Sheri Fink - Five Days at Memorial

Interviews

Dr. Joseph Andrews; Roger Bernier; Dr. Guthrie Birkhead; Dr. Frederick “Skip” Burkle Jr.; Dr. Elizabeth Lee Daugherty; Dr. Karen DeSalvo; Dr. Laura Evans; Dr. Thomas A. Farley; Robert Gallagher; Howard Gwon; Monica Gwon; Dr. Aarti Kinikar; RADM Ann R. Knebel; Ann Nugent; Dr. Tia Powell; Dr. Nirav R. Shah; Eugene Tangney; Warner Thomas; Dr. Eric Toner; Jacqueline Toner.

Notes

1 One lesson from Katrina : Interview with Warner Thomas, president and chief operating officer of Ochsner Health System (August 28, 2012). See also: Fink, Sheri, “Hospitals, Nursing Homes Are Better Prepared for Hurricane Isaac Than Earlier Storms,” Times-Picayune , August 28, 2012. http://www.nola.com/hurricane/index.ssf/2012/08/hospitals_nursing_homes_better.html. By the 2013 hurricane season, post-Katrina improvements to Ochsner Baptist Medical Center included “new and restored electrical generators and power transfer switches, central plant infrastructure raised on a platform, a new water well to maintain cooling systems in the event of a city water loss and a restored heliport with an additional elevator stop directly from the heliport to the new NICU,” according to an e-mail from Ochsner Health System public relations manager Stafford Scott Maestri (August 2013).

2 Two months later : Fink, Sheri, “In Hurricane’s Wake, Decisions Not to Evacuate Hospitals Raise Questions,” ProPublica, November 1, 2012; http://www.propublica.org/article/in-hurricanes-wake-decisions-not-to-evacuate-hospitals-raise-questions/.

3 Dr. Laura Evans : Interview with Dr. Laura Evans (March 2013). See also: Fink, Sheri, “Beyond Hurricane Heroics: What Sandy Has to Teach Us All About Preparedness,” Stanford Medicine Magazine (Summer 2013); http://stanmed.stanford.edu/2013summer/article5.html; and Uppal, Amit, Laura Evans, Nishay Chitkara, et al, “In Search of the Silver Lining: The Impact of Superstorm Sandy on Bellevue Hospital,” Annals of the American Thoacic Society , vol. 10, no. 2 (2013), pp. 135–142; http://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201212-116OT.

4 protocol for rationing ventilators : Fink, Sheri, “Flu Nightmare: In Severe Pandemic, Officials Ponder Disconnecting Ventilators from Some Patients,” ProPublica. September 23, 2009; http://www.propublica.org/article/flu-nightmare-officials-ponder-disconnecting-ventilators-from-some-pat-923. The plan is available here: http://www.health.ny.gov/diseases/communicable/influenza/pandemic/ventilators.

5 according to reports : Altevogt, Bruce M., Clare Stroud, Sarah L. Hanson, Dan Hanfling, and Lawrence O. Gostin, eds. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations : A Letter Report (Washington, DC: The National Academies Press, 2009); http://www.nap.edu/openbook.php?record_id=12749; Institute of Medicine, Crisis Standards of Care : A Systems Framework for Catastrophic Disaster Response, vols. 1–7 (Washington, DC: The National Academies Press, 2012); http://www.nap.edu/openbook.php?record_id=13351.

6 A bioethicist uninvolved : In an e-mail (November 12, 2009), Dr. Lachlan Forrow, director of ethics and palliative care programs, Beth Israel Deaconess Medical Center, wrote: “Rather than thinking about exceptional moral rules for exceptional moral situations we should almost always see exceptional moral situations as opportunities for us to show exceptionally-deep commitment to our deepest moral values. This includes holding ourselves morally accountable, compassionately but still firmly, if we become—however tragically and unavoidably—involved in violating core values.” Father John F. Tuohey, regional director of the Providence Center for Health Ethics in Portland, Oregon, commented during a 2009 panel discussion with Dr. Pou in Chicago: “As bad as disasters are, even worse is survivors who don’t trust each other.”

7 In some states : Fink, Sheri, “Preparing for a Pandemic, State Health Departments Struggle with Rationing Decisions,” ProPublica and the New York Times , October 24, 2009. http://www.propublica.org/article/preparing-for-a-pandemic-state-health-departments-struggle-rationing-1024/.

8 mounting evidence suggests : Fink, Sheri, “Worst Case: Rethinking Tertiary Triage Protocols in Pandemics and Other Health Emergencies.” Critical Care , 14:103 (2009); http://ccforum.com/content/14/1/103.

9 “A new model of triage” : Guest, T., G. Tantam, N. Donlin, K. Tantam, H. McMillan, A. Tillyard, “An observational cohort study of triage for critical care provision during pandemic influenza: ‘clipboard physicians’ or ‘evidence based medicine’?” Anaesthesia , vol. 64, no. 11 (2009): 1199–1206; http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2009.06084.x/pdf.

10 New models have been proposed : For example, White, Douglas, Mitchell Katz, John Luce and Bernard Lo, “Who Should Receive Life Support During a Public Health Emergency? Using Ethical Principles to Improve Allocation Decisions,” Annals of Internal Medicine , vol. 150 (2009): 132–138; http://chpe.creighton.edu/events/images/life_support.pdf.

11 small but particularly troubling study : Khan, Z., J. Hulme, N. Sherwood, “An assessment of the validity of SOFA score based triage in H1N1 critically ill patients during an influenza pandemic,” Anaesthesia , vol. 64, no. 12 (2009): 1283–1288; http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2009.06135.x/pdf.

12 report on what the teams had learned : Fink, Sheri, “Doctors Face Ethical Decisions in Haiti,” PRI’s The World , 2010; http://media.theworld.org/audio/022320107.mp3.

13 Connecticut Hospice : Interview with Dr. Joseph Andrews and Ann Nugent (February 2013).

14 “an important component” : New York State Workgroup on Ventilator Allocation in an Influenza Pandemic/NYS DOH/ NYS Task Force on Life and the Law, “Allocation of Ventilators in an Influenza Pandemic: Planning Document” (March 15, 2007, draft for public comment); http://www.health.ny.gov/diseases/communicable/influenza/pandemic/ventilators.

15 An answer to Birkhead’s question : The project described is: “Too Many Patients, Too Few Resources,” sponsored by the Hospital Preparedness Program 2012, US Department of Health and Human Services. Principal investigator: Dr. Elizabeth Lee Daugherty, also led by Howie Gwon, Dr. Eric Toner, Alan Regenberg, and Chrissie Juliano. Cosponsored by the Johns Hopkins Berman Institute for Bioethics; Johns Hopkins University School of Medicine Department of Pulmonary and Critical Care Medicine; Johns Hopkins Office of Emergency Management; Program for Deliberative Democracy, Carnegie Mellon University; RESOLVE, INC.; The Center for Ethics and Policy, Carnegie Mellon University; University of Pittsburgh Medical School Department of Critical Care Medicine; UPMC Center for Health Security.

16 “If this were to happen” : Alex Brecht, at “Too Many Patients” forum, Baltimore, Maryland, May 5, 2012.

17 “It’s really hard for me to say” : Cierra Brown, ibid.

18 “There’s so many social ramifications” : Tiffany Jackson, ibid.

19 “We talked about politics” : Maayan Voss de Bettancourt, eulogy at funeral for Irvin Zelitzky, September 6, 2011.

20 public engagement exercise was held : Fink, Sheri, “Rationing Medical Care: Health Officials Struggle with Setting Standards,” ProPublica and MinnPost.com, December 21, 2009; http://www.propublica.org/article/rationing-medical-care-health-officials-struggle-with-setting-standards-122.