1. Mason, Diana J. PhD, RN, FAAN

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The conditions in your city and hospital are deteriorating quickly. People who can get out have left or are leaving. You and others are sleep deprived but trying to keep patients alive and comfortable in sweltering heat and high humidity. There's no fresh water. Food and medical supplies are rationed, sanitation facilities have failed, security is inadequate, with reports of violence, and there's no help in sight.

Figure. Diana J. Mas... - Click to enlarge in new windowFigure. Diana J. Mason, PhD, RN, FAAN

Chances are good you have never endured the working conditions that nurses in New Orleans faced last year-few American nurses have-and no documentary or news report will let us know what it was really like for them.


Still, since July, when nurses Lori L. Budo and Cheri A. Landry and physician Anna M. Pou were accused of second-degree murder, I've been trying to put myself in their shoes. Louisiana attorney general Charles Foti, Jr., has said that on or about September 1, 2005-three days after Hurricane Katrina hit the city-these three administered lethal doses of morphine and midazolam (Versed) to four patients at Memorial Medical Center (owned by Tenet Healthcare Corporation), with the intention of killing them. Budo, Landry, and Pou have proclaimed their innocence.


The patients were on a critical care unit leased by LifeCare Hospitals to care for those with catastrophic injury or illness. Some of these patients had do-not-resuscitate orders; 24 of the 55 patients on the LifeCare unit died in the three days after the hurricane. One of the four patients the nurses and physician allegedly killed was a cognitively aware man, Emmett Everett, age 61, who weighed 380 lbs. and was paralyzed. The other three patients-Hollis Alford, age 66; Rose Savoie, age 90; and Ireatha Watson, age 89-were critically ill and, according to Foti's affidavit, deemed by hospital administrators to be too sick to move.


But evacuation can kill even those not as sick. On August 18 the inspector general for the Department of Health and Human Services issued a report on the 2004 and 2005 hurricane seasons (online at, showing that nursing home residents who were evacuated suffered more than those who remained. And a report by Kathryn Hyer and colleagues (published online by Health Affairs on August 29), on a "Hurricane Summit" that was held earlier this year, noted that long-term care providers weren't even on the radar screens of emergency response systems during Hurricane Katrina.


The drugs allegedly administered in these cases are common analgesics and anxiolytics used in palliative care. So why did the attorney general assume that the intent was to kill? According to "medical experts" cited in an article on August 24 in the Times-Picayune, "it is just as plausible that the drugs were being used to help comfort dying patients or help prepare them for a painful evacuation." Why aren't others being held accountable for criminal neglect?


These three professionals have been charged with murder; meanwhile,


* other staff evacuated. Would the nurses have been accused of murder had they left their patients to die a slow death?


* the owner of the hospital, Tenet Healthcare Corporation, failed to ensure the safety of staff and patients; the medical director of LifeCare had evacuated before or during the storm; and local, state, and federal governments were indifferent, inept, or negligent.



I see all nurses who worked during Katrina as heroes who made the best of nearly impossible circumstances. Budo, Landry, and Pou are innocent until they are proven guilty. But I'll bet that a jury of their peers-others who were stranded in New Orleans during the flood-won't indict them. That may not assuage the grief of the families of the patients who died, but it might be the only just response.


What would you have done in such a disaster? You probably would have gone to work, as Budo and Landry did. They're paying an awfully hefty price for their heroism.