Versed

Versed, a brand name for midazolam, became one of the most consequential substances in the investigation of patient deaths at Memorial Medical Center. Its presence in postmortem tissue helped focus attention on medication given during the evacuation, but could not by itself establish how much a patient had received, whether it caused that patient’s death, or what the person administering it intended. The dispute over Versed therefore became a dispute over the limits of forensic evidence as well as the boundaries between comfort care and potentially lethal treatment.

Identification and Detection

The book identifies Versed as midazolam, a drug found alongside morphine in tissue samples from some patients who died at Memorial and LifeCare. Early testing was undertaken because the bodies had remained in the heat for more than a week before recovery, making blood sampling unavailable. Investigators were advised that drugs might still be detectable in more durable tissues, including liver, brain, and muscle, or in fluid that accumulates in the abdomen after death.

On September 22, investigators sent tissue samples from eighteen Memorial bodies to National Medical Services, Inc., a forensic toxicology laboratory in Willow Grove, Pennsylvania. When the laboratory’s findings were discussed, the initial report was that nine of the eighteen cases were positive for morphine and approximately five or six additional cases were positive for midazolam. The count described results at that stage of the inquiry; it was not, by itself, a finding that Versed had caused any particular death.

Later, Robert Middleberg presented results from a broader set of forty-one bodies from Memorial and LifeCare. Twenty-three had tested positive for morphine, midazolam, or both. That combined figure established the breadth of drug detection in the examined cases, not a uniform pattern of administration: each patient’s circumstances and medical history still required separate consideration.

Limits of the Toxicology Evidence

The passage from detection to interpretation was uncertain. Middleberg cautioned that postmortem tissue testing was not as straightforward as blood testing in a living patient. Prolonged exposure to heat could have altered drug concentrations, so the laboratory figures could not simply be read as the levels present immediately before death. He urged the experts to examine each patient’s clinical history alongside the test results.

The reviewers therefore had to distinguish among several possibilities: a large dose given shortly before death, repeated doses that accumulated over time, and concentrations affected by conditions such as kidney failure or liver disease. They also considered whether combining morphine and midazolam might pose particular risks for patients with those conditions, and whether medicines known to suppress breathing could be dangerous to a patient not receiving respiratory support. The records did not always establish precise times of death, further limiting comparisons between medication and outcome.

The condition of the bodies became a point of disagreement among consultants. Steven Karch argued that drug levels in a cadaver could bear little relationship to levels before death and advised that medical causes of death remain undetermined in the cases he reviewed. Michael Baden considered the uncertainty about exact dose distinct from the fact that the drugs were present, and argued that the presence of morphine and Versed shortly before death mattered where no competing cause of death had been identified. Cyril Wecht challenged Karch’s account of postmortem change, reporting that some measured levels were very high. He had tested the theory with samples exposed to hot, humid conditions and compared them with refrigerated samples, finding no significant difference. The experiment was small, not definitive, and neither published nor reviewed by other scientists; it added evidence to a contested record rather than resolving it.

A Patient-Specific Test of the Findings

The review of LifeCare patient Alice Hutzler showed why the experts examined records case by case. Hutzler, a ninety-year-old nursing-home resident being treated for pneumonia, had morphine and midazolam in her liver, brain, and muscle tissue. Her chart, however, recorded neither drug as prescribed and was current until a few hours before her death was recorded on September 1.

The available notes described Hutzler as resting comfortably the previous afternoon. Her nurses had not documented complaints of pain or distress that indicated a need for either medication that night. Those details did not independently establish how the drugs entered her body or determine their role in her death. They did, however, make her case a concrete test of the difference between a positive toxicology result and a documented clinical reason for treatment.

Clinical and Ethical Dispute

The forensic debate overlapped with a dispute over whether the medication could be understood as palliative sedation. Some observers suggested that the medical professionals might invoke that practice as a defense. Arthur Caplan, an ethicist, concluded that the conduct described at Memorial did not fit within its usual framework. In his analysis, an intention to ease pain would be expected to involve careful, gradual medication and at least some documentation. He noted that clinicians had recorded some medication orders by hand during the disaster, suggesting that record-keeping, though difficult, was not impossible. He was also troubled by the apparent rapid introduction of large amounts of drugs known to be dangerous and by the absence of consultation with family members who were present. He did not accept that killing was the sole means of relieving possible suffering.

Rick Simmons, Anna Pou’s attorney, had found no useful American Medical Association guidance specifically addressing comfort care in disasters. The organization’s palliative-care guidelines called for consultation with relatives and documentation of medication, steps that had not occurred in Pou’s case. Simmons argued that ordinary guidelines did not answer what clinicians should do when they could not consult families or maintain records. The gap between those practical conditions and established standards sharpened the dispute; it did not itself determine whether the medications had been properly administered.

From Medication Evidence to Public Consequences

The evidence became part of the public argument about the deaths and the proposed legal protection of medical workers. Pou later spoke to professional audiences about disaster conditions, emergency care, and immunity laws. In those presentations, she did not discuss the decision to medicate at least nineteen patients on September 1, all of whom died as helicopters and boats evacuated Memorial. The book presents this omission as significant because her public account focused on difficult triage and emergency work while leaving out the medication episode central to the investigation.

The case remained contested even after the grand jury declined to indict. Frank Minyard weighed competing expert opinions and struggled to determine what the tissue findings established. He believed the evidence against medication-related deaths was clearest in the case of Emmett Everett, while he found other cases less certain; his judgments reflected both the toxicology dispute and his uncertainty about intent. The wider disagreement also had consequences for medical ethics. Wecht warned that allowing clinicians broad discretion to give large amounts of morphine and Versed in a disaster without a full accounting could establish a dangerous precedent. Caplan feared that, without formal analysis, the moral questions would remain unresolved. In this account, Versed is not a forensic answer in itself: it is a detected drug at the center of an unresolved chain of questions about administration, medical effect, documentation, and responsibility.