Patient Deaths in New Orleans: Mercy Killing or Palliative Care?
Peter A. Clark, S.J., Ph.D.
St. Joseph's University
Philadelphia PA USA
The Internet Journal of Law, Healthcare and Ethics. 2007. Volume 4 Number 2. Open Access Article.
On July 18, 2006 Dr. Anna Pou, a surgeon and respected medical school professor, and two nurses, Cheri A. Landry and Lori L. Budo were arrested on suspicion of second degree murder. Charles C. Foti, the Louisiana Attorney General, accused them of using lethal injections to kill four elderly patients at Memorial Medical Center in New Orleans in the aftermath of hurricane Katrina. The case has been turned over to the Orleans Parish District Attorney, who will present it to a grand jury before deciding whether to bring charges. Thirty-four patients died at Memorial Medical Center as a result of hurricane Katrina and this has led to intense speculation about how some of them died. According to newspaper accounts many of the patients were evacuated from the hospital, which was surrounded by five feet of water, had no electricity, dwindling food and medical supplies and was baking in 100-degree-plus heat. The sickest, however, were left behind. “The four victims were actually patients of LifeCare Hospital, an intensive-care unit that leased space from Memorial Hospital and had a separate staff. With chaotic evacuations taking place, many by boat, Dr. Pou and a Memorial Hospital official who has not been charged by Mr. Foti told witnesses that the LifeCare patients ‘were probably not going to survive,’ according to the affidavit released from the office of Attorney General Foti.” 1The affidavit further states that the arrests grew out of accusations by four supervisors for LifeCare Hospitals. “As hopes for a full rescue seemed to fade on the third day after the storm, three of the LifeCare employees say that Dr. Pou told them she was going to inject a ‘lethal dose' into patients who seemed unlikely to survive. The affidavit goes on further to state that witnesses saw Dr. Pou and the two nurses fill syringes and go into patient's rooms.” 2Medical tests revealed that morphine and another powerful sedative, Versed, were found in tissue samples of the four patients. Medical records show that none of the four patients had been receiving either drug in their regular medical treatment. 3In reality, it appears there is little direct knowledge of what actually happened inside the rooms of these patients. The defense lawyers have questioned the credibility of the LifeCare employees. The company has acknowledged that 24 of its 55 patients died as a result of the storm, and that its top administrator and medical director were not present during these days. 4The affidavit also suggests that many staff members at the hospital were familiar with Dr. Pou's plan and that it was openly discussed; and portrays witnesses as being barred by staff members from entering an area on the second floor where LifeCare patients were housed in the final days. 5Again, much of this is speculation and has not been confirmed. Numerous medical, legal and ethical questions have arisen as a result of these findings. Were Dr. Pou and the two nurses scapegoats for the delays in evacuating the hospital? Were they scapegoats to cover-up the incompetence of the top administrators at LifeCare? Were Dr. Pou and the two nurses heroes for having volunteered for storm duty and remaining at the hospital for five days or are they criminals who took the law into their own hands and committed homicide? Was this an act of homicide or were the patients suffering and in need of high doses of pain medication for palliation?
At the present time no one has been charged in the investigation. Investigators have subpoenaed more than 70 witnesses and are examining volumes of evidence. Lawyers for the three accused health care professionals argue that “the facts will reveal heroic efforts by the physician and the staff in a desperate situation.” 6This situation comes down to determining whether the pain medication was given with the direct intention to ease the pain of these patients in a desperate situation or to directly terminate the patients. Unfortunately, according to New Orleans Coroner Frank Minyard, the bodies of the four patients were not retrieved from the hospital until two weeks after the storm and were in advanced stages of decomposition. This undermines the accuracy of toxicology tests. 7Therefore, there are real questions about the reliability of the forensic evidence. This incident has prompted a national debate about mercy killing and the role of physicians in hopeless situations. Was this an example of medical professionals attempting to “play God” or was it a form of palliative care? This case hinges on knowing the precise facts of the case. One ethical principle that can be used to understand this case is the principle of double effect.