The Story Behind a 2010 Dart Award Winner

In the catastrophic aftermath of Hurricane Katrina, one story riveted the medical community: At Memorial Medical Center, doctors and nurses were accused of euthanizing sick patients in the flooded hospital. In the ensuing legal and media battle, the details of exactly what happened remained murky even as the implications of the case grew. After a grand jury failed to indict anyone, and as shock turned to support for the accused, the story became ammunition for a growing movement to change medical standards and exempt health workers from prosecution for their conduct during disasters. 

Four years later, after two and a half years of investigation, ProPublica reporter Sheri Fink has written the definitive account of those four tragic days. Drawing on her experience as a physician, humanitarian aid workers and previous reporting on medical care in wartime conditions, Fink tracked down previously unavailable records and interviewed dozens of those involved, including several who spoke on the record for the first time. Her 13,000-word narrative "The Deadly Choices at Memorial," appearing as part of a multimedia package at ProPublica.org and in the Aug. 30 edition of the New York Times Magazine, elucidates the context and consequences of the decisions that left at least 18 patients dead after injections of painkillers and sedatives administered in the final hours of the hospital's evacuation.

In an exclusive interview with Bruce Shapiro, executive director of the Dart Center for Journalism and Trauma, Sheri Fink described how she found the story, how she reported it and how she sees its broader implications.

Video produced by Stan Alcorn and Malcolm Murray

She began by setting the scene.

Sheri Fink: Imagine this happens: storm hits early Monday; Tuesday everything goes down, and now you're Thursday. And you've been carrying patients (no elevators working), carrying them downstairs. Everybody's sweating. Patients are separated from their nurses, their nursing units, the medical care that they usually give. Medical care has gone down to fanning people with some cardboard.

After describing how she came to the story and what she uncovered, Shapiro asked about the reporting process.

Bruce Shapiro: Takes a lot of trust for even a physicians who wants, or somebody who could be branded unethical or could be branded a perpetrator, to talk to you. How did that go? How did you prepare for that?

SF: Very few people do things in this world to be evil. People generally believe in what it is they've done. And I feel like, as a journalist, if you can go in there and be willing to hear that — that honest truth, their reality — that's the real key. And that was the same in Bosnia. You know, I wrote about a hospital where there was a genocide. There was a genocide in the town that I wrote about. And I interviewed people on both sides of that conflict, and it was the same idea of going in there and just wanting, genuinely wanting to hear their perspective, and I feel like people generally want to share that.

At the end of the interview, they discussed some of the broader legal, ethical and policy implications.

BS: On the one hand, this is simply a fascinating inside narrative of a terrible incident. But it does have some broader implications, which you get to toward the end of your story. Talk a little bit about that. Why is this story particularly important?

SF: Number one: people in a hospital should never have to face this kind of thing again. If at all possible, we need to do better as a country to prevent people from ever having to make these decisions and be put in this situation. So I hope that's sort of the overarching impression that people come away with ...

There are [also], I think, two major things that have come out of this story before I got involved it, and I hope maybe we can look at with different eyes after knowing more about what happened there. Two things. One is that regular physicians, nurses, who heard about what happened, who heard that a doctors and two nurses who were highly respected had been arrested, very much became worried and wanted liability reform. [They] wanted special laws that would say — from state to state, or even federally — that you can't prosecute people, you can't sue people, for doing their best in an awful circumstance.

BS: And where do you come down on that, after looking at this for a while?

SF: The idea that many people are arguing for now is that we need a set of standards that are not the same usual medical standards that would apply during disasters ... The idea that doctors and nurses can't practice as they normally would in a disasters situation; obviously that's a given. However, ... the question of whether we should change standards and how we do it, I think is [a conversation] that Americans, regular citizens, need to be brought into ...

And the number one, number one lesson about triage that I think is important for people to walk away with, is that you always need to be looking at what your resources are and what the status of the patient is. And a lot of these new standards aren't emphasizing the need for constantly reassessing those things.

BS: So, as often happens with journalists, your story is hitting at a time that may give it a particular context. This story is hitting in the middle of a great national debate about the health care system ... Is there a way in which ... either Katrina writ large or the events at Memorial tie in at all to this great national discussion that's going on now?

SF: Yeah, absolutely it does. It's sort of a case study for these larger issues of how we manage resources. It is the extreme example of having a limited set of resources that you need to figure out how to steward or split up between various people ...

And the other aspect ... we aren't perhaps talking enough about is the importance of putting some investment into disaster preparedness of our health system ...

I guess the real relevance here, from a journalistic standpoint, is to look at the fact that America is going to face future disasters. We're going to have more hurricanes. We have threats of pandemic diseases, including influenza this season. There are going to be times where resources are limited. There are going to be times, unfortunately, where government fails, as government failed these people, and health workers and patients get trapped in very difficult situations. So the question, the whole reason to go back and look at this, is to say, "What can we learn? What is it that this story teaches us?"