“Five Days at Memorial”: How would your hospital perform?

BOOKFINK2-articleLargeIf you work for a healthcare organization, I urge you to read Sheri Fink’s account of the deaths of forty-five patients at Memorial Hospital in New Orleans during Hurricane Katrina. Some of these patients died after injections of morphine and Versed administered by hospital staff.

When you read Five Days, ask yourself how your organization would perform during a natural disaster or mass casualty event.

This is a story of comprehensive organizational failure. We know about the failures of the federal, state, and municipal governments during Katrina. What I didn’t know was how badly the hospital performed.

  1. The failure of Memorial Hospital’s leadership to adequately prepare for flood consequences foreseen in their own disaster planning.
  2. The irresponsible passivity of Tenet, Memorial’s corporate owners as the disaster unfolded. There is little evidence that these — well, reptiles is the word that comes to mind — understood themselves to be, like, providing health care.
  3. The failure of the hospital staff to maintain morale, discipline, and a chain of command in the face of threats to patients’ lives.
  4. Above all, the failure of medical ethics at Memorial. There were two failures here. First, it was wrong to kill the patients. But I knew what I thought about that before I read the book. What shocked me was the lack of professionalism shown by the Memorial doctors. There had, apparently, been little organizational reflection on principles of end-of-life decision making, let alone triage. Individual physicians took it on themselves to make furtive end-of-life decisions without consulting colleagues, let alone family members. The physicians clearly understood that they were making grave decisions, but none of them understood that awareness of gravity should prompt one to give an account of your reasons for action to others, to be sure that you are making a morally acceptable choice.

I don’t know how well I would have performed had I been an employee of Memorial. But we can learn from their experience. Fink’s book provides important data about the ethical culture of healthcare organizations and why that culture matters.


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