To paraphrase our very good friend Editilla, We Coulda been a Contenda Sports Blog, and indeed some of my favorite posts from a response standpoint have delved into other issues and not the financial ones that are my passion. My post from last month on the New York Times story on the Memorial docs after Katrina is an example of that though it didn’t generate on blog comments as much as a firestorm of off blog emails. I wanted to follow-up but the news cycle on the subject has again gone dark so despite being loaded with killer information on the happenings at the NOLA area hospitals in the days immediately after the great flood caused by the levee failures during Katrina I had no basis in the news cycle to publish the information. I also had to laugh at the reaction to the original post too because one of our most loyal readers found out his bro also reads us though they had vastly differing takes on the events at Memorial Hospital after Katrina. (You guys know who you are so be sweet to each other ;-))
Before I contrast Dr Life with my prior post on Dr Death lets begin with the story that broke last week on the Times Picayune concerning Dr. William Armington’s libel suit against the New York Times:
A doctor who was at Memorial Medical Center in the days after Hurricane Katrina has filed a federal libel suit claiming an article published in The New York Times Magazine in August defamed him by suggesting he knew of euthanasia at the hospital and failed to stop it.
The lawsuit filed by Dr. William Armington, a neuroradiologist who previously practiced in the New Orleans area and now lives in Oregon, claims the article “propagated false, misleading, and damaging statements, directly or through inference and innuendo, that Dr. Armington was aware of, participated in, and failed to stop criminal homicide or criminal manslaughter at Memorial Medical Center.”
The lawsuit is filed against the Times, the author, Dr. Sheri Fink, and ProPublica.org, a nonprofit news organization where Fink works. A spokeswoman for the Times said in an e-mail that the paper is “confident the story is accurate,” adding, “We intend to defend the suit vigorously.” Richard Tofel, general manager for ProPublica, made a similar pledge.
The article contained new details about what happened at the hospital, including quoting two physicians — but not Armington — who said they gave patients morphine and other drugs with the knowledge their actions would hasten the patients’ deaths.
After the storm, then-Attorney General Charles Foti’s investigation into nine of the deaths at Memorial focused on Dr. Anna Pou and two nurses. Pou was arrested for second-degree murder in 2006 in connection with four of those deaths, but a state grand jury in 2007 refused the charges. The two nurses were given immunity by Orleans Parish prosecutors in exchange for their testimony.
The 13,000-word article contains two paragraphs that refer to Armington. In the first paragraph, Armington comments on a group decision by physicians to evacuate the patients with do-not-resuscitate orders last. In the second paragraph, Fink wrote that Armington “suspected euthanasia might occur” based on a discussion with another doctor and noted he didn’t “intervene directly” with other physicians sedating the patients.
Armington said in the lawsuit that during the crisis, he was focused on evacuating patients from Memorial. He did not know of any euthanasia plans or actions by any other doctors.
My first reaction to reading this story was, “How dumb for that Doc to file a libel suit.” Doing so guarantees more of the exact kind of publicity he does not want and since Dr Armington is a bit player in this whole sorry affair (as evidenced by the passing mention of his name in the long article) my non legal opinion is his chances of prevailing are somewhere between slim and none. Simply put the man’s ego is writing checks his lawyers will happily cash but to no good end for himself or the other docs.
Never one to pass up the proverbial gift horse this recent turn of events allows me to highlight another NOLA area Doc, this one from Charity Hospital which managed not to fill up the hospital chapel full of stiffs despite being without power longer than Memorial in Doctor Ben deBoisblanc. What a study in contrast between Charity and Memorial Hospital as the picture on the left indicates as the hospital staff smiles for the camera while fanning a critically ill patient. This gentleman survived both his illness and Katrina thanks to their heroism and dedication. IMHO Dr deBoisblanc provided leadership that was missing from the equation at Memorial.Don’t take my word for it though, let visit with Dr deBoisblanc and his story on the Katrina Experience Blog:
I remember waking up about midnight. The wind blew pretty hard and the windows started to rattle. I could feel the building shake–a big, massive, concrete building that had been a civil defense shelter during the Cold War.From 1:00am to 3:00am, we heard windows popping out of buildings and crashing to the ground. I couldn’t go back to sleep. I couldn’t tell where the windows were popping out of—our building, or the building next to us. I just knew that they were popping and crashing. It was all very exciting.We first lost power right around daybreak. The emergency generators kicked on. For reasons I still don’t understand, the power went out again on our side of the hospital. We were plunged into darkness. There were very few windows in the ICU. The flashlights popped out. We’d done this drill a hundred times so four people ran to the bedside of a patient, grabbed a bag and started squeezing the bag. We had about 11 patients in the Medical ICU. Nine of them were on breathing machines, mechanical ventilators–all of them very sick. Each person would grab a bag. I went around and I checked with each one. I went from bed to bed to bed, checking to make sure everybody was OK.I remember getting around to bed 11, to Hunter Reeves. Hunter, this 23-year-old kid, he had Good Pasture’s Syndrome. Good Pasture’s Syndrome is a disease that causes you to have hemorrhaging in your lungs, and kidney failure. He was sent to us maybe 2 or 3 days before the hurricane, from a small hospital in Independence. They sent him to us because we’re an academic medical center. Hunter was on a ventilator with, on a breathing machine with a tube down his throat, on a very high oxygen concentration because of his lung failure. His respiratory failure was very severe. He was also getting dialysis.There was a woman, Celeste Widell, who was a respiratory therapist. I said, Celeste, are you OK? Yeah, yeah, yeah. Fine. I left. Came back about twenty minutes later. Are you OK, are you OK—yeah yeah yeah. Then I got to Celeste. Why don’t you let me give you a break? No, I’m fine. Alright. Came back an hour later. Got up to Hunter’s room and I said, Celeste, you’re still here? Why don’t you take a break? Let me give you a break. No, I’m OK.It kind of gave me a little chill. I realized, whoa, Celeste wasn’t going to let anyone mess with Hunter. That was her patient. I didn’t realize it at the time, but I really think that it had something to do with the fact that Celeste was a single mom. Her only son, her everything, Christopher, had died the year before. Sudden cardiac death, during football practice. Very sad. She was devastated by that. Took a long time before she could come back to work. This was a chance for her to feel like a mother again. A protector. No one, me included, was going to get in the way of that. I think it was people taking ownership for individual patients was why we did as well as we did.
The rest of Monday was a struggle to keep patients alive. Most of the equipment in the ICU continued to operate, although it was alarming that it was on battery backup. We bagged the patients—actually squeezing the bags—because the ventilators were not happy very long on battery backup. We could see on the other side of the hospital that there was still electricity. Our side was black.A few of our residents found some extension cords and strung together 300 feet. We plugged eight ventilators into this, using surge protectors and all these little multi-port extension cords. We stretched it as far as we could toward the other side of the hospital. It’s a huge hospital. We got to the middle; we couldn’t quite get to the other side. We plugged in to the only outlet that we could reach with our extension cords that had electricity: the Coke machine. We were able to power up a few of our ventilators that way and get back into business.We had about an inch of water in the ICU. We started to clean up. Mopping up an ICU with an inch of water is a big deal, so we said, gosh, wouldn’t it be nice to have a wet vac. We called our housekeepers, and they brought over a wet vac. They started wet vacing up. Well, they had a long extension on the wet vac, and started in the central hallway, and started moving toward the ICU, cleaning up the water. At about 2:00pm, the power went out for our ventilators. The extension cord power went out–only to find out that the janitors had unplugged our extension cord to plug in a wet vac, not realizing what it went to.We plugged back in. We had power, via that extension cord, for most of the day.
I remember waking up around 3:00am. When the sound of all the electrical equipment goes dead—you know how white noise puts you to sleep? The absence of white noise wakes you up. When everything got quiet, I immediately snapped to, ran in the ICU, and started the drill all over again. Squeeze the bags, try to troubleshoot the extension cord, figure out what’s happening. This time, it was obvious the other side of the hospital was black.The radio said something about a levee break. Not until sunrise did we realize that the city was flooding from every direction. The generators, or their connections, or circuitry, or whatever, had been submerged. We figured we weren’t going to get out that day. We still had aspirations of getting out soon.I went down to a meeting that we had of our emergency operations. We discussed our evacuation plans. We were told that we were going to leave the hospital that morning. FEMA was due to arrive with trucks, boats, whatever, to evacuate all of the patients. When they arrived, we were to stand down. I remember saying that well, I’m sorry, but most of these people who are going to be working for FEMA are not critical care personnel. They’re not critical care physicians. Some of them may be nurses, some of them may not be, some may be doctors, some may not be. We are struggling to keep these patients alive. We’re trained to do this. We know the patients. And we are struggling to keep them alive. I don’t think it’s a good idea to turn these patients over. With no more resources than we have, I think we ought to go with the patients. “Oh, no, no, no, no. That’s not the way these things operate. When they show up here, you’re just to stand down.”
Needless to say, FEMA didn’t come Tuesday morning. FEMA didn’t come on Tuesday afternoon, didn’t come on Wednesday. Wednesday afternoon. Thursday. To make a long story short, FEMA didn’t come until Friday afternoon. But we didn’t know it at the time. We were expecting this evacuation. So at first, our posture was really, let’s wait. Let’s wait to be rescued.In retrospect, that was a mistake. Waiting for someone to help you is always a mistake. It was a mistake for several reasons. One, is it wastes valuable time. But two, it creates a sense of helplessness. From that is borne despair and fear. Having a mission is very empowering. Having a goal distracts you, keeps you from thinking about what else is going on around you.So Tuesday, we just waited. Morale started to tank. No one had bathed in a couple of days. We didn’t have water. We didn’t have electricity; we were squeezing the bags on the ventilators. The back-up generators that we had didn’t have fuel.We realized that we weren’t going to get out on Tuesday. Rumblings started in the ICU. That nobody cared about us, that we’d been forgotten.
We formulated several plans, almost in parallel, of how we were going to evacuate people. The medical intensive care unit had its own plan. We couldn’t call anybody—not the police, the fire department. We couldn’t call anybody–except for one person who answered his phone. That was Wolf Blitzer on CNN. One of the residents was able to get a live feed on Wolf Blitzer’s show and let him know that we had not been evacuated. We were still there and we had all these sick patients.The President of a helicopter company picked up on that and called us on this phone. He told us that he would send us helicopters if we could find a place for him to land. He was already doing evacuations at Tulane Hospital. You could see there were helicopters everywhere. Hundreds of helicopters buzzing around the city.We went around looking for places for the helicopters to land. The Superdome, we thought, was under siege. Wasn’t, but we didn’t know that. That was the only commercial heliport in the area. We looked around at University Hospital. I went down the street by boat, talked to them down there. They thought the building could not support any helicopters. No one could land on top of Charity Hospital because it’s an uneven rooftop. We learned then that helicopters were landing on top of a parking garage over at Tulane Hospital. Someone thought we could use that to evacuate our own patients.We formulated this plan to evacuate our four sickest patients. About this same time, I remember walking down the hallway and kicking the boxed-up generators. How could we have generators but not have fuel? Then one of the respiratory therapists said, “Well Doc, I’ll getcha some fuel.” I said, “Well, how are you going to do that, Nelson?” Nelson Paige. He said, “Doc, I’ve got a Mississippi credit card.” I just dismissed him. I didn’t even think about it. He came back about an hour later with a jerry can full of diesel. I said, “Nelson, where did that come from?” He said, “I bought it with my Mississippi credit card.” I said, “Nelson, what’s a Mississippi credit card?” He takes out a hammer and a screw driver. He and a couple of other people had waded around the hospital, found some stalled trucks, and just banged open the fuel caps and siphoned out fuel for the generators. We were able to power up these little generators, which did take a load off of some of our personnel who had been bagging for hours.Hunter Reeves was in bad shape. I think Hunter was last dialyzed on Friday or Saturday. It was Wednesday. One of the things that happens when your kidneys fail is your potassium level goes way up. We had no idea what his potassium level was. Things were, to say the least, desperate for Hunter. We were barely able to keep him alive. We had a couple of other patients we were barely able to keep alive.So, we took Hunter. We also took this kid who had lymphoma, kidney failure, liver failure, and hypotension. We took two patients from the neurosurgical ICU who were in bad shape: both of them had closed head injuries. One of them had had a pulmonary embolism. Both were very sick and on breathing machines.So this guy said he’d send four helicopters and we decided to take those four patients. He said, “I can get you helicopters over there. We’re going to leave from the New Orleans International Airport, we’re gonna have a helicopter come every fifteen minutes, but you’ve got to get them over there [to the Tulane Parking Garage].” So we were like, how are we going to get them over there? The water was about five or six feet deep between us and the hospital. We had seen some big National Guard trucks negotiating the flood waters. But they weren’t around.Somebody went out and found a National Guardsman who had a truck, and said look, you’ve got to come help us. He said OK. We brought the first four patients down the stairs, all six or seven flights of stairs, and loaded them in the back of this truck.
We proceed to Tulane’s parking garage in the flood waters. The sun was getting low. Halfway there, Hunter’s blood pressure dropped. His oxygenation level dropped. We made an empiric diagnosis that he’d collapsed his lung. He’d already collapsed his right lung. He had a tube in his side. So halfway over there, using flashlights, we put a tube into his left lung. What you do is make a cut about two inches long on the side of his chest with a scalpel and poke a big clamp through his chest wall into the space on the side of his lung. It’s a surgical procedure. We did that without any anesthetic. We didn’t have any anesthetic or any sedation, so people were holding Hunter down. Thank God he doesn’t remember this. We did this surgical procedure on him in the back of a truck in the middle of swamp with flashlights. It was just the craziest thing. But his blood pressure came up. So did his oxygenation.
As I researched this post it became apparent that the missing factor at Memorial was leadership. Left to their own devices and most likely panicked as a result of the devastation decisions were made that cost people their lives. While it is easy to second guess the decisions made at Memorial Hospital in the aftermath of Katrina, the finality of those decisons are undeniable. Doctors take an oath and are supposed to know better. Though I wouldn’t count on it with the revelations in that New York Times story perhaps justice will still be theirs. Meantime Slabbed salutes the heroism of the medical professionals at Charity Hospital many of whom were Slabbed themselves yet put all that aside for the good of their patients.