US hospital told family their daughter had checked out when in fact she'd died(theguardian.com)
theguardian.com
US hospital told family their daughter had checked out when in fact she'd died
https://www.theguardian.com/us-news/article/2024/aug/21/sacramento-hospital-patient-death-checked-out
230 comments
When I was a teenageer a school counselor incorrectly perceived me to be in a crisis and had me sent to 72 hour hold (which stays on certain records for quite a while and can be incredibly disruptive, but that's besides the point) - for some reason I was sent almost 40 miles away in another county in a city I'd never been. The hospital doctors took one look at me and realized I didn't belong there, but to do a discharge apparently is a pretty lengthy process once this process is initiated - almost 20 hours later (again, being held completely against my will for no reason) they released me. I asked them where I was supposed to go and if I could call my dad. They said no, but they gave me two (2) bus tokens, which wasn't enough to get back where my car was parked at the school, plus I had no idea how to use the bus system in that county, and didn't have my glasses, phone, or wallet.
I really don't know how long it took or how I made it, but many many hours later I made it back to my car. I had to beg for money and walk the last several miles once I recognized finally where I was. It really sucked, and ever since then I've had a great deal of sympathy for people that are churned through this terrible system and spit right back out with no dignity whatsoever, let alone empathy. This incident disrupted my life irreversibly (ended up missing tests and having to do a medical withdrawal from school, lost scholarships, etc) and derailed a lot of things I had wanted to do for many, many years. The hospital/medical care industrial complex doesn't optimize for empathy. They're just trying to get the bodies through as quickly as possible.
I really don't know how long it took or how I made it, but many many hours later I made it back to my car. I had to beg for money and walk the last several miles once I recognized finally where I was. It really sucked, and ever since then I've had a great deal of sympathy for people that are churned through this terrible system and spit right back out with no dignity whatsoever, let alone empathy. This incident disrupted my life irreversibly (ended up missing tests and having to do a medical withdrawal from school, lost scholarships, etc) and derailed a lot of things I had wanted to do for many, many years. The hospital/medical care industrial complex doesn't optimize for empathy. They're just trying to get the bodies through as quickly as possible.
>When I was a teenageer a school counselor incorrectly perceived me to be in a crisis and had me sent to 72 hour hold
How could they do that without notifying your parents and telling them exactly where you've been sent to, and what they should do?!
How could they've done that without giving the hospital your parents' contact info? How could the hospital accept you without requesting it, given that you were sent from school, where you have limited rights because they have the responsibility for your well-being?
How could have they discharged without allowing you to contact your family yourself?
This should be grounds for a civil lawsuit, if not criminal prosecution. I am not a lawyer, but I really hope that anyone reading this would contact one if they end in a situation like that.
>They're just trying to get the bodies through as quickly as possible.
I don't think taking 30 seconds over those 20 hours to contact your family would've slowed them down any.
This is not about efficiency. They should not be allowed to operate.
How could they do that without notifying your parents and telling them exactly where you've been sent to, and what they should do?!
How could they've done that without giving the hospital your parents' contact info? How could the hospital accept you without requesting it, given that you were sent from school, where you have limited rights because they have the responsibility for your well-being?
How could have they discharged without allowing you to contact your family yourself?
This should be grounds for a civil lawsuit, if not criminal prosecution. I am not a lawyer, but I really hope that anyone reading this would contact one if they end in a situation like that.
>They're just trying to get the bodies through as quickly as possible.
I don't think taking 30 seconds over those 20 hours to contact your family would've slowed them down any.
This is not about efficiency. They should not be allowed to operate.
I was an adult and had been independent since 17. I do not recall the hospital ever asking me for contact info. I had nothing on me except my keys, no id. and frankly by the time I had got there in cuffs and realized what was happening was not in a great mood to cooperate, either.
I know for a fact the school never contacted my emergency contacts but there wasn’t really anyone to contact to begin with so I don’t fault them for that.
What should have happened was I referred to a school therapist or actual doctor.
To explain further what this place was like - it was the county mental facility at a large hospital. imagine a toned down version nurse ratchet kind of setting, people defecating on themselves, screaming, people in straight jackets. and then me, a slightly disheveled kid who was stressed about finals. they wanted me out of there immediately once they realized what was going on because they were already full. then when they process the paper work you get shuffled to a front desk behind a window who just wants you out of their sight ASAP. I remember I had to actually argue for the bus tokens and the woman seemed exasperated with even that.
I know for a fact the school never contacted my emergency contacts but there wasn’t really anyone to contact to begin with so I don’t fault them for that.
What should have happened was I referred to a school therapist or actual doctor.
To explain further what this place was like - it was the county mental facility at a large hospital. imagine a toned down version nurse ratchet kind of setting, people defecating on themselves, screaming, people in straight jackets. and then me, a slightly disheveled kid who was stressed about finals. they wanted me out of there immediately once they realized what was going on because they were already full. then when they process the paper work you get shuffled to a front desk behind a window who just wants you out of their sight ASAP. I remember I had to actually argue for the bus tokens and the woman seemed exasperated with even that.
> shuffled to a front desk behind a window who just wants you out of their sight ASAP
That’s their problem, especially if they deal with proper mental issues, you can’t just dump these kind of people on the street.
That’s their problem, especially if they deal with proper mental issues, you can’t just dump these kind of people on the street.
In these times having people dumped on the streets seems rather like a feature, not a bug. Liberty! screech
> in a crisis and had me sent to 72 hour hold
Oftentimes it's not even that, or can go to the opposite extreme. It can be "or until evaluated by a psychiatrist or MHP".
I'm a paramedic in Washington. The biggest example of this I remember was a 14yo, intentional pharma overdose. We brought her in, "invol". Four and a half hours later, call goes out, same address, 14 year old girl, overdose. We checked with dispatch, was there a glitch?
Nope. Psychiatrist had spoken to her, determined she was "no threat to herself". Parents drove her home, and within fifteen minutes she'd locked herself in the bathroom again, and taken more of the same meds.
Was furious. Between the psychiatrist, parents not locking up the meds, hell, the ER, she probably still had drugs in her system.
"Maybe hold on to her for more than four hours this time."
Also, tangentially, if EMS wants to transport you involuntarily, we actually need Law Enforcement involvement - they don't even necessarily need to talk to the patient, but they do need to complete the paperwork that takes them into custody, which they then "assign" to us. EMS generally has no power to treat you against your will (however, if you are actively a threat to yourself, we can act on that, usually restraint and sedation. Or there is 'implied consent' where if you lose the ability to effectively consent, the law assumes that a rational person would want aid to be rendered).
Oftentimes it's not even that, or can go to the opposite extreme. It can be "or until evaluated by a psychiatrist or MHP".
I'm a paramedic in Washington. The biggest example of this I remember was a 14yo, intentional pharma overdose. We brought her in, "invol". Four and a half hours later, call goes out, same address, 14 year old girl, overdose. We checked with dispatch, was there a glitch?
Nope. Psychiatrist had spoken to her, determined she was "no threat to herself". Parents drove her home, and within fifteen minutes she'd locked herself in the bathroom again, and taken more of the same meds.
Was furious. Between the psychiatrist, parents not locking up the meds, hell, the ER, she probably still had drugs in her system.
"Maybe hold on to her for more than four hours this time."
Also, tangentially, if EMS wants to transport you involuntarily, we actually need Law Enforcement involvement - they don't even necessarily need to talk to the patient, but they do need to complete the paperwork that takes them into custody, which they then "assign" to us. EMS generally has no power to treat you against your will (however, if you are actively a threat to yourself, we can act on that, usually restraint and sedation. Or there is 'implied consent' where if you lose the ability to effectively consent, the law assumes that a rational person would want aid to be rendered).
I’m aware of a lot of this dynamic and have written extensively about it elsewhere - in this case though, especially looking back, it was ridiculous. I was extremely stressed about finals and didnt know what to do. Was borderline homeless and struggling to support myself. I had never seen a counselor or therapist before and was mildly depressed. she asked me a few leading questions like “how would you feel if you failed your finals and dropped out?” and I said something along the lines of “I guess I’d feel suicidal.” then, “do you feel suicidal now?” and I said I wasn’t sure. Then she goes, “so you cant tell me if you go home right now, you cant guarantee me you won’t kill yourself?”
now at this point I had zero ideation even, no plan, no intentions of killing myself, but being a pedantic dork studying philosophy I said I wasn’t sure about that, because I really wasn’t sure what to say. 10 minutes later a cop shows up, puts me in handcuffs, parades me off campus in them and people I knew saw it. I had absolutely no clue what was going on and had to sign papers I didn’t want to sign and when I protested the answer was basically “you can come voluntarily or with force, your choice.”
It ended up doing far more harm than good for me. I know physicians personally that will often throw people into 72 hour holds in the ER “just to be safe,” either not understanding or caring the long term consequences of being put in an involuntary hold. These same physicians have told me she did the “right” thing but anyone with common sense and experience could figure out very quickly I was not a danger to anyone. I was just trying to find some help because I was overwhelmed.
now at this point I had zero ideation even, no plan, no intentions of killing myself, but being a pedantic dork studying philosophy I said I wasn’t sure about that, because I really wasn’t sure what to say. 10 minutes later a cop shows up, puts me in handcuffs, parades me off campus in them and people I knew saw it. I had absolutely no clue what was going on and had to sign papers I didn’t want to sign and when I protested the answer was basically “you can come voluntarily or with force, your choice.”
It ended up doing far more harm than good for me. I know physicians personally that will often throw people into 72 hour holds in the ER “just to be safe,” either not understanding or caring the long term consequences of being put in an involuntary hold. These same physicians have told me she did the “right” thing but anyone with common sense and experience could figure out very quickly I was not a danger to anyone. I was just trying to find some help because I was overwhelmed.
I am very sorry for your experience - that's entirely horrible.
I'm the same as you, too, and pondering the deeper, thinking answers.
That whole process sounds messed up. I would say over 99% (and that's not an exaggeration, but literal) of our invol patients do not have police involved (other than to submit paperwork to the hospital), let alone cuffs. Our EMS protocols DO require soft restraints during transport, but we generally make a point of being apologetic about it, putting them on at the last moment and that we will take them off ASAP (essentially once the ambulance is in Park). Even this is only because, unfortunately, some of those patients have attempted to exit a moving ambulance, sometimes at freeway speeds.
I'm curious what papers were put in front of you, though, as the whole point of the involuntary custody process is that your acknowledgement is not necessary (at that point - after the mental health hold hearing, in front of a judge - you are asked to acknowledge/sign, but not required).
I'm the same as you, too, and pondering the deeper, thinking answers.
That whole process sounds messed up. I would say over 99% (and that's not an exaggeration, but literal) of our invol patients do not have police involved (other than to submit paperwork to the hospital), let alone cuffs. Our EMS protocols DO require soft restraints during transport, but we generally make a point of being apologetic about it, putting them on at the last moment and that we will take them off ASAP (essentially once the ambulance is in Park). Even this is only because, unfortunately, some of those patients have attempted to exit a moving ambulance, sometimes at freeway speeds.
I'm curious what papers were put in front of you, though, as the whole point of the involuntary custody process is that your acknowledgement is not necessary (at that point - after the mental health hold hearing, in front of a judge - you are asked to acknowledge/sign, but not required).
This is california law and I believe the code is 51-50 but this is over 20 years ago so I’m a little fuzzy. I think looking back they were just liability papers the university was having me sign, I remember having to acknowledge things (that I didnt have time to read) that I wouldnt be able to purchase a firearm for 7 years and a whole bunch of other legal gobbledegook about being detained and what my rights were. The whole time a cop is standing above me making me sign it though and no one was answering my questions. I was extraordinarily confused for most of it until the cuffs went on and I had kind of a vague understanding I had said something wrong. At no point did anyone tell me what I did other than to tell me stuff like “you’re very ill and are being looked after for your own safety, care will be provided to you and you will be ok” kind of stuff. I cannot stress enough that this assessment was based on less than a 10 minute conversation with me. They even had a followup with me I was forced to go to, because I had missed the finals (because i was gone for like 3 days) and therefore actually failed. So they then convinced me to do a medical withdrawal to save my grade which very ironically led me to actually dropping out because I lost all my scholarships and grants. I would have probably been fine had I never sought help, and I suspect although my experience was extreme and probably malfeasant, that this treatment of people undergoing difficult mental things is probably very commonplace within the system.
This happened to a friend of mine in the last year. He went to the ER for something and joked about feeling suicidal. Meanwhile people I know who are actually suicidal are impossible to get admitted. Sorry that happened to you. I really wish there was a better feedback mechanism in American healthcare
Thanks, ironically this is one of those policies that has misaligned incentives everywhere. The doctor does not have any incentive other than to "play extra safe" and punt anyone they think is having a crisis into other hands - they're usually very busy, especially in the ER, which is typically full of mentally ill people. This has the opposite effect of actually helping people though - what happens to your friend if he actually is feeling suicidal in the future? 0 chance he seeks help, it's way too risky to even state outloud. And when people have no outlet for this kind of problem or thoughts, bad things happen.
Looking back with a more historical lens I think at the time this happened for me was shortly after columbine and everyone was freaked out about mentally ill people shooting up a place because that had at that time been a shocking incident.
Looking back with a more historical lens I think at the time this happened for me was shortly after columbine and everyone was freaked out about mentally ill people shooting up a place because that had at that time been a shocking incident.
> You'd be amazed how bad hospitals can be at keeping track of fairly critical things.
Got to experience that first-hand when my partner lost her pregnancy. We went in for the procedure to remove the nonviable fetus and were advised we had 14 days to arrange for a mortuary to take the remains if we wished to keep them, which we did. At 7 days when the mortuary tried to arrange for pick-up, we were informed that the hospital had disposed of the remains. It was "very uncommon" for people to want to take the remains, so they got lax in following their procedure and jumped the guns. Left us nothing to take home. It still sucks.
Got to experience that first-hand when my partner lost her pregnancy. We went in for the procedure to remove the nonviable fetus and were advised we had 14 days to arrange for a mortuary to take the remains if we wished to keep them, which we did. At 7 days when the mortuary tried to arrange for pick-up, we were informed that the hospital had disposed of the remains. It was "very uncommon" for people to want to take the remains, so they got lax in following their procedure and jumped the guns. Left us nothing to take home. It still sucks.
that stuff is worth a lot, probably went to the highest bidder, tissue banks, stem cells, ... they probably tell the same to all the parents, to redirect the anger towards some average Jane and Joe... while trying not to visualize the ice and careful packaging in which they got it "disposed off" through some medical courier.
(sarcasm warning) But who can fault them, imagine they had to explain to each pair of parents from scratch what is happening behind the scenes, and how such decisions are being made with little to no public discussion let alone democratic oversight? The time it would take compared to the harvesting itself would be intolerable. Intolerable! Not to speak of having to invest in bulletproof panes from behind which they would quickly learn to explain all this.
(sarcasm warning) But who can fault them, imagine they had to explain to each pair of parents from scratch what is happening behind the scenes, and how such decisions are being made with little to no public discussion let alone democratic oversight? The time it would take compared to the harvesting itself would be intolerable. Intolerable! Not to speak of having to invest in bulletproof panes from behind which they would quickly learn to explain all this.
That's some conspiracy stuff, got proof? I mean... You're not even a real doctor, you make pizza's.
I'm not OP but John Oliver had a pretty good episode about hospitals, organ donation organisations and even non-profits, all benefit from a opaque system intentionally designed to hide where bodies go when "disposed" -- Here's a youtube link to the episode (may be blocked in certain regions due to copyright) https://www.youtube.com/watch?v=Tn7egDQ9lPg
> Apparently it's common and not even something there's any recourse for.
It's a sad fact but hospitals have no one who is responsible for advocating for your care. I think it's a major ethical flaw in our entire healthcare model. People are not medical experts or legal experts and when they are suffering they're even less capable of handling that burden.
To expect the hospital with a financial incentive to do this is absolute folly. It just doesn't happen. They'll _absolutely_ get your insurance information, even when you're laying in the ER and doctors are still attending to you, but they'll provide you less than nothing when it comes to understanding your care and your options.
We afford people public defenders as disinterested third parties when they're accused of the most petty of crimes, yet, you're absolutely on your own when it comes to the hospital. This is a complete social moral failure.
It's a sad fact but hospitals have no one who is responsible for advocating for your care. I think it's a major ethical flaw in our entire healthcare model. People are not medical experts or legal experts and when they are suffering they're even less capable of handling that burden.
To expect the hospital with a financial incentive to do this is absolute folly. It just doesn't happen. They'll _absolutely_ get your insurance information, even when you're laying in the ER and doctors are still attending to you, but they'll provide you less than nothing when it comes to understanding your care and your options.
We afford people public defenders as disinterested third parties when they're accused of the most petty of crimes, yet, you're absolutely on your own when it comes to the hospital. This is a complete social moral failure.
The number one actual reason to have kids is to guarantee that you have your own de facto “medical advocate” who will do all of what you described for you.
Those who don’t have kids will learn quickly how hospitals treat those without children. It’s not pretty.
Those who don’t have kids will learn quickly how hospitals treat those without children. It’s not pretty.
One time I went to A&E in the UK, I saw a young unconscious woman outside, laying next to a wheelchair. I told the receptionist and was told she had to come in for treatment. Another patient tried to get her into the wheelchair but ultimately I got an ambulance involved to bring her in.
The nurse then recognized the woman, for it was the very nurse who had rolled her out for fresh air some time ago.
It was a cold night, as well. I think there was some snow, or it was about to snow.
There is definitely an over-reliance on schematics in emergency medicine. The moment a slightly more complicated patient is involved or one falls outside the schematic otherwise, their risk of serious health injury or death goes up a lot.
This was always interesting to me. I went to medschool, and I remember my peers as people who genuinely wanted to help others. Few would have refused to help someone collapsed outside in the cold. But our medical system has changed a lot, many more people do it for the pay slip. Most probably still care about the patients but I suppose some portion genuinely don’t. If it’s not on the schematic, they won’t care for it.
The nurse then recognized the woman, for it was the very nurse who had rolled her out for fresh air some time ago.
It was a cold night, as well. I think there was some snow, or it was about to snow.
There is definitely an over-reliance on schematics in emergency medicine. The moment a slightly more complicated patient is involved or one falls outside the schematic otherwise, their risk of serious health injury or death goes up a lot.
This was always interesting to me. I went to medschool, and I remember my peers as people who genuinely wanted to help others. Few would have refused to help someone collapsed outside in the cold. But our medical system has changed a lot, many more people do it for the pay slip. Most probably still care about the patients but I suppose some portion genuinely don’t. If it’s not on the schematic, they won’t care for it.
Being overworked will do that to you.
It’s like asking a software engineer to write a hundred new features in a given sprint while the rest of the application is in flames. Eventually you stop aspiring to build good software and just hope enough of your code works that it’s good enough for some people.
Unfortunately medical services are literal life and death services. So we have it much easier as software engineers.
It’s like asking a software engineer to write a hundred new features in a given sprint while the rest of the application is in flames. Eventually you stop aspiring to build good software and just hope enough of your code works that it’s good enough for some people.
Unfortunately medical services are literal life and death services. So we have it much easier as software engineers.
I don't know why I read the last part "medieval services are literal life and death services".
that is, until people who work in literal life and death services have to use software written by overworked engineers...
I've always had the experience that all employees at hospitals act like contractors. Usually great at what they do but no sense or willingness to look beyond their direct job responsibility.
There’s a common reason for that: overworked, over stressed, and underpaid. Eventually the exhaustion will turn you into a numb zombie clocking in and out. There’s no easy solution since healthcare is already expensive.
I have worked in an hospital and that is clearly not true.
Reading that makes me incredibly outraged. I'm sorry that happened and your family had to go through that.
I am so sorry for what happened to your brother and your family.
The hospital is directly responsible for your cousin's death.
The fact that they assured the mother that they'll keep him, specifically told her to come the next day, and then forcibly discharged him at 2am without either calling his mother or even providing mother's contact to him should be grounds for criminal prosecution.
This is beyond negligence. They lied to the mother and knowingly forced him out when they were responsible for his well-being.
It would've cost them $0.00 to dial his mom's number. The fact that he asked for his mom's phone and they refused means they did it on purpose. This sounds very much like and indication of malicious intent to me.
I hope your family sues the bejeesus out of the hospital, and that someone will get a felony charge over this.
This hospital mot merely betrayed the trust of your family. It is literally a public health hazard. It should not continue existing.
The hospital is directly responsible for your cousin's death.
The fact that they assured the mother that they'll keep him, specifically told her to come the next day, and then forcibly discharged him at 2am without either calling his mother or even providing mother's contact to him should be grounds for criminal prosecution.
This is beyond negligence. They lied to the mother and knowingly forced him out when they were responsible for his well-being.
It would've cost them $0.00 to dial his mom's number. The fact that he asked for his mom's phone and they refused means they did it on purpose. This sounds very much like and indication of malicious intent to me.
I hope your family sues the bejeesus out of the hospital, and that someone will get a felony charge over this.
This hospital mot merely betrayed the trust of your family. It is literally a public health hazard. It should not continue existing.
> Forcibly discharging someone under those circumstances and refusing to even contact their emergency contacts is beyond belief
I don’t know what it is legally but morally that is negligent manslaughter.
I don’t know what it is legally but morally that is negligent manslaughter.
Are they suing the hospital and care team for many millions of dollars? That's the level of neglect of responsibility that should get you enough money to own the hospital that did that kind of thing.
I regularly have to aggressively bully medical care teams for myself and others to get them to do the right, obvious things.
I do not trust doctors, they do not care to figure out problems, ignore so many people's problems, and make wildly stupid mistakes all of the time.
I regularly have to aggressively bully medical care teams for myself and others to get them to do the right, obvious things.
I do not trust doctors, they do not care to figure out problems, ignore so many people's problems, and make wildly stupid mistakes all of the time.
> Are they suing the hospital and care team for many millions of dollars?
Did you try clicking the link? They are. 5 million dollars. I expect they will win, and that still won't make them whole.
Did you try clicking the link? They are. 5 million dollars. I expect they will win, and that still won't make them whole.
You’re replying to someone who in turn was asking the GP a question about their comment, not about the article.
Last time I went to the ER, they checked me in under the completely wrong name. Like it wasn't even close. Luckily I noticed the wrist band was wrong and pointed it out, but they then had to re-do tests since they had been done under the other person. It really makes me think how bad that could have been though. What if I went unconscious, and they used the info on the wrist band to look up medical history? What if they gave me medication based on that incorrect history? And at the very least they wouldn't have the right emergency contact info...
That is potentially extremely dangerous for the person they mistook you for as well, and they would have NO way to notice it and fix it. Catching that mistake possibly saved both of your lives!
To force someone out who was guaranteed wouldn't be; to withhold documented caretaker/relative phone numbers from them when they have no other help; then to force them from the premises with no resources.
I want this to be a lie, but I don't treat HN comments that way. This is horrible, absolutely appalling.
I want this to be a lie, but I don't treat HN comments that way. This is horrible, absolutely appalling.
I wonder how much this correlates with socioeconomic status.
When my kids were born, the hospital had this incredibly elaborate, incredibly detailed checklists of things that needed to be in order before they would let you leave. Did you have a carseat? Did you have a ride home? Did the doctor come by and give you discharge instructions? Do you have all the belongings you came with? Did you fill out the birth certificate application? Have all your discharge papers been signed?
They actually wouldn't let my wife walk herself down - they had to call Transport, and she had to be wheeled down in a wheelchair with the baby's carseat on her lap, and I had to be waiting at the designated curbside to pick her up. She was perfectly capable of walking herself down, and we were both capable of putting the carseat into the car in a normal parking spot, but everything had to be done in the presence of an orderly.
This is the same health care company mentioned in the article, but at a pretty affluent suburb of Silicon Valley.
When my kids were born, the hospital had this incredibly elaborate, incredibly detailed checklists of things that needed to be in order before they would let you leave. Did you have a carseat? Did you have a ride home? Did the doctor come by and give you discharge instructions? Do you have all the belongings you came with? Did you fill out the birth certificate application? Have all your discharge papers been signed?
They actually wouldn't let my wife walk herself down - they had to call Transport, and she had to be wheeled down in a wheelchair with the baby's carseat on her lap, and I had to be waiting at the designated curbside to pick her up. She was perfectly capable of walking herself down, and we were both capable of putting the carseat into the car in a normal parking spot, but everything had to be done in the presence of an orderly.
This is the same health care company mentioned in the article, but at a pretty affluent suburb of Silicon Valley.
None of those checklist things are done out of an interest in care - it is about avoiding liability.
Going to disagree hard here, numerous studies have shown checklists improve patient outcome. Similarly, they improve safety in numerous industries. And requiring two person sign off on dangerous actions in the hospital also improves outcomes. Sure, following these practices is helpful in a lawsuit, but primarily because they are best practices.
I'm pretty sure that the person you're replying to isn't making a claim about the utility of checklists but the content of the enumerated checklist items.
Only in the USA will you see people being rolled in a wheelchair at the door.
The only reason is people love to sue for anything in this country. This is unrelated to best practices.
The only reason is people love to sue for anything in this country. This is unrelated to best practices.
>The only reason is people love to sue for anything in this country
People "love to sue" in this country because the court system was designed to be THE place where problems are solved. Can't have a federal agency who's job it is to make sure hospitals don't kill people, that would be tyranny, better make everyone sue them instead.
This affects everything in the US. It only affects hospitals worse because the US cost of healthcare is so stupidly artificially inflated that you have to sue for very minor things so you can pay the $40k it takes for some basic physical therapy.
People "love to sue" in this country because the court system was designed to be THE place where problems are solved. Can't have a federal agency who's job it is to make sure hospitals don't kill people, that would be tyranny, better make everyone sue them instead.
This affects everything in the US. It only affects hospitals worse because the US cost of healthcare is so stupidly artificially inflated that you have to sue for very minor things so you can pay the $40k it takes for some basic physical therapy.
I don't understand the completely unnecessary cynicism in this comment.
Do you really believe that everyone working in maternity wards in hospitals cares absolutely nothing about babies?
Do you really believe that everyone working in maternity wards in hospitals cares absolutely nothing about babies?
Have you seen the itemized bills for giving birth in an American hospital? They'll even try to mutilate an infant boy and charge you for it unless you emphatically opt out.
I want to see the criminals in the medical ethics community who ever greenlit this nonsense to have justice served upon them. Europeans would jail American doctors for what they do to babies here.
are you talking about circumcision? Do they do that automatically to all newborns?
It is not automatic, but it is default behavior.
They'll schedule it by default and often argue with parents who try to cancel it. It's about money for the hospital and they don't care about the suffering it causes, nor the completely unnecessary financial burden it places on young families.
For them to be so soulless when it concerns infants, you can be sure they aren't any better when they're just dealing with adults. Greedy psychopaths are overrepresented in the medical industry.
For them to be so soulless when it concerns infants, you can be sure they aren't any better when they're just dealing with adults. Greedy psychopaths are overrepresented in the medical industry.
Is go further and say that all doctors who work in those wards and perform male genital mutilation must hate babies, otherwise I have no explanation for how they can ignore the fact that their European peers would throw most American doctors in jail for the things they do to newborns.
But your not being taken care of by a person. Your being taken care of by the system. The nice nurse goes home in 3 hours, the nice doctor has 9 other patients. The secretary relies on the information in The computer. The people may very well care a lot. The system does not.
Checklists have been demonstrated to improve care quality because when it's the not-so-nice nurse that's on shift, and the doctor's been awake for 60 hours straight, the stuff that's on the checklist still gets done.
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“It’s the corporations, mahn!”
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One can be forced to mindlessly perform ridiculously constricting duties that have everything to do with limiting liability and nothing to do with outcomes, while also caring about babies.
Re: Understanding the cynicism: For example it is intriguing that they insisted on using a wheelchair to get in the car, but not to get out.
But what's even more revealing is that the child had to be in a car seat while on his mother's lap.
There are some circumstances where people don't realize they can just say "no".
I suspect this is one such case.
I suspect this is one such case.
They didn't say that, they said the checklist is there for liability reasons and not for genuine care reasons.
The "won't let mom walk to the door" thing is a great microcosm of that—it's a blanket policy applied to all mothers regardless of need.
My wife had our youngest at home but we had to take her to the hospital afterward because her lungs were a little sticky and she needed a respirator for ~4 hours. I took our daughter in and my wife followed a few hours later, walking all the way into the hospital.
The NICU wouldn't discharge us for two days (which is a whole liability > care story of its own), but when they finally did they insisted that my wife—who had had the baby at home and driven to and walked into the hospital while mere hours postpartum—needed to be in a wheelchair to the curb.
We liked that shift of nurses, they clearly cared, but no one in that room looked at my wife standing by the warmer and thought "she needs a wheelchair". They had a checklist and they were going to be darn sure they followed it.
The "won't let mom walk to the door" thing is a great microcosm of that—it's a blanket policy applied to all mothers regardless of need.
My wife had our youngest at home but we had to take her to the hospital afterward because her lungs were a little sticky and she needed a respirator for ~4 hours. I took our daughter in and my wife followed a few hours later, walking all the way into the hospital.
The NICU wouldn't discharge us for two days (which is a whole liability > care story of its own), but when they finally did they insisted that my wife—who had had the baby at home and driven to and walked into the hospital while mere hours postpartum—needed to be in a wheelchair to the curb.
We liked that shift of nurses, they clearly cared, but no one in that room looked at my wife standing by the warmer and thought "she needs a wheelchair". They had a checklist and they were going to be darn sure they followed it.
You can always refuse. They can't kidnap you or the baby if for whatever reason you don't want a wheelchair, and it's almost always illegal to block the exits without a court order or documented altered mental status.
I appreciate your willingness to push for your rights here. But the situation is surprisingly similar to refusing to let a cop search your trunk. You can say no, but that K-9 unit is going to take four hours to get there from the station 20 minutes away. They will make your life hell.
I've definitely been in hospital situations with my children where I was honestly afraid (perceived or real threat, I still don't know) that they were going to report me for child abuse if I took my kids home and refused care. People with authority are kinda scary, and while I love for us to all choose rights over security, sometimes I just don't want to have to fight for everything.
And this is where police states evolve from.
I've definitely been in hospital situations with my children where I was honestly afraid (perceived or real threat, I still don't know) that they were going to report me for child abuse if I took my kids home and refused care. People with authority are kinda scary, and while I love for us to all choose rights over security, sometimes I just don't want to have to fight for everything.
And this is where police states evolve from.
> You can say no, but that K-9 unit is going to take four hours to get there from the station
Holding someone for longer than the traffic stop requires to wait for a drug dog is illegal in the USA. That's not to say it never happens, but it's grounds to exclude any evidence found, and for a lawsuit.
https://en.wikipedia.org/wiki/Rodriguez_v._United_States
Holding someone for longer than the traffic stop requires to wait for a drug dog is illegal in the USA. That's not to say it never happens, but it's grounds to exclude any evidence found, and for a lawsuit.
https://en.wikipedia.org/wiki/Rodriguez_v._United_States
Over half the population doesn't have the funds to enforce that and effectively ultimately has no such rights in this situation and many like it.
Not to mention that proving that the drug dog didn't actually need to take that long would probably be extremely difficult.
How long the drug dog needs is irrelevant; if they want to use a dog without consent or probable cause to search, they need to get it there while they still have legal grounds to detain the suspect. A traffic violation is grounds to detain someone long enough to issue a citation, but not longer.
The judge won't be amused if the police say it took them 45 minutes to write a speeding ticket.
The judge won't be amused if the police say it took them 45 minutes to write a speeding ticket.
But for the judge to be amused would require the affected person to have the legal intelligence, moral fortitude and general life "legalness" (because maybe you doubt your US legal status even if your life is mostly above board) to pursue one shitty officer's stop.
I've definitely been detained for what seemed to me an acceptable amount of time for a traffic stop, but who's to say the cop can't come up with myriad reasons it had to take that long? Is 35 minutes too long? Is 38 minutes? Who's keeping time, and who's word is taken as truth?
I've definitely been detained for what seemed to me an acceptable amount of time for a traffic stop, but who's to say the cop can't come up with myriad reasons it had to take that long? Is 35 minutes too long? Is 38 minutes? Who's keeping time, and who's word is taken as truth?
After 48 hours of putting up with hospital rules in order to avoid an AMA discharge, we were just happy to be done. They certainly didn't frame it as optional, and it wasn't worth the fight.
None of what you said supports that checklist following is only for decreasing liability and not towards patient wellness. It may be the case but it doesn't really follow though.
It doesn't prove anything, but I consider it to be a strong anecdote supporting the argument that individual wellness is not the primary motivation for these checklists.
I can see an argument that it's about increasing average wellness across all people ever taken care of by that NICU, but from the perspective of an individual patient there's no difference between the two motivations—the point is that your own care is not the important thing to the hospital at that time, what's important is the rules and regulations.
In our case, we both felt that our care was actually actively hampered by NICU discharge rules that were designed for premature babies and were completely inappropriate for our late-term baby. The wheelchair was just the last hurrah of the situationally-inappropriate hospital regulations.
I can see an argument that it's about increasing average wellness across all people ever taken care of by that NICU, but from the perspective of an individual patient there's no difference between the two motivations—the point is that your own care is not the important thing to the hospital at that time, what's important is the rules and regulations.
In our case, we both felt that our care was actually actively hampered by NICU discharge rules that were designed for premature babies and were completely inappropriate for our late-term baby. The wheelchair was just the last hurrah of the situationally-inappropriate hospital regulations.
The story doesn't prove "only" by itself, but it's a good example of the checklist doing something for liability and not wellness.
Everyone in maternity wards is underpaid and overworked, and the checklist is there and rigorously followed so we don't have mothers with c-sections tearing open on the way out because no one brought a wheelchair.
I don't understand that one very much. If walking is going to tear them open, isn't it better to have that happen at the hospital instead of half an hour later at home? I don't think much healing is going to happen in between.
Is the risk sufficiently on a per-step basis to make that worth it?
Is the risk sufficiently on a per-step basis to make that worth it?
...which might still be socioeconomically correlated. People who make half a million a year can afford lawyers. People who make $50K/year generally cannot.
The interesting point here is about how so many institutions become so much sloppier when the legal system becomes unaffordable for a majority of residents. Unsurprising, but it has pretty far-flung consequences if you're trying to root-cause why so much of America seems like a 3rd-world country today.
The interesting point here is about how so many institutions become so much sloppier when the legal system becomes unaffordable for a majority of residents. Unsurprising, but it has pretty far-flung consequences if you're trying to root-cause why so much of America seems like a 3rd-world country today.
I get tired of the constant deferral to socioeconomics as an excuse. It's pretty simple, we don't allow people to be born with zero documentation in the US. This would be a massive fuckup, and it doesn't matter if the kid is poor, they still need a birth certificate to get a social security number. They've had a long time to put whatever systems in place prevent that from getting missed, even in the poorest zip codes.
And as far as safety, it's not always legal liability. I'm sure a good portion is, but we're talking about newborn babies right now. Most people don't want to have any part in a newborn being harmed, so it's trivially easy to get employees to take that stuff seriously.
And as far as safety, it's not always legal liability. I'm sure a good portion is, but we're talking about newborn babies right now. Most people don't want to have any part in a newborn being harmed, so it's trivially easy to get employees to take that stuff seriously.
>Most people don't want to have any part in a newborn being harmed
And nobody is ever the bad guy in their own story. During my sister's birth, she got stuck, and the doctor, instead of doing the normal and accepted and standard fix of breaking one bone, broke a different one instead. This damaged nerves in her arm and permanently disabled her. Turns out, he did the exact same thing to another kid in town a few years later. ALSO turns out, he had to stop practicing medicine in a different state because he kept doing that to a bunch of babies, so instead of retiring or retraining because he obviously did not know what he was doing, he moved to bumb-fuck nowhere so he could keep doing it. I bet he even thought he was a good doctor.
It is never trivially easy to get someone to do something they don't want to do, like admitting they fuck up, or that they are careless about something they don't think is important.
We only got $10k in the malpractice suit, which doesn't even cover like a year of physical therapy, for a lifelong and entirely avoidable disability of her dominant arm. She had to learn to be left handed. If our family didn't have state employee insurance, we would have never seen a doctor, like most people in poverty.
And nobody is ever the bad guy in their own story. During my sister's birth, she got stuck, and the doctor, instead of doing the normal and accepted and standard fix of breaking one bone, broke a different one instead. This damaged nerves in her arm and permanently disabled her. Turns out, he did the exact same thing to another kid in town a few years later. ALSO turns out, he had to stop practicing medicine in a different state because he kept doing that to a bunch of babies, so instead of retiring or retraining because he obviously did not know what he was doing, he moved to bumb-fuck nowhere so he could keep doing it. I bet he even thought he was a good doctor.
It is never trivially easy to get someone to do something they don't want to do, like admitting they fuck up, or that they are careless about something they don't think is important.
We only got $10k in the malpractice suit, which doesn't even cover like a year of physical therapy, for a lifelong and entirely avoidable disability of her dominant arm. She had to learn to be left handed. If our family didn't have state employee insurance, we would have never seen a doctor, like most people in poverty.
Nobody's excusing anything. It's an
explanation. You're comparing apples to oranges: things that are free and done by the state compared to things that cost done by for-profit corporations.
We do let millions of people in without documentation, and they are nearly all poor. The underclass somehow manages while the upper class ducks everything up.
We had the opposite. They tried on multiple occasions to evict my wife after a C section while she was in an incredible amount of pain.
They kept giving her an oxy in the morning, then after it set in, asking her to rate her pain level, and recording it. Which is backwards.
Then they blamed her for not asking for more pain meds, which she had.
Then they told her to just ask for more pain meds, which we did.
Then the nurse told her that shes not allowed to have any more pain meds. At which point I went full Karen, got our stay extended by 2 nights.
Apparently the midwives expected her to be walking up and down the corridor, which was not a requirement and not part of the treatment, just to demonstrate her pain levels.
They kept giving her an oxy in the morning, then after it set in, asking her to rate her pain level, and recording it. Which is backwards.
Then they blamed her for not asking for more pain meds, which she had.
Then they told her to just ask for more pain meds, which we did.
Then the nurse told her that shes not allowed to have any more pain meds. At which point I went full Karen, got our stay extended by 2 nights.
Apparently the midwives expected her to be walking up and down the corridor, which was not a requirement and not part of the treatment, just to demonstrate her pain levels.
Oh god, I hate nurses you make you prove your pain level.
When I was a university student, my tonsils suddenly swelled up so much that I was unable to speak and I was having difficulty just breathing.
I went to the university urgent care, and the nurse showed me a pain scale and asked me what my pain level was. I pointed at the '7', and she told me I needed to actually say the number to her. I kept trying (it was extremely painful to try, more like a 9!) but I physically could not make the sound — which just pissed her off even more. At long last, she got so frustrated that she stormed out and finally got the doctor.
When the doctor examined me, he told me that I had the biggest tonsils he had ever seen in his career.
He diagnosed me with mono and put me on steroid treatment, and my tonsils were back to normal by that evening.
When I was a university student, my tonsils suddenly swelled up so much that I was unable to speak and I was having difficulty just breathing.
I went to the university urgent care, and the nurse showed me a pain scale and asked me what my pain level was. I pointed at the '7', and she told me I needed to actually say the number to her. I kept trying (it was extremely painful to try, more like a 9!) but I physically could not make the sound — which just pissed her off even more. At long last, she got so frustrated that she stormed out and finally got the doctor.
When the doctor examined me, he told me that I had the biggest tonsils he had ever seen in his career.
He diagnosed me with mono and put me on steroid treatment, and my tonsils were back to normal by that evening.
Having a low child mortality is important, and we've done so many good things in the last couple of decades, but I'm starting to think we're at the point now where the money you have to spend to make a meaningful difference is better spent in other areas of health care.
A classical example of this is in Norway. There's nothing that gives you access to more resources than being pregnant or being in care of a newborn. You can suffer from all kinds of mental health issues for your entire life, struggle to be a productive member of society and be in and out of temporary treatment and be on social benefits. But the moment someone is pregnant they get will be top priority for anything that is even remotely connected with child mortality, almost regardless of how benign something is.
I personally know several people that finally got the help they had been so desperately been begging for, just because they got pregnant. We could have saved them from literal decades of suffering by just providing good treatment early. I'm willing to bet that we'd even be in a position to spend even more money on reducing child mortality, because when you start doing the math of how much they ended up costing society it really adds up.
A classical example of this is in Norway. There's nothing that gives you access to more resources than being pregnant or being in care of a newborn. You can suffer from all kinds of mental health issues for your entire life, struggle to be a productive member of society and be in and out of temporary treatment and be on social benefits. But the moment someone is pregnant they get will be top priority for anything that is even remotely connected with child mortality, almost regardless of how benign something is.
I personally know several people that finally got the help they had been so desperately been begging for, just because they got pregnant. We could have saved them from literal decades of suffering by just providing good treatment early. I'm willing to bet that we'd even be in a position to spend even more money on reducing child mortality, because when you start doing the math of how much they ended up costing society it really adds up.
> They actually wouldn't let my wife walk herself down - they had to call Transport, and she had to be wheeled down in a wheelchair with the baby's carseat on her lap, and I had to be waiting at the designated curbside to pick her up. She was perfectly capable of walking herself down, and we were both capable of putting the carseat into the car in a normal parking spot, but everything had to be done in the presence of an orderly.
I have tonic-clonic seizures; at least 4 hospitals have wheeled me out that way, suffering no argument otherwise. I guess it is common.
I have tonic-clonic seizures; at least 4 hospitals have wheeled me out that way, suffering no argument otherwise. I guess it is common.
A lot. A friend worked for years in a well known hospital in PHL (that closed somewhat recently), and they were pushed to get people with no insurance out as fast as they could.
If they know you won't be paying, they will try to kick you out as fast as they can and consequences be damned, if you don't have insurance you likely don't know/understand your rights and wouldn't sue them.
If they know you won't be paying, they will try to kick you out as fast as they can and consequences be damned, if you don't have insurance you likely don't know/understand your rights and wouldn't sue them.
Those checklists have done a good job preventing infant kidnapping.
Such professionalism and high quality care like this are why American doctors deserve their huge salaries, massive houses and vacation properties, boats and sports cars, and of course are entitled to our thanks and adoration. Truly, a saintly class of people who all got into this line of work to help people.
News flash - most doctors all over the world are doing it for money and status. It's a job.
I think the doctors aren't the ones to blame here, it's the hospital administrators.
American doctors want the public to believe they are powerless victims of the system that makes them wealthy while bankrupting patients.
Good lord that's awful, I'm sorry for your loss.
if it's true that he was discharged and didn't leave against medical advice, that sounds like a fairly straightforward and expensive lawsuit against the hospital. And some hospitals only change their behavior when beaten by large expensive lawsuits...
> You'd be amazed how bad hospitals can be at keeping track of fairly critical things.
should be
> You'd be amazed how bad hospitals in the States can be at keeping track of fairly critical things.
should be
> You'd be amazed how bad hospitals in the States can be at keeping track of fairly critical things.
[deleted]
It's sad that the for profit healthcare system incentivises leaving an entire town without critical healthcare. It is a failure on every level.
We need AIs for personal advocacy.
SkyPuncher(8)
> an autopsy that could have indicated whether there had been medical malpractice associated with her death was “rendered impossible”, according to the lawsuit
This crosses into criminal liability.
This crosses into criminal liability.
This is just horrible but I’m not surprised since I have read so many stories of malpractice recently, from the skull flap thing to the Texas hospital triple booking surgeons to other stuff
It's amazing how many stories like this come out of the U.S. Normally, one can say "you get what you pay for" but what American hospitals charge for this level of quality is so expensive compared to other countries.
[deleted]
Anywhere with a hospital and medical care can have issues. Here’s a few high profile cases in the UK.
https://www.howellslegal.co.uk/news/post/The-5-Largest-Perso...
https://www.howellslegal.co.uk/news/post/The-5-Largest-Perso...
I think the difference in this case isn't the quality but the cost for said quality.
Triple booking surgeons? Do they think patients in need of surgeries are just going to up and cancel, and hospitals are behaving like airlines?
More common than you think.
A lot of hospital care is done by residents with surgeons overseeing and stepping in for the most difficult parts.
Our healthcare system would literally collapse without residents doing the heavy lifting. It won’t change until we stop artificially limiting the supply of doctors or give mid level practitioners more power.
A lot of hospital care is done by residents with surgeons overseeing and stepping in for the most difficult parts.
Our healthcare system would literally collapse without residents doing the heavy lifting. It won’t change until we stop artificially limiting the supply of doctors or give mid level practitioners more power.
Yep professional medical organizations and universities are causing this artificial supply limit to benefit those who are already practicing and part of this ecosystem.
Without claiming the two systems have the same limiting factors, the UK health system is also struggling, and there the staff shortage is the government's limits on (1) how many spots universities have, (2) immigration.
This is despite health in general, and the HNS in particular, being a major source of interest for the electorate.
This is despite health in general, and the HNS in particular, being a major source of interest for the electorate.
A large fraction of the new doctors in my town in Canada are Britons who have emigrated here. The Canadian government is actively recruiting them.
Why could that be? Does that factor into your assertion?
Why could that be? Does that factor into your assertion?
What the Canadian government does isn't as important as the (now previous) UK government telling foreign doctors to keep away while also not offering enough local people the opportunity to train to make up the difference between supply and demand.
The UK government has no power to keep people in (though my own departure shows they could do a better job of not making people want to leave in the first place), but it does have power over the other two.
The UK government has no power to keep people in (though my own departure shows they could do a better job of not making people want to leave in the first place), but it does have power over the other two.
Alternatively (or also) pay scales and emigration. There are doctors leaving for Australia (which advertised golden handshakes & Australian lifestyle in the UK to UK doctors) and nurses for better pay/conditions in private care facilities; it's not (just) a supply of trained people at source issue.
Salaries are also much more compressed than in North America - UK junior doctors generally earn more than NA residents, but then not that much more (maybe 4-5x from lowest to highest, not >10x to reach hundreds of thousands) as consultants (attendings). Locum pay & additional private work can make up for some of that, but probably not all, and I assume similar could be done in NA if you wanted to earn more (or open their own practice, pharma sponsorship, etc.)
It's probably true in general (relatively compressed salary ranges) actually, not just in medicine.
Salaries are also much more compressed than in North America - UK junior doctors generally earn more than NA residents, but then not that much more (maybe 4-5x from lowest to highest, not >10x to reach hundreds of thousands) as consultants (attendings). Locum pay & additional private work can make up for some of that, but probably not all, and I assume similar could be done in NA if you wanted to earn more (or open their own practice, pharma sponsorship, etc.)
It's probably true in general (relatively compressed salary ranges) actually, not just in medicine.
Or both, both would be nice.
Until then I guess we all just have to make sure we never need to use the healthcare system we all pay so much for.
Until then I guess we all just have to make sure we never need to use the healthcare system we all pay so much for.
https://www.usatoday.com/story/news/health/2024/06/25/baylor...
In Texas, three hospitals (Baylor St. Luke’s Medical Center (BSLMC), Baylor College of Medicine (BCM) and Surgical Associates of Texas P.A. (SAT)) agreed to pay $15m as part of a settlement with the DOJ. These doctors/surgeons were booked for multiple simultaneous procedures that they could not have possibly conducted, even though they recorded things to make it look like they conducted all the surgeries. In reality many procedures were performed by unqualified residents and other caretakers and not who the patient was told would be performing the procedure.
> To make it seem as if the teaching physicians were present during the "entire" operation, they would lie on medical records, the court filings say. The medical staff also would not tell patients that the surgeon planned on leaving the room to perform another operation, the documents continued.
This only came out because of a whistleblower, and because the DOJ pursued it. It is nearly impossible for a patient to know if they are wronged or harmed this way because they are put under for these procedures, and because friends/family are typically not allowed to observe or record anything (likely to prevent accountability). And then there’s the cost of lawsuits, the stress, and limitations under law (like tort reform in Texas) - it’s just lucky that this was pursued by a government agency (DOJ).
> Under the False Claims Act, the private whistleblower who reported the allegations will receive over $3 million from the settlement, the Justice Department said.
We need more incentives like this, but we also need greater penalties and jail time for the practitioners and literally everyone who knew. They should be investigating who was in the room, what was recorded in logs, and who accessed records, and go after all of them. Right now, this settlement achieves nothing. Some articles claimed that these hospitals made more than $150 million off these procedures for which they are settling the lawsuit for just $15 million.
In Texas, three hospitals (Baylor St. Luke’s Medical Center (BSLMC), Baylor College of Medicine (BCM) and Surgical Associates of Texas P.A. (SAT)) agreed to pay $15m as part of a settlement with the DOJ. These doctors/surgeons were booked for multiple simultaneous procedures that they could not have possibly conducted, even though they recorded things to make it look like they conducted all the surgeries. In reality many procedures were performed by unqualified residents and other caretakers and not who the patient was told would be performing the procedure.
> To make it seem as if the teaching physicians were present during the "entire" operation, they would lie on medical records, the court filings say. The medical staff also would not tell patients that the surgeon planned on leaving the room to perform another operation, the documents continued.
This only came out because of a whistleblower, and because the DOJ pursued it. It is nearly impossible for a patient to know if they are wronged or harmed this way because they are put under for these procedures, and because friends/family are typically not allowed to observe or record anything (likely to prevent accountability). And then there’s the cost of lawsuits, the stress, and limitations under law (like tort reform in Texas) - it’s just lucky that this was pursued by a government agency (DOJ).
> Under the False Claims Act, the private whistleblower who reported the allegations will receive over $3 million from the settlement, the Justice Department said.
We need more incentives like this, but we also need greater penalties and jail time for the practitioners and literally everyone who knew. They should be investigating who was in the room, what was recorded in logs, and who accessed records, and go after all of them. Right now, this settlement achieves nothing. Some articles claimed that these hospitals made more than $150 million off these procedures for which they are settling the lawsuit for just $15 million.
Lack of accountability leads to outcomes. As a patient, you don't know your trust is being violated (in this specific scenario).
https://www.seattletimes.com/nation-world/texas-heart-surgeo...
https://www.justice.gov/usao-sdtx/pr/texas-medical-center-in...
https://www.seattletimes.com/nation-world/texas-heart-surgeo...
https://www.justice.gov/usao-sdtx/pr/texas-medical-center-in...
Texas also has "tort reform", limiting you to a maximum of $250k in damages. Good luck suing a big hospital for malpractice, you gotta pay the lawyer too out of that $250k.
I hope that limit only applies to punitive damages. For medical malpractice in the US, actual damages could easily exceed $250k.
The cap applies to actual damages, specifically non-economic actual damages such as pain and suffering, mental anguish, and loss of companionship. It does not apply to economic actual damages such as lost wages and medical costs.
Before tort reform punitive damages were already capped in Texas at a value twice the amount of economic damages plus the amount of non-economic damages, so tort reform does also have a effect of sometimes reducing punitive damages.
Before tort reform punitive damages were already capped in Texas at a value twice the amount of economic damages plus the amount of non-economic damages, so tort reform does also have a effect of sometimes reducing punitive damages.
> you gotta pay the lawyer too out of that $250k
On average, a medical malpractice case might require anywhere from 500 to 1,000 hours of legal work, with more complex cases potentially requiring over 2,000 hours.
Average lawyer cost in 2022 was $313/hr.
So we're basically looking at, generously, 750 hrs x $300, or $225k to the lawyer.
And that's just one side - the hospital presumably pays near the same.
... Huh.
Once again, I am stunned at the American legal system being so obviously and cartoonishly evil.
On average, a medical malpractice case might require anywhere from 500 to 1,000 hours of legal work, with more complex cases potentially requiring over 2,000 hours.
Average lawyer cost in 2022 was $313/hr.
So we're basically looking at, generously, 750 hrs x $300, or $225k to the lawyer.
And that's just one side - the hospital presumably pays near the same.
... Huh.
Once again, I am stunned at the American legal system being so obviously and cartoonishly evil.
The Texas legal system to be specific.
Texas is probably limiting malpractice suit damages because they are a significant contributor to our insane healthcare costs. The math above where a hospital is out a minimum of $200k for any suit that isn't thrown out is not restricted to Texas; this is a national issue with some Texas duck tape slapped on.
That’s a good argument for it that I didn’t think of. But I can’t help but think this was likely just some business friendly thing that was lobbied for under the misleading label of “reform”
It's an argument that hasn't borne out in practice.
Texas medical costs are lock-step with the lest of the country.
Texas malpractice rates are leading the country.
Texas medical costs are lock-step with the lest of the country.
Texas malpractice rates are leading the country.
They are more likely limiting malpractice suit damages because hospitals and clinics donate to political campaigns, but people hurt by medical malpractice don't.
The end result is that doctors are essentially lawsuit-proof (as the minimum cost of a suit exceeds the maximum possible recovery) in Texas, and you have no recourse if yours was at fault.
It's a beautiful system.
The end result is that doctors are essentially lawsuit-proof (as the minimum cost of a suit exceeds the maximum possible recovery) in Texas, and you have no recourse if yours was at fault.
It's a beautiful system.
It’s absolutely insane how many people don’t show up for doctors appointments, including surgery.
Dare I ask about "the skull flap thing"?
https://lawandcrime.com/lawsuit/lawsuit-claims-emory-lost-pa...
Basically they had to cut into someone’s skull as part of a surgery. They did not label and catalog skull parts properly. Because they lost the skull part they had to use a synthetic skull flap, and they charged the patient for it. The synthetic flap caused an infection. The patient was on the hook for something like $150K for all of this (the synthetic part, the procedure of placing it, the infection) which was due to the hospital’s own criminal negligence. An investigated showed that the hospital was not properly labeling and cataloging parts for many patients and basically had a mess of random skull parts that would not make their way back to all those patients, so it is a systemic issue and not just an unfortunate one off mistake. All of this is alleged and there is a lawsuit pending, but it seems to me like the part about a systemic issue of mishandled parts is confirmed.
Basically they had to cut into someone’s skull as part of a surgery. They did not label and catalog skull parts properly. Because they lost the skull part they had to use a synthetic skull flap, and they charged the patient for it. The synthetic flap caused an infection. The patient was on the hook for something like $150K for all of this (the synthetic part, the procedure of placing it, the infection) which was due to the hospital’s own criminal negligence. An investigated showed that the hospital was not properly labeling and cataloging parts for many patients and basically had a mess of random skull parts that would not make their way back to all those patients, so it is a systemic issue and not just an unfortunate one off mistake. All of this is alleged and there is a lawsuit pending, but it seems to me like the part about a systemic issue of mishandled parts is confirmed.
I hate when that happens:
Obligatory.
Lawyer: "Doctor, before you performed the autopsy, did you check for a pulse?"
Witness: "No."
Lawyer: "Did you check for blood pressure?"
Witness: "No."
Lawyer: "Did you check for breathing?"
Witness: "No."
Lawyer: "So, then it is possible that the patient was alive when you began the autopsy?"
Witness: "No."
Lawyer: "How can you be so sure, Doctor?"
Witness: "Because his brain was sitting on my desk in a jar."
Lawyer: "But could the patient have still been alive nevertheless?"
Witness: "Yes, it is possible that he could have been alive and practicing law somewhere."
Obligatory.
Lawyer: "Doctor, before you performed the autopsy, did you check for a pulse?"
Witness: "No."
Lawyer: "Did you check for blood pressure?"
Witness: "No."
Lawyer: "Did you check for breathing?"
Witness: "No."
Lawyer: "So, then it is possible that the patient was alive when you began the autopsy?"
Witness: "No."
Lawyer: "How can you be so sure, Doctor?"
Witness: "Because his brain was sitting on my desk in a jar."
Lawyer: "But could the patient have still been alive nevertheless?"
Witness: "Yes, it is possible that he could have been alive and practicing law somewhere."
I'm just imagining some refrigerator in the nurse's breakroom with a big fiesta bowl of what looks like odd tortilla chips with a Post-In note labeled "skull bits do not eat".
This is truly horrifying and also illustrates a massive incentive problem. The hospital probably made money through its negligence (until the inevitable lawsuit)
Sounds like material for the next Dr. Death season. The first two seasons were both pretty great.
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Personal story:
A couple of years ago I climbed Mt Whitney in California. One of the climbers that day was from the east coast and failed to show up for work a few days later. The family became concerned and called the car rental agency in Las Vegas where he flew to and rented his car. The agency said the car had been returned. After another day of him missing they called the car rental agency again to confirm and once again the agency said the car was in the lot. The next day the rangers found the car was still parked in the Mt Whitney parking lot and search and rescue was finally dispatched.
In this case I believe it didn't make a difference because the climber appeared to die from acute injury on the mountain the day of his climb but in another scenario maybe those 2 days would've been the difference between being rescued or dying from exposure.
A couple of years ago I climbed Mt Whitney in California. One of the climbers that day was from the east coast and failed to show up for work a few days later. The family became concerned and called the car rental agency in Las Vegas where he flew to and rented his car. The agency said the car had been returned. After another day of him missing they called the car rental agency again to confirm and once again the agency said the car was in the lot. The next day the rangers found the car was still parked in the Mt Whitney parking lot and search and rescue was finally dispatched.
In this case I believe it didn't make a difference because the climber appeared to die from acute injury on the mountain the day of his climb but in another scenario maybe those 2 days would've been the difference between being rescued or dying from exposure.
I recently faced a personal catastrophe because a low ranking clerical worker mixed up a form.
I’m not mad about it. I’m mad there’s no apology because the company insists they did nothing wrong.
Another company, the one reading the form, is responsible for services rendered in regards to the form. Clearly not the form-fillers fault.
I’m not mad about it. I’m mad there’s no apology because the company insists they did nothing wrong.
Another company, the one reading the form, is responsible for services rendered in regards to the form. Clearly not the form-fillers fault.
Oh so many systems take "pass the buck" to an insane level. My employer switched insurance providers recently. Twice we were referred to a specialist for one of my kids and each time it took about a week for the referral to be approved (apparently the PCP referring you isn't enough with this HMO).
The only thing that has changed is my HMO; the kids still have the same pediatrician with the same office staff for which referrals were never a problem in the past. However, the insurance company made sure to tell me that they are not the ones delaying it, because it's technically the administrative department of my pediatrician that has to do the referral review. The fact that insurance company mandates that the referral review must be performed by a licensed nurse and follow a byzantine process, of course, has nothing to do with the delay.
The only thing that has changed is my HMO; the kids still have the same pediatrician with the same office staff for which referrals were never a problem in the past. However, the insurance company made sure to tell me that they are not the ones delaying it, because it's technically the administrative department of my pediatrician that has to do the referral review. The fact that insurance company mandates that the referral review must be performed by a licensed nurse and follow a byzantine process, of course, has nothing to do with the delay.
I read the headline expecting that it was a simple misunderstanding or clerical error, with limited impact to within 24 hours.
The article is so much worse and the headline buries the lede. I would be horrified. My condolences to the family.
The article is so much worse and the headline buries the lede. I would be horrified. My condolences to the family.
Completely agree. I can't imagine being lead on a wild goose chase looking for a loved one only to be told by police that said party lied to me. I guess there's a lesson here: talk with nurses. I'm sure some would toe the line but if something smells fishy, I'm sure someone will crack. Then again, maybe only one nurse would know the truth so it's may not be easy.
It's worse than that, it's like burying a double or even triple lede:
- it's not just that the hospital told her family totally the wrong thing for a day or a year...
- or even negligently cremated or buried her in a pauper's grave...
- but they also mishandled the corpse, which IIUC is a misdemeanor (corpse desecration, which is a felony, might not apply), by shipping her decomposing body to an off-site warehouse morgue.
- and failing to timely issue a death certificate or do an autopsy prevents determining whether there had been medical malpractice associated with her death.
- it's not just that the hospital told her family totally the wrong thing for a day or a year...
- or even negligently cremated or buried her in a pauper's grave...
- but they also mishandled the corpse, which IIUC is a misdemeanor (corpse desecration, which is a felony, might not apply), by shipping her decomposing body to an off-site warehouse morgue.
- and failing to timely issue a death certificate or do an autopsy prevents determining whether there had been medical malpractice associated with her death.
and they didn't even know she was dead - the death certificate was not completed until her body had been rotting in their facility for a year.
Crazy. I wonder if they made a mistake, somehow killing her, but thought she was indigent or mentally ill, and that's why they did all this. Then again, it sounds like she was treated many times by this hospital. I cannot fathom the circumstances where the actions after her death could have been a simple mistake, but they've had 16 months to come up with a story and destroy all the evidence, so we may never know the truth.
Honestly, this was the first thought I had when I read the article. I worked in this space for several years and interacted with many doctors - just like in any other professional industry, some people have stellar reputations that precede them, while a few are infamous for their malpractice and unethical behavior. The perverse incentive arises when a hospital has a publicized malpractice lawsuit or criminal investigation - everyone who works at that for-profit medical institution has an incentive to protect its reputation (i.e. its profitability). This has allowed "angel of death" doctors/nurses to kill hundreds of people over the years, since there isn't much incentive to dig too deeply into "excess mortality" statistics (a famous example being Harold Shipman who could have easily been detected 2 years and over 100 victims earlier).
Covering up a case of medical malpractice by surreptitiously filling out discharge paperwork is certainly possible. A surprisingly large component of healthcare processes is to blindly trust that doctors are manually entering information truthfully and accurately. The fact that they couldn't locate her body for an entire year strongly suggests a criminal conspiracy to hide the body.
Covering up a case of medical malpractice by surreptitiously filling out discharge paperwork is certainly possible. A surprisingly large component of healthcare processes is to blindly trust that doctors are manually entering information truthfully and accurately. The fact that they couldn't locate her body for an entire year strongly suggests a criminal conspiracy to hide the body.
As a victim of medical malpractice, it's terrifying to me that someone could have killed me to cover it up.
I'm glad we pay for the most expensive medical care in the world in the US. That's what keeps the quality so high.
Sorry but I think you pay for the most expensive _doctors_ in the world...
It would seem that the actual care you receive is only remotely related to that.
It would seem that the actual care you receive is only remotely related to that.
The comment you’re replying to was sarcastic, I think they probably strongly agree with you.
(Not your fault not to notice though, sarcasm can be very subtle)
(Not your fault not to notice though, sarcasm can be very subtle)
It should have /s I guess, however, I am not native English and could not read that differently than /s.
This is very sad. My condolences to the family.
Reading the timeline, I can’t help but speculate that there’s a darker side to this.
Two days before “checking out”, the daughter called the mom to say she was better and was about to leave. Soon after that, something bad happens (possibly malpractice) and she dies. An autopsy would reveal the true cause of death, so the hospital quietly ships her to an off-site morgue, doesn’t even fill a death certificate, and fabricates her checking out.
Now the body is beyond decomposed and an autopsy is impossible. The hospital claims it was a simple mix-up and gets away with a bit of bad press and a negligence charge.
Two days before “checking out”, the daughter called the mom to say she was better and was about to leave. Soon after that, something bad happens (possibly malpractice) and she dies. An autopsy would reveal the true cause of death, so the hospital quietly ships her to an off-site morgue, doesn’t even fill a death certificate, and fabricates her checking out.
Now the body is beyond decomposed and an autopsy is impossible. The hospital claims it was a simple mix-up and gets away with a bit of bad press and a negligence charge.
I was reading something recently about pleading the fifth, (like if someone at the hospital was called to testify), I read that in criminal cases, pleading the fifth could not be used against the defendant. However in civil cases, jurors are instructed to assume their refusal to testify would implicate their guilt. I didn’t verify what I read, so take it with a grain of salt.
"Dignity Health, which operates Mercy San Juan..."
It appears they need a name change after this lawsuit
It appears they need a name change after this lawsuit
As usual when entities have these noble names, they don’t mean your or my dignity.
Low quality places have the most absurd names in this country. For example, there is a trailer park nearby with a "Manor Lane". At least they put it by "Shady Lane" to balance expectations.
Sanatoriums, asylums, mental institutes, and retirement homes… all called Mount Pleasant.
M'unpleasant.
any apartment complex that advertises 'luxury' is by definition not.
Blind date with the chancer
We had oysters and dry lancers
And the check when it arrived we went dutch, dutch, dutch, dutch
A redder shade of neck on a whiter shade of trash
And this emory board is giving me a rash
I'm flat out
You're so beautiful to look at when you cry
Freeze, don't move
You've been chosen as an extra in the movie adaptation of the sequel to your life
We had oysters and dry lancers
And the check when it arrived we went dutch, dutch, dutch, dutch
A redder shade of neck on a whiter shade of trash
And this emory board is giving me a rash
I'm flat out
You're so beautiful to look at when you cry
Freeze, don't move
You've been chosen as an extra in the movie adaptation of the sequel to your life
Dignity health is god awful. I've never had a good experience with them.
The "in" in "indignity" is silent.
I wonder if it's possible that she checked herself out but immediately died outside the hospital which would explain why the paper work was in order. I would not explain why after being ID'd, why family wasn't informed or how she was placed into offsite storage facility. Gross incompetence and criminal negligence. I hope the family gets the 5x the jury award as requested. Didn't know you could even do that.
> I wonder if it's possible that she checked herself out but immediately died outside the hospital
I find that really unlikely.
I mean, for starters, they had her body and knew it was her body in storage. That doesn't happen if they don't have IDs attached to the corpse. I find it unlikely that the hospital wouldn't be ringing the family like crazy because of a body they want to unload. Especially if they have the paperwork showing that she'd checked out. There'd be no reason not to almost immediately say "Hey, actually, we found her right outside the hospital dead, sorry for your loss".
I'm guessing an obvious fuck up killed her like 10xing her insulin dosage by mistake. Or administering something other than insulin.
And it wouldn't surprise me if, conveniently, 17 or 24 months just happens to be the retention policy for medical records.
I find that really unlikely.
I mean, for starters, they had her body and knew it was her body in storage. That doesn't happen if they don't have IDs attached to the corpse. I find it unlikely that the hospital wouldn't be ringing the family like crazy because of a body they want to unload. Especially if they have the paperwork showing that she'd checked out. There'd be no reason not to almost immediately say "Hey, actually, we found her right outside the hospital dead, sorry for your loss".
I'm guessing an obvious fuck up killed her like 10xing her insulin dosage by mistake. Or administering something other than insulin.
And it wouldn't surprise me if, conveniently, 17 or 24 months just happens to be the retention policy for medical records.
> And it wouldn't surprise me if, conveniently, 17 or 24 months just happens to be the retention policy for medical records.
This was in California, where the law [0] is 7 years minimum, potentially more if the patient was a minor.
AFAICT every state wants at least ~5 years of retention.
[0] https://www.law.cornell.edu/regulations/california/22-CCR-72...
This was in California, where the law [0] is 7 years minimum, potentially more if the patient was a minor.
AFAICT every state wants at least ~5 years of retention.
[0] https://www.law.cornell.edu/regulations/california/22-CCR-72...
Or they needed to keep the body long enough that any evidence of malpractice could be hidden.
Like she died and the medical examiner took her directly? It doesn't sound like it from this: "The 31-year-old died in the care of Mercy San Juan medical center in Sacramento in April 2023. The hospital shipped her body to a storage facility"
I hear you but they also say that she signed herself out. That means she signed a waiver.
Perhaps someone signed a waiver. Based on the rest of the story I don’t think we can assume they are telling the truth without any evidence here.
Completely agree. It's the sort of case that their should be jail time, just not financial consequences.
Jail time in a system where responsibility is so diffused won't happen.
Front-desk has a signed waiver? Good luck proving that it was the person on shift at the time who forged it, she doesn't remember what happened a year ago, and the existence of the fraudulent waiver isn't proof that she authored it.
Nobody's responsible, and nobody's accountable. There's a legal requirement that someone at the hospital should have done their jobs, but there's no legal requirement that forces someone particular to do them.
Front-desk has a signed waiver? Good luck proving that it was the person on shift at the time who forged it, she doesn't remember what happened a year ago, and the existence of the fraudulent waiver isn't proof that she authored it.
Nobody's responsible, and nobody's accountable. There's a legal requirement that someone at the hospital should have done their jobs, but there's no legal requirement that forces someone particular to do them.
I think that would have been figured out. However, I see another scenario:
She checks herself out (given that she called about leaving I find it reasonable to think she might have), goes to the bathroom and arrests in a stall but is not discovered for a while.
The family is looking for her, the hospital correctly notes that she had checked herself out. Eventually her body is found. She's not a patient since she checked herself out. Somehow it fell through the cracks about notifying her family, or perhaps she didn't have ID on her and the body was sent as a Jane Doe.
She checks herself out (given that she called about leaving I find it reasonable to think she might have), goes to the bathroom and arrests in a stall but is not discovered for a while.
The family is looking for her, the hospital correctly notes that she had checked herself out. Eventually her body is found. She's not a patient since she checked herself out. Somehow it fell through the cracks about notifying her family, or perhaps she didn't have ID on her and the body was sent as a Jane Doe.
>Mercy San Juan hospital failed in its most fundamental duty to notify Jessie’s family of her death
Despite the misconduct, I think saving people's lives is the most fundamental duty of a hospital.
Despite the misconduct, I think saving people's lives is the most fundamental duty of a hospital.
You are interpreting “fundamental” as ‘highest priority’, which is not the only, (or most commonly expressed) definition of the word.
Fundamental is also defined as “so basic as to be hard to alter, resolve, or overcome.”
I would argue that ‘saving lives’ is not a ‘basic’ process; it is complex. However, informing someone’s next-of-kin of their passing, is a basic (ie fundamental) role of a healthcare facility.
Fundamental is also defined as “so basic as to be hard to alter, resolve, or overcome.”
I would argue that ‘saving lives’ is not a ‘basic’ process; it is complex. However, informing someone’s next-of-kin of their passing, is a basic (ie fundamental) role of a healthcare facility.
There can be multiple most fundamental duties: https://proofwiki.org/wiki/Maximal_Element_need_not_be_Uniqu...
Look, that's a great proof and all but it has nothing to do with the situation at hand. Just because mathematics say there can be two maximal elements doesn't mean morality agrees - and this is the domain of morality, not mathematics.
I disagree. When you say “I just had the most exhilarating experience”, that doesn’t mean that there can only be a single most exhilarating experience. And, independent of that, morality also doesn’t imply that there can be only one most fundamental duty.
Ridiculous. Stop playing pointless language games.
But it says "its" not "one of its", that suggests only one maximum.
That doesn’t follow. “John failed in his duty to regularly check the logs” doesn’t imply that John can’t simultaneously have had any other duties. You have to parse it as “its (most fundamental duty to notify Jessie’s family of her death)”, not as “(its most fundamental duty) to (notify Jessie’s family of her death)”, so to speak.
This is one of those things where people think that because they learned something in set theory 101 or intro to computers that it maps perfectly to real life situations.
Ok, let me translate it into non-math for you - there can be a goal that is a "highest priority" for the organisation in the sense that no other goal is a higher priority, and yet there are other goals for the organization that are equal to it in priority.
Isn't "a Maximal Element need not be Unique" a more elegant and much more succinct way of saying the same thing?
Isn't "a Maximal Element need not be Unique" a more elegant and much more succinct way of saying the same thing?
Yeah: “we failed at our one job” should have been IMMEDIATELY expressed to the family.
If this happened in any of the majour european countries we would have that news in the headlines of newspapers and newscasts for several days.
How come that is not the same in the US even more so given that the health sector is mostly privatized and therefore "should be" more efficient ( when in fact is clear that it is a complete failure compared to European standards) ? .
I think it is worth pointing out that many European health systems do have strong private elements (e.g. most of them pay pharma companies for making medicine) and NHS in the UK as a goverment focused health system is still quiet bad compared to other European countries.
But to your original question: As you are hanging around these website, I notice (and you too maybe), that even the most educated Americans have an "only American" world view. They consider it is the best country in the world anyway and don't care about other parts of the world.
In German news on German problems (e.g. Digitalisation) journalist sometimes point other countries as a positive example or role model (here Estonia or rarely Ukraine). On American problems it does not happen and we (as a I assume you live on my site of the Atlantic) just nodding our head why it does not change. It would need to change a deeply entrenced attitude. On this discussion page here they dont discuss how other countries do it. Not a single example how to make it better. Because the US is on the top of the hill anyway.
But to your original question: As you are hanging around these website, I notice (and you too maybe), that even the most educated Americans have an "only American" world view. They consider it is the best country in the world anyway and don't care about other parts of the world.
In German news on German problems (e.g. Digitalisation) journalist sometimes point other countries as a positive example or role model (here Estonia or rarely Ukraine). On American problems it does not happen and we (as a I assume you live on my site of the Atlantic) just nodding our head why it does not change. It would need to change a deeply entrenced attitude. On this discussion page here they dont discuss how other countries do it. Not a single example how to make it better. Because the US is on the top of the hill anyway.
I am an American and have lived most of my life in the US, but I have lived overseas for the last 12 years.
My experience is that Americans are very insular and do not know much about other countries because American-owned new media focuses on US stories, most major social media sites are American-owned and overwhelmingly populated with other Americans, etc.
Americans are insulated simply because the information sectors they have access to are dominated by American businesses. Hell, even the Internet itself is American. (This is the same reason that non-American countries are also overwhelmed by American issues/news/culture.)
It is not because Americans think they are superior, and it does not cause Americans to think they are superior. Degree of insulation and sense of superiority are independent variables, and Americans (especially middle-aged and younger) are actually quite low on the sense-of-superiority scale — certainly way, way lower than most Europeans in my experience. (This is not intended as a slight against Europeans; you have very good reasons to prefer Europe to the US.)
Every American I know has serious complaints about the US and is acutely aware that other countries leave the US in the dust in several of areas, including (though certainly not limited to) healthcare. There are of course some nationalist extremists out there who will argue otherwise, and they can be especially noisy on the internet because that is the nature of extremists, but these are not the average people you meet walking down an American street.
Most Americans may not know the ins and outs of other countries' healthcare systems, and therefore may not speak in any detail about those systems on American media sites like this one, but that isn't because they think theirs is the best. They may not ponder the ways that Estonia or Germany has the better healthcare system, but that's because they would be over the moon for anything half as good as either of them.
The USA's political flaws unfortunately run very deep and are in no way the fault of the modern American people. The US Constitution is a very old, very hard-to-change document that was designed primarily to make the US government as stable as possible — at the cost of responsiveness to democratic will.
Basically all of the genuine democracies (I am not talking about dictatorships that larp as democracies) created after American democracy were designed to correct the flaws of the US Constitution: the first-past-the-post voting system, the extreme difficulty of adding amendments, etc. That's why they have nice things.
My experience is that Americans are very insular and do not know much about other countries because American-owned new media focuses on US stories, most major social media sites are American-owned and overwhelmingly populated with other Americans, etc.
Americans are insulated simply because the information sectors they have access to are dominated by American businesses. Hell, even the Internet itself is American. (This is the same reason that non-American countries are also overwhelmed by American issues/news/culture.)
It is not because Americans think they are superior, and it does not cause Americans to think they are superior. Degree of insulation and sense of superiority are independent variables, and Americans (especially middle-aged and younger) are actually quite low on the sense-of-superiority scale — certainly way, way lower than most Europeans in my experience. (This is not intended as a slight against Europeans; you have very good reasons to prefer Europe to the US.)
Every American I know has serious complaints about the US and is acutely aware that other countries leave the US in the dust in several of areas, including (though certainly not limited to) healthcare. There are of course some nationalist extremists out there who will argue otherwise, and they can be especially noisy on the internet because that is the nature of extremists, but these are not the average people you meet walking down an American street.
Most Americans may not know the ins and outs of other countries' healthcare systems, and therefore may not speak in any detail about those systems on American media sites like this one, but that isn't because they think theirs is the best. They may not ponder the ways that Estonia or Germany has the better healthcare system, but that's because they would be over the moon for anything half as good as either of them.
The USA's political flaws unfortunately run very deep and are in no way the fault of the modern American people. The US Constitution is a very old, very hard-to-change document that was designed primarily to make the US government as stable as possible — at the cost of responsiveness to democratic will.
Basically all of the genuine democracies (I am not talking about dictatorships that larp as democracies) created after American democracy were designed to correct the flaws of the US Constitution: the first-past-the-post voting system, the extreme difficulty of adding amendments, etc. That's why they have nice things.
This might sound silly, but technically speaking how does this kind of notification work in relation to HIPAA? Is there some kind of a carve out that allows hospitals to tell your family you've "been discharged against medical advice"? How does next of kin notification work for death?
To put it another way, clearly the outcome in this story was unacceptable, but what was the correct outcome?
To put it another way, clearly the outcome in this story was unacceptable, but what was the correct outcome?
You're conflating information privacy guidelines (i.e. HIPAA) with next-of-kin reporting which is usually specified by state law. If you check out the probate process which distributes an estate after death, it can vary considerably from state to state and has a lot more judicial involvement. HIPAA is not an enforced statute or law, it's a set of civil rights guidelines which allow hefty fines to be levied by OCR (Office of Civil Rights) when a violation is reported and investigated.
HIPAA does specifically allow for the sharing of PHI with family and friends of a with substantial leeway given to medical professionals to document their reasoning for sharing information if it is "in the patient's best interest". In the hypothetical scenario where concerned family/friends are inquiring about a discharge, it would be perfectly acceptable to share certain details of the discharge if the healthcare provider is willing to document and possibly defend their decision.
In this case, not reporting to next of kin was certainly not in the patient's best interest and a prima facie case of misconduct. As someone who sat at the intersection of health and law for several years, I can't see any possible legal justification or loophole for the hospital to avoid a hefty settlement. As some of the other comments on this thread suggest, this shocking oversight may not be an isolated case, so a hefty monetary penalty is the only realistic way to force the other for-profit health systems of America to implement better processes for this.
HIPAA does specifically allow for the sharing of PHI with family and friends of a with substantial leeway given to medical professionals to document their reasoning for sharing information if it is "in the patient's best interest". In the hypothetical scenario where concerned family/friends are inquiring about a discharge, it would be perfectly acceptable to share certain details of the discharge if the healthcare provider is willing to document and possibly defend their decision.
In this case, not reporting to next of kin was certainly not in the patient's best interest and a prima facie case of misconduct. As someone who sat at the intersection of health and law for several years, I can't see any possible legal justification or loophole for the hospital to avoid a hefty settlement. As some of the other comments on this thread suggest, this shocking oversight may not be an isolated case, so a hefty monetary penalty is the only realistic way to force the other for-profit health systems of America to implement better processes for this.
I see, that makes sense, thanks!
So, after the patient died, what is the mechanism by which the family should have been contacted?
Later, if that failed and the family came to ask the hospital, the correct answer was "they're dead", not "we can't tell you" (and especially not "they were discharged against medical advice"!). How does the hospital authenticate and authorize the inquiry party?
Edit: also, is being dead PHI?
So, after the patient died, what is the mechanism by which the family should have been contacted?
Later, if that failed and the family came to ask the hospital, the correct answer was "they're dead", not "we can't tell you" (and especially not "they were discharged against medical advice"!). How does the hospital authenticate and authorize the inquiry party?
Edit: also, is being dead PHI?
If a hospital becomes aware of a death, they need to let the medical examiner know. In turn, they or the medical examiner issues a death certificate, etc.
You can't just truck the body off to storage and then forget about it.
You can't just truck the body off to storage and then forget about it.
Death certificates can be shared with parents, siblings, and children of the deceased in every state; and most states they are public records that everyone can access.
Obviously the death certificate here was quite delayed, but this shows that generally the fact of death is something that can be shared with those suing.
Obviously the death certificate here was quite delayed, but this shows that generally the fact of death is something that can be shared with those suing.
I recently had an opportunity to learn something about software used in hospitals and it was a shock. Are you laughing about the JS or web developer meme as a symbol for clueless people? Well, I need to tell you that every JS or web dev is a code guru compared to the guys I have seen in medical / hospital software.
While your web dev has a very good idea about infrastructure and code maintenance these guys are usually clueless about CI, git, secrets management etc. but still they now all want to migrate their stuff to azure, because it’s cool… to say the truth I didn’t understand the reason why they want to. People that are basically relying on Microsoft wizard based development.
Shocking was that this was not only some bureaucracy software, but systems that are used for actual operations and patient management.
I guess that many people died already because windows developers but nobody did a systematic investigation so we don’t know.
While your web dev has a very good idea about infrastructure and code maintenance these guys are usually clueless about CI, git, secrets management etc. but still they now all want to migrate their stuff to azure, because it’s cool… to say the truth I didn’t understand the reason why they want to. People that are basically relying on Microsoft wizard based development.
Shocking was that this was not only some bureaucracy software, but systems that are used for actual operations and patient management.
I guess that many people died already because windows developers but nobody did a systematic investigation so we don’t know.
I can’t be the only person that thought about the Arrested Development ‘literal doctor’ [1] when reading the headline?
[1] https://youtu.be/0BUBd9dQvtY
[1] https://youtu.be/0BUBd9dQvtY
> according to a civil lawsuit against the hospital.
Shouldn't this be a criminal case?
Shouldn't this be a criminal case?
Only if the likelihood of guilt is beyond a reasonable doubt, which the DA may not want to try. In civil suits the bar is lower as it's only a requirement for a preponderance of evidence.
Odds are the hospital will settle this out of court for an undisclosed sum because they can't realistically have their records on the matter brought to light. Was it medical malpractice?! We'll never know.
Odds are the hospital will settle this out of court for an undisclosed sum because they can't realistically have their records on the matter brought to light. Was it medical malpractice?! We'll never know.
>Odds are the hospital will settle this out of court for an undisclosed sum because they can't realistically have their records on the matter brought to light
IMO it should not be legally possible to settle something this dire out of court. You shouldn't be able to bury anything simply by paying a large sum.
IMO it should not be legally possible to settle something this dire out of court. You shouldn't be able to bury anything simply by paying a large sum.
I think those are orthogonal. If I wrong you I can be brought up on criminal charges, and independently, you can sue for damages.
Only if a prosecutor wants it to be.
What specific criminal laws are you suggesting were broken?
Obviously a lot of crap happened here but there's not a legal obligation to be helpful to next-of-kin. Suing for vague "damages" is going to be far more productive.
Obviously a lot of crap happened here but there's not a legal obligation to be helpful to next-of-kin. Suing for vague "damages" is going to be far more productive.
Taking her remains without the knowledge and consent of her next of kin is surely illegal. If I put a corpse in a warehouse for a year while the family was begging me to tell them where their loved one was, I would expect to face criminal negligence charges at the least.
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My neighbor, who has bipolar mania, was in the hospital for a 72-hour hold. She wanted to leave, naturally, and a "patient advocate" made it happen "against the doctor's orders." So I'm trying to figure out how the choices of someone who cannot soundly judge their own condition take priority over that of the doctor in charge of them.
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My classmate from nursing school is an RN at that hospital, I'm not surprised.
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I hope they get awarded 100x what they’re asking for.
It says she was taken in due to a diabetic episode.
What on earth is that? Hypo/hyperglycaemia? You'd have to have extremely poorly managed type 1 diabetes for that to become fatal without a massive screwup at that age.
What on earth is that? Hypo/hyperglycaemia? You'd have to have extremely poorly managed type 1 diabetes for that to become fatal without a massive screwup at that age.
this sounds very close to victim blaming in a country where insulin is not considered a human right, let alone the fact that many people in America only effectively have access to human insulin instead of analogs with higher efficacy and shorter absorption time. also people can develop t1d well into adulthood. we don’t have any information about this persons life nor should we need any.
this event is just one more reason i’m terrified to be diabetic in this country.
honestly the way you posed this question is awful and I invite you to reconsider your intent. hopefully the benefit of my doubt is not misplaced.
this event is just one more reason i’m terrified to be diabetic in this country.
honestly the way you posed this question is awful and I invite you to reconsider your intent. hopefully the benefit of my doubt is not misplaced.
I had a cousin who voluntarily checked himself into the hospital related to severe withdrawal symptoms (and had bouts of psychosis related to said with withdrawal - meth addictions are nasty). His mother stayed for awhile but had to leave for work. She was repeatedly guaranteed by multiple doctors and nurses that he could not check himself out and would be there for several days at least. They told her to come back the next morning.
Late that night, he was discharged. Not even "he checked himself out". The hospital discharged him (and that's over an hour ride away from home, btw - no hospitals in rural areas these days).
He had no phone and no wallet. According to staff, he tried to call his mother to pick him up, but couldn't remember her cell phone number (it had changed recently). He called his sister and left a message, but she was traveling and didn't get it until much later. According to the hospital, he tried to call several different numbers trying to get a ride home and they made him stop and made him leave. In a quite rough downtown area he was not familiar with. While clearly not in his right mind. At 2am. With no wallet, no phone, no nothing.
The hospital had his mother's contact info. They did not give it to him even when he requested it. They did not attempt to contact her in any way.
We still don't know what happened afterwards. His body was found four days later in the river and it had been there for awhile.
Forcibly discharging someone under those circumstances and refusing to even contact their emergency contacts is beyond belief. I'm furious about it. Apparently it's common and not even something there's any recourse for.