Monday, September 30, 2013

Playing God? New book explores life-and-death decisions at N.O. hospital after Katrina

Floodwaters rising and generators failing, Memorial Medical Center in New Orleans was in dire straits in the days after Hurricane Katrina.

Administrators, doctors, nurses and other staff were faced with evacuating hundreds of patients, family members and even pets using few resources.

Some patients never made it out.

Sheri Fink is the author of "Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital." (Jen Dessinger)

Their deaths were the subject of Pulitzer Prize-winning reporting by Sheri Fink, a trained physician and journalist, in 2010.

Now Fink has painstakingly detailed those dramatic days – and their legal and cultural fallout -- in a compelling new book: “Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital.” 

Fink draws back the curtain on Memorial, giving readers a close-up view of the people who sheltered at the hospital and the patients who lived and died there. Their deaths raised questions about alleged "lethal doses" of medications.

But it doesn't stop there. "Five Days" also follows the investigation that targeted New Orleans native Dr. Anna Pou and others. Pou was never indicted.

In the book, Fink explores big questions that still demand answers today, such as: How should the health-care industry prepare for disasters? What criteria should determine the allocation of scarce medical resources?

Fink, who has a M.D. and Ph.D. from Stanford University, answered questions from about her book and the issues it addresses.
 Five Days At Memorial- Final Jacket.jpg

What’s the message – if there is one – in “Five Days?”

Fink: I won’t speak for readers, because I think everyone will have their own take-aways, but for me, now, it is the importance of investing in disaster preparedness at your workplace and for your family. Have plans, and be prepared to change them to fit the actual circumstances.

 Be an advocate for your loved ones in the hospital. Ask tough questions of your local hospital and health system about preparedness for the likeliest emergencies and express your views on how medical resources should be allocated in case they ever fall short. 

Most of all, if you ever face a significant disaster, do your best to keep up the spirits of those around you, act flexibly and creatively to help, try to sort rumors from truth, and remember that the decisions you make will have repercussions after the disaster has passed. 

The moral values, ethical codes and laws that guide our choices in normal times are, if anything, even more important to help us navigate the confusing and disorienting time of a disaster.

Do you believe that the people in the book "played God?”

Fink: The Attorney General of Louisiana and some family members of the patients who died at Memorial Medical Center after Hurricane Katrina made that allegation. They believed that doctors and nurses decided which patients would live and die. 

On the other hand, one of the nurse managers I interviewed said she felt medical professionals were asked to play God all the time, not only in disasters. 

What’s clear is that the law and ethical codes of the medical profession do not permit doctors to bring about patients’ deaths intentionally, and that is what some doctors told me they did in this case.

How did you go about the reporting for the articles/book?

Fink: I interviewed hundreds of people -- those at the hospital, investigators, family members of the dead, experts -- and collected materials, including everything from diaries and photographs to weather reports and architectural diagrams. And, of course, I visited the sites and looked for every article, report and book that related to these events. 

Was there one character or anecdote that stood out in your reporting? 

Fink: Dr. Pou received a great deal of media attention because colleagues at the hospital accused her of having given "lethal doses" to patients, and she was arrested for second degree murder in the deaths of a number of them. 

She maintained her innocence, and a grand jury refused to indict her. I discovered that other doctors were involved with injecting patients with morphine and the fast-acting sedative Versed, and two of them told me they had done so to hasten the deaths of their patients. Colleagues of theirs at the hospital told me they objected to these actions, believing them in no way necessary or appropriate. 

The real story here is revealed in the range of voices and perspectives on those events, and that's why “Five Days at Memorial” is a book. The length of a book provided an opportunity to give a nuanced picture of what happened and what it means. 

What surprised you the most about this story?

Fink: The fact that certain doctors had given patients medicine for the purpose of bringing about death. As someone who had delivered humanitarian aid in crisis zones and written a book about a besieged Bosnian war hospital in just about the most dire prolonged, situation imaginable, I don’t think I’d ever, outside of the realm of fiction, heard of actions like this. I had a hard time believing it had happened.

Once that was clear, it was important and urgent to understand how things could have devolved so quickly in an American hospital that respected physicians took part in it.

What would you still like to know? Any unanswered questions?

Fink: The death of one of the patients, a 61-year-old man named Emmett Everett, was particularly striking. The morning he died, he was alert, ate his breakfast, and had asked his nurses, “Are we ready to rock and roll?” 

He weighed around 380 pounds and was paralyzed. According to several witnesses, staff discussed his situation with Dr. Pou, and it was decided that he was too heavy to be carried downstairs and rescued, although others who worked in the hospital later said they would have gladly helped carry him if they’d been told a heavyset man on the seventh floor needed to be transported. 

He was found dead that afternoon, and toxicology tests showed morphine and a fast-acting sedative drug, Versed, in his body, neither of which he had been receiving or had been prescribed for him.

Dr. Pou was seen walking into his room before he died but has not commented on his death other than through her lawyer, who said Mr. Everett died of an enlarged heart — several forensic pathologists concluded that his death was a homicide, a result of the drugs that were injected into him. 

His main complaints that morning were dizziness and the desire not to be left behind at the hospital. Why were the drugs given to him and who gave them? There has been no explanation.

Did the reporting process change you personally. If so, how?

Fink: It made me more passionate about the need for better disaster preparedness on the part of our country—from government to businesses to individuals. And the need for more research to understand how we can improve resilience.

What has been the reaction from the medical community and from New Orleans – to reporting or the book?

Fink: There have been some good discussions about disaster preparedness, ethics, and end-of-life issues. I was in Louisiana last weekend, and one hospital administrator told me she checked with her plant operations team after she started reading “Five Days at Memorial” to make sure her hospital’s backup generator systems were protected from flooding.

What lessons did the country learn from Katrina? 

Fink: We learned we have some major vulnerabilities, particularly in the healthcare sector, which is a great first step, but now we have to fix them! “Five Days at Memorial” spells that out — the final section takes the reader from Hurricane Katrina to today, with stops in places like Haiti and New York City after Hurricane Sandy, and what we have and haven’t learned.