"Someday," the letter writer warned, "the truth will be told".--anonymous writer, in response to an essay for Modern Healthcare written by Touro Infirmary CEO, Les Hirsch.

 

The writer called out Hirsch, who was explaining away actions taken by hospital staff during Hurricane Katrina. The anonymous writer questioned the moral judgement of nurses and doctor's who were entrusted to care for those patients that could not help themselves and who were completely dependent upon hospital employees for safe evacuation. 

"One of the nurses helping with the hospital evacuation came upon 16 bodies in your building. It was reported that numerous morphine vials were found littering the floor. One of these bodies was still alive and is currently receiving treatment in another hospital. Why were these patients left to die? Were they euthanized? How did you decide which ones to leave, based it on ability to pay? I find the actions of this hospital deplorable. No patient should be left to die or euthanized."

 

Shortly after Hurricane Katrina, the attorney general's office was contacted time and again with complaints about other hospitals and nursing homes in New Orleans. Accusations were flying and the allegations being reported were normally unheard of. However, all allegations had to be investigated. The worst was yet to come. 

Memorial Medical Center housed a "hospital within a hospital" on it's seventh floor. This leased space belonged to LifeCare, a specialized hospital that provided long term treatment to very sick patients, the majority of those elderly and many dependent on ventilators, a breathing apparatus for patients unable to breathe on their own. LifeCare had two other campuses in the surrounding area and it was decided, with Hurricane Katrina barreling towards New Orleans, that most would be transported to a safer location. The leased floor at Memorial seemed like the ideal place to bunker down.

New Orleans was under mandatory evacuation orders but this did not include hospitals. Katrina was expected to be a Category Five storm. Flooding was going to be a factor. Electricity would be lost. Backup generators would be rendered useless at ground level. Because of costly expenses, many of the local hospitals ignored suggestions to move back up power systems to higher elevations. Memorial Medical Center was in trouble. No one could have known what was to come. In the end, Dr. Anna Pou, and two nurses were criminally accused of ending the lives of the patients they cared for during the harrowing days after Hurricane Katrina wreaked it's havoc on a hospital that was all but forgotten and left to fend for itself. With no real hurricane disaster plans to follow, difficult decisions were made during an unimaginable time of crisis. Were those decisions right? Who gave the orders? 

"There were some patients there that, who were critically ill, and regardless of the storm were, uh, had the orders of Do Not Resuscitate, in other words that if they died to allow them to die naturally, and not to, um, use any heroic methods to resuscitate them." As she spoke, she nodded emphatically, as if to bring along her interviewer or her audience, or perhaps to convince herself. "We all did everything in our power to give the best treatment that we could to the patients in the hospital, to make them comfortable." -- Dr. Anna Pou

 

I remember Hurricane Katrina well. It was my parent's anniversary. At first, it looked like New Orleans would be ok. Then the levees broke. It was hard to believe, especially when the sun was shining, that one hundred miles seperated us from one of the biggest natural disasters to ever occur in the U.S. The scenes unfolding on television were beyond heartbreaking. The images were beyond comprehension. This cannot be happening. In America! All day long, we watched helplessly as Blackhawks and many other helicopters passed overhead, flying east to pluck survivors to safety. To dry ground. To Houston. To Lafayette. To Baton Rouge. We were dry and safe at my mom and dad's. The sun was shining. It wasn't even raining here. We soon began to worry about our relatives, my aunt and cousin, who lived on the west bank in Marrero. Cousins that lived on the east side of New Orleans. My beloved Granny that lived just south of New Orleans, in Houma, the city where I was born. What in the world was happening to our state? The Gulf Coast? It was in utter chaos. Still, we were here. We were safe. But over there, in a city I had lived and loved in, people were dying. People were drowning. Normal people were behaving like criminals, need and hunger forcing them to act out of character. It didn't look like the New Orleans I loved. It didn't even look like America. And, while all this devastation was going on, doctors and nurses were trying to do their best to save their patients. I remember being grateful that my daughter was no longer here on Earth. She had passed three years before Katrina. We practically lived in ICU at Children’s Hospital on Henry Clay Avenue. Were she alive, chances are, she and I would've been there. I love and miss my girl but there's no way I'd have wished her here to die like that or to suffer as they did in so many of the New Orleans hospitals. After reading this book, compiled of Fink's six year's of investigative reporting, I seriously question the choices of the staff at Memorial and LifeCare. As a doctor or nurse, you take an oath to heal and comfort. My daughter is a nurse. Her patients love and admire her. My daughter loves her job. She's compassionate, caring, attentive. I know in my heart that she would never abandon those in need, nor do I think she would have taken the easy way out and gone along with a decision that, in my opinion, lessoned the burden for a weary, fearful staff but was cruelly disguised as comfort care. Sheri Fink does an amazing job of fact finding, and interviewing those immediately involved. Fink doesn't sugarcoat the horror behind the broken glass windows at Memorial. It's a disturbing look at the breakdown of a hospital in crisis mode, when people stop caring about tomorrow because they want to survive today. Hopefully, for the future, Hurricane Katrina will have taught us all to be better prepared. I'm hoping that city leaders, government officials, and hospital executives have a clearer plan in place for natural disasters. The outcome could've been so different at Memorial and other area hospitals during Katrina had they taken proper precautions and learned from the first storm that flooded the newly built hospital in 1926. They had 90 years to prepare for a catastrophe like Hurricane Katrina. Ninety years!! Apparently, millions of dollars can appear to cost more than the lives of the elderly, the disabled, DNR's, and innocent infants. Fink's book is an eye-opener and very compelling. 

Sheri Fink is a New York Times correspondent. She and her colleagues were recognized with the 2015 Pulitzer Prize for international reporting on the West Africa Eola crisis. Her story "The Deadly Choices at Memorial", co-published by ProPublica and the New York Times Magazine, received a 2010 Pulitzer Prize and a National Magazine Award. Sheri Fink can be found on Twitter @sherifink and Facebook at sherifinkbooks. Visit her website at www.sherifink.net.

*Many thanks to Blogging For Books for sending me a copy of this book for review. Opinions are my own. Quotes are from book.