“The Deadly Choices at Memorial”

"The human condition-according to the sixteenth-century French philosopher Michel de Montaigne, each one of us carries the full burden of the human condition. All that we see in others-both the darkness and the light-is also present in ourselves." 1,001 Meditations~Mike George


A few weeks back I was listening to Democracy Now with Amy Goodman. The show was discussing past events that took place after Hurricane Katrina hit New Orleans on August 29, 2005, specifically about the deadly choices that were made at Memorial Medical Center. The clip painted a vivid picture of not only the hospital working conditions, but what the doctors, nurses and patients faced after the hurricane. The main piece of the show was interviewing Sherri Fink, a reporter for ProPublica, and a doctor, who spent the last two-and-a-half-years investigating the many human tragedies that occurred in the aftermath of the storm. To gain a richer understanding, I also read her article, “The Deadly Choices at Memorial: Strained by Katrina, A Hospital Faced Deadly Choices,” a 13,000-word article that illustrates the full story of what really happened to some of the patients at Memorial. The article made the cover of New York Times Sunday Magazine published August 30, 2009, four years after Katrina.
Both the article and interview on Democracy Now made the following points:
• Thousands of people lost their lives in the actual hurricane and in the subsequent floods. In all, 45 of those people were patients at Memorial hospital, who all died within days after the storm, 9 of which went under investigation as potential victims, 4 of which were concluded as homicide.
• On the morning of Aug 29th 2005 the hospital overall took the hit well, the backup power generator was working. Over 2,000 people were inside the hospital when Katrina hit, about 200 patients and 600 workers. On Tuesday, the water started to rise, and the temperature began to rise above 100 degrees. 48 hours after Katrina hit the generators went out.
• Mandatory evacuation was given to everyone in New Orleans except those in the hospitals.
• They needed to get the patients out, so they began to triage (a word from the army) patients, and gave them each numbers 1, 2, 3’s. 1’s being the first evacuated out. Their initial decision was to evacuate babies in neonatal care, pregnant mothers, and critical I.C.U patients first.
• All D.N.R. (Do Not Resuscitate) patients were scheduled to go last. (DNR is almost always signed by a doctor with informed patient consent, and means a patient whose heartbeat or breathing has stopped will not be revived. This is different than a living will). Dr. Deichman said in an interview that D.N.R. patients most likely had terminal or irreversible conditions, and he believed they should be evacuated last because they had the “least to lose.”
• Nurses and doctors worked days none-stop with very little sleep and under very stressful conditions. Many used manual ventilators to assist patients in breathing once the power went out.
• LifeCare Hospital of New Orleans rented the 7th floor of Memorial, and their goal was to assist long term acute patients until they improved enough to return home or to a nursing facility. Many of the 52 patients at LifeCare were on ventilators and were bed-bound. When the power went out, their conditions decreased rapidly.
• Anna Pou, a 49 year-old head and neck cancer surgeon, who was said to have a very strong work ethic and liked by many of her patients was put at the forefront of investigation into the deaths of patients at Memorial. She pleaded “I am not murderer, we are not murderers.”
• Did the doctors, primarily Dr. Pou work in good faith? She claimed she was “helping her patients through their pain.”
• Decisions were made to inject morphine and midazolam into patients, 17 total, 9 of which were on the seventh floor, 4 of which were later concluded as homicide. Emmett Everette, who was alert throughout, said “I’m ready to rock and roll” when people around were talking about evacuation, but because of a spinal cord injury which left him paraplegic, and possibly because he weighed 300+ lbs (although other people over 300 lbs were evacuated out of the hospital) drugs (morphine and midazolam) were used to “ease” his pain.
• Dr. Cook, a week into an administrator position at Memorial, pronounced a patient dead and left the time blank as he directed a nurse to increase the pain killers and walked away. In an interview, Cook said “To me, it was a no-brainer, and to this day I don’t feel bad about what I did. I gave her medicine so I could get rid of her faster, get the nurses off the floor…there is no question I hastened her demise.”
• New Orleans grand jury did not indict Pou and the two nurses associated with second degree murder. The case has been closed and will not reopen for investigation.
Why is important to Social work; The social justice slant:
• What kind of disaster preparedness do we have? Is it a failure of government that doctors and nurses are put into these situations?
• Poe asked this question in national conference of hospital disaster planning, “how long should health care workers have to be with their patients who may not survive?”
• Fink (news investigator) asked these questions in her article: “Which patients get limited care, and who decides? Where is the line between appropriate care and mercy killing?
• Is what happened at Memorial ethical or is it illegal?
• Also mentioned were the issues/concerns of euthanasia (assisted suicide)?
• Tracy Washington (a civil rights attorney), also interviewed on Democracy Now, noted that recovery in New Orleans was based on promises and not based on rights. She mentioned Charity Public Hospital, a teaching hospital, which was hit by the storm, is still not reopened, and that it was the best trauma one facility in the area. After Katrina, it was cleaned out and prepared to take in patients and was put into “surgery ready” condition. The state of Louisiana said that they could get money from federal government to repair the hospital, but due to lack of coordination between the state and federal government, the hospital is still closed. She also mentioned inadequate mental health services after Katrina. She said if you have a mental health crisis, the only place to go is Parish Prison, where you can be locked up for 30 day. She brought up issues of race and class status pertaining to housing. She said the most marginalized people, Blacks and Hispanics, are having difficulty returning home. They got a one-way ticket and no way of affording to get back. She said, “It affects this community, it affects how we live and it affects the color of this community.” Has the recovery plan of New Orleans failed to include comprehensive health and mental health services?
• Also on Democracy Now activist Rebecca Solnit, who studies disaster sociology, made a powerful point that amidst the chaos of disaster, a sense of community was built. She wrote a book called A Paradise Built in hell: The Extraordinary Communities that Arise in Disaster. She wonders how did they come together? Improvised communities were built up all over New Orleans yet the media framed a picture savageness and fear amongst people. A sense of joy in helping each other was achieved but not talked about. Normal roles and boundaries were removed, and people had to make strong decisions to take care of each other, really people came together. The truth is that the majority of people were altruistic, generous and heroic. They displayed courage.
As I reflect back on my own training as a certified EMT and Wilderness First Responder, and soon to be social worker, I wonder what decisions I would have made under those same conditions. Has anyone trained or actually done CPR for more than two minutes? It gets very tiring fast. What values do we as a sociality hold against the sick and ageing? As a social worker, what social justice ethics does this bring up? What policies can we lobby for to protect ALL people in future natural disasters? What inequalities and injustices were made against people of color and low economic status? How can we take the ideas of building healthy and positive communities and put them into practice not only after disaster strikes? These questions came to me as I read and listened to the stories told about the decisions made Memorial Hospital. I don’t necessarily have the answers, it just brings up so much, but find it important to consider when talking about human rights.

References
Fink, S. (2009) Strained By Katrina, a Hospital Faced Deadly Choices. New York Times Magazine. Retrieved 9/8/09: http://www.nytimes.com/2009/08/30/magazine/30doctors.html?_r=2&scp=1&sq=%93T e%20Deadly%20Choices%20at%20Memorial%94%96Investigation%20of%20New%2 Orleans%20Hospital%20Tells%20Story%20of%20How%20Medical%20Staff%20Euth nized%20Patients%20in%20Katrina%20Aftermath&st=cse
Goodman, Amy (August 31, 2009). Democracy Now: The War and Peace Report (Radio Broadcast). Pacifica Public Broadcast.