by Sheri Fink
93 case of physician involvement: The Robert Semrau case from Canada concerns a (non-medical) soldier charged with homicide on the battlefield for an alleged mercy killing of a Taliban fighter. See, for example, Friscolanti, Michael, “A Soldier’s Choice,” Maclean’s, 123, 19 (May 24, 2010): 20–25; and Carlson, Kathryn Blaze, “‘An Act of So-Called Mercy’: Semrau Case Hinges on ‘Soldier’s Pact,’” National Post, July 7, 2010.
94 “a soft quiet death”: Harris, John. Lexicon Technicum: Or, An Universal English Dictionary of Arts and Sciences, vol. 1, 4th ed. (London, 1725). The earliest reference mentioned in the Oxford English Dictionary, in the first listed sense of “a gentle and easy death,” is Hall, Bishop Joseph. Balme of Gilead: Or, Comforts for the Distressed (London, 1646): “But let me prescribe, and commend to thee, my sonne, this true spirituall meanes of thine happy Euthanasia.”
95 “To surrender to superior forces”: See “Permissive Euthanasia” in Boston Medical and Surgical Journal, CX, 1 (January 3, 1884): 19–20 (available on Google Books). This fascinating editorial shows that long before the age of high-tech medicine, late nineteenth-century doctors grappled with some of the same dilemmas twenty-first-century doctors do, including whether to keep fighting to save someone who is dying. The writer wonders if euthanasia will one day become “a recognized branch of medical science” (playfully predicting this may happen by the fortieth century). An example is given of a patient with metastatic cancer: “For weeks the physician has combatted death […] all for what? To exhaust the strength and perhaps imperil the lives of the remainder of the household; to keep in their home a body which is repulsive to every sense and a mind which is no longer that of their friend, but which is overclouded if not maniacal; or, if the sufferer retains consciousness, to meet her bitter reproaches for prolonging her misery. Shall not a man under such circumstances give up the fight, take off the spur of the stimulant, and let exhausted nature sink to rest?” The writer of the editorial sees symbolism in Edgar Allan Poe’s “The Facts in the Case of M. Valdemar” (1850), a creepy tale about a dead man kept alive through entrancement as he rots away. See also Emanuel, Ezekiel J., “The History of Euthanasia Debates in the United States and Britain,” Annals of Internal Medicine, 121 (1994): 793–802.
96 These ideas […] extermination camps in Poland: See, for example, Burleigh, Michael. Death and Deliverance: ‘Euthanasia’ in Germany c. 1900–1945 (London: Pan Books, 2002; 1st ed., Cambridge University Press, 1994); Gesundheit, Benjamin, Avraham Steinberg, Shimon Glick, et al, “Euthanasia: An Overview and the Jewish Perspective,” Cancer Investigation, 24 (2006): 621–629. Interview with Dr. Shimon Glick (May 16, 2010).
97 Psychiatrists have profiled: Kaplan, Robert M., “The Clinicide Phenomenon: An Exploration of Medical Murder,” Australian Psychiatry, 15, 4 (2007): 299–304.
98 a Dutch court: See, for example: Sheldon, Tony, “Andries Postma,” BMJ 334, 7588 (February 10, 2007): 320; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1796690/.
99 one pharmacy chain: Multipharma chain. Personal communication, Dr. Eric Dachy, May 5, 2013.
100 not always followed: The study is referred to in Pereira, J., “Legalizing Euthanasia or Assisted Suicide: The Illusion of Safeguards and Controls,” Current Oncology, 18, 2 (April 2011): e38–e45.
101 Groningen Protocol: Verhagen, Eduard and Pieter J. J. Sauer, “The Groningen Protocol—Euthanasia in Severely Ill Newborns,” NEJM 352 (2005): 959–962.
102 “life has been completed”: Peters, Marleen, “Completed Life: What Are We Talking About? Questions and Answers,” trans. Maarten Pennink, Amsterdam, NVVE/Right to Die Netherlands, February 2010.
103 The debate in the United States: See, for example, Cahill, Lisa Sowle, “Richard A. McCormick, S.J.’s ‘To Save or Let Die: The Dilemma of Modern Medicine’” in Walter, Jennifer K. and Eran P. Klein, eds., The Story of Bioethics (Washington, DC: Georgetown University Press, 2003).
104 Karen Ann Quinlan: See, for example, Lepore, Jill, “The Politics of Death: From Abortion to Health Care—How the Hysterical Style Overtook the National Debate,” The New Yorker (November 30, 2009).
105 Clarence Herbert case: See, for example, Lo, Bernard, “The Death of Clarence Herbert: Withdrawing Care Is Not Murder,” Annals of Internal Medicine, no. 101 (1984): 248–251.
106 Ohio legislature: “An Act Entitled an Act Concerning Administration of Drugs, Etc., to Mortally Wounded and Diseased Persons,” The St. Louis Medical Review, 54 (January 27, 1906). Retrieved from Google Books.
107 Studies in: Summarized in Gostin, Lawrence, “Drawing a Line Between Killing and Letting Die,” The Journal of Law, Medicine & Ethics, 21 (Spring 1993).
108 “N.O. Coroner”: Meitrodt, Jeffrey, “N.O. Coroner Finds No Evidence of Homicide,” Times-Picayune, February 1, 2007, A1.
109 When a New York Times reporter: Nossiter, Adam and Shaila Dewan, “New Orleans Coroner Sees No Evidence Yet for Indictments,” New York Times, February 2, 2007.
110 Karch had staked: See, for example, Karch, Steven B., “Is Post-Mortem Toxicology Quackery?” Journal of Clinical Forensic Medicine 10 (2003): 197–198; and Drummer, Olaf, A. Robert W. Forrest, Bruce Goldberger, and Steven B. Karch, “Forensic Science in the Dock: Postmortem Measurements of Drug Concentration in Blood Have Little Meaning,” BMJ 329 (September 18, 2004): 636–7.
111 well-known textbook: Karch, Steven B. and Olaf Drummer. Karch’s Pathology of Drug Abuse (Boca Raton, FL: CRC Press; 5th ed. available August 2013).
112 “These people were given”: Dr. Michael Baden interview (January 22, 2008).
113 He put Karch’s theory: Wecht and Kaufmann, A Question of Murder, 278–9; Dr. Cyril Wecht interviews with author (2008).
114 reported on the selection: Filosa, Gwen, “Memorial Evidence to Be Reviewed; Murder of 4 Patients After Katrina Alleged,” Times-Picayune, February 16, 2007.
115 “Dr. Pou’s heroism”: “AAO-HNS Statement on the Continuing Prosecution of Dr. Anna Pou,” American Academy of Otolaryngology Head and Neck Surgery, February 24, 2007; http://www.newswise.com/articles/view/527596.
116 “Very alone” and “What’s Father”: Interview with Dr. Anna Pou (July 23, 2008). See also the website of the National Seelos Shrine & The Seelos Center, New Orleans: www.seelos.org.
117 76 percent: Interview with Richard Simmons (May 2, 2007) and letter from Richard Simmons to author, August 14, 2009.
118 told a reporter: Berry, Jason, “Charles Foti and the Memorial Three,” Gambit Weekly, October 31, 2006.
119 “frivolous lawsuits”: Richard Simmons, comment during author’s interview with Dr. Anna Pou (July 23, 2008) “as Third World”: Dr. Anna Pou comments at Houston disaster-preparedness seminar, May 19, 2007.
120 On May 19: “Friends of Anna” disaster-preparedness seminar and dinner/fund-raiser held in Houston, Texas, attended by author as described in Notes to Chapter 3.
121 flying at night: Interviews were conducted with ten USCG and USCG Auxiliary members involved in coordinating or conducting nighttime operations at Memorial. The USCG, in response to a FOIA request, also produced a spreadsheet of flight record “bluesheets,” which show that many post-Katrina flight operations took place after dark. There is ample publicly available documentation of nighttime search and rescue operations undertaken at considerable risk after Katrina. See, for example, “The U.S. Coast Guard and Hurricane Katrina: Historical Index”; http://www.uscg.mil/history/katrina/katrinaindex.asp.
122 Pou’s former chairman: Dr. Byron Bailey.
123 World Medical Association: “World Medical Association Statement on Medical Ethics in the Event of Disasters,” adopted September 1994 and revised October 2006; http://www.wma.net/en/30publications/10policies/d7/.
124 collaborated with the attorney: Cobb, James Jr. Flood of Lies: The St. Rita’s Nursing Home Tragedy (Gretna, LA: Pelican Publishing, 2013), p. 227, and interview with James Cobb Jr. (May 4, 2013).
125 “nefarious conspiracy”: The allegation was made i
n court documents, as described in Rioux, Paul, “Judge Refuses to Remove Foti From St. Rita’s Prosecution,” Times-Picayune, August 1, 2007; http://blog.nola.com/times-picayune/2007/08/judge_refuses_to_remove_foti_f.html.
126 hold the Army Corps of Engineers: Cobb, Flood of Lies (p. 226) and interview with James Cobb Jr. (July 2013). Cobb no longer had Foti’s filing available, and the author could not independently verify its content before publication.
127 plot media strategy: Interview with Richard Simmons (May 2, 2007).
128 an ongoing case: See note for page 363 re: the Danziger Bridge shootings.
129 chanting “Heroes!”: Maggi, Laura and Brendan McCarthy, “Cheers, Jeers Greet Jail-Bound Officers in Danziger Bridge Shooting,” Times-Picayune, January 3, 2007; http://www.nola.com/crime/index.ssf/2007/01/cheers_jeers_greet_jail-bound.html.
130 On June 13, 2007: Supreme Court of Louisiana No. 2007-OK-1197 in Re: Special Investigation; http://www.lasc.org/opinions/2007/07OK1197.pfc.dip.pdf; “Application for Supervisory Writs Filed on Behalf of Applicants Witness #1, Witness #2, and Witness #3” (undated); “Motion and Order to Compel Testimony” and “Order,” State of Louisiana in Re Special Investigation, Criminal District Court, Parish of Orleans, Special Grand Jury, May 17, 2007; Maggi, Laura, “Immunity Offered to Memorial Nurses to Testify,” Times-Picayune, June 19, 2007; http://blog.nola.com/times-picayune/2007/06/immunity_offered_to_memorial_n.html.
131 “It just goes under a different name”: Interview with Karen Wynn (December 7, 2008).
132 published the first issue: Disaster Medicine and Public Health Preparedness.
133 a minority of American physicians: The AMA did not respond to a request for current membership statistics. Authors have suggested that in recent years, only around 15 percent of practicing US physicians were members. See, for example, Roger Collier, “American Medical Association Membership Woes Continue,” CMAJ, 183, 11, E713–E714, August 9, 2011; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153537/.
134 Rick Simmons appeared: Transcript of remarks, provided by Richard Simmons. See also, Sorrel, Amy Lynn, “AMA Meeting: Doctors Who Give Disaster Aid Seek Liability Shield,” American Medical News (July 16, 2007).
135 delegates voted to create: D-435.976 “Protection From Liability Arising from Care Rendered to Patients During Officially Declared Disasters”; http://www.ama-assn.org/resources/doc/PolicyFinder/policyfiles/DIR/D-435.976.HTM.
136 Minyard liked […] later describe it: This section is based on roughly a dozen interviews conducted with Dr. Minyard (2007–2010) and interviews with the forensic colleagues to whom he turned for advice on his findings. Minyard at one point told the author that he decided that four of the nine deaths the grand jury was considering were homicides, and his statement was included in “Deadly Choices” in 2009. However, copies of drafts of a letter to district attorney Jordan, dated June and July of 2007 and prepared on behalf of attorney general Foti, state that “Dr. Minyard still maintains that homicide is the manner of death only in connection with the deaths of two patients, Emmett Everett and Rose Savoie. To date, his determination of the manner of death of the other seven patients who died on the 7th floor on 9/1/05 remain ‘undetermined.’” It is unclear if Minyard had already testified before the grand jury at the point the letter was written, or if he did so later and changed two of the “undetermined” cases to “homicide.” In interviews, Dr. Minyard resisted describing exactly what he told the grand jury, claiming that it was secret. However, Minyard had a duty as coroner to classify the deaths as part of autopsy reports, which are considered public records under Louisiana law. When other members of the media sought the autopsy reports of the Katrina dead, Minyard, essentially setting his own law, at first refused to release them. The Times-Picayune and, separately, reporter A. C. Thompson, successfully sued to obtain them. However, the copies Minyard provided left empty spaces next to “classification of death” (see, for example, Maggi, Laura, “Autopsy Reports Aren’t Complete: Deaths at Memorial Weren’t Classified,” Times-Picayune, October 23, 2007). Likewise, family members of the Memorial and LifeCare deceased are entitled to death certificates. Those who have requested them in recent years have found them similarly incomplete, in some cases still marked “pending investigation.” Rose Savoie’s grandson, Doug, repeatedly requested a copy of her death certificate on behalf of his family. He was told in 2010—five years after Katrina—that the coroner hadn’t finished it. Savoie sent letters to the coroner asking that this be done, but it was not. He requested help from the International Association of Coroners and Medical Examiners. But the latest copy of the certificate sent to the Savoie family, in 2010, notes nothing at all in terms of the cause of his grandmother’s death and is stamped “under investigation.” As of August 2013, the Savoie family still had not received a completed death certificate.
137 forensic all-stars: Wecht and Kaufmann, A Question of Murder, p. 286.
138 to support her: Dr. John Thiele died at his home on December 31, 2010. For years during the course of his treatment for metastatic cancer, he continued to practice medicine, making patient rounds even while wearing his chemotherapy pack.
139 social columnist: Nolan, Nell, “Common Concerns Celebrated,” Times-Picayune, July 24, 2007.
140 published an op-ed: Foti, Charles, “Katrina Was No Excuse: No Circumstances Can Justify the Taking of Innocent Human Lives,” USA Today, July 27, 2007, 10A; http://usatoday30.usatoday.com/printedition/news/20070727/oppose27.art.htm.
141 popular national lecturer: See for example, Conde, Crystal, “Ethics in Crisis Care: Dr. Anna Pou Addresses Texas Medical Association’s 2012 General Session,” Louisiana Medical News (July 31, 2012; first published in Texas Medicine); http://www.louisianamedicalnews.com/ethics-in-crisis-care-dr-anna-pou-addresses-texas-medical-association-s-2012-general-session-cms-2120. “I felt like I was on the Titanic,” she told the Texas Medical Association in 2012, where she received a standing ovation. She has referred to what happened at Memorial and her subsequent arrest as a “personal tragedy.” In arrangements with meeting organizers, Pou has often prevented journalists from attending her lectures about Katrina. FEMA called us: Anna Pou, “Legal and Ethical Considerations in Crisis Care,” lecture at the California Hospital Association’s Disaster Planning for California Hospitals Conference, September 23, 2010, Sacramento, California.
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).