Memorial second-floor DNR patient medication incident

At Memorial Medical Center, the medication of DNR patients waiting on the second floor became a consequential and contested episode in the hospital’s evacuation. Karen Wynn and other caregivers saw patients struggling in extreme heat and believed medication could ease their distress; some also believed the patients were already dying. Other staff members feared that the drugs were hastening death and that patients who had survived so far might still reach safety. The scene therefore turned on more than the patients’ DNR status: it exposed a conflict over what comfort, treatment, and evacuation required when choices were being made amid severe constraints and uncertainty.

Setting and Immediate Circumstances

The second-floor lobby had become a makeshift care and evacuation area. About a dozen patients designated as 3s remained near an ATM, marked with large DNR tags. Other patients waited on stretchers and cots in the lobby and along a corridor leading toward the machine room, where they could be moved through an opening into the garage. The area had an exposed, open-air quality after floor-to-ceiling windows on the north side had been broken out. Patients were still awaiting transfer while staff worked in oppressive heat.

Wynn, an experienced surgical intensive-care nurse, saw that there was work left to do on the second floor. She had assumed that the patients on the seventh floor, in LifeCare Hospitals of New Orleans, had already been evacuated. When Cheri Landry returned from there and told Wynn that staff were giving medication to patients on the second floor, Wynn asked what she could do. Landry asked her to check on people. Wynn focused on four women lying beside the corridor and noticed one elderly woman breathing with difficulty.

Medication and Competing Judgments

The supplies on a nearby table included Morphine and Midazolam, also known by the brand name Versed. Wynn knew the combination from intensive-care practice: it could sedate patients on ventilators, ease discomfort or air hunger before a breathing tube was removed, and reduce a patient’s drive to breathe. That clinical familiarity shaped her interpretation of what the drugs could do, but it also made the risks relevant. The medications were intended for intravenous use, and many patients lacked IV lines. Wynn and Anna Pou requested boxes of IV catheters, but not the fluids and tubing that would have been needed to hydrate patients who could not drink adequately. A nurse held a flashlight while Pou started an IV.

Wynn believed the patients appeared to be suffering and that their deaths were already in progress. Although she had not examined every patient, she relied on what she could see and hear, together with decades of intensive-care experience, to judge that they were unlikely to survive. In her view, the drugs might speed death without changing the eventual outcome. Moving patients through the opening into the garage and transporting them by pickup truck also seemed dangerous to her; she thought sedation would be appropriate even for that journey. Her stated aim was comfort and dignity, not a claim that medication could restore the patients or secure their evacuation.

Wynn diluted what she later remembered as a 10-milligram vial of Morphine and a small amount of Midazolam in saline, drew the mixture into a syringe, and administered it slowly through the elderly woman’s IV before flushing the line. The woman appeared to struggle less to breathe and died about half an hour later. Wynn also saw John Thiele and nurses attending to another patient who had already received Morphine. Thiele said he had done what he could to make that patient comfortable. The episode thus joined a palliative rationale to a foreseeable danger: these drugs could suppress breathing, while staff were administering them to patients who were not on respirators.

Objections, Deaths, and Evacuation

Not everyone interpreted the care as Wynn did. One young nurse had previously been told not to start IVs in DNR patients during the hospital’s emergency mode. Seeing staff place IVs in patients who were still alive unsettled her. Another nurse, Julie Couvillon, later saw a patient with a very low oxygen reading and noticed that some patients did not look right. She recalled a colleague trying to find someone who could reverse medication given to a patient struggling to breathe, but no one was willing to do so. A group of nurses instead carried that patient toward the garage and helipad in the hope that a rapid transfer might offer a chance of survival.

Accounts also differed over the purpose and meaning of the medication. Some nurses familiar with the patients believed they might still make it to safety; other employees thought the situation was horrible but necessary. One caregiver feared that the medicines were being used for the greater good of an exhausted staff facing too many immobile patients, while acknowledging that she did not know whether Pou had ordered the drugs or what her intentions were. These were witnesses’ concerns, not a settled finding about why medication was given. As patients died, Wynn and colleagues covered them with sheets and moved them discreetly into the chapel, away from more alert patients still waiting in the evacuation line. Boats and helicopters continued to remove patients and visitors; Wynn and other nurses helped lift some of the last patients through the machine-room opening.

Investigation and Unresolved Evidence

The later inquiry had to distinguish drug exposure from cause of death and from intent. Because the bodies had remained in heat for more than a week, the Orleans Parish coroner initially doubted that autopsies could establish what had happened; blood samples, for example, were unavailable. Experts advised that drugs might still be detectable in other tissues, and investigators sent samples from eighteen Memorial bodies to a forensic laboratory. In an initial report on those cases, nine tested positive for Morphine and about five or six for Midazolam. In a later review of forty-one Memorial and LifeCare bodies, twenty-three tested positive for one or both drugs.

Those results did not settle the question. Postmortem drug concentrations could be affected by decomposition and heat, and investigators considered patients’ medical histories, possible repeated dosing, organ disease, and the effects of breathing-suppressing medication in patients without respirators. Some experts emphasized that the drugs had been present shortly before death and that no competing cause of death had been established in certain cases. Others urged caution about inferring the dose or cause from decomposed tissue. The evidence therefore supported questions about medication and timing without, by itself, establishing a single account of every patient’s death or the intentions behind each administration.

Personal and Ethical Aftermath

For Wynn, the event remained bound to the practical judgments she had made at the bedside and to the emotional cost of recounting them. Preparing for possible grand-jury testimony made her feel as though she were reliving the events; she recognized what she thought were lasting signs of trauma in herself and colleagues. She had worked at Memorial for roughly twenty-five years, often putting patients and managerial duties ahead of family, and had herself helped schedule nurses for the storm. Afterward, she no longer wanted the same professional responsibility and felt she had lost part of herself at the hospital.

The episode’s ethical tension is sharpened by the difference between a DNR designation and a decision to stop all care. The patients were still alive, still awaiting evacuation, and in some cases still receiving medication intended to relieve distress. Yet the same medication could affect breathing, and staff disagreed about whether the patients’ prospects were hopeless or whether transfer remained possible. The incident’s enduring significance lies in that collision: an emergency care decision made under pressure became, in retrospect, a question about comfort, survival, evidence, and who had the authority to decide.