Running head: BAD CHOICES AT MEMORIAL

Bad Choices at Memorial

Leslie Wiley
The Robert B. Miller College
BSRN-415 Nursing Ethics
Lori Van Zoeren, Professor
December 2, 2015

Abstract

BAD CHOICES AT MEMORIAL

Hurricane Katrina wreaked havoc on Memorial Hospital in downtown

New Orleans in August 2005. Five days were spent in horrendous conditions.
One physician, Dr. Anna Pou, and two nurses, Lori Budo and Cheri Landry,
were charged with murder after injecting patients with Morphine and Versed.
This paper takes the viewpoint that those three ladies were unethical and
morally wrong by killing patients that they had yet to rescue from the
hospital. Sheri Finks book Five Days At Memorial, among other sources,
were used to give supporting evidence that what occurred at Memorial
Hospital should not have occurred regardless of the situation that they were
in.

BAD CHOICES AT MEMORIAL

Bad Choices at Memorial

Have you ever been in a situation that you thought compared to hell?
At the time, it was the worst scenario and there wasnt an end in sight? That
must have been what was going through every persons mind during the five
days that were spent at Memorial Hospital following Hurricane Katrina.
Hurricane Katrina hit New Orleans and the coast in August of 2005. The city
flooded and chaos followed. During a crisis it is pretty common for people to
panic, make bad decisions, or make mistakes. However, it is not okay to kill.
Whether working in healthcare or not, respect for persons is a moral and
ethical obligation that should be of utmost importance at all times. At
Memorial Hospital the situation was felt to be so extreme, by three people,
that Morphine and Versed were given at high doses to end patients lives.
Dr. Anna Pou, Lori Budo, RN, and Cheri Landry, RN were morally and ethically
wrong to kill patients at Memorial Hospital following the aftermath of
Hurricane Katrina.
Most healthcare professionals choose the healthcare profession to help
people. It is a calling. Nurses are taught about respect in school. Respect
for religion, respect for culture, respect for wishes, and respect for autonomy.
Respecting autonomy, telling the truth, keeping promises, or avoiding killing
people are all examples of duties that many hold we owe people regardless
of consequences (Fry, Veatch, & Taylor, P.137). Dr. Anna Pou, and the two
nurses that assisted her, killed their patients. They lacked respect for the
patients wishes as well as their lives. Many citizens backed the three

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women and blamed the government for a lack of resources. Resources or

not, they took the easy way out. There were just as many citizens that were
outraged by the situation at Memorial Hospital and felt that Dr. Anna Pou,
Lori Budo, and Cheri Landry should pay for their crime. On the TimesPicayune website there were multiple discussion threads. One specific
person, DM Edwards, had worked during the disaster at a different
healthcare facility and said Our whole purpose for being here was to aid the
patients; not to kill them because we wanted them out of our misery (Fink,
P.349). Everybody at Memorial Hospital during this disaster was miserable.
Temperatures reached above one hundred degrees, there was no running
water, no electricity, and the smell was awful. Staff members persevered
and got most people out of the hospital so there is no excuse why the last
remaining patients were injected with Morphine and Versed until they took
their last breath. Bailey states that 45 decomposing corpses were
eventually removed from the hospital, many more than were found at any
other comparable hospital in the flooded city (2010).
Euthanasia is a Greek term that means good death. For centuries,
English-language writers used this term to mean a soft quiet death, or an
easy passage out of this world (Fink, p.398). All of the patients at Memorial
Hospital were sick, however, not all of them were terminal. Dr. Anna Pous
lawyer defended her with the use of terms such as hospice, terminal
sedation, and palliative sedation. Fink addressed all of these topics in her
book. She stated that hospice was a philosophy and a movement to care

BAD CHOICES AT MEMORIAL

for the terminally ill (p.404). Terminal sedation is a way that physicians
meet the goal of relieving terminally ill patients discomfort (p.404). This
means without killing the patient and that didnt happen at Memorial
Hospital. Many patients were killed. Palliative care addresses the suffering
of a terminally ill patient. Syme states that giving people control over the
end of their lives is one of the most valuable palliative tools we have at our
disposal (2015). The patients at Memorial Hospital were not given this
option. They had no say in the outcome of their lives. Patients put their
trust in the healthcare providers and that trust was broken. They were given
a false sense of hope when Pou stated Im going to give you something to
make you feel better (p. 307).

That was murder. She knew what she was

doing. Both the terms murder and euthanasia include the act of
intentionally causing death. The difference is that the reason for euthanasia
is usually to relieve pain and suffering. Pou may have thought that she was
doing the right thing but this act was not ethical or legally justified. (Shea,
2010). Shea also states that:
Creating an exception to the prohibition against euthanasia in
disaster or extreme emergency situations, however, either by way of
expressly incorporating its use into a framework for disaster response, or
simply condoning it, has no legal or ethical foundation in our country and is
not necessary as a means to cope with disasters. Involuntary euthanasia is
directly contrary to the established principles of patient autonomy and selfdetermination and inevitably requires a determination by the physician of

BAD CHOICES AT MEMORIAL

what is an acceptable quality of life for the patient. Carving out a disaster
exception to this prohibition would create a dangerous deviation from these
principles under the most volatile circumstances and would jeopardize the
most vulnerable individuals. (2010)
When Memorial Hospital opened its doors to the public it swore to
follow the three-pronged mission: the alleviation of pain, the prolongation of
life, and the relief of suffering (Fink, p. 14). During the Hurricane Katrina
disaster most physicians and nurses poured their blood, sweat, and tears
into caring for patients. The conditions were atrocious, staff was tired, and
everybody worried that they might not get out. Yet, they continued to do
their best as this was their calling. On a normal day nurses work long hours,
are lucky to get a lunch, rarely get breaks, and sometimes never use the
restroom during a shift. All without complaining. The Hurricane Katrina
disaster made those days look like a walk in the park. One of the elderly
ladies at the hospital grabbed the arm of Gina Isbell, a registered nurse, and
told her If Im alive tomorrow its because of you (Fink, p.452). Isbell felt
that her and her colleagues had done their very best. She felt that if another
disaster happened that she would step up and be there to care for patients
because it was her job, her oath (Fink, p.452). Unfortunately, all of this
great teamwork was somewhat overshadowed by the carelessness of three
colleagues that felt the need to play God that day.
In the Bible, God is specific about the act of killing. Exodus 20:13
states, You shall not murder (Holy Bible, New International Version ). This

BAD CHOICES AT MEMORIAL

is part of the Ten Commandments. Not everybody follows the Christian

religion. This happens to be my personal belief and where I get my morals
from. It is how I judge right and wrong. Dr. Anna Pou is a Christian, yet failed
to follow the Ten Commandments. Regardless of religion, our government
doesnt agree with murder either. Murder is the unlawful killing of a human
being with malice aforethought (Cornell, n.d.). Dr. Anna Pou made the
decision to order Morphine and Versed. With the assistance of Lori Budo and
Cheri Landry all remaining patients were given an intravenous line and the
medications were given. All of those patients expired due to respiratory
failure. The majority of these patients had not had previous orders on their
charts for either drug. Many were not in pain. The only reason to give those
medications were to stop respirations. This wasnt an accident. (Fink, 2013).
Frank Minyard was the coroner that was assisting the district attorneys
and special agents with the investigation. After numerous meetings in which
the special agents thought they had a win in the bag, Frank Minyard turned
on them. On February 1, 2007, Minyard made the decision that he found no
evidence of homicide (Fink, p.406). He told special agent Rider that
because there was a huge amount of local support for Dr. Anna Pou that a
homicide declaration would look bad for the city (Fink, p.407). Politics
played a big role in the outcome of this case. Many people let others
persuade their decisions instead of looking at the facts versus what the law
states. Members of the grand jury were not sequestered so there was a lot
of bias. They were able to watch the news and speak with whomever. Many

BAD CHOICES AT MEMORIAL

associations, such as the American Medical Association and the American

Nursing Association, were making statements that warned all of those
watching that medical professionals would leave Louisiana if a physician
was indicted after serving in a disaster (Fink, p.437). Dr. Baltz was irate
and claimed that all of Pous supporters were wrong to threaten and hold a
gun to the head of the community (Fink, p.442). In the end, Dr. Anna Pou,
along with Lori Budo and Cheri Landry, were acquitted. One particular juror
felt that there were many issues with the trial. A witness that saw Dr. Anna
Pou inject patients with lethal drugs was not asked to testify that day. She
also has the image of Emmett Everett, one of the deceased patients, in her
mind and it will stay with her always. He was an obese gentleman that was
not in imminent danger of death. The juror was convinced-and, she
believed, all of her fellow jurors were too-that a crime had occurred on that
fifth day at Memorial (Fink, p.461).
There was another physician that assisted Dr. Anna Pou with the
administration of Morphine and Versed. His name was never mentioned so
charges were never brought on him. Dr. John Thiele was worried for a year
that every time his doorbell rang it would be the police looking to arrest him.
The same month that the grand jury was selected, Dr. Thiele was found to
have metastatic colon cancer. He ended up in the ICU on a ventilator and
physicians werent sure he was going to make it. Somehow he recovered
and went on to practice medicine again. (Fink, 2013). Dr. Thiele would later
recall that if the family members of a patient in a similar condition had

BAD CHOICES AT MEMORIAL

come to him for doctorly advice, he would have painted a hell of a bad
picture for them, letting them know, realistically, that recovery was unlikely
(Fink, p.441). How fortunate for him that the medical profession didnt give
up on him as he and Dr. Anna Pou gave up on the patients at Memorial
Hospital that werent near to the same condition that Dr. Thiele was.
Following the disaster that Hurricane Katrina left behind there have
been many improvements to disaster preparedness. I dont think that we
can be completely prepared but its imperative that hospitals do the best
they can. Doing something is better than nothing. Many hospitals have
emergency preparedness plans but are their nurses ready? Most nurses felt
that they learned better with hands on, however, information should be
shared so that everyone that is on staff at hospitals understands what the
procedures are in the event of an emergency. There have been many studies
done to see how well hospitals are prepared. One study found that there has
been failures when it comes to addressing ethical considerations while
planning and preparing nurses for disasters. Johnstone and Turale state this
oversight is significant because it leaves both the nursing profession and the
public vulnerable to the otherwise preventable harms of what Thomas et al.
(2007:S26) refer to as unjust and regrettable decisions being made during a
catastrophic mass casualty event (2014). Following Hurricane Katrina and
due to the charges brought against Dr. Anna Pou, disaster experts asked for
guidance on the topic of euthanasia during disasters. They found that

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neither the law nor ethics support the intentional hastening of death, even
in a crisis (Fink, p.468).
Dr. Anna Pou, Lori Budo, RN, and Cheri Landry, RN were morally and
ethically wrong to kill patients at Memorial Hospital following the aftermath
of Hurricane Katrina.

If politics were not involved they probably would have

had a different outcome at their trial. Whether the act of administering

lethal doses of Morphine and Versed is based on religion or the law of our
government, killing is wrong. Lives were cut short. The memories of those
patients will forever be remembered as they made a difference in how
disasters are handled and brought light to disaster preparedness around the
country. All of those involved at Memorial Hospital will have to answer for
their actions one day and have to live with their decisions and guilt for the
rest of their lives. I am sympathetic to what they endured for those five
days, but I am not sympathetic to the decisions that they made.

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References
18 U.S. Code 1111 - Murder. (n.d.). In Cornell University Law School.
Retrieved November 29, 2015, from
https://www.law.cornell.edu/uscode/text/18/1111.
Bailey, R. (2010, September). The Case of Dr. Anna Pou-Physician Liability in
Emergency Situations [Electronic version]. American Medical
Association Journal of Ethics, 12(9), 726-730.
Fink, S. (2013). Five Days At Memorial (First ed.). New York, NY: Crown
Publishers.
Johnstone, M. J., & Turale, S. (2014). Nurses' experiences of ethical
preparedness for public health emergencies and healthcare disasters:
A systematic review of qualitative evidence [Electronic version].
Nursing and Health Sciences, 16(1), 67-77. doi:10.1111/nhs.12130
New International Version Life Application Study Bible. Exodus (p. 125).
(2011). Grand Rapids, MI: Zondervan.

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Shea, F. K. (2010). Hurricane Katrina and the Legal Bioethical Implications of

Involuntary Euthanasia as a Component of Disaster Management in
Extreme Emergency Situation [Electronic version]. Annals of Health
Law, 19(1), 133-139.
Syme, R. (2015, July). Palliative Care: The Gap Between Rhetoric and Reality.
Vital Speeches of the Day, 81(7), 202-205. Retrieved from Ebsco.

Criteria

Cover/Title Page
5 Points

Abstract
5 points

Exceeds
Expectations

Meets
Expectations

Below
Expectations

(5 points)

(4 points)

(0-3 points)

Title page is
included and title
appropriately
describes topic in
paper. Clean and
professional
appearance.
(5 points)

Title or subject not

clear. Clean and
professional
appearance.

Title page is not

included or nonprofessional in
appearance.

(4 points)

(0-3 points)

Abstract is proper
length. Provides a
comprehensive
summary of the
content of the paper
and is easy to
understand.

Abstract is proper
length but provides
a brief summary of
the content of the
paper. Somewhat
informative and
understandable.

Abstract is not the

proper length or
absent. Not very
informative or
understandable.

Total
200/200

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Introduction/Position
choice statement
10 Points

Presentation of Paper
focus/Position
65 Points

13

(9-10 points)

(7-8 points)

(0-6 points)

There is an
excellent, clear,
brief, introduction
of the position
choice with a
statement in the
introduction to the
paper that will be
discussed.
(60-65 points)

The papers central

purpose is
somewhat unclear
about what the
paper topic will be
about.

The papers central

purpose is unclear
or absent. The
reader does not
have a good
understanding what
the paper will be
about.

(55-59 points)

(<55 points)

There is an
All areas are
Not all areas are
excellent analysis of covered.
covered. Purpose is
the issues, concerns, Information
unclear.
and challenges
provides reasonable Information
related to the
support for the
supports a central
position choice
purpose or
purpose at times.
taken by student. argument and
Analysis is vague.
All areas are
displays evidence Transitions in
covered, with
of a basis analysis thoughts do not
purpose readily
of a significant
demonstrate
apparent. Balanced topic. Shows some thoughts that are
presentation of
analysis but is
connected.
relevant and
disconnected at
legitimate
times. Some
information. Shows paragraph
a thoughtful, intransitions
depth analysis of a appropriate but
significant topic.
some are confusing.
Reader gains
important insights.
Paragraph
transitions create
seamless flow to
connect thoughts.
(55-60 points)
(50-54 points)
(< 49 points)

Support for decision

demonstrated with
references (4-8 sources There is an
utilized)
excellent
60 Points
demonstration of
the application of
knowledge from
resources. Sources
are relevant,

Position is largely
supported with
resources that are
mostly current. A
few resources may
not be relevant or a
reliable source or

Purpose of the
paper is not well
supported with
sufficient
resources.

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14

accurate and
not well integrated
reliable to add
into the paper.
strength to the
paper. Resources are
skillfully referenced
throughout the
paper.
Conclusion
15 Points

(13-15 points)

(10-12 points)

There is an
There is a good
excellent summary summary or
or conclusion
conclusion related
related to the key to the key points in
points in the paper. the paper. Some
No new information new information
is introduced
may be introduced

(0-9 points)
There is a below
average summary
or conclusion
related to key
points in the paper.
Mostly new
information was
introduced
(0-5 points)

References

(8-10 points)

(6-7 points)

10 Points

There are at least 4

sources that are
current (<5 years
unless classic
source) with all
being from
scholarly sources.
(8-10 points)

There are 2-3

sources that are
current (<5 years
unless classic
source) with most
being from
scholarly sources.
(6-7 points)

Paper is well
organized and
thoughts are
arranged logically,
flow smoothly with
strong transitions
from paragraph to
paragraph. The
reader can follow
the line of
reasoning. Tone is
formal and
professional
throughout.
(17-20 points)

Paper is organized Paper lacks logical

for the most part
organization and
although
reader cannot
occasionally ideas identify a line of
may not flow well reasoning. The
between
tone is informal
paragraphs. Ideas throughout.
are usually arranged
logically and for the
most part the reader
can follow the line
of reasoning. Tone
is generally formal
and professional.
(14-16 points)
(0-13 points)

Organization /Tone
10 Points

Use of APA formatIncluding sentence

structure, spelling,

APA format is used Minor errors in

The resources are

not current and are
not from scholarly
sources.

(0-5 points)

Frequent errors in

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grammar
20 Points

Total Points 200

accurately and
APA with the
APA format.
consistently in the majority of the
Numerous spelling
paper. Writing is
paper being in
or grammar errors.
free from spelling proper APA format. Paper is
and grammar errors. Some spelling or significantly longer
Length is as
grammar errors.
or shorter than
specified (6-8
Paper is slightly
specified. Errors in
pages). Sentences shorter or longer
sentence structure
are well-phrased; than guidelines
are frequent and
word choice is
specify. Mostly well distracting. Many
consistently precise phrased, some
words are used
and accurate.
sentences are
inappropriately.
Section headings awkwardly
present if indicated. constructed, word
Running head is
choice is limited,
correct on all pages. and some words are
used
inappropriately.
Some subsections
divided but not a
clear idea of how to
divide thoughts.

15

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16

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