Sunday, August 30, 2009

Oy veh: Strained by Katrina, a Hospital Faced Deadly Choices (NYT Magazine)

I just spent the morning reading a New York Times magazine article on Memorial Medical Center in New Orleans. When Hurricane Katrina hit, the hospital lost power. As we know, the rescue operation was botched. There was gunfire in the streets and limited supplies. Doctors at the hospital decided that they would triage patients.

In a military setting, casualties are expected to occur en masse and medical and evacuation resources may be limited. Military personnel have to do the greatest good for the greatest number with their limited resources. Casualties who can be saved with immediate care are given priority. Casualties with light wounds are given a lesser priority, as are casualties whose injuries are too severe to help on site. There is basically no choice but to ration care.

In a civilian disaster setting in a Western country, one would normally expect help to come relatively quickly. In Katrina's case, it didn't. The personnel on scene at Memorial also did not have military or disaster experience. They decided to give a lesser priority to patients in poor condition who had standing Do Not Resuscitate orders. Additionally, some doctors decided to administer lethal doses of sedatives to patients who were not expected to live.

There had been gunfire in the streets for days on end, and hospital personnel had had little to no sleep. The hospital was flooded and lost its power generators - this compromised the ICU equipment. Additionally, lines of communication were complicated by the fact that a for-profit hospital operated within Memorial; LifeCare leased some space to provide very intensive rescue care to patients so that they might survive until they could transfer to a nursing home of hospice. The presence of two chains of command and very sick patients was an additional complication.

Mistakes were inevitable, and there was initially enough for prosecutors to seek indictments for murder on several doctors. The criminal charges were dismissed, but there were subsequent civil suits.

Racial relations also complicated things. Most of the clinicians and administrators were White. One Black doctor noted and protested when several Black people attempted to seek medical care several days after the flood and were turned away. One of the patients who died, and whose death might have been averted even with the scarce resources on hand, was Black.

Whether or not mistakes were made, readers should realize that the hospital personnel were in an unimaginable situation for which they had not been adequately trained. They acted as best they could. To the extent that mistakes were made, the families of the victims deserve compensation as appropriate through the legal system. Of course, for the families of the victims who were Black, the situation may merely reinforce their often well-founded belief that the system isn't working.


Anna Renee said...

As much as some would like to lay blame, the situation was terrible and people both victims and hospital personnel reacted out of their understanding, beliefs, their levels of compassion and training, etc. Dont we all react from our worldview?


W said...

Well, personally, I'd prefer not to lay blame in this case. However, if mistakes were made, the victims need appropriate compensation. This can be achieved through an apology plus a settlement, or a malpractice suit. I'd prefer the former, since it involves less blaming than the latter.

Unfortunately, the hospital in question may not have the resources to appropriately compensate the victims of whatever misjudgements its personnel may have made.

In any case, it bears repeating that the hospital personnel were in an emergency situation that they did not train for. Given that they did not intentionally kill anyone or act recklessly, we should be very careful before assigning blame.