After The FloodFive Days At Memorial: Life And Death In A Storm-Ravaged Hospital by Fink Sheri New York (NY) : Crown , 2013 576 pp., $27.00

Abstract

Book Review Health AffairsVol. 32, No. 12: The Future Of Emergency Medicine: Challenges & Opportunities After The FloodJeremy Brown Affiliations Jeremy Brown ( [email protected] ) is the director of the Office of Emergency Care Research at the National Institutes of Health, in Bethesda, Maryland. PUBLISHED:December 2013Free Accesshttps://doi.org/10.1377/hlthaff.2013.1231AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSNursesElderly patientsMedicaid patientsHospitalsHospital medical staffFive Days at Memorial: Life and Death in a Storm-Ravaged Hospital is more than 500 pages long, but it’s the content that is most weighty. We all remember Hurricane Katrina and the images of the Superdome. Many will recall the criticism of Michael Brown, director of the Federal Emergency Management Agency (FEMA), who was relieved of his position less than two weeks after the hurricane had destroyed much of New Orleans. And some might know of the questions that surrounded the deaths of a large number of patients at Memorial Medical Center in New Orleans. It’s this lesser-known chapter of the Katrina story that Sheri Fink tells—a story of chaos that every professional involved in disaster planning should read. Fink is no stranger to telling the story of a health system in chaos. In her 2003 work War Hospital , she described the experiences of doctors, nurses, and patients trapped in a war zone. In Five Days at Memorial , it is a natural disaster that traps a group of patients, family members, and medical care providers inside a hospital without power and with limited ability to communicate with the outside world. About fifty patients, including seven who were ventilator dependent, were trapped on the seventh floor, and over five days, these patients were cared for by nurses, pharmacists, paramedics, family members, and physicians. Hospital executives tried to convince government officials to evacuate the patients at Memorial and were directed to officials at the Centers for Medicare and Medicaid Services (CMS). CMS directed them to the Federation of American Hospitals, which in turn appealed to the Department of Health and Human Services (HHS). And then HHS reached back to the federation, the American Hospital Association, and FEMA.We learn much about Karen Wynn, nurse manager of the intensive care unit, who cared for her patients, nurses, and sixteen-year-old daughter, who had joined her at the hospital. Wynn did a variety of tasks from prying boards off of windows to get fresh air into the building to carrying patients up stairwells lit with only a flashlight. She also administered a combination of morphine and midazolam to an elderly woman struggling to breathe; the woman died soon after.Anna Maria Pou, an otolaryngologist, was another provider assigned to work at Memorial during the hurricane. Like Wynn, she moved patients toward the evacuation sites and squeezed ambu bags for the ventilator-dependent patients. She was also part of a triage system, well described by Fink, in which it was decided that the sickest patients would be evacuated last. Five days after the storm, Pou wrote prescriptions for very large doses of morphine for three of the remaining patients on the second floor, and witnesses would recall Pou then going to the seventh floor to end the lives of nine surviving patients there.Members of a disaster mortuary team arrived at Memorial on September 11, more than a week after the last living patients and staff had been evacuated. They recovered forty-five bodies—the largest number of bodies found at any Katrina-struck hospital or nursing home. Pou claimed that the staff “did everything in our power to give the best possible treatment that we could to the patients in the hospital, to make them comfortable.” But the sheer number of dead patients was enough to raise questions. Were the deaths because of regrettable acts of nature, a chaotic government response, poorly constructed flood protection, corporate greed, or acts of euthanasia? The second half of Five Days at Memorial addresses the Louisiana attorney general’s investigation into these deaths and is a harrowing account on its own terms. Toxicology tests on the bodies confirmed the presence of high concentrations of morphine, and questions of intentional killings were made in the media. Pou was arrested and charged with second-degree murder and nine counts of conspiracy to commit murder. The grand jury declined to indict Pou on every charge. There are numerous lessons from Katrina for disaster medicine and health policy. Natural disasters will result in ordeals for patients and providers, and Fink reminds us to plan ahead rather than to indict after the fact. Sadly, it’s not a lesson we seem ready to heed. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 December 2013 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF download