Kevin, M.D. - Medical Weblog

Dr. Anna Pou, Hurricane Katrina, and euthanasia

Dr. Anna Pou, an ear, nose and throat specialist, and nurses Lori L. Budo and Cheri Landry were each booked with four counts of second-degree murder.

"We feel they abused their rights as medical professionals," Foti said. "We'’re talking about people that were maybe pretending they were God. They made that decision. We did not take this case lightly." . . .

. . . Foti said some of the Memorial patients had a DNR, or a "Do Not Resuscitate" order, the pact between patient and doctor that no heroic measures be made by medical staff to save the patient'’s life.

But a DNR is not a defense in this case, Foti said.

None of the four patients were receiving either morphine, the powerful painkiller, or Versed, the brand name for the central nervous system depressant called midazolam hydrochloride, as treatment while at Memorial Medical Center, said Foti . . .

. . . Foti had Pou arrested in her home, while she was still dressed in her medical scrubs, despite the fact that she had agreed to turn herself in weeks ago if an arrest warrant were issued, Pou'’s attorney Rick Simmons said.

In the aftermath of the Katrina crisis, Dr Pou told a Louisiana television station some patients were under "do not resuscitate" orders made prior to the hurricane. "In other words ... to allow them to die naturally and not to use any heroic methods to resuscitate them," she said. "We all did everything in our power to give the best treatment we could to the patients in the hospital, to make them comfortable."

The investigation into deaths at the hospital gathered pace in October 2005 when Bryant King, a doctor working there during the hurricane, told CNN he had heard another doctor talk of putting patients "out of their misery". He had seen Dr Pou holding a handful of syringes later that day, he said.

But in a statement at the time Dr Pou's lawyer, Rick Simmons, painted a picture of medical staff working "tirelessly for five days to save and evacuate patients, none of whom were abandoned".

Polimom'’s finding it very hard to condemn the actions of the folks who were in that hospital. Even if these health care professionals did what they'’re accused of, the chaos and despair in the days following the storm were, I believe, impossible to judge from anyone watching from outside.

That said, I'm quite concerned the media coverage of the charges and the public discussion of what happened is going to spill over onto 'regular' end of life care and be full of misrepresentations, half-truths, and gloriously inaccurate and damaging portrayals of end of life symptom management, comfort care, etc. being life- shortening care, and somehow dangerous and ethically suspect.

What struck me the most, at the time I first posted it, was the vehemence of some commenters about how ridiculous this report was. One suspects there will be no humble pie eaten by those who sarcastically castigated me for posting on such obviously fictitious urban legends.

But sometimes the truth can be more frightening than fiction.

"We have people who are volunteering their services and putting their lives on the line. It's going to make it less likely they'll do that in the future," said Dr. Peter deBlieux, an emergency room and intensive care doctor who stayed at Charity Hospital during Katrina.

DeBoisblanc said it's also likely to make doctors less eager to return as the city tries to recover from the hurricane.

"If you think that going after physicians and nurses while hardened criminals are ruling this town, if you think that's an image that's going to bring people back, you've got to be kidding yourself," he said, noting the recent rash of violent crime in New Orleans.

Some doctors saw the accusations leveled by Louisiana Atty. Gen. Charles C. Foti Jr. on Tuesday as brash, misguided moves that permanently smeared the reputation of three respected colleagues.

Others were disgusted that suspicion was being heaped on a small cadre of healthcare workers who stayed, at great personal risk, to tend to the sick — and in conditions that most American doctors have experienced only in wartime.

"This is vilifying the heroes," said Dr. Daniel Nuss, who supervises the accused doctor, Anna Pou, at the Louisiana State University Health Sciences Center. "I think it's presumptuous for the attorney general or anyone else to try to assign blame for what happened under such desperate circumstances."

I worked with Dr. Pou for more than four years at the University of Texas Medical Branch in the operating room and she was my doctor when I needed surgery.

She is a compassionate lady and has a wonderful bedside manner. After long hours in the operating room, she was always grateful for our work.

I can only imagine what transpired in the midst of Hurricane Katrina and what she and the other nurses were faced with.

Playing God, nah. She, in my opinion, was a patient advocate who helped these do-not-resuscitate patients through a cruel, miserable death that awaited them.

Dr. Steven Miles, a professor of medicine at the University of Minnesota’s bioethics center, told the Associated Press that rather than trying to kill, it is more likely that the three women were trying to relieve patients’ pain "in a resource-poor environment and were doing the best they could."

Miles told the AP that there are cases on record where patients have required apparently fatal morphine doses to relieve extreme pain; he doubts the charges will be proven. "I’m inclined to believe this was palliative sedation that’s been misread," he said. Mercy killings would be "not only highly frowned upon, but also rare. It’s highly unlikely that’s what happened here."

Dr. Anna Pou was abandoned to a medical hell on earth. I wonder where the Louisiana Attorney General was during that time? Some air-conditioned command center?

There's little doubt that Anna Pou will be talking to her Medical Board (and it's a Board that has a reputation for being harsh to the ladies). She cannot practice while charges are pending. No money will be coming in to pay for her defense, or fend off the sharks in the water.

Meanwhile, the general public remains completely in the dark about what is really going down in medicine. After all, it happens in the dark.

And who cares about one "rich" doctor?

In short, Dr. Pou is no murderer. This prosecution has all the earmarks of yet another lynch mob that is more interested in myths than reality, so watch it closely.

I trained under Dr. Anna Pou when she was a teaching professor at the University of Texas Medical Branch in Galveston, TX. I can attest to Dr. Pou’s dedication to her patients, concern for the poor and indigent, and devotion to her profession. She is not only a very skilled Head and Neck Surgeon/Oncologist, but also a person who has a desire to help mankind.

It does not surprise me that she altruistically volunteered to help during the devastating Katrina catastrophe. It is difficult for me to imagine the events that took place- no electricity, limited resources, flooding, mayhem, looting, and gunshots on the streets with critically ill patients to take care of. It is easy for us bystanders to judge the events that transpired. The facts are that us others fled (FEMA, government officials including the mayor, New Orleans Police, and other medical professionals); Dr. Pou and those brave nurses stayed and were tested like none of us have been before. I don’t know if political or entertainment value are the factors that brought these brave soldiers to trial. Be it what it may, I’m sure Dr. Pou and the nurses will be found to be one of the great heroes of this extremely tragic tale. I would hope we the people would bring the federal, state, and local government to trial for placing us on trial.

Chaos reigned supreme in New Orleans. And, help was nowhere to be found. This was not business as usual on the ICU unit. It was hell on earth. It was the equivalent of conditions in a war zone. And, absent absolute depraved indifference to human life, medical judgments made under those conditions should not be second guessed. And, those making the decisions certainly should not be prosecuted for murder and facing a life sentence.

It's disgraceful--as disgraceful as our government's response, or lack thereof, to Katrina.

It's hard to figure out what's going on with Foti in this case. As Criminal Sheriff, he's never been directly involved in pro-life issues, so his opinions on these haven't been all that visible. There's more to this than meets the eye, to be sure, but it's so difficult to see what. The religious forces in the state will want to characterize any euthanasia case as homicide to shut down any legitimization of the concept. Then there's the business of health care. Memorial's pending sale to Ochsner Healthcare might be moving management to throw the doc and these two nurses under a bus.

It's disappointing to read an article such as this, because it indicates how little the truth can have to do with a criminal case in our judicial system.

In contrast, Foti's arrest of Pou and the two nurses is abnormal and ethically flawed. Foti announced his office had filed charges of second degree murder, but he was mistaken. As in Texas, the Louisiana attorney general has no authority to bring criminal charges. That's the job of the district attorney.

"Foti accomplished nothing," said Timothy Meche, a New Orleans defense attorney. "In order to bring criminal charges, the district attorney has to present the case to a grand jury, which most people here think won't indict."

Actually, Foti's theater, factual errors and legal overreaching have done a lot. They slashed the reputations of three caregivers who, up to now, have been distinguished only by their outstanding dedication.

Long after their case concludes, the memory of Foti's witch hunt will linger. Across the country, caregivers are watching. Could they, too, be so casually accused and smeared for giving aid during disaster? Maybe, some of these doctors will conclude, compassion and duty are not worth the risk.

I wonder what the families of the dead people think of this. And I want to know when the people who were really responsible for those deaths will be charged.

Murder charges could bring sentences of life in prison, but dangers also include difficulty with careers and civil suits. "The amount of volunteers is going to be drastically reduced if there is another hurricane because they are not going to take the chance," medical equipment salesman Ray Landry said, citing chats with doctors.

Louisiana State University, where Pou is an associate professor and which has a major medical complex, has fielded many similar complaints, spokesman Charles Zewe said. "We hadn't expected the doctors and nurses to say, 'Next time around, we may not be there,"' he said.

I am surprised that the attorney general would rely on post-mortem drug levels to determine whether these drugs were administered in proper dosages. The drug levels in the patients - whatever they may be - mean nothing. Some patients receive very, very high doses of the medications with minimal effects, while other patients are very sensitive and require very little. The idea that you can check a drug level and determine intent is absurd.

We don't know the whole story from all participants, including Dr. Pou and the nurses: what the conditions were like and what their intentions were. Until all the facts are known, it's wrong for the attorney general to act as if he's dealing with hardened criminals. He may very well be dealing with heroes.

When a diver plunges to the bottom of an ocean full of fish and only comes up with three guppies, it makes one wonder. There were a dozen hospitals operating in New Orleans during Katrina, and 34 people died at Memorial. Dozens more died in other facilities. Out of all those deaths, and all those hospitals, it perplexes that a 10-month investigation could only come up with 1 doctor, 2 nurses, and 4 patients. Were the rumors totally overblown? Or was there a widespread problem, and is what we have just a trio of scapegoats?

It is possible that in all those hospitals with all those doctors and patients only three exhibited suspicious behavior, but it gives pause to anyone with common sense. We are supposed to think that all the rest of those deaths are on the up and up. That there is no moral difference between a patient euthanized and one abandoned. That someone who stayed behind to care for patients for 5 days in 110 degree heat, with no electricity and no drugs besides morphine, is morally indistinguishable from Jeffrey Dahmer. That no one else bears any responsibility for what happened. Just these three villains.

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