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'Five Days': Grim reminder of Katrina

| Saturday, Oct. 26, 2013, 6:27 p.m.

When Hurricane Katrina devastated New Orleans in 2005, the city's hospitals faced awful dilemmas. Should all patients, no matter their medical conditions, be evacuated as the flood waters rose — even as sites appropriate for housing patients safely became unavailable? As crimes of desperation and opportunity sprung up in neighborhood after neighborhood? Or should some of the patients remain in the hospitals, as power outages occurred, as medical supplies ran short, as physicians and nurses and nonmedical staff wanted to evacuate because they feared for their own lives?

Obviously, no “correct” answers existed in such an extreme crisis. The New Orleans hospital in question here had existed since 1926, originally as Southern Baptist Hospital, later as Memorial Medical Center, which provided 317 patient beds and extensive outpatient services.

Journalist Sheri Fink, the holder of M.D. and Ph.D. degrees, decided to investigate what occurred inside Memorial Medical Center during the five most trying days of the hurricane and its aftermath. Numerous patients were not evacuated from the hospital, and early indications suggested that 45 patients who died on the premises might have survived if they had been evacuated.

Three warnings here: One is a spoiler alert. This review will reveal what some potential readers might want to discover for themselves about the outcome of the investigations into the dead patients.

Second, anybody who reads the book should be prepared to consume chapter after chapter of sickening details.

Third, readers who are able to stomach the hugely depressing, graphic content should understand that the narrative is difficult to follow at times. Although Fink shines the spotlight brightly on about a dozen characters, so many others enter and exit that even the most conscientious reader might have difficulty keeping track.

The characters include the hospital's medical staff and nonmedical staff, the hospital's corporate owners, patients and their relatives, medical examiners and related forensic experts, lawyers and investigators, politicians, journalists and biomedical ethicists, among others.

Fink chose to focus most intently on Dr. Anna Marie Pou, a physician who remained inside Memorial Medical Center with the nonevacuated patients. With no electricity (thus, no air conditioning) at the end of a hot, humid August; with dwindling medical supplies and the stench of urine and feces and vomit and death permeating every floor of the building; with no clear orders from government agencies or corporate headquarters or the highest-level medical staff about what to do; Pou remained on duty, at great hazard to her own health.

A head and neck surgeon who specialized in treating cancer patients, Pou had no template for this kind of emergency. The central mystery of the book is whether some or all of the 45 dead patients expired because Pou — along with other physicians and nurses — intentionally ended those lives with drug cocktails intended to minimize suffering. And if Pou administered drug cocktails, should the result be considered merciful euthanasia, callous euthanasia, the felony of manslaughter or the more serious felony of homicide?

The second part of the book focuses on investigations by the state attorney general and the local prosecutor. As the investigations dragged on, Fink gets inside the heads of law enforcement officials, especially Assistant Attorney General Arthur “Butch” Schafer and Virginia Rider, an investigator working with Schafer.

Based on sometimes contradictory evidence accumulated from hundreds of human sources and extensive but incomplete medical records, Schafer and Rider believed Pou had crossed lines during unprecedented circumstances and become a killer.

Because of the complicated legal system within Louisiana, however, Schafer and Rider had to turn over their evidence and their opinions to the local prosecutor's office, where a lawyer had to present it to a panel of 12 citizens constituting a grand jury.

The jury failed to indict the doctor. The mountains of evidence turned out to be circumstantial. The grand jurors heard and saw no evidence demonstrating for certain that Pou had injected any Memorial Medical Center patient with a lethal dose of any substance.

Based on the case presented by Fink, the investigation was called for, but it seems apparent that Pou should have escaped prosecution. Other readers are almost certain to reach different conclusions.

Steve Weinberg is a staff writer for the Atlanta Journal-Constitution.

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