LifeCare; twenty-three tested positive for morphine, midazolam, or both. Those figures applied to the combined group, not to LifeCare alone. Experts cautioned that postmortem tissue results were harder to interpret than blood tests from living patients, particularly because prolonged heat could alter drug concentrations. They therefore examined the clinical histories case by case, asking whether drugs had been given in a single large dose or accumulated through repeated doses, whether illnesses such as kidney or liver disease affected processing, and whether the drugs’ respiratory effects fit the known timing of deaths. The disagreement was not simply about whether drugs were detected, but what those findings could establish about treatment and death.

Witnesses and the Grand-Jury Record

The investigation also had to account for the way memories and testimony were formed. After the evacuation, several LifeCare witnesses discussed events and worked together on a written timeline. Investigators worried that public reports and conversations between witnesses could alter recollections, so they sought additional interviews conducted without leading questions, as well as contemporaneous documents and physical evidence. The book’s account likewise distinguishes between recollections and records, noting that memories sometimes conflicted and that not every participant agreed to speak.

In testimony described in a letter about the grand-jury proceedings, Cheri Landry said she had injected as many as four LifeCare patients on the seventh floor, as well as two patients on the second floor. She acknowledged that she did not know the seventh-floor patients’ medical conditions or medications, and said she assumed they had do-not-resuscitate orders and believed they were going to die. Lori Budo similarly said she did not know those patients’ conditions or DNR status; she testified that she had injected two seventh-floor patients. These accounts documented what the nurses believed, while also exposing the limits of their knowledge about the patients they treated.

LifeCare leaders were called only at the grand jury’s final meeting, according to the same account. Assistant administrator Diane Robichaux and nurse executive Therese Mendez described Pou as saying she was assuming responsibility for the patients and that they would receive a lethal dose of drugs. Neither leader witnessed what followed: they had gone to clear staff from the floor. Johnson, who had stood at patients’ bedsides and witnessed injections, was not called, although people close to her later recalled that she had been scheduled to appear that day. Her absence left the grand jury without her eyewitness account of the seventh-floor events.

The attorney general’s team also objected that the jurors had not heard from LifeCare employees and administrators about their efforts to arrange an evacuation or the confusing directions they received from Memorial. The team said the jurors were not given relevant messages and that LifeCare witnesses had offered statements voluntarily, without immunity. Experts who had analyzed the deaths were prepared to testify but were not called, nor were family members including Carrie Everett, Angela McManus, and Kathryn Nelson, who had been made to leave LifeCare shortly before the injections. The resulting record contained testimony from Memorial nurses but, in the view of the prosecutors’ letter, omitted accounts needed to describe the patients’ condition, LifeCare’s evacuation efforts, and the care provided. LifeCare thus remained more than the location of the disputed events: it was also the point where questions about patient care, witness access, and the completeness of the investigation converged.