JTrain, blogging at Majikthise, has an interesting post up about a post-Katrina situation he blogged about almost two years ago. Two years ago, the stories about doctors issuing morphine doses that may have hastened the deaths of some patients in an overwhelmed New Orleans hospital were only rumors, and at the time, J (who’s a doctor that does a lot of E.R. work) explained the concept of a triage:
“Triage”, as the word root implies, originally meant separating patients into three groups–those who would likely be OK without medical care, those who are beyond any help, and those who can benefit from medical care. The idea is to concentrate resources where they can do the most good; it’s no use spending valuable time working on someone with hours left to live no matter what when you can save decades of meaningful life for three or four other people in the same time. In that case, the right thing to do is to provide comfort for the dying, and in a serious and urgent situation, that might include active euthanasia.
If you have sufficient resources, choosing between comforting the dying and attending the salvageable isn’t necessary, but obviously in a hellhole battlefield-style situation like New Orleans after Katrina, there’s a direct conflict. The dying become a direct resource-suck that could end up killing the salvageable. In this case, J broke down the likely options for the dying:
–Evacuate the patients. It may not even be an option. If it is, they’ll probably die en route. If they do make it, it’s just so that they can wait to die in a different building, probably still separated from family, and (just to be frank about it) using resources and manpower that are already scarce to delay the inevitable for a little bit. The patients’ last hours will be spent in a flurry of activity, and on the other end comfort will almost certainly take a back seat to raw necessity.
–Leave the patients. They won’t make it, but the lack of nursing care or meds will mean their last hours will be spent alone and miserable. This is not an option, IMO.
–Push the morphine.
From a strictly utilitarian standpoint, there is only one good option, and a disaster like Katrina brings out the utilitarian in all of us. That doesn’t make it easy to do, or easy to accept.
Of course, people who make necessary but unpleasant decisions are attractive after-the-fact scapegoats, especially in a situation where the real targets of ire are too big and escape justice far too easily. (Namely, the Grover Norquist conservatives who have pushed the idea of cutting funding to the bone, which has turned the Mississippi River into a source of much tragedy from one American end to the other.) Which is what I suspect happened with the prosecution of Dr. Anna Pou and two nurses, who were charged with murder for hastening the demise of deathbed patients with pain-killing drugs during the post-Katrina insanity.
I’ll be blunt: I find the entire end-of-life debate frustrating. I don’t think that people should live their last days or hours in blinding pain when they have an option to go out more easily, just so that we the living can pat ourselves on the back about our super special morals that don’t take pain into account.
The grand jury in Louisiana refused to indict, thank the Disco Ball, and Newsweek has an interview with Dr. Pou up where she explains that the situation may have been even more hectic than most of us assumed two years ago. As J says:
It never occurred to me that people would want to use the hospital as a shelter; the hospital couldn’t really say no, but it must have made things difficult. The battlefield-style triage I described in my earlier post was being done quite literally, with numbers taped to patient’s chests. For some reason the part I have the hardest time envisioning is the pitch-black darkness.
In case there’s any doubt that Dr. Pou and the nurses were being scapegoated, I remind the audience that people were held for over a year after Katrina without being charged for things like loitering and traffic tickets. Surely the justice system’s resources would be better spent clearing innocent people out of jail than prosecuting the people who bothered to stay behind and help people while our President was busy whistling Dixie and the rest of the government was playing a game of pass the buck. It strains credulity to think that people who stayed behind to help had some secretly murderous intentions.
It’s easy for you or me to sit in our air-conditioned, well-lit homes and pass judgment. It’s easier than sitting and thinking about the fact that the right decisions in this world are not always easy. And it’s a lot easier than processing hundreds of patients after a horrific national disaster without light to guide you and with the knowledge that some of them are going to die, and the only thing you can do is make that easy or make that hard for them. I know that my friend who spent weeks after Katrina in the Astrodome helping organize Texas doctors to administer care was more exhausted that I’ve ever seen her during that time, and she gave off the distinct vibe of being traumatized by the experience. I know that my godfather who went to New Orleans to help find and identify bodies after the fact was deeply traumatized by the event.
And these people had the advantage of dealing with the situation in the relative quiet of the aftermath. They were dealing with the already dead or those who were well enough to get out.
I can’t imagine the sheer impossibility of dealing with the people on the cusp in the darkness with the fetid waters at the door and thousands of people clamoring for help. I don’t think any of us can.
Or, to quote J once more:
I suppose Dr. Fou was supposed to “trust the Lord” and wait for a miracle. I have to tell you–if I’m ever in a pitch dark 100-degree hospital with five feet of water on the first floor, 2000 patients and refugees cramming the hallways, and my city falling apart around me, I’m going to go ahead and assume that God is not on my side.
Corpses floating in the streets of New Orleans, Bush in the White House. Yes, there is no god and he’s not going to save us. We have to save ourselves.
56 Responses to “Scapegoating those who stayed behind”
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“Corpses floating in the streets of New Orleans, Bush in the White House. Yes, there is no god and he’s not going to save us. We have to save ourselves.”
Tin soldiers and
Nixon’s comingBush ain’t coming, we’re finally on our own…While nurses and doctors should be held to a higher standard, so many people forgot that they were people, too. They were victims, survivors. We should be thanking them for being brave enough to stay and continue doing their jobs in the midst of a disaster the likes of which many of us will never see.
Thank you for the reminder.
Drowning in a bathtub is good! Just no giving government morphine first because that’s agin God!
Not like we let baybees die when they already born while protecting feti, no sir!
Well said. This case was appalling, and the witch-hunt nauseated me from the first time the story broke, months ago.
I don’t believe in euthanasia. I think it’s usually wrong. It’s also important to note that the patients (at least not all) had terminal illnesses. In any other hospital, at any other time, this would have been murder. But in this specific case? I don’t know. I don’t know what I would have done if I was there. The conditions sound horrible and scary, and patients were dying of heat and dehydration even though their illnesses weren’t terminal. In the abstract, I’d say it was wrong. In hindsight, it was wrong because rescuers got their shortly afterwards and many of the patients could have been saved. But, trying to imagine it in the moment? The darkness, the heat, things getting worse and worse, patients dying anyways, not knowing when or if rescuers were going to get there? I can’t honestly say I wouldn’t have done what they did.
I’m guessing this was pushed by an ambitious D.A. up for election soon. I’m gonna guess he/she is a conservative as well.
THis is a little OT, but what is with the “should be held to a higher standard” meme lately? TEACHERS should be held to a higher standard (no art teachers should ever MODEL for other artists, even though that is what you spend your entire undergraduate traiing doing) DOCTORS and NURSES should be held to a higher standard. SOCIAL WORKERS should be held to a higher standard. Etc.
Are the only ones NOT to be “held to a higher standard” businessmen and politicians?
Honestly it starts to sound to me like “Professions likely to draw Liberals” should be held to (an imaginary, and arbitrary) higher standard.
I think it would be FINE if this all-too-convenient, blame SOMEBODY meme died a quick death. How about if EVERYONE is held to the same civilized and decent standard?
I’m sorry, I probably should have been more clear and it was a lazy choice of words. I do believe, though, that when people are highly trained in special areas that affect the wellbeing or health of others, they should be held to a higher ethical standard than others. Not that we shouldn’t all be ethical, but we don’t have as many people putting their entire lives in our hands and our mistakes aren’t usually as costly.
I hope this makes a little more sense, but I get your point.
To be honest, I don’t think this was scapegoating. I think in the end the doctor was given a gift because the DA didn’t want to deal with the politics. Check out CNN’s report on what happened with the grand jury:
http://www.cnn.com/2007/US/08/26/hospital.grandjury/index.html#cnnSTCVideo
The evidence seems to be that conscious, competent patients were killed without their knowledge or consent. Check out what wasn’t presented to the grand jury:
http://i.a.cnn.net/cnn/2007/images/08/27/memorial.medical.center.pdf
CNN’s fighting to keep these records from being sealed by the hospital’s lawyers, and for the sake of the victim’s families I really hope they win that fight.
To be honest, I don’t think this was scapegoating. I think in the end the doctor was given a gift because the DA didn’t want to deal with the politics. Check out CNN’s report on what happened with the grand jury:
http://www.cnn.com/2007/US/08/26/hospital.grandjury/index.html#cnnSTCVideo
The evidence seems to be that conscious, competent patients were killed without their knowledge or consent. Check out what wasn’t presented to the grand jury:
http://i.a.cnn.net/cnn/2007/images/08/27/memorial.medical.center.pdf
CNN’s fighting to keep these records from being sealed by the hospital’s lawyers, and for the sake of the victim’s families I really hope they win that fight.
To be honest, I don’t think this was scapegoating. I think in the end the doctor was given a gift because the DA didn’t want to deal with the politics. Check out CNN’s report on what happened with the grand jury:
http://www.cnn.com/2007/US/08/26/hospital.grandjury/index.html#cnnSTCVideo
There’s a link on that page to the evidence that the jury didn’t see, which seems pretty damning that conscious, competent patients were killed without their knowledge or consent. CNN’s fighting to keep these records from being sealed by the hospital’s lawyers, and for the sake of the victim’s families I really hope they win that fight.
On the one hand I’m a pretty straightforward utilitarian consequentialist of the humanist stripe. One the other hand, giving doctors leeway on decisions like euthanasia immediately brings to mind the image of Dr Bill Frist deciding if I’m worth saving.
I think that the grand jury made the right call, but I think that having at least some oversight of these sort of cases is an absolute necessity. For the record - If I’m ever in the situation of the critical patients in this case - go ahead and snuff me quick, and take care of the people who have a real chance.
At the risk of too many thoughts in a single comment - thinking like that of the prosecutor is one of the reasons that people rack up most of their lifetime medical costs in the last few months of life. At some point you have to accept you’re not going to live forever and just take your lumps. Live well today and when the time comes it won’t be a tragedy, just an unfortunate fact.
Doctors, nurses, social workers, lawyers, and other service-providing professionals all have profession-specific standards of conduct. Yes, even lawyers have some standards, for example, client confidentiality, obligation to work in client’s interest, obligation to avoid conflict of interest, obligation to avoid perjury, obligation to abide by the existing laws and the Constitutions of the US and of their states, etc.
Almost all physicians can contemplate the Katrina situation and then conclude that Dr. Pou probably behaved in an ethical fashion given the material constraints and extreme conditions. Almost all physicians would object to dosing terminal patients with morphine against that patient’s desire, even if it might be in the best interests of the patient. But who outside the hospital knew what kind of consent was given, was possible?
Thanks for the links.
I haven’t delved into the details of exactly what happened and exactly what the patients’ circumstances were. I’m willing to accept the possibility that some of the choices Dr. Pou made were bad ones. But hindsight is 20/20. In those conditions, with that level of exhaustion, dehydration, and desparation, bad decisions happen.
We know now that they were able to evacuate the hospital within a few days, but how did they know that? For all they knew, it was going to be another week before they could get those patients out, if at all.
Whether it was justified or not, Dr. Pou thought those patients were going to be left to suffer. If she truly believed that, her actions were justified. I can’t imagine what other motivation she could have had.
(Oh, and my ER days are pretty much behind me. Now I’m the guy they call once the patient is nice and stable, and that’s the way I like it.
)
I don’t believe in euthanasia. I think it’s usually wrong.
Ordinarily I’d plump with the “my life, my decision; your life, your decision” ethic.
I’m dubious about applying this wholeheartedly to euthanasia, though - there’s a damned good chance that people aren’t in their right minds when they make these decisions. If a person has a right to end their life on their own terms (and I believe they do), then I’d hope there was some mechanism to prevent them from making that decision arbitrarily.
I’ve never understood why we regard euthanasia for pets to be the sensible and compassionate thing to do to minimise their suffering, yet when it comes to people the only “compassionate” option is to prolong their suffering as much as possible. Sure, I realise there are all sorts of practical problems with who gets to make the decisions, but in principle…
Good post.
The tricky bit with euthanasia is that our committment to a reasonable amount of care for people while they have reasonable prospects of enjoying life and accomplishing something in it is so badly compromised. As we all know, health care, and for that matter every aspect contributing to quality of life, is of course differentially offered depending on one’s socioeconomic status.
The issue becomes very stark for disabled people, who immediately on becoming disabled start having the worth of their lives questioned. So, in that context, the “option” of ending it all begins to look suspiciously like a convenient way of getting rid of inconvenient people. This is why a major movement of disabled people goes by the name of “Not Dead Yet;” if it were up to the establishment, a lot of them would be, one way or another.
I did a paper in a class on Nazi Germany in which I investigated what effect, if any, German churches had toward restraining various Nazi extermination policies. I pretty much came up empty, except for one interesting category–when Nazi logic suggested that wounded soldiers ought to be put out of the way so as not to impede the nation, that’s when protest became effective, and that’s a point the churches, notably the Catholic Church, managed to score.
Triage of course was evolved on battlefields. There, the soldiers whose lives were being judged have generally met these criteria: they were taken in as more or less fit before being wounded; and they were part of a collective enterprise that in principle valued all members as worthy. Therefore, presumably, when battlefield medics had to make judgements as to who would get care and who would be allowed either to more or less heal on their own or die, they made them objectively on the basis of actual prognoses in the short run. But even among Germans committed to the Nazi state, it seemed a bit much to just write off people who had given their all just because now they weren’t apparently going to be much more use.
Based on my own subjective experience as the close companion of a woman whose life was overshadowed by severe disability that eventually led to her death by heart failure at age 52, as well as listening to the agitations of other disabled people on one hand, versus the stark fact on the other that in October 2004, Natasha was doomed to die given our medical state of the art (ie, we don’t have artificial hearts worthy of the name)–I don’t think there are quick, easy answers on this. In fact we all do come to the end of our ropes eventually, and at that point (a point when, generally, we are rendered legally or even absolutely incompetent to make decisions, due to pain meds, or the failure of our bodies to keep our brains working at normal levels) it is a matter of deciding whether to cling to each moment versus accepting that the end has come and going for minimal misery. But these final crises are a different question from the quality and level of care needed to put off that final crisis, and the ugly fact is, we have “triage” long before then. Unlike soldiers together on a battlefield, we don’t judge the worth of lives by a single standard before the particular emergencies set in.
In the end, I think people have the fundamental right to live as they see fit, given the options they’ve got, and their choices ought to be respected. But I can’t separate it from the context of a society that systematically terrorizes and squeezes the lives out of people generally.
So I’m very wary of snap judgements and sweeping vague principles that don’t look into the details of the cases. In the immediate aftermath of Katrina, an emergency akin to a battlefield existed, and surely some kind of triage, including what is called “comfort care,” was necessary. But I wouldn’t know how to judge particular allegations that this or that doctor crossed over from properly medical judgements to broader judgements of the perceived social worth of categories of survivors, without knowing details. Because it is all too plausible that some medical professionals would take advantage of the emergency to pass judgement on people; that after all is exactly what I accuse the whole US establishment of doing both in scanting preparation and in all sorts of inappropriate response to the actual emergency. But neither does the mere fact that the medics on the ground did essentially euthanize some people automatically mean they did so for racist or other bigoted reasons.
“For the record - If I’m ever in the situation of the critical patients in this case - go ahead and snuff me quick, and take care of the people who have a real chance.”
Same here. I’ve been in extreme pain in the past, and I’ve been afraid for my life for medical reasons. If it hadn’t been possible then to be treated, I’d have taken any option to at least go out easy. Furthermore, I am disabled– and I’ve nothing against people wanting every moment of life possible, but I’d rather not be forced to die in agony over the course of days because the doctors were worried about prosecution.
Excellent post - very thought provoking. Even though I support euthanasia as a compassionate end of life option, you can’t help but be chilled by the thought of having to make that choice under those awful conditions.
What really, really gets me about Dr. Pou’s situation is that the MDs who chose to leave were NOT prosecuted for patient abandonment. Instead, the medical people who stayed — the heroes, here — were prosecuted.
I have a question for all the conservatives in far-from-New Orleans places like Chicago and Tulsa and such who said the people who died after the hurricane deserved to because they didn’t flee. My question is simply this: when there is a natural disaster in your area, how many people outside of your own family will you have room for in your car as you flee? You’ve got your guns and your cash and gold and food, but how many neighbors? Is a suitcase more valuable than a stranger?
I hope in the event of an emergency I meet some new people in my neighborhood even if I’m just getting the hell out.
KM, if you don’t think was scapegoating, please explain why the DA went after this while people languished in jail for traffic tickets.
The grand jury refused to indict. That means there wasn’t enough evidence to go to trial. We’re talking a relatively low standard of proof to pass and the DA couldn’t pass it. There were decisions made that some people feel from their well-lit, air-conditioned homes that they would not make. But a grand jury that was close enough to the event to remember that doctors who stayed behind were heroes, not murderers intent on getting away with something probably sees it a bit differently.
I live a day’s drive from New Orleans and still our city was flooded with refugees. It’s easy for people far away and two years later to make snap judgments, but since our homeless shelters are still overflowing because of this, I don’t have the luxury of forgetting how we’re talking about hundreds of thousands of people throwing themselves to the four winds. And that this wasn’t a situation where a doctor had a nice, luxurious time to weigh her options, airlift someone out (remember the Superdome?), or maybe get some hospice care called in.
The hospice people gave my grandpa morphine at the end because his legs hurt so bad. They also gave him some kind of muscle relaxant because apparently people tend to twitch when they’re dying and this is uncomfortable. He was 97 and his body was shutting down and morphine just made dying easier. I don’t know whether or not it hastened the process, but it did make it easier for him. Everybody has to die sometime, and it seems to me it’s better to die quietly rather than twitching and in pain.
Morphine has a side effect btw. It restricts breathing. Given to someone in a bad health state or severly injured the morphine will hasten death. Doesn’t take that much either. Also like several specilists noted the water contamination etc would have made the autopsy reports unreliable.
Some of the people angry about the situtation seem to forget that in such a situation keeping track of what patients are getting the medicine or who have recieved the medicine is chaotic. Record keeping isn’t going to be a priority and in a case of short suppiles patients are going to be given what they can get not necessarily what is on their chart.
My sister was a nurse at Memorial prior to being evacuated to the Convention Center. The Hospital was turning away people that swam up to their necks or are in boats proclaiming they needed medical attention. She saw doctors break down in tears from seeing people turned away because the hospital couldn’t aid anyone.
Also the people honestly did think they had been left to die. There was no word that rescue was coming. My sister said a lot of the trouble in the convention center would have been avoided if the people had been told that in a few days they would be on cruise ships or in a trailer park with food provided to them. It was safer sleeping outside then inside the convention center
It’s still hard for me to believe this happened. It seems like a distant nightmare brought on by the mind-warpingly intense heat of August two years ago. I know it wasn’t –I remember the horrifying news footage and the kids from New Orleans crying in the student union building– but it’s still difficult to process. “America” and “400,000+ IDPs (internally dispalced persons)” is still hard to process.
As with Iraq, there will have to be a reckoning for this.
It’s still hard for me to believe this happened. It seems like a distant nightmare brought on by the mind-warpingly intense heat of August two years ago. I know it wasn’t –I remember the horrifying news footage and the kids from New Orleans crying in the student union building– but it’s still difficult to process. “America” and “400,000+ IDPs (internally dispalced persons)” is still hard to process.
As with Iraq, there will have to be a reckoning for this.
That picture looks like something from a horror movie, like it’s a still from 28 Days Later or another of those post-apocalyptic films. And yet real people — real human beings — had to live through it and are still dealing with the aftermath.
So, km, you think that Dr. Pou seized the opportunity to get rid of some disabled people by overdosing them with morphine under the pretext of an emergency?
Whether it was justified or not, Dr. Pou thought those patients were going to be left to suffer.
We also have to consider the sheer number of hours the physicians and staff went without food (they gave it to the patients), without much water (ditto) and without sleep in horrifying conditions. None of this makes for good decisionmaking ability or perspective.
Instead of vilifying individuals, we should be asking why in the HELL these people were put in this position to begin with! This wasn’t an earthquake or tsunami or volcanic eruption or other completely unpredictable situation - it was widely considered to be an EVENTUALITY that a Cat 4 or 5 hurricane would hit NO and take out a huge chunk of the city. AN EVENTUALITY with high probability measured acrose YEARS. Not centuries, years.
You’d have thunk that a major medical center would have been fully prepared, mebbe?
I am in favor of a patient’s right to commit suicide, if suffering from a terminal disease, with an inevitable and painful death in the near future: and for that suicide to be assisted by a doctor or relative at the patient’s request after procedures have been followed in order to prevent a patient from being railroaded into the decision.
Fairly clearly, that isn’t what happened in New Orleans.
I agree, however, with what others have already said: If deliberate overdoses of morphine were given to kill conscious, competent patients without their consent, that was a bad decision, but - even if it could be proved in a court of law that Dr Pou did that, which I gather it cannot - I think that under the circumstances, she certainly ought to be forgiven it: bad situations lead to bad decisions. It makes no more sense to convict her than it does to convict the young man who drove refugees in a school bus of illegal driving, or to charge the women who gave up their newborn babies to be airlifted out with abandonment.
I have known 3 people who chose to die, and when. Both my maternal grandparents, in fact. In both of those cases, it was complications of their existing medical conditions that killed them, but they both chose to succomb. The third was one of the Scout leaders, who just didn’t want to live anymore (his wife had run off with one of the Cub Scout leaders, other personal problems too numerous to name).
Having seen what they went through, my grandmother especially, I can’t really help but support euthanasia. Horrible, painful, debilitating and terminal? I’m stubborn and hopeful to a fault, so I probably wouldn’t make that decision for myself, but I know it just doesn’t make sense to continue suffering when there is no longer any hope of getting better, but the knowledge that it will get worse.
In this specific case, the doctor probably made the right decision in that it was the best decision she could make at the time with the information she had. I’d hate to have been in her position, and probably would have made similar decisions. You know, if I were a doctor or something. Spend your resources where they will do the most good and move on.
“You’d have thunk that a major medical center would have been fully prepared, mebbe?”
As far as prepartion goes they were. They had the proper amount of supplies to last as long as the plans allowed. The thing people don’t understand is that a major hospital is like a small city with several thousand people in it. Do you know how much food, resources are consumed by that many people in a day? Now figure out the storage requirements. Also figure that the place is flooded.
New Orleans has several hurricane exacuations a year. Guess what that does to a city budget if they try to evacuate even 1% of the population. The people that couldn’t evacuate had no transportation or couldn’t afford it. They often lived in areas where due to the tram system no one owned a car. It’s like Washington DC or New York a lot of people don’t want the hassle of a car in a crowded city when you have a city transit system that is quite capable of taking you where you need to go or you get taxis.
When someone evacuates outside their home town do you have any idea of how much it costs to get lodgings/food for a few days? Even if you have relatives or friends willing to take you it is still expensive. When you have several exacutations in which nothing happened a lot of people will think the same thing will happen the hurricane will not come so why bother with the trip outside the city.
As for the hospitals guess what they had private agencies who were supposed to get everyone out either by the agencies own resources or with the assistance of federal agencies.
Not the DA, but rather the Louisiana Attorney General Charles Foti made the case his cause celebre.
One thing that probably factored into the dropping of the case is that public sentiment here in N.O. has been overwhelmingly on the side of Dr. Pou. We remember what it was like, how desperate and uncertain — even for those who evacuated, everyone still had friends and relatives whom we were desperately trying to contact as we watched, horrified, the destruction of our home.
I was in a hotel room in Baton Rouge with some friends, who included the son of a veteran LA politician. Another of our friends, a nurse, was stuck at University hospital. There was no voice communication, but we could sometimes get text messages through after the storm had passed. Our politically connected friend, with his father’s help, was trying to get them help — we heard all about Charity and Memorial on the news, but it didn’t seem that anyone even knew there were folks at University Hospital. Her text messages became incresingly desperate, as water became scarce and fires could be seen out windows and gunshots herad and the temperature inside rose. One of her messages still really sticks with me:
“Babies dying in ICU”
Our friend’s dad was trying to reach the governor, to let her know of the situation and get them out. At one point, miracle of miracles, in the wee small hours of a morning, we got a voice call through (we’d kept trying over and over, despite so many hours of no success). As soon as the other medical people there realized someone had a call to the “outside” they all began giving us messages for their families, like “here’s my husband’s name & number. Tell him I’m alive, and to go with the children to my mother’s” We wrote them all down, and made the calls when we lost our connection to N.O. Everyone we called was desperate for more information, and we had to tell them, “I’m sorry, that’s all I know…s/he is okay, that’s his/her message, and we’re trying to get someone to go help them.”
Finally, finally, boats/helicopters came to the hospital. They got the patients away first. Our friend, with other medical personnel, was summarily dumped on the Causeway overpass where tons of other people were gathered to await some hope of rescue. Traumatized though they were, they started helping with triage on the sick and injured there. She finally made her way to baton Rouge, on a series of boats of autombiles, a totally makeshift journey without any guidance. The only official help was that very very late removal from the hospital itself, to the overpass. “That’s it, now you’re on your own.”
No one here judges those who made hard hard decisions in those days. It was beyond awful, and no one who didn’t live through it has a right to pass judgment on those who stayed behind to help and did the very best they could.
They had the proper amount of supplies to last as long as the plans allowed. The thing people don’t understand is that a major hospital is like a small city with several thousand people in it. Do you know how much food, resources are consumed by that many people in a day? Now figure out the storage requirements.
And this differs from the typical hugeantic Navy ship or submarine, how? If an aircraft carrier or sub can stay at sea with limited space for provisions and still function for months, I think a hospital can get it figured out for a week and plan for flooding. They can even buy space-efficient rations from the military to store.
I have worked in major hospitals and in a major hospital area. Saying “the plan worked as planned but failed because it was based on erroneous presumptions which ignored known facts” isn’t good enough.
Their plans did not include the scenarios that had been predicted for MANY years and which were eventual, not probable. Their plans were flawed. There was no will to plan properly and great hope that eventual meant “never” if one prayed hard enough. There is no excuse for the indifference, incompetence, and ignorance that let to this situation. None. That’s why it is so much easier to blame doctors for “ethical lapses” that may have resulted in a few deaths rather than “ethical lapses” that lead to scores of deaths INCLUDING those in extreme triage situations.
And this differs from the typical hugeantic Navy ship or submarine, how?
Because you don’t have hundreds of non-sailors descending on the ship when you’re in the middle of the ocean and far from land. Unless you think the hospital employees should have refused to let anyone who was not already a patient or employee through the doors?
Seconding Mnemosyne; The theoretical ship is undamaged, free of refugees and full of youngish, healthy, trained individuals. And a large part of the mission of a ship is to be self contained for extended periods of time. To add that capability to a hospital would take away other capabilities by consuming large amounts of space and personnel and budget.
It’s too bad there’s not an organization designed to respond to extraordinary disasters that we could blame for failing despite having sufficient warning and resources. I guess we’ll just have to stick with blaming people that did the best they could.
Unless you think the hospital employees should have refused to let anyone who was not already a patient or employee through the doors?
And you think that wasn’t something that could be expected or planned for? That people would descend on a building marked “shelter” as in “fallout shelter”?
Having worked in large urban hospitals and sat in on emergency planning meetings as a spectator, I ain’t buying the “oh where did these people come from” argument any more than the “how could we know it was going to flood when we are below sea level and the area flooded several times in the past century” nonsense. Hospital folks know that their buildings will become shelters in extreme circumstances - or they should!
It is time to hold the politicians and administrators accountable, not scapegoat the staff who stayed.
The current state of healthcare for the terminally-ill: Torture for Profit.
The longer they can keep you alive, the more money they make…
And you think that wasn’t something that could be expected or planned for? That people would descend on a building marked “shelter” as in “fallout shelter”?
I think that their plan in case of a Category 5 assumed that most of the people in the surrounding neighborhood would be evacuated before the storm hit, so they would deal mostly with existing patients and a few brought in who were hurt by the storm. I don’t think anyone thought that George Bush would tell New Orleans to go fuck itself and refuse to help with storm preparations.
They were faced with a situation they hadn’t imagined — there was no federal help and very little state help, so they were completely on their own. Maybe they should have planned to be completely shafted when it came to rescue aid, but I can’t entirely blame them for not foreseeing it.
Of the things that the hospital didn’t plan for, they probably didn’t expect FEMA to turn down aid from other cities and states.
You can blame the administrators for a lack of imagination, but I don’t think they were directly responsible the way the state and federal governments were. After the Northridge earthquake, we had emergency responders in the area within hours. After Hurricane Katrina, it took three days.
It’s too bad there’s not an organization designed to respond to extraordinary disasters that we could blame for failing despite having sufficient warning and resources. I guess we’ll just have to stick with blaming people that did the best they could.
Eggzackly. We had a series of tornadoes here in 1998, and FEMA was wonderful.
That’s because James Lee Witt had been there for several years and had whipped it into shape, transformed from the crony dumping ground it had been for years. Unlike Brownie The Schlemiel, Witt had years of experience in disaster management.
By 2005, a lot of the smart, experienced people who’d worked under Witt had quit in disgust. Plus, the agency had been placed under the aegis of Homeland Security and bumped below cabinet status.
Compound that with the depraved indifference of so many, right up to the President himself, and it was a recipe for disaster. Help that should have arrived within two or three days took a week or more.
The one example that just shakes me to my core is the Coast Guard divers who risked life and limb to navigate around trees and power lines to airlift people to that overpass, only to have them die because nobody could get them some goddamn bottled water.
How the hell do you plan for that?
Most of the hospital floors were flooded. What do you think happens to those supplies and food stored on those floors? Add in the heat and humidty to the food supplies and do you think the food is edible or that there is clean water to drink? Forget refrigration or technological filtering because the power is out as well. Emergency generators that a hospital uses are meant to last a frigging week. Of course they got flooded and hence couldn’t work. The smaller generators some of them were stolen by the police who often joined in on the looting.
A sub has rules and strict training to ration and prolong the food. If the sub was severly damaged however and the food stores destroyed you think they can last a few days without the brig being overflowed or executions for mutiny taken place?
As for the hospitals they can only take in so many people. They were turning hundreds away because they couldn’t help anyone. When the medical staff was evacuated a lot of them kept their badges hidden because the people were incredibly angry at them for turning away people.
Ms Kate (etc,). . . I agree with you completely. I have a relative who’s teaches, and is considered pretty well known, in the emergency planning and response area, and she has always said that planning and resource management were the top two requirements for an effective response. That said, I doubt any privately owned hospital would invest in the planning or supplies to be ready for such an emergency — it simply isn’t profitable.
Health care providers should be held to a higher standard then others. They are charged with caring for their fellow women and men with the primary charge of first doing no harm. In this case, these health care workers did what was necessary to reduce the amount of harm done to both the patients that survived and the one’s who didn’t.
Terminal is terminal - if you come to me and say “You’re dying there’s nothing that can be done, but if I can end your life now, I may be able to help others.” I’d say: “Go for it”
IMHO: we have the great sanctimony about the value of life in this country, but is mainly a cover for our fear and hypocrisy.
km, that CNN report uses a big scary voiceover to state that all of the medical experts (five of them, I think) determined that the manner of death for all nine patients in question was homicide. Why is this sinister, shocking news? (Which is the way the CNN report comes across.) Homicide means causing the death of a human being. It’s a neutral term with regard to intent. These women were charged with 2nd degree murder, which requires intent.
Dr. Pou has said repeatedly that it was not her intent to kill the patients.
“The intention was to help the patients that were having pain and sedate the patients who were anxious. That was it.”
“Q: Did you consider when giving the injections that they might hasten these patients’ deaths?
A: I guess the thought crossed my mind. Any time you give medicine it crosses your mind. There’s always a risk of hastening death.”
“Basically what we’re trying to do is help the patients. Let me tell you—God strike me dead—what we were trying to do was help the patients. Everything was done with their best interest in mind. First and foremost. Any medicines given were for comfort. If in doing so it hastened their deaths, then that’s what happened. But, this was not, “I’m going to go to the seventh floor and murder some people.” We’re here to help patients.”
That CNN report is all “Dun dun DUN!” and seems to imply that the medical experts believe that the patients were murdered. The medical experts are only testifying about the cause of death, not the intent, so I’m not sure what CNN is going on about. Unless they think Dr. Pou is outright lying.
And actually, in looking at Louisiana’s criminal code, second degree murder in LA requires specific intent, not just general intent. This means the person must have “actively desired” the patient’s death, as opposed to being “reasonably certain” that death would result from her actions. And it carries a mandatory life sentence without the possibility of parole.
Link
There aren’t many times when I think the word “travesty” is appropriate in a non-hyperbolic sense, but it would have been a travesty if these doctors had to spend the rest of their lives in prison for what they did.
yes, to call out what someone mentioned above: the situation in which Dr Pou found herself is more analogous to the situation on a carrier proximate to the Pearl Harbor bombings than to an ordinarily functioning carrier. Let’s not forget that aircraft carriers have LIGHTS and RUNNING WATER, two things Pou and her staff were operating without.
So, anyone wanna ask a WWII vet how calm and peaceful things were during Pearl Harbor? Anyone wanna grill him or her about “bad decisions” that had unfortunate consequences?
And another thing: If the emergency plans were indeed inadequate, how is that the responsibility of the doctor and nurses? They didn’t draw them up.
Of course morphine can hasten death. Duh. That doesn’t mean it’s unethical to use it in palliative care. Once you know that you can’t save someone, you need to relieve suffering, which includes giving enough painkillers to actually stop pain (and cancer pain is especially difficult to deal with). That’s quite different from terminal sedation.
If the power in the hospital was out, it means no oxygen for patients with respiratory failure, no dialysis for patients with kidney failure, no ECG monitors for cardiology patients (which means you don’t know how much arrythmia medication you can give), no ventilators for ICU patients, no surgery for trauma patients, no manual defibrillators working… Relieving pain is one thing you can do without access to electricity.
I’m so glad that at least the jury had sanity instead of sanctimony.
Re: The Terri thing again
I’m reminded of /an/ unfortunate American tendency to follow the letter of the law in defiance of the spirit.
I consider it a gross violation of human rights, that Terri was allowed to die of starvation, which was what they did to her when they pulled out the feeding tube. If a patient can’t feed himself because his arms are injured, for example, and his caregivers didn’t feed him and allowed him to die of hunger, than they are guilty of neglecting him to his death.
They should have either a)Continue the feeding tube OR b) give her morphine. It’s just plainly sadistic stupidity that it’s legal to starve her to death but not to give her a lethal injection, or put her under. I don’t remember feeling any pain from the gas mask when I went under for a surgery, just do that but more.
- MG
Another side of the disaster planning: who’s will to get fired during the non-disaster times by saying, “We have to take these millions of dollars away from caring for our current patients, some of whom will die as a result, so that we can potentially do a better job taking care of patients during a natural disaster”?
Some of the preparedness is obvious and necessary, but some of it is simply to big for any single large institution to shoulder.
I always figured that in case of natural disaster, foreseen or not, it was the American way for “the government,” without a lot of quarreling over whose baliwick was what, and “civil society”–Red Cross, Scouts, religious organizations, etc–to step in ASAP and pragmatically work together as they had in countless similar situations before. One might gripe about the outcomes, but all the foot-dragging, blame-shifting, and other pettifogging of the Bush Admin was gobstoppingly out of that paradigm. Anyone who knew their real track record, or the specific pleas and complaints of people on the ground in the Gulf Coast area years before the storm formed, or for that matter the stated intentions of BushCo, not to mention their specific track record in Iraq, nor even needing to consider how much of the usual responders (National Guard especially) were tied up over there, would not have been surprised.
But we were all appalled nonetheless.
So, no, I’d expect entities like hospitals to have a reasonable reserve of stuff for emergencies, but that it was only reasonable for such organizations to plan on the assumption that those were just to tide them over until the cavalry arrived, as we expect in the USA.
remember that Dr. Pou said that she did not give fatal overdoses or intend to. consider that she is telling the truth. the paid medical experts charles foti recruited have credibility problems of their own. a doctor who claimed he heard talk of euthanasia abandoned the hospital early and walked away from all the sick people there. the grand jury was tasked to hear the prosecution’s argument and decide if it was credible. if they were doing their job they heard the evidence and judged that there was not sufficient to take it to trial.
by pressing criminal charges charles foti destroyed the good name of a doctor and two nurses, and made it less likely that the families of the people who died will get to hear the whole truth.
My father died of complications from eshophigial cancer.
During his last several days he was not competent, but in extreme pain, as was evident to anybody watching over him.
His attending, two days before my father died, gathered the family together He reitereted that my father was going to pass very soon. He broached the tactic of pain management to increase dosages of morphine by multiples of what he was currently receiving.
My mother reluctantly agreed.
My sister, even in the full knowledge that my father was not going to live more than a week, at the outside, went start bonkers and browbeat my mother into refusing permission, on the grounds that my father “would get addicted.”
There is a certain mindset among some people that medical reality is suspended because they wish it so.
Thus, those who imagine that a hospital that is flooded, no power for lights, refrigeration or HVAC and with close to no supplies can, by some effort of Randian will, be able to function normally.
Trying to compare a navy ship to a hospital is rather silly! Especially a hospital that is trying to function at some level during a natural disaster. Navy ships are created, maintained and run so that they can function for long periods of time without outside help during natural disasters, war time EVEN durning PEACE. It’s their purpose. The people on these ships are trained to do so as well. You cannot expect a hospital to be really well prepared for those kinds of circumstances. Especially those that New Orleans was dealing with. Besides all of the readiness navy ships have, each person is highly trained to do very specific things which does not include dealing with more than half the ship’s crew being unable to preform their duties. The doctor’s and nurses in New Orleans that actually stayed behind have amazing hearts. They were basically dealing with a sinking ship and a skeleton crew. Bravo to Dr. Pou and those nurses for doing the best they could with what they had! Shame on the local government, the state government and the national government for doing nothing.
A side note: I had a friend that was a marine reservist at the time of Katrina. His unit was mobilized and sent to New Orleans and Baton Rouge to aid those that needed help. He and his fellow soldiers were appauled when what they were ORDERED to do was clean up the mayor’s house. (There were still people in the convention center and stadium. Still people on roof tops waiting for help. I’m sure the hospitals hadn’t been completely evacuated at this time. And his job was to pick up the mayor’s YARD!!) We do need to quit blaming the people who stayed to help. They gave alot and we repay them by ignoring them or prosecuting them. Shame on the State of Louisiana!