September 1, 2005

September 1, 2005, was the fifth day of the crisis at Memorial Medical Center and the day when rescue and patient medication unfolded at the hospital at the same time. It began roughly seventy-two hours after Hurricane Katrina struck. Helicopters and boats were arriving, but patients remained inside, staff were exhausted, and decisions made that morning would later be examined through testimony, medical records, and toxicology. The date became a hinge in the book’s account: the long failure to prepare and evacuate converged with disputed actions on LifeCare’s seventh floor, just as the means of rescue were expanding.

Risks Carried Into the Day

The dangers of September 1 had been shaped by decisions made before the storm. After Hurricane Ivan narrowly missed in 2004, Memorial’s leaders reviewed their hurricane plans. Eric Yancovich attended a meeting with the U.S. Army Corps of Engineers and studied storm-surge models. Those models indicated that a Category Four or Five storm could drive twelve to fifteen feet of water around Memorial, a hospital situated three feet below sea level. The forecasts made the hospital’s dependence on its emergency power system a central concern, but the system contained vulnerable components of the kind that had failed at hospitals during flooding in the Texas Medical Center after Tropical Storm Allison inundated Houston in 2001.

Memorial’s three teal generators stood taller than an adult and each had a capacity of 750 kilowatts. Yet their ability to produce electricity depended on a larger system of feed lines, riser circuits, and transfer switches. Outside contractors ordinarily serviced the generators; hospital maintenance staff performed basic upkeep and brief monthly tests. The tests reflected standards designed around generators supporting vital functions for minutes or hours, not prolonged operation. By the time floodwaters threatened the hospital, the power system had become what Yancovich recognized as its weak point. Susan Mulderick advised CEO René Goux that evacuation appeared likely, and Goux contacted his superiors at Tenet Healthcare.

The wider city’s evacuation problems also formed part of the day’s context. The mayor had ordered residents to leave, but many had no cars, while plans to transport them lacked enough drivers. People who could evacuate on their own were already caught in interstate traffic. The Superdome had been designated a shelter of last resort, and officials urged people with medical conditions to go there without explaining what assistance they could expect. Acadian dispatchers faced calls to transport patients from hospitals, nursing homes, and homes; many of the roughly two dozen ambulances made available were themselves stuck in traffic. Some ambulance crews therefore took patients to the Superdome rather than attempting to drive them out of the city.

The Fifth Morning at Memorial

The hospital’s immediate circumstances were severe but not identical to the worst forecasts. Water around its sloping grounds had stabilized at about five to six feet; the additional fifteen feet feared by staff had not arrived. The emergency continued to narrow people’s attention to their own immediate surroundings. Karen Wynn encountered an outpatient who had made it through the floodwaters for a regularly scheduled chemotherapy appointment and told her that treatment could not be given that day. The encounter illustrated how ordinary expectations persisted even as the hospital’s capacity to provide ordinary care had collapsed.

Early on Thursday morning, doctors gathered in a second-floor radiology suite. Surgery chief John Walsh recounted the difficult night: staff had stayed awake caring for patients, some were demoralized, and complaints had arisen about one physician’s behavior. Soon after sunrise, another gathering took place on the emergency-room ramp. Mulderick stood on a curb to address the group, with Goux and medical chairman Richard Deichmann beside her. Doctors, nursing managers, maintenance workers, and security staff crowded together, and the meeting was difficult to hear. The scene joined administrative command to the practical confusion of a hospital trying to organize its next moves.

At LifeCare, which occupied the seventh floor, assistant administrator Diane Robichaux later described the staff’s overnight efforts to keep patients alive. By Wednesday, the smell from the unrefrigerated morgue on the eighth floor had reached the floor below. Staff had used rubbing alcohol and gravity-drip intravenous fluids in efforts to cool and sustain patients. Robichaux recalled that she and two colleagues went downstairs on Thursday morning to speak with Mulderick and heard that the plan was not to leave any living patients behind. Therese Mendez, who had worked overnight on the first floor, later recalled hearing helicopters repeatedly after daybreak. When she returned to LifeCare around eight or nine in the morning, she saw patients in serious condition; two had died on Wednesday, while the others were still alive.

The evacuation brought fear and conflicting recollections. LifeCare respiratory therapist Stahelin later said that an armed, uniformed man he believed was a National Guardsman came to the respiratory lounge and ordered everyone to leave. At the boat drop-off point, Stahelin recalled asking an infectious-disease doctor what would happen to the patients remaining upstairs. He attributed to her a distressed answer suggesting that the patients would be helped to heaven; she later denied that the conversation had taken place. The episode entered the record not as an uncontested account, but as an example of how September 1 was reconstructed through memories that did not always agree.

Patient Medication and Deaths

Robichaux and LifeCare physical medicine director Kristy Johnson tried that morning to work out how to remove Emmett Everett, a patient whose size made evacuation difficult. Later, Anna Pou came upstairs and discussed Everett’s prospects with them in a physical-therapy charting room. One of Everett’s nurses, Andre Gremillion, was asked to sedate him; he left the room crying. These details later became part of the inquiry into how decisions about evacuation, sedation, and medication were made for patients who remained on the floor.

Johnson subsequently told investigators that she had seen Pou draw fluid from vials into syringes and carry syringes with Memorial nurses. Johnson had escorted health professionals to patients’ bedsides, witnessed some injections, held patients’ hands, and prayed. Investigators also heard from Mendez and Robichaux, though neither saw what happened after the two women left to clear staff from the floor. Mendez later testified that Pou had said she was assuming responsibility for the patients and that they would receive a lethal dose. Such accounts became central to the dispute over what staff knew and what occurred after LifeCare personnel departed.

By that afternoon, all nine of the remaining LifeCare patients had died. Rose Savoie was among them. In a later account, investigators reported that a nurse identified as Lori Budo injected Savoie and that Savoie responded that it burned. Toxicology tests found morphine and midazolam in four LifeCare patients initially named in an investigative affidavit: Everett, Savoie, Ireatha Watson, and Hollis Alford. Watson was eighty-nine and had dementia; Alford was sixty-six and gravely ill with a blood infection. Pathologist Cyril Wecht concluded that all four had died from lethal amounts of the drugs. The affidavit also described the provision of morphine, Versed, and injection supplies by LifeCare nurse Steven Harris, and alleged that Pou and Memorial nurses had administered drugs to patients.

The later evidence extended beyond the seventh floor. Investigators and forensic specialists found a striking pattern among patients who died after helicopters and boats arrived on Thursday morning and whose bodies were tested: all nine LifeCare patients, nine patients in the second-floor lobby, and Merle Lagasse tested positive for the drugs. A later account placed the number of patients medicated that Thursday at at least nineteen, all of whom died as helicopters and boats emptied the hospital. These findings established a consequential overlap between the arrival of rescue and the deaths under investigation; they did not erase the need to distinguish toxicology results, witnesses’ recollections, and allegations about intent.

How the Date Was Reconstructed

The inquiry into September 1 developed over months. On October 12, Virginia Rider and Butch Schafer returned to New Orleans to reinterview key LifeCare witnesses in person and review photographs with them. Investigators drew on accounts from Robichaux, Mendez, Johnson, and Harris, including reports that LifeCare staff had been told the patients were not expected to make it out and that staff should leave. The accounts differed in what each witness had personally observed, a distinction that shaped the later evidentiary record.

Memorial pathologist John Skinner and laboratory director David Heikamp supplied another part of that record. On Thursday afternoon, they walked through the hospital to confirm that everyone had left and to record the names and locations of the dead. Deichmann and Goux had asked Skinner earlier in the week to keep track of deaths. The resulting documentation tied individual bodies and places inside the hospital to a day otherwise marked by movement, interruption, and uncertain communication.

The date also became the subject of competing public narratives. Not Dead Yet, an anti-euthanasia organization, argued that the staff’s ability to evacuate depended on being able to report that no living patients remained. Anna Pou later became a popular national lecturer on ethical questions in disaster medicine. At a California conference, she described federal officials as having warned that airboats would be taken away at noon and urged people to get out before then. Rider and Schafer’s investigation and years of reporting had not substantiated that claim. The contrast shows how September 1 continued to be retold after the immediate emergency: as a contested sequence of practical decisions, witness memories, and claims about what compelled them.

In the book’s larger account, the day’s significance lies partly in its timing. The plan to medicate patients went ahead as helicopters arrived in force and rescue capacity increased. That concurrence does not, by itself, settle why particular decisions were made, but it sharpens the central question of the date: how a hospital’s prolonged emergency, inadequate preparation, and fragmented evacuation became entangled with actions that investigators later treated as possible crimes. September 1 is therefore both a point on the evacuation timeline and the focal date through which the book examines the consequences of institutional failure and the unresolved meaning of care under disaster conditions.