Behind a thick steel door is a walk-in cooler with bodies wrapped in black bags lining the shelves. Across the hall is another door and another cooler, and inside, a recent arrival under a body bag. The building is separate from the rest of the Orleans Parish Coroner's Office, with its own HVAC system circulating the odor of death away from the lobby.
Coroner Jeffrey Rouse asks, "Are you squeamish?"
But when Rouse opens the door to a large autopsy room, he reveals a pristine surgery suite surrounded by new medical equipment, as spotless, sterile and temperature-controlled as the massive coolers outside its doors. A small black iPod dock blasts gospel music from the corner of the room.
Just a few months ago, these bodies would have been stored in three refrigerated trailers retrofitted with air-conditioning equipment not designed for something as sensitive as a morgue. There were no office suites, or lobbies, or private rooms with tissues on conference room tables for grieving families and people requesting protective custody for their loved ones. Hurricane Katrina and the federal floods destroyed the coroner's office in the basement of Criminal District Court. The office spent the next decade in a Central City funeral home parking lot — until January, when city officials cut the ribbon on a $15 million facility on Earhart Boulevard.
Rouse committed his career to public psychiatry, saying he's made a "conscious choice in that to not go Uptown and open up a practice and make a bunch of money giving Ritalin and Prozac to stressed white people" — and he now oversees one of the largest public health strongholds in the state.
The new coroner's office is a three-story, 23,000- square-foot facility — funded by FEMA reimbursements, Law Enforcement District Bond funds and Disaster Community Development Block Grant funds — with refrigerated storage that can accommodate up to 112 bodies, with five autopsy stations, a mental health suite and an entire floor for toxicology and histology labs. It's the office's first "real" building since 2005, and Rouse's first since he began his term as coroner in 2014 with an office that performs 1,200 autopsies a year — more than twice the workload of Jefferson Parish and with half the budget, he points out. And Rouse says he's "stoked."
There's a big pile of papers on the floor near Rouse's desk — "spring cleaning," he says. The administrative floor is filled with desks and metal filing cabinets still wrapped in plastic, hauled from the old office.
Rouse — holding a paper cup of coffee and an iPhone with a cracked screen — slouches in a black nylon motorcycle jacket at the end of a long, polished table in a conference room that is nearly empty, except for several shelves devoted to his personal medical library.
"The typical day is, uh, weird," he says. "I think — I know — we are almost finished with the modernization and almost finished with cleaning up old crap. Still, there's vestiges of crap."
The office performs roughly 1,000 autopsies a year for Orleans Parish, with death investigators responding to 500 to 600 scenes — all on an annual budget from the city at a little more than $2.2 million. The office also earns extra revenue performing several dozen autopsies for other parishes. The St. Tammany Parish Coroner's Office operates on an annual budget of $5.3 million and the Jefferson Parish Coroner's Office has a $5.5 million budget for 300 annual autopsies.
"You take Jefferson Parish, St. Tammany, Baton Rouge and add them together and that's what we're dealing with on a daily basis on a budget that's a fraction of what they got," Rouse says. "We're always hustling to get that done."
Among the building's $15 million in bells and whistles, which includes the city's Emergency Medical Services (EMS) headquarters next door, is a wing dedicated to toxicology, from blood tests to vitreous (eye) fluids to histology, studying microscopic slides of pieces of the body. They test heart tissue for evidence of cardiac anomalies and lungs for pneumonia, all to help determine cause of death. The city hailed it as a state-of-the-art achievement.
But Rouse says there's no one to staff it and he doesn't have enough money to run it.
Rouse estimates it would cost another $850,000 a year to pay for a full-time lab director, staff and supplies. For now, as the office has been doing for years, Rouse sends samples to a lab in St. Louis, which eats up $200,000 to $250,000 of his budget each year, with a four- to-six week turnaround for results. While there's a $600,000 difference between in-house testing and outsourcing to a lab outside the state, the downside, Rouse says, is time.
"It was forward-thinking to at least provide us the space — now it's on me to hustle enough to get the money to do it," Rouse says, adding that he'd consider renting the space for extra revenue. "I don't want it to be totally mothballed. Any space that's mothballed too long tends to deteriorate."
But the new expansion finally made room for a mental health wing. Rouse joined the coroner's office psychiatric staff while still a resident at Charity Hospital. In Louisiana, coroners can evaluate the credibility of people seeking help for their loved ones and issue orders of protective custody. "Ninety-nine times out of 100, it's a credible cry for help," Rouse says.
Families can request a warrant for a loved one, and the New Orleans Police Department (NOPD) brings that person to an emergency room or psychiatric ward where a team of psychiatrists evaluates whether there's a legal justification for temporarily restricting that person's liberty. "In that sense, it's true forensic psychiatric work," Rouse says. "It's going in and trying to answer a legal question for which the questions are medical and psychiatric."
At the old office, families had those kinds of private conversations in the makeshift lobby, surrounded by staffers or people walking into the office. In 2006, Rouse met a family seeking protective custody for a family member at a coffee shop. He asked whether the family member had access to a gun. They said no.
"We go to the scene, pull up in front of the house, and the guy starts shooting at me," Rouse says. "I have to believe that a family member may be much more likely to tell us the dangerous stuff in a private setting than they would in the lobby sitting next to the mailman and a funeral home company getting a release next to the receptionist."
At his office's Jan. 13 ribbon-cutting, Rouse called the coroner's office "the final destination for the ills of humanity, for the violence, the drugs, the accidents, the unexpected and premature departures from this earth."
Rouse's typically dense speeches and his often-dramatic campaign messages echoed in his emotional pitches to the New Orleans City Council when requesting budget hikes for the beginning of his fiscal year. (District B Councilwoman LaToya Cantrell remarked at his second budget appearance that Rouse was building up his "swagger.")
He's only the third in a 50-year history of New Orleans coroners. Rouse's predecessor, Dr. Frank Minyard, served 10 consecutive terms in the office, beginning in 1974. The trumpet-playing gynecologist who helped run a methadone clinic for recovering heroin addicts took over the office from Carl Rabin, who began in 1968. Minyard helped modernize the office and put a public face to the coroner's job, notably with Pepto Bismol-colored bumper stickers asking, "Have you hugged a child today?"
In a 2014 election in which Orleans Parish voters also re-elected Mayor Mitch Landrieu and Sheriff Marlin Gusman, a then-39-year-old Rouse narrowly defeated a then-72-year-old Dwight McKenna. Minyard backed Rouse, who doesn't believe coroners should be elected.
Rouse worked as a psychiatrist in Minyard's office for more than a decade and was chief deputy coroner before he was tapped for the top job.
"I'm not necessarily the guy who's going to be at every ribbon cutting and fundraiser and bouncing around town to shake hands," Rouse says. "That's some of the stuff you have to do to get elected. I'm operating out of the assumption, somewhat naively, that if you apply yourself to your job, you do good work, you put in good policies that make people believe in the office ... you connect with the families and bring your integrity to the game, that goes a long way in the politics of it.
"Did I get this job to like, eat at Mandina's every Friday and get driven around by a driver with a pin on my lapel and go to Mardi Gras balls? Absolutely not."
Rouse was valedictorian of his graduating class at Jesuit High School in 1992. He graduated from Duke University in 1996 and Georgetown in 2000. He also plays drums in a garage band — badly. "I'm nowhere near the level of doing it publicly," he says.
"I've been out and around — it's the crucible that clarifies your thoughts and the way you present and do all that," he says. "I'd like to think it's the combination of a bookish nerd with the ability to just talk and connect with people. ... When I make a presentation, it's pulling out the valedictorian in me. I'm comfortable in this job now. I know what it is, I know where it needs to go and I've grown into it."
The back end of the Minyard administration showed signs of decay, failing to classify in-custody deaths and frequently colluding with law enforcement, and, amid the chaos of Katrina and the levee failures in September 2005, refusing to classify the death of Henry Glover — shot by police in an Algiers strip mall and burned in the backseat of a car — as a homicide. Rouse classified Glover's death a homicide in 2015.
In-custody deaths are "the highest profile stuff a coroner does," Rouse says. "There was no organized process for that. I'll just be blunt — there was a historical distrust of the diagnoses."
Rouse, chief investigator Brian Lapeyrolerie and a dozen law enforcement officials, including NOPD Superintendent Michael Harrison, perform parallel investigations at the scene of an in-custody death, not solely relying on NOPD's investigation and crime lab. "Nobody touches the body until we get there," Rouse says. "We press the pause button."
The coroner doesn't perform an autopsy until the office contacts the next of kin, in person, and tells them what happens next. The family also has time to reach an attorney, and the coroner can call the FBI, the District Attorney and other relative parties to attend the autopsy "so everyone is in the room, watching the autopsy at the exact same time," Rouse says.
"All these sorts of the cases that happened before me that made me say, 'Look, I don't want people thinking I'm in bed with the cops, or I'm trying to cover up anything for anybody,'" he says. "What can't happen in New Orleans is to have a situation like what happened in other jurisdictions — either Baltimore, Staten Island [New York] or Ferguson [Missouri] — where the coroner basically didn't say anything, stayed totally silent, and that only fed into a perception that there's something to hide.
"Granted, I'm not going to post autopsy photos on a billboard, but as soon as we're done with that autopsy and go back to the police monitor, the FBI, they can all talk about what they saw, and the point is, they all got to see it."
In December last year, the coroner's office responded to a police shooting in New Orleans East following an early-morning traffic stop. Rouse's investigation found Officer Frederick Carter struck 33-year-old Calvin McKinnis several times when returning fire.
But competence of the coroner's office was questioned late last year when police discovered the body of Shade Sanguis on Oct. 25 — he remained in the coroner's custody for five weeks before he was identified, despite the fact that NOPD had received a missing persons report Oct. 16. The coroner's office classified Sanguis' death as a suicide in December, signaling a lack of communication between NOPD and the coroner's office. Rouse says he can't discuss what happened in the case due to pending litigation.
Boxes of mason jars line one side of a loading dock in the back of the coroner's building, connected to the coolers. From here, vans can bring in bodies for autopsy, and funeral homes can pick them up.
The coroner also acts as a funeral director for "pauper's burials," cases in which a deceased person doesn't have a family or the family doesn't have the means for a burial. The city performs several group burials in New Orleans East each year.
Rouse now is responding to a growing crisis as heroin and opiate overdoses prompted the New Orleans Health Department to issue a public health advisory last month. Rouse responded to 44 accidental overdose deaths in 2014 and 43 deaths in 2015. There were seven in January alone. More than 100 people were treated for overdoses in January 2016, compared to 78 over the same time last year.
In his free time, Rouse volunteers at Grace Outreach Center, a group home in Central City for people with substance abuse issues and mental illness. With the closure of Charity Hospital and the loss of the public Southeast Louisiana Hospital, the city no longer has a public detox facility or mental health hospital.
"We're having more and more of these opiate-related deaths. It's exceedingly difficult to get detox treatment, even if you have money," Rouse says. "The lack of intermediate care beds, the lack of a detox facility and the lack of group homes means we have fewer ways to keep people out of the traditional criminal justice system. ... There's lots of eyes on the issue. The question is how successful are we going to be in spending some dollars from the society's till on this issue knowing that ... for every dollar you spend on mental health you save three dollars on the criminal justice system."
In his latest speeches, Rouse reminds New Orleanians to drive safer, eat healthier and be nice. He vented on social media last July 2, a particularly bloody day on New Orleans streets: "4 homicides in 6 hours this afternoon. Four, for Christ's sake."
"New Orleans is a difficult place to grow a brain," Rouse says. The lack of access to health care, education and healthy food, plus battling the "chaos and trauma at the home [make it seem normal] that conflicts end in death, that that's OK."
"EMS is saving people now — you have to see EMS as part of a larger hospital system. The stuff they can do in the field, be it tourniquets or injecting things straight into the bone for IV fluid, they're able to do things now they weren't able to do five years ago, certainly 10 years ago," Rouse says. "Unfortunately, if you have to pick a place to get shot, New Orleans is a pretty good place. ... They're saving people I can't believe they're saving. ... It has been a true education as to how many gunshot wounds people receive when they're murdered. We're talking 10, 20, 30, 40 gunshots."
Though the number of murders has dropped incrementally in New Orleans — from 199 in 2011 to 150 in 2015 — it rose again in 2015 with 164 murders. Then there are "delayed homicides," in which people who survived a gunshot wound have ongoing complications and succumb to their injuries. Rouse considers those to be homicides as well. These numbers are the least malleable. Whereas a police report offers one account, the coroner makes it final; there's no argument whether a death is really a death.
"We're down to this murder rate, and we're pleased with it, only in light of how far we've come from utterly ridiculous levels," he says. "Now we're just at ridiculous levels."