drbon

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i was just wondering what everyone thinks about the case going on right now in New Orleans. The background is that there is one doc and 2 nurses who could get life jail sentences for giving lethal injections to four terminally ill cancer patients 4 days after their hospital was cut off from the rest of the world with flooding and no electricity.
it seems like the DA of the city and the media in general think this is a pretty cut and dry case of murder, but i think it's more complicated than that....
 

spalatin

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drbon said:
i was just wondering what everyone thinks about the case going on right now in New Orleans. The background is that there is one doc and 2 nurses who could get life jail sentences for giving lethal injections to four terminally ill cancer patients 4 days after their hospital was cut off from the rest of the world with flooding and no electricity.
it seems like the DA of the city and the media in general think this is a pretty cut and dry case of murder, but i think it's more complicated than that....
So did Kevorkian, now serving life in Michigan for murdering a man in the same way on video tape then aired on 60 Minutes.

Cancer is a chronic illness that can be managed with proper care. Birth is a terminal illness. There is nothing complicated here. Medicine is a healing art, killing is not and is a conflict of interest. That's why the ethisicsts proscribe MDs from performing executions. too.

A recent case in west Michigan involved a new doc who wanted to cut off life support from a patient who was intubated on the vent against the wishes of her family. The court ruled against him, and the patient is alive and doing well now, off the vent and out of the hospital.

Real docs do not kill their patients. At least not on purpose.
 

a_ditchdoc

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spalatin said:
Cancer is a chronic illness that can be managed with proper care.
Real docs do not kill their patients. At least not on purpose.

Diabetes is a chronic illness. Many cancers, unfortunately, are not. This is why they are often call it a "terminal illness." And while "real doctors" should not kill thier patients on purpose, neither should they keep them alive via artificial means in order to merely prolong the suffering of an inevitable death. I am not sure of what happened in New Orleans, I suppose the trial will figure that all out. But, giving drugs to alleviate suffering, that may incidentally shorten life, is not considered unethical. Giving an injection with the sole purpose of ending life is entirely different. Let's hear what the health care providers involved have to say. Thus far we have only heard the prosecutors side...
 
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sophiejane

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spalatin said:
Real docs do not kill their patients. At least not on purpose.
Yes they do. It happens all the time in the Netherlands where euthanasia is legal and all sorts of protective measures and regulations are in place for terminal pateints who request it. Are they not real docs in the Netherlands?

Why is it okay for a doc to allow a patient to refuse chemotherapy and die at home but it's not okay for the patient (and we don't know that it wasn't the patient's request--I am inclined to think it was) to request a more comfortable way to die?

So, if we are proactive in helping them die with peace and dignity at their own request, we are murderers, but if we stand back and let them bleed out, suffocate, starve etc. at home in bed then we are noble physicians.

Hmm.
 

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a_ditchdoc said:
Diabetes is a chronic illness. Many cancers, unfortunately, are not. This is why they are often call it a "terminal illness." And while "real doctors" should not kill thier patients on purpose, neither should they keep them alive via artificial means in order to merely prolong the suffering of an inevitable death. I am not sure of what happened in New Orleans, I suppose the trial will figure that all out. But, giving drugs to alleviate suffering, that may incidentally shorten life, is not considered unethical. Giving an injection with the sole purpose of ending life is entirely different. Let's hear what the health care providers involved have to say. Thus far we have only heard the prosecutors side...
Interesting discussion. I agree that keeping a patient alive via artificial means and artificially prolonging the dying process in inappropriate. Giving drugs to control pain and signs and symptoms of progressive illness is also appropriate even if it hastens minimally, the dying process. I also agree that you are correct, in that we need to hear both sides of the story.

I think the above poster assumed, perhaps prematurely, that the facts stated were correct. I agree with him/her in general. Half of my practice will be treating palliative cancer cases for symptom management. Hospice does not consider anyone terminal unless someone has less than six months, and since we are not prophets, who's to say how long someone has? But we can make an educated guess and go from there.

I agree with both of you that doctors should not be giving lethal injections of any kind with the intent to end suffering by killing someone outright.
 

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None of us have all the facts on this yet. My understanding from the preliminary info is that these were critically ill patients who were being bagged by had because the electricity had failed and the vents wouldn't work. The AC had failed and this doc and the nurses, who were among the few left who had not abandoned the hospital to flee and save themselves, were left with almost no resources. Given the choice of just allowing the pateints to die a sweltering, hypercapnic death without any comfort measures they medicated the pateints. If their intent was to provide comfort and death was a result then they did the right thing. If I were in a similar situation I'd have done the same.
 
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drbon

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just for clarification on what the media is saying about the case so far:
News Article
personally, i blame the government for not evacuating that hospital. there is no reason why doctors should have slaved away for over 4 days trying to keep alive countless patients with no electricity in over 100 degrees. i think that this doc and nurses did the best that they could do, and i doubt that they decided to inject these patients because they felt like it. it was probably a matter of tending to other patients and not wanting these patients to suffer a terrible death.....of course, we need to wait for more details tho...
 

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Cancer is a chronic illness that can be managed with proper care. Birth is a terminal illness. There is nothing complicated here. Medicine is a healing art, killing is not and is a conflict of interest.
Could you BE more uninformed?!?!?!?!?! :eek: For anyone who's interested, see the similar, but more honest and thought provoking thread in the anesthesiology forum.
 

organicmatter

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My feeling, admittedly without knowing all the facts, is that if these health care workers are prosecuted successfully, a mockery of justice will have been committed.
 

irrka

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I remember hearing about this back right after Katrina, and thinking that there's no way in hell this would ever make it to trial. I'm with drbon on this one, and i seriously doubt anyone in their right mind wanders around saying, hey, let's just kill these guys. If anything, i think it was heroic of these several people to stick around when all the rest of the staff has abandoned the building and the patients for as long as they managed. Just abandoning the patients with no chance for relief seems like the more punishable act here, doesnt it?
 

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I don't really know all the background but what I do know is no of us were in that hospital, in those md/rn's shoes and while we can look back on it now when we are knee deep in the dodge its hard to look at it different. Don't get me wrong I belive in right, wrong, the value of life, etc.
 

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Taken from a thread in the anesthesiology forum, from a doctor who was actually there:

"OH! HEY! COUNSELOR FOTI!

Have you heard?

A familymember of one of the patients involved in this issue is speaking out IN SUPPORT OF DOCTOR POU'S ACTIONS.

Hmmmmm...

maybe the familymember has no need/desire to politically-grandstand, and is speaking from the heart about the truth , unlike you, Counselor Foti, you spineless-publicity-seeking-mothr-fkkkkrrrr, who is

trying to distort the truth, at THE EXPENSE OF OTHERS.

Said familymember was interviewed and realized the significance of Doctor Pou's care....uhhhh.....Counselor Foti.....

DOCTOR POU COULDVE PADDLED HERSELF TO SAFETY.

BUT SHE CONTINUED TO CARE FOR PATIENTS. WHO, BY THE WAY, WERE NOT HER PATIENTS.

HER INTERVENTION WAS PHILANTHROPIC."

The rule of double effect applies to Dr. Pou here. It was the only palliative care she could offer; given the lack of resources probably the only way the docs and nurses had left to provide comfort care. We titrate our doses so carefully, tweak this and that so that God forbid a lethal dose be delivered to a miserable patient who has asked you to die, but it wasn't possible here. All the doctors who sweated it out post-Katrina, probably scared out of their minds for themselves and wanting nothing more than to hightail it out of there with their families, to care for anyone who needed it, deserves the highest praise...not self-righteous mouthings about the sanctity of life by people who couldn't respect said sanctity enough to properly evacuate a city.
 

mig26x

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so this doctors who stayed during a hurricane type 4, with the city flooded, no water, no electricity, no personnel to help them, they dont know how there own families are doing and if they are alive or not, no food, gangs shooting at evacuation helicopters, the hospital is filling with water and they are questionning this people why they took those desicions?

First, lets beging by asking the judge or the jury if they would have stayed behind in there jobs while a hurricane 4 is coming down on a below sea level city, second it was the 4th day of no running water, food, electricity and this were cancer patients, they werent little kids with the common cold.

Giving this people life in jail is wrong, it was HELL down there and no one was there to help them!!

I think the goverment wants to clean their own BS by giving this people life in jail.
 

SimulD

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I think Foti is an absolute moron to say that this is a "simple case of murder." What does he know about heroism? He's a politician with a big mouth parading around as a sheriff, and he has been this way for many years.

I read that the patients were given Versed for anxiety and morphine for pain, and that the doses given were reasonable for terminally ill patients with some tolerance to opiates/benzos.

The city of New Orleans is bankrupt as is, and this trial will take up enough resources as is, not mentioning the fall-out that a guilty verdict would have on physicians' practice rights. The city's docs would essentially have to leave town if another storm occurs, to escape possible criminal prosecution in the case decisions have to be made. What an absolute disaster.

-S
 

3dtp

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SimulD said:
I think Foti is an absolute moron to say that this is a "simple case of murder." What does he know about heroism? He's a politician with a big mouth parading around as a sheriff, and he has been this way for many years.

I read that the patients were given Versed for anxiety and morphine for pain, and that the doses given were reasonable for terminally ill patients with some tolerance to opiates/benzos.

The city of New Orleans is bankrupt as is, and this trial will take up enough resources as is, not mentioning the fall-out that a guilty verdict would have on physicians' practice rights. The city's docs would essentially have to leave town if another storm occurs, to escape possible criminal prosecution in the case decisions have to be made. What an absolute disaster.

-S
Agree. Now that more news on this has come out. The LA Times had a pretty good article that was balanced this week. It does appear that the AG is grasping at straws in a grandstand attempt to get re-elected.

The AMAs Pain Mangement course makes it very clear that chronic opiate/benzo use causes substantial tolerance, and therefore one would expect elevated levels in chronic patients maintained on these drugs for extended periods. I've experienced it myself, when I have had to give significantly higher doses of narcotics than expected to chronic opiate users to control cancer pain.

The American Academy of Hospice and Palliative Medicine state that the need for proper pain and symptom management including anxiolytics in chronic illness has to be balanced with the possibility of hastening death but this is acceptable so long as the intent is to manage the symptoms/signs of disease.

Between the med-mal lawyers, the grandstanding political lawyers making waves in very questionable situations where it appears that everything possible was being done to care for patients, and political patsies to the HMOs like our esteemed Senator Frist, it's a wonder anyone wants to be a doc these days.
 

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Many see accused New Orleans MD as hero

By MICHELLE ROBERTS, Associated Press Writer Sun Jul 23, 1:45 AM ET

NEW ORLEANS - To Louisiana's attorney general, the doctor and two nurses arrested this past week are murderers. But many in the medical community are outraged at the arrests, saying the three caregivers are heroes who faced unimaginable horrors as Hurricane Katrina flooded the city and trapped them and their patients.
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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.

Dr. Ben deBoisblanc, director of critical care at Charity Hospital, said he and others are angry at the accusations against a doctor and nurses who risked their own safety, and provided care in a chaotic and frightening situation.

"This doctor and these nurses were heroes. They stayed behind of their own volition to care for desperately ill people. They had an opportunity to leave and chose not to," he said.

Memorial Medical was swamped with 10 feet of water and isolated by Katrina's flooding. The 317-bed hospital had no electricity and the temperature inside rose over 100 degrees as the staff tried to tend to patients who waited four days to be evacuated.

Attorneys for the trio say they are innocent. DeBoisblanc and others fear the accusations may discourage other health professionals.

"We have people who are volunteering their services and putting their lives on the line. It's going to make it less likely they'll do that in the future," said Dr. Peter deBlieux, an emergency room and intensive care doctor who stayed at Charity Hospital during Katrina.

DeBoisblanc said it's also likely to make doctors less eager to return as the city tries to recover from the hurricane.

"If you think that going after physicians and nurses while hardened criminals are ruling this town, if you think that's an image that's going to bring people back, you've got to be kidding yourself," he said, noting the recent rash of violent crime in New Orleans.

Kris Wartelle, a spokeswoman for the attorney general's office, said the agency had to investigate the claims at Memorial because it must enforce the law.

"Where is the sympathy for the victims? Why is there no outcry for the people who would have not died had they gotten out?" she said. "These are not terminal people begging to be put out of their misery."

Pou, Landry and Budo were the first medical professionals charged in a monthslong criminal investigation into whether many of New Orleans' sick and elderly were abandoned or put out of their misery in the days after the storm.

"This case is not over yet," said Louisiana Attorney General Charles C. Foti.

Hundreds of people were stranded in the hospital with no power to run lights or elevators and no running water. Anyone willing to carry a gun was deputized to watch the entrances as people broke into nearby buildings.

"We had no communication floor to floor, much less to the outside world. We were surrounded by water. It was hotter than Hades," said Dr. Gregory Vorhoff, who was at Memorial after the storm but left to seek help before the alleged killings. "It was as bad as you can imagine."

Under such conditions, even patients who might have been able to walk or were relatively stable before Katrina could easily have lapsed into critical condition, doctors say.

"It's very easy for a relatively healthy person to go down quickly," said Dr. Daniel Nuss, Pou's department head at Louisiana State University, where Pou has given up clinical duties until the case is resolved.

He and other doctors said the morphine and Versed that investigators found in the patients' bodies are commonly given to relieve suffering and anxiety.

"If you didn't find sedatives and analgesics in these people, I would think that was inhumane," deBoisblanc said. "The very fact that you found these drugs means nothing."
 
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