First, do no harm
August 28, 2009 12:29 AM Subscribe
Was it triage or murder? A disturbing NY Times story about the choices made by certain medical staff at a New Orleans hospital during Hurricane Katrina. Long and not easy reading.
I read the whole piece and came away with the feeling that it was supposed to be a journalistic indictment of the Katrina doctors.
I still think that those doctors were heroes, and this article didn't change that. They made some horrifying, terrifying decisions in the hope that they could alleviate suffering and perhaps spare their patients gruesome deaths at the hands of nature or roving bands of looters. There were no "good" choices that day, only less bad ones.
I, for one, am glad that these doctors cared enough about their patients to end their lives with such dignity.
posted by Avenger at 2:05 AM on August 28, 2009 [18 favorites]
I still think that those doctors were heroes, and this article didn't change that. They made some horrifying, terrifying decisions in the hope that they could alleviate suffering and perhaps spare their patients gruesome deaths at the hands of nature or roving bands of looters. There were no "good" choices that day, only less bad ones.
I, for one, am glad that these doctors cared enough about their patients to end their lives with such dignity.
posted by Avenger at 2:05 AM on August 28, 2009 [18 favorites]
holy fuck.
posted by fourcheesemac at 2:32 AM on August 28, 2009 [1 favorite]
posted by fourcheesemac at 2:32 AM on August 28, 2009 [1 favorite]
BTW: Sheri Fink's article was co-published by NYT and ProPublica, which deserves some traffic love too. Here is the ProPublica link (same article).
posted by fourcheesemac at 2:34 AM on August 28, 2009 [3 favorites]
posted by fourcheesemac at 2:34 AM on August 28, 2009 [3 favorites]
I share Avenger's sentiments, with the exception of the feeling that the article was supposed to be an indictment. It was perhaps not a flattering portrayal of Pou in some parts, but I didn't take away any bias against the doctors.
[on preview, I also share fourcheesemac's sentiment. The men swimming in the "toxic water" with the woman on the mattress... Wow.]
posted by kmennie at 2:39 AM on August 28, 2009 [1 favorite]
[on preview, I also share fourcheesemac's sentiment. The men swimming in the "toxic water" with the woman on the mattress... Wow.]
posted by kmennie at 2:39 AM on August 28, 2009 [1 favorite]
I agree that the doctors (and other health care workers) were heroic in staying at the hospital for many days after Katrina struck.
However, the article strongly suggests that Pou and others ended the lives of some patients who could have been evacuated and could have lived. In particular, rescuers and evacuation teams were never told that some of these patients were still in the hospital.
(Plus, this is a terrible misuse of a DNR. When you have a DNR, you're asking to not be brought back if, e.g., your heart or lungs fail. Not to be denied evacuation or given a lethal dose of morphine while you are still conscious!)
posted by a.dog at 3:07 AM on August 28, 2009 [3 favorites]
However, the article strongly suggests that Pou and others ended the lives of some patients who could have been evacuated and could have lived. In particular, rescuers and evacuation teams were never told that some of these patients were still in the hospital.
(Plus, this is a terrible misuse of a DNR. When you have a DNR, you're asking to not be brought back if, e.g., your heart or lungs fail. Not to be denied evacuation or given a lethal dose of morphine while you are still conscious!)
posted by a.dog at 3:07 AM on August 28, 2009 [3 favorites]
This is particularly important as health officials are now weighing, with little public discussion and insufficient scientific evidence, protocols for making the kind of agonizing decisions that will, no doubt, arise again.
Wow. I can't believe the NY Times is repeating that Death Panel bullshit in such an underhanded way. Unbelievable. Shame on them.
In any case, Dubya and his wrinklebag racist of a mother should have both been put in front of a judge for their conduct during Hurricane Katrina, before any of these doctors were arrested.
posted by Blazecock Pileon at 3:16 AM on August 28, 2009 [5 favorites]
Wow. I can't believe the NY Times is repeating that Death Panel bullshit in such an underhanded way. Unbelievable. Shame on them.
In any case, Dubya and his wrinklebag racist of a mother should have both been put in front of a judge for their conduct during Hurricane Katrina, before any of these doctors were arrested.
posted by Blazecock Pileon at 3:16 AM on August 28, 2009 [5 favorites]
and his wrinklebag racist of a mother should have both been put in front of a judge for their conduct during Hurricane Katrina
What law did she break?
posted by Cyrano at 3:45 AM on August 28, 2009
What law did she break?
posted by Cyrano at 3:45 AM on August 28, 2009
Blame is useful when it leads to improvement.
I admire doctors that work at community hospitals. When you hear interviews of emergency workers after a crisis they frequently credit their training. What happened at Memorial was a failure of the process not of the people. The focal point of the failure is here:
posted by vapidave at 3:50 AM on August 28, 2009 [3 favorites]
I admire doctors that work at community hospitals. When you hear interviews of emergency workers after a crisis they frequently credit their training. What happened at Memorial was a failure of the process not of the people. The focal point of the failure is here:
"The longtime chairwoman of the hospital’s emergency-preparedness committee, Mulderick had helped draft Memorial’s emergency plan. But the 246-page document offered no guidance for dealing with a complete power failure or for how to evacuate the hospital if the streets were flooded."This in New Orleans. Somewhere in the bureaucracy of Memorial is a hole that people fell through.
posted by vapidave at 3:50 AM on August 28, 2009 [3 favorites]
I am amazed that these Doctors have defenders.
How low has American society fallen that these people can be considered heroic or even excusable by a even a tiny fraction of the population?
They failed utterly at their responsibilities, made horribly stupid decisions and deliberately killed people not at the peak of the crisis but near it's end.
Fucking awful.
posted by srboisvert at 4:10 AM on August 28, 2009 [2 favorites]
How low has American society fallen that these people can be considered heroic or even excusable by a even a tiny fraction of the population?
They failed utterly at their responsibilities, made horribly stupid decisions and deliberately killed people not at the peak of the crisis but near it's end.
Fucking awful.
posted by srboisvert at 4:10 AM on August 28, 2009 [2 favorites]
It is important to distinguish between triage and actively killing your patients. I understand that the intention was to lessen their suffering, but it crosses a fundamental ethical line in medicine, and a fundamental legal one. I don't know what the right answers were here, but I don't think the ethical ramifications can be dismissed simply because it was a crisis.
posted by Astro Zombie at 4:22 AM on August 28, 2009 [1 favorite]
posted by Astro Zombie at 4:22 AM on August 28, 2009 [1 favorite]
Your rhetorical question - "What it triage or murder?" - is interesting and a bit redundant. While the term triage is often used casually to describe the waiting room sorting process, it's origin is a deliberate process of dividing people into three groups:
# 1) Those who are likely to live, regardless of what care they receive;
# 2) Those who are likely to die, regardless of what care they receive;
# 3) Those for whom immediate care might make a positive difference in outcome.
In the strictest battlefield sense - which is where the concept originated - triage is the act of deciding who will live and who will likely die. A horrible decision to have to make, one that I hope is never on my or your shoulders.
posted by jbickers at 4:26 AM on August 28, 2009 [5 favorites]
# 1) Those who are likely to live, regardless of what care they receive;
# 2) Those who are likely to die, regardless of what care they receive;
# 3) Those for whom immediate care might make a positive difference in outcome.
In the strictest battlefield sense - which is where the concept originated - triage is the act of deciding who will live and who will likely die. A horrible decision to have to make, one that I hope is never on my or your shoulders.
posted by jbickers at 4:26 AM on August 28, 2009 [5 favorites]
From a journalism perspective, this story is really interesting- the author, Sheri Fink, works for the non-profit ProPublica and not the Times. It isn't clear how costs/revenue are shared, or why they ended up in the Times and not purely at ProPublica. I'd love to know more about that.
posted by louie at 4:48 AM on August 28, 2009
posted by louie at 4:48 AM on August 28, 2009
I should probably expand on my original comments by talking about my experience with triage. I first learned about the details of triage during my EMS training last year. As jbickers points out above, it's ghoulish business.
As an EMT, arriving on scene for a mass-casualty incident, it is my job, in effect, to decide who I can save and who I can't. There is no exact science to determine how this works, unfortunately. We are expected to have a certain grasp of who is going to make it based on our training and experience, and generally the experienced medics are pretty good at it.
Alot of the patients in the hospital were basically "black-tagged". They had little to no hope of survival even with heroic medical intervention, and there were many other more promising (green, yellow and red-tagged) patients who needed help. In an emergency situation, the black-tagged people would have been left to die anyway.
That is the nub for me: the doctors had black-tagged these patients, knew it was basically hopeless, and were faced with a choice -- let them die "naturally" and "ethically" in sweltering heat or beneath flood waters, or painlessly euthanize them.
It's not a good choice, no matter how you look at it. And nobody here is saying that old sick people should be automatically euthanized. I just imagine myself in a similar situation, responding to horrifying carnage, trying to help the patients I can while pitying the patients that I can't. If I were faced with a similar situation -- the total breakdown of civilization itself -- I imagine that I would at least be tempted to draw out my vial of morphine and save my dying patients from an even worse fate.
I'm not sure if that makes me a monster or a saint. Maybe both.
posted by Avenger at 4:52 AM on August 28, 2009 [44 favorites]
As an EMT, arriving on scene for a mass-casualty incident, it is my job, in effect, to decide who I can save and who I can't. There is no exact science to determine how this works, unfortunately. We are expected to have a certain grasp of who is going to make it based on our training and experience, and generally the experienced medics are pretty good at it.
Alot of the patients in the hospital were basically "black-tagged". They had little to no hope of survival even with heroic medical intervention, and there were many other more promising (green, yellow and red-tagged) patients who needed help. In an emergency situation, the black-tagged people would have been left to die anyway.
That is the nub for me: the doctors had black-tagged these patients, knew it was basically hopeless, and were faced with a choice -- let them die "naturally" and "ethically" in sweltering heat or beneath flood waters, or painlessly euthanize them.
It's not a good choice, no matter how you look at it. And nobody here is saying that old sick people should be automatically euthanized. I just imagine myself in a similar situation, responding to horrifying carnage, trying to help the patients I can while pitying the patients that I can't. If I were faced with a similar situation -- the total breakdown of civilization itself -- I imagine that I would at least be tempted to draw out my vial of morphine and save my dying patients from an even worse fate.
I'm not sure if that makes me a monster or a saint. Maybe both.
posted by Avenger at 4:52 AM on August 28, 2009 [44 favorites]
There, a knee was flung akimbo.
There were mutants!?
My next MeFi sockpuppet name is going to be CheckDefinition2.
posted by rokusan at 5:18 AM on August 28, 2009 [2 favorites]
There were mutants!?
My next MeFi sockpuppet name is going to be CheckDefinition2.
posted by rokusan at 5:18 AM on August 28, 2009 [2 favorites]
and his wrinklebag racist of a mother should have both been put in front of a judge for their conduct during Hurricane Katrina
What law did she break?
Just the laws of common decency. I'll probably never forget her words as she was interviewed in one of our sports arenas that was being used to house and give aid to evacuees: "And so many of the people in the arena here, you know, were underprivileged anyway," she said, "so this is working very well for them."
posted by Houstonian at 5:19 AM on August 28, 2009 [5 favorites]
What law did she break?
Just the laws of common decency. I'll probably never forget her words as she was interviewed in one of our sports arenas that was being used to house and give aid to evacuees: "And so many of the people in the arena here, you know, were underprivileged anyway," she said, "so this is working very well for them."
posted by Houstonian at 5:19 AM on August 28, 2009 [5 favorites]
Nope, I'd say saint. Also I appreciate the perspective from someone who actually has worked in medicine.
posted by ®@ at 5:20 AM on August 28, 2009
posted by ®@ at 5:20 AM on August 28, 2009
I can see how being lost and abandoned in the middle of a dying city would lead these doctors to those choices. They were making decisions they'd never had to make before, never thought about and weighed in unstressed times, in the middle of what felt like an apocalypse. Some of their decisions, from this article, certainly don't seem like the right ones.
I moved back home to New Orleans three days before the storm. Lost most of my stuff. Spent a stressed-out week driving aimlessly around the South with my mother and a friend of hers, then a few more weeks in Lafayette with relatives. I would not say I was exactly sane for any of it; desperately hanging onto the news to find out what the hell had happened to the city, aghast at the way the Bush administration was handling it.
I was out of the flood, just worrying about my stuff and I was not sane. These doctors were in the middle of it, with all those stresses of worrying about friends and family and possessions that I had, plus having to care for a few hundred patients.
I don't think they made the right decisions. But I don't think they were capable of making them. Hell, I feel lonely and afraid just remembering my Katrina experience.
I'm not sure if that excuses their choices. But...
...I've been sitting here for about ten minutes trying to decide what goes after that "but". I can't get it into words. It's a "but" that goes through a big complicated knot of pain.
posted by egypturnash at 5:25 AM on August 28, 2009 [17 favorites]
I moved back home to New Orleans three days before the storm. Lost most of my stuff. Spent a stressed-out week driving aimlessly around the South with my mother and a friend of hers, then a few more weeks in Lafayette with relatives. I would not say I was exactly sane for any of it; desperately hanging onto the news to find out what the hell had happened to the city, aghast at the way the Bush administration was handling it.
I was out of the flood, just worrying about my stuff and I was not sane. These doctors were in the middle of it, with all those stresses of worrying about friends and family and possessions that I had, plus having to care for a few hundred patients.
I don't think they made the right decisions. But I don't think they were capable of making them. Hell, I feel lonely and afraid just remembering my Katrina experience.
I'm not sure if that excuses their choices. But...
...I've been sitting here for about ten minutes trying to decide what goes after that "but". I can't get it into words. It's a "but" that goes through a big complicated knot of pain.
posted by egypturnash at 5:25 AM on August 28, 2009 [17 favorites]
Thanks for this post.
It is important to distinguish between triage and actively killing your patients. I understand that the intention was to lessen their suffering, but it crosses a fundamental ethical line in medicine, and a fundamental legal one. I don't know what the right answers were here, but I don't think the ethical ramifications can be dismissed simply because it was a crisis.
I don't think the ethical ramifications can or should be dismissed by the fact that they were made in crisis. However, I think it's helpful to remember that the doctors weren't just in the midst of a generic crisis. They were operating in a situation where all available systems had failed -- and by systems I mean everything from the AC, to the emergency plan (which, as noted above, failed to make any provisions for a total blackout or flood), to a total failure of social structures for prevention and intervention. This was a crisis characterized by total systemic collapse. It created an impossible situation for the hospital staff, and I think that in this type of environment it was inevitable that they made some problematic (and in some cases deeply flawed) decisions as a result.
posted by foxy_hedgehog at 5:34 AM on August 28, 2009 [5 favorites]
It is important to distinguish between triage and actively killing your patients. I understand that the intention was to lessen their suffering, but it crosses a fundamental ethical line in medicine, and a fundamental legal one. I don't know what the right answers were here, but I don't think the ethical ramifications can be dismissed simply because it was a crisis.
I don't think the ethical ramifications can or should be dismissed by the fact that they were made in crisis. However, I think it's helpful to remember that the doctors weren't just in the midst of a generic crisis. They were operating in a situation where all available systems had failed -- and by systems I mean everything from the AC, to the emergency plan (which, as noted above, failed to make any provisions for a total blackout or flood), to a total failure of social structures for prevention and intervention. This was a crisis characterized by total systemic collapse. It created an impossible situation for the hospital staff, and I think that in this type of environment it was inevitable that they made some problematic (and in some cases deeply flawed) decisions as a result.
posted by foxy_hedgehog at 5:34 AM on August 28, 2009 [5 favorites]
The question, and the lesson, for doctors and other medical staff, may be this: Would it be better to evacuate ahead of a major storm, leaving your job, hospital, and patients behind, rather than stay and deal with a potentially unmanageable situation?
I am sure that many health care providers in the New Orleans area have looked at this doctor's case, and have come to the conclusion that it would be better to run than to serve the next time.
posted by Midnight Skulker at 5:36 AM on August 28, 2009 [6 favorites]
I am sure that many health care providers in the New Orleans area have looked at this doctor's case, and have come to the conclusion that it would be better to run than to serve the next time.
posted by Midnight Skulker at 5:36 AM on August 28, 2009 [6 favorites]
I do think it's worth looking at the fact that this hospital triaged their patience on the fly, and made decisions that are very different from some established systems of triage -- for one thing, they evacuated their healthiest patients first, and left the patients who had DNR orders to last. This is not the point of a DNR, and, over the course of the story, it becomes obvious that the suffering of these patience was increased by this, as, once the power went out, their essential lifepreserving equipment ceased to function. Additionally, by the end of the story, the hospital staff was too exhausted to assist a number of patients who needed to be carried out, which may not have been the case had the patients with the greatest needs been evacuated first. It's also worth noting that this hospital had a significantly larger number of fatalities than other New Orleans hospitals.
Yes, it was a crisis. But there had been a risk of exactly the same crisis the previous summer, with Hurricane Ivan, and the "filling the bowl" scenario was a well-established one in New Orleans, and yet it sounds like this hospital's preparation for this sort of emergency were minimal and they were just making it up as they went along; the story makes it clear, for example, that nobody had any triage training, and that the reason the hospital lost power was because the generator was on the ground floor, where it could easily be short circuited -- a problem the hospital was aware of, but decided was too expensive to resolve. Had one of the people who died in the hospital been a relative of mine, establish one of the ones who was actively euthanized by the staff, I don't know that I would consider that actions of the staff heroic, and I certainly would be looking to the understand why the hospital hadn't even minimally prepared for this sort of emergency.
posted by Astro Zombie at 5:56 AM on August 28, 2009 [11 favorites]
Yes, it was a crisis. But there had been a risk of exactly the same crisis the previous summer, with Hurricane Ivan, and the "filling the bowl" scenario was a well-established one in New Orleans, and yet it sounds like this hospital's preparation for this sort of emergency were minimal and they were just making it up as they went along; the story makes it clear, for example, that nobody had any triage training, and that the reason the hospital lost power was because the generator was on the ground floor, where it could easily be short circuited -- a problem the hospital was aware of, but decided was too expensive to resolve. Had one of the people who died in the hospital been a relative of mine, establish one of the ones who was actively euthanized by the staff, I don't know that I would consider that actions of the staff heroic, and I certainly would be looking to the understand why the hospital hadn't even minimally prepared for this sort of emergency.
posted by Astro Zombie at 5:56 AM on August 28, 2009 [11 favorites]
"Especially" rather; not "establish."
posted by Astro Zombie at 5:57 AM on August 28, 2009
posted by Astro Zombie at 5:57 AM on August 28, 2009
Had one of the people who died in the hospital been a relative of mine, establish one of the ones who was actively euthanized by the staff, I don't know that I would consider that actions of the staff heroic, and I certainly would be looking to the understand why the hospital hadn't even minimally prepared for this sort of emergency.
This is just it -- I completely agree. But then the focus becomes the lack of emergency training and the gaping holes in the hospital's emergency plans (no provision for flooding? In New Orleans? Are you kidding?), rather than the decisions made by individual doctors in the moment.
posted by foxy_hedgehog at 6:02 AM on August 28, 2009 [2 favorites]
This is just it -- I completely agree. But then the focus becomes the lack of emergency training and the gaping holes in the hospital's emergency plans (no provision for flooding? In New Orleans? Are you kidding?), rather than the decisions made by individual doctors in the moment.
posted by foxy_hedgehog at 6:02 AM on August 28, 2009 [2 favorites]
There are no concrete answers. Or, there are no easy, concrete answers.
When my mother was dying from multiple myeloma in the 1980s, she was on a programmed morphine drip. The dials were locked by the medical staff. On what was her last day, we'd been going to the nurses to say that she was gasping and having trouble breathing (we didn't know about Cheyne-Stokes breathing being the harbinger of death). The attending ordered the dials unlocked and said we could increase the morphine drip if she seemed to be having problems, but that anything over 40 on the dial might suppress her breathing enough to stop altogether after a few minutes. "Do you understand what I'm telling you? You can adjust the dial, but I need to let you know that anything over 40 will cause her to stop breathing. I'm asking you again--do you understand?" We did. There was no hope at all for mother. In the end, we did nothing, and she died later that afternoon. But I still remember what we were shown and told, and I wonder how many other families were shown and told the same thing.
I think those doctors and nurses in the article are guilty of homicide. But I don't know their state of mind, what they knew or didn't know was going to happen in the next few hours. Prosecute them? Why make them the scapegoats for a system that either was designed for failure or because some people high up--who can't be touched--made cynical decisions. No, no easy answers. No neat solutions.
posted by paddbear at 6:54 AM on August 28, 2009 [2 favorites]
When my mother was dying from multiple myeloma in the 1980s, she was on a programmed morphine drip. The dials were locked by the medical staff. On what was her last day, we'd been going to the nurses to say that she was gasping and having trouble breathing (we didn't know about Cheyne-Stokes breathing being the harbinger of death). The attending ordered the dials unlocked and said we could increase the morphine drip if she seemed to be having problems, but that anything over 40 on the dial might suppress her breathing enough to stop altogether after a few minutes. "Do you understand what I'm telling you? You can adjust the dial, but I need to let you know that anything over 40 will cause her to stop breathing. I'm asking you again--do you understand?" We did. There was no hope at all for mother. In the end, we did nothing, and she died later that afternoon. But I still remember what we were shown and told, and I wonder how many other families were shown and told the same thing.
I think those doctors and nurses in the article are guilty of homicide. But I don't know their state of mind, what they knew or didn't know was going to happen in the next few hours. Prosecute them? Why make them the scapegoats for a system that either was designed for failure or because some people high up--who can't be touched--made cynical decisions. No, no easy answers. No neat solutions.
posted by paddbear at 6:54 AM on August 28, 2009 [2 favorites]
This is particularly important as health officials are now weighing, with little public discussion and insufficient scientific evidence, protocols for making the kind of agonizing decisions that will, no doubt, arise again.
Wow. I can't believe the NY Times is repeating that Death Panel bullshit in such an underhanded way. Unbelievable. Shame on them.
I did not read it that way at all but rather as the agonizing decisions that will rise again when an earthquake devastates California or a tsunami swamps Florida or the killer flu lays waste to the entire country. If nothing else, the in-depth study of what exactly happened in the aftermath of Katrina should give medical staff a better idea of what can and does go wrong during an emergency situation of such epic proportions so that better protocol standards can be written, taught, and understood.
posted by Secret Life of Gravy at 6:59 AM on August 28, 2009 [1 favorite]
Wow. I can't believe the NY Times is repeating that Death Panel bullshit in such an underhanded way. Unbelievable. Shame on them.
I did not read it that way at all but rather as the agonizing decisions that will rise again when an earthquake devastates California or a tsunami swamps Florida or the killer flu lays waste to the entire country. If nothing else, the in-depth study of what exactly happened in the aftermath of Katrina should give medical staff a better idea of what can and does go wrong during an emergency situation of such epic proportions so that better protocol standards can be written, taught, and understood.
posted by Secret Life of Gravy at 6:59 AM on August 28, 2009 [1 favorite]
Here's a livejournal account of RN at a different hospital in NOLA. Scroll through her entries for the whole 5 days she was there.
I find this whole thing impossible to pass judgement on as a casual outsider. I can only hope that the people who do have to sort through the documentation, interview families and healthcare workers can then somehow make a proper moral decision that can lead to some additional healing for those involved as well as the community at large. That storm didn't just physically beat the area, it left behind a huge emotional wound that lingers.
Previous storms do teach preventative planning for the future. After Katrina and Tropical Storm Allison changes were made to the Texas Medical Center (a bowl that flooded during Allison) that seemed to work well during Ike where I worked the hurricane in a hospital. We didn't flood or loose electricity this time. Clean water was available most of the time.
All the same people got weird in there. It was 4 days locked in behind huge metal flood gates - the line between work and the rest of your life was completely obliterated. The rest of the world went on. You don't know what's going on with your family outside because there's no way to communicate with them. People got claustrophobic really fast. The isolation was confusing. Traumatic things happen. Patients still got sicker. Projectiles from nearby construction hit the buildings like we were a pin cushion. Eventually we were able to text people outside and some would hear just a little about a damaged home or injured relative. It sucked. And this was a hospital with lots of financial support, State and private, and an hour inland away from the coastal impact.
I cannot imagine how hellish it could get without electricity and water. Blame has to be further up the line. Where the financial decision was made to not move generators out of basements or whatever. Egypternash's inability to put it into words is infinitely eloquent to me.
And I LOATHE Barbara Bush for her comments at the Astrodome and her inability to even vaguely comprehend why they were offensive.
posted by dog food sugar at 7:22 AM on August 28, 2009 [14 favorites]
I find this whole thing impossible to pass judgement on as a casual outsider. I can only hope that the people who do have to sort through the documentation, interview families and healthcare workers can then somehow make a proper moral decision that can lead to some additional healing for those involved as well as the community at large. That storm didn't just physically beat the area, it left behind a huge emotional wound that lingers.
Previous storms do teach preventative planning for the future. After Katrina and Tropical Storm Allison changes were made to the Texas Medical Center (a bowl that flooded during Allison) that seemed to work well during Ike where I worked the hurricane in a hospital. We didn't flood or loose electricity this time. Clean water was available most of the time.
All the same people got weird in there. It was 4 days locked in behind huge metal flood gates - the line between work and the rest of your life was completely obliterated. The rest of the world went on. You don't know what's going on with your family outside because there's no way to communicate with them. People got claustrophobic really fast. The isolation was confusing. Traumatic things happen. Patients still got sicker. Projectiles from nearby construction hit the buildings like we were a pin cushion. Eventually we were able to text people outside and some would hear just a little about a damaged home or injured relative. It sucked. And this was a hospital with lots of financial support, State and private, and an hour inland away from the coastal impact.
I cannot imagine how hellish it could get without electricity and water. Blame has to be further up the line. Where the financial decision was made to not move generators out of basements or whatever. Egypternash's inability to put it into words is infinitely eloquent to me.
And I LOATHE Barbara Bush for her comments at the Astrodome and her inability to even vaguely comprehend why they were offensive.
posted by dog food sugar at 7:22 AM on August 28, 2009 [14 favorites]
They failed utterly at their responsibilities, made horribly stupid decisions and deliberately killed people not at the peak of the crisis but near it's end.
When your supply lines are cut, they're cut. There is no peak crisis - it's a progressive downward slide into oblivion. Every hour is the new darkest hour and if you don't know when relief is coming there's just a continuously growing peak. I'm sure if these guys could have saved the game and reloaded it five or ten times, they'd have done things differently. If you want to be outraged, ask why there weren't a couple LHA or LPDs (like maybe this one) sitting in the Gulf with a continuous dotted line of helicopters going to places like this hospital 15 minutes after the trailing edge of the storm passed.
The correct response to this story is to look at what these people did and beg God that you never find yourself in anything resembling their shoes, not figure that, with your superior machomancy, it would have been no worse than that one year at summer camp when it rained a lot.
posted by Kid Charlemagne at 7:22 AM on August 28, 2009 [17 favorites]
When your supply lines are cut, they're cut. There is no peak crisis - it's a progressive downward slide into oblivion. Every hour is the new darkest hour and if you don't know when relief is coming there's just a continuously growing peak. I'm sure if these guys could have saved the game and reloaded it five or ten times, they'd have done things differently. If you want to be outraged, ask why there weren't a couple LHA or LPDs (like maybe this one) sitting in the Gulf with a continuous dotted line of helicopters going to places like this hospital 15 minutes after the trailing edge of the storm passed.
The correct response to this story is to look at what these people did and beg God that you never find yourself in anything resembling their shoes, not figure that, with your superior machomancy, it would have been no worse than that one year at summer camp when it rained a lot.
posted by Kid Charlemagne at 7:22 AM on August 28, 2009 [17 favorites]
In this level of disaster you come to understans that there are, generally, no good decisions. Rather, there are bad decisions of varying degrees. The doctors are dealing with, in real time, something usually confined to Philosophy 101 classes. Reality vs. Theory. Their reality was; no AC, limited inaccurate information, every staff person working under terrible mind numbing stress, fearing for their own safety, fearing for their incommunicado friends and family and finally the rising number or dead and near dead. They had to "force" structure into the chaos. Had to. The alternative would have been worse, in my opinion.
In sum: These were tough decisions made under duress. The logic model may seem cold and the circumstances easier to understand 4 years later from our informed vantage point but the people who lived/worked through it did the best work that they could.
posted by zerobyproxy at 7:23 AM on August 28, 2009 [3 favorites]
In sum: These were tough decisions made under duress. The logic model may seem cold and the circumstances easier to understand 4 years later from our informed vantage point but the people who lived/worked through it did the best work that they could.
posted by zerobyproxy at 7:23 AM on August 28, 2009 [3 favorites]
I thought it was clear from the story that some of the patients they killed were not terminal. I don't see how what they did to Everett, especially, is excusable and am surprised people still think these folks are saints, heroes, etc. after reading this.
Given the circumstances and the failures all the way up the chain (the gov't, the hospital's lack of disaster preparedness, no triage training, the mental effects of lack of sleep, stress, and fear on the doctors and nurses), I don't think Pou et al are necessarily criminal, but I think it's incredibly disturbing that she is involved in setting policy and making law for future situations like this. While her perspective could be useful if she were honest about what she did, my impression from the article is that she continues to state that she didn't kill/euthanize anyone and holds herself out as an example to others.
posted by Mavri at 8:22 AM on August 28, 2009 [4 favorites]
Given the circumstances and the failures all the way up the chain (the gov't, the hospital's lack of disaster preparedness, no triage training, the mental effects of lack of sleep, stress, and fear on the doctors and nurses), I don't think Pou et al are necessarily criminal, but I think it's incredibly disturbing that she is involved in setting policy and making law for future situations like this. While her perspective could be useful if she were honest about what she did, my impression from the article is that she continues to state that she didn't kill/euthanize anyone and holds herself out as an example to others.
posted by Mavri at 8:22 AM on August 28, 2009 [4 favorites]
I have to preface this by saying that I am for assisted suicide, allowing people to die, and so forth.
I can't help but wonder if these people aren't the Katrina scapegoats — this is the point at which people most obviously died by the direct action of another person in close proximity. These are not intangibles, like poverty, or accidents, like drowning. This is the event at which you can point your finger and say "This person stopped that person's respiration."
The problem with that approach is that these folks would never have had to make those terrible decisions were they not on the ass-end of a series of very, very poor decisions by others, from the folks who maintain the levees to Heck of a Job, Brownie. In the calculus of apportioning blame, I would tend to put more of it higher up.
In that situation, I probably would have euthanized those patients, too, but I might have also saved the last injection for myself.
posted by adipocere at 8:38 AM on August 28, 2009 [3 favorites]
I can't help but wonder if these people aren't the Katrina scapegoats — this is the point at which people most obviously died by the direct action of another person in close proximity. These are not intangibles, like poverty, or accidents, like drowning. This is the event at which you can point your finger and say "This person stopped that person's respiration."
The problem with that approach is that these folks would never have had to make those terrible decisions were they not on the ass-end of a series of very, very poor decisions by others, from the folks who maintain the levees to Heck of a Job, Brownie. In the calculus of apportioning blame, I would tend to put more of it higher up.
In that situation, I probably would have euthanized those patients, too, but I might have also saved the last injection for myself.
posted by adipocere at 8:38 AM on August 28, 2009 [3 favorites]
How many hospitals are trained to deal with battlefield conditions?
At about 2 a.m. on Wednesday, Aug. 31 — nearly 48 hours after Katrina made landfall near New Orleans — Memorial’s backup generators sputtered and stopped… In LifeCare on the seventh floor, critically ill patients began suffering the consequences…posted by noway at 8:40 AM on August 28, 2009 [1 favorite]
The sun rose and with it the sultry New Orleans temperature, which was on its way to the mid-90s. The hospital was stifling, its walls sweating. Water had stopped flowing from taps, toilets were backed up and the stench of sewage mixed with the odor of hundreds of unwashed bodies…
Pou and her colleagues had little if any training in triage systems and were not guided by any particular triage protocol…
“You can’t do this!” King shouted at Goux. “You gotta help people!” But the family was turned away.
King was out of touch with reality, Cook told me he thought at the time. Memorial wasn’t so much a hospital anymore but a shelter that was running out of supplies and needed to be emptied. Cook also worried that intruders from the neighborhood might ransack the hospital for drugs and people’s valuables.
I am a physician in Houston. I was stuck in a hospital at the med ctr for both Allison and Ike. Allison was horrible, because the generators were in the basement and went out immediately, Ike almost as bad but the electric stayed on. I have given alot of $$$ to Dr. Pou for her defense.
On paper, what Dr. Pou did sounds gruesome. But I have been in situations maybe 1/10 of the level that she went through. I know Dr. Pou, and she is truly one of the best and brightest in the medical field. She is a patient advocate. The decisions she made during Katrina *under the circumstances* IMO were appropriate and with the patients' best interests. Just because someone had a DNR did not mean that they were disregarded. For example, I have a DNR prepared for an unforeseeable situation, though I am a healthy man. The 'DNRs' who were given a painless end were not healthy like me. A dialysis patient who is weeks away from obtaining dialysis and will likely die painfully was an example of one of the 'euthanized'.
It breaks my spirit to see this Monday morning quarterbacking on what these medical professionals should have done. Dr. Pou is not a monster. She is anything but that. She is not only brilliant, but has an amazing stamina and work ethic that she brings to her profession. I am awed by her, personally.
I ask that before you judge her or the other medical workers involved during Katrina, that you try to understand the unreal circumstances that they were presented with. New Orleans during the most sweltering part of the summer is hard to live through, then cut out electricity and any sense of a rescue effort (Where exactly WAS Brownie during the first few days?!)
I stand by Dr. Pou now, as I did then. She is not a hero for her actions, but she is the epitome of someone I want in charge of a situation like this. She did her best and used her best judgment. Please keep this in your consideration of her and fellow workers during this crisis.
posted by WilliamMD at 8:46 AM on August 28, 2009 [46 favorites]
On paper, what Dr. Pou did sounds gruesome. But I have been in situations maybe 1/10 of the level that she went through. I know Dr. Pou, and she is truly one of the best and brightest in the medical field. She is a patient advocate. The decisions she made during Katrina *under the circumstances* IMO were appropriate and with the patients' best interests. Just because someone had a DNR did not mean that they were disregarded. For example, I have a DNR prepared for an unforeseeable situation, though I am a healthy man. The 'DNRs' who were given a painless end were not healthy like me. A dialysis patient who is weeks away from obtaining dialysis and will likely die painfully was an example of one of the 'euthanized'.
It breaks my spirit to see this Monday morning quarterbacking on what these medical professionals should have done. Dr. Pou is not a monster. She is anything but that. She is not only brilliant, but has an amazing stamina and work ethic that she brings to her profession. I am awed by her, personally.
I ask that before you judge her or the other medical workers involved during Katrina, that you try to understand the unreal circumstances that they were presented with. New Orleans during the most sweltering part of the summer is hard to live through, then cut out electricity and any sense of a rescue effort (Where exactly WAS Brownie during the first few days?!)
I stand by Dr. Pou now, as I did then. She is not a hero for her actions, but she is the epitome of someone I want in charge of a situation like this. She did her best and used her best judgment. Please keep this in your consideration of her and fellow workers during this crisis.
posted by WilliamMD at 8:46 AM on August 28, 2009 [46 favorites]
Dr. Pou did an incredibly compassionate thing. Instead of turning away (like so many Americans did) and leaving these people to die slowly and painfully, she allowed them at least the dignity of a quiet death. Good for her. I hope the families of her "victims" can see this some day.
posted by oinopaponton at 8:53 AM on August 28, 2009 [2 favorites]
posted by oinopaponton at 8:53 AM on August 28, 2009 [2 favorites]
I guess, what I don't understand, is why people are going after the doctors who were faced with the kind of hellish situation that nobody EVER wants to find themselves enduring, let alone having to make difficult decisions about life and death and care options in the face of a completely collapsed system. Why are they not going after the administration of the hospital, who failed utterly and completely to have any plans in place at all for dealing with floods and power outages and necessary helicopter transport evacuations of patients? THOSE are the people who need to be sued to within an inch of their existence. Am I missing some legal nonsense which protects them?
posted by hippybear at 9:17 AM on August 28, 2009 [2 favorites]
posted by hippybear at 9:17 AM on August 28, 2009 [2 favorites]
They killed a man who would have survived, but was too heavy for them to move.
But they also wouldn't let a group of young, stronger men in the hospital, who could have helped move heavier patients, because they were scary (aka black and from the ghetto).
This was racism/prejudice, and murder.
posted by jb at 9:19 AM on August 28, 2009 [7 favorites]
But they also wouldn't let a group of young, stronger men in the hospital, who could have helped move heavier patients, because they were scary (aka black and from the ghetto).
This was racism/prejudice, and murder.
posted by jb at 9:19 AM on August 28, 2009 [7 favorites]
I got halfway though his article on BART and had to stop with tears in my eyes. It didn't help that it was the 1 year anniversary of my step-dad's death in a hospital while I held his hand.
The rest of the article may end up changing my mind but I'm having trouble putting too much blame on the line level people.
Everybody else with real power to save people in this process cut and run or failed hopelessly in the planning process. If we can save Berlin with an air drop, if we can hand carry pallets of 100$ bills to Bagdad, we can save 100 people in a hospital in New Orleans.
Hearing about a nurse hand bagging someone and staying with them until they died just breaks my heart that we put her in that situation.
Living in San Francisco I hope that everyone involved with emergency planning in the case of an earthquake read this article and it kept them up all night last night.
posted by bottlebrushtree at 9:21 AM on August 28, 2009
The rest of the article may end up changing my mind but I'm having trouble putting too much blame on the line level people.
Everybody else with real power to save people in this process cut and run or failed hopelessly in the planning process. If we can save Berlin with an air drop, if we can hand carry pallets of 100$ bills to Bagdad, we can save 100 people in a hospital in New Orleans.
Hearing about a nurse hand bagging someone and staying with them until they died just breaks my heart that we put her in that situation.
Living in San Francisco I hope that everyone involved with emergency planning in the case of an earthquake read this article and it kept them up all night last night.
posted by bottlebrushtree at 9:21 AM on August 28, 2009
Was it triage or murder?
Having read the article I'd say that yes, it was triage or murder.
Seriously, I'd say some lines were crossed, specifically with the guy who begged several times not to be left behind and was then given "something to help him with his dizziness."
posted by infinitywaltz at 9:27 AM on August 28, 2009 [1 favorite]
Having read the article I'd say that yes, it was triage or murder.
Seriously, I'd say some lines were crossed, specifically with the guy who begged several times not to be left behind and was then given "something to help him with his dizziness."
posted by infinitywaltz at 9:27 AM on August 28, 2009 [1 favorite]
And I LOATHE Barbara Bush for her comments at the Astrodome and her inability to even vaguely comprehend why they were offensive.
She will always be "The Silver D-bag" in my eyes for her complete insensitivity.
posted by porn in the woods at 9:37 AM on August 28, 2009 [1 favorite]
She will always be "The Silver D-bag" in my eyes for her complete insensitivity.
posted by porn in the woods at 9:37 AM on August 28, 2009 [1 favorite]
If I ever end up expectant in a mass-casualty incident that completely overwhelms the medical facilities near me, I hope to whatever gods are out there that some corpsman can spare the time and morphine to do what these doctors and nurses did. My family can think what they want, but that corpsman would be a hero to me for a few less-painful minutes.
That's fine. We should develop some sort of modified DNR order you can sign that will volunteer you for morphine and put you at the back of the line for evacuation in the event of a disaster. Personally, I'll take the choppers. Thanks.
posted by Slap Factory at 9:44 AM on August 28, 2009 [1 favorite]
That's fine. We should develop some sort of modified DNR order you can sign that will volunteer you for morphine and put you at the back of the line for evacuation in the event of a disaster. Personally, I'll take the choppers. Thanks.
posted by Slap Factory at 9:44 AM on August 28, 2009 [1 favorite]
On second thought, the NYT article suggests that any un-modified DNR order would do the trick.
posted by Slap Factory at 9:48 AM on August 28, 2009
posted by Slap Factory at 9:48 AM on August 28, 2009
Four years on, Katrina remains cursed by rumour, cliche, lies and racism: Ordinary people mostly behaved well. Those in power panicked, spread fear and fiction, and showed eagerness to kill
posted by Artw at 9:52 AM on August 28, 2009 [2 favorites]
posted by Artw at 9:52 AM on August 28, 2009 [2 favorites]
Dr. Pou did an incredibly compassionate thing. Instead of turning away (like so many Americans did) and leaving these people to die slowly and painfully, she allowed them at least the dignity of a quiet death.
How does this apply to the patient(s) who were not terminal? How does this apply to Everett?
The decisions she made during Katrina *under the circumstances* IMO were appropriate and with the patients' best interests.
Again, how? I really don't understand how killing Everett b/c they thought he was too heavy to move was in his best interests. Some of the others seemed similarly questionable, but his case was egregious.
I agree that they went through hell, and I agree that they couldn't save everyone, and I even agree that euthanasia might have been appropriate in some cases. It's tragic and heartbreaking to read about the nurse who had to hold that man's hand when they couldn't bag him anymore. But I just can't see how to excuse some of the choices they made with regard to who should be killed.
This was racism/prejudice.
This is the big issue that isn't really addressed in the article.
posted by Mavri at 9:59 AM on August 28, 2009 [4 favorites]
How does this apply to the patient(s) who were not terminal? How does this apply to Everett?
The decisions she made during Katrina *under the circumstances* IMO were appropriate and with the patients' best interests.
Again, how? I really don't understand how killing Everett b/c they thought he was too heavy to move was in his best interests. Some of the others seemed similarly questionable, but his case was egregious.
I agree that they went through hell, and I agree that they couldn't save everyone, and I even agree that euthanasia might have been appropriate in some cases. It's tragic and heartbreaking to read about the nurse who had to hold that man's hand when they couldn't bag him anymore. But I just can't see how to excuse some of the choices they made with regard to who should be killed.
This was racism/prejudice.
This is the big issue that isn't really addressed in the article.
posted by Mavri at 9:59 AM on August 28, 2009 [4 favorites]
I live in New Orleans. Two of my children were born in Memorial, one of them less than five weeks before Katrina. We personally knew some of the medical staff that remained through the disaster and heard from them afterwards their accounts of what it was like.
The author claims to have access to previously unknown information. She invites you to forget the fact that even a grand jury wouldn’t even indict, but that instead, only she has the real story. This is simply not true. Her account is built largely around information of people who would not speak to her, and instead what those people allegedly stated as set forth in the AG’s affidavit.
For example, with regard to Therese Mendez, Cheri Landry, and Lori Budro (the nurses upon whose accounts the author heavily relies), the DA cut a deal with them that he would not indict them in return for their cooperation against Pou. Although the grand jury testimony is secret, these nurses’ allegations were certainly before the grand jury because the investigator from the AG office gave an affidavit based in part on what they said. The author even notes that none of these nurses would speak to her, so the author’s account of what they had to say came entirely from the AG’s allegations.
Who else gave the AG’s office the information as set forth in the affidavit behind the second degree murder charge? Employees of LifeCare. LifeCare had abandoned its patients on the seventh floor, which is why Memorial personnel (including Pou) were involved in the first place. In addition to avoiding their own personal prosecutions, LifeCare & its employees have considerable interest in putting the black hat on Memorial.
The author has an interview with Dr. Ewing Cook, who had no first hand knowledge of anything that happened in the LifeCare ward but who readily stated to the author his opinion that euthanasia would have been just fine.
The author breezily asserts that “Despite all the expert determinations of homicide, [the coroner] was still struggling with what to tell the grand jury.” This is pure garbage. “All the expert determinations of homicide” is postulated as a given when that was a serious issue in dispute, something the author deliberately conceals. The reason that the grand jury wouldn’t even indict is because the overwhelming medical evidence was that the combination of morphine and midazolam did not suggest homicide. They are commonly mixed palliatives, commonly given by doctors to end-of-life patients for the purpose of relieving pain and trauma even in non-emergency settings, even while knowing that a potential adverse side effect is death. In fact, many agree that a mix of morphine & midazolam would be a very unreliable way of inducing death. Another doctor on the premises (Dr. Roy Culotta) also gave morphine & midazolam to help ease other LifeCare patients’ pain and distress after the power on their ventilators went off. They all survived. No “euthanasia” either intended or resulted.
The author inscribes motives all over the coroner, basically outright saying that he knew Pou was a killer but that putting her on trial would be bad for the city. In fact, the determination of “homicide” rested on the analysis of Dr. Cyril Wecht, a media personality who can be reliably counted upon to give a verdict of “intentional fatal overdose” in high profile cases. He operates a private forensic consulting business, and was indicted for using the public resources available to him as a county coroner in Pennsylvania in connection with his for-profit consulting business of giving medical opinions in favor of prosecutions. The author instead chooses to drag Frank Minyard's good faith through the mud.
The only really new thing the author adds to the facts that have been long-known is the account of Dr. John Thiele. He basically says that he was in the room and he participated and it was intentional murder. She says that he has never before discussed his Katrina experiences… except that he actually has, repeatedly. This is the first we’ve heard him make statements like this, however. I’m looking forward to some followup with regard to Dr. Thiele, but the rest of the article is a propaganda piece.
If your first knowledge of this story comes from this New York Times piece, you may not understand the unbelievable amount of spin that has been put into this article. The choice of little details thrown in to cast certain characters in a certain light, the narrative juxtaposition of dying patients with non-chalant recollections by the doctors in charge. If I taught a journalism class, I would hold this article up as a wonderful example of how to shade facts, assume the truth of disputed matters, and construct narrative to lead your readers to agree with your own conclusions.
posted by chicxulub at 9:59 AM on August 28, 2009 [42 favorites]
The author claims to have access to previously unknown information. She invites you to forget the fact that even a grand jury wouldn’t even indict, but that instead, only she has the real story. This is simply not true. Her account is built largely around information of people who would not speak to her, and instead what those people allegedly stated as set forth in the AG’s affidavit.
For example, with regard to Therese Mendez, Cheri Landry, and Lori Budro (the nurses upon whose accounts the author heavily relies), the DA cut a deal with them that he would not indict them in return for their cooperation against Pou. Although the grand jury testimony is secret, these nurses’ allegations were certainly before the grand jury because the investigator from the AG office gave an affidavit based in part on what they said. The author even notes that none of these nurses would speak to her, so the author’s account of what they had to say came entirely from the AG’s allegations.
Who else gave the AG’s office the information as set forth in the affidavit behind the second degree murder charge? Employees of LifeCare. LifeCare had abandoned its patients on the seventh floor, which is why Memorial personnel (including Pou) were involved in the first place. In addition to avoiding their own personal prosecutions, LifeCare & its employees have considerable interest in putting the black hat on Memorial.
The author has an interview with Dr. Ewing Cook, who had no first hand knowledge of anything that happened in the LifeCare ward but who readily stated to the author his opinion that euthanasia would have been just fine.
The author breezily asserts that “Despite all the expert determinations of homicide, [the coroner] was still struggling with what to tell the grand jury.” This is pure garbage. “All the expert determinations of homicide” is postulated as a given when that was a serious issue in dispute, something the author deliberately conceals. The reason that the grand jury wouldn’t even indict is because the overwhelming medical evidence was that the combination of morphine and midazolam did not suggest homicide. They are commonly mixed palliatives, commonly given by doctors to end-of-life patients for the purpose of relieving pain and trauma even in non-emergency settings, even while knowing that a potential adverse side effect is death. In fact, many agree that a mix of morphine & midazolam would be a very unreliable way of inducing death. Another doctor on the premises (Dr. Roy Culotta) also gave morphine & midazolam to help ease other LifeCare patients’ pain and distress after the power on their ventilators went off. They all survived. No “euthanasia” either intended or resulted.
The author inscribes motives all over the coroner, basically outright saying that he knew Pou was a killer but that putting her on trial would be bad for the city. In fact, the determination of “homicide” rested on the analysis of Dr. Cyril Wecht, a media personality who can be reliably counted upon to give a verdict of “intentional fatal overdose” in high profile cases. He operates a private forensic consulting business, and was indicted for using the public resources available to him as a county coroner in Pennsylvania in connection with his for-profit consulting business of giving medical opinions in favor of prosecutions. The author instead chooses to drag Frank Minyard's good faith through the mud.
The only really new thing the author adds to the facts that have been long-known is the account of Dr. John Thiele. He basically says that he was in the room and he participated and it was intentional murder. She says that he has never before discussed his Katrina experiences… except that he actually has, repeatedly. This is the first we’ve heard him make statements like this, however. I’m looking forward to some followup with regard to Dr. Thiele, but the rest of the article is a propaganda piece.
If your first knowledge of this story comes from this New York Times piece, you may not understand the unbelievable amount of spin that has been put into this article. The choice of little details thrown in to cast certain characters in a certain light, the narrative juxtaposition of dying patients with non-chalant recollections by the doctors in charge. If I taught a journalism class, I would hold this article up as a wonderful example of how to shade facts, assume the truth of disputed matters, and construct narrative to lead your readers to agree with your own conclusions.
posted by chicxulub at 9:59 AM on August 28, 2009 [42 favorites]
The people making these decisions had no idea how long they were going to be there. They did know that their ability to keep these patients alive was being limited almost hourly. The options seemed to be either leave patients alone to die without any more pain medication or someone to hold their hand (since the cops were saying that everyone had to be out and they would no longer protect from looters) - or to end that life compassionately.This would be well and good except for the cases that were not terminal and were aware and interacting with staff. How on earth are those situations considered compassionate? What about the fact that rescuers have said that they didn't even know about the existence of some of these people and they could have gotten more out? Those patients that were terminal, those patients whose lives depended completely on mechanical support -- those I can see as compassionate care. It is the cases that do not fit into that picture that concern me. What of the son who was told he couldn't take his mother in law out of the hospital? Mind you, she was in the "last to be rescued" group. It was assumed she wanted to die because she had a DNR. But, she'd had that DNR for decades. It only indicated what she wanted done in the event her heart or breathing stopped. Good on the son for ignoring the official seeming people's orders. Many people would have acquiesced. There also was an indication in the article (I'm not so sure was supported) that the doctors who made the decision to euthanize somehow had the misunderstanding that everyone in that unit was unconscious and that DNRs meant they were terminal. I find that misunderstanding concerning.
posted by Librarygeek at 10:46 AM on August 28, 2009 [1 favorite]
"He expected that the people firing guns into the chaos of New Orleans — ‘‘the animals,’’ he called them — would storm the hospital, looking for drugs after everyone else was gone. ‘‘I figured, What would they do, these crazy black people who think they’ve been oppressed for all these years by white people? I mean if they’re capable of shooting at somebody, why are they not capable of raping them or, or, you know, dismembering them? What’s to prevent them from doing things like that?’’"
I remember being (naively, I guess) surprised by how many people expected (and almost seemed like they welcomed) the outbreak of anarchy back when I was watching the media coverage of Katrina four years ago. If you expect things to go to hell, I imagine this would predispose you to wanting to mercifully euthanize the sick and dying before the "animals" got to them. It seems more like the expectations of anarchy led to the breakout of anarchy in this particular situation, though.
posted by longdaysjourney at 10:56 AM on August 28, 2009
That would seem to be the crucial part of the background to this - see the Guardian link above.
posted by Artw at 11:11 AM on August 28, 2009 [1 favorite]
posted by Artw at 11:11 AM on August 28, 2009 [1 favorite]
Thanks for interesting points brought up in the discussion (first FPP). I was quite tired when I posted this last night, and apologize for the rather linkbaity titling and lack of contextual linkage.
posted by anigbrowl at 11:13 AM on August 28, 2009
posted by anigbrowl at 11:13 AM on August 28, 2009
I remember being (naively, I guess) surprised by how many people expected (and almost seemed like they welcomed) the outbreak of anarchy back when I was watching the media coverage of Katrina four years ago.
For years the right wing, particularly the southern right wing, has been pushing just that as an scenario to back their Second Amendment rights.
I believe this is projection. I think that if a disaster of similar magnitude happened in, say, Texas, there would be wide-spread civil disorder and hundreds of murders.
posted by lupus_yonderboy at 11:39 AM on August 28, 2009
For years the right wing, particularly the southern right wing, has been pushing just that as an scenario to back their Second Amendment rights.
I believe this is projection. I think that if a disaster of similar magnitude happened in, say, Texas, there would be wide-spread civil disorder and hundreds of murders.
posted by lupus_yonderboy at 11:39 AM on August 28, 2009
I'm having trouble with the responses in this thread. If the article is truly and grossly misleading than that's one thing. But, if that doctor, or any doctor knowingly lied to patients telling them she was doing something for their dizziness because they weren't positive they could evacuate them? If the man who was ASKING to be saved and not left behind who was completely awake and alert was injected because he was fat and sick, but not dying? Any person who was alert and awake and unable to be saved should have been given the button (or syringe) but NO ONE should have pressed that button for them without their consent.
I'm not against euthanasia or helping dying people in a crisis or anything, and I obviously wasn't there to know the exact situation. But if those facts are as laid out in the article than it wasn't just homicide in some cases, it was probably murder.
posted by haveanicesummer at 11:41 AM on August 28, 2009 [3 favorites]
I'm not against euthanasia or helping dying people in a crisis or anything, and I obviously wasn't there to know the exact situation. But if those facts are as laid out in the article than it wasn't just homicide in some cases, it was probably murder.
posted by haveanicesummer at 11:41 AM on August 28, 2009 [3 favorites]
I think a fair argument could be made that FOX and other news networks killed those patients.
posted by Artw at 11:42 AM on August 28, 2009 [4 favorites]
posted by Artw at 11:42 AM on August 28, 2009 [4 favorites]
And regarding the center of the article - it's hard to fully condone all the doctors' decisions, but I'd have to say that I truly believe that they were attempting to do the "best thing possible" and the fact that they committed what might have been errors of judgement was because they were temporarily driven into extreme mental states by the unremitting horror.
The responsibility for these preventable deaths lies entirely at the foot of the Bush government in general and the Department of Homeland Security in specific. No one should ever forget that. Blaming these poor doctors, who are victims under any reasonable interpretation of the events, is simply unfair.
posted by lupus_yonderboy at 11:46 AM on August 28, 2009 [2 favorites]
The responsibility for these preventable deaths lies entirely at the foot of the Bush government in general and the Department of Homeland Security in specific. No one should ever forget that. Blaming these poor doctors, who are victims under any reasonable interpretation of the events, is simply unfair.
posted by lupus_yonderboy at 11:46 AM on August 28, 2009 [2 favorites]
This would be well and good except for the cases that were not terminal and were aware and interacting with staff.
Seriously. If a person has capacity to make decisions about their own medical care, then they're supposed to make those decisions themselves. Some of the people killed were conscious and asking for help. Maybe the decision should have been put to them directly--do you want to risk dying here alone waiting for rescue or die a peaceful death right now? It wasn't the doctors' or nurses' jobs to answer that question. Maybe Mr. Everett would have been willing to take the risk that "these crazy black people who think they’ve been oppressed for all these years by white people" would come and do terrible things to him. Maybe he'd have been rescued.
In fact, the determination of “homicide” rested on the analysis of Dr. Cyril Wecht, a media personality who can be reliably counted upon to give a verdict of “intentional fatal overdose” in high profile cases.
What about all the other doctors who were consulted and agreed that some of the cases were homicides? The story may be spun, but are you saying that it's untrue that Minyard consulted three additional doctors after the group that included Wecht (and Minyard and two other doctors) made their homicide determinations?
posted by Mavri at 11:51 AM on August 28, 2009 [1 favorite]
Seriously. If a person has capacity to make decisions about their own medical care, then they're supposed to make those decisions themselves. Some of the people killed were conscious and asking for help. Maybe the decision should have been put to them directly--do you want to risk dying here alone waiting for rescue or die a peaceful death right now? It wasn't the doctors' or nurses' jobs to answer that question. Maybe Mr. Everett would have been willing to take the risk that "these crazy black people who think they’ve been oppressed for all these years by white people" would come and do terrible things to him. Maybe he'd have been rescued.
In fact, the determination of “homicide” rested on the analysis of Dr. Cyril Wecht, a media personality who can be reliably counted upon to give a verdict of “intentional fatal overdose” in high profile cases.
What about all the other doctors who were consulted and agreed that some of the cases were homicides? The story may be spun, but are you saying that it's untrue that Minyard consulted three additional doctors after the group that included Wecht (and Minyard and two other doctors) made their homicide determinations?
posted by Mavri at 11:51 AM on August 28, 2009 [1 favorite]
The lesson I take from this is that hospitals need a standardized triage procedure in place for emergencies.
Those who were in fairly good health and could sit up or walk would be categorized “1’s” and prioritized first for evacuation. Those who were sicker and would need more assistance were “2’s.” A final group of patients were assigned “3’s” and were slated to be evacuated last. That group included those whom doctors judged to be very ill and also, as doctors agreed the day before, those with D.N.R. orders.
This is just ass-backwards. If they'd taken the 3's first, this would be an article about a bunch of bored, healthy people sitting around a hospital. Interpreting a DNR order to mean "not worth saving" is the other huge mistake here.
posted by designbot at 12:07 PM on August 28, 2009 [2 favorites]
Those who were in fairly good health and could sit up or walk would be categorized “1’s” and prioritized first for evacuation. Those who were sicker and would need more assistance were “2’s.” A final group of patients were assigned “3’s” and were slated to be evacuated last. That group included those whom doctors judged to be very ill and also, as doctors agreed the day before, those with D.N.R. orders.
This is just ass-backwards. If they'd taken the 3's first, this would be an article about a bunch of bored, healthy people sitting around a hospital. Interpreting a DNR order to mean "not worth saving" is the other huge mistake here.
posted by designbot at 12:07 PM on August 28, 2009 [2 favorites]
How many hospitals are trained to deal with battlefield conditions?
One would hope all of them, considering what a hospital is. I mean, of all possible facilities that you'd think would be prepared for a disastrous event...
But clearly not.
posted by rokusan at 12:07 PM on August 28, 2009
One would hope all of them, considering what a hospital is. I mean, of all possible facilities that you'd think would be prepared for a disastrous event...
But clearly not.
posted by rokusan at 12:07 PM on August 28, 2009
WRT people's concerns about Monday-morning quarterbacking:
I think it's entirely fair to point out that nobody commenting in this thread (at least as of yet) was actually there, and as such, can't speak to the exact circumstances or chain of events, let alone what they would've done in the same situation.
That said, I don't think that precludes a conversation about the ethical implications of what happened. Much as it's important for medical centers to establish thorough and clear guidelines for action in a crisis, well before they're actually in a crisis, I think it's also important for individuals, as patients and family members, to figure out where they stand when it comes to life-saving measures.
I'm young and (knock on wood) don't have much of a reason to worry about whether or not I want to sign a DNR right now. That doesn't mean I shouldn't start thinking about it (and try to understand the real-world implications of my decision), so that when the time comes, I'll have some idea of how to approach the question.
posted by evidenceofabsence at 12:44 PM on August 28, 2009
I think it's entirely fair to point out that nobody commenting in this thread (at least as of yet) was actually there, and as such, can't speak to the exact circumstances or chain of events, let alone what they would've done in the same situation.
That said, I don't think that precludes a conversation about the ethical implications of what happened. Much as it's important for medical centers to establish thorough and clear guidelines for action in a crisis, well before they're actually in a crisis, I think it's also important for individuals, as patients and family members, to figure out where they stand when it comes to life-saving measures.
I'm young and (knock on wood) don't have much of a reason to worry about whether or not I want to sign a DNR right now. That doesn't mean I shouldn't start thinking about it (and try to understand the real-world implications of my decision), so that when the time comes, I'll have some idea of how to approach the question.
posted by evidenceofabsence at 12:44 PM on August 28, 2009
i once worked as a nurse's aide in a nursing home, and witnessed the use of morphine to hasten the death of a woman in the last stages of MS. she was in horrific pain, and i remember feeling quite sure it was her wish.
this article though--provided it isn't profoundly skewed--does bother me quite a bit. i mean, yes. there were obviously some people who were on the edge of death. but the obese patients... the ones who were conscious, the ones who were not disclosed to the rescuers.... this was bad. i understand the situation was dire, and that they were in a horrific situation. but sleep deprivation and racial fear played a role in what happened as well.
posted by RedEmma at 12:50 PM on August 28, 2009
this article though--provided it isn't profoundly skewed--does bother me quite a bit. i mean, yes. there were obviously some people who were on the edge of death. but the obese patients... the ones who were conscious, the ones who were not disclosed to the rescuers.... this was bad. i understand the situation was dire, and that they were in a horrific situation. but sleep deprivation and racial fear played a role in what happened as well.
posted by RedEmma at 12:50 PM on August 28, 2009
Mavri,
The other doctors (all of whom are very high profile) consulted all shared the opinion that any presence of Versed (mizadolam) outside of use for surgical anaesthesia is a red flag indicator of foul play. I do not know what the greater weight of the medical community is on this but I do know that a very substantial number of medical professionals - including those present at Memorial (Dr. Roy Culotta) emphatically disagree with this.
Reviewing some of the comments posted in this thread, it appears the article has had the precise effect the author intended - i.e., many people now accept it as axiomatic that Dr. Pou administered medicine with the specific intent to cause death, and now instead grapple with the secondary question of whether the circumstances excuse this. In other words, people assume the truth of the very matter at the heart of the dispute.
Charles Foti is an absolute cowboy. He had Dr. Pou arrested by surprise while wearing her scrubs by a heavily armed team of men (naturally, with cameras flashing nearby). Foti immediately steps up to a pre-arranged CNN news conference with a splashy announcement. He was fairly contemptible as an attorney general in Louisiana and was looking at an election where his prospects were so bad he might not even make the runoff - even as an incumbent. Ergo a high-profile announcement like this. I don't believe that the fact he brought this case to begin with is any kind of prima facie evidence that the prosecution had any merit whatsoever.
posted by chicxulub at 1:08 PM on August 28, 2009 [4 favorites]
The other doctors (all of whom are very high profile) consulted all shared the opinion that any presence of Versed (mizadolam) outside of use for surgical anaesthesia is a red flag indicator of foul play. I do not know what the greater weight of the medical community is on this but I do know that a very substantial number of medical professionals - including those present at Memorial (Dr. Roy Culotta) emphatically disagree with this.
Reviewing some of the comments posted in this thread, it appears the article has had the precise effect the author intended - i.e., many people now accept it as axiomatic that Dr. Pou administered medicine with the specific intent to cause death, and now instead grapple with the secondary question of whether the circumstances excuse this. In other words, people assume the truth of the very matter at the heart of the dispute.
Charles Foti is an absolute cowboy. He had Dr. Pou arrested by surprise while wearing her scrubs by a heavily armed team of men (naturally, with cameras flashing nearby). Foti immediately steps up to a pre-arranged CNN news conference with a splashy announcement. He was fairly contemptible as an attorney general in Louisiana and was looking at an election where his prospects were so bad he might not even make the runoff - even as an incumbent. Ergo a high-profile announcement like this. I don't believe that the fact he brought this case to begin with is any kind of prima facie evidence that the prosecution had any merit whatsoever.
posted by chicxulub at 1:08 PM on August 28, 2009 [4 favorites]
For years the right wing, particularly the southern right wing, has been pushing just that as an scenario to back their Second Amendment rights.
I believe this is projection. I think that if a disaster of similar magnitude happened in, say, Texas, there would be wide-spread civil disorder and hundreds of murders.
Wow. And you actually think that you are in any meaningful way different from the people who expected the citizens of New Orleans to behave the same way?
posted by Dolukhanova at 1:19 PM on August 28, 2009 [3 favorites]
I'm willing, on balance, to give Dr. Pou the benefit of the doubt for the actions she took under extreme duress. But I am really really uncomfortable with her turning around and advocating for her makeshift triaging criteria to become the standard ones that other hospitals train their staff to use in the future. I think that she should certainly advocate for contingency plans existing, sure, but promoting the practice of treating DNRs as though they meant "Do not rescue" is just... icky.
posted by rivenwanderer at 1:49 PM on August 28, 2009 [2 favorites]
posted by rivenwanderer at 1:49 PM on August 28, 2009 [2 favorites]
She has said that informed consent is impossible during disasters and that doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have Do Not Resuscitate orders — an approach that she and her colleagues used as conditions worsened after Katrina.
Nobody is arguing that we should have a documented, formal informed consent process in the midst of a disaster. This isn't the way emergency care works. But it doesn't follow that the most well patients should be priority.
Dr. Pou and her colleagues made some poor decisions during the evacuation of their hospital. This situation was incomprehensibly bad and I think we can all cut earnest, caring people trying to do their best some slack.
But turning your poor decision-making in the midst of disaster into a new standard of care is bizarre and arrogant. She doesn't think she did anything wrong - fine. But how the fuck can she construe the outcome of those decisions as being effective? How can she think that the results of their backwards triage system indicate that others should adopt that approach? They ended up with more dead people than other hospitals. That's not what a best practice looks like.
posted by jeoc at 2:25 PM on August 28, 2009 [3 favorites]
Nobody is arguing that we should have a documented, formal informed consent process in the midst of a disaster. This isn't the way emergency care works. But it doesn't follow that the most well patients should be priority.
Dr. Pou and her colleagues made some poor decisions during the evacuation of their hospital. This situation was incomprehensibly bad and I think we can all cut earnest, caring people trying to do their best some slack.
But turning your poor decision-making in the midst of disaster into a new standard of care is bizarre and arrogant. She doesn't think she did anything wrong - fine. But how the fuck can she construe the outcome of those decisions as being effective? How can she think that the results of their backwards triage system indicate that others should adopt that approach? They ended up with more dead people than other hospitals. That's not what a best practice looks like.
posted by jeoc at 2:25 PM on August 28, 2009 [3 favorites]
I do not stand in judgment of these health care providers who were working under near-impossible circumstances. Saving lives is part of their job, but clearly they went far beyond the call of duty to save some of their patients.
But as an EMT and a nursing student, I still think what they did was wrong wrong wrongity wrong. Euthanizing a spinal cord-injured patient because he's too heavy? No. Not a gray area.
That man was not "black tagged". In fact, in the system of triage I was trained in, you basically need absent respirations to get a black tag.
I am glad to have read this, because one day I may be in a similar situation, and maybe something from this article will come back to me and stay my hand.
posted by molybdenumblue at 2:30 PM on August 28, 2009 [4 favorites]
But as an EMT and a nursing student, I still think what they did was wrong wrong wrongity wrong. Euthanizing a spinal cord-injured patient because he's too heavy? No. Not a gray area.
That man was not "black tagged". In fact, in the system of triage I was trained in, you basically need absent respirations to get a black tag.
I am glad to have read this, because one day I may be in a similar situation, and maybe something from this article will come back to me and stay my hand.
posted by molybdenumblue at 2:30 PM on August 28, 2009 [4 favorites]
At the risk of a derail: Rebecca Solnit, the author of the Guardian piece linked here, has a new book out looking at communal responses to disasters, including Katrina. She spoke about it on NPR here.
posted by foxy_hedgehog at 2:35 PM on August 28, 2009 [1 favorite]
posted by foxy_hedgehog at 2:35 PM on August 28, 2009 [1 favorite]
nyt;dr
From the comments, I probably learned a lot more anyway, and with less of a "yellow" tint to the screen.
Is the person that decided not to fix the levee being charged with hundreds of counts of murder? Didn't think so.
These people made hard choices. I don't think I'd want to be euthanized unless it was on my say so. Telling someone a fatal dose is for something else, goes against everything I believe in. But, some people might not be able to handle the truth of death, so maybe for them that would be the only way.
I am glad I have not had to make these kinds of choices, and that I have not had them second guessed in the cold light of political theater. This is old news, bringing it up now can only be to bolster the whole death panel thing. Ugh.
posted by Antidisestablishmentarianist at 2:45 PM on August 28, 2009
From the comments, I probably learned a lot more anyway, and with less of a "yellow" tint to the screen.
Is the person that decided not to fix the levee being charged with hundreds of counts of murder? Didn't think so.
These people made hard choices. I don't think I'd want to be euthanized unless it was on my say so. Telling someone a fatal dose is for something else, goes against everything I believe in. But, some people might not be able to handle the truth of death, so maybe for them that would be the only way.
I am glad I have not had to make these kinds of choices, and that I have not had them second guessed in the cold light of political theater. This is old news, bringing it up now can only be to bolster the whole death panel thing. Ugh.
posted by Antidisestablishmentarianist at 2:45 PM on August 28, 2009
knees flung akimbo was the name of my band in high school.
“I find this whole thing impossible to pass judgement on as a casual outsider.”
Yeah, that’s what does it for me. The newspaper says what it says, but we don’t really know for certain what happened there.
At the core of it is – what possible benefit would a medical practitioner have to callously euthanize a given patient?
I mean, you don’t go into medicine because of your racist beliefs or to quit on people when they need you. Maybe you might want to make money, but for the most part it’s an altruistic profession.
I see no reason why they would have done other than what they did do based on anything but what they thought best at the time. One can debate as a practical matter as to whether this was the best thing to do but that’s with the benefit of hindsight and without regard to the immediacy of the situation.
They are tough calls and ones best not second guessed by moral platitudes. One can consult another doctor and ask them – but again – that doctor wasn’t there in the situation making judgements from a variety of future scenarios – many of which included abandonment and many of which were completely plausible.
I’ve been trained to respond in mass casualty situations under battlefield conditions – it is not at all pretty. There are no ethical considerations that can cover the event – before the event. All the guidelines drop into pure practical when considerations of outside support are dropped. In some instances you save only who you can carry. I don’t even want to go in to the outline on radiation casualties. F'ing nightmare I hope never to endure.
There is a difference between medical practice and resource and support coordination. I’ve seen doctors do more with less than I could believe in conditions I didn’t think they could save any lives under. But under those circumstances I was part of the support (security) and had we not been there, it wouldn’t have happened. You’re not going to save anyone if you’re dead yourself.
On top of that, body disposal becomes a priority, that’s not going to happen without some manpower, evacuation becomes tougher as time goes on – so logical priority (at least in a war zone) should go to the ambulatory (in part, folks are less likely to shoot motionless wounded). Water is an interesting thing. It’s a tough resource to have limited. I’ve seen folks die of thirst. Pretty ugly. If I’m looking at three days without water to give them, or give them a shot now to avoid all that pain – tough call.
And I think what’s most critical is that lack of support. In the face of abandonment there can be no questions of ethics, only questions of survival.
The “though there was nothing in the orders that stated this” motif is reiterated throughout the piece – but again – how valid are any outside considerations if those outside forces have abandoned the area and withdrawn essential support. And this ‘playing God’ thing – yeah, uh, well he sent the f’ing hurricane didn’t he? And the government handed those doctors the right when it beached them.
Legality is a joke in those cases. Especially since - how can one lay claim to authority if one has abandoned any pretense of support?
(“We’d experienced the helicopters’ stopping flying to us”)
Furthermore, I think a moral imperative “you should…” loses all validity after the person in question hasn’t slept for 72 hours.
You can’t be expected to work yourself to death any more than you can give more blood than reasonable to patients. I think there was a very real sense that if the medical workers left they would be abandoning their patients. But if they stayed – conceivably would they have been stranded as well?
On the other side of that equation – one can’t base decisions on what one thinks might happen and claim they’re legitimate if they’re not purely practical. Fear is an enemy in that regard. And the Racism (yeah, capitalized) shown is on the opposite side of that ethical question.
But in Thiele’s case everyone had abandoned them, no one else was there to take care of those people while they died, if they had gotten evaced it would have been into the arms of a disaster mgt. team who apparently had even less resources.
There’s no good or bad here. No one is a hero or villain for continuing to live or making decisions to help some live perhaps at the expense of others who are less likely to live.
We all do what we have to do every day but we conveniently forget the massive support systems that let us forget that.
We forget how much of our life is dependent on the mercy and sufferance of others and that in fact our proxies extend far enough to make off the cuff moral condemnations. “Gee Smed, hunting is wrong and evil because you shouldn’t kill animals” *munch munch munch a cheeseburger*
Ignorance in this case is the luxury of asking "what were they thinking?" - well you don't know because you weren't there and you can only question the decision making because its after the fact and you know now certain things they didn't know. So why not question that assumption first? Why not question why it is you don't know? That would lead you to first causes. Which leads to to the abandonment by Bushco.
I don’t see how the medical personnel did anything anywhere near as egregious as Bushco did.
Indeed, they executed their duties to the best of their abilities with what they had. Maybe they were wrong, maybe they were right. But they’re the ones who were there doing it and absent malicious intent I don’t see how it’s possible to condemn them without a full knowledge of what occurred on scene.
And that is impossible because our government completely abdicated its duty. And then casually reasserted its authority over right and wrong when it became more convenient and, in this case, decided to try to prosecute people who did do what they could do.
If I were there, if I were going to die, I wouldn’t want the person who decided – whether they were wrong or right - to spare me pain in my final hours to be prosecuted under the auspices of the assholes who left me to die in the first place.
That’s all the moral clarity I need.
posted by Smedleyman at 4:01 PM on August 28, 2009 [10 favorites]
“I find this whole thing impossible to pass judgement on as a casual outsider.”
Yeah, that’s what does it for me. The newspaper says what it says, but we don’t really know for certain what happened there.
At the core of it is – what possible benefit would a medical practitioner have to callously euthanize a given patient?
I mean, you don’t go into medicine because of your racist beliefs or to quit on people when they need you. Maybe you might want to make money, but for the most part it’s an altruistic profession.
I see no reason why they would have done other than what they did do based on anything but what they thought best at the time. One can debate as a practical matter as to whether this was the best thing to do but that’s with the benefit of hindsight and without regard to the immediacy of the situation.
They are tough calls and ones best not second guessed by moral platitudes. One can consult another doctor and ask them – but again – that doctor wasn’t there in the situation making judgements from a variety of future scenarios – many of which included abandonment and many of which were completely plausible.
I’ve been trained to respond in mass casualty situations under battlefield conditions – it is not at all pretty. There are no ethical considerations that can cover the event – before the event. All the guidelines drop into pure practical when considerations of outside support are dropped. In some instances you save only who you can carry. I don’t even want to go in to the outline on radiation casualties. F'ing nightmare I hope never to endure.
There is a difference between medical practice and resource and support coordination. I’ve seen doctors do more with less than I could believe in conditions I didn’t think they could save any lives under. But under those circumstances I was part of the support (security) and had we not been there, it wouldn’t have happened. You’re not going to save anyone if you’re dead yourself.
On top of that, body disposal becomes a priority, that’s not going to happen without some manpower, evacuation becomes tougher as time goes on – so logical priority (at least in a war zone) should go to the ambulatory (in part, folks are less likely to shoot motionless wounded). Water is an interesting thing. It’s a tough resource to have limited. I’ve seen folks die of thirst. Pretty ugly. If I’m looking at three days without water to give them, or give them a shot now to avoid all that pain – tough call.
And I think what’s most critical is that lack of support. In the face of abandonment there can be no questions of ethics, only questions of survival.
The “though there was nothing in the orders that stated this” motif is reiterated throughout the piece – but again – how valid are any outside considerations if those outside forces have abandoned the area and withdrawn essential support. And this ‘playing God’ thing – yeah, uh, well he sent the f’ing hurricane didn’t he? And the government handed those doctors the right when it beached them.
Legality is a joke in those cases. Especially since - how can one lay claim to authority if one has abandoned any pretense of support?
(“We’d experienced the helicopters’ stopping flying to us”)
Furthermore, I think a moral imperative “you should…” loses all validity after the person in question hasn’t slept for 72 hours.
You can’t be expected to work yourself to death any more than you can give more blood than reasonable to patients. I think there was a very real sense that if the medical workers left they would be abandoning their patients. But if they stayed – conceivably would they have been stranded as well?
On the other side of that equation – one can’t base decisions on what one thinks might happen and claim they’re legitimate if they’re not purely practical. Fear is an enemy in that regard. And the Racism (yeah, capitalized) shown is on the opposite side of that ethical question.
But in Thiele’s case everyone had abandoned them, no one else was there to take care of those people while they died, if they had gotten evaced it would have been into the arms of a disaster mgt. team who apparently had even less resources.
There’s no good or bad here. No one is a hero or villain for continuing to live or making decisions to help some live perhaps at the expense of others who are less likely to live.
We all do what we have to do every day but we conveniently forget the massive support systems that let us forget that.
We forget how much of our life is dependent on the mercy and sufferance of others and that in fact our proxies extend far enough to make off the cuff moral condemnations. “Gee Smed, hunting is wrong and evil because you shouldn’t kill animals” *munch munch munch a cheeseburger*
Ignorance in this case is the luxury of asking "what were they thinking?" - well you don't know because you weren't there and you can only question the decision making because its after the fact and you know now certain things they didn't know. So why not question that assumption first? Why not question why it is you don't know? That would lead you to first causes. Which leads to to the abandonment by Bushco.
I don’t see how the medical personnel did anything anywhere near as egregious as Bushco did.
Indeed, they executed their duties to the best of their abilities with what they had. Maybe they were wrong, maybe they were right. But they’re the ones who were there doing it and absent malicious intent I don’t see how it’s possible to condemn them without a full knowledge of what occurred on scene.
And that is impossible because our government completely abdicated its duty. And then casually reasserted its authority over right and wrong when it became more convenient and, in this case, decided to try to prosecute people who did do what they could do.
If I were there, if I were going to die, I wouldn’t want the person who decided – whether they were wrong or right - to spare me pain in my final hours to be prosecuted under the auspices of the assholes who left me to die in the first place.
That’s all the moral clarity I need.
posted by Smedleyman at 4:01 PM on August 28, 2009 [10 favorites]
To clarify: "You can’t be expected to work yourself to death any more than you can give more blood than reasonable to patients." - you can't give more of your own blood to patients than is reasonable otherwise you drop and you're no good to anyone. Seen that too.
posted by Smedleyman at 4:07 PM on August 28, 2009
posted by Smedleyman at 4:07 PM on August 28, 2009
The best thing to come out of all of this, clearly, is that these doctors learned a valuable lesson and can be allowed to return to work in underfunded, broken-down facilities with the sickest and most neglected patients out there, albeit scared shitless at the prospect of going to jail for the whims of a priapically overzealous DA. They clearly forgot how fortunate they were to be working there in the first place and how many doctors are salivating at a chance to make a living in similar high fashion.
posted by docpops at 4:50 PM on August 28, 2009
posted by docpops at 4:50 PM on August 28, 2009
I understand your point, Rokusan, that a hospital of all places should be prepared to deal with battlefield conditions and/or a disastrous events. But I don't think that's a universal definition of a hospital – though it would be for battlefield hospitals (e.g., MASH.)
A more universal definition of a hospital is a facility that helps people who have survived a disaster. For the hospital itself to be prepared to survive a disaster is another story.
While I agree that all hospitals should have disaster preparedness plans I would imagine that in most cases those amount to making do until help arrives. If help does not arrive…
posted by noway at 5:12 PM on August 28, 2009
A more universal definition of a hospital is a facility that helps people who have survived a disaster. For the hospital itself to be prepared to survive a disaster is another story.
While I agree that all hospitals should have disaster preparedness plans I would imagine that in most cases those amount to making do until help arrives. If help does not arrive…
posted by noway at 5:12 PM on August 28, 2009
Naomi Klein's talk at Big Ideas (thanks Jasper Friendly Bear) goes into detail about the harrowing medical situation in NOLA post-Katrina. One of the stories she tells is of an intern at a rich, suburban hospital (which was practically empty during the heart of the disaster) who literally did not think to volunteer care in the heart of the city.
posted by l33tpolicywonk at 6:39 PM on August 28, 2009 [1 favorite]
posted by l33tpolicywonk at 6:39 PM on August 28, 2009 [1 favorite]
And you actually think that you are in any meaningful way different from the people who expected the citizens of New Orleans to behave the same way?
Perhaps you missed the point that I am implying that people project what they themselves would do onto others. Therefore it is logical that people who project "civil disorder and murders during an emergency" would in fact actually cause such a thing themselves if the right situation presented itself.
Certainly, I feel it's quite fair to make deductions from people's knee-jerk reactions.
Would I do that? No. I don't own a gun; I'm not a fighter; I'd simply die.
If people make abhorrent, fallacious claims about others, I'm perfectly within my rights to form a bad opinion of them. I'm hardly being hypocritical.
posted by lupus_yonderboy at 9:10 PM on August 28, 2009
Perhaps you missed the point that I am implying that people project what they themselves would do onto others. Therefore it is logical that people who project "civil disorder and murders during an emergency" would in fact actually cause such a thing themselves if the right situation presented itself.
Certainly, I feel it's quite fair to make deductions from people's knee-jerk reactions.
Would I do that? No. I don't own a gun; I'm not a fighter; I'd simply die.
If people make abhorrent, fallacious claims about others, I'm perfectly within my rights to form a bad opinion of them. I'm hardly being hypocritical.
posted by lupus_yonderboy at 9:10 PM on August 28, 2009
With the piss-poor job the media did covering Katrina, I guess I should not be surprised with this article which is bordering on libel.
I have more faith in a grand jury investigation than I do a single NY times piece and they found Pou innocent and Foti subsequently lost his position as AG.
I am sure there were discussions of euthanasia, but I am putting this particular incident into the same file as the murders in the superdome, the raped children and the freezer full of bodies. Myth.
posted by psycho-alchemy at 2:33 AM on August 29, 2009
I have more faith in a grand jury investigation than I do a single NY times piece and they found Pou innocent and Foti subsequently lost his position as AG.
I am sure there were discussions of euthanasia, but I am putting this particular incident into the same file as the murders in the superdome, the raped children and the freezer full of bodies. Myth.
posted by psycho-alchemy at 2:33 AM on August 29, 2009
I don't want to get into the politics of this situation; clearly harrowing and difficult, and many involved have clear agendas, worthy or otherwise. What I find fascinating is how the solutions presented were largely informed by the availability and expertise around. Access to materials that could hasten death seemed to lend themselves to the thought processes that lead to the involuntary euthanasias performed by the staff. Were the same people, should they have been holed up in a mechanic's workshop, turned to using welding torches or hammers to euthanise those unlikely to be rescuable?
Medical knowledge and access to tools wields more power than almost any other profession, other than the armed forces (for examples of it going wrong, see Harold Shipman. While this can have a subtext of private vs public care, shipman worked for a nationalised health service.
Thanks for the post Anigbrowl, and insight, everyone.
posted by davemee at 2:39 AM on August 29, 2009
Medical knowledge and access to tools wields more power than almost any other profession, other than the armed forces (for examples of it going wrong, see Harold Shipman. While this can have a subtext of private vs public care, shipman worked for a nationalised health service.
Thanks for the post Anigbrowl, and insight, everyone.
posted by davemee at 2:39 AM on August 29, 2009
Here's a very sad article by Greg Palast with a little more information about the causes of the catastrophe.
History will judge the Bush administration very harshly. (And I'm sure that the Obama administration's ongoing efforts to protect the Bush government from the slightest consequence of their actions won't look so good, either.)
posted by lupus_yonderboy at 7:18 AM on August 29, 2009
History will judge the Bush administration very harshly. (And I'm sure that the Obama administration's ongoing efforts to protect the Bush government from the slightest consequence of their actions won't look so good, either.)
posted by lupus_yonderboy at 7:18 AM on August 29, 2009
But turning your poor decision-making in the midst of disaster into a new standard of care is bizarre and arrogant. She doesn't think she did anything wrong - fine. But how the fuck can she construe the outcome of those decisions as being effective?
The article is a bit troublesome. I am reluctant to judge the medical and emergency people involved given the circumstances, but I'm not convinced this account is accurate in the first place.
In any event, although the medical field in the US is plagued with political problems and has no shortage of giant egos, a disaster-event triage system which is ineffective will not be used very many times, if ever. I'm confident that, if there are issues with the methods, people will not blindly adopt the system.
posted by krinklyfig at 1:44 PM on August 29, 2009
The article is a bit troublesome. I am reluctant to judge the medical and emergency people involved given the circumstances, but I'm not convinced this account is accurate in the first place.
In any event, although the medical field in the US is plagued with political problems and has no shortage of giant egos, a disaster-event triage system which is ineffective will not be used very many times, if ever. I'm confident that, if there are issues with the methods, people will not blindly adopt the system.
posted by krinklyfig at 1:44 PM on August 29, 2009
History will judge the Bush administration very harshly.
Come now. You're forgetting the role of Louisiana's governor Kathleen Blanco, who dithered about admitting the scope of the problem and admitting the National Guard, and then talked up the alleged crisis at the Superdome until nobody was willing to set foot there. Mayor Ray Nagin, whose idea of an evacuation program was to tell people to drive out the city. The various Levee Boards that had stymied a centralised reconstruction of the levees. The Army Corp of Engineers, whose responsibility the failing levees ultimately were. The police who fled, or started looting, or both. The designers of the pumping stations that flooded. The people who put generators at ground level. There's plenty of blame to go around.
posted by Joe in Australia at 4:25 AM on August 30, 2009
Come now. You're forgetting the role of Louisiana's governor Kathleen Blanco, who dithered about admitting the scope of the problem and admitting the National Guard, and then talked up the alleged crisis at the Superdome until nobody was willing to set foot there. Mayor Ray Nagin, whose idea of an evacuation program was to tell people to drive out the city. The various Levee Boards that had stymied a centralised reconstruction of the levees. The Army Corp of Engineers, whose responsibility the failing levees ultimately were. The police who fled, or started looting, or both. The designers of the pumping stations that flooded. The people who put generators at ground level. There's plenty of blame to go around.
posted by Joe in Australia at 4:25 AM on August 30, 2009
Yes, Blanco and Nagin are convenient scapegoats for this crisis. As someone who was actually there for it, both saved my life, and the plan that Nagin did have -- Contraflow -- worked exactly as it should have. New Orleans is a poor city and relied on the Feds for crisis preparation, as well as to maintain the levies. Blaming the city, or the state, for the problems of Katrina is simply diverting attention from the real culpability.
I don't recall Blanco dithering. She requested $130 million is aid for the crisis before it even happened, citing the expected severity. Also, I don't recall her refusing the admittance of the National Guard, but merely refused an offer to federalize it, as did Mississippi's governor, Haley Barbour, both out of concerns that a federalized National Guard would not be flexible enough.
I am curious as to where you are getting this. I can't find confirmation of your comments about Blanco from anything other than right wing talking points Web site, and neither can I find anything that demonstrates that Nagin was solely, or even primarily, responsible for the city's disaster preparedness plans. Are you sure you're citing history, and not merely parroting some popular spin designed to deflect legitimate frustration as to how the federal government failed New Orleans?
posted by Astro Zombie at 4:11 PM on August 30, 2009
I don't recall Blanco dithering. She requested $130 million is aid for the crisis before it even happened, citing the expected severity. Also, I don't recall her refusing the admittance of the National Guard, but merely refused an offer to federalize it, as did Mississippi's governor, Haley Barbour, both out of concerns that a federalized National Guard would not be flexible enough.
I am curious as to where you are getting this. I can't find confirmation of your comments about Blanco from anything other than right wing talking points Web site, and neither can I find anything that demonstrates that Nagin was solely, or even primarily, responsible for the city's disaster preparedness plans. Are you sure you're citing history, and not merely parroting some popular spin designed to deflect legitimate frustration as to how the federal government failed New Orleans?
posted by Astro Zombie at 4:11 PM on August 30, 2009
I was there too, actually, visiting relatives. I arrived for a visit on Thursday; evacuated Sunday; and flew home from Memphis on Wednesday. My views about Governor Blanco's response were formed by the news reports I read and watched around the time. According to Snopes some of these reports were wrong, but I believe it's clear that there was an incoherent response at every level of government. Surely you recall the events at the Superdome, where the government did not even know what was going on. You would think that they might have had a satellite radio and generators to power lights. Surely you recall the Gretna police turning back refugees from New Orleans - that's an example of local government actively working against an evacuation. New Orleans' own police force was so disorganised that they were still trying, months later, to identify and deal with officers that had abandoned their posts.
I don't live in New Orleans and my views are undoubtedly colored by those of commentators I read. None the less, I confidently assert that there were multiple failures in the response to Katrina, many of which were caused by a lack of preparedness, and that although the Federal Government is being blamed for its reaction to the crisis, the crisis itself would have been ameliorated by better planning.
posted by Joe in Australia at 11:52 PM on August 30, 2009
I don't live in New Orleans and my views are undoubtedly colored by those of commentators I read. None the less, I confidently assert that there were multiple failures in the response to Katrina, many of which were caused by a lack of preparedness, and that although the Federal Government is being blamed for its reaction to the crisis, the crisis itself would have been ameliorated by better planning.
posted by Joe in Australia at 11:52 PM on August 30, 2009
I believe this is projection. I think that if a disaster of similar magnitude happened in, say, Texas, there would be wide-spread civil disorder and hundreds of murders.
I believe this poster is full of baloney. I was in New Orleans for Katrina and I was in Houston for Ike (a storm which completely trashed Galveston). First Ike anecdote. When the city was in disaster recovery mode (very little power, &c.) the mayor was on the radio and in response to reporters badgering informed us that he had sent a couple of the Feds home because they were insufficiently creative to handle a Texas size emergency.
"If you need help unloading trucks at a food ice water distribution center and somebody wants to help, you do not make them fill out a four page form with three carbons. Use your head people."
It was my proudest moment ever in my new hometown.
Second the New York Times Magazine article. This is very well written. Those doctors and nurses in that hospital ought to get a medal. The guy who pushed for prosecuting them is apparently a disgrace even for a Louisiana politician. Not easy to do that.
posted by bukvich at 9:36 AM on August 31, 2009
I believe this poster is full of baloney. I was in New Orleans for Katrina and I was in Houston for Ike (a storm which completely trashed Galveston). First Ike anecdote. When the city was in disaster recovery mode (very little power, &c.) the mayor was on the radio and in response to reporters badgering informed us that he had sent a couple of the Feds home because they were insufficiently creative to handle a Texas size emergency.
"If you need help unloading trucks at a food ice water distribution center and somebody wants to help, you do not make them fill out a four page form with three carbons. Use your head people."
It was my proudest moment ever in my new hometown.
Second the New York Times Magazine article. This is very well written. Those doctors and nurses in that hospital ought to get a medal. The guy who pushed for prosecuting them is apparently a disgrace even for a Louisiana politician. Not easy to do that.
posted by bukvich at 9:36 AM on August 31, 2009
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There were mutants!? That is disturbing.
posted by biffa at 1:43 AM on August 28, 2009