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August 30, 2007

New Orleans doctor finally tells her side

The J Train here...while serious and important tasks* will likely prevent me from adding much to this open guest blogger call, I wanted to follow up on a post I wrote here almost two years ago.

At that point there were only rumors that some patients had died after being given large doses of morphine as a New Orleans hospital was being evacuated.  It was almost a year later when Dr. Anna Pou and two nurses were arrested, charged with four counts of second degree murder.  The charges against the nurses were dropped.  The grand jury refused to indict Dr. Pou, but not before Louisiana Attorney General Charles Foti made a colossal grandstanding ass of himself over it.  (He earned the #4 spot on the Ten Worst Prosecutors 2007 list, and there was some damn tough competition for that honor this year.)

Now Newsweek has an interview with Dr. Pou, and from the sound of it the situation was even worse than I imagined.  It never occurred to me that people would want to use the hospital as a shelter; the hospital couldn't really say no, but it must have made things difficult.  The battlefield-style triage I described in my earlier post was being done quite literally, with numbers taped to patient's chests.  For some reason the part I have the hardest time envisioning is the pitch-black darkness.

I should read more about Foti's pursuit of the case, because I just don't understand what he hoped to gain.  I guess he was trying to pander to the God Squad, but did he really think there was a net gain in vilifying a respected surgeon who stayed behind to care for and evacuate a hospital full of patients?  It's like trying to indict one of the firefighters who went back into the burning towers on 9/11.  Even if what she did was 100% wrong (and, I stress, it wasn't), she did it after two straight nonstop days of a job no one should have to do in conditions no one should have to endure.  I'd love to believe that even the people still wearing their Save Terri T-shirts understand that.

I suppose Dr. Fou was supposed to "trust the Lord" and wait for a miracle.  I have to tell you--if I'm ever in a pitch dark 100-degree hospital with five feet of water on the first floor, 2000 patients and refugees cramming the hallways, and my city falling apart around me, I'm going to go ahead and assume that God is not on my side.

(Check me out over at The J Train.  It's been pretty haphazard lately, but it has its moments.)

* Metroid Prime 3

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Comments

I am a nurse.

Show me that those people stayed behind, during a storm that destroyed everything they ever owned, to do harm. Despite their vows. Despite everything deepest in their souls.

Show me. I'd like to see what you have.

Fucking cowards. Show me.

If the evidence he had was correct (i.e. the witnesses were accurate and honest), then this was murder. It may be hard to grasp, but it was his moral and legal obligation to prosecute based on that evidence, and I'm glad he didn't take political pressure into account.

Yes, her explanation is "interesting" but the dead aren't here to be interviewed about how they were never even consulted about her "decision." Newsweek never asks about their consent but it's the distinction between "a doctor's difficult decision" and "murder."

At least one of those patients was fully alert and asking about what he was being given, and according to the affidavit his own nurse was asked to do it because he knew her, and she refused to have anything to do with the injection. That man, by the way, was not terminal - just paralyzed.

Try and put yourself in the victims' place instead of Dr. Pou's for a second, and ask yourself if you really would be just fine with your doctor giving you a lethal drug without your knowledge or consent. (It seems to me the only substantive difference between Foti's version of what happened and hers is that in his version the drug was "definitely" lethal. In her version it was only "potentially" lethal.)

Oh, I'm not buying that this wasn't a scapegoating attempt. Prisoners sat for years in New Orleans prisons without getting processed because of fucking traffic tickets, but they can prioritize this? I'm not buying it.

Kate, you’ve got a valid point, but remember we live in George Bush’s post 9/11 world- everything’s changed. The Louisiana National Guard was busy in Iraq, no help was coming, and if N.O. is hit with another hurricane, no help will be forthcoming again. Desperate triage is the new paradigm; ask any of the remaining doctors in any Baghdad hospital.

I see that the Dubya snake has slithered off of Air force One onto the tarmac in New Orleans for the second anniversary of N.O.’s ethnic cleansing. As if, what with cottonmouths and water moccasins, they didn’t have enough vipers down there.

Kate, if you had read J-Train's original post, which is linked above, you'd see that triage most definitely involves putting yourself in the patient's shoes. The choice was death now by painless injection or death later, alone, in the heat and dark, of exhaustion, dehydration, or possibly slow drowning. Why is it war doctors and commanders can make similar decisions, but not those doctors? Thank goodness the people of New Orleans saw through the grotesque publicity hound Foti and his ghoulish buddies like Wecht and did justice in this case. Your basic problem is not seeing the difference between law and justice. Justice is about making a judgment about the act in its context, not about blindly applying "facts" to "laws." That's why we have judges and juries, and not computers.

"Judge not lest you be judged". Doctor's don't take any oaths to commit suicide by drowning or dehydration. I wasn't there - and neither was my federal government which I (and those in NO) had depended upon for succor in times of absolute disaster. So I certainly wouldn't presume to judge those who WERE there, were abandoned, and had to make decisions.

Cranky

"So I certainly wouldn't presume to judge those who WERE there, were abandoned, and had to make decisions."

"you've really driven home the fact that being a doctor can often force a person to make gut-wrenching choices."


Except it wasn't her decision, and it wasn't her choice - *certainly* not for the conscious patients. It was the patients choice - whatever the circumstances - and that's what makes this murder. (Assuming the evidence presented was accurate).

And no, regardless of everyone's insisting otherwise, a hurricane doesn't mean all laws and medical ethics go completely out the window. What she did according to the affidavits had nothing to do with triage - whether ordinary or "desperate."

It's a prosecutor's job to presume to judge, and Foti made the absolute right call - both morally and legally - despite tremendous pressure.

What if she had simply taken a gun and shot these patients one by one - conscious or not, and without warning or permission if they were conscious. Would you feel as well-disposed towards her?

Kate, what exactly is your problem? Foti presented his case (or more precisely, the DA of Orleans Parish presented the case) and a grand jury refused to indict. Foti came off looking like a publicity hound preying on a tragedy, Pou came off like a hero, and you come off like someone with a bizarre axe to grind. Why do you hate America? Our justice system, in this case, the people of New Orleans, examined the evidence and declined to indict Pou. The criminal case is over, and I for one join with the overwhelming majority of my fellow Louisiana citizens in hoping Pou wins the civil cases.

I don't know anything about Foti himself, but I don't see any evidence here that he was grandstanding, or pandering to religious fundamentalists. I'm not religious, I believe in the right to assisted suicide, and am all in favor of hospice care. But in those cases the patient decides that death is the preferable option. It may be that some of you would prefer a certain death by painless injection to an almost-certain death by drowning or dehydration. But that's your preference, not necessarily the patient's. It's not up to the doctor to decide who would be better off being euthanised---it's up to the patient. If the patient is conscious, you have to ask them what they want, not decide for them, regardless of whether it's an emergency situation. This is not triage. In triage you prioritize cases, and don't help those who get lower priority---you don't actively kill them. To kill people without their consent, as Pou did, is wrong.

That said, I recognize that I'm saying this from the comfort and safety of my home, several years after the fact, and not while exhausted after several days of working in an impossibly horrible situation. I have no idea what I would have done if I had been in Pou's place. In fact, I'm sure I wouldn't have been in her place, as I would have fled the hospital long before things reached that point. I have no reason to doubt that she's a good person, or even a heroic person, and don't think the interests of justice would be served by her being in jail. So I'm glad that the grand jury didn't indict. But what Pou did was morally wrong, and more importantly for Foti's case, clearly illegal (the jury apparently deciding to practice sympathetic jury nullification, rather than strictly applying the law). I don't think that Foti needs to be a grandstanding, religious zealot to have prosecuted this. John Protevi correctly makes the point that the law and justice are different matters, but Foti's job is to apply the law.

Autumn Harvest's got it just about right. I'm not sure exactly what would be "morally right". Each patient would be a different case, depending on how far gone they are, how miserable a death they may face, whether they can actually apprehend the gravity of their situation, etc. I don't think I could put them down. (A phrase you'd use for a dog, but also a phrase you'd use for a dog you loved.) If I were in the doctor's situation and had simply abandoned people to die, would I have accused myself of cowardice later? I have no idea. I also don't think as a prosecutor I could have brought murder charges. Perhaps some lesser charge.

The fact that it ever came to that is outrageous, and the fact that we're just another hurricane or earthquake away from the same thing happening again is even more appalling. Get ready for more. Bush has managed to bring a permanent hurricane Katrina to Iraq, where these kinds of horrifying moral choices are now daily fare, and in the process pissed away the money that might have prevented us from having to make hellish decisions when the next inevitable disaster occurs here.

Heckuva job George.

I wouldn't presume to pass judgment on Dr Pou, at least not before I had examined all the evidence in the case. Of course, if you've been following this story, you already are aware that the grand jury was not presented with the reports of five "experts" who examined the forensic evidence. All of those "experts" thought the evidence pointed toward homicide. Maybe they were wrong. I don't know.

I'm not sure what to think about this, but it does strike me that, given the situation -- people were exhausted, stressed, dehydrated, scared, and in a place that was overcrowded, dark, and chaotic -- any account of what happened (including Dr. Pou's) is bound to be inaccurate. At the time, people were probably misunderstanding each other right and left.

Anyone who has spent any time with a person who is dying in a properly functioning hospital or hospice no less - and not just dying, but suffering the most horrible pain imaginable - can only glimpse the agony and horror and moral suffering this doctor must have endured as she made decisions. How dare they sit in judgement of her! She was an angel to those people, an angel. She deserves a medal.

This story is so sickening I cannot get my head around it. I hope this woman feels feels the support of the sensible nation.

Well and dayum, if a prosecutor can charge a doctor trying to function as best she could in the most appalling conditions imagineable, and a whole lot of people agree with that prosecutor, why isn't the nation charging Bush with crimes against humanity for God's sake. It was his administration that made the levies fail, his administration that ignored the aftermath, his administration that brought the suffering, the dying and the death. It was his administration that put doctors like her in that situation. Surely to God, if she deserved to face a grand jury, Bush and his lackeys should be facing a grand jury.

Put yourself in the prosecutor's shoes. You have what appears to be incontrovertible evidence that murder happened. The defendant is very sypmpathetic and did not act for their own gain (in fact was possibly in peril at the same time and acting heroically). Do you not indict? Do you allow an extenuating circumstances exception for murder that doesn't exist in the law? What do you do?

Forget about Foti's personality or "grandstanding'; what if Anna Pou was guilty of murder (and what I have read, as I understand it, tend to point in that direction) do YOU (not Foti) just walk away?

Oppression and discrimination against people with disabilities seems to be the one commonality shared the right and the left.

Imagine if we change the words "sick" and "disabled" and inserted the word "Black" or "Hispanic." We implemented a system of reverse triage and put numbers from one to three on the chest of those who would be rescued. It was a crude system but it as the best we could think of at the time.

We decided since Caucasians have the longest life span they would be number 1, Asians and other lighter skinned people would be 2, and those with black or brown skin whose lifespan is shorter would be labeled 3. Since it was unlikely that the 3's would be rescued, I decided it would be better to give them a "potentially" lethal dose of morphine to spare them the agony of dehydration.

As a person with a disability, I have experienced more discrimination from doctors than I have construction workers. If you think oppression and discrimination weren't a factor in Dr. Pou's decision to administer a lethal dose of medication to people whose life she deemed less valuable then you're bigot.

Dr. Pou has denied trying to hasten anyone's death. The grand jury heard the state's evidence against her--firsthand, not just what's in the news. Charles Foti paid some consultants to act as epert witnesses in his case, but the medical examiner in New Orleans did not find evidence of intentional overdose.
Regardless of your opinion on euthanasia, please consider the possibility that Lori Budo, Sherry Landry and Anna Pou gave heroic service in a disaster, and then were brought up on false charges.
If you think that politics had nothing to do with the charges, look at Charles Foti's vengeful slandering of their names after they were aquitted.

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