Wednesday, June 20, 2007

Prescription for a Healthcare Crisis

The first law of medicine is to do no harm to one's patient. The second should be not to let politicians make medical decisions lest you harm the profession, thereby harming patients. A doctor and some nurses in New Orleans stand accused of violating the first. Their accusers -- Louisiana's elected Attorney General Charles Foti and Orleans Parish D.A. Eddie Jordan -- have violated the second.

This story, like so many others, begins with Hurricane Katrina. Dr. Anna Pou, an ear, nose and throat specialist who specialized in head and neck cancers, and nurses Lori L. Budo and Cheri Landry were working at Memorial Hospital in New Orleans in the wake of Hurricane Katrina. They each have been charged with murder for the supposed mercy killings (euthanasia) of four cancer patients who died in their care shortly after the Hurricane. What is remarkable is not that the patients died, but that they lasted so long.

Conditions at the hospital were deplorable by even third-world standards. The hospital's first floor was flooded with ten feet of water. There was no electricity, and temperatures inside reached 110 degrees. Public officials told the doctors inside that evacuating the hospital was not a high priority while other citizens were stranded on rooftops. There were many reports of gunshots in the vicinity. The four patients in question were patients of a company called Lifecare, which ran an acute care facility for the critically ill. Dr. Pou and her staff tended to these patients after there own assigned doctor failed to show up. If illness alone didn't kill the patients -- and at least 34 died that week -- then dehydration, lack of medicine, and despair certainly could have been contributing factors.

The doctor and nurses say they did no more than comfort patients in pain -- traditional palliative care. The Orleans Parish Coroner has already ruled that the deaths were "undetermined," meaning that the available evidence does not support a finding of homicide. That should end of the inquiry. But where science has left off, politics evidently takes charge.

The State evidently has a weak case. Apparently unable to secure an indictment, DA Eddie Jordan has offered the nurses immunity from prosecution in exchange for their grand jury testimony. (Otherwise, facing prosecution, they have no obligation to testify for fear of self incrimination.) In my experience, prosecutors offer immunity deals when they have no other evidence on which to rely. There still is no guarantee the nurses will implicate Dr. Pou. They are obligated only to testify truthfully, which means they may well bolster her defense.

Even if there's an indictment, I think this case will be a hard sell to the jury. The facts are murky at best, and there will be a tremendous amount of sympathy for the doctor and nurses who stayed behind to help. The jury (and anyone else) surely will ask, "Where was the assigned doctor? Where were the rescuers? Where were the family members that were so concerned for their loved ones? Where were Eddie Jordan and Charles Foti when the hospital was under siege. What more could these doctors and nurses possibly have done? Would you want your loved ones to continue to suffer under these circumstances?"

It is unclear why these charges are being pursued. Is is political pandering? Are elected prosecutors trying to impose new heroic medicine standards? And why so aggressively prosecute this kind of case when prosecutors seem either uninterested in or bungle prosecutions for violent street crimes? Whatever the reason, it surely will forever damage the medical profession in Louisiana. What doctors are ever going to want to stay behind in time of need if they will face second-guessing and, worse, criminal prosecution? Apparently the assigned doctors who left their posts get a free pass. I suppose it's no wonder that healthcare professionals are not exactly flocking to work in Louisiana. I hope voters feel assured in the future when they sit patiently in the emergency room and hear "Dr. Foti will see you now."

1 comment:

Anonymous said...

These nurses and doctors could have left on a boat like Dr. Bryant King did. He is the one who went to Cnn with the accusations. Instead of staying and saying NO, if these things were really happening, he abandoned his patients and the dedicated drs. and nurses who stayed. He is a jerk and Charles Foti is a jerk,who by the way, no one will take care of when he is sick and old.