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MICHELE NORRIS, Host:

From NPR News, this is ALL THINGS CONSIDERED. I'm Michele Norris.

ROBERT SIEGEL, Host:

And I'm Robert Siegel. Soon after Hurricane Katrina struck, the first unconfirmed reports of mercy killings or euthanasia patients at New Orleans hospitals surfaced. For months, the Louisiana Attorney General has been investigating these charges. That investigation has centered on the actions of doctors and nurses at the city's Memorial Hospital.

NORRIS: NPR has reviewed secret court documents related to the investigation. The documents revealed chilling details about events at Memorial Hospital in the chaotic days following the storm. They include accounts from hospital administrators who saw a doctor filling syringes and painkillers and heard plans to give patients lethal doses. The witnesses also heard staff say the decisions were made to end some patients' lives.

NPR's Carrie Kahn has the story.

CARRIE KAHN: Conditions at New Orleans Memorial Hospital after Katrina struck the city were horrendous. The hospital was flooded, power was out and back-up generators failed. Temperatures inside the hospital quickly soared past 100 degrees and patients were in distress. But it was on the seventh floor of the hospital where the situation was most dire. Memorial Hospital leased the floor to LifeCare Hospitals, a separate long-term patient care facility. There, doctors and nurses were faced with few options.

Conditions were deteriorating rapidly, evacuations were sporadic and security was compromised. Staff agonized whether to attempt to transport critically ill patients who might not survive the arduous evacuation. It appears another choice was considered, whether to end the lives of those who could not be moved. In the court documents reviewed by NPR, none of four key witnesses say they knew who made the decision to administer lethal doses of painkillers to patients, but all four heard discussions that a decision had been made to end patients' lives.

According to the documents, attorneys for LifeCare reported all of this to the Louisiana Attorney General's office on September 14, 2005. Angela McManus's mother had been on a LifeCare floor, the seventh floor, for two weeks before Katrina hit. Seventy-eight-year-old Wilda Faye McManus was battling a persistent infection due to complications from rectal cancer. Angela McManus says she was given a bed next to her mother and never left her side until Tuesday, the day after the hurricane. She says nurses told her that helicopters were coming for the seventh-floor patients and that McManus needed to get down to the first floor and wait for evacuation boats.

Ms. Manus says on the first floor, she could hear gunshots outside the hospital. She saw looters sacking a corner drugstore. At this point, many sources confirmed 2,000 people, employees, patients and relatives, were trapped in the hospital.

ANGELA MCMANUS: The sewer lines had backed up and we were down there in all this stifling heat, and this odor was just horrendous, and people were trying to get into the hospital just to get to higher ground, and they weren't allowing that. So they boarded the doors up, and we were in there, just smothering, all night long.

KAHN: By Wednesday morning, McManus learned her mother had not been evacuated, as promised. She rushed back to the seventh floor.

How was she when you found her?

MCMANUS: She was real lethargic, very lethargic. She would talk to me and then just doze back off. I'm like, what's going on with her? I was just sitting there talking to her and stroking her, and she was sleeping the whole time. I'm like, something is wrong. But, of course, with everything going on around me, I didn't know it was wrong. You know, I couldn't even think straight myself.

KAHN: McManus says nurses told her that her mother had been sedated. She grew concerned. She said her mother's pain had been manageable with Tylenol and an occasional painkiller. She watched her mom sleep and passed the hours singing gospel hymns. McManus says attempts were made to evacuate other patients from the seventh floor. She vividly recalls workers desperately trying to get one woman out of the hospital. She says that patient died in the process.

But McManus says she really got scared for her mother when she overheard nurses saying a decision was made not to evacuate LifeCare's DNR patients.

MCMANUS: DNR means do no resuscitate. It doesn't mean do not rescue, do not take care of.

KAHN: Angela McManus says she franticly tried to rescind her mother's DNR order, to no avail. On Wednesday evening, two full days after Katrina hit, three New Orleans police officers approached her, she says with guns drawn, and told her she would have to leave. New Orleans police confirm that armed officers evacuated non-essential staff from the hospital. McManus, confronted by police, raced to her mother's bed.

MCMANUS: And I woke her up, and I talked to her until I had to leave, and I told her I was okay to go on and be with Jesus, and she understood me because she cried. First, she screamed, then she cried, and I said, Momma, do you understand? And she said yes, and she asked me to sing to her one more time. And I did it, and everybody was crying, and then I left. I had to leave her there. The police actually escorted me seven floors down.

KAHN: McManus says when she left, only eight patients, including her mother, remained alive in the LifeCare unit. According to court documents reviewed by NPR, one key discussion took place on Thursday, September 1, during what's described as an incident-command meeting held on the hospital's emergency ramp. A nurse told LifeCare's pharmacy director that the hospital's seventh-floor LifeCare patients were critical and not expected to be evacuated with the rest of the hospital. According to statements given to the Attorney General's office, LifeCare's pharmacy director, the director of physical medicine and an assistant administrator say they were told that the evacuation plan for the seventh floor was to, "not leave any living patients behind," and that, "a lethal dose would be administered."

In the eyewitness accounts reviewed by NPR, LifeCare's pharmacy director says later that Thursday morning, he found Dr. Anna Pou in the seventh-floor medical charting room. According to his statement, Dr. Pou and two unnamed nurses informed him that it had been decided to administer lethal doses to LifeCare patients. From the documents reviewed by NPR, it's not clear who gave the order. When asked what medication was to be given, the director told the investigator that Dr. Pou showed him a big pack of vials of morphine. The LifeCare director states that before evacuating, he saw Dr. Pou and the two nurses enter the rooms of remaining LifeCare patients.

No one has been charged in the investigation, and nowhere in the documents or in independent interviews conducted by NPR does anyone confirm seeing doctors or nurses administering lethal doses of morphine.

That's just one of the challenges facing Louisiana State Attorney General Charles Foti as he tries to piece together exactly what happened at Memorial. For weeks, the Attorney General and his office have had the same response. Foti says he cannot comment on the ongoing investigation. His spokeswoman, Kris Wartelle, says investigators have subpoenaed more than 70 witnesses and are examining volumes of evidence.

KRIS WARTELLE: That's just a monumental task. I mean, to get the information back that would prove something like that, it's a serious task, and it's one that's not easily accomplished.

KAHN: Despite repeated phone calls and letters, Dr. Pou could not be reached for comment. She's retaining an attorney. Her lawyer Rick Simmons provided NPR with a written statement. It says, Dr. Pou and other medical personnel at Memorial Hospital worked tirelessly for five days to save and evacuate patients, none of whom were abandoned. Simmons would not go on tape, but in a telephone conversation, he told NPR that "Dr. Pou did not engage in any criminal actions" and he says he's confident that the facts will reveal heroic efforts by the physicians and the staff in a desperate situation.

Tenet Healthcare Corporation, which owns Memorial Hospital, declined to comment on tape for this report. On its web site, Tenet expresses regret for the loss of life at Memorial and praises the work of its doctors and staff. Tenet acknowledges that Attorney General investigators searched Memorial Hospital on October 1st, 2005, and removed records and other materials, particularly from the LifeCare Facility.

Tenet spokesperson Harry Anderson, who would not be taped, said during a phone interview with NPR that evacuation plans for the seventh floor of Memorial was the sole responsibility of LifeCare Hospital.

LifeCare spokeswoman Paula Lovelle would not comment on the investigation, but stressed that the company is cooperating fully with the Attorney General.

PAULA LOVELL: But in deference to the ongoing efforts of the AG's office and out of respect for the families of patients, we're unable to make any comment on matters related to the investigation.

KAHN: For his part, New Orleans coroner Frank Minyard says proving that lethal doses of morphine were given is going to be difficult. As part of the investigation, he removed tissue samples for toxicology tests from all bodies found at Memorial. He would not say if he found traces of morphine in the samples.

Minyard says the bodies were not retrieved from the hospital until two weeks after the storm, and were in advanced stages of decomposition. He says that undermines that accuracy of toxicology tests.

FRANK MINYARD: The whole deal is if these people have been treated with that for their pain prior to the storm, they're going to have it in their system because they are sick people and their system's not working like it should work.

KAHN: In the absence of reliable forensic evidence, all parties say the patients' charts with the morphine dosage levels will be crucial to the case. The Attorney General's office will not confirm whether he's seen them.

Angela McManus has retained a lawyer to investigate the circumstances of her mother's death. She wants answers.

MCMANUS: You know, I, of course I don't know what God's will is. I don't know when he was calling her home. If he did in fact do it, okay. But if man decided that, I want to know that. My family needs peace about that.

KAHN: A funeral for McManus's mother was held in Georgia late last year. McManus says relatives sang the same hymns she sang to her mother that last night they were together on Memorial's seventh floor. She says singing it now gives her some comfort.

(Soundbite of Ms. McManus singing hymn)

Carrie Kahn, NPR News.

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