Dr. Pou's plight: Heroic actions, harrowing aftermath

The New Orleans case shows the importance of protecting physicians who volunteer in disaster or emergency situations.

Posted Aug. 20, 2007.

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In the end, justice prevailed for New Orleans otorhinolaryngologist Anna Maria Pou, MD. A grand jury acted correctly, with admirable courage and wisdom, when in July it decided against indicting the physician on charges that she killed nine patients with lethal doses of pain medication in the Hurricane Katrina aftermath.

It's a shame, though, that Dr. Pou had to endure 23 months of uncertainty as the wheels of justice stereotypically ground slowly to this conclusion.

She and two nurses whom Louisiana Attorney General Charles C. Foti Jr. accused of murder stayed behind at Memorial Hospital to care for patients in deplorable, chaotic conditions -- no electricity, 100-degree heat, limited food and water. Fifteen feet of water and poor response in evacuating those trapped in the city kept Dr. Pou, the nurses and patients in the hospital for four days. (The charges against the nurses were dropped earlier, resulting in their being compelled to testify before the grand jury.)

Dr. Pou could have chosen to evacuate the area before the storm hit. She could have chosen to ride out the storm at home with her family. But she didn't. She stayed behind to help those too sick to leave the hospital when Katrina slammed ashore.

Hopefully the national headline-making news of the murder charges levied against Dr. Pou won't dissuade doctors from volunteering in future emergency situations.

A step in preventing that from happening would be reassuring physicians that they will not be unfairly punished for staying behind to do their jobs at a time when most are fleeing for safer ground.

With future natural or man-made disasters inevitable, no physician should ever have to endure what Dr. Pou did. That's why we need better state and federal laws to provide immunity to physicians in disaster situations.

No single federal law gives physicians working in federally declared disasters or emergencies comprehensive protection from civil or criminal liability. Some civil liability protection is in place, but it depends on the physician volunteer's status and, in some cases, where the physician is providing care.

And state laws vary. Some states specifically give physician volunteers protection from civil liability. Criminal liability protection, though, is not included.

On a national level, qualified physician volunteers should receive automatic medical liability immunity when a national disaster or federal emergency is declared.

To address the problem, the AMA House of Delegates at its Annual Meeting in June reaffirmed policy supporting national legislation to that effect. It also called on the Association to develop and disseminate model state legislation that would give qualified physicians automatic medical liability immunity in a state or federally declared disaster or emergency, unless it is proven by clear and convincing evidence that a physician acted with malicious intent, wanton disregard for a patient's well-being or similar willful misconduct.

And legislation needs to go a step further. In a time when prosecutors are increasingly seeking to criminalize medical acts -- as in Dr. Pou's case -- laws must provide doctors protection from unwarranted criminal and civil actions against physicians doing their job under the harshest of conditions in emergencies and disasters.

To that effect, the AMA is revising its existing model state legislation, An Act to Prohibit the Criminalization of Healthcare Decision-Making. The objective is to shield, from criminal liability, physician volunteers responding to a federally declared emergency or disaster. The provision would apply whether or not the physician volunteer is licensed to practice within the state.

These protections are key to assuring that physicians who volunteer to care for those in disaster areas won't be subjected to the same treatment Dr. Pou received after heroically staying behind to help those who couldn't help themselves.

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