Lie of the storm

Dr. Anne Pou was charged with killing patients, but a grand jury refused to indict.

As Hurricane Katrina approached on Aug. 28, 2005, the staff and patients at Memorial Medical Center in New Orleans felt fairly well-prepared to ride out the Category Five storm.

They really had no choice: Mayor Ray Nagin had no systems in place to evacuate hospitals, and had announced that hospital staff and patients were exempt from his evacuation order. “A very dangerous situation” could erupt if hospitals were unable to care for anyone injured in the storm, he said.

What happened next is one of the less-recalled stories of Katrina. As Sheri Fink recounts in her astounding new book, “Five Days at Memorial,” a desperate skeleton staff attempted to treat hundreds of patients amid growing suspicion that at least one doctor had begun euthanizing the weakest. As another doctor said in the middle of the crisis: “Everybody’s a patient, including us.”

With just hours to prepare for the storm, doctors and nurses did what they could: they went home to pack up food, supplies, and in many cases, pets. They parked their cars high above ground. Orders were placed for emergency stockpiles of medications. Still, many of the nearly 2,000 staff and patients at Memorial felt safe: not one storm had ever breached the 80-year-old building, made of concrete and steel and spanning the length of two city blocks. As nurse Cathy Green told her daughter, “If I’m in trouble [here] . . . it means the entire city would be destroyed.”

Aug. 29 was a hellish morning, winds from the hurricane blowing out windows. But by nightfall, the waters had receded, and Memorial’s backup generator kicked in. The refrain in the hospital that night: “We dodged a bullet.”

For a time on Day 3, rescue seemed simple and imminent, but the only links to the outside world were an intermittent Internet connection and tiny radios that nurses kept on as they made their rounds.

It wasn’t long before panic steadily spread through the placid hallways, however; there were reports of rising waters, armed looters, martial law. A National Guardsman who ran into staffers outside Memorial told them the levees had broken, and that 15 feet of water was coming. All of Memorial’s generators were at ground level — as was the case at all but two of the 18 hospitals in the area.

Across the street, a Walgreens was rampaged by marauders, and Memorial’s command team immediately locked the hospital down. A swift inventory of medicine and supplies was executed, but most alarming was the lack of the most basic necessity: clean water.

Another emergency meeting was called around 10 a.m., after staffers had silently watched water spouting from sewers, gushing up the streets and toward Memorial. They were now in a state of panic: Of all the plans drawn up for flooding, 273 pages worth, evacuations had never been anticipated. They had no protocol, no contingencies — nothing. There was a helipad on the roof, but it had been disused for so long that doctors weren’t sure it could support helicopters anymore, and the hospital didn’t have a contract with air transport.

Most urgent were the 16 critically ill newborns. Their evacuation began by happenstance, when an exhausted doctor named Paul Primeaux, taking a break up on the helipad, waved hello to a passing Black Hawk. The pilot swung down and landed — the helipad worked. Primeaux asked if they could take a baby from the NICU; the answer was yes, but only one. The elevators were a risk, and the baby had to be nestled into a portable incubator and carefully transported up several flights of stairs.

The pilot was infuriated. “That took too long,” he said. “You’ve got to figure out a better system.”

A decision was quietly made that, in order to speed things up and prevent sick patients from suffering on the roof while waiting for a helicopter, the healthiest patients would go first, the most critical last.

By the end of Day 3, nearly 60 patients had been rescued from Memorial. Among the 52 most critical, none had been evacuated.

The first patient to die while medical staff did nothing was 80-year-old John Russell. He had been put on a ventilator, but with the power out and the hospital in chaos, nurse Gina Isbell was manually pumping air into his lungs. She had been at it for an hour when, finally, Russell was being prepped for the heliport. A passing doctor looked down, told Isbell that Russell needed oxygen and the hospital had no more.

“You have to let him go,” he said.

Isbell stopped. Russell died. The doctor was wrong: the hospital had oxygen left, so much that the night before, exhausted nurses had passed around a mask in the lounge, taking hits to cool off and relax.

It was now Day 4. That night, Dr. Anna Pou, a head and neck surgeon, attended to a tracheostomy patient suffering a blocked airway. He, too, needed a ventilator, and Pou alternated the manual airbag with two other staffers. After leaving briefly to check on other patients, Pou came back to find the patient dead.

The rescue teams who were making it through were angry with the potential survivability of their cargo.

“We need more viable patients,” one rescuer said. “Y’all can’t keep bringing patients like this to us.”

Shortly after, another decision was handed down: Any patient with a Do Not Resuscitate order — whether they were near death or not — was not to be evacuated.

There were 115 patients left at Memorial by Day 5. Forty were confined to wheelchairs, 30 to beds, and 60 were critical. The hospital reeked of sweat, urine and feces.

One distraught doctor, Kathleen Fournier, approached Susan Mulderick, the director of nursing and head of the emergency preparedness committee. Fournier had brought her cat to the hospital, and now the animal was gravely ill. Would Mulderick end her pet’s suffering?

This was the first moment that the subject was broached. Initially shocked, Mulderick spoke to Pou. They wondered: If the animals could be helped in this way, why not the patients?

Pou consulted with another doctor, Ewing Cook, who she believed would be sympathetic. Cook routinely treated end-stage patients, and he instructed Pou on how to mix morphine with a particular sedative that would stop their breathing.

By now the entire hospital was in a state of alarm. Word had gone out that the last rescue mission was happening that night — all of New Orleans was powerless and lawless, and anyone left behind tonight was on their own. Helicopter pilots were refusing to take any bed-bound patients, forcing staffers to prop up the sickest in wheelchairs, then peel them off in streams of feces.

Up on the seventh floor, where the most critical patients lay, regular staffers were told that their patients were being placed under new care, and they were to leave the floor immediately. Gina Isbell, the nurse who had let that first patient go, was frantic, and cornered an administrator.

“Are they going to do something with those patients?” Isbell asked.

“Yeah, they are,” the administrator said. “Our patients aren’t going to be evacuated. They aren’t going to leave.”

In the days following, the hospital’s parent company sent a memo to Memorial employees, instructing them on how to respond to family members of the deceased. It noted that most of them probably knew only what they’d heard on the news, and encouraged them to “tell [the] truth, i.e., patient may have died due to lack of electricity or high temperatures, etc.”

Rumors about what had gone on at Memorial spread rapidly, and the discovery of empty syringes and vials of morphine surrounding many of the hospital’s dead led the state to open an investigation. Dr. Pou knew that they would be coming right for her, and on Sept. 19, her friend Mulderick told her not to say a word, that the hospital’s parent company, Tenet, would be in touch.

‘Can we do this?” That was the question Dr. John Thiele recalled asking a colleague just before they began. He had never formally met Dr. Pou, but he knew what she was planning and approached her.

“Can I help you?” he said.

“No,” she replied, more than once.

“I want to be here,” he said. “I want to help you.”

Thiele recalled injecting four patients himself.

Several other Memorial staffers stated that they had knowledge of Pou euthanizing patients, though no one reported having seen her do it. One nurse, Andre Gremillion, had been assigned to an overweight critical-care patient named Emmett Everett. A meeting had been called to evaluate Everett’s chances, and Gremillion later stated that Dr. Pou told him, “If you don’t feel comfortable, don’t do it, because it will come back and haunt you. The first time I did it, I wasn’t ready and it haunted me for two years.”

Everett’s family would not learn he had died until 15 days later.

As the investigation dragged on, Pou returned to practicing medicine, the staffers who had worked alongside her torn. Some felt that Pou and those who helped her had no right to decide who lived or died; others felt that the true fault was with the local, state and federal governments, and that desperation and chaos had led to what seemed, at the time, the most compassionate actions to take.

On July 17, 2006, Pou and two nurses were arrested and charged with four counts of murder. Based on toxicology reports, investigators believed that about 21 of the 45 bodies recovered at Memorial had been euthanized. Pou was promptly released on $100,000 bail, and the DA’s office watched as the community at large rallied around her, raising $30,000 for her legal defense fund.

Simultaneously, a number of Memorial employees sued Tenet for egregious negligence, and a “Dateline” report revealed similarly deplorable conditions at Lindy Boggs Medical Center, also owned by Tenet. There, doctors took Magic Markers and scrawled “A,” “B,” or “C” on patients’ foreheads — “A”s to be evacuated first, “C”s, the sickest, last. One doctor compared it to Auschwitz. Ultimately, all 175 staffers at Lindy Boggs made it out, leaving behind 25 of the critically ill, an unknown number put down by staff.

In the end, the DA opted not to prosecute those two nurses, and a grand jury refused to indict Anna Pou. In that deliberation room, one juror stood among his peers. “Does anyone feel that they’re making a mistake?” he asked. They all said no.

mcallahan@nypost.com