Normally I'd agree with the prosecutors, but post-Katrina conditions were extra-ordinary. Patients who were in hospital for non-life-threatening conditions were dying from the heat. Under the circumstances, I'm inclined to think that the nurses and doctor acted humanely and ethically. It's a matter of opinion, in hindsight, whether their actions should be considered criminal.
Posts: 1785 | Registered: May 1999
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I saw this a few minutes ago, and almost started a thread for it.
I wonder if they will admit to the alleged intentional overdoses and plead special circumstances? Post-Katrina was certainly an extraordinarily difficult time, even for the healthy. I'm sure being in a flooded hospital was a nightmare for patients and their caretakers.
Still, I think that's up to a jury. Presumably the DA wasn't convinced they acted ethically.
quote:The arrest warrants say Dr. Anna Pou and the two nurses intentionally killed four patients at Memorial Medical Center "by administering or causing to be administered lethal doses of morphine sulphate (morphine) and midazolam (Versed)."
In an accompanying affidavit, an agent for the Louisiana Justice Department wrote that Pou told a nurse executive three days after the hurricane hit that "lethal doses" would be administered to those patients who could not be evacuated.
Pou said the patients remaining at the hospital would likely not survive and that a "decision had been made to administer lethal doses" to them, the affidavit says.
"'Lethal doses of what?'" the nurse executive asked, according to the affidvit says. It says Pou answered: "morphine and ativan."
If the allegations are true, this is murder. If on the jury and I believed the allegations, I'd vote to convict. If the prosecutor, I would have proceeded with the case.
There's no excuse for what they did, assuming, again, that the facts are as alleged.
Posts: 26071 | Registered: Oct 2003
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Doing what they are accused of is wrong, of course. But I feel for them, though.
Medical personnel forced to work in darkness in 100 degree heat for what, 100 hours straight? Without enough support staff? With miserable patients suffering badly from the same conditions? I'm not sure I'd be in my right mind at that point. I find it troubling to think they will judged as harshly as other cases that don't involve inhumane treatment of health care workers. I hope the conditions and their frame of mind will be taken into consideration. Posts: 1990 | Registered: Feb 2001
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Hmm... that article left a lot of questions unanswered. By "could not be evacuated", are they saying that these people would have otherwise just been left to die? As in, were these lethal doses given in preparation for an evacuation they would not be able to join, or just on a whim one night?
And the daughter of the 70 year old woman who died after "seeming fine" earlier in the day, is there any reason to suspect that this woman was one of the four? The article says they were looking for evidence of euthanasia in the remains, did they find any?
There's just way too many facts missing, and it's a very sensational story. I have a very hard time believing that three people who have dedicated their lives to healing the sick would suddenly become bloodthirsty murderers on a killing spree in their own hospital, but it's very easy for me to believe that they were faced with some very difficult choices after three horrific days, and made terrible but reasonable-under-the-circumstances decisions.
I guess time will tell.
Posts: 1681 | Registered: Jun 2004
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quote: made terrible but reasonable-under-the-circumstances decisions.
Giving a lethal injection is not reasonable-under-the-circumstances. I doubt they went on a bloodthirsty killing as well, and you're right that we don't know the facts. But if someone purposefully loaded two syringes with lethal doses of drugs and purposefully injected them with the intent to kill a patient, they committed murder. That's not a reasonable response to the conditions.
If they gave a higher than usual dose of morphine to control pain because of unusual conditions or lack of resources to render the care they otherwise would have and this caused an accidental death, then the circumstances should absolutely be taken into account.
Posts: 26071 | Registered: Oct 2003
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Oh man, I could totally see giving someone a lethal injection being reasonable-under-the-circumstances, if the circumstances involve over 3 days of crushing heat, dehydration, starvation, exhaustion, darkness, crapping in plastic bags, rioting, dead bodies floating by the window, with no end in sight... if, as a medical professional, you honestly believe that a particular patient will not survive long enough to be rescued, or will not be able to evacuate IF a rescue comes, and their continued existence in said circumstances is only prolonging their suffering... I could definitely see euthanasia being a "reasonable option".
Maybe not legally, and maybe not from an air conditioned office with plenty of food and water within reach. But reading through the nurse's blog about her experiences in another hospital, and how changing patients to "DNR" status and ceasing to pump their air bags was a "reasonable option" under the circumstances, I don't see this as much of a stretch. To be honest, I could see myself requesting such an option as a patient if I were old, frail, and in the middle of a nightmare like that.
Posts: 1681 | Registered: Jun 2004
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quote:Would it have been criminal for them to abandon their post?
Almost certainly, barring threat of physical harm to the staff.
quote:Oh man, I could totally see giving someone a lethal injection being reasonable-under-the-circumstances, if the circumstances involve over 3 days of crushing heat, dehydration, starvation, exhaustion, darkness, crapping in plastic bags, rioting, dead bodies floating by the window, with no end in sight... if, as a medical professional, you honestly believe that a particular patient will not survive long enough to be rescued, or will not be able to evacuate IF a rescue comes, and their continued existence in said circumstances is only prolonging their suffering... I could definitely see euthanasia being a "reasonable option".
It's quite simply not their call to make, and it needs to emphatically be not their call.
quote:But reading through the nurse's blog about her experiences in another hospital, and how changing patients to "DNR" status and ceasing to pump their air bags was a "reasonable option" under the circumstances, I don't see this as much of a stretch.
There's a huge stretch between triage (edit: based on) lack of resources to care for a given patient and active killing. And it's important to keep it a huge stretch, air-conditioning not withstanding.
quote:To be honest, I could see myself requesting such an option as a patient if I were old, frail, and in the middle of a nightmare like that.
We'll have to see if they try to present such a defense. There is no consent defense to murder, but it's certainly the kind of thing a jury might decide to base a nullification decision on.
Posts: 26071 | Registered: Oct 2003
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This is the biggest problem I have with the prosecution:
quote:"We're not calling this euthanasia. We're not calling this mercy killings. This is second-degree murder," said Kris Wartelle, a spokeswoman for Attorney General Charles C. Foti.
To the best of my knowledge, euthanasia is not legal. I don't know if there's a legal distinction, but the prosecutors' statement seems to indicate that there were no mitigating circumstances, and that these people were not killed because the doctors considered it the most merciful option, but rather, simply because they chose to kill them.
What I want to know is, if the prosecutors were calling it euthanasia, what would the charge be? Is there anything in the law that addresses whether they saw this as the most merciful option?
Posts: 3735 | Registered: Mar 2002
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I agree, the medical staff probably thought that there was no more they could for the patients they killed. It was just a matter of either them dying from what ever illness they had, which probably would have been a slow death, or the doctor's simply ending their lives a little quicker. Would you want your last memories to those of the terrible heat, the headaches and heat stroke that came with it, and the wails and sufferings of other hospital patients? The doctors killed them because they thought it would be easiest for both them and the patient. I'm not saying that they shouldn't be charged, I'm just saying that I would have done the same thing, and I would have wanted them to kill me if I was a hopless patient.
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quote:What I want to know is, if the prosecutors were calling it euthanasia, what would the charge be? Is there anything in the law that addresses whether they saw this as the most merciful option?
My guess is it would still be murder. Louisiana law is quite different than what I'm used to, but neither the Model Penal Code nor common law recognize any charge-mitigation based on "mercy." The MPC has an emotional disturbance mitigation that might come into play, reducing it to the equivalent of manslaughter. Other than that, mitigation would be relevant to sentencing, not guilt.
quote:I would have wanted them to kill me if I was a hopless patient.
I, quite frankly, don't want the doctor or nurse caring for me to decide when it's hopeless enough for them to kill me.
Beyond that, the hopelessness had to factor in things they just couldn't know, including the speed of the rescue.
quote:Originally posted by SoaPiNuReYe: I agree, the medical staff probably thought that there was no more they could for the patients they killed. It was just a matter of either them dying from what ever illness they had, which probably would have been a slow death, or the doctor's simply ending their lives a little quicker. Would you want your last memories to those of the terrible heat, the headaches and heat stroke that came with it, and the wails and sufferings of other hospital patients? The doctors killed them because they thought it would be easiest for both them and the patient. I'm not saying that they shouldn't be charged, I'm just saying that I would have done the same thing, and I would have wanted them to kill me if I was a hopless patient.
Really? What if rescuers had shown up a few hours later?
I would be ok with them giving high doses of sedatives (so the patients would not be in pain), even though that might cause death. But actively choosing to kill them?
No, I'm with Dags on this one. That is murder, plain and simple.
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It might have been murder, but it wasn't necessarily simple.
Just imagine: they couldn't leave. They didn't have any relief for days. They couldn't stop work. They couldn't run away. Any choice they made would have been wrong. All they could do was carry on, with misery all around, until they got to the point of hopelessness and did something they would never have countenanced before.
Or maybe they had murderous intent all along. I just don't believe it.
If I get trapped in a hospital situation like that, I'll be sure to use the morphine on myself before my judgement has a chance to be too impaired.
Posts: 1990 | Registered: Feb 2001
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No, it IS simple. They could have used enough to put the patients deeply under. Killing them was really not the only choice (other than just going on as they were, which I agree they could not have).
Posts: 32919 | Registered: Mar 2003
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Oh, absolutely agreed. I do not mean to imply that at all, and I apologize if I did.
Moreover, I do not think they are in any way a threat to society, and I hope that is taken into account during sentencing (if it goes that far).
Posts: 32919 | Registered: Mar 2003
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Dag, how would it be illegal to leave the patients? Immoral perhaps, but there are limits to what you can force another person to go through, even if they are medical personnel.
Tough doesn't even begin to describe it.
Posts: 15082 | Registered: Jul 2001
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quote:Dag, how would it be illegal to leave the patients? Immoral perhaps, but there are limits to what you can force another person to go through, even if they are medical personnel.
Note what I said about "barring..."
In general, there is no criminal liability based on failure to act. Suppose I see my most hated enemy drowning, and I'm standing right next to a life jacket that I could throw him that would save his life. I will be prosecuted for nothing if I fail to do so, even if I start applauding while he drowns.
Unless I were a lifeguard or in some other way had assumed a duty to rescue, that is (we'll assume no family relationship, either).
Health care workers assume a duty for their patients. There are things that excuse it, which is why I added the "barring..." exception.
Other things that can create a duty: relationship (wife/husband, parent/child, common enterprise - you have a duty to try to save your mountain climbing partner), contractual (lifeguard, etc.), creation of the danger with or without fault, or starting an attempt to rescue. It varies state by state, but this is the complete list.
Posts: 26071 | Registered: Oct 2003
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This may be totally naive, but I know a doc who worked in NO at the major trauma center up to about a few months before Katrina. I read that initially that hospital was implicated in some suspicious deaths and I asked him about it. His response was "no way, it wouldn't happen there with XXX on the scene." Sure enough that doctor (XXX) was on the scene and they interviewed him about possible so-called "mercy killings." His answer was forceful and perfect. It was just a plain, "no, we don't do that."
And, really, I have to draw a parallel to some recent cases that sndrake has been e-mailing me about -- parents killing their autistic children and citing the stress of taking care of those kids.
I invite everyone to at least take a look at the "Not Dead Yet" website to see what a well-thought out stance on the whole issue of "mercy" kiling that group has put together.
I have a great deal of sympathy for these doctors. But I do not believe they should have killing a patient as an option under any circumstances. Period.
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This is precisely what I was trying to get at with my remark about keeping the stretch between triage and euthanasia huge.
I also recommend the Not Dead Yet site. It helped clarify a lot of things for me - not that I was ever a mercy killing supporter, but rather why it's so important not to legitimize the idea with legal recognition. Even when that recognition is simply a lesser criminal charge ("murder with compassion"), not outright permission.
Posts: 26071 | Registered: Oct 2003
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I'm not sure it would be possible to calculate "enough morphine to put them under and keep them comfortable" without enough personnel awake and alert to monitor the patients. That is, I don't think that can be titrated in advance -- that level of sedation in this sort of patient requires constant monitoring and tweaking based on the effects as they happen.
I don't know what these medical personnel did, obviously. I hope there was no deliberate wrongdoing.
I do recall being on my 50th hour without sleep in an ICU and being unable to focus my eyes on an X-ray. Literally, I could not control my eye muscles enough to focus. I think (under that level of stress) I'd have been hallucinating to some extent after 100 hours.
quote:Originally posted by ssasse: I'm not sure it would be possible to calculate "enough morphine to put them under and keep them comfortable" without enough personnel awake and alert to monitor the patients. That is, I don't think that can be titrated in advance -- that level of sedation in this sort of patient requires constant monitoring and tweaking based on the effects as they happen.
That makes sense. And if the accusation were that an attempt to do that had gone wrong and resulted in deaths, I would absolutely be against any criminal charges being filed.
But that is not what is being claimed -- by either side, AFAIK. (Upon rereading the article, it may be what the defense is claiming. I'm unclear on what their claims actually are.)
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quote:Originally posted by rivka: That makes sense. And if the accusation were that an attempt to do that had gone wrong and resulted in deaths, I would absolutely be against any criminal charges being filed.
But that is not what is being claimed -- by either side, AFAIK.
I don't even know for sure what is being claimed by either side, much less what actually happened -- that's for sure. I was just reading the thread and trying to put myself in that situation, and I think all the blood left my face.
I'm not trying to argue -- just thinking. I suppose in that case I think I'd guess at a dose that might work for awhile and let myself crash when I had to (I've slept propped up on a wall before, and once when I was really worried about a patient, I slept on a blanket on the floor next to his bed). But I expect that I'd find something like this situation: the morphine given for sedation had relaxed the throat muscles, and without somone to suction the airway, the patient would have probably awoken to being drowned in his own saliva. Which may well have been more moral than the hypothetical alternative of giving too much deliberately, but it would have been a really hard thing to do.
Actually, given that likelihood, I might well decide to crash without giving anyone any sedation or painkillers, just in the hopes they'd still be alive when I could focus my eyes again to read the numbers. But god, that would be ghastly.
[I mean, maybe necesary, but ghastly. Because if you didn't have someone awake and aware enough to monitor the patients who couldn't be permitted out of bed, you'd have to use full restraints on them. (Usually at least one limb is left free, and that choice is rotated through all four to prevent skin damage and ulceration.) And I've seen disorientated and/or demented patients scream until the vessels in and around their eyes burst open, and tongues get chewn, and whatnot. That's one reason why a calming medication (like the Valium class, such as Ativan) is given along with sedatives. The disorientation of sleepiness can make things worse.
And, good grief, if these were elderly ICU patients, their skin would be like tissue paper. It bruises and shreds even with the gentlest tape -- four points restraint alone without medication for four hours and some would've shredded off their own skin under the restraints.
Good jimminy. A nightmare. Might well be the only choice, though.]
posted
I would oppose criminal liability for either choice you described (assuming we're talking about the Katrina situation still).
Posts: 26071 | Registered: Oct 2003
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quote:Originally posted by Dagonee: I would oppose criminal liability for either choice you described (assuming we're talking about the Katrina situation still).
Yeah, exactly. It's another thing entirely when people aren't being pushed to the veritable limits of physical capability.
I strongly support caregiver relief services, though. I think it's excellent preventive medicine.
Posts: 132 | Registered: Jun 2006
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I'm still thinking about how insane it was to work in an ICU for 50 hours onsite without sleep. I mean, those weren't fifty hours where ever fifth hour you could zone out for 15 minutes and just rest your mind. At least for us, that night, we had 2 critical enough patients that we were in constant decision-making mode: ordering and reading labs, reinserting IVs, drawing our own blood gases and adjusting ventilation.
Kind of like rush hour autobahn without any pullover stations.
Of course, they may have been without power for a good bit of those 100 hours. As horrible as it sounds, that may have made for less to think about. But no -- without electricity of some kind, there would be no ventilators, so they would be hand-bagging all of those patients who could not breathe for themselves. Good lord.
[Not that it would have justified any so-called "mercy-killing," mind you. But man, I can't imagine how someone could still be making reasonable decisions after 100 straight hours without relief assistance in there. Truly, it seems beyond the limits of what someone could take and not be severely altered mentally.]
Posts: 132 | Registered: Jun 2006
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quote:I'm still thinking about how insane it was to work in an ICU for 50 hours onsite without sleep. I mean, those weren't fifty hours where ever fifth hour you could zone out for 15 minutes and just rest your mind. At least for us, that night, we had 2 critical enough patients that we were in constant decision-making mode: ordering and reading labs, reinserting IVs, drawing our own blood gases and adjusting ventilation.
I might support criminal liability for a hospital who had someone work those hours. Assuming the person doing the working was a resident or intern, I think the authority of the hospital would be a sufficient defense, as long as the hospital knew how long the intern had been without sleep. Of course, that's assuming the scheduling was a non-emergency.
I've often wondered why anyone thinks such shifts are safe.
I woke up on the beltway about 10 yards from a concrete embankment after 2 days without sleep. If someone had been in the right lane I swerved into without looking, I'd have killed us both. I can't imagine being responsible for life or death decisions in that state or worse.
Posts: 26071 | Registered: Oct 2003
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It's over now, at least in theory. Our particular program was put on probation for too many ICU hours, too long of shifts, and not enough documented teaching time. They were actually quite close to being shut down if things did not change.
And there are new national regulations for accredidation which prohibit those shifts -- at least now, you can only work 24 hours + an additional 6, making 30 total (but you can't be made to accept new patients in those last 6, so that helps). [Then at least 6 hours off before the next shift begins, or maybe eight. And you have to average at least 4 24-hr days off per month, I think.]
Regardless, there was a lot of crabbing about the changes from within, even among some residents, because the gung-ho hooh-rah prove-myself-better-than-anyone-else mentality still often gets in the way of good care.
Glad you made it okay through your accident, Dagonee. Dave fell asleep at the wheel once and went off the side of the road. No damage, but he's a real spitfire on the subject now. Makes me call in to verify that I'm in a hotel when I drive long trips cross-country. *grin
Protects both me and our other fair citizens.
Posts: 132 | Registered: Jun 2006
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quote:And there are new national regulations for accredidation which prohibit those shifts -- at least now, you can only work 24 hours + an additional 6, making 30 total (but you can't be made to accept new patients in those last 6, so that helps). [Then at least 6 hours off before the next shift begins, or maybe eight. And you have to average at least 4 24-hr days off per month, I think.]
Regardless, there was a lot of crabbing about the changes from within, even among some residents, because the gung-ho hooh-rah prove-myself-better-than-anyone-else mentality still often gets in the way of good care.
I'm glad to hear they changed that, but sad it was opposed like that.
quote:No damage, but he's a real spitfire on the subject now.
Me, too. I'm glad Dave was OK.
I'll tell you what, it's amazing how a real adrenaline rush can wake you up.
Posts: 26071 | Registered: Oct 2003
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quote:Originally posted by Dagonee: I'm glad to hear they changed that, but sad it was opposed like that.
It was bizarre. There was a senior resident who I really respect(ed) that actually said: "How dare they tell me I can't work two straight days if I want to?*** We aren't children. We can decide for ourselves."
Bizarre. Bizarre. I bet the same person would've been mighty ticked to be a passenger on a plane flown by a pilot who made that argument. Unfortunately, it seems almost axiomatic that medical caregivers -- especially early in training, I think -- have to distance themselves from the patients they serve. Kind of like an underscoring of the distance.
quote: I'll tell you what, it's amazing how a real adrenaline rush can wake you up.
Word.
I could use a little right now. Actually, now I get to decide that I can shut my eyes and sleep.
Ahhh, mercy. *smile
'Night!
---
Edited to add: ***Many residents would scrunch shifts together in order to stretch out the limited vacation days as much as possible -- i.e., two people would trade the on-call shifts that occurred after each of their weeklong vacations, but may have meant doubling up on oncall nights at other times to compensate.
Posts: 132 | Registered: Jun 2006
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I just wanted to jump in for a minute. I am swamped with preparations for Saturday's Disability Pride Parade, and dealing with the aftermath of an action last week in which roughly 35 disability activists including myself came unannounced and unvited to a bioethics conference featuring a "dialogue" between conservatives and liberals. I ended up giving an improptu "keynote" for the conference, which, I am happy to say, had something in it for both "liberal" and "conservative" bioethicists to hate.
In the meantime, has anyone noticed that it's highly irresponsible for the press to be referring to these murder accusations as "euthanasia" or "mercy killings"? Those terms frame motive and suggest a lessening of guilt. Shouldn't we get to the actual trial before we start using those terms?
A few months ago, grand jury testimony on this case was leaked to NPR. According to the NPR reports, witnesses gave clear statements regarding Pou's intentions (to kill the patients) and that the motive was that they were under orders to leave no patients behind. There was no evidence that any patient *asked* to be killed or even knew what was about to happen to them.
When the NPR story broke, I was interviewed on a couple of radio shows. I readily concur that *lots* of people did things during Katrina they would never have done otherwise and will never do again. Many of them are still being charged with crimes and will have their cases argued in the legal system.
If there were extenuating circumstances - desperatiion, diminished capacity, etc. - they should be worked out in the legal system. And the jury will no doubt be comprised of people who lived through Katrina.
But killing is serious. The alleged victims *deserve* no less than the charges being brought in criminal court. Anything less would be one more act of abandonment in a chapter of American history in which "abandonment" is a prevailing theme.
quote:In the meantime, has anyone noticed that it's highly irresponsible for the press to be referring to these murder accusations as "euthanasia" or "mercy killings"?
Yeah - the Post led off that way. USA Today scare quoted "mercy killings," which to my reader's eye makes a huge distinction, but may not to the average reader.
(Now that I look back, they may not be scare quotes but references to specific spoken words.)
quote:But killing is serious. The alleged victims *deserve* no less than the charges being brought in criminal court. Anything less would be one more act of abandonment in a chapter of American history in which "abandonment" is a prevailing theme.
I've got a paper brewing in the back of my head about enforcement of crime as a civil right. It would be broader in scope than the minimization of homicide based on characteristics of the victim, but that would factor prominently into it.
Years away, but things like this and the Canadian story from last year have gotten my brain bubbling.
Posts: 26071 | Registered: Oct 2003
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When I used to work as an EMT on an ambulance, we were often trained about how to triage in multi-casualty situations, and how the ones you can't save you have to leave and go treat the ones you can when there are more patients than personnel and emergency transport can handle at once -- address the ones with the best chance for survival.
Luckily, I was never put in a multi-casualty situation where I had to make those kinds of decisions. But I often wondered about how I would handle it.
Even that said -- in those worse case scenarios, the triage would be to treat survivable ones first, but definately not to hasten the death on the ones we felt like we couldn't save.
I can't imagine being in the position of those hospital workers. It must have been horrible. Not that I'm justifying what they did -- not at all. I hope they did not do this deliberately. But if they did, then it is just wrong.
Believe it or not, I am really not in a "lynching" mood over this (those are scare quotes, not implying anyone said this). I believe a jury that lived through the same horrible situation in New Orleans can probably make a fair judgement on this.
It's a given the medical people were exhausted and scared - panicked, even. I don't know about Louisiana, but in most states there is more flexibility in sentencing due to extenuating circumstances in cases of second-degree murder, which is what the charges are.
I *do* object to the *press* trying this by calling the alleged killings "euthanasia" and "mercy killings." (Media in general seem to jump at the term, when the victim is old, ill or disabled. The newspaper in Springfield IL did some "creative writing" when it called the recent alleged murder of a 3-year-old girl who had autism "an alleged mercy killing," to the horror and anger of the rest of the family. Newspaper doesn't care - they've never apologized or corrected the fabrication.)
quote:Feb. 21, 2006 -- On February 16th, 2006, NPR revealed that it had access to "secret court documents" of the investigations of alleged killing of patients at Memorial Medical Center in New Orleans in the aftermath of Hurricane Katrina.
The NPR account tells a chilling story. But unfortunately, NPR and others in the media are still calling the alleged homicides "mercy killings."
The following is a statement by Not Dead Yet, a national disability rights group, in response to the framing of these homicides as "merciful" acts:
The term mercy killing is a loaded one, a term that tends to generate sympathy for the killer. It's also generally used in those cases when the victim of a murder is old, ill or disabled.
Within days of Katrina striking New Orleans, rumors surfaced of "mercy killings" and euthanasia at one or more hospitals in the area. Apparently, these were more than just rumors -- the attorney general in Louisiana has been investigating the allegations, although little about the investigation has become public.
Until now.
On February 16, NPR aired a story on All Things Considered after reviewing secret court documents from the investigation. They make it clear that the allegations -- if true -- had little to do with compassion or mercy.
Briefly, the allegations revolve around a group of patients left on the seventh floor at Memorial Medical Center. This floor was leased to a different entity, LifeCare Hospitals. According to NPR, the patients on the seventh floor were all DNR patients -- they had "do not resuscitate" orders.
Life in the hospital was terrible. There was no power and no functioning plumbing. The temperature was about 100 degrees inside the hospital. There were looters hitting nearby buildings and people trying to get into the hospital itself. The staff who were required to stay with the soon-to-be-abandoned patients wanted to get out.
Here is an excerpt from the story:
"According to statements given to an investigator in the attorney general's office, LifeCare's pharmacy director, the director of physical medicine and an assistant administrator say they were told that the 'evacuation plan' for the seventh floor was to not leave any living patients behind, and that a lethal dose would be administered, according to their statements in court documents."
In other words, the only way the staff could evacuate was if they could report there were no more living patients to take care of. This was not about compassion or mercy. It was about throwing someone else over the side of the lifeboat in order to save themselves.
In fact, this doesn't look all that different from the abandonment of the 34 individuals in St. Rita's Nursing Home in Bernard Parrish. In that incident, 34 people drowned after they were abandoned by staff. Death by drowning is easy to prove and so the owners of the nursing home are charged with 34 counts of negligent homicide. It's unclear what will happen in the case of LifeCare medical staff. It's hard to prove morphine medication overdoses in badly decomposed bodies.
Admittedly, the hospital staff must have been exhausted and scared. We can never know how they rationalized their actions (providing the accounts given by NPR are true). But that doesn't make the alleged killings merciful -- and no one should refer to these killings using that term again. No one's calling the owners of St. Rita's merciful or caring. The same standard should apply to the LifeCare allegations.
posted
Sara, the blog posted above does indeed have a description of patients being hand-bagged for hours on end, people rotating through the bagging and trying to take care of the other patients in between. It also says that after this had gone on so long they couldn't keep it up anymore, the doctors decided to "t-bar" (I think that was the word used, does that make any sense?) the trach patients so any who could breathe on their own didn't have to be hand-bagged. I believe that she said they lost one patient as a result. I don't think anyone would file criminal charges about that. She also describes a patient being made a DNR because the conditions were such that they would be unable to revive him anyway, and the resources that would have been used might save another patient. Again, I don't think anyone would file criminal charges there, either. (The one the doctor declared a DNR due to emergency conditions did indeed die.) There's also an anguished description of having no morgue, so one room on the second floor (first floor was completely flooded) was declared the "new morgue"-- and there was no refrigeration, and no air conditioning, and nothing to do with the bodies but wrap them up and leave them there.
It reads like she was still in shock when she wrote it, it's rather flat at times, like she just couldn't take in what actually happened, but the horror still comes through.
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I wonder what the other viable option was. Just triage those patients as unable to be saved and let them linger and die for 2-3 days with no care while they worked on the patients who could be saved?
Which is worse, realizing that they were beyond the capabilities of the resources to save and giving them a painless death, or leaving them to die over a long, painful period of time?
Would the medical staff be going to trial for murder in the second case?
Posts: 3950 | Registered: Mar 2006
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The thing is, they can't really know how long a time those patients would have had to linger. What if they gave them a lethal injection and five minutes later an Army helicopter lands on the roof with medical supplies and relief personnel that would have been able to continue their care?
Posts: 14428 | Registered: Aug 2001
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You are boiling the situation to essentially one of two choices.
Other hospitals in the area were also in desperate shape, but this is the only one in which this kind of scenario played out.
As far as I know, other hospitals tried to evacuate the patients and a great many of the frailer ones died during the attempt. But they died knowing someone was trying to save them.
We don't know much about the alleged victims - only one is publicly known. And she's described by her daughter as someone who was a religious church-going woman. In other words, this is not the way she would have wanted to go out. But that decision wasn't left to her - to stay and pray, attempt evacuation (and probably die), or be killed. This woman, anyway, would not have gone for the third choice. Maybe that's why she and others (reportedly) weren't asked.
Posts: 4344 | Registered: Mar 2003
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quote:Originally posted by MightyCow: I wonder what the other viable option was. Just triage those patients as unable to be saved and let them linger and die for 2-3 days with no care while they worked on the patients who could be saved?
Which is worse, realizing that they were beyond the capabilities of the resources to save and giving them a painless death, or leaving them to die over a long, painful period of time?
Would the medical staff be going to trial for murder in the second case?
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I will say (without hesitation) that the balance of power in these sorts of situations has always been with the medical establishment and physicians. That's a fact of life, and that's what makes it so imperative that people like sndrake and the other members of the NDY organization be strong, vocal, constant, and insistent critics of the system.
Doubtlessly there will be wrongdoings sometimes, and doubtlessly some will be covered up (that's what happens when you have the balance of power -- shameful, but another fact about how systems work). I'd much rather aim at erring on the side of over-suspiciousness than under. Stakes too high and the imbalance of power is just too great. Period.
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, here is 
