Memorial Medical Center Patient Medication and Euthanasia Controversy

The Memorial Medical Center Patient Medication and Euthanasia Controversy developed during the hospital’s evacuation crisis, when staff debated how to respond to patients suffering amid heat, exhaustion, and shrinking prospects for rescue. The dispute joined two questions that were not the same: how to relieve distress through comfort care, and whether medication was being used with the understanding that it would hasten death. Later forensic testing established that some patients’ tissues contained morphine or midazolam, but the condition of the bodies and conflicting expert interpretations complicated conclusions about dose, cause of death, and intent.

Conditions and the Meaning of DNR

By September 1, patients remained in difficult conditions inside Memorial Medical Center. Susan Mulderick, the hospital’s nursing executive, encountered patients in the second-floor lobby who were frightened and in need of help. Heat and shortages of diapers and clean linens made it difficult to keep some patients clean and comfortable. The strains of care formed the immediate setting for her question about what the hospital could do for those who could not be evacuated promptly.

The medication debate followed an evacuation policy that had already placed some patients at particular risk. Doctors had decided that patients with Do-not-resuscitate (DNR) orders would be evacuated last, even though such an order meant that a patient whose heartbeat or breathing stopped should not be revived; it was not itself a declaration that the patient was terminal or that rescue should be withheld. The distinction mattered in practice. On another floor, a patient’s daughter sought to cancel her mother’s DNR order after realizing that staff were treating it as a reason to leave her behind. The patient was then moved toward rescue. That episode exposed how a decision intended to govern resuscitation could be understood as a judgment about a patient’s claim to evacuation.

The decision also carried a history of unequal access to care. Jannie Burgess, one of the DNR patients in the intensive care unit, had spent decades nursing in New Orleans hospitals and nursing homes while being barred, because of her race, from receiving care at some private hospitals where she could work. The hospital where she was now a patient had opened in 1926 as Southern Baptist Hospital; it took more than four decades before she could be treated there. Her presence among the patients assigned last priority gave the evacuation rule a human history beyond its administrative rationale.

From Comfort Care to a Disputed Proposal

Mulderick had seen staff members attend to pets while patients remained in distress. She told a radiologist that staff were discussing euthanizing animals but not what could be done to help patients. Her stated concern, as she later described it, was to relieve pain and dull patients’ awareness of intolerable conditions—not to end their lives. The radiologist understood the remark as raising euthanasia as an option and asked medical chief Richard Deichmann to convene a discussion. Deichmann rejected the idea, saying that euthanasia was illegal and that patients with DNR orders were still to be evacuated eventually.

The disagreement was sharpened by the fact that people understood Mulderick’s words differently. Emergency physician Karen Cockerham heard them as a proposal to consider euthanizing patients, and thought the possibility should be discussed. Deichmann later recalled a separate, private conversation in which Mulderick asked whether euthanizing DNR patients would be humane; Mulderick, through her attorney, denied having raised that question with him or anyone else at Memorial. The book presents the recollections as contested, not as a settled account of a single agreed plan. The uncertainty about what had been proposed became part of the controversy itself.

Mulderick found support for medication from Anna Pou, a physician who had been directing care on the second floor. Pou compared the patients before her to some of her cancer patients, for whom comfort rather than further curative treatment could become the focus. She said she would use pain medication but was unsure what to give. Mulderick then asked Ewing Cook, a pulmonologist she had worked with for two decades, to advise Pou before he left by boat to try to rescue his son, who had been trapped by flooding. Cook had experience helping patients taken off life support die without pain and anxiety, and believed in making dying patients comfortable.

Cook spoke with Pou about patients categorized as requiring the least intensive care, including people from Memorial Medical Center and LifeCare Hospitals who remained in staging areas, as well as nine LifeCare patients still upstairs. He believed evacuation of the nine down five flights of stairs would be extremely difficult and saw no outside help arriving. He advised Pou to use morphine with a benzodiazepine sedative. Cook later said he understood his advice as a way to make patients go to sleep and die; comfort medication already being prescribed for pain and anxiety was, in his account, different. This distinction—between relieving suffering and using a combination understood to suppress breathing until death—became central to later scrutiny.

Prescriptions and Patients

Pou wrote prescriptions for three patients in the second-floor lobby: Wilmer Cooley, an eighty-two-year-old LifeCare patient with heart problems, a serious infection, and a need for dialysis; Carrie Mae Hall, known as Ma’Dear, a LifeCare patient with a tracheostomy whose determination to survive had impressed a nurse; and Donna Cotham, a forty-one-year-old Memorial patient and mother of four with liver disease. Cooley had a DNR order. Cotham’s condition had worsened, and although doctors had planned to transfer her to intensive care, that unit was evacuating and she had not been moved. Nurses had considered her unlikely to survive.

For each patient, Pou prescribed nine vials of concentrated intravenous morphine, totaling 90 milligrams, and wrote only that it was to be administered as directed. That amount was nine times the highest dose she had prescribed for pain in the previous two days to a colleague’s cancer patient, who was already taking morphine and tolerant of its effects. Pou included her Drug Enforcement Administration number, authorizing her to prescribe controlled substances, and a pharmacist filled the prescriptions. The documented amount and the sparse administration instruction later became concrete evidence for investigators, but neither detail by itself established how much each patient received or what the prescriber intended.

Toxicology and Competing Interpretations

Investigators initially worried that the bodies, recovered after more than a week in the heat, would not yield useful evidence. Frank Minyard, the Orleans Parish coroner, had first told Virginia Rider that decomposition made blood testing for lethal drug levels impractical. A volunteer pathologist suggested that drugs might remain detectable in more durable tissues, including liver, brain, and muscle, or in fluid that accumulated in the abdomen. At the attorney general’s request, Minyard agreed to have a federal disaster mortuary team collect tissue samples from patients who had died at hospitals and nursing homes in the parish.

In an initial report on eighteen Memorial cases, the laboratory found morphine in nine and midazolam in about five or six others. Later, Robert Middleberg’s laboratory reported that twenty-three of forty-one bodies from Memorial Medical Center and LifeCare Hospitals had tested positive for morphine, midazolam, or both. The findings established the presence of the drugs in the tested tissues, but interpreting postmortem concentrations was more difficult than interpreting blood tests from living patients. Heat and decomposition could affect concentrations, and the experts considered whether drugs had been administered in a single large dose or accumulated through repeated doses, how kidney or liver disease might alter processing, and whether drug effects fit the known timing of deaths.

The experts did not agree on what the results could prove. Steven Karch argued that after bodies had remained in extreme heat for ten days, drug concentrations could not reliably establish causes of death and should remain undetermined. Michael Baden countered that the drugs’ presence mattered even if the administered dose could not be reconstructed, and said there was no competing cause of death in the cases he discussed. Cyril Wecht characterized some detected levels as very high and tested whether hot, humid conditions substantially altered drug levels in samples from overdose deaths. His small, unpublished study found no significant difference from refrigerated samples, but it was not definitive or independently vetted.

Consequences and Context

The controversy did not end with a toxicology result. Minyard weighed the competing opinions while considering what he could tell a grand jury. He gave substantial weight to Karch’s position, also held by a toxicologist retained by Pou’s attorney. Wecht’s counterargument and Baden’s view remained part of the evidentiary dispute. Minyard anticipated that a trial would turn into a battle among forensic experts and feared that the parish might lose on reasonable doubt, a consequence he considered against the wider needs of the city’s recovery. The distinction between detecting medication, establishing a fatal mechanism, and proving criminal intent remained unresolved in the debate presented here.

The book also sets Memorial’s experience beside that of Charity Hospital, where staff worked through flooding, loss of power and basic services, and other severe dangers. Charity had roughly twice as many patients across its campuses as Memorial and a lower staff-to-patient ratio; transfers were not completed until September 2, a day later than at Memorial, yet fewer than ten patients died. Accounts from Charity workers described continued bedside care and efforts to sustain morale. This contrast does not by itself explain different outcomes, but it widens the question beyond individual prescribing decisions to include evacuation policy, staffing, institutional conditions, and the choices available to caregivers. What began as a dispute over how to ease suffering thus became a broader, contested inquiry into the meaning of rescue, the limits of comfort care, and what evidence can establish after a disaster.