Louisiana Attorney General's Office

The Louisiana Attorney General’s Office became the central state investigative body examining deaths at medical facilities after Hurricane Katrina. Attorney General Charles Foti publicly promised a full inquiry into what he called a horrific tragedy at St. Rita’s Nursing Home, while his Medicaid Fraud Control Unit opened investigations into every hospital and nursing home where patients had died. The inquiry widened far beyond one facility: Foti said investigators were examining thirteen nursing homes and six hospitals across the greater New Orleans region. At the same time, allegations that health-care workers had intentionally killed patients were so unfamiliar to the unit that investigators initially found the possibility nearly outlandish.

Mandate and Scope

Foti’s public commitment reflected both the scale of the deaths and his stated concern for older people. A longtime elected sheriff of Orleans Parish before becoming attorney general, he had a substantial elderly constituency. He had also cared for his own father until the older man died that May at ninety-two, driving him away from the predicted paths of several hurricanes. Against that background, Foti pledged to investigate the St. Rita’s deaths fully and directed the unit to examine deaths at other facilities as well.

Arthur “Butch” Schafer, an experienced criminal prosecutor specializing in complex cases, became a central figure in the Memorial inquiry, working with Special Agent Virginia Rider and a small team of colleagues. The office’s investigation therefore joined two related but distinct tasks: examining deaths throughout the region and determining whether particular deaths at Memorial could support criminal charges. Schafer and his coworkers had rarely encountered allegations of intentional killing in health-care settings; even deaths attributed to abuse had emerged only rarely in the unit’s work. That made the Memorial allegations not simply a new case, but an unexpected kind of case for the investigators to assess.

Building the Memorial Case

The office’s attempt to search Memorial required investigators to show a judge that a crime was likely to have occurred there. After an earlier, unwelcome appearance at the hospital, they considered a consensual search unlikely. Schafer discussed possible charges with his superiors, and Rider consulted the Louisiana statute because alleged murders were outside her usual experience. She prepared an affidavit summarizing accounts from Therese Mendez, Diane Robichaux, Kristy Johnson, and Steven Harris, then submitted it with an application to search for items necessary to prove second-degree murder. In Louisiana, the distinction between first- and second-degree murder concerned the nature of the victims rather than premeditation; the definition of second-degree murder included a specific intent to kill.

Witness accounts were only one part of the case the office had to assemble. By December, Rider, Schafer, and their coworkers had gathered detailed toxicology reports, medical records, and autopsies concerning four LifeCare patients on Memorial’s seventh floor. The Orleans Parish coroner, Frank Minyard, was a gynecologist and did not consider himself trained to interpret the material with the certainty prosecutors sought. He recommended Cyril Wecht, a forensic pathologist and longtime colleague, who had worked on the John F. Kennedy assassination case and the O.J. Simpson murder trial.

The forensic evidence presented difficulties from the start. Minyard initially told Rider that examining the Memorial bodies would be useless: they had remained in the heat for more than a week before recovery, and, for example, blood could not be sampled to test for lethal drug levels. Later toxicology findings nevertheless reported drugs in postmortem tissue. In one set of eighteen cases, nine tested positive for morphine and about five or six more for midazolam. The finding established drug presence, but not by itself the dose, timing, or cause of death.

That distinction became central to the office’s work with expert evidence. Toxicology in postmortem tissue was not as straightforward to interpret as a blood test from a living patient; time in the heat could have altered drug concentrations. Robert Middleberg advised colleagues to consider each patient’s medical history alongside the laboratory results, and the experts examined records case by case. Minyard later consulted Steven B. Karch and gave considerable weight to Karch’s view, which was also shared by a local toxicologist retained by Anna Pou’s attorney. Forensic pathologist Michael Baden disputed the importance of uncertainty about dosage: he argued that morphine and Versed had been given shortly before the patients died and that no competing cause of death had been established. The disagreement left the office confronting separate questions about exposure, causation, and intent rather than treating a positive result as proof of all three.

Investigation, Publicity, and Evidentiary Limits

As the investigation became public, Foti predicted it would be completed in two weeks and asked anyone with information to come forward. The scale he described—thirteen nursing homes and six hospitals—underscored that the Memorial case was one front in a wider inquiry, even as its possible criminal implications drew particular attention. By the time of the arrests, Rider and her partners had accumulated about 50,000 pages of documentary evidence. The Orleans Parish District Attorney’s Office requested a case summary, and Rider prepared one with help from other agents; it grew longer as she worked.

Publicity also complicated the assessment of witness recollections. Reports could prompt witnesses to remember details, but the book notes that new information and discussion could also contaminate or reshape memories. Several LifeCare witnesses had spoken after evacuation and consulted on a written timeline of their experiences. The office’s investigation thus depended on testimony whose reliability had to be considered alongside when it was given and what witnesses might have heard or discussed in the meantime. These cautions did not resolve the allegations; they marked limits on how confidently investigators could treat later recollections as independent accounts.

A further unresolved question concerned who, if anyone, had made a decision to give patients lethal doses. Investigators had not interviewed anyone who admitted to being a decision maker. They increasingly examined the corporation that owned Memorial and employed its executives, seeking to determine what Pou had meant when she allegedly told Mendez that a decision had been made. The inquiry therefore reached beyond the actions of individuals at the bedside to questions about authority and responsibility, without yet establishing who had directed the alleged decision.

Arrests and the Office’s Record

At the afternoon press conference in Baton Rouge, Rider stood among male colleagues in a conference room crowded with reporters. Schafer arrived in a polo shirt bearing the attorney general’s office logo after staying in New Orleans overnight to monitor the booking process and check that the arrest paperwork was correct. Foti’s media staff distributed arrest warrants in dark-blue folders. The scene presented the investigation as an official state action, but the case remained contested: the existence of warrants and a large documentary record did not settle what the medical and witness evidence proved.

Even the possible charges remained under discussion. At a 2007 sworn witness examination, Schafer said investigators had not reached a decision about which charges might apply, including lesser charges such as manslaughter. The record therefore distinguishes the decision to investigate and arrest from a settled conclusion about the appropriate criminal theory. The office’s work developed through legal review, an extensive evidentiary compilation, and competing expert interpretations, rather than through a single decisive forensic finding.

The handling of expert reports also became part of the public aftermath. At the conclusion of the criminal case the following year, Foti’s office released a lightly redacted version of the consultants’ reports at a press conference and to a small number of reporters. Memorial employees sued as Jane and John Does and successfully stopped further release; the reports were later posted on CNN’s website. Pou’s response accused the attorney general of releasing documents to justify her earlier arrest before the October 2007 election. The accusation records a dispute over the office’s motives, not an established explanation for its actions. Across the investigation, the Louisiana Attorney General’s Office occupied both roles that defined the case’s public meaning: it gathered evidence to pursue possible criminal responsibility, and its decisions about arrests and disclosure themselves became subjects of controversy.