Wednesday, July 12, 2017

"Mercy killings" after Hurricane Katrina

Back in 2008, I put up an article here that combined four earlier posts I'd written following Hurricanes Katrina and Rita in 2005.  I summarized the 'lessons learned' during that crisis, for the benefit of those trying to plan and prepare for future disasters.  It remains one of my most viewed articles, and I still occasionally receive reader e-mail thanking me for putting it up.

Courtesy of a link at Commander Zero's place, I was reminded today about a 2009 article in the New York Times, describing the chaotic evacuation of patients from a New Orleans hospital during Hurricane Katrina.  There's little doubt that a number of patients were euthanized - i.e. deliberately killed - rather than evacuated, according to criteria established 'on the fly' by a few doctors who were in attendance.  Charges of murder were initiated, but never tried in court, which I think was a pity.  I have little doubt that murder was done under the guise of alleged 'medical necessity'.

It's a very sobering article to read, particularly when one remembers that none of those who died would necessarily have expected to be placed at risk under such circumstances.  Illness or injury can strike any of us at the least opportune time . . . and we, too, may find life-or-death decisions being made about (and for) us by others, without so much as a 'by your leave'.  Here's a lengthy extract from a much longer article.

It is now evident that more medical professionals were involved in the decision to inject patients — and far more patients were injected — than was previously understood. When the names on toxicology reports and autopsies are matched with recollections and documentation from the days after Katrina, it appears that at least 17 patients were injected with morphine or the sedative midazolam, or both, after a long-awaited rescue effort was at last emptying the hospital. A number of these patients were extremely ill and might not have survived the evacuation. Several were almost certainly not near death when they were injected, according to medical professionals who treated them at Memorial and an internist’s review of their charts and autopsies that was commissioned by investigators but never made public.

. . .

The full details of what Pou did, and why, may never be known. But the arguments she is making about disaster preparedness — that medical workers should be virtually immune from prosecution for good-faith work during devastating events and that lifesaving interventions, including evacuation, shouldn’t necessarily go to the sickest first — deserve closer attention. This is particularly important as health officials are now weighing, with little public discussion and insufficient scientific evidence, protocols for making the kind of agonizing decisions that will, no doubt, arise again.

At a recent national conference for hospital disaster planners, Pou asked a question: “How long should health care workers have to be with patients who may not survive?” The story of Memorial Medical Center raises other questions: Which patients should get a share of limited resources, and who decides? What does it mean to do the greatest good for the greatest number, and does that end justify all means? Where is the line between appropriate comfort care and mercy killing? How, if at all, should doctors and nurses be held accountable for their actions in the most desperate of circumstances, especially when their government fails them?

. . .

Morphine, a powerful narcotic, is frequently used to control severe pain or discomfort. But the drug can also slow breathing, and suddenly introducing much higher doses can lead to death.

Doctors, nurses and clinical researchers who specialize in treating patients near the ends of their lives say that this “double effect” poses little danger when drugs are administered properly. Cook says it’s not so simple. “If you don’t think that by giving a person a lot of morphine you’re not prematurely sending them to their grave, then you’re a very naïve doctor,” Cook told me when we spoke for the first time, in December 2007. “We kill ’em.”

In fact, the distinction between murder and medical care often comes down to the intent of the person administering the drug. Cook walked this line often as a pulmonologist, he told me, and he prided himself as the go-to man for difficult end-of-life situations. When a very sick patient or the patient’s family made the decision to disconnect a ventilator, for example, Cook would prescribe morphine to make sure the patient wasn’t gasping for breath as the machine was withdrawn.

Often Cook found that achieving this level of comfort required enough morphine that the drug markedly suppressed the patient’s breathing. The intent was to provide comfort, but the result was to hasten death, and Cook knew it. To Cook, the difference between something ethical and something illegal “is so fine as to be imperceivable.”

. . .

Records showed that more than half of the 41 bodies from Memorial that were analyzed by Middleberg’s lab tested positive for morphine or midazolam, or both. Middleberg had handled thousands of cases in his career, and the high drug concentrations found in many of the patients stuck out “like a sore thumb,” he told me.

There's much more at the link.  I strongly recommend that you click over there and read the whole thing.  It's scary in its implications of what might happen to any of us, if we're unfortunate enough to be caught up in such a mess.



indyjonesouthere said...

This was necessitated only because neither the mayor or governor followed their emergency plan. Every jurisdiction has one but it requires intelligent, thoughtful construction of the plan and implementation of the plan. They did neither and simply ran for their lives. Even the facility these elderly were in failed to follow their plan...where was the transportation that should have been prearranged and located nearby with drivers and attendants already assigned? One can simply never count of a political solution to keep themselves must fend for yourself and your family.

Will said...

"It's scary in its implications of what might happen to any of us, if we're unfortunate enough to be caught up in such a mess."

Commander Zero blogged about being in a hospital with a burst appendix recently, and having the #3 strongest earthquake in that area strike while laying in bed. So, yeah, you don't have to be some type of late term cancer patient to end up in a potentially tight spot, when it comes to a hospital's internally designed triage situation.

Snoggeramus said...

Professor William Toffler from Oregon spoke in Australia just a couple of weeks ago about the impact of legalising euthanasia on both patient care and the medical culture. The video and transcript of his presentation is available at

kurt9 said...

Hurricanes do not just show up unexpected, like earthquakes. There is usually several days of warning where people can evacuate. Why wasn't this hospital evacuated a day or two prior to Katrina hotting? If they had started the evacuation several days prior, they could have gotten everyone out before the storm hit.

Does anyone know why the evacuation was started too late/

JK Brown said...


First off, New Orleans received minimal damage from Katrina. The levees were stressed by the storm, but didn't breach for 12-24 hours as the water pushed west found the century's worth of political malfeasance built into them. They had a couple days of progressive flooding (and clear weather) that they didn't use to evacuate.

In any case, on Friday, the storm was still going ashore in Florida. The path shifted late Friday, but even then few were taking it serious. On Sunday morning, people along the MS coast were starting to get animated about the storm. It was a very unique storm. I forget its final category when it came ashore, but it had flooding projected by the Navy for a Cat 5. This was because it came ashore over the Pearl River right next to the Delta. The Delta plugged the drain for the storm surge so more water backed up across the front of the storm and the surge was higher than the meteorology would predict. But all that was in Mississippi. In New Orleans, the winds pushed water up on the levees and they were also part of the plug for the storm surge. But the levees were not breeched by the storm proper, but they were stressed which then let the water relatively slowly exploit weaknesses.

HMS Defiant said...

The wise will think about it. The foolish will react to yet another piece of crap from reporters at the New York Times.

I look at it with a somewhat jaundiced eye. There is enough of my upbringing that condemns self destruction. It's a deadly sin and then weighs in that if, after all that, somebody slips a terminal patient a killer dose, that's not suicide. That's a doorway which one may step through without fear or favor.

One has to keep in mind that I think that this was best captured in the movie Gladiator. You may laugh now.

Anyone with any kind of religious bent has to be curious about what's on the other side but most religions ban the practice of inviting oneself.

Quentin said...

I'm not sure I understand your concern. You've been in combat. You must have seen medics deciding who lives and who dies. How is this so different?

Anonymous said...

I was not aware that this occurred. Doctors cardinal rule is Do No Harm, but given a hurricane flooding the streets, they didn't have much choice.

The biggest lesson for me - evacuation of these patients should have occurred and would have saved (at least temporarily) some of them. The patients were at the wrong place at the wrong time.

Peter said...

@Quentin: Combat is an entirely different set of circumstances. One is caught in a situation where there are no better alternatives.

If you read the article, you'll note that evacuation was available - it was just a question of when it would arrive, and then how much trouble it would be to take advantage of it. Under the circumstances, doctors made judgment calls that I think were profoundly wrong . . . but, of course, they remain convinced that they were right - and, what's more, that they had the right to make those calls. That, too, I disagree with. When humans begin to play God, only evil can result.

Anonymous said...

They didn't evacuate ahead of time because it costs time and MONEY. And, where would they evacuate to? The US medical system doesn't have thousands of empty beds waiting for patients. Shelters don't get set up until AFTER and they don't get set up outside of the affected zone.

Living in the Gulf Coast hurricane region, or I guess anywhere else, comes with responsibilities and judgement calls.

Do you evacuate and to where? WHEN do you go? As mentioned, evacuation costs money. It can cost lives (one of the considerations in the article was that some of the patients were unlikely to survive the stress of the evac.)

One of the biggest hindrances to making good choices is that the media, and I include the weathermen and agencies in that group, live on hyperbole, exaggeration, and also cower in the fear of lawsuits. They have every reason to play UP the severity of storms, "in an abundance of caution", and none to report calmly or accurately. AND hurricane prediction is TOUGH. Even acting with knowledge and diligence, most of the forecasters are simply wrong.

The result is, no one trusted the warnings.

Compare and contrast with the evac for Rita, which followed Katrina. Roads were PACKED with evacuating people. Everyone saw Katrina and didn't want to be stuck in that.

10 years pass and we once again have to learn the lessons. Look at the hype for Sandy. Look at the hype for the winter storms of the last 2 years.

I think the biggest (and root) cause of the decisions made that week was that the stressed, exhausted, physically, emotionally and INFORMATIONALLY isolated Drs and RNs acted as if it was TEOTWAWKI, when it was in fact just a limited regional disaster.

For me, looking at the incident with hindsight, there are some lessons to be learned.

Only you care about YOU. - if you are in a facility when SHTF, YOU need a plan. If your loved one is there, YOU need a plan. Aesop has written MANY times, they are not ready. They don't have good plans.

If you are part of the response, you need to communicate. - Make sure that people have a realistic understanding of the situation. "We are working the issues, people are being evac'd. We will get to you. LOTS of help is coming from outside the disaster zone. This will be over in a few days. It will get better."

If you are stuck in the middle, with responsibilities but no ability to act, you need to seek as much info as possible. You need to assess your OWN mental and physical state, and stay as fit as possible. You need to continually step back and take a deep breath and remind yourself that this is a TEMPORARY condition, and a LOCAL one. It's most likely NOT TEOTWAWKI.

If you are a planner, you need to incorporate the points above into your plans and scenarios.

If you are just a private Joe, you need to understand that NO ONE is incorporating those points into their plans, and make plans of your own.


for extra credit, see also

A Texan said...

It's pretty rich that an article such as that is concerned about people dying in the medical system under such circumstances but ok with socialized medicine that also kills thousands each year in many countries.

Paul, Dammit! said...

I had this conversation during the Ship's Medicine Chest class that management-level merchant officers used to have to take. The trauma doc ( a former Navy corpseman, too) that I was shadowing talked about his abhorrence of prescribing a quietus, that it was murder and a violation of all medical oaths, which was separate from prescribing morphine for a fatally or severely-injured casualty. His view, which I find reasonable, dealt with intent. So long as the intent was pain management and not death, accidental or incidental death, while legally an issue for the doctor to deal with, was not a moral quagmire at all.

Tom Bridgeland said...

Simply having large amounts of morphine in a patient's system is no evidence of foul play. On any given day, the great majority of my patients will have morphine or another opiod given. Some have been on large doses for years, and the amount given would be enough to kill a person who was unused to opiods.