Hurricane Katrina and Dr. Pou

Hurricane Katrina and Dr. Pou

14-15 Ethics Bowl Case #8

Dr. Pou

Dr. PouPracticed for more than 15 years

Head and neck surgeon specializing in treating cancer patients

Charged with murdering 4 patients by injecting them with two different drugs

A forensic pathologist “concluded that all four deaths were homicides, caused by human intervention.”

Actually accused of euthanizing at least 9 patients, as many as 20

Memorial Medical Center

5 days without power before everyone was rescued

200 people trapped

sporadic rescue efforts

34 bodies recovered

“battlefield conditions”

10 feet of water

110 degree heat

nearby violence

No powers; generators ran out after about a day; back-up batteries only lasted 30 minutes

No fresh water

Dwindling supplies

Stopped treatment and focused on keeping patients comfortable

Turned away new patients

Triage Procedures

Typically, medical workers try to divvy up care to achieve the greatest good for the greatest number of people (Utilitarianism).

What does “greatest good” mean? Is it the number of lives saved? Years of life saved? Best “quality” years of lived saved? Or something else entirely?

D.N.R.

Signed by a doctor with informed consent

Means a patient whose heartbeat or breathing has stopped would not be revived

Different from a living willAllows patients with a “terminal and irreversible” condition to request in advance that “life -sustaining procedures” be withheld or withdrawn

Patient Evacuation

1Fairly good health

Can sit up or walk

NICU babies and pregnant mothers

2Sicker

Need more assistance

3Very ill

With D.N.R. ordersThought “patients who did not wish their lives to be prolonged by extraordinary measures wouldn’t want to be saved at the expense of others”

Evacuation Measures

Helipads on the roof of a parking structureHad to get patients to the 2nd floor, through a 3’ x 3’ hatch, and up a small metal ramp

Air boats from emergency room ramp

Taken to Louis Armstrong New Orleans International Airport“Hundreds of hospital and nursing home patients had been dropped there from across the disaster zone; they were met by federal disaster-management teams that were so understaffed and undersupplied that they couldn’t provide even basic nursing care to many patients. Reflecting on the scene at the airport, Thiele told me that the if patients he injected with drugs had made it there, “They wouldn’t have survived.”

Interview with Sheri Fink

The Daily Show

Interview with Dr. Pou

CBS News

After Hurricane Katrina

Found not guilty by Grand Jury; Civil charges still pending

Helped write and pass 3 laws in Louisiana that offer immunity the health care professionals form most civil lawsuits for their work in future disasters, from hurricans to terrorist attacks to pandemic influenza

Advising state and national medical organizations on disaster preparedness and legal reform

“Informed consent is not possible during disasters…Doctors need to be able to evacuate the sickest or most severely injured patients last—along with those who have D.N.R. orders>”

Questions to Consider

Did Dr. Pou and the nurses do the right thing in hastening the death of some of their patients during Katrina?

Should doctors be held to different standards of care during emergency situations?

Should the sickest be evacuated from hospitals first in emergency situations like Katrina, or should they be last because healthier patients have a better chance of surviving?

More Questions to Consider

How long should health care workers have to be with patients who may not survive?

Which patients should get a share of limited resources, and who decides?

What does it mean to do the greatest good for the greatest umber, and does that end justify all means?

Where is the line between appropriate care and mercy killings?

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?