Did Katrina Prosecutor Mean to Lose All Along?

AMA, Art Caplan, Katrina, medical killings, Our News & Commentary Blog

(Note – I’ve made slight edits from yesterday’s original version of this entry to eliminate some ambiguity in places. Hopefully, these minor edits fix that ambiguity.)

During the last week of July, the news broke that a grand jury refused to indict Dr. Anna Pou on charges related to the deaths of four patients in the aftermath of Hurricane Katrina. A couple critical voices buried in the coverage were easily missed. For example, Arthur Caplan, who frequently disagrees with disability activists (which is fair enough, but he’s also been known to misrepresent what we say to his larger audience at MSNBC) and doesn’t welcome our input into bioethics discussions, expressed his disappointment over the failure to indict:

“There is evidence that merits a trial and consideration of the claims and counter claims of all parties involved,” Caplan said in an e-mail response to written questions. He was out of the country.

“I don’t know and would not predict what the outcome of a trial would be, but I think there is more than enough evidence to justify a trial,” he wrote. Caplan said in his report for the state that he reviewed nine deaths at the hospital.

“Each person died with massive doses of narcotic drugs in their bodies,” he wrote. “There is no evidence of consent. There is no documentation or record of any request on the part of any patient for assistance in dying.”

Had Caplan known at the time that even more important evidence and testimony allegedly never reached the Grand Jury, he might not have been surprised at the outcome.

Over the weekend, there were disturbing allegations that the grand jury never got to hear important testimony – testimony supporting the allegations that patients were indeed intentionally killed by Pou and possibly others:

A New Orleans grand jury that declined to indict a doctor on charges that she murdered patients in the chaotic days after Hurricane Katrina never heard testimony from five medical experts brought in by the state to analyze the deaths.

All five concluded that as many as nine patients were victims of homicide.

In detailed, written statements, the five specialists — whose expertise includes forensic medicine, medical ethics and palliative care — determined that patients at Memorial Medical Center had been deliberately killed with overdoses of drugs after Katrina struck New Orleans in 2005.

(Report with expert witnesses – pdf)

The experts weren’t the only ones whose accounts weren’t heard by the grand jury:

Family members of another one of the patients, Elaine Nelson, hired their own forensic expert to explore why the 90-year-old woman died. The report alarmed her son, Craig, a New Orleans lawyer.

“It showed that Mom had received on September 1 eight milligrams of morphine, which was four times the amount that she was prescribed by her doctor, and which was a lethal amount that was certainly enough to kill her,” Nelson said.

Nelson said neither he nor his sister Kathy, a registered nurse who was with their mother after Katrina until guards ordered her to leave the hospital, were called before the grand jury. Their forensic expert wasn’t called either.

Nelson has filed a lawsuit against the hospital owner and others. He said he refused a settlement offer because he wants the truth to come out, especially now that Jordan has closed the case. Nelson said he is disappointed in the way the grand jury was conducted.

“I think they’d want to hear as much evidence as possible to make a well-informed decision,” he said.

In spite of the gleeful applause coming out from organizations like the American Medical Association, the suspicion that maybe this DA presented a case in a way that was guaranteed to lose serves no one. It doesn’t serve the families who want answers. It doesn’t serve the reputation of Anna Pou, who will never be really free of the allegations if her “exoneration” depended on a tainted process.

I find myself in the odd position of agreeing with Art Caplan – although it’s been happening more recently – when he said there is “more than enough evidence to justify a trial.”

In the course of such a trial, the guilt or innocence of Pou could have been argued before a jury. And even if found guilty, a jury of peers that lived through the nightmarish conditions of Katrina would have been ideally suited to decide if the extreme circumstances were mitigating enough to soften its judgement.

Speaking of Caplan, given his stance on the failure to indict in the Katrina deaths, I suspect he and I might be on the same page in regard to the AMA’s move to exploit the publicity surrounding Pou and Katrina. In the same article linked above, it was revealed the AMA plans to “develop model legislation to shield physicians from civil or criminal liability when caring for patients in a declared disaster area.”

Sweet. I am sure the police, who had to deal with the mess out on the streets during and after Katrina would love the same deal. But maybe they don’t have a lot to worry about – maybe no one in positions of authority has anything to worry about.

In the course of researching this, I realized that it’s easy to miss the bigger context of the current events in New Orleans. It’s possible that the less-than-stellar performance is par for the course in this area.

The latest news indicates that prosecutorial blunders may result in effectively ruining the case of police officers facing trial for shooting a man with developmental disabilities in the back during Katrina.

One has to wonder if there are cases in which the District Attorney there is actually playing to win. –Stephen Drake

George Exoo – Suicide Tourist

george exoo, Our News & Commentary Blog, satire, Switzerland

Right now, activists on both sides of the euthanasia debate are awaiting the fate of George Exoo. He currently resides in a jail cell in West Virginia while Judge R. Clarke VanDervort weighs his decision in regard to Ireland’s request to extradite Exoo. Irish authorities want to try Exoo on charges related to his role in the death of Rosemary Toole Gilhooley in 2002.

Gilhooley reportedly paid Exoo and a companion $2500 to pay for his travel and expenses.

Exoo was founder of the Compassionate Chaplaincy, that by its own description, was “a 501(c)(3) nonprofit organization provides end-of-life counseling and compassionate terminal assistance to those whose lives have become insurmountably, unrelentingly, and endlessly painful and wish to end their lives at their own chosen times.”

This got me thinking. People who follow euthanasia-related news are familiar with the bizarre “suicide tourism” that has developed in Switzerland. In “suicide tourism,” disabled and ill people from outside Switzerland have entered the country for the purpose of getting “help” in committing suicide from the group Dignitas.

Exoo, it seems, took the idea of “suicide tourist” in a new direction. He was able to use the opportunity of Gilhooley’s plight, for example, to get two-way tickets for two between the U.S. and Ireland. To be fair, he and his companion took a trip to Amsterdam on their own dimes, but it is obvious the fare between the U.S. and Ireland is a lot more expensive than that part of the trip.

I’m a child of the 1960s. A popular poster during my teenage years (popular among my crowd, anyway) was a poster that took the established military recruitment posters suggesting enlistees would “see the world” and turned it inside out.

The poster was the conventional “Uncle Sam” pointing at you and said “Join the Army – travel to distant lands; meet exciting, unusual people and kill them.”

I have no idea if Exoo ever recruited members for his “Compassionate Chaplaincy,” but I thought maybe he might have a recruiting poster that looked something like this:


The image above is a poster with the title “Join Reverend Exoo and the Compassionate Chaplaincy.” Below that is a drawn caricature of Exoo. Underneath the caricature are the words: “travel to exotic, distant lands; meet exciting, unusual people and help them kill themselves – all travel, lodging and recreational expenses reimbursed – cash up front.”

Right now, we can just sit along and wait, along with George Exoo. And think about what kinds of things we won’t do for a paid trip to Ireland. –Stephen Drake

Ruben Navarro and Our Need to Speak Out

Our News & Commentary Blog, professional accountability, Ruben Navarro, wrongful death

Ruben Navarro’s death is “old news” by internet standards. He was a man with adrenal leukodystrophy whose path to death included an alleged attempt to kill him by a transplant surgeon. Five medical professionals stood by while transplant physician Hootan Roozrokh ordered massive doses of ativan and morphine for Navarro. One of those physicians was Navarro’s attending physician. A sixth medical professional, a nurse, administered the injections that Roozrokh ordered. Roozrokh is now facing felony charges of dependent adult abuse, administering a harmful substance and prescribing controlled substances without a legitimate medical purpose.

For the full story of Navarro’s life and death, please read Diagnosis: Murder by Cilla Sluga for the most comprehensive investigative reporting on the life and death of Ruben Navarro.

Ruben Navarro’s “medical lynching” occurred under the heart beating cadaver donor protocols. Unlike the more common organ harvesting done when someone is declared “brain dead,” the organs are removed shortly after a person undergoes cardiac arrest. This protocol is somewhat controversial, but many thoughtful people support it as ethical if it is done properly. Wesley Smith, for example, laid out his reasoning about the practice in this essay.

Whether it’s ethical or not, the practice has at least two big problems that don’t exist within the more common practice of harvesting after pronouncement of brain death:

  • In the case of brain death, physical functions can be maintained while arrangements are made to harvest organs after removal of artificial ventilation, minimizing time pressure;

  • The new protocol opens up potential “candidates” for organ harvesting who are not dead or dying at all. Ruben Navarro, for example, could have gone on indefinitely on a ventilator and may even have achieved some level of recovery if he had not been disconnected from his ventilator.

Meanwhile, there are several important issues demanding discussion, but no bioethicist or journalist we can find is discussing them (thanks to Cilla Sluga as a source for more than one of these important questions):

  • Was Ruben Navarro really dying? In the wrongful death complaint brought by Navarro’s mother, she claims the hospital told her that the hospital had a limit of five days for coma patients being on a ventilator? Could Ruben Navarro have experienced some level of recovery if he’d been given longer than five days? Is this claim true? How did she come to believe that? What does that mean about her “consent” to having his ventilator removed?

  • Can we trust the coroner’s report? Cilla Sluga reports that a betadine solution administered into Navarro’s intestines is toxic when taken internally. Navarro lived for hours after the alleged overdoses of ativan and morphine. Did the betadine kill him?

  • Why was no one else in the room charged with a crime? The medical professionals in that room all had a duty to prevent harm from being done to a patient. How did the medical review boards come to a decision that neither the attending physician nor the nurse who administered the injections did nothing wrong? Could they tell us what the heck they did right? What does this tell us about the medical profession’s ability to police itself and discipline its members for misconduct?

Right now, the news coverage has died down on Navarro, but it will flare up again, and more than once. Look for it to flare up again around September 12, when transplant surgeon Hootan Roozrokh will be arraigned.

So far, transplant advocacy organizations, bioethicists, and transplant recipients have made themselves heard in the coverage. That’s exactly what they should be doing in terms of advancing their respective interests.

Ruben Navarro, though, was a member of the disability community, and our voices have been absent. We need to claim our place in this story. The nightmarish treatment of Ruben Navarro resonates with some of the worst nightmares that many of our brothers and sisters talk quietly about.

To put it bluntly, Ruben Navarro would probably have been rejected out of hand as eligible for being a recipient if he had needed a transplant. It makes the circus of horrors accompanying the rush to make him a donor all the more appalling.

It’s time to get louder.

It’s especially important in California where legalization of assisted suicide is being pushed. Part of the “push” includes glowing promises about “safeguards” and “oversight” – the same kinds of safeguards and oversight that “protected” Ruben Navarro.

For some ideas on what to get loud about, check out this archived episode of WBAI’s “The Largest Minority.” Cilla Sluga and I discuss the Navarro case. –Stephen Drake

Addendum: I was just alerted that the archived audio of a show I did last week is now available. Thanks to host Geoff Langhorne of “disRespect disability awareness radio.” Disabled Los Angeles Man Put Down for Organs ? can be now be heard online or downloaded.

Criste Reimer’s Death Not About Health Care Debt or Compassion

homicide, Homicide / 'Mercy Killing', Our News & Commentary Blog, research

As I noted yesterday, the first reports of Criste Reimer’s death created a strong impression of a loving husband pushing his wife to her death, because he (or they) had run out of options due to growing debts related to Criste Reimer’s health problems. Many bloggers are saying that our “profit-driven health health care system” was the real culprit in Criste Reimer’s violent death.

Not Dead Yet was a proud sponsor of the SiCKO Rally in Chicago. Being on the front-lines of a “bottom-line” health care system, we support universal coverage. We can find enough martyrs in this system without trying to make Criste Reimer one – and erasing her status as a victim of domestic violence.

The second wave of stories, in which Criste Reimer’s mother and sister talked to the press, tell a different story. Here is some of what was reported in an interview on a Wichita news show:

The family doesn’t believe Criste had cancer as Stanley told police. They believe he was after oil money from property in Texas given to Criste by a relative. But whatever the motive, the family never suspected Criste would die like this.

The family also cast doubts on reports of Criste’s cancer and added they have had concerns aobut Stanley Reimer’s emotional stability for some time. Criste’s mother also says that her daughter had been staying with her for several months, but that Stanley made a surprise visit a month ago. Criste went back home with him at that time, but had recently told them she wanted to go back to her mom’s home.

This pattern of sympathetic portrayals of elderly husbands killing their wives isn’t exactly unusual. Neither is the “second wave” of coverage that gives a darker picture. We saw that play out in the media here a few years ago in the coverage of the murder of Shirley Harrison.

It turns out that mutual suicide pacts and motivations of real compassion are rare in such murders or murder/suicides. Julie E. Malphurs and Donna Cohen have conducted several studies on this increasing type of domestic violence.

Donna Cohen, in a media release from Carers New Zealand, shared some of the research findings:

“These are not acts of love. They are not compassionate homicides. They are acts of desperation and depression, other forms of psychopathology, or domestic violence.”

Dr Cohen’s research indicates that older men – who almost always initiate the acts – routinely proceed without their wife’s knowledge or consent. She says true pacts occur in perhaps one half of 1 per cent of elder homicide-suicides.

Of the hundreds of homicide-suicide deaths in the US each year, the rate amongst over 55s is twice that of under 55s. Homicide-suicides now account for about three per cent of all suicides, and about 12 per cent of homicides in the older population.

“One of our most distressing findings is evidence that older women who are killed are not knowing or willing participants,” says Dr Cohen. “Often they are killed in their sleep or shot in the back of the head or chest.”

Her research indicates that about a third of elder homicide-suicides occur in a context of domestic violence, an ugly contrast to the Norman Rockwell image of loving clan matriarch and patriarch.

In the end, it looks like Criste Reimer’s death — if it’s true her husband pushed her to her death – had nothing to do with compassion or the health care system.

Instead, it’s another instance of a man stressed and resorting to violence as a coping mechanism. –Stephen Drake

Criste Reimer: The Political Turns Personal

homicide, Homicide / 'Mercy Killing', Our News & Commentary Blog

Last week, the media reports of Criste Reimer’s death made their way across the country – in newspapers and on the internet. Criste Reimer was allegedly thrown off a fourth floor balcony by her husband. The early reports have led many in the public to believe her death is a moral lesson in either compassion, the cost of health care or both. Her family doesn’t think her death has anything to do with either of those issues.

This all got unexpectedly personal. Some of Criste Reimer’s messages to online groups have been posted elsewhere, all from 1998.One of the things I knew about Reimer from the news articles is that she had hydrocephalus. Until a few years ago, I had a website on hydrocephalus and got quite a bit of mail through it. (Her parents had rejected doctors’ advice to take her out of school due to the severe cognitive disabilities they believed she would have due to her hydrocephalus and neurofibromatosis.)

I checked my email archives using just the first part of the posted email address, since many people keep a favorite screen name even when they switch email services. Sure enough, there was a message from 2002 from a woman signing herself as Criste Reimer. The message I got from Criste was like the ones I’ve seen posted elsewhere.

I contacted Liz W., a woman who I know is connected to all of the types of forums in which I would have met Criste Reimer. Here’s what she had to say: “I have not stopped thinking of Criste and her family…it’s just so hard for me to believe her husband could claim to love her and do something like that to her. I’m heartbroken…We were on a few forums together, but I hadn’t heard from her for several months. She didn’t have a mean bone in her body. I’m blind with rage over this. Son of a bitch…may he rot in hell.”

Right now, Criste Reimer’s death is being glommed on to in various ways by people for various political reasons. It’s easy for those enthusiastic do-gooders to forget that Criste Reimer was a woman and a valued part of more than one community. A woman who touched many lives, including mine. –Stephen Drake