Grand jury clears Dr. Pou; medicine wants to protect future disaster responders

With murder charges against this physician dropped, the AMA is developing model legislation to prevent unjust accusations against other doctors trying to help.

By — Posted Aug. 13, 2007

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For four days following Hurricane Katrina, Anna Maria Pou, MD, fought hellish conditions -- no power, limited food and water, 100-degree temperatures, and the stench of human waste and remains -- to care for patients stranded in New Orleans' Memorial Medical Center by 15 feet of floodwaters.

And for 384 days following her arrest last year, Dr. Pou battled accusations that she murdered four patients with what state Attorney General Charles C. Foti Jr. called a "lethal cocktail" of morphine and midazolam. Dr. Pou and her defenders argued that she was providing appropriate palliative care to very ill patients.

An Orleans Parish grand jury last month sided with Dr. Pou, declining to indict on the nine murder counts eventually brought by District Attorney Eddie Jordan, who inherited the case from Foti.

Dr. Pou, associate professor of otorhinolaryngology at the Louisiana State University School of Medicine, fell to her knees and thanked God when she heard news of the grand jury's decision, the Times-Picayune reported.

"This is not a triumph, but a moment of remembrance for those who lost their lives during the storm," Dr. Pou said in a statement. "We need to remember the magnitude of human suffering that occurred in the city of New Orleans in the wake of Hurricane Katrina so that we can ensure that this never happens again -- and that no health care professional should ever go through this again."

Two nurses who worked at Memorial alongside Dr. Pou, Cheri Landry and Lori Budo, also were arrested and accused of murder last year. In June, prosecutors opted not to charge them and instead forced them to testify to the grand jury that heard Dr. Pou's case.

The grand jury's decision "is a vindication," said Daniel W. Nuss, MD, chair of the LSU School of Medicine's Dept. of Otorhinolaryngology. "We knew [Dr. Pou] was innocent of all these charges. I have known this lady for more than a decade, and her actions have always been those of nothing less than a perfect doctor."

Dr. Pou's attorney, Richard T. Simmons Jr., said he hopes the case "has some effect on any future prosecutor who would try to seize the moment and second-guess physicians' medical judgment" in catastrophic conditions.

Foti, up for re-election in October, said the grand jury got it wrong because it did not see all the expert evidence his office accumulated during its 10-month investigation. Foti has filed a motion in state court asking for permission to release publicly medical expert reports that conclude, according to media accounts, that lethal doses of morphine and midazolam caused the patients' deaths. A February 2007 Orleans Parish coroner's report classified the Memorial deaths as "undetermined."

Simmons said Foti has little reason to complain because Assistant Attorney General Julie Cullen worked on the case with prosecutors in the DA's office, and could have asked the reports be presented to the grand jury.

Organized medicine, which was concerned the criminal investigation could harm physicians' willingness to answer the call of duty during times of calamity, greeted the news with jubilation.

"The AMA is proud of Dr. Pou and the many heroic physicians and other health care professionals who sacrificed and distinguished themselves in the aftermath of Hurricane Katrina," American Medical Association Board of Trustees Chair Edward L. Langston, MD, said in a statement. "We believe these physicians served as bright lights during New Orleans' darkest hour."

Dr. Langston said the AMA continues to be very concerned about the criminalization of medical judgment, especially during disasters. Delegates at the Annual Meeting in June directed the AMA to develop model legislation to shield physicians from civil or criminal liability when caring for patients in a declared disaster area.

In a statement, the Louisiana State Medical Society said it "strongly believes that Dr. Pou courageously performed her duties as a physician under the most challenging and horrific conditions. The decisions she made were in the best interests of the patients under her care.

"We hope the grand jury's decision will remove the 'chilling effect' these charges have had, and encourage physicians and other health care providers to continue to volunteer during disaster and emergency situations," the medical society said.

Dr. Pou still faces civil liability lawsuits in three of the patient deaths. In June, she sued Foti and the state Office of Risk Management to reclaim her civil defense costs, which Louisiana normally covers for state employees such as Dr. Pou.

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How events unfolded

August and September 2005 Hurricane Katrina floodwaters leave Memorial Medical Center without power and sanitation for four days. More than 1,000 people are evacuated from Memorial, but 45 patients die.

July 2006 Louisiana Attorney General Charles C. Foti Jr. has Anna Maria Pou, MD, and nurses Cheri Landry and Lori Budo arrested on four counts of second-degree murder; they proclaim innocence. Foti hands over evidence to Orleans Parish District Attorney Eddie Jordan.

January 2007 Orleans Parish Coroner Frank Minyard classifies the four deaths as "undetermined" -- not homicides.

February A 16-member grand jury is impaneled.

June Prosecutors don't charge the nurses but force them to testify before the grand jury.

July Dr. Pou files suit to force the state to pay her legal fees in defending civil lawsuits by families of three of the patients who died. Days later, the grand jury declines to indict Dr. Pou.

Sources: AMNews, Times-Picayune, International Herald Tribune news reports

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