An Alternate History of Katrina
I want to share with my readers a few email messages I have gotten recently. First, this letter comes from a nurse who apparently weathered Hurricane Katrina in a hospital in New Orleans that I worked at many times as a resident:
I was at Lindy Boggs (Mercy Hosp) through the storm. I had an article printed as well in JCN.Apparently we don't have similar attitudes towards the way people and the government behaved.
My observations, while standing on the rooftop trying to be noticed....helicopters thick in the air as soon as the wind died down. Military, police, EMT's, Paramedics...people everywhere trying their best to evacuate an entire city. Standing on the interstate on broken I10 loading ambulances until I could hardly stand up anymore... good people doing their best. The Govt doing it's best!
I do not agree with you here. It was, after all...a huge city. And we did behave rather badly on national TV.
I think the rescue efforts were commendable. I would like to see more gratitude and less finger pointing. What other nation would mount such a massive rescue effort?
This nurse may be the only person from New Orleans I know of who felt the government did a good job after Katrina. I do not feel the need to debate her or discredit her – she is entitled to her opinion after all, as I am mine – but since it is my blog I would like to make a few observations.
First, even if one is to give the government a passing grade on Katrina (and I know of very few people who would), certainly the response was not all it could have been. Even if the response was good, there is always room for improvement. In the aftermath of Katrina, constructive criticism is much more important than self-congratulations. The government cannot be allowed to get away with self-congratulations because politicians are way too good at this. If we give them our approval, they will be all too willing to close their eyes to obvious opportunities to improve, and it is our peril if we allow this to happen.
Second, I have to take issue with the line: “What other nation would mount such a massive rescue effort?” This implies that if a similar disaster occurred in another industrialized nation like Britain or France or Japan, the government of that nation would not make every effort to rescue victims. That argument is totally without foundation. In fact, Japan in particular has had a marvelous history of overcoming natural disasters, most recently after the Kobe earthquake of 1995. It is one thing to say that the American government is good. It is another to say that we are better than other nations just because. Americans sometimes exhibit a disturbing tendency to assume everything here is unquestionably the best. When we do that we condemn ourselves to less than the best because we give up looking abroad for new and better approaches to problems.
Euthanasia at Memorial Hospital; An Idle Rant on the Topic of Nonmalfeasance
Regarding the accusation that Dr. Anna Pou, a physician at Memorial Hospital in New Orleans, committed 5 acts of euthanasia in the aftermath of Hurricane Katrina: A friend forwarded to me an interesting exchange between a New Orleans ENT (Ears, Nose, and Throat specialist) and a malpractice lawyer.
The first quote is from the ENT, a person I know well. Keep in mind that the writer is in the same specialty as Dr. Pou and knows her personally. The “Foti” in the quote is Charles Foti, the Attorney General of Louisiana who charged Anna Pou and two nurses with euthanasia after Hurricane Katrina. (Note: I have made no effort to correct the grammar.)
Just my opinion as a physician, but
Foti should be held accountable for his obscene abuse of power in declaring these professionals guilty of murder without benefit of actual charges, grand jury, prosecution by DA with jurisdiction or a court, etc.
Secondly, he should likely be disbarred for not recusing himself for refusing to allow the state to defend from malpractice allegations these providers who were working for the state, and therefor "insured" by the state for malpractice. Particularly since his inane accusations precipitated the lawsuits.
Clearly he has a conflict of interest by virtue of his unethical & unprofessional pre-judgment of guilt rather than presumption of innocence.
His arrogance is despicable.
Even if these people are ultimately found guilty, has he handled the case properly? Has he tainted the process? Does it matter to anyone?
Where is the Bar Association, Supreme Court, Federal Attorney General Association or other entities with jurisdiction over such a legal authority running rampant?
What the ENT is referring to here is that Mr. Foti called a news conference and publicly accused Dr. Pou and the two nurses of murder. This is not the usual procedure. Protocol is would be to privately conduct an investigation and turn over the findings to the District Attorney in New Orleans without public comment. It is not up to Foti to charge Pou. This case falls entirely within the jurisdiction of Eddie Jordan, the Orleans Parish DA.
He has a point. This is not how murder charges are usually brought up.
His second point is that Anne Pou was a professor at the LSU Medical School. Her malpractice is paid by the state. Since Foti is the default state legal counsel, he is in the peculiar position of defending and accusing Pou at the same time. To extract himself from this predicament, Foti has refused to defend Pou against malpractice suits. This puts Foti in a very bad light, though I am less sure than the ENT that it merits disbarment.
A malpractice lawyer who represents one the family of one of the euthanized patients responds:
I will refrain from the debate as to whether Foti handled the matter properly, as I agree that I would have handled things differently, primarily to ensure that the Orleans DA would be assured of convictions. But let's not try and "victimize" Dr. Pou and the others. I represent the families of one of the victims who were killed by the Dr. Keep in mind that Dr. Pou was not even their treating physician and had no authority whatsoever to touch my clients' parent. NONE. She had no business on the seventh floor. And, by all accounts, she didn't ask my client if he wanted to die.
Who's the real victim here? Was Foti wrong? Maybe. But by comparison any mistakes he may have made here pale in comparison to the ones that those here that have sworn to "First, do no harm."
I have numerous problems problems with this response. First, he begins with the assumption that the patients were euthanized, and this has not been proven. Not only that, but no one has been charged yet. I suppose as the attorney for the aggrieved family he has to advocate the family's position, but he is also a lawyer. He should be protecting the integrity of the legal process as well.
As I have stated in a post before, there is only hearsay evidence that anyone was euthanized. No one saw it happen, and there is no documentation of it happening. Foti’s claim that the autopsy reports “prove” murder is ridiculous. The bodies were lying dead and decaying in an abandoned hospital for weeks before they were recovered. Under those conditions, it is simply not possible to determine if a patient was a recipient of a lethal dose of morphine or not.
The argument that Dr. Pou was not the "treating physician" is also specious. There were only a few doctors in that whole hospital. The "treating physician" had abandoned the patient and the hospital. It could have been malpractice for Dr. Pou to refuse to deliver care if the treating physician was unavailable. Moreover, if Dr. Pou was simply delivering emergency treatment when no other help was available, she may have been covered under the Good Samaritan law, which protects doctors from malpractice suits when they deliver emergency care to people who would get no help otherwise.
The “treating physician” argument is exceedingly dangerous. It implies that if I am rounding in the hospital at night and I observe a patient clutch his chest and collapse in the hallway, I should not touch him because I am not the treating doctor. Is that the way this lawyer wants medicine practiced?
But the argument I find most offensive is his invocation of the "First, do no harm" principle. He has no idea what he is talking about. No doctor in any country in the world ever swears to “First, do no harm.” This is not in the Hippocratic Oath, and anyway, the Hippocratic Oath is not required for a medical license in the U.S.
To set the record straight, the Hippocratic Oath was originally composed in Greek and exists in many different English translations. Some, but not all, medical schools ask their graduates to take this oath at commencement. Because the wording varies so widely, it is not considered a binding legal or ethical basis for medical practice. Here, however, is passage from an often quoted version:
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
To please no one will I prescribe a deadly drug nor give advice which may cause his death.
As an interesting aside, the original oath also includes this language:
Nor will I give a woman a pessary to procure abortion.
It is not clear where the words “First, do no harm” come from, but some people trace them to a phrase used by the Greek philosopher Galen that was later quoted by Hippocrates in one of his works.
Thus, it is true that the Hippocratic Oath does prohibit euthanasia. It also admonishes against harming patients, but this is not the same thing as saying that doing no harm is the first principle of medicine. If the reader will abide with me, I want to press this point further, because I think it is very important.
Medical ethicists often refer to the “first, do no harm” (from the Latin, primum non nocere) as the doctrine of nonmalfeasance. Nonmalfeasance is not considered an absolute rule, but instead one that must be balanced against other ethical principles, including beneficence, justice, and autonomy. In other words, a physician must weigh the harm a medical treatment may cause for a patient against many factors, such as the benefits the treatment would incur, the patient’s natural right to have access to appropriate treatment, his right to comfort from suffering, and the right of a patient to participate in the choice of his own treatment.
If any doctor took the primum non nocere doctrine as an absolute, there would be no chemotherapy for cancer. No one would ever undergo surgery. If there is a prohibition against doing any harm whatsoever, then there is no opportunity for medical treatment because there is no tolerance for risk, or for untoward side effects. Nonmalfeasance is not a law, or even an ethical rule. It is a guidepost.
Primum non nocere is, however, a rule lawyers like to use to win lawsuits against drug companies. But thank God, it is not the overarching rule of medicine.
It never ceases to annoy me when primum non nocere is invoked as a criticism of doctors. Usually when the complaint of nonmalfeasance is leveled against a doctor, it is in a legal context, as in, “You did not do your duty (the patient was harmed); therefore you must pay.” I find this insulting because it overlooks the reality of medicine, which is that medical therapy is a complex balancing act of risks and benefits. “First, do no harm” is way too simple a code to be used alone in the judgment of a medical act.
Since the priniple of nonmalfeasance is not found in any law, a doctor who is accused of violating this principle is being accused of not adhering to a principle that is beyond mere law. Should doctors be held to a standard above law? Of course they should. But courts are for enforcing the law, and not for enforcing principles that are above the law. A doctor should not be successfully sued for violating a principle that the law has not codified. Ethical violations should be properly investigated by professional panels and punished by professional standards, and legal violations should be tried in court and punished according to the law. What we have here is a lawyer who accuses a doctor of ethical transgressions that are above the law but still wants to use these same non-legal principles to collect the big moolah through civil court.
The proper question is, was a murder committed? If a jury says yes, then Pou should be punished. If no, she should not be tried in any court on the basis of a nonmalfeasance principle that has no real basis in law that I know of. Put another way, if Pou did not actively kill the patient, the fact that the patient may have died as an unintended consequence of medical care is not a matter for the courts, criminal or civil. It is a matter for medical ethics boards, and it should be properly hashed out there.
And if that is not enough, this silly lawyer complains that Dr. Pou “didn't ask my client if he wanted to die.” Now, I am not a lawyer, but to my knowledge, if the patient had asked to die and Dr. Pou complied with his request, she would have been practicing physician-assisted suicide, which is just as illegal in Louisiana as euthanasia. So he makes a distinction without a difference. Now that’s what I call a keen legal mind.