Monday, July 31, 2006

Legal Defense Fund Information For Dr. Pou

A legal defense fund has been set up to help Anna Pou defend herself against criminal charges. Contributions may be sent to:

201 St. Charles Avenue
Suite 114-363
New Orleans, LA 70170

I'm sure any amount will be appreciated.

Sunday, July 30, 2006

Risks of Epidural Analgesia for Labor

Anesthesiology has a nice article which attempt to quantify some of the less common risks of having an epidural during labor: epidural hematoma, infection, and neurologic injury.

Epidural hematoma 1 in 168,000 6 per million
Deep epidural infection 1 in 145,000 7 per million
Persistent neurologic injury 1 in 240,000 4 per million
Transient neurologic injury
[< 1 year]
1 in 6,700 180 per million

It contains an interesting tidbit others might find interesting, too. There are 4 million births in the United States each year and 2.4 million involve epidural analgesia. Wow. That's three fifth of all live birth get an epidural! (And some call nights, it seems every single one does...)

Tuesday, July 25, 2006

TIME: It was Heroism, Not Homicide, During Katrina

From a critical care physicians stranded in a nearby hospital during Katrina:

"The major difference between comfort care and euthanasia or murder is intent. In a dying patient, giving sedatives and pain killers with the intent to cause death would be considered euthanasia or murder, while giving the same drugs in the same dosages with the intent to relieve suffering would be considered good, compassionate medicine, even if death were to be a consequence. In the wake of Katrina if a patient had died in a hospital without evidence of having received comfort care, I would question that treatment.


"We don't know the whole story from all participants, including Dr. Pou and the nurses: what the conditions were like and what their intentions were. Until all the facts are known, it's wrong for the attorney general to act as if he's dealing with hardened criminals. He may very well be dealing with heroes."

My thoughts exactly...


Sunday, July 23, 2006

Pennsylvania Showing Net Loss of Physicians Over Time

The number of physicians in Pennsylvania has declined by approximately ten percent between 1999 and 2005. On its own that number may not sound like such a huge drop. Compare that number to the other 20 most populous states and it becomes obvious that the difference is very significant.

Almost all of have seen net increases of between 7% and 35% over the same period. I would find it very interesting to know how long the wait is for a new patient appointment in an internal medicine practice in Pennsylvania vs. these states that have seen an increase. A knee replacement? First visit to a Neurologist. Follow up visits? You get my drift. Pennsylvania has a population that is among the most aged. Medicare just announced plans for more cuts. New physicians are choosing not to practice in Pennsylvania and we've seen a net loss of 10% in our physicians with unique provider numbers over the last six years. Get the picture, Governor Rendel?

Data from State of Medicine in Pennsylvania--2005

Friday, July 21, 2006

NYT: Medical and Ethical Questions Raised on Deaths of Critically Ill Patients

There's a very good article in the July 20 New York Times titled "Medical and Ethical Questions Raised on Deaths of Critically Ill Patients" that describes the ethical questions raised in the New Orleans case with some very good quotes:

"“I’m fundamentally unconvinced of the framing of the story,” said Dr. Steven Miles, a professor of medicine at the University of Minnesota and an expert on the care of dying patients. “I’m not inclined to believe this is a euthanasia scenario or a physician-assisted suicide scenario.”

One reason, Dr. Miles said, is that the drugs found in the dead patients — morphine and the sedative Versed — are not all that deadly and may not even have been what killed the patients. Many patients develop tolerances to the drugs and can handle high doses, he said. Barbiturates, readily available in a hospital, would be a far more efficient way to kill somebody if that was the intent, he added.

“The selection of drugs looks to me to be more typical of the drugs selected for providing palliative care rather than killing patients,” Dr. Miles said. Palliative care is treatment given strictly to keep a patient comfortable. "

Wednesday, July 19, 2006

Dr. Anna Pou Is Not a Murderer

I just learned that a former colleague and friend has been charged with second degree murder in the death of four patients at a New Orleans hospital after Katrina. I worked with Dr. Anna Pou in the operating room when we were both in Galveston, Texas for three years in the late nineties. She worked as a head and neck surgeon specializing in cancer surgery and I provided anesthesia for many of her cases. After reading the story my only reaction is that this entire case is about an attorney general making a name for himself. Dr. Pou is a wonderful, caring, highly skilled surgeon. Her concern has always been for the comfort and well-being of her patients.

When I spoke to her by telephone several months ago to express my support, we were unfortunately not able to discuss the events leading up to the criminal charges filed Monday. I don't believe any of us can truly imagine the conditions at Memorial Medical Center in the days following the hurricane. The fact that she was there, taking care of patients rather than safely evacuated with her husband, reflects the deep committment she felt to her patients and is consistent with what I know about her.

In my mind, this case is all about whether or not the intent of administering morphine was to alleviate suffering or to cause death. If the purpose of administering morphine was to treat pain or aleviate suffering, then doing so is permissible even if respiratory depression and hastening of death is a forseable consequence. This ethical position is termed the 'Principle of Double Effect.'In normal practice a hospital ethics committee would be asked to help make these evaluations. Dr. Pou had no such resource available to her.

I'll be writing more about his case as information comes out.

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