Pulitzer Prize awarded to physician for Katrina coverage

A physician turned news reporter has been awarded the Pulitzer Prize for investigative journalism for her August 2009 New York Times Magazine article chronicling controversial medical decisions made by doctors and nurses stranded at a New Orleans hospital after Hurricane Katrina.

Sheri Fink, MD, PhD, who writes for the investigative news organization ProPublica, received the prestigious award after spending more than two years researching events at Memorial Medical Center, where several patients were found dead after the 2005 storm.

The article, "The Deadly Choices at Memorial," emerged after New Orleans otolaryngologist Anna Maria Pou, MD, and two nurses became subjects of a state criminal investigation for alleged mercy killings during the aftermath of the hurricane that left those at the hospital facing 100-degree heat and rising flood waters, with no power and scarce resources. A grand jury in 2007 declined to indict the medical professionals, who have maintained their innocence.

The article was also awarded a Sigma Delta Chi Award from the Society of Professional Journalists.

Dr. Fink said she hopes the article calls attention to the medical and ethical pressures doctors and nurses face during disasters.

Sheri Fink, MD, PhD Photo courtesy of propublica.org

"Hopefully by reading the story and thinking about these issues, other doctors and nurses can be better prepared, because we really do have medical structures that are vulnerable to disaster," she said. "One really important thing to look at is how to expand resources."

Dr. Fink got her medical degree and a PhD in neuroscience from Stanford University in California. Before entering residency, she took time off in 1998 to begin work on a book about the effect of the Bosnian war on hospitals. While she was in Bosnia, the Kosovo war broke out, and she ended up putting her medical skills to work assisting a humanitarian aid organization treating refugees.

During the experience, Dr. Fink said she was torn between dedicating herself to a career in clinical medicine or journalism. She chose the latter after realizing she was driven by an enthusiasm for communicating about medical topics.

Since then, Dr. Fink said her medical background and experience in international emergency and conflict settings around the globe, most recently in Haiti, have served her well in reporting on how medical professionals are forced to cope in crisis scenarios. While she does not practice medicine, she has continued her humanitarian efforts in between reporting assignments.

Dr. Fink hesitated to compare the situation in New Orleans with struggles volunteers face in relief efforts. "But I have certainly felt the frustration of wanting to do more for patients and coming up against real obstacles in the ability to do that."

Like many in the medical field, Dr. Fink said she took notice when a well-respected physician and two well-respected nurses were being investigated for second-degree murder in the aftermath of Katrina. "It prompted me to look into what really happened there and what could be learned from it."

Lessons learned

Out of the experience, "one of the things that really became clear to me was the question of triage," Dr. Fink said. For example, her article detailed doctors' and nurses' decisions to prioritize patients based on their conditions in the face of limited treatment options and evacuation efforts.

"Very often, we look at it in terms of who gets what, and who doesn't get. And I think that there's another way to look at triage, and how to maximize the good that you do," Dr. Fink said. "When you are exhausted, and if you haven't been prepared to be in a disaster situation, and there's fear in the air, it can get difficult to think creatively ... and a really important aspect of triage is to always re-evaluate the needs and resources at hand."

She used an example from her article of some doctors and nurses who, rather than wait for rescue crews, found and hot-wired abandoned boats to carry patients out.

Her award-winning article appeared at a time of national debate over disaster preparedness and legal protections for medical workers caught in crises. In 2008, the American Medical Association introduced model legislation providing qualified liability protections to disaster responders. That year, Louisiana became the testing ground as one of the first states to pass such a law.

The article also was read by at least some members of an Institute of Medicine committee charged with drafting national guidelines on crisis standards of care in light of the H1N1 flu pandemic. The "Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations" was released in September 2009.

James G. Hodge Jr., a professor of law and ethics at the Sandra Day O'Connor College of Law at the Arizona State University who served on the IOM committee, said he found the article influential.

"It was a very compelling illustration of the significant ethical and legal issues [doctors] face not only in the throws of an emergency, but also in the aftermath," said Hodge, speaking on his own behalf. "What [the IOM] did in relation to that work to delve into the crisis of H1N1 was so necessary because of what people like [Dr. Fink] documented is happening in these events."