The Memorial Medical Center Patient Injection Incident arose during the hospital evacuation after Hurricane Katrina, when patients remained in oppressive conditions and staff faced the prospect of moving people who were already gravely ill. On the second floor, Karen Wynn gave an elderly woman morphine and midazolam after seeing her struggling to breathe; the woman died about half an hour later. Other staff members described medication being given to patients on both the second and seventh floors. The deaths, conflicting understandings of the drugs’ purpose, and uncertainty about what the evidence could establish turned bedside decisions into a criminal investigation and a lasting ethical dispute.

Conditions on the Second Floor

Wynn had not gone into LifeCare because she assumed its patients had already been evacuated. She learned otherwise when Cheri Landry told her she was going upstairs with Anna Pou to make patients comfortable. Back on the second floor, Wynn saw that evacuation was still underway: patients marked with DNR tags remained near an ATM, while others waited on stretchers and cots along the lobby and corridor for transfer through an opening into the garage. The lobby’s broken windows left part of the makeshift unit exposed above floodwaters.

Landry returned from LifeCare and told Wynn that sedatives were being given to patients on the second floor. When Wynn asked what she could do, Landry told her to check on people. Wynn focused on four women lying near the corridor and singled out an elderly woman whose breathing appeared labored. At a table of supplies, she found morphine and midazolam, also known by the brand name Versed. She knew the combination from intensive care: it could sedate ventilated patients, and it was also used to ease distress when life support was withdrawn.

The practical details of the episode matter to the dispute that followed. Many patients lacked IV lines. Wynn and Pou requested boxes of IV catheters, but not the IV fluids and tubing that would have been needed to hydrate patients who could not drink. With a male nurse holding a flashlight, Pou began an IV. The available drugs and equipment could be used to relieve distress, but the circumstances also raised questions about what the staff expected the medication to do.

Wynn’s Medication and the Disputed Meaning of Comfort

Wynn believed that some patients were already dying and that morphine and Versed could hasten that process. She had not examined every patient, but drew on what she saw and heard, and on decades of nursing experience, to judge that some would not survive. She also feared that moving them—through the opening in the machine-room wall and up to the garage—could itself precipitate their deaths. In her view, medication could spare them distress during either the wait or the transfer.

Wynn diluted what she later recalled as a 10-milligram vial of morphine with a small amount of midazolam in saline. She administered the mixture slowly through the elderly woman’s IV and flushed the line. The woman appeared to struggle less to breathe and died within about half an hour. The account establishes the sequence and Wynn’s interpretation of the woman’s condition; it does not, by itself, establish the precise contribution of the drugs to her death.

Other observations sharpened the disagreement. One nurse saw a patient struggling to breathe after an injection and searched for someone who could reverse the medication or provide an antidote. She later recalled being told that the drugs were what needed to be done, and understood some colleagues to regard them as a way to get exhausted staff out more quickly when many patients could not move. Several employees said Pou had ordered the drugs, but the nurse did not know whether that was true or what Pou intended. Other nurses familiar with the patients believed they could still reach safety. When no one attempted to reverse the drugs, a group carried the struggling patient toward the garage, hoping the helipad might offer a chance of survival.

Deaths, Evacuation, and Differing Cases

As patients who had received injections died, Wynn and colleagues covered them with sheets and moved them into the chapel, trying not to draw the attention of more alert patients still waiting to be evacuated. Someone unlocked the chapel for the group and locked it again after they left. Boats and helicopters continued to remove patients and visitors through the day; Wynn and other nurses helped lift some of the last patients through the machine-room opening.

The account also distinguishes the second-floor episodes from care provided to Merle Lagasse on the garage roof. Lagasse, who had advanced cancer and emphysema, was waiting for rescue when a nurse noticed her gasping and asked her physician, Roy Culotta, for medication to ease her breathing. Culotta believed she was actively dying and took her out of the evacuation line. He obtained morphine, Versed, and Ativan, knowing that her tolerance for narcotics was high and believing a large dose would ease her suffering while undoubtedly hastening death. Lagasse and her daughter had not agreed to a DNR order. A nurse administered the drugs Culotta ordered; Lagasse was taken back into the hospital, where Culotta stayed with her when she died. The episode underscores that the controversy encompassed decisions made in different circumstances, with differing patient histories and clinical judgments.

The evidence did not show that every patient who received medication died. A later note on the investigation states that an unnamed cancer patient survived the ordeal at Memorial after individual morphine doses between 2 and 10 milligrams were dispensed on Wednesday and Thursday for a patient Pou was covering. The patient’s description was consistent with pharmacy records, but the author did not name her because her family had not been reached. Investigators also found a box containing potassium chloride, a drug used to euthanize pets. However, people interviewed about the patient injections did not recall potassium chloride being used to hasten human deaths, and the drug could not be detected through postmortem toxicology.

Toxicology and Unresolved Causation

Because the bodies had decomposed in the heat for more than a week before recovery, Orleans Parish coroner Frank Minyard initially doubted that autopsies could establish whether patients had received lethal drug doses. A volunteer pathologist advised that drugs might remain detectable in liver, brain, muscle, or abdominal fluid even when blood sampling was no longer possible. At the attorney general’s request, a federal disaster mortuary team collected tissue from people who had died at hospitals and nursing homes in Orleans Parish. On September 22, investigators took samples from eighteen Memorial patients to National Medical Services, Inc., in Pennsylvania.

In an early report on those eighteen cases, the laboratory found morphine in nine and midazolam in about five or six. The names reported as positive matched the attorney’s list of suspicious deaths, a list the laboratory had not been given. Later, among forty-one bodies from Memorial and LifeCare analyzed by the laboratory, twenty-three tested positive for morphine, midazolam, or both. Those findings established drug presence, but interpretation remained contested: postmortem tissue results were not equivalent to blood tests from living patients, and prolonged exposure to heat might affect concentrations. The experts therefore examined each patient’s medical history and records alongside the laboratory results, including possible repeated doses, impaired drug processing, effects on breathing, and the timing of death.

The specialists also disagreed about what could be inferred from the results. Steven Karch argued that after ten days at high temperatures, the medical causes of death should remain undetermined. Michael Baden countered that, whatever uncertainty remained about dosage, the drugs were present and there was no competing cause of death. Cyril Wecht described some measured levels as extremely high and tested whether hot, humid conditions changed drug levels in samples from known overdose deaths. His small, unpublished study found no significant difference from refrigerated samples, but was not definitive. The conflict was therefore not simply over whether medication was detected; it concerned how far that evidence could support conclusions about dose, causation, intent, and criminal responsibility.

Aftermath and Continuing Dispute

The investigation and its aftermath carried the event beyond the hospital. Gina Isbell, a LifeCare nurse, described poor sleep, nightmares in which she saw patients’ faces, and guilt about the staff she had selected to work during the storm. She had left Memorial by small boat and returned to find her home and community in St. Bernard Parish devastated. Later, even after a special grand jury declined to indict Pou, Isbell remained angry that help had come too slowly and felt permanently changed by the storm. She also held to the belief that her colleagues had done their best and said she would serve again if asked.

Wynn, too, struggled with what had happened. Preparing for possible grand-jury testimony meant revisiting the events; after meetings with her lawyer, it could take weeks for her to feel able to move forward. She recognized what she thought might be post-traumatic stress in herself and colleagues and no longer wanted the responsibilities of nursing management. John Thiele, who had also participated in injections, later experienced a prolonged, critical illness. A nurse believed he seemed remorseful and had thought he was acting compassionately, but Thiele denied that recollection and said he remained confident in what he had done. He distinguished his own condition from those of some Memorial patients because he believed his problems could still be reversed.

The incident’s unresolved core is visible in these opposing accounts: medication could be understood as an attempt to reduce suffering in patients thought to be near death, while its capacity to suppress breathing, the circumstances of its administration, and some patients’ survival prospects made that explanation fiercely contested. The forensic findings added evidence but did not settle every question about individual deaths or intention. The event thus remained both a record of care under catastrophic conditions and a dispute over how clinicians and investigators should distinguish comfort, foreseeable risk, and the deliberate hastening of death.