Should They Have Been Charged?

I find it ludicrous that, as reported in this article, two physicians and a nurse were charged with murder and face life sentences for their actions in the aftermath of Katrina:

Dr. Anna Pou and nurses Cheri Landry and Lori Budo were accused of being principals to second-degree murder in the deaths of four patients at Memorial Medical Center three days after Katrina hit. The charge carries a mandatory life sentence, though the state will turn the case over to the New Orleans prosecutor, who will decide whether to ask a grand jury to bring charges.

Pou, Landry and Budo are accused of killing four patients, ages 61 to 90, with morphine and a powerful sedative called Versed.

Our government had seemingly abandoned the people of New Orleans in the week following Katrina.  It seemed that way to those of us watching in horror from the safety of our homes in areas not ravaged by the hurricane.  One can only imagine how it felt to those stranded in New Orleans, in sweltering heat, with no aid in sight and no means of communicating with people in the building next door, let alone with those outside of New Orleans.

And, the nurses and physicians who stayed behind were faced with the monumental task of caring for critically ill people without the bells and whistles of modern medicine--with their drug supplies being rapidly depleted.  There was no electricity, no running water, no modern day conveniences.  Nurses  manually ventilated those who had been on ventilators.   Snipers shot at the few rescue helicopters that made it through.  Celebrities rowed into New Orleans on boats while the the almighty United States government, with all of its money, power and resources couldn't seem to get its act together in order to simply drop bottled water into the convention center.

Chaos reigned supreme in New Orleans.  And, help was nowhere to be found.  This was not business as usual on the ICU unit.  It was hell on earth.  It was the equivalent of conditions in a war zone.  And, absent absolute depraved indifference to human life, medical judgments made under those conditions should not be second guessed.  And, those making the decisions certainly should not be prosecuted for murder and facing a life sentence.

It's disgraceful--as disgraceful as our government's response, or lack thereof, to Katrina. 

Comments

[Richard]

I read the article you linked to. The key question seems to be whether the morphine and Versed was given to the patients to ease their symptoms, or whether it was put into them with the intent to kill them. If we are really a nation of laws, then our personal opinions about it are not very relevant, as the latter scenario (i.e., intent to kill them) is clearly still illegal, disaster zone or no disaster zone. I conjecture the intent was a little of both, that is, ease of symptoms and a bit of, “Well, if it kills them, they’re chances of quality of life were slim anyway.” It’s going to be hard to prove for the prosecution.

I suspect you’d see this case differently if the patients who died from the drugs had been ages 11 to 40 rather than 61 to 90. Truth is, our society and our medical community do not really value the lives of the old to the extent we do the lives of the young, because the old have less quantity and quality left than do the young, but we will vigorously beat away anyone who suggests this fact might be true of us.

p.s. Check this out about Versed: “VERSED has been associated with respiratory depression and respiratory arrest, especially when used for sedation in noncritical care settings. VERSED has been associated with reports of respiratory depression, airway obstruction, desaturation, hypoxia, and apnea, most often when used concomitantly with other central nervous system depressants (e.g., opioids). VERSED should be used only in hospital or ambulatory care settings, including physicians' and dentists' offices, THAT CAN PROVIDE FOR CONTINUOUS MONITORING OF RESPIRATORY AND CARDIAC FUNCTION. IMMEDIATE AVAILABILITY OF RESUSCITATIVE DRUGS AND AGE- AND SIZE-APPROPRIATE EQUIPMENT FOR VENTILATION AND INTUBATION, AND PERSONNEL TRAINED IN THEIR USE AND SKILLED IN AIRWAY MANAGEMENT SHOULD BE ASSURED. For deeply sedated patients, a dedicated individual, other than the practitioner performing the procedure, should monitor the patient throughout the procedure.”

Pretty powerful stuff. With all the safety and monitoring requirements, why would you give it to a patient in a hospital that had lost, as you put it, all the “bells and whistles of modern medicine”? Doesn’t sound good for the defense, does it?

[NBlack]

First off, it was a critical care setting--I've read a number of articles indicating that it was an acute care unit-albeit one without power. So, Versed was not necessarily contraindicated.

And, the info. you listed includes all known risks, since the whole point of listing the risks is to CYA, right? And, a known risk isn't necessarily a likely risk.

Additionally, give this article a quick read: http://seattletimes.nwsource.com/html/nationworld/2003144085_ethics22.html

From that article: "Intention is the single most important element" in judging the ethical appropriateness of such decisions, Murray said.

"In normal circumstances, we have a clear, bright line between relieving pain and hastening death," said David Magnus, president of Stanford University's Center for Biomedical Ethics. "You are allowed to relieve pain even if it has a foreseeable but unintended consequence of hastening death."

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Accordingly, if the Versed and other drugs were given with the intent to relieve pain as opposed to hastening death, then no medical line was crossed. It was simply ordinary discretionary medical judgement exercised in extraordinary conditions.

I think that the prosecution has an uphill battle ahead of them in terms of proving intent. How exactly can they do tha, unless they were able to flip one of the co-defendants?

Also, see this article: http://www.nola.com/news/t-p/frontpage/index.ssf?/base/news-6/1153639893230580.xml&coll=1

regarding the difficulty proving the levels of meds in the bodies given the amount of time that had passed and the fact that blood was unavailable.

Yet another hurdle for the prosecution...