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Katrina Doctors Faced Deadly Choices

From (fittingly enough) the ‘Preview’ (for their magazine) section of the New York Times:

The Deadly Choices at Memorial


August 30, 2009

The smell of death was overpowering the moment a relief worker cracked open one of the hospital chapel’s wooden doors. Inside, more than a dozen bodies lay motionless on low cots and on the ground, shrouded in white sheets. Here, a wisp of gray hair peeked out. There, a knee was flung akimbo. A pallid hand reached across a blue gown.

Within days, the grisly tableau became the focus of an investigation into what happened when the floodwaters of Hurricane Katrina marooned Memorial Medical Center in Uptown New Orleans. The hurricane knocked out power and running water and sent the temperatures inside above 100 degrees. Still, investigators were surprised at the number of bodies in the makeshift morgue and were stunned when health care workers charged that a well-regarded doctor and two respected nurses had hastened the deaths of some patients by injecting them with lethal doses of drugs. Mortuary workers eventually carried 45 corpses from Memorial, more than from any comparable-size hospital in the drowned city.

Investigators pored over the evidence, and in July 2006, nearly a year after Katrina, Louisiana Department of Justice agents arrested the doctor and the nurses in connection with the deaths of four patients. The physician, Anna Pou, defended herself on national television, saying her role was to “help” patients “through their pain,” a position she maintains today. After a New Orleans grand jury declined to indict her on second-degree murder charges, the case faded from view.

In the four years since Katrina, Pou has helped write and pass three laws in Louisiana that offer immunity to health care professionals from most civil lawsuits — though not in cases of willful misconduct — for their work in future disasters, from hurricanes to terrorist attacks to pandemic influenza. The laws also encourage prosecutors to await the findings of a medical panel before deciding whether to prosecute medical professionals. Pou has also been advising state and national medical organizations on disaster preparedness and legal reform; she has lectured on medicine and ethics at national conferences and addressed military medical trainees. In her advocacy, she argues for changing the standards of medical care in emergencies. She has said that informed consent is impossible during disasters and that doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have Do Not Resuscitate orders — an approach that she and her colleagues used as conditions worsened after Katrina.

Pou and others cite what happened at Memorial and Pou’s subsequent arrest — which she has referred to as a “personal tragedy” — to justify changing the standards of care during crises. But the story of what happened in the frantic days when Memorial was cut off from the world has not been fully told. Over the past two and a half years, I have obtained previously unavailable records and interviewed dozens of people who were involved in the events at Memorial and the investigation that followed.

The interviews and documents cast the story of Pou and her colleagues in a new light. It is now evident that more medical professionals were involved in the decision to inject patients — and far more patients were injected — than was previously understood. When the names on toxicology reports and autopsies are matched with recollections and documentation from the days after Katrina, it appears that at least 17 patients were injected with morphine or the sedative midazolam, or both, after a long-awaited rescue effort was at last emptying the hospital. A number of these patients were extremely ill and might not have survived the evacuation. Several were almost certainly not near death when they were injected, according to medical professionals who treated them at Memorial and an internist’s review of their charts and autopsies that was commissioned by investigators but never made public.

In the course of my reporting, I went to several events involving Pou, including two fund-raisers on her behalf, a conference and several of her appearances before the Louisiana Legislature. Pou also sat down with me for a long interview last year, but she has repeatedly declined to discuss any details related to patient deaths, citing three ongoing wrongful-death suits and the need for sensitivity in the cases of those who have not sued. She has prevented journalists from attending her lectures about Katrina and filed a brief with the Louisiana Supreme Court opposing the release of a 50,000-page file assembled by investigators on deaths at Memorial.

The full details of what Pou did, and why, may never be known. But the arguments she is making about disaster preparedness — that medical workers should be virtually immune from prosecution for good-faith work during devastating events and that lifesaving interventions, including evacuation, shouldn’t necessarily go to the sickest first — deserve closer attention. This is particularly important as health officials are now weighing, with little public discussion and insufficient scientific evidence, protocols for making the kind of agonizing decisions that will, no doubt, arise again.

At a recent national conference for hospital disaster planners, Pou asked a question: “How long should health care workers have to be with patients who may not survive?” The story of Memorial Medical Center raises other questions: Which patients should get a share of limited resources, and who decides? What does it mean to do the greatest good for the greatest number, and does that end justify all means? Where is the line between appropriate comfort care and mercy killing? How, if at all, should doctors and nurses be held accountable for their actions in the most desperate of circumstances, especially when their government fails them?

The debate among medical professionals about how to handle disasters is intensifying, with Pou and her version of the Memorial narrative often at the center. At a conference for hospital executives and state disaster planners a few months ago in Chicago, she did not mention that she injected patients, saying that helicopters arrived in the afternoon of Thursday, Sept. 1, and “we were able to evacuate the rest.”

Pou projected the booking photo from her arrest onto the screen as she argued for laws to shield health workers from civil and criminal liability in disasters.

Before delivering the keynote address, Pou participated in a panel on the “moral and ethical issues” that could arise if standards of care were altered in disasters. At one point, one of the panelists, Father John F. Tuohey, regional director of the Providence Center for Health Care Ethics in Portland, Ore., said that there are dangers whenever rules are set that would deny or remove certain groups of patients from access to lifesaving resources. The implication was that if people outside the medical community don’t know what the rules are or feel excluded from the process of making them or don’t understand why some people receive essential care and some don’t, their confidence in the people who care for them risks being eroded. “As bad as disasters are,” he said, “even worse is survivors who don’t trust each other.”

Sheri Fink, an M.D., is a staff reporter at ProPublica, the independent nonprofit investigative organization. She is the author of “War Hospital: A True Story of Surgery and Survival” and is a senior fellow at the Harvard Humanitarian Initiative.

Granted this article is hellaciously long and meandering article, even by the standards of the New York Times.

But it is an important foreshadowing of what we will face under any nationalized healthcare system, whether it has ‘death panels’ or not.

This article was posted by Steve on Thursday, August 27th, 2009. Comments are currently closed.

11 Responses to “Katrina Doctors Faced Deadly Choices”

  1. Liberals Demise says:

    Boo frickin’ Hoo!!
    The people want their pound of flesh and the liberals are gonna make damn sure they get it. Even if it is your flesh they serve up.
    “Never let a good disaster go by without seeing the $$$$ flash before your eyes!!”

  2. ilzito guacamolito says:

    I am sick of the distortion of the term ‘death panels’ by libs since Sarah Palin used it. She chose such an extreme term to draw attention to the inevitable health care rationing should ObamaCare come to pass. When DC bureacrats are the ones determining who gets care because the well is running dry, someone will have to do without.

  3. 12 Gauge Rage says:

    Nobody should be above the law like this woman. What she and her colleagues did was pure evil. And she has no remorse for her actions. This is why a lot of us don’t want Obama care. Should a cabal of powerful doctors get to decide who lives and dies without any input from the patients or their families?

    When I get older I’d rather be the one who decides how I’ll go and when. Let me spend my final moments in a quiet place in the country. Not strapped to a hospital gurney with an expressionless doctor looking into my face and a needle in his hand, telling me to lie still and it’ll be over quickly.

  4. pdsand says:

    First do no harm?

    I think the fact that more people died in her hospital than in any other means that she is the least qualified to speak on these issues, right?

    “How, if at all, should doctors and nurses be held accountable for their actions in the most desperate of circumstances, especially when their government fails them?”

    I think the fact that the article even mentions these people were killed after the evacuation started means that their government did not fail them, but quite the opposite.

  5. canary says:

    As a former medic in the military, this protocol of treating the least injured first, and leaving the worst injured last, has been trying to be pushed way before Katrina. Under the guise of getting the least injured back on the front line as soon as possible, excuse. But, I figured that the real reason is they don’t want to pay for soldier’s artificial body parts. The way they treated my dad, well, he lived a better life, and made this a better world, and done more things than most have done in their life times.
    Ya know, what’s really pathetic, is how Obama gives an entire page, to a bump on his head, and then a cut on his arm. I think what a big baby. I think most white people have had it harder than that cry-baby, poor me,
    egotistical cold hearted possibly from another planet glob of blob.

    • caligirl9 says:

      It’s what’s taught in mass casualty triage—you have to make a decision based upon manpower and what resources you have available. You put the walking wounded one place, the salvageable another, and the moribund … where they lie.
      It’s a numeric system that can be taught to lay people, so there is no objectivity. It was very hard for me to accept, but it’s the “emergency services” industry standard right now.

    • canary says:

      Caligirl, do you mean that they are doing this in civilian disastors now, or they are not just doing it in military now. I figured most just ignore it and help the worst wounded first anyways.

  6. DougHI says:

    Comments link on cigarette post does not work.

    House of Sweetness and Spite

    http://www.nytimes.com/2009/08/30/realestate/30scape.html?8dpc – House of Sweetness and Spite

  7. 12 Gauge Rage says:

    Are they doing this sort of reverse triage mentality in our emergency rooms now? I was always taught as an EMT that the worst cases had priority.

  8. proreason says:

    The article appeared in the New York Slimes.

    It has no credibility whatsoever.

    It might be true, but long experience indicates the truth is likely to be far different from the words on the paper.

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