Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (93 page)

142
The obvious effect
: Richard Simmons, letter to author, August 9, 2009.

143
state of Louisiana paid
: Morris, Tim, “Senate Approves Payment for Dr. Anna Pou’s Legal Bills,”
Times Picayune
, June 16, 2009;
http://www.nola.com/politics/index.ssf/2009/06/senate_approves_payment_for_dr.html
.

144
The Memorial class action suit was settled
: Interviews over the course of the litigation with several of the attorneys representing the class, including: Joseph Bruno, Mark P. Glago, Anthony Irpino, Todd R. Slack, and Roderick “Rico” Alvendia. Information was also provided by Rick Black (then-) director of communications for Tenet Healthcare. See also Fink, Sheri, “Trial to Open in Lawsuit Connected to Hospital Deaths After Katrina,” ProPublica and the
New York Times
, March 20, 2011;
http://www.propublica.org/article/trial-to-open-in-lawsuit-connected-to-hospital-deaths-after-katrina/
; Fink, Sheri, “Lawsuit Against New Orleans Hospital Settles Shortly After Trial Begins,” ProPublica, March 23, 2011;
http://www.propublica.org/article/lawsuit-against-new-orleans-hospital-settles-shortly-after-trial-begins
; Fink, Sheri, “Class-Action Suit Filed After Katrina Hospital Deaths Settled for $25 Million,” ProPublica, July 21, 2011;
http://www.propublica.org/article/class-action-suit-filed-after-katrina-hospital-deaths-settled-for-25-millio
.

145
According to the guidelines
: “Special Master’s Report and Recommendation on Allocation Model,”
Preston, et al v. Tenet
, September 19, 2012. Some family members of deceased patients were dissatisfied with their settlements both in the class action and in individual suits (for families that opted out of the class action) against Memorial, particularly after the lengthy legal battles they endured. In the
Preston, et al v. Tenet
case, families of patients who died received $167,229.73, to be divided among all survivors (some who died had a large number of children). Karen Lagasse’s suit on behalf of her mother, Merle, settled for $270,000 (prior to the reduction of 33?% attorney fees), according to a copy of the settlement check filed by a Tenet attorney in the court record. The settlement, achieved through mediation, left Lagasse angry, because she felt justice was not done and the amount was not enough to force the hospital or the involved physicians to change their practices in the future. “The whole fact doctors would decide who’s worthy to live, who’s not, who’s going to be evacuated and who’s not going to be evacuated, who’s going to be left and who’s going to take them out—what kind of morality is that?” she asked in January 2013. “I feel
like I’m the little voice saying, ‘Don’t you realize it could be your wife? Don’t you realize it could be your child?’ They got away with it; it’s not going to stop.”

EPILOGUE

Interviews

Dr. Joseph Andrews; Roger Bernier; Dr. Guthrie Birkhead; Dr. Frederick “Skip” Burkle Jr.; Dr. Elizabeth Lee Daugherty; Dr. Karen DeSalvo; Dr. Laura Evans; Dr. Thomas A. Farley; Robert Gallagher; Howard Gwon; Monica Gwon; Dr. Aarti Kinikar; RADM Ann R. Knebel; Ann Nugent; Dr. Tia Powell; Dr. Nirav R. Shah; Eugene Tangney; Warner Thomas; Dr. Eric Toner; Jacqueline Toner.

Notes

  
1
One lesson from Katrina
: Interview with Warner Thomas, president and chief operating officer of Ochsner Health System (August 28, 2012). See also: Fink, Sheri, “Hospitals, Nursing Homes Are Better Prepared for Hurricane Isaac Than Earlier Storms,”
Times-Picayune
, August 28, 2012.
http://www.nola.com/hurricane/index.ssf/2012/08/hospitals_nursing_homes_better.html
. By the 2013 hurricane season, post-Katrina improvements to Ochsner Baptist Medical Center included “new and restored electrical generators and power transfer switches, central plant infrastructure raised on a platform, a new water well to maintain cooling systems in the event of a city water loss and a restored heliport with an additional elevator stop directly from the heliport to the new NICU,” according to an e-mail from Ochsner Health System public relations manager Stafford Scott Maestri (August 2013).

  
2
Two months later
: Fink, Sheri, “In Hurricane’s Wake, Decisions Not to Evacuate Hospitals Raise Questions,” ProPublica, November 1, 2012;
http://www.propublica.org/article/in-hurricanes-wake-decisions-not-to-evacuate-hospitals-raise-questions/
.

  
3
Dr. Laura Evans
: Interview with Dr. Laura Evans (March 2013). See also: Fink, Sheri, “Beyond Hurricane Heroics: What Sandy Has to Teach Us All About Preparedness,”
Stanford Medicine Magazine
(Summer 2013);
http://stanmed.stanford.edu/2013summer/article5.html
; and Uppal, Amit, Laura Evans, Nishay Chitkara, et al, “In Search of the Silver Lining: The Impact of Superstorm Sandy on Bellevue Hospital,”
Annals of the American Thoacic Society
, vol. 10, no. 2 (2013), pp. 135–142;
http://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201212-116OT
.

  
4
protocol for rationing ventilators
: Fink, Sheri, “Flu Nightmare: In Severe Pandemic, Officials Ponder Disconnecting Ventilators from Some Patients,” ProPublica. September 23, 2009;
http://www.propublica.org/article/flu-nightmare-officials-ponder-disconnecting-ventilators-from-some-pat-923
. The plan is available here:
http://www.health.ny.gov/diseases/communicable/influenza/pandemic/ventilators
.

  
5
according to reports
: Altevogt, Bruce M., Clare Stroud, Sarah L. Hanson, Dan Hanfling, and Lawrence O. Gostin, eds.
Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations
:
A Letter Report
(Washington, DC: The National Academies Press, 2009);
http://www.nap.edu/openbook.php?record_id=12749
; Institute of Medicine,
Crisis Standards of Care
:
A Systems Framework for Catastrophic Disaster Response, vols. 1–7
(Washington, DC: The National Academies Press, 2012);
http://www.nap.edu/openbook.php?record_id=13351
.

  
6
A bioethicist uninvolved
: In an e-mail (November 12, 2009), Dr. Lachlan Forrow, director of ethics and palliative care programs, Beth Israel Deaconess Medical Center, wrote: “Rather than thinking
about exceptional moral rules for exceptional moral situations we should almost always see exceptional moral situations as opportunities for us to show exceptionally-deep commitment to our deepest moral values. This includes holding ourselves morally accountable, compassionately but still firmly, if we become—however tragically and unavoidably—involved in violating core values.” Father John F. Tuohey, regional director of the Providence Center for Health Ethics in Portland, Oregon, commented during a 2009 panel discussion with Dr. Pou in Chicago: “As bad as disasters are, even worse is survivors who don’t trust each other.”

  
7
In some states
: Fink, Sheri, “Preparing for a Pandemic, State Health Departments Struggle with Rationing Decisions,” ProPublica and the
New York Times
, October 24, 2009.
http://www.propublica.org/article/preparing-for-a-pandemic-state-health-departments-struggle-rationing-1024/
.

  
8
mounting evidence suggests
: Fink, Sheri, “Worst Case: Rethinking Tertiary Triage Protocols in Pandemics and Other Health Emergencies.”
Critical Care
, 14:103 (2009);
http://ccforum.com/content/14/1/103
.

  
9
“A new model of triage”
: Guest, T., G. Tantam, N. Donlin, K. Tantam, H. McMillan, A. Tillyard, “An observational cohort study of triage for critical care provision during pandemic influenza: ‘clipboard physicians’ or ‘evidence based medicine’?”
Anaesthesia
, vol. 64, no. 11 (2009): 1199–1206;
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2009.06084.x/pdf
.

 
10
New models have been proposed
: For example, White, Douglas, Mitchell Katz, John Luce and Bernard Lo, “Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions,”
Annals of Internal Medicine
, vol. 150 (2009): 132–138;
http://chpe.creighton.edu/events/images/life_support.pdf
.

 
11
small but particularly troubling study
: Khan, Z., J. Hulme, N. Sherwood, “An assessment of the validity of SOFA score based triage in H1N1 critically ill patients during an influenza pandemic,”
Anaesthesia
, vol. 64, no. 12 (2009): 1283–1288;
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2009.06135.x/pdf
.

 
12
report on what the teams had learned
: Fink, Sheri, “Doctors Face Ethical Decisions in Haiti,”
PRI’s The World
, 2010;
http://media.theworld.org/audio/022320107.mp3
.

 
13
Connecticut Hospice
: Interview with Dr. Joseph Andrews and Ann Nugent (February 2013).

 
14
“an important component”
: New York State Workgroup on Ventilator Allocation in an Influenza Pandemic/NYS DOH/ NYS Task Force on Life and the Law, “Allocation of Ventilators in an Influenza Pandemic: Planning Document” (March 15, 2007, draft for public comment);
http://www.health.ny.gov/diseases/communicable/influenza/pandemic/ventilators
.

 
15
An answer to Birkhead’s question
: The project described is: “Too Many Patients, Too Few Resources,” sponsored by the Hospital Preparedness Program 2012, US Department of Health and Human Services. Principal investigator: Dr. Elizabeth Lee Daugherty, also led by Howie Gwon, Dr. Eric Toner, Alan Regenberg, and Chrissie Juliano. Cosponsored by the Johns Hopkins Berman Institute for Bioethics; Johns Hopkins University School of Medicine Department of Pulmonary and Critical Care Medicine; Johns Hopkins Office of Emergency Management; Program for Deliberative Democracy, Carnegie Mellon University; RESOLVE, INC.; The Center for Ethics and Policy, Carnegie Mellon University; University of Pittsburgh Medical School Department of Critical Care Medicine; UPMC Center for Health Security.

 
16
“If this were to happen”
: Alex Brecht, at “Too Many Patients” forum, Baltimore, Maryland, May 5, 2012.

 
17
“It’s really hard for me to say”
: Cierra Brown, ibid.

 
18
“There’s so many social ramifications”
: Tiffany Jackson, ibid.

 
19
“We talked about politics”
: Maayan Voss de Bettancourt, eulogy at funeral for Irvin Zelitzky, September 6, 2011.

 
20
public engagement exercise was held
: Fink, Sheri, “Rationing Medical Care: Health Officials Struggle with Setting Standards,” ProPublica and
MinnPost.com
, December 21, 2009;
http://www.propublica.org/article/rationing-medical-care-health-officials-struggle-with-setting-standards-122
.

 
21
the project report said
: “Public Engagement Project on Medical Service Prioritization During an Influenza Pandemic,” Public Health—Seattle and King County, September 29, 2009;
http://s3.amazonaws.com/propublica/assets/docs/seattle_public_engagement_project_final_sept2009.pdf
.

 
22
In 2009, the CDC
: Roger Bernier, interview, 2009.

 
23
extensive report
: Institute of Medicine,
Crisis Standards of Care
, 2012, volume 6, pp. 347–463.
“more than an accurate estimate”
: Altevogt, et al,
Guidance for Establishing Crisis Standards
, 2009.

 
24
described in an academic paper
: Burkle, F. M. Jr., “Mass Casualty Management of a Large-Scale Bioterrorist Event: An Epidemiological Approach That Shapes Triage Decisions,”
Emergency Medicine Clinics of North America
, vol. 20 (2002): 409–36.

 
25
A pediatrician, Dr. Aarti Kinikar
: Fink, Sheri. “India: Rationing Health in Disasters,”
PRI’s The World
, December 17, 2010;
www.rationinghealth.org
.