Analysis of Memorial Hospital evacuation during Katerina

Analysis of Memorial Hospital evacuation during Katerina Alexander RotoloDaemen College Analysis of Memorial Hospital evacuation during Katerina. Hurricane Katrina can be remembered as one of the most devastating natural disasters in United States history. Natural disasters are unfortunate events in which we have as humans have little control. Medical professionals play a crucial role in stabilization and evacuation of those affected in these times of chaos. Memorial Medical Center was placed in the spotlight for their evacuation efforts, failed protocol, and allegations of euthanasia of patients. Protocol in evacuation Aug. 30th, 2005 the streets surrounding the hospital began to flood, and Memorial Medical Center’s evacuation plan began to fail. New Orleans, a city seated below sea level, neighboring the Gulf of Mexico, and situated on the Mississippi River is no stranger to hurricane activity. Susan Mulderick- Nursing director, was the emergency-incident commander during Katrina (Fink, 2009). Mulderick- an advanced practicing nurse and the appointed incident commander had a critical role during this event. Mulderick-the appointed commander, was responsible for coordination and facilitation of movement during the evacuation. Mulderick along with others formed a collaborative team operating as a chain of command. This chain of command is known as the Hospital Emergency Incident Command System (HEICS) (Chetwynd, 2017). (HEICS) Is defined as “a team of people, trained to respond to an incident- anything from an epidemic threat to a mass casualty incident” (Chetwynd, 2017, p. 1). Mulderick was well versed in the hospitals 246-page emergency plan. In her advanced practice, she served as a chairwoman on the emergency-preparedness committee and personally aided in drafting the plan (Fink, 2009). The first contributing part of this ethical disaster was the lack of protocol for a complete power failure, and absence of complete evacuation guidelines (Fink, 2009). Memorial, seated below sea level should have considered that a complete power failure was a realistic possibility. In fact, according to Flink (2009), after Hurricane Ivan senior administrators were warned about the possibility of complete loss of power second to flooding. Instead of fixing the problem, cheaper solutions were implemented (Flink, 2009). This lack of protocol was one of the many ways administration including Mulderick, L. René Goux- chief executive, and Richard Deichmann- medical- department chairman would contribute to a long list of ethical conflicts to come. Order in evacuation With the lack of protocol for evacuation and the quickly approaching time to act, Deichmann met with appropriate staff to discuss triage and evacuation measures. Triage in disaster shifts the idea from “doing what’s best for the individual patient to doing the greatest good for the largest number of people” ( Lee, 2010, p. 1). Literature about evacuation can be somewhat controversial. Overall, the literature suggests the order of evacuation depends on the time frame, level of evacuation and acuity of patients to be evacuated (Department of Public Health, Emergency Preparedness and Response Exercise Program 2014). If resources are adequate and the severity of the situation is time sensitive; priority is- patients in immediate danger, ambulatory patients, those requiring some assistance on general care units, and patients in intensive care (Department of Public Health, Emergency Preparedness and Response Exercise Program (2014). The guidelines suggest “if a given ICU is more unsafe than the rest of the hospital, the patients in that ICU should be given a higher priority for evacuation, even in critically time-sensitive situation” (Department of Public Health, Emergency Preparedness, and Response Exercise Program, 2014, Plan activation section, para 20). Deichmann and other appointed staff met to discuss how evacuation should take place. Staff agreed, patients of the neonatal intensive-care unit, Intensive care unit, and pregnant mothers were at the highest risk of deterioration; with the potential loss of power and resources- they should go first (Flink, 2009). Deichmann then made a bold statement; he suggested those with a Do Not Resuscitate order (D.N.R) should go last (Flink, 2009). Evacuation priority is a controversial and ethically challenging task (Department of Public Health, Emergency Preparedness and Response Exercise Program 2014). There were many ethical dilemmas Memorial would face. Perhaps, Memorials largest ethical failure leading to subsequent failures was the decision to make patients with D.N.R orders the last priority. A D.N.R is a widely-recognized order among healthcare professionals; a basic understanding is that in the event a patient’s heart shall stop, life-saving measures (CPR) should not take place. “But Deichmann had a different understanding, he told me not long ago. He said that patients with D.N.R. orders had terminal or irreversible conditions, and at Memorial, he believed they should go last because they would have had the ‘‘least to lose” (Flink, 2009, p. 4). Although Deichmann’s words are harsh a lot of the population with D.N.R orders do have terminal or irreversible conditions; however, that is not always the case. Some individuals who elect to make themselves a D.N.R are in good health or at least stable and for personal or spiritual reasons do not wish to be resuscitated. A D.N.R is not a wish for death and certainly does not imply the patient go last in an evacuation. This assumption made by Deichmann led to the vote that these patients go last in the evacuating Memorial. This decision goes against the ethical principle of Justice. Justice in ethics goes beyond fairness – “In health care ethics I have found it useful to subdivide obligations of justice into three categories: fair distribution of scarce resources (distributive justice), respect for people’s rights (rights-based justice) and respect for morally acceptable laws (legal justice)” (Gillon, 1994, p. 185). One of several people affected by this ethical failure was Wilda Mcmanus. Mcmanus- A LifeCare patient at Memorial was robbed the opportunity to evacuate the building leading to euthanasia and her demise. In the case of distributive justice, the letters D.N.R waved her right to timely evacuation services. These services were not distributed to her because of here resuscitation status. Mcmanus would not be offered evacuation services and would eventually be euthanized, taking away her right to live. Anna Pou- a highly regarded physician, was responsible for euthanizing Mcmanus. Though Pou’s intentions may have been good, euthanasia is illegal and in the case of legal justice can be considered homicide. “Beneficence: This principle states that health care providers must do all they can to benefit the patient in each situation. All procedures and treatments recommended must be with the intention to do the most good for the patient” (How the four principles of health care ethics improve patient care, n.d). One could argue that Pou’s actions may have been to the patient’s benefit for that specific situation. The alternative to Pou’s action may have been patient death after suffering due to lack of resources, power, running water and sweltering heat. That said, the decision to evacuate D.N.R patients last goes against the principle of beneficence for the patient and ultimately led to Wilda Mcmanus death. You could undoubtedly make arguments for all four ethical principles (justice, autonomy, beneficence, and nonmaleficence) for Mcmanus and all the other patients involved. Prevention and discussion Preventing something like this is not an abstract thought. Preparation and implementing protocol may have prevented unnecessary measures. The opportunity to intervene was when Deichmann proposed the idea. In Muldericks shoes, I would have brought about the discussion of the ethical consequences. If those in favor had valid points, I would have tried to get additional information and contact other hospital emergency-incident commanders to collaborate. Others may have had evacuation protocols for this situation and could have offered advice. It is the same principle of collaboration between providers. Sometimes a provider may have little experience with a particular condition. If so, they do not just treat the condition blindly, they consult and collaborate to do what’s best for the patient. To put it simply, if you do not know the right thing to do, ask. Memorial did not have a protocol for complete power failure and total evacuation; had they asked for help and guidance this situation may have been avoided. It would be naïve to say collaboration would have prevented every death. The fact is, some of these patients were not going to survive evacuation. Knowing that it is safe to say collaboration may have prevented some unnecessary action and may have offered a better alternative in triage and evacuation. We can learn from Hurricane Katerina and the actions at Memorial. In healthcare that is the goal not to place the blame on one person but to analyze the event in hopes of prevention in the future. Reference Chetwynd, E. (2017). Developing a hospital emergency incident command system (HEICS). Retrieved from https://www.everbridge.com/blog/developing-hospital-emergency-incident-command-system-heics/ Department of Public Health, Emergency Preparedness and Response Exercise Program (2014). (MDPH) hospital evacuation planning guide. Retrieved from https://www.mass.gov/files/documents/2016/07/tx/planning-guide.pdfFlink, S. (2009). The deadly choices at memorial. The New York Times. Gillon, R. (1994). Medical ethics: Four principles plus attention to scope. BMJ, 309, 184-188. How the four principles of health care ethics improve patient care. (n.d). Saint Joseph’s University Web site. Retrieved from https://online.sju.edu/graduate/masters-health-administration/resources/articles/four-principles-of-health-care-ethics-improve-patient-care

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