Patients and staff are evacuated from Memorial Medical Center during the Katrina disaster
My first impression when I heard the charges against Anna Pou was shock and disbelief. I know Dr. Pou and have found her to be among the most professional and ethical physicians I know. Then I heard the attorney general and I became even more incredulous. He referred to a combination of drugs she used with her patients — the sedative Versed and the painkiller morphine — as a "lethal cocktail guaranteed to kill." This is absurd. If it were true, then thousands of people would be dying at the hands of doctors every day, because we use these drugs in combination all the time to give comfort, either during hospital procedures or at the end of life.
We struggle with end-of-life issues every single day. An episode like Katrina only complicates this struggle because it puts additional physiologic stresses on patients and emotional stresses on those who care for them. You can imagine a New Orleans summer without air conditioning — how unbearably hot it can be. At Charity Hospital, not far from where Dr. Pou was working, I and nearly 60 other staff doctors, nurses, and residents were stuck in a hospital without electricity, without water, without food, for five days with about 340 patients, 50 of them critically ill. We had no ability to use ventilators, so we had to squeeze ambu bags by hand to get air into their lungs. We had no monitoring equipment, no X-ray, no laboratory, no dialysis. Compounding all this, we were unable to have families at the bedside — or even available by phone — to participate in treatment decisions for the sickest patients. It was very, very difficult.
Like every acute-care hospital, we had patients die during the Katrina crisis — nine in all, and we did our best to make sure that when these patients died, they died with dignity and as comfortably as possible. Versed and morphine are appropriate drugs to ease suffering at the end of life in such a situation. Versed relieves anxiety and gives patients amnesia for events so they don't have horrible recollections of frightening events. Morphine is used to relieve pain. The combination is not some witch's brew, as was inferred during the press conference announcing the arrests. At the end of life we want to make sure that the experience is as comfortable as it can be. If a patients attention is focused on pain, he or she might miss an opportunity for closure.
The major difference between comfort care and euthanasia or murder is intent. In a dying patient, giving sedatives and pain killers with the intent to cause death would be considered euthanasia or murder, while giving the same drugs in the same dosages with the intent to relieve suffering would be considered good, compassionate medicine, even if death were to be a consequence. In the wake of Katrina if a patient had died in a hospital without evidence of having received comfort care, I would question that treatment.
I am surprised that the attorney general would rely on post-mortem drug levels to determine whether these drugs were administered in proper dosages. The drug levels in the patients — whatever they may be — mean nothing. Some patients receive very, very high doses of the medications with minimal effects, while other patients are very sensitive and require very little. The idea that you can check a drug level and determine intent is absurd.
We don't know the whole story from all participants, including Dr. Pou and the nurses: what the conditions were like and what their intentions were. Until all the facts are known, it's wrong for the attorney general to act as if he's dealing with hardened criminals. He may very well be dealing with heroes.