The Physician's Role in Crisis

Reading the stories in the New York Times (for example, these forwarded by Nancy Valko, here and here) about the arrests of two nurses and one doctor in New Orleans on charges of homicide during the aftermath of Katrina has me concerned that I have never read about a formal medical review of the case.

I can't imagine the heart-wrenching pain of watching my patients as they become more and more uncomfortable. Of not being able to transport them because I can't move them through what has been described as a 3 foot by 3 foot hole to get them to the roof. Watching the ventilators fail. Watching my staff fatique as they try to hand ventilate all the patients. Knowing that there are no medicines to make patients breathe, only medicines that can make them comfortable and make them unaware as their diseases cause them to smother and suffocate.

I, too, would give medicine to relieve the respiratory distress, while being aware of the risk of depressing the breathing drive. And I would discuss my thought processes with my staff and pray that rescue would come before the drive to breathe was suppressed enough to cause the patient to die. I'm not sure how much solace I would feel in knowing that those who have no drive to breathe will at least be sedated enough to never feel smothered.

I'm concerned that the State Attorney General has pressed homicide charges against these women before there was a formal medical review or evaluation.

I'm concerned that one report says that medicines found in the patients at autopsy were medicines that "they were not supposed to have in their bodies." If the physician prescribed them for legitimate purposes, then this statement is patently false. The medical review should come first, in order to evaluate medical decisions.

I have not heard an accurate account of the numbers of patients on ventilators and other machines dependent on electricity. No one has listed the medications that were available to the doctors and nurses. Even though the papers report conversations about "lethal doses" (from anonymous sources), none of them say the witnesses claim the doses were given with the intention of causing death.

The doctrine of double effect allows risk while relieving pain and suffering as long as the intent is not to cause the death of those suffering.

The heat alone would have put patients with mild lung disease, diabetes, and those who are underweight at risk of dehydration leading to respiratory distress which could not be relieved in the heat without sedation and ventilation. The humidity would have actually increased the respiratory distress.



Without the means to cool the patients, administer IV fluids, and/or put the patients on ventilators, it was appropriate to sedate the patients to relieve their pain.

For that matter, sedation can be used to slow the progression of respiratory distress. Morphine can be given as a mist in these cases. Regardless, sedation is usually needed in order to ventilate patients.

So what would the Attorney General have done with no resources other than sedatives? Would he have let these men and women die in pain?

The doctor and nurses in question did not abandon their patients. Instead, the reports are that they fought to care for all the patients and help as many survive as possible.

Why would any doctor or nurse remain in such conditions at the time? Will any be willing in the future? The answer to this last is, "Yes, even at risk of being arrested for caring for our patients."