The author of this book, what is the timeline of your bookmore what is the timeline of your book . I am talking about five days in 2005 when the levees failed in new orleans after Hurricane Katrina and water drowned one of americas most beloved cities and looking specifically over what happened at those days in one of the hospitals that was surrounded by water. What is Memorial Hospital . Memorial Medical Center was one of those longstanding Community Hospitals that had been built in 1926 and was the place people went for storms. Staff would go there even if they didnt have to work. They brought along their pets sometimes. If you are going to work a hurricane you need somewhere for the pets, they brought Family Members and even checked an extra patient in who might not be safe at home. This was a place everybody thought was safe in a storm. They would ride out hurricanes like the 1965 hurricane. Yes. What happened was this at several vulnerabilities that i learned Many American hospitals do in flood zones and one of the was elements of the electrical power system were below flood level so when the water started approaching the hospital they knew they had to evacuate, city power was gone. They were relying on backup generators and they knew within hours how power would fail. When helicopters started landing on the roof to take people there were 250 patients, thousand people, doctors, nurses, staff, Family Members including rescue first when you know you have hours left of power so that was the first dilemma. It started getting hot inside the hospital. Another vulnerability, american hospitals have, i am sorry to say is they are not required for their backup Power Systems to be able to keep the airconditioning or the heating depending on where you are functioning so even before all power was lost it was august, it was new orleans, hotter than is in miami and it started getting very hot in that hospital making it difficult for the patients and the people working there. Where is memorial in new orleans . It is up town in new orleans but it is two feet below sea level. It is like a bowl and it dips below sea level likable. Many of the hospitals were in a similar situation. What is memorials reputation . The reputation was excellent. This was a place where people were proud to work. The giants of medicine in new orleans have walked the halls. People were proud to work. It was a place where ratner said would work and have a child and the child would grow up and work in the same unit. There were multi generational families who worked at the top of those. The real family, the Real Community and well regarded. Has been a Baptist Hospital originally known as Southern Baptist and with these changes in medicine we saw in the 90s and 2,000s was bought by a for profit company. Is memorial opened today . It is under new ownership and back with the baptist name. The same building . The same building. I was just there the other day, they opened the neonatal i see you where people go to have their babies, many people were born at Baptist Hospital. They made improvements in their electrical system that unfortunately hospitals in my city where i live now, new york, do not have to make these improvements until 2013 because we discovered with Hurricane Sandy we have the same vulnerabilities in new york and many places are in flood prone areas that do not have their Power Systems protected but this hospital now does so they felt secure enough to bring the babys back but eight years later it is a very long time for this rebuilding to occur. Walk us through the five days. What is the date we are talking about and what happened on the first day . Basically the first day everybody arrived, the next morning of the storm hit, very severe storm, it was scary but when you talk to people that is not what they remember. They remember that there is a which is the day near this hospital water started coming up. The fourth day all power was lost. It became very critical. You can imagine in an american hospital, doctors and nurses rely on power to do just about everything weather running at iv that used to be run by gravity, now there are electrical pumps, to the medical records systems which are now digital. That doesnt work when the power fails. Think about ventilators. People who rely on machines to help them brief. Those failed. Doctors had decided to get the neonatal off of little babies and intensive care unit patients but they also designated a group of patients to go last. The sickest patients with do not resuscitate orders. We learned in america that may not be the best way to do tree osh, to figure out how , to fi the resources people need and a do not resuscitate order doesnt necessarily mean somebody cant benefit from care, doctors had to make the decision on the fly, they were hot and scared so these patients, it was decided they would go last and imagine they moved the patients out of their room into staging areas thinking helicopters would be coming but at some point, everybody was up on their rooftops. Many people did not evacuate the city. Remember the images of people waving anything they could to get helicopters to rescue them. The pilots had to decide do i rescue someone off of law rooftop who might not have water . Do i go to this hospital where presumably they have supplies which they did, helicopters dropped off madison they needed. They have water, they have food. Sometimes the helicopters came very slowly and these patients grew sicker and sicker and some staff grew very afraid. Sheri fink, thousand people in the hospital when katrina hit. How many people were evacuated . What happened was through incredible work, creative thinking, literally doctors and Staff Members who went out and knew there were boats on trailers in the neighborhood and when water rose, they hot wired one of them, brought it back to the hospital and started getting ablebodied people out because dry ground was only eight blocks away. They could float them there, that would be a way to rescue them. They got people out that way, they got pets out that way and they started euthanizing pets because they felt we cant put them on a helicopter, trying to take patients and Family Members out but it turns out through creative thinking they were able to expand those resources and bring boats to the hospital. One of the big lessons of 5 days at memorial life and death in a stormravaged hospital is you and me, any of us can be in a disaster where official help doesnt come quickly enough and it is through creative thinking that prepares you so you and me care for ourselves, Family Members, our community. We saw it in the philippines, the help comes a little too late. Theres a Family Member of a patient too who outside of new orleans, to the checkpoints which were closed, back to the border of the city, found some guys with swamp posts and directed them to the hospital, not only heard and her husbands mother, but many people at the hospital. So overall there was an incredible effort that kitchen with helicopters, no air traffic control, risking their lives to land on this helipad that hadnt been used in years. What was found after were 45 bodies at the top, 40 patients who died of those 45 during or after the disaster and that is when this question began why did so many patients died at this hospital that at many hospitals in a similar situation. The phone numbers are up on the screen. If you elect to participate in art conversation the, the author of five basin. Ipat o tell us develop a pulitzerversan winner and a medical doctor. Ys t we are talking about hurricaneat katrina. 202 is the area code. He lived in the east essential times and bad. S. 585381 fink is a medical doctor. 202 5853890 for eastern and central time zones and 202 5853891 is the mountain and pacific phone number. You can also send us a tweet. There is great dissension over this, there were people who felt like this was the right thing to do and some of them bravely spoke to me and i say bravely because ultimately there were arrests involved because of this. So there were people who thought that we should give these patients some medicine and help them to their death, it essentially. One of the doctors i spoke with said that he was so frightened that he called his wife and said i dont think im going to see you again, he thought he had to get out of that hospital and what would happen to the patients. Which doctors this . He was he passed away recently, but he was a Critical Care doctor at memorial. He was there for the five days . He certainly was. And he felt it was the right thing to do but there were others who didnt. Can you say that the doctors at memorial were euthanizing patients . Well, the book, five days at memorial life and death in a stormravaged hospital, takes you into debt by euthanasia they hasten the death by euthanasia or medicines, order can be called death by murder. He arrested several because a yearlong investigation took place and some of the staff who felt like, according to medical ethics and the laws of the land, according to the will of the Family Members who are present in some cases, that we dont do this. That there is a tradition in medicine the goes back to the time of hippocrates the doctors should not be in the role of hastening death and that is something that our medical codes in the United States are very against and they say they are not allowed. There are few places where euthanasia is allowed, but only with the consensus and under strict rules towards the end of life if a patient wishes such a thing. Who is the next doctor . She is one of the doctors who is ahead in neck surgeon and she gave some of the medicines to patients and i should say investigation showed that 20 patients received combination of morphine and a powerful sedative, one or the other or both and died that thursday, september 1. Many physicians and nurses, several were involved in this and she was one of them, there were two nurses that were also arrested, the three of them were arrested and accused by the attorney general of seconddegree murder in the deaths of several patients. And they were arrested because the prosecutors had the most evidence when it came to them and there were witnesses who had seen them and who had spoken with them about giving these medicines are among the doctors we spoke with me openly about what they did, while she spoke with me, would not address the issues around those deaths, not surprisingly, if you are arrested and accused of murder obviously. Family members, all of those lawsuits are settled or dismissed now, but i think that on the advice of her attorney, she is not really address the issues at the core and say only that she was innocent and not guilty of murder. Is she still practicing medicine . Yes. Where is that . Louisiana state university, she was promoted after these events because because while the evidence was there, although these deaths were hasten, the drugs were given. What the motivation was was really what the case was hinged upon. And however if it was given for comfort, that is something that we do allow in the United States, certainly, to treat patients for comfort towards the end of their lives. But the experts were called in to look at these cases were pretty convinced, there is one who dissented, that just the pattern of so many deaths in such a short period of time led them to believe that this was more than just an effort to provide comfort. But there was great sympathy for these Health Professionals in louisiana because of the larger context that the decisions were made in. And failures to respond quickly enough on a governmental level, so given that context, they felt that how can these arrests, with all of that failing around them. Sheri fink, when the news reports come out about what may have occurred at memorial . Very early on there were doctors and nurses who really disagreed and who had been involved in the discussions over hastening death, euthanasia, putting people out of their misery, whatever order you want to use on a company felt that this was wrong and that the patients were not suffering where this was called for even for comfort medicines. One doctor said to me that our job is not to bring about death and he really dissented in some of them spoke with the media. So very early on there were intimations of what might have occurred. But of course, no real evidence and a lot of people tended to dismiss those stories as sensationalistic and not really believe what happens. And i felt like i had worked in disaster and conflict zones myself as an aid worker and my first book was about a hospital under siege for three years during the bosnian genocide. That number had actually heard of a situation getting so desperate that doctors and nurses really thought that some of them thought this might be the best option. And i felt it was urgent for our country to know the true story and that that was the best way to honor the sacrifices of the people who worked so hard in this situation and the lives of the people that have passed away. For us to face this head on and not walk away from it and to look at these events. Whatever the motivation and the feelings of the people who did this. Obviously thinking that it was the best thing to do. We need to learn from this and go forward. We dont want to see this type of thing happen again. So theres all sorts of vulnerabilities in the country, organizations Getting Better prepared with leadership and communication and individuals having our own things. The first half of the book is by an hour by hour rechristen what happened and we have, unlike these doctors and nurses were stuck in a situation, we have the luxury of thinking about it before it ever happens and what we would want to do in a crisis like this. You have a picture here of Memorial Hospital under water. Please call on in. The phone numbers on your screen, divided by region if you are interested in participating. But it was this taken . That was taken on the fifth day. There was an effort to evacuate the hospital just as those injections were taking place in this is one headed toward for the hospital. Thats the main hospital. And this is the garage ramp and patients again, creative thinking is what saved lives here. They save so many lives and they pushed the patients until the mob that down ramp of this circle parking garage and then carried none of these rickety metal steps to the top of that here birdsall every patient, when the power fails you have no elevators, just imagine. You can see the water on the streets below. Still how isolated were the people at memorial on day four and a five . They were isolated. You know, this is the hospital that is two city blocks long like many of our hospitals. There just wasnt a pattern of regular meetings that people felt like communication was good in the hospital. So there were a few people who had radios and who were in touch with the rescuers and the coast guard left the radio there. So rumors just flew. And i was writing the book, as i thought about it, i thought about the callin radio show that was happening and people were calling in and reporting what was happening and there were people at the hospital with batterypowered radios listening and there were rumors of sharks and Hotel Swimming Pools and that zombies are taking over new orleans, really, does is what people were saying. A lot of the cell phones werent working, and the phones cut out, they didnt have satellite phones working. And so you asked where they cut off and it felt very cut off. Was the temperature in the hospital . People estimated it at a hundred degrees. The local weather stations not keeping records at that time. But i got weather records and i i would say it was released in the 90s in the area around the hospital and inside it became human. If youve ever been in the hospital, modern hospitals are kind of sealed shut and when the power goes down from which it sometimes does, if you have no airconditioning, the walls start to sweat. It becomes slippery on the floor and it becomes very humid and hot and difficult to work in Peoples Energy was sapped. Did they have water . They did have water, not running water. But they have ample supplies of water. But some people fear that it would run out and they were afraid of that. Sheri fink, you are a medical doctor as well. And have you thought about putting yourself into place for those five days at memorial . I have worked in disaster zones as a volunteer with some of the nongovernmental organizations. And that is really what made me interested in looking at this story. I certainly was not there when this happened and that is why it took me six years to gather documentation and to really try to piece together moment by moment what happened. But what i have is empathy for people working under situations of great stress and just what lack of sleep can do to you, what it can do to you when you hear gunshots going off and bombs exploding. And so i think that that gave me some sympathy for the conditions were these patients euthanized in your opinion . I think it is completely clear that data cannot be argued that 20 patients were found with these drugs in our bodies and it was well documented by the hospital and when they died and where they died and they receive these medicines on thursday, september 1, and they died within a short period of time. As for the intentionality of each person that did this act, that is sort of up to each person to say. Two doctors said that we did it intentionally hasten the death of the patients and others that i was trying to give comfort. And so i think that when you read the book, i wanted to show the different perspectives. I didnt want to insert myself in their and the whole question of the legal aspect was how do we adjudicate these potentially criminal acts in the context of this disaster. Sheri fink is our guest, author of five days at memorial life and death in a stormravaged hospital and shes a medical doctor. We have is about the from a call from isabella in florida. Caller hello,. We are listening. Caller okay. Im going to have to move on, im sorry. We are going to move on, and we are going to go to our caller from portland, oregon. We are listening, please make your comment for sheri fink. Caller hello, i was reading about this during the time of the New York Times writeup on it. I dont know if you were the author of that piece in the New York Times or not. But it seemed like there was a lot of [inaudible] and there was one woman director of the hospital who is making these decisions and i guess another part of it is that there really was no smoking gun in the sense that you said those two doctors came out and said yes, we did this. But they argue that no one ever said lets kill these people and so therefore people just kind of got off, and they use that as the defense of not being clear, but many people said that they knew that thats what they were going to do, yet no one actually said those words out loud to all of the individual doctors. So was wondering if you could comment on that and if you were involved with the New York Times writeup in the degree to which the hospital staff was told that. And just as a commentary, i feel more sympathy for the patients. I know you are trying to stress the fact that these doctors were under immense pressure but im sorry, i have more sympathy for the patients. They are there for their care and regardless of the stress and how it is that they were thinking, their job is to save lives and it just shows you how it was during Hurricane Katrina that so many people shirk their duties and responsibilities and police and hospital people, that they ended up killing people as opposed to trying to care for the citizens and residents. Thank you. The book raises this question is a time of crisis a time when we allow our moral our moral values to five hours at a time when we really need to hold even more closely to our root moral values and that is one of the questions that the book raises. And i think that many people were very disturbed because i should say it wasnt just patients who are teetering at the end of life who receive these drugs, in fact, one case in particular, and that ever everett was a 61yearold woman partially paralyzed, but he was hodgins and he had expressed a desire to be rescued and he didnt sell breakfast that morning and told his nurses that are we ready to rock n roll. He said one specific nurse, dont let them leave me behind, dont let them leave me behind. And she was devastated because because he was one of the patients who received these drugs and he was 380 pounds in the hospital without elevators functioning and according to people who participated in the discussion about him, they felt that that they were so out of hope that they felt that they couldnt carry him down the staircase. And i feel that we really need to think about this because obesity is an issue in our country. This came up at bellevue last year as well. The last person rescued when the waters came up on the east river in new york city, a big public hospital, 20 some stories high, is a 500pound man and they didnt give up hope. They kept carrying the fuel of two backup generators after the fuel pumps failed in the basement. And then until they could get elevator running and getting him out safely. So a lot of people feel the way that you do and it is one of those reasons why we really need to look at these issues. And as to this, i think that if you read the book five days at memorial life and death in a stormravaged hospital, i interviewed everyone i could, where did you hear about this idea, where did that person here from that person and etc. And you can kind of see how that initial idea was introduced in a context at first euthanizing pets and perhaps offhand comments about we are putting the patients in making the pets comfortable, when we do more for the patients. The patients were getting comfort medicines all on. They were giving them doses of what they needed for pain and four for distress as well. So the question of how does that idea percolate through the medical staff, embraced by some, rejected by others, its all in the book, and yes, i did write the New York Times article that you mentioned and early version of this story, which i felt even in 13,000 words could not tell the whole story and that is why i took another three years and wrote five days at memorial life and death in a stormravaged hospital. What did you when your poll surprise for . Remapped for the magazine that this caller was referring to that was published in 2009. We have chuck from arnold, maryland. Hello, doctor sheri fink. I have a question for you. I organized a group under fbi volunteer program called [inaudible] where we looked at longterm disasters and we have a group of doctors, including folks in the military and looking at the Health Care Infrastructure nationwide. Im wondering if you would be interested in participating with Critical Infrastructure and how to do it and what we might do to improve it for things like this. And i didnt know there was an interesting might have been a way to contact you to participate in that. Thank you. I urge anyone who wants to get in touch, you can go to my website which is sheri fink. Net and i am also on twitter and i have my Facebook Page and there is a contact form on the website as well. And i think that im really glad to hear that and i have heard that before. Since the book has been published for some really fantastic initiatives of people really realizing that we have seen so many disasters and vulnerabilities in different parts of the country and it is really a wonderful thing when various organizations and individuals get involved in looking at these preparedness issues and there are certain things that could be implemented who started the investigation into Memorial Hospital . It was started by the medicaid Fraud Control unit and it turns out that these units are in every state, it is a body that is sort of a combination of federal monies as well as state resources. Just. It was housed in the state capital and they typically investigate medicaid fraud, so this might be anything from abuse of elderly people in a nursing home to financial shenanigans going on and help facility that receives medicaid money which is most of them and they looked at best. The second half of five days at memorial life and death in a stormravaged hospital, you meet those young and passionate individuals. When these allegations are accusations came out, there was a code of silence and people were afraid, knowing that the investigation was going on. So they faced a tough battle piecing together what happened. The bodies sat in an unrefrigerated condition for a long time, so even if you do toxicology test on them, they could detect the amount of drugs, but im sorry they could detect presence of certain drugs but the amounts are very difficult to detect. So its the whole second half of the book is how they piece together these conditions and after a year of investigating is when the arrests took place. The next call comes from walter in new haven connecticut. You are on booktv on cspan2. Caller hello, yes, i would like to comment on the military situation and i suppose they can only say that they can actually save and i suppose it is taken out of their hands and they do what they can. And im wondering if medical training, so the determination is sort of taken away from them. So maybe the expectation of this and watching what you can expect and what it can actually do and who they can actually save as opposed to what they think they can do. Thank you for asking that question. I looked at the history and what we are talking about here is triaged, which comes from a french word, it referred to the sorting of coffee beans and that was exactly as you said, the original conception if you have a battlefield situation with people injured and who do you save first say verse than his concept was we save the most grievously injured without regard to race or distinction and its egalitarian, as the french would refer to it. And then some years later there was this concept added which would imply this much but this group of patients might go last. And perhaps their care would wire too many resources if you say that person, you might lose to other people, or perhaps you dont even have the resources to save them. And interestingly, when we look at the triaged protocol, say that her email and units in america use today, i was surprised to learn that there are roughly nine wellrecognized systems in the u. S. For it and they dont operate that category. And for us while we are not always good at predicting which of the patients will have no chance of survival and which will have a chance if we rescue them first. There has not been a lot of research on triage and i would urge anyone watching today and if you know a young person who is going up and wanting to research something important in the medical field, we dont even know how these different methods of triaged might impact the overall population and really it is about this normally, we try to do our best with each individual patient and we treat them according to the cute their situation is. We are flipping two or more populations on this kind of based approach. The number of lives saved, quality years of life, should age play a role, should we try to aim for justice and should we do it randomly, these are things that are debated and i think that we in america need to think about this in this particular story is one example and we face these types of situations across the Health Care System when you think about who gets resources and doesnt. Or when we prepare for a pandemic, there are discussions starting to go on that would help medical professionals make these decisions and to guide them. These guidelines are being made, for the most part, by small groups of Health Professionals and they may have very different values on the larger public and i would urge anyone who is interested in us, to please get involved and take a look at your Health Department website in your state and see what is going on in terms of development of these guidelines. The next call comes from jana and wholesome, montana. Please go ahead with your question. Thank you. Hello, sheri fink. Im just curious how many people [inaudible] thank you. Why is that important to you . And i think she hung up. Okay, im glad to have a chance to answer this because in the book i didnt really make it clear that i felt that the race of the person was not i felt it wasnt necessary to always mention that. So some people have assumed that this was perhaps euthanasia of all africanamerican people because there was this doctor who he spoke about who had said something when i interviewed him, having to do with race and having to do with historical situations and we withdraw in our own communities and we feel comfortable with the people we are closest to them perhaps those potential fissures in society can open if were not careful and if we allow ourselves to fear this, for example. But as best as i can tell of the 20 patients that received those drugs, about half and half africanamerican and caucasian or white or whatever words we want to do is to denote those races. We dont know what the denominator was in terms of the overall racial breakdown of those over there. But i can certainly say that it was not all one race or another who received those drugs and who died and they were a very low socioeconomic status as well. To the families get involved in these patients . They did. I think some people assume that this was a merciful act of the families would be glad if they think you are putting my loved one out of their misery in this awful situation when they had maybe not a great chance to survive. Part of the problem was the staff didnt even know where they were sending people to and whether the next place would have the kind of care that people would need. The Family Members were not asked what they wanted and several were made to leave their loved ones to get on votes and evacuate themselves. I would say almost every single one feels that this was wrong except for maybe one exception, if the loved one even if they hadnt wanted to live, they still had value and that effort should have been made to rescue them. And i think its fascinating in the epilogue that takes you all the way up and it came out this fall and it takes you right up to Hurricane Sandy and some of the more recent disasters. We found that one of the big challenges is that even short of euthanasia, this a time of crisis and often Family Members are not involved in the larger public is not involved. You say how can we possibly do that. But there is an example before Hurricane Sandy was approaching, and connecticut there is a hospice there. And they realized that they would have do it evacuate in short order and they assumed that they would move the most fragile and sickest is that patients first. Then they went and they spoke with the families and they asked the families and they found something but the staff did not anticipate, which is that the Family Members closest to death wanted to go last and they wanted every chance for their loved one to be a part of that. So i think we can sometimes find things and its crucial, really. The next call comes from sheila and louisiana. Wheres your location . Caller [inaudible] we are having trouble hearing. Im south of monroe, louisiana. Hello . Please go ahead, we are listening. Caller hello, i like your book. And i think that these doctors have a tough call. Before Hurricane Katrina hit, because of new orleans, what happened there and we never heard anything about that. I have researched this many times. She was talking about a leper colony near new orleans and she wanted to know what happened to that. I am not familiar, but thank you for the question. How much did Hurricane Katrina cost the Health Care Systems . Not only were these doctors and nurses brought before a grand jury, which i should say they did not indict, but there were many lawsuits against the corporation itself for what one lawyer described as a new theory of liability and failure to prepare for potential and possible disaster and they knew that hurricanes could hit new orleans and that there could be flooding in the new that there was a vulnerability in many hospitals. So the hospitals have been sued by the people who were in them, not only people who died, but those who suffered during the days of heat and fear and it was an particular suit and certified as a class action on behalf of basically everyone in the hospital. Because of workers compensation, they couldnt be part of the suit as workers, but just as it reached a stage of jury selection, the corporation and the plaintiff settled for 25 billion without any sort of admission of any sort of responsibility. So that was just divided of this year and people just received it this year and everyone ive talked to is pretty much unhappy with the amount that they received. People feel that at least one daughter one patient who had received this, sort of let her own lawsuit and she settled this year she says she just fell at the amount wasnt enough to make the corporation think harder about Disaster Preparedness and making these investments and you have to wonder in this is a Critical Infrastructure. We want them not to be places of danger for the patients and im. All of us may need them ourselves if there is a hurricane or an attack of some type. We need that to be able to continue to function. Thinking about that is Big Questions for our country. Hello, i really love this book and i think its amazing and i just wanted to ask questions. Number one was the issue of abandonment. I know that the defense counsel for these doctors, they are using an argument in a disaster situation with american law and state law doesnt apply anymore than i thought that was very deserving and i just wanted to get your thoughts on those things. Sure. I think that american law still applies and honestly it was difficult in a situation that juries do have discretion and they are able to, in this case, it became a question of whether that jury really heard all the evidence or whether they didnt hear all of the evidence for this. We both apologized, to nicole in brooklyn. So who designed this . I think its brilliant. And that is exactly the effect that is being done. What has been accepted by everybody is what manson himself wants to tell people. Ill legitimate son of a teenage prostitute mother who cared so little about her child how when he was nine or ten she was so tired of having to even try to take care of him. She threw him in the juvenile Justice System where he suffered grately greatly and his life turned bad. He didnt know who his father was, he didnt think his mother knew. So he said he finally learned, even as a child, that the street was his father and prison was his mother. Thats what everybody pretty much accepted. I decided to check it out. So the first part is lets look at the mans whole life. How did he get there . Second question, where was he and what kind of things were happening in our culture that made it possible for a Charles Manson to recruit a few dozen followers who would do these kinds of god awful things. Again, history doesnt happen in a vacuum. Im kind of convinced if Charles Manson had been paroled from prison in nebraska and ended up in omaha ha
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