NOLA Memorial Medical Center deaths……Holding Judgement

From Scout:

dr pou

Dr. Anna Pou

In an announcement Tuesday that garnered a great deal of media attention, Louisiana Attorney General Charles Foti had a doctor and 2 nurses arrested for second degree murder in the deaths of 4 patients at NOLA‘s Memorial Medical Center in the days after Katrina struck. It is a story that is tragic and complicated. The safest conclusion at this point in its telling is don’t conclude anything yet. As with any story there will invariably be more than one side. Medical experts and supporters of the doctor in question, Dr. Anna Pou, are coming forward with another side of this story.

This is a story that apparently begins with the media investigation of accusations. Dr. Daniel Nuss who is the LSU Department Chair for Dr. Pou, an LSU employee, had this to say yesterday in a statement of support for Pou:

Apparently there were individuals in the hospital who could not understand why so many people were dying. Allegations were made, egregiously accusing Dr. Pou and the others of giving too much narcotic pain medication, and even using the word “euthanasia.² This attracted national news coverage, which became absurdly sensationalistic. Because of the widespread news coverage, an official investigation was launched.

It was CNN which reported on this story for months beginning in October. It was a story they claimed as their exclusive.

From an October 13 CNN transcript….

CNN’s Jonathan Freed takes a look at serious allegations at one city hospital, and this is a story you will only see on CNN.

Click Read More for the rest

From Scout:

The CNN story is based on interviews with several Memorial staff members particularly Dr. Bryant King who was a contract doctor hired “about a month” prior to Katrina. CNN first reported on October 13 and more in depth on December 22, claims from King that he had a a conversation with a doctor who said an “administrator suggested patients be put ‘out of their misery.‘ When King objected, this physician acknowledged his concerns but said that ‘this other [third] doctor said she’d be willing to do it’.” Bryant went on to claim this about Dr. Pou…

King said another hospital administrator asked if he and the two other remaining doctors should pray. King says one of those doctors, Dr. Anna Pou, had a handful of syringes.

“This is on the second floor in the lobby. And across that walkway there is a group of patients and Anna standing there with a handful of syringes talking to patients,” he said. “And the words that I heard her say were, ‘I’m going to give you something to make you feel better.”

According to CNN, a nurse manager “said the physician who had expressed opposition to euthanasia to Dr. King also spoke to her about it.” However on the same day that the CNN story appeared the Time Picayune carried a story which could cast doubt on King’s claims…

Published reports on the inquiry have relied heavily on allegations from Dr. Bryant King that doctors had discussed giving patients lethal overdoses of narcotics and that an administrator had suggested praying about it.

King could not be reached for comment Thursday, and two Memorial staff doctors who were at the hospital until the last patient left said no such discussions ever took place.

The administrator who allegedly urged praying denied doing so, said Steve Campanini, a spokesman for Tenet Healthcare Corp., Memorial’s owner.

The administrator, whom Campanini declined to name, “authorized me to say that there was no such meeting and that Dr. King either misspoke or is a liar,” Campanini said.

If this case ever does go to trial it will probably hinge on the credibility of various Memorial Hospital staff and their testimony which appears to be at odds with one another. Character witnesses and medical experts will likely weigh in also.

The New York Times carried 2 stories today that also offer another side to this story. The first is a report on doctors who know and support Dr. Pou ……

Her supporters, though, say there is another explanation: she was using drugs to try to calm and comfort patients who had nearly reached their limit.

Eugene Myers, a professor at the University of Pittsburgh who helped train Dr. Pou, said that what she had told him shortly after the hurricane sounded heroic.

He said Dr. Pou had told him that she and Lori Budo and Cheri Landry, two nurses who have also been arrested in the case either helped evacuate the last patients or tried to make them comfortable with pain medications.

Asked about the accusation that she had given the patients lethal doses, he said: “That is not in the character of Anna Maria Pou. Here’s a woman whose absolutely dedicated to excellence in patient care. Read the Rest

The second story reports on questions raised by medical and ethics experts regarding the case. For example….

In interviews, several experts said that although they did not know the details of the case, they suspected that it had to be more complicated than the “plain and simple homicide” asserted by the attorney general, Charles C. Foti.

The doctor and nurses may have engaged in mercy killing; if so, given the circumstances, it is not clear that any jury would convict them, a legal expert said. Another possibility, medical experts said, is that the patients were suffering and the only way to keep them comfortable was with high drug doses that may, incidentally, have hastened their deaths. It is not known, though, how much the patients were suffering.

“I’m fundamentally unconvinced of the framing of the story,” said Dr. Steven Miles, a professor of medicine at the University of Minnesota and an expert on the care of dying patients. “I’m not inclined to believe this is a euthanasia scenario or a physician-assisted suicide scenario.”

One reason, Dr. Miles said, is that the drugs found in the dead patients — morphine and the sedative Versed — are not all that deadly and may not even have been what killed the patients. Many patients develop tolerances to the drugs and can handle high doses, he said. Barbiturates, readily available in a hospital, would be a far more efficient way to kill somebody if that was the intent, he added.

“The selection of drugs looks to me to be more typical of the drugs selected for providing palliative care rather than killing patients,” Dr. Miles said. Palliative care is treatment given strictly to keep a patient comfortable.

Given the history of the horrors of Katrina I think that people throughout the country and the world will have assumed the worst when they heard the news of Foti’s arrests in this case and in turn will be inclined to believe the charges outright. Given the many outstanding questions this would be unfortunate. I think the people of New Orleans will be less likely to rush to judgment. Those who did not evacuate know the impossible situations in which people were placed in those days after Katrina. Those who did evacuate will likely think far be it for them to judge someone who stayed to help. Several NOLA bloggers have weighed in on AG Foti’s actions or motivations with these charges which can be found Here and Here and Here and Here and Here.

To their analysis I would add the possible factor, that Dr. Daniel Nussof raised, of pressure from media expose’ such as CNN’s as having played a role in his pursuing the investigation and bringing charges. The Mercy Hospital investigation was an outgrowth of the investigation of the St. Rita’s nursing home deaths which drew considerable media attention, national outrage and likely pressure on officials to take some action. The owners of St. Rita’s were roundly vilified for allegedly abandoning their residents. Foti quickly brought negligent homicide charges against the owners based on not having evacuated residents. In November USA Today carried a story that included information that “debunk(s)… reports that the Manganese (owners) abandoned their nursing home during rescue efforts there.” The St. Rita’s story evolved and changed over time as more facts became known. The apparent last word on the present status of the case via Foti’s web site is that the “investigation is ongoing.”

That case is perhaps a cautionary tale for the Memorial Medical Center case telling us to…. wait for the facts before judging Dr. Anna Pou, Nurses Cheri Landry and Lori Budo.