I would like to hear more about an investigation into the failure to evacuate the hospitals in New Orleans after hurricane Katrina last year. I’d also like to hear about a medical review of the care of the patients – the medical review should come before any criminal charges, in fact.
Instead, the Louisiana Attorney General is trying to convince a grand jury to charge two nurses and a doctor with second degree murder for their actions after the patients had been abandoned for days, with only a few staff members remaining. And the AG has reportedly accused the doctor of murder and playing God, when talking about the case in a press conference.
If the doctor and the two nurses conspired to intentionally cause the death of patients, it is murder, and can never be excused. It is never acceptable to relieve suffering by killing the human being who is suffering.
On the other hand, these patients had been left in the heat without ventilators, dialysis, cardiac monitors and finely tuned IV medications or the personnel to administer all these things. Other patients had already died from dehydration. It would have been ethical to use what medications were available to relieve the respiratory distress and pain of the patients, even if that relief had a known risk of precipitating death due to the underlying disease. I’m not a critical care doctor, but versed and morphine would have been my choice, also.
The doctor firmly states that she is innocent. The nurses also say that they are all innocent. From the September 21 NO Times Picayune:
The 317-bed hospital had swallowed 10 feet of water, the electricity had failed and temperatures had spiked to over 100 degrees.
At least 34 people died at the hospital, many succumbing to dehydration as they waited for four days for boats to arrive.
“I do not believe in euthanasia,” said Pou. “I have spent my entire life taking care of patients. I have no history of doing anything other than good for my patients. … Why would I suddenly start murdering people?”
The medical community has aggressively defended the doctor and the nurses, pointing out that morphine and Versed, the two drugs allegedly injected into the patients, are commonly used in combination to reduce pain.
It’s a point Pou makes, saying that her goal was to “ensure they do not suffer in pain.”
According to state investigators, tissue samples from the dead, who ranged in age from 61 to 90, tested positive for both morphine and Versed, and the amount of Versed was found to be higher than the usual therapeutic dose.
Pou acknowledges the drugs could have caused harm, but stresses: “Anytime you provide pain medicine to anybody, there is a risk. But as I said, my role is to help them through the pain.”
And, now, the Louisiana State Medical Society is backing the doctor.
La. medical group supports doctor accused of killing patients
9/27/2006, 6:50 p.m. CT
By MARY FOSTER
The Associated Press
NEW ORLEANS (AP) — A state medical organization on Wednesday came out strongly in support of the Louisiana physician accused of killing four critically ill patients at Memorial Medical Center in the aftermath of Hurricane Katrina.
Dr. Anna Pou and nurses Cheri Landry and Lori Budo, were arrested and booked on second-degree murder after an investigation by Louisiana Attorney General Charles Foti, who said the trio injected a lethal cocktail of sedatives into the four bedridden patients, after determining they were too ill to be moved.
“The Louisiana State Medical Society is confident that Dr. Pou performed courageously under the most challenging and horrific conditions and made decisions in the best interest of her patients,” said a statement from LSMS President Dr. Floyd A. Buras. The statement was released Wednesday.
The statement came on the same day Memorial reopened its New Orleans Heart and Surgery Institute. But the main building remains closed.
The doctor and two nurses have not been formally charged, pending the outcome of a New Orleans grand jury investigation.
Speaking Sunday night on the television show “60 Minutes,” Pou emphatically denied killing the patients.
“No, I did not murder those patients,” said Pou, who’s been practicing medicine for more than 15 years. “I’ve spent my entire life taking care of patients. I have no history of doing anything other than good for my patients. I do the best of my ability. Why, would I suddenly start murdering people? It doesn’t make sense.”
The LSMS statement said that Pou has a long and distinguished career as a “talented surgeon and dedicated educator” which should not be tarnished by the accusations against her.
“Her recent statements regarding the events clearly show her dedication to providing care and hope to her patients when all hope seemed abandoned,” the statement said.
On Monday the American Medical Association issued a statement saying it would continue to monitor the case closely.
“The facts of this case appear complex, remain under investigation, and based on media reports, are sharply contested,” the statement said.
The AMA said it has a policy on several of the issues in the investigation, including encouragement of physician involvement in disaster preparedness and a doctor’s obligation to relieve pain and suffering.
The organization also opposes the “criminalization of medical judgment,” the statement said.
Foti released a statement late Wednesday detailing the scope of the investigation and pointing out that many hospitals were in trouble after the hurricane.
“However, this is the only hospital where doctors, nurses and other health care professionals and witnesses on the scene reported suspicious deaths of patients,” Foti’s statement said. “Many came forward and reported to us after witnessing events they believed were wrong and against ethical and legal standards.”
Foti said he believes in the presumption of innocence, and does not want the case tried in the media “where the defense seems to want it argued.”
Pou’s attorney, Rick Simmons, said he has only been trying to counter Foti’s comments at a news conference in which Foti called Pou a murderer and said she was playing God.
“When the prosecutor makes those type of comments it’s appropriate for the defense to respond,” Simmons said. “I was only responding to his effort to prejudice the public through the media.”
>Do little things like investigations and truth matter in this any more? Everyone has already made up their minds who to side with.I am reminded to some extent of a number of websites I saw after the last alleged deliberate killing of civilians in Iraq – some websites were campaigning to defend those accused, protesting their innocence and screaming that taking any action against them would be a victory for the insurgents who framed them. Other websites were saying that the accused were clearly guilty as hell, and that they must be severely and publicly punished if the coallition troops were to maintain the moral high-ground and the support of civilians.The former websites were run by Bush-supporters. The latter by anti-Bush campaigners (Who are not nessicarily the same as Democrat supporters). I did not find a single exception to this.Now… it seems to me that the people running those sites, on either side, did not care even the tiniest bit for an investigation, or for the facts. They also believed what they claimed: They each saw an accusation of a high-profile crime, and assumed the version of events that would best benefit their own political position.And that, I think, it what has happened here. The accusation has become political. People have already decided upon guilt or innocense without the need for such inconvenient things as evidence or investigation, and nothing is going to shift their views.
>I have some real problems with these accusations and the way they are presented to the media. I think that the AG over there is demogoging.I highly doubt that these were instances of euthanasia. I await evidence beyond a reasonable doubt.
>I worry that I'm adding to the sensationalism by commenting on the story. However, the issue goes beyond injustice and the abuse of the courts and the AG's office. It goes to the nature of the practice of medicine, altruism, and empathy.I hope and pray that the grand jury has intelligent, thoughtful members who will stand up to the AG. And that the Louisiana State Medical Society will stand behind Dr. Pou and these nurses. The action to prosecute under criminal law also complicates the proper oversite by the Louisiana Medical Board and the local medical community.I wonder where the charges against Tenet, the corporation who owns the hospital, are. Who is responsible for leaving the patients in the first place?
>Having worked in a 13 story hospital in an earthquake prone area of the west coast, I and my co-workers used to discuss the issue of when told to evacuate and my patients are too sick to move, we all said, better give me enough meds to "make my patient comfortable". There are a lot of uncharted issues with this case. If what the doctors and nurses say is true, that they gave the meds strictly for the relief of pain, then they are supported by previous statements by the American Nurses Association as well as the United States Supreme Court who have previously ruled that "giving pain medication with the intent to relieve pain, even if the side effect is death" is not punishable in criminal court. It will be interesting to follow this case.
>Thanks for the knowledgeable comments, CCN.Triage and palliative medicine with limited resources and abilities can look – or be made to look – like actions that were meant to cause the death of some patients. You confirm that we can accept that some will die due to our medicine, while not intending to kill.However, the difference was the expected and accepted endpoint. If the patients had slept comfortably after the meds but continued to breathe, would the doc or nurses given more versed?