The link to the experts’ reports in the case against Dr. Pou has been published by CNN.
I was worried that I was just reacting in defense of a fellow doctor, so I spent quite a bit of time reviewing and typing up a summary, in order to get as much of the case as clear as I could. The reports by Baden and Brescia convinced me that I was right to defend Pou.
A February, 2006 “All Things Considered” (National Public Radio) article that describes the conditions that led up to the charges. (The photograph above is from that article.) 2000 people were in the hospital after the hurricane. Some were patients and their families, some were from the surrounding area and trying to get to high ground. All had to be evacuated.
A Ms. McManus, the daughter of one of the patients described the attempted evacuation of one lady who died due to the efforts:
According to McManus, attempts were made to evacuate other patients from the seventh floor. She recalls seeing workers desperately trying to get one woman out of the hospital, only to see that the woman died in the process.
That article also describes Ms. McManus’ evacuation at gun point by the local police.
I used Baden’s report for the order, with correlation from Brescia’s notes added (in italics) where he seemed to give additional information. These were incredibly sick patients, and there is at least some indication and documentation of pain, anxiety, worsening condition in each case. No one should be surprised that the patients died that last day. The worst thing that could be proven from the pathologist’s notes is that the documentation wasn’t done by a lot of people, over several days. (Not surprising considering the conditions.)
1. Paraplegic admitted 7/13/05 to Chalmette hospital for fecal impaction and pitting edema of LE. Surgery was being considered before evacuation to New Orleans. There were no Physician’s notes in the charts after transfer to Life Care in NO. The nurse’s note 8/31 documented the evacuation order by verbal order from a Dr Thien. Someone called wife 8/31 to check on her safety (I can’t tell whether the patient made or received the call. BBN) Positive morphine and versed in tissues at autopsy. Body removed from hosp. 9/11, Autopsy 9/17.
Dr. Brescia noted that patient had a “mega colon,” “chronic ileus” and cirrhotic. It looks as though this patient was prescribed Ativan for anxiety before the last day, and there’s documentation about the patient being or complainig about being “hot” and “too big to move.”
2. Admitted to NO hospital for decubitis ulcers. CVA, Dementia, pernicious anemia, contractures, bed bound total care. Alert/Awake, but no verbalizing. Bilateral Above the Knee Amputation due to ulcers planned but not done. Dr. LaCorte made notes. 8/31 code blue, F 105, sinus tachycardia at 123. Aspiration pneumonia afterwards. “No c/o pain.” Body recovered 9/11. Autopsy showed gangrene of toes Rt. Foot. Cerebral atrophy, “prominent post mortem changes.” + Morphine and versed.
3. Transferred from Chalmet 8/22 with acute bronchitis, hyperkalemia, renal insufficiency. 8/25 notes improved function. Darvocet 8/24. Fentanyl 8/28. (Shows pain, BBN.) Recovery 9/11, Autopsy 9/18. moderate to advanced decomposition. Morphine in liver.
4. Nursing home resident admitted to NO Memorial from NO Methodist Hospital 7/1, 2005 with coffee ground emesis, sepsis and hypotension. 8/7 surgical treatment of cellulitis. 8/30 Dr. Cashman ordered evacuation. 8/31 Dr. Joubert ordered “prn MSO4 1-4 mgm ivp/im q 1 hr prn restlessness/agitation.” Joubert hadn’t seen patient. Body recovered 9/11 Autopsy 9/19, extensive decomposition. “Bronchopneumonic changes limited to the lower lung lobes and pyelonephritic changes were present in both kidneys.” (bilateral lower lobe pneumonia and bilateral kidney infection) + Morphine and versed.
Brescia’s notes on his patient # 1: Sepsis GI bleeds, DNR. Orders 8/5 Restraints, PEG, debridemet (sic). 8/7 penile cellulitis, Ativan prn agitation 104.8 temp. 8/26 “Outlook poor . . . hospice not unreasonable.” 8/27 last entry by MD “quiet vs. stable Antibiotics” 8/21 MS for agitation, “last seen alive.” “9/1 No lights, water toilet air, electricity. T 102 (squared) sponge bath.” (I’m not sure whether this last was from the records or Dr. Brescia’s opinions. BBN)
5. Admitted to NO with multiple infected decubitus ulcers and malnutrition 7/19. Lt Leg debridement 7/26, rt leg debridement 8/19, Rt. Below the knee amputation 8/26. Evac order 8/31. Body recovered 9/11, Autopsy 9/17. Moderate decomposition and bronchopneumonia rt lung. + Vicodan (sic), morphine, versed.
6. Nursing Home resident admitted to Chalmette 8/12 for treatment of decubitus ulcers. Evac to NO 8/27. History of Congestive Heart Failure, organic brain syndrome, Chronic Obstructive Pulmonary Disease. 8/30 evac order. 8/31 fever 100.8. Body recovered 9/11, autopsy 9/21. + Morphine and versed.
7. Admitted to NO Memorial 8/2 and LifeCare 8/10 severe decubitus ulcers, H/o Arteriosclerotic heart disease, CVA hypertension and rectal surgery for cancer with a permanent colostomy. 8/22 inferior vena cava filter inserted Bilateral deep venous thrombosis. CT 8/25 showed osteomyelitis and abcess in pubic bone. Temp 104 9/29. Note 8/39 “no acute distress.” 8/31 signed order to evac. Unsigned order for morphine 1-4 mg every hour for restlessness/agitation Ativan 1-2 mg every hour for restlessness/agitation. Nurses note 8/31 Vicodan (sic) given for c/o of pain. Autopsy moderate to advance degree of decomposition and heart disease. No pulmonary embolism or other acute pathology. +morphine and versed. (note, no dates for recovery, autopsy)
Dr. Brescia’s notes have dates apparently crossed out, but documents temperatures, “uncomfortable,” “daughter refuses surgery,” “thick secretions,” ” yelling out,” “Doctor gave something to make ‘feel better’ x3 doses”
8. Admitted to Chalmette for treatment of pneumonia and sepsis. 8/25 transferred to Life Care Chalmette and 8/27 evac to LC NO. Treated for Arteriosclerotic heart diseas, congestive heart failure, hypertension and acute renal failure with last dialysis 8/26. 8/30 vital signs normal no note of pain. Autopsy moderate decomposition severe arteriosclerotic heart disease. +morphine and versed. (No dates for recovery, autopsy. BBN)
Dr. Brescia’s notes:
Oxygen, PEG, foley Coded during dialysis. Dialysis m/w/f Last note, “quiet vs. stable” Last nursing note 8/30/05 BP 128/56, 69, 22 awake, no distress.
“nl breathing no pain”per Dr. B(my question: ? With a respiratory rate of 22?BBN)
Autopsy – rt coronary 100% thrombosis.
9. Admitted to LC NO from Memorial NO 8/8 for decubitus ulcers, dehydration and malnutrition. Morphine 8/22. Order for morphine d/c’d 8/24, with Fentanyl patch and as needed Demerol. 8/30: vital signs normal, Demerol for pain. At 8 PM, temp 106.4 breathing agonal. Evac ordered. Autopsy severe arteriosclerotic heart disease. +fentanyl, demorol, morphine. “The presence of morphine in liver, brain, muscle and purge fluids demonstrate that the heart was beating and __ was alive with that injection was given.
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