A Doctor Gets Blamed

There's an article in Newsweek (linked here under del.icio.us) about Dr. Pou and the events in New Orleans after Katrina in the hospital where she was working. Conditions were appalling (no food, no water, no electricity), they were receiving no assistance, and patients were dying. Dr. Pou was arrested on murder charges, accused of deliberately killing 9 of the patients. Recently, a grand jury refused to indict her. I say, thank God for that; the accusations by the Louisiana Attorney General (and NOT supported by the District Attorney, who is the guy whose job it is to decide whether or not somebody should be prosecuted) were nonsensical and irresponsible. Here are excerpts from the interview in Newsweek:


Tell me about conditions from Wednesday night [THREE DAYS AFTER THE HURRICANE] until Thursday.

By the time Wednesday evening came around, if you can imagine in our mind, there is a central area that is a sea of people. A lot of very sick patients in that central triage area. It’s grossly backed up. Few patients had been evacuated. So there was just enough space to walk between the stretchers. It is extremely dark. We’re having to care for patients by flashlight. There were patients that were moaning, patients that are crying. We’re trying to cool them off. We had some dirty water we could use, some ice. We were sponging them down, giving them sips of bottled water, those who could drink. The heat was—there is no way to describe that heat. I was in it and I can’t believe how hot it was. There are people fanning patients with cardboard, nurses everywhere, a few doctors and wall-to-wall patients. Patients are so frightened and we’re saying prayers with them. We kind of looked around at each other and said, “You know there’s not a whole lot we can really do for those people.” We’re waiting [for help]. The people in that area could have [been evacuated] by boat but no boats were coming. I would do what I could with the nurses: changing diapers, cooling patients down with fanning. It wasn’t like, “I’m a doctor, you’re a nurse.” We were all human beings trying to help another human being, whatever it took.

Were people still dying at this point?

Every now and then a nurse would say, “Dr. Pou, this patient isn’t breathing any more.” Or I would be fanning patients and watch them take their last breath. So that’s basically what it was like Wednesday night: kind of a feeling of helplessness, frustration, sadness. It’s sad. You look around and think we live in the greatest country in the world and yet the sick could basically be abandoned like this.

What happened Thursday?

On Thursday morning we were told nobody was coming and we had to fend for ourselves. Everybody was kind of like at a loss here. What is plan B? Or plan C?
At what point did it become clear some patients wouldn’t make it out alive?I think when we went to reverse triage. It was always everybody’s hope that every single person would make it out of the hospital. Everybody did everything to make that happen. What you have to do when resources are limited, you have to save the people you know that you can save. And not everybody is going to survive those kind of conditions. And we knew that. People were dying. People were dying in the hospital. Not through lack of effort. Healthy people were getting sick. Employees’ family members were getting sick. People from the neighborhood came in getting sick. We were trying to find insulin for people. It was a mass of people—very chaotic. You have to realize there were people everywhere, not only patients, but 2,000 people in the hospital. That is a lot of people.

Tell me about the decision to administer painkillers to the nine people on the seventh floor.

There were patients, all of us knew, still remaining in the LifeCare unit. They were category three [in the reverse triage system]. We all believed eventually everybody was going to leave the hospital. We just didn’t know when or what was the time frame. So we knew that patients were going to be there for long time. We knew they were going to be there another day. That they would go through at least another day of hell. Basically it was decided to give the patients sedation.

Who exactly made the decision?

It was basically a group decision. I was asked to go check on patients on LifeCare.

So who was the doctor in charge on the LifeCare’s acute unit on the seventh floor?

To my knowledge nobody was there. The medical director was not there.

Who sent you to the seventh floor?

It was a group decision. I didn’t really volunteer for anything.

How did you come to be the one administering the injections? Louisiana Attorney General Charles Foti made a point of saying you had administered medication to people who were not your patients.

This was an emergency situation. There were no LifeCare doctors. In an emergency situation, the patients become everybody’s patients. What are you supposed to do if a patient needs to be cleaned and have IV fluids, say, “You’re not my patient, good luck”? That’s absurd. If that’s the case I dare say three-fourths of the population of Memorial Hospital would have been left without a doctor. We’re in medicine because we care about people. This is what we do. We don’t run around murdering people. That’s why what he said is so ludicrous.

What was your intention when you administered injections to the nine patients in the acute unit?

The intention was to help the patients that were having pain and sedate the patients who were anxious. That was it. Reverse triage meant the sickest would be the last to be triaged. We didn’t know how much longer they would be there. I take care of patients with cancer, so if I was a murderer, it would really be an interesting combination, very incongruous.

Did you consider when giving the injections that they might hasten these patients’ deaths?

I guess the thought crossed my mind. Any time you give medicine it crosses your mind. There’s always a risk of hastening death. There is a risk with every single thing we do in medicine. Every time you give antibiotics there’s a risk.

Did that factor into your decision to administer these painkillers and sedatives?

Basically what we’re trying to do is help the patients. Let me tell you—God strike me dead—what we were trying to do was help the patients. Everything was done with their best interest in mind. First and foremost. Any medicines given were for comfort. If in doing so it hastened their deaths, then that’s what happened. But, this was not, “I’m going to go to the seventh floor and murder some people.” We’re here to help patients.

How uncomfortable were the patients on the seventh floor?

I don’t want to be disrespectful to the dead [and give any specifics]. In general, LifeCare patients are very sick people, extremely ill or chronically ill. [And the harsh environment] took a toll on patients. Patients were dying.

As a physician how do you balance risk and the need for palliative care?

Any physician cannot practice medicine if we could not give painkillers. It would be barbaric. “Oh you’re dying of metastatic lung cancer, but if we give you morphine for pain, you may die a day earlier?” What do you do, not give the medicine? So it is usually disease and illness that is responsible for a patient’s death. The intention is to alleviate pain and give the patient the best quality of life. That is part of the Hippocratic oath, that I’m not going to let you die in misery and agony. It was a very, very helpless, helpless experience. All you could do is make them comfortable. And I shouldn’t downplay that.

When did you leave the hospital and who was still there when you left?

I left Thursday around 6 p.m. in a helicopter. When I left no one was in the hospital. There were a handful of patients on the helipad. I went to [another hospital and then] on a bus to Baton Rouge because my family was there.

How did you feel?

I was tired but I was more in total disbelief that the sick and the poor could be abandoned the way that they were in the United States of America. I never thought I would ever live to see that day. I was sad, heartbroken, kind of amazed and shocked at the lack of organization—the fact that there was no type of coordination. I have friends who practice in the third world and this was less than third world.

What was it like to be arrested in 2006?

I had [performed] surgery that Monday. It was bedlam in the medical community after Katrina. I had surgery Monday, Tuesday, Wednesday, Thursday and clinic on Friday. And the attorney general’s office knew that. I was taking care of indigent patients. He put my patients at risk. I am still angry about that. And then I was basically sitting by myself eating a salad, still in scrubs. I was starving and really dehydrated because I had been on call the weekend and been up 48 hours before. There was a knock on the door. It was four agents from the attorney general’s office.
The whole way [to jail] I was asking God to help my family get through this. I have nieces and nephews, and my hospitalized patients, who found out about this on the 10 o’clock news, which was heinous. Had I known [about the arrest], I could have spoken to my patients. Instead I just don’t show up and they see me on the news. There were cancer surgeries that had to be rescheduled. These patients’ treatments were delayed because of what happened. I am still furious about it. It just really makes me mad.