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Medical Care in a Disaster

April 28, 2008

A couple of days ago, I posted a few articles to my del.icio.us page about Dr. Anna Pou. Folks in the medical community have been following Dr. Pou’s case very closely, and are making decisions on future response activities based upon how she’s being treated.

For those of you who haven’t heard about Dr. Pou, in August 2005, she was a cancer surgeon working at LSU School of Medicine. After Hurricane Katrina, Memorial Medical Center, where Dr. Pou was when the storm hit, experienced a horrific set of circumstances in which more than 30 patients–critical care, the sickest of the sick–died. Prior to the hurricane’s landfall, the majority of patients there were evacuated. Some stayed behind because they couldn’t be moved from the hospital. Dr. Pou was one of a number of doctors and nurses who stayed behind to care for those folks.

We all remember what happened to the city at large, but at the hospital, the conditions were unreal. The entire first floor was flooded, there was no power, temperatures reached over 100 degrees. Moving patients meant physically carrying them up or down stifling stairwells–no small feat when two of the patients who stayed behind weighed 400 pounds. To evacuate folks after the storm, they had to be carried down to the second floor, through a break in the wall between the hospital and the parking garage, then up to the roof of the garage to reach a makeshift helipad for the med-evac helicopter. By the second day, the doctors were in a sort of reverse triage situation, where the patients most likely to make it were given the most attention.

A horrible situation, no doubt, and one that no doctor really wants to be forced to work in. Then it got worse.

In July 2006, the Louisiana State Attorney General had Dr. Pou and 2 nurses arrested for murder. Several of her colleagues were prepared to testify that Dr. Pou administered lethal doses of medication to nine of the patients who died.

The bodies were not recovered for more than a week after the storm, and had decomposed to the point where the medical examiner could not make a determination of cause of death. Anecdotes from the staff at Memorial led the Attorney General to make the charges, but Dr. Pou has steadfastly denied any wrongdoing, saying she was acting only to help. Dr. Pou responded to a letter in the New England Journal of Medicine once again denying any wrongdoing here, making sure to mention that the case being compiled against her was rejected by the grand jury

Now you can see where the problem arises, right? If we’re going to start arresting doctors for deaths that occurs during a disaster, what doctor would treat? What if Dr. Pou was a volunteer and not covered by Memorial and LSU’s insurance?

I know that I have a few readers who are interested in Medical Reserve Corps issues, so I want to make sure that they realize that the ongoing saga of Dr. Pou is a testament to being able to protect one’s volunteers. I urge everyone involved with disaster volunteering, both organizers and volunteers, to make sure that good doctors and nurses will be able to practice without fear or reproach. As an organizer, it’s the least you can do; as a volunteer, it’s the least that should be expected.

Photo courtesy of dental ben.

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