Roy Culotta administering comfort medication to Merle Lagasse

Roy Culotta administering comfort medication to Merle Lagasse became one of the clearest individual episodes in the wider dispute over patient care during the evacuation from Memorial Medical Center. Lagasse, who had advanced cancer and emphysema, developed severe breathing distress while awaiting rescue on the parking garage roof. Culotta believed she was dying and ordered morphine and sedatives to relieve her suffering, while acknowledging that the medication would hasten her death. He accompanied her back into the hospital and was with her when she died. The episode later raised difficult questions about clinical judgment, intention, and what the available evidence could establish.

A Patient in the Evacuation Line

By the time Lagasse reached the top of the garage, she had spent days in the heat and had been separated from her daughter the day before, when she was moved through a hole in the machine room. The last patients were being brought to the roof as daylight faded. A nurse noticed that Lagasse was gasping and asked Culotta, her physician, to provide medication to ease her breathing.

Culotta assessed her as being in respiratory distress and believed she was actively dying. He took her out of the evacuation line and asked an intensive-care nurse to retrieve painkillers and sedatives from the hospital. His decision thus arose at the intersection of two immediate demands: an effort to evacuate patients and a judgment that Lagasse could not continue waiting without relief. The account does not describe a new agreement by Lagasse or her daughter to forgo treatment; it specifically notes that they had not agreed to a do-not-resuscitate order.

Medication Retrieved from the Hospital

The nurse reached the hospital’s seventh floor by crossing from the garage over the roof of an intervening building. A wooden pallet bridged the gap, and a hose served as a handhold for staff moving between the helipad and the building to collect supplies. The nurse returned with morphine, Versed, and Ativan. Culotta assumed the drugs came from a locked storage box in the intensive-care unit.

Culotta had treated Lagasse for weeks, using narcotics to address pain and anxiety caused by her spreading cancer. He understood that she had developed a high tolerance, and thought a large amount of morphine would be needed to relieve her gasping and suffering. He also believed the dose would undoubtedly hasten her death. During her hospitalization, he had considered her treatment options limited; keeping her pain and anxiety under control had been a central goal of his care. That history helps explain his clinical reasoning, but it does not erase the conflict between the relief he sought and the fatal consequence he anticipated.

The drugs were administered at the garage, where there was no electricity for the usual infusion equipment. In a later interview, Culotta explained that the nurse injected a bolus into Lagasse’s vein rather than using an electric pump to deliver a controlled amount over time. He could not recall the precise dose, only that it was high, and connected that decision to her tolerance from weeks of narcotic treatment. He described the difference from ordinary practice in practical terms: without power, the team could not titrate medication gradually through a pump.

Return to the Hospital and Death

After the nurse gave the medication Culotta had ordered, Lagasse was placed in the back of a truck. Culotta drove down from the garage with her and brought her into Memorial Medical Center. He stayed with her as she died. The account establishes both his role in ordering the drugs and his presence at the end of her life, but it does not establish an exact dose or a precise interval between administration and death.

When investigators later asked about the deaths of patients on the garage roof, Culotta recounted Lagasse’s case as one of two instances in which patients in respiratory distress were medicated while awaiting helicopters. He identified Lagasse as a patient he had cared for during the preceding two weeks, described her as having end-stage lung cancer, and recalled fetching morphine and Ativan, as well as Versed. He said the purpose was to relieve suffering and acknowledged that morphine hastens death. His account made the competing elements of the decision unusually explicit: he believed Lagasse was dying, wanted to make her comfortable, and understood the medication could bring death sooner.

Clinical and Forensic Uncertainty

Culotta identified the breathing pattern he observed as Cheyne-Stokes respiration and regarded it as a sign that death was near. An investigator later found that this pattern can precede death but also occurs in other circumstances, including sleep and conditions such as heart failure or brain damage. That broader medical information suggested that a patient displaying the pattern was not necessarily about to die. It did not, by itself, determine Lagasse’s condition or show what would have happened without medication. The distinction matters because the episode rests partly on Culotta’s bedside assessment under extraordinary conditions, while later scrutiny questioned how reliably that breathing pattern predicted imminent death.

The investigation also faced limits in determining what drugs had been given and how they related to individual deaths. Memorial’s bodies had remained in the heat for more than a week before recovery, leading Orleans Parish coroner Frank Minyard initially to doubt that autopsies could yield useful blood samples. A volunteer pathologist advised investigators that drugs might still be detectable in other tissues or in fluid within the abdomen. On September 22, investigators sent tissue samples from eighteen Memorial Medical Center bodies to National Medical Services, Inc., for testing; a laboratory report later discussed in an interview found morphine in nine of those cases and midazolam in several others. Those group findings do not, on the evidence presented here, identify Lagasse’s individual toxicology result.

Subsequent expert discussions underscored the difference between detecting medication and proving how it caused a particular death. Testing postmortem tissue was not as straightforward as testing blood from a living patient, and heat and decomposition could affect the concentrations measured. Frank Minyard consulted Steven Karch, who argued that drug levels in bodies exposed to prolonged heat could not reliably establish causes of death. Michael Baden emphasized that drugs had been present shortly before the deaths and said there was no competing cause in the cases he discussed; Cyril Wecht challenged Karch’s account of how heat affected measured drug levels, while acknowledging the limited nature of his own small experiment. These disagreements framed the wider investigation, not a definitive individual finding about Lagasse.

Significance of the Episode

The episode is consequential because it preserves the distinction between an anticipated consequence and a stated purpose without resolving the moral and legal question between them. Culotta believed medication would ease Lagasse’s breathing and suffering, yet also believed it would hasten death; the record further shows that the drugs were given as a bolus without the controls available through an electric pump. Her treatment therefore cannot be reduced either to a routine comfort measure or, on these facts alone, to a settled finding of intentional killing. The scene’s significance lies in the pressure exerted by the evacuation crisis, the physician’s knowledge of the likely effect, and the limits of later evidence in separating relief, foreseeable harm, and intent.