Parents Break Teen Out of Mayo Clinic(minnesota.cbslocal.com)
minnesota.cbslocal.com
Parents Break Teen Out of Mayo Clinic
https://minnesota.cbslocal.com/2018/08/13/teenager-escape-mayo-clinic/
179 comments
Note that due to medical privacy law we can't hear the hospital's side of this. There may be something there and it's not unheard of for the parents to also be weird and controlling.
> financially benefits from that control
Yeah, this is a more fundamental problem with for-profit hospitals - money gets involved in treatment decisions.
> financially benefits from that control
Yeah, this is a more fundamental problem with for-profit hospitals - money gets involved in treatment decisions.
The patient signed a release form, but the hospital still refused to answer the claims.
“Alyssa signed the form, but Plumbo declined to answer CNN's questions on the record.” https://amp.cnn.com/cnn/2018/08/13/health/mayo-clinic-escape...
“Alyssa signed the form, but Plumbo declined to answer CNN's questions on the record.” https://amp.cnn.com/cnn/2018/08/13/health/mayo-clinic-escape...
Yep. That is pretty damning in my opinion.
I've seen this too, but I've found ego is much more of a problem. I've seen doctors get locked into a course of action and get fixated on it. At that point, facts don't matter. They HAVE to be right. The other staff fall into line, because they have an ongoing work relationship, and only a transient connection to the patient.
It's good that at least for now there is still choice in facilities in our country. This would have been a much different outcome otherwise.
It's good that at least for now there is still choice in facilities in our country. This would have been a much different outcome otherwise.
In another thread on long hospital shifts, commenters made the point that the detrimental effect of subtle information lost during a shift change often outweighs the effect of sleep loss during a long shift, when looking at patient outcomes.
I wouldn't be surprised if doctors here were gaming the rules because they knew a transfer would cause more harm than good.
On one hand, it's bad to disregard patient autonomy and legitimate guardianship, especially in such an extreme way.
On the other hand, if I was a professional convinced that not doing so would be likely to cause the death of a patient, I can't tell you for sure that I wouldn't do the same thing. The Hippocratic Oath does not say "First, follow the law; Second, do no harm".
I wouldn't be surprised if doctors here were gaming the rules because they knew a transfer would cause more harm than good.
On one hand, it's bad to disregard patient autonomy and legitimate guardianship, especially in such an extreme way.
On the other hand, if I was a professional convinced that not doing so would be likely to cause the death of a patient, I can't tell you for sure that I wouldn't do the same thing. The Hippocratic Oath does not say "First, follow the law; Second, do no harm".
>In another thread on long hospital shifts, commenters made the point that the detrimental effect of subtle information lost during a shift change often outweighs the effect of sleep loss during a long shift, when looking at patient outcomes.
>I wouldn't be surprised if doctors here were gaming the rules because they knew a transfer would cause more harm than good.
Well then they could have told the family that was their line of reasoning for not wanting the transfer. If they had a defensible reason they would have worked that angle before using the system to try to make an end run around the patient's/family's wishes.
>I wouldn't be surprised if doctors here were gaming the rules because they knew a transfer would cause more harm than good.
Well then they could have told the family that was their line of reasoning for not wanting the transfer. If they had a defensible reason they would have worked that angle before using the system to try to make an end run around the patient's/family's wishes.
Hospitals in the UK have for the last few years been receiving training to counter this, based on the lessons learnt by the airline industry - Cockpit Management. This was set in motion by an airline pilot whose daughter died in a hospital because of a mistake made by a senior surgeon who wouldn't listen to the junior staff who had noticed it. The tl;dr of it is that saying "Stop, I think you are making a mistake" is an effective way for junior staff to get senior staff to pay attention, and can save lives.
I'm not sure it's entirely solved.
Anecdote: I had whooping cough a few years ago, unbeknownst to me, during a national whooping cough epidemic, where the NHS had put out a bulletin telling doctors to look out for whooping cough.
During this time I had fits where I wouldn't be able to call an ambulance because of the shaking. I also could have potentially killed infants I came into contact with.
Both the NHS and private doctor ignored the possibility of me having the disease - my partner's mother, a registered nurse, even suggested I ask them to look for it - simply because they didn't think of it when they first arrived.
And of course both the private and NHS doctors arrived late, don't apologise, and insist I call them by their title rather than their name.
My general feeling of the medical industry in the UK is that it has more respect for formality than professionalism.
Anecdote: I had whooping cough a few years ago, unbeknownst to me, during a national whooping cough epidemic, where the NHS had put out a bulletin telling doctors to look out for whooping cough.
During this time I had fits where I wouldn't be able to call an ambulance because of the shaking. I also could have potentially killed infants I came into contact with.
Both the NHS and private doctor ignored the possibility of me having the disease - my partner's mother, a registered nurse, even suggested I ask them to look for it - simply because they didn't think of it when they first arrived.
And of course both the private and NHS doctors arrived late, don't apologise, and insist I call them by their title rather than their name.
My general feeling of the medical industry in the UK is that it has more respect for formality than professionalism.
> Yeah, this is a more fundamental problem with for-profit hospitals - money gets involved in treatment decisions.
Mayo is not for-profit.
Mayo is not for-profit.
With 63,000 employeess, annual revenues & total assets in the double digit billions, and a couple billion in liquid cash... they’re a very profitable not for-profit.
Everything in the USA is for-profit.. It is only a scale of how much.
> credit goes to a couple judges who denied the Mayo clinic's requests
Also to the police, who refused to pursue the "abduction" once it was clear that the patient was being taken care of at another hospital.
Also to the police, who refused to pursue the "abduction" once it was clear that the patient was being taken care of at another hospital.
The patient should not need to be checked into another hospital in order for the police to assist the patient and her family, if only because the reason they cannot check into another hospital is that the patient is being illegally detained. To the contrary, the police should be the ones telling the hospital that it's illegal for them to detain the patient, and then assisting the patient in leaving without interference by the hospital staff.
The police chased the victim instead of the perpetrator believing the hospital despite the hospital's obvious lies. Yes, it's amazing they did finally stop but giving them credit for chasing a sick girl to another state is preposterous.
> The police chased the victim instead of the perpetrator believing the hospital despite the hospital's obvious lies.
They were told it was a medical emergency, and they had no information to contradict that. (Yes, obviously the parents said it wasn't, but the parents aren't trained medical professionals). Once they got conflicting information, they could back out of the matter—and did so.
They were told it was a medical emergency, and they had no information to contradict that. (Yes, obviously the parents said it wasn't, but the parents aren't trained medical professionals). Once they got conflicting information, they could back out of the matter—and did so.
Credit, really? For pursuing the only sane course of action after all others have been played out?
Buy US policing standards I'd call that a resounding success story
This. If they had had the bad luck of being pulled over on their way to SD it could have easily escalated into an OJ style chase and that could end well or it could have ended very badly.
On the flip side, we have thousands of obviously mentally ill people on the street homeless because we can't commit them because of that human autonomy that you mention.
It all points to public healthcare where there is governance at a political level and not profit level.
It all points to public healthcare where there is governance at a political level and not profit level.
It's unconscionable to suggest that hospitals be allowed to legally kidnap people because of something as hand wavy as 'some homeless are mentally ill'.
This is a complicated issue. I've seen this happen in practice. As long as the process remains conservative and respectful of the patient, it results in better outcomes for the patient and a more peaceful society.
The cases where I have seen this happen: schizophrenia, drug-induced psychosis, acute mania, dementia.
Patients come out far better in an institutionalized setting, as opposed to being on the streets and walking aimlessly in dangerous traffic.
The cases where I have seen this happen: schizophrenia, drug-induced psychosis, acute mania, dementia.
Patients come out far better in an institutionalized setting, as opposed to being on the streets and walking aimlessly in dangerous traffic.
Having experienced this: I think the word "conservative" doesn't quite capture the severity of detaining someone for mental health reasons. It has been argued that when someone is detained on mental health grounds, this is equivalent to a breach or suspension of the social contract in respect of that person. It is extremely unsatisfactory, though it might be a least bad option.
Outcomes might be better than if there was no intervention, but that doesn't necessarily imply that mental health services are effectively doing anything more than providing "protective custody".
Outcomes might be better than if there was no intervention, but that doesn't necessarily imply that mental health services are effectively doing anything more than providing "protective custody".
There's a huge, gigantic, gaping chasm between a hospital patient with no history of mental illness with two parents, neither of which have a history of mental illness, and a schizophrenic homeless person. Saying one has anything to do with the other to justify a hospital kidnapping its own patients is seriously messed up.
I was referring to your reply to outside1234's comment. His answer was in the scope of the "obviously mentally ill" population. And I addressed your reply to that.
It is incorrect to take my response outside of its intended context and attempt to attack it there.
It is incorrect to take my response outside of its intended context and attempt to attack it there.
lylecubed(1)
Reagan’s LPS Act didn’t apply any nuance, common-sense or transition when defunding JFK’s community treatment program, and just dumped people whom aren’t in contact with reality or self-care onto the street. Complete lawlessness is infinite tyranny.
https://www.nytimes.com/1984/10/30/science/how-release-of-me...
Also, O’Conner vs. Donaldson was the key case that caused a significant shift in mental health treatment.
Blaming Reagan is intellectually lazy.
Also, O’Conner vs. Donaldson was the key case that caused a significant shift in mental health treatment.
Blaming Reagan is intellectually lazy.
[deleted]
Committing someone to enforced treatment is an absolutely massive action. In the UK, it requires a police officer, doctor, and social worker to all agree that it is necessary.
It doesn't require police.
There are different forms of detention, and different forms of forced treatment.
These are described (for England) in the Mental Health Act.
This is what it means to be sectioned - you are detained under section of the mental health act.
The most common sections are:
Section 136: a police officer can detain you in a public place and take you to a place of safety to be assessed. This requires one police officer. It lasts a maximum of 24 hours (but it can be extended by 12 hours).
Section 2: this is a short 28 day hold for assessment and treatment. It requires 2 doctors and an AMHP. Traditionally AMHPs were social workers, but they don't have to be and there are increasing numbers of nurses becoming AMHPs.
Section 3: this is a six month hold for treatment. It requires 2 doctors and an AMHP.
Section 4 is another short term hold (72 hours) that can be used in emergencies if there's only 1 doctor available.
https://www.rethink.org/living-with-mental-illness/mental-he...
There are different forms of detention, and different forms of forced treatment.
These are described (for England) in the Mental Health Act.
This is what it means to be sectioned - you are detained under section of the mental health act.
The most common sections are:
Section 136: a police officer can detain you in a public place and take you to a place of safety to be assessed. This requires one police officer. It lasts a maximum of 24 hours (but it can be extended by 12 hours).
Section 2: this is a short 28 day hold for assessment and treatment. It requires 2 doctors and an AMHP. Traditionally AMHPs were social workers, but they don't have to be and there are increasing numbers of nurses becoming AMHPs.
Section 3: this is a six month hold for treatment. It requires 2 doctors and an AMHP.
Section 4 is another short term hold (72 hours) that can be used in emergencies if there's only 1 doctor available.
https://www.rethink.org/living-with-mental-illness/mental-he...
Some people are on the street because it is the least worst option available to them.
They changed the law in part because of the horrifying conditions under which people were living who had been committed.
Having slept in a tent for nearly 6 years, I would take that over de facto imprisonment in an asylum any day. I did spend 10 days in an asylum in my teens. This is not an uninformed opinion by any stretch.
They changed the law in part because of the horrifying conditions under which people were living who had been committed.
Having slept in a tent for nearly 6 years, I would take that over de facto imprisonment in an asylum any day. I did spend 10 days in an asylum in my teens. This is not an uninformed opinion by any stretch.
What if “asylums” were much better funded and better equipped - closer to (if not exceeding) celebrity rehab facilities than today’s popular-culture impression of an archaic asylum?
My sister actually works for the CDC and she's had cancer multiple times. She was patient zero in a study in another state from the one she lived in. One of the times she had cancer, she flew regularly to a state of the art facility for about 18 months to not die from her very aggressive form of cancer.
At that time, we were still close. When we talked on the phone, we would quote some Star Trek line about "Good God Jim, you can't leave him in the hands of 20th Century medicine!"
(Not the quote, but the rescue scene where the good doctor describes chemo as "sounds like the Spanish Inquisition": https://www.youtube.com/watch?v=MMaGnpVaSGQ)
I was in a really nice facility. I was not crazy. I was just a teenager who had been molested and raped by a relative who was not old enough to legally advocate for myself. (it's a long story)
You would need to do better than merely throwing money at the problem and upgrading our current cages to cushy gilded cages for me to feel that it had some hope of being better than sleeping in a tent in the woods on my own recognizance.
"Bars do not a prison make". And gilded bars do not a civilized climate make by any stretch of the imagination.
At that time, we were still close. When we talked on the phone, we would quote some Star Trek line about "Good God Jim, you can't leave him in the hands of 20th Century medicine!"
(Not the quote, but the rescue scene where the good doctor describes chemo as "sounds like the Spanish Inquisition": https://www.youtube.com/watch?v=MMaGnpVaSGQ)
I was in a really nice facility. I was not crazy. I was just a teenager who had been molested and raped by a relative who was not old enough to legally advocate for myself. (it's a long story)
You would need to do better than merely throwing money at the problem and upgrading our current cages to cushy gilded cages for me to feel that it had some hope of being better than sleeping in a tent in the woods on my own recognizance.
"Bars do not a prison make". And gilded bars do not a civilized climate make by any stretch of the imagination.
obviously mentally ill people on the street homeless because we can't commit them because of that human autonomy that you mention.
Obviously mentally ill, or politically out of favor? I see what you're getting at, and I'm sympathetic. OTOH, history has shown that slope to be unbelievably steep and not very grippy, IMO. I wish I had even the remotest hint where to start to find the happy medium.
Obviously mentally ill, or politically out of favor? I see what you're getting at, and I'm sympathetic. OTOH, history has shown that slope to be unbelievably steep and not very grippy, IMO. I wish I had even the remotest hint where to start to find the happy medium.
> It all points to public healthcare where there is governance at a political level and not profit level.
Might want to consider that political abuse of psychiatric diagnoses to get opponents or agitators involuntarily committed to asylums or hospitals is not exactly unheard of.
Might want to consider that political abuse of psychiatric diagnoses to get opponents or agitators involuntarily committed to asylums or hospitals is not exactly unheard of.
This is plain stupid. A for-profit hospital will benefit from abusing any patient while a political abuse only targets a small portion of opponents. And political abuse is an issue of the counter-powers in your political system, not of the way hospitals work: a functional political system will have functional public hospitals, but a functional economy will have private hospitals whose interests diverge substantially from the patients ones.
> This is plain stupid.
Not stupid you are just young and ill informed.
> While on a phone call with Helen Thomas about the Watergate break-in, King pulled the phone cord from the wall. She was held against her will in a California hotel room and forcefully sedated by a psychiatrist after a physical struggle with five men that left her needing stitches.
https://en.wikipedia.org/wiki/Martha_Mitchell
Not stupid you are just young and ill informed.
> While on a phone call with Helen Thomas about the Watergate break-in, King pulled the phone cord from the wall. She was held against her will in a California hotel room and forcefully sedated by a psychiatrist after a physical struggle with five men that left her needing stitches.
https://en.wikipedia.org/wiki/Martha_Mitchell
I'm not saying this does not exist, i'm pretty aware that this is a real problem. I'm just saying that this remark--even if true and on point--doesn't constitute a valid argument against public hospitals since (1) this problem of public hospitals has already a much more widespread cousin in the private sector and (2) it is not intrinsically a problem of the hospital but a governance issue (which is called power abuse and has a lot of other symptoms).
The US got really leery of committing people to mental hospitals on little hard evidence because the power was being widely abused.
The usual argument is there options in between living on the streets and being imprisoned in a mental hospital. My brother is mildly retarded and lives in a apartment complex where there very minimal supervision. He has a car and a job and can come and go as he pleases. 'Supervision' is there mostly to protect him from 'us' not the other way around.
The usual argument is there options in between living on the streets and being imprisoned in a mental hospital. My brother is mildly retarded and lives in a apartment complex where there very minimal supervision. He has a car and a job and can come and go as he pleases. 'Supervision' is there mostly to protect him from 'us' not the other way around.
> It all points to public healthcare where there is governance at a political level and not profit level.
Because no-one has ever been kidnapped for political reasons?
Because no-one has ever been kidnapped for political reasons?
> we have thousands of obviously mentally ill people on the street homeless because we can't commit them because of that human autonomy that you mention.
I think there's more to it than that, if we look at some graphs over time.
I think there's more to it than that, if we look at some graphs over time.
It is always nuanced of course. The inability to lock people up in California as a result of the patients rights act[1] had its effects, but a general backing off of mental institutions from both the Federal and State governments was a big problem. The 55% number in [1] matches up with my experience with homeless in the Bay Area. The tricky bit is that survivor bias is an issue as well as mentally ill people are less likely to 'blend in' and keep a low profile so in street encounters it can seem like a higher percentage than it is. Similarly in food kitchen lines the mentally ill are at a disadvantage if they lack planning skills to get into the line.
[1] 2015 In the San Francisco Homeless Count, 55 percent of people experiencing chronic homelessness report they have emotional or psychiatric conditions. -- https://www.kqed.org/news/11209729/did-the-emptying-of-menta...
[1] 2015 In the San Francisco Homeless Count, 55 percent of people experiencing chronic homelessness report they have emotional or psychiatric conditions. -- https://www.kqed.org/news/11209729/did-the-emptying-of-menta...
Have these homeless people been offered housing and treatment in a setting that preserves their autonomy and turned that down? I highly doubt it. Commitment shouldn't even be under consideration except for people who have refused treatment without confinement.
"obviously mentally ill people on the street homeless"
The problem with forced treatment is that while there is a category of people who can be said to be in need of help, there are others who are quite within their right to do with their lives whatever they please, as long as they are not explicitly breaking the law, but prefer non-conventional life choices.
The main problem with enforced norms is that it pigeonholes everyone into "standard acceptable human" categorization, and if you don't fit into it, you become an outlaw.
The western societies had great fun categorizing people into various abnormality groups, leading into practical eugenics (forced sterilizatin) and forced incarceration. See for example [0].
Germany's 1940's escapades brought this arbitrary categorization fad to an end with the holocaust, where it became explicitly clear what the logical end result is when you start mass categorizing people into first-grade and second-grade citizens.
I have close relatives who would have benefitted from forced treatment, but I still prefer a society that does not do this.
True, there is a difference between eugenics and declaring someone 'too sick', but not that great actually since we don't really have a reliable gauge for a persons mental health - hence, it becomes arbitrary categorization based on just not falling within subjective norms of the dominating culture within society.
[0] https://www.nature.com/scitable/forums/genetics-generation/a...
The problem with forced treatment is that while there is a category of people who can be said to be in need of help, there are others who are quite within their right to do with their lives whatever they please, as long as they are not explicitly breaking the law, but prefer non-conventional life choices.
The main problem with enforced norms is that it pigeonholes everyone into "standard acceptable human" categorization, and if you don't fit into it, you become an outlaw.
The western societies had great fun categorizing people into various abnormality groups, leading into practical eugenics (forced sterilizatin) and forced incarceration. See for example [0].
Germany's 1940's escapades brought this arbitrary categorization fad to an end with the holocaust, where it became explicitly clear what the logical end result is when you start mass categorizing people into first-grade and second-grade citizens.
I have close relatives who would have benefitted from forced treatment, but I still prefer a society that does not do this.
True, there is a difference between eugenics and declaring someone 'too sick', but not that great actually since we don't really have a reliable gauge for a persons mental health - hence, it becomes arbitrary categorization based on just not falling within subjective norms of the dominating culture within society.
[0] https://www.nature.com/scitable/forums/genetics-generation/a...
As you pointed out: " there is a category of people who can be said to be in need of help, there are others who are quite within their right to do with their lives whatever they please". But, if you only provide help to those who need it and are willing to accept it, there would be no forced-treatment-problem like described. I am convinced that quite a few of the "homeless, mentally ill" would be willing to accept help, that they are usually denied (because of the lack of a house, job and insurance).
Reposting a comment I made in another thread here:
But public healthcare service is much worse in my experience. I'm forced to be a part of a public system but I'd very much prefer to be able to pay private insurance and use private hospitals. We have private hospitals, but the government insurance isn't accepted there (because the law and the system doesn't allow it) and that makes it prohibitively expensive to me even though I'm a software developer for a USA company making nearly 6 figures - I'd have more than enough money for private services, but the government demands so much that I simply don't have enough left, and so I'm forced to take the "free" services (very huge quotes as I'm paying US$1500 per month for my government health insurance specifically - it's a separate line on my tax report).
Anecdotal story: One time I've driven my girlfriend to a major hospital (in the capital city of the country) because she had acute abdomen pains and the ambulance wouldn't even get there within 20 minutes (again, I live in the capital city). We spent more than 4 hours waiting before somebody even looked at her even though I tried really hard to get someone to look at her immediately, it simply wasn't possible; during our journey from the main gate to the emergency room, we were met with extreme disinterest in anything regarding our well being or providing good services at all. They sent me to a wrong building THREE TIMES while I was carrying her in hands even though I asked VERY CLEARLY where the emergency service is. When we got there, I had to pay around 100 CZK (5 USD) to even get into a queue, but no one told us, with no signs or anything around - the problem is that I specifically asked THE GUY THAT I LATER PAID TO if we need to do something. He didn't even look at me and he didn't even know where is the emergency room in his building. And then I had to pay around 50 USD for parking there for so long.
I have many first-hand experiences like that, e.g. you wouldn't believe the conditions and treatment that awaits you if you need to be hospitalized (5 and more people in one room, of course no AC, one shower and 2 toilets for ~10 rooms, one electrical socket for the whole room, of course no internet, TV always on at full volume, food that couldn't even be considered leftovers from neighboring low-tier restaurants, total disinterest of nurses and straight-up anger towards patients that need anything, people often need to have their beds in the hallway because there are not enough rooms, etc).
If you're pregnant, tough luck, there are literally 5 year-long queues to get into a "good" hospital (very low quality by US standards) and if you want something that is at least of average quality by US standards, you have only two options: Corruption or private - I have a whole savings account for that, but I'm a high income individual (it costs around US$50k in a private "high quality" hospital that'd be considered below average in the US, and there is no way to insure yourself against expenses in private hospitals, and even if there was, it'd be on top of the US$1500 I'm already paying).
My grandfather died because of these low quality services, but of course tough luck suing anyone or getting any compensation, that's simply not possible because "that's just how it is" is considered to be acceptable defense of the hospital and the system. Even if you're successful, the biggest compensation ever granted (and that happened just once) was around US$10k.
The only thing that is "good" (average compared to the US) is what we call "high-intensive hospital care", but you don't get into that very often - that's a completely separate department for people with very severe illness or very severe other problems, and of course even if you really need it, qualifying for it is very hard because there are not enough places.
Fuck public healthcare services. I'm completely okay with donating (even through taxes) some sum of money so everyone can have access to healthcare, but I want to buy my own healthcare services on a free market.
I live in Central Europe, btw. I expect downvotes to flow, but it'd be nice to have a discussion, so please, reply instead of downvoting if possible.
But public healthcare service is much worse in my experience. I'm forced to be a part of a public system but I'd very much prefer to be able to pay private insurance and use private hospitals. We have private hospitals, but the government insurance isn't accepted there (because the law and the system doesn't allow it) and that makes it prohibitively expensive to me even though I'm a software developer for a USA company making nearly 6 figures - I'd have more than enough money for private services, but the government demands so much that I simply don't have enough left, and so I'm forced to take the "free" services (very huge quotes as I'm paying US$1500 per month for my government health insurance specifically - it's a separate line on my tax report).
Anecdotal story: One time I've driven my girlfriend to a major hospital (in the capital city of the country) because she had acute abdomen pains and the ambulance wouldn't even get there within 20 minutes (again, I live in the capital city). We spent more than 4 hours waiting before somebody even looked at her even though I tried really hard to get someone to look at her immediately, it simply wasn't possible; during our journey from the main gate to the emergency room, we were met with extreme disinterest in anything regarding our well being or providing good services at all. They sent me to a wrong building THREE TIMES while I was carrying her in hands even though I asked VERY CLEARLY where the emergency service is. When we got there, I had to pay around 100 CZK (5 USD) to even get into a queue, but no one told us, with no signs or anything around - the problem is that I specifically asked THE GUY THAT I LATER PAID TO if we need to do something. He didn't even look at me and he didn't even know where is the emergency room in his building. And then I had to pay around 50 USD for parking there for so long.
I have many first-hand experiences like that, e.g. you wouldn't believe the conditions and treatment that awaits you if you need to be hospitalized (5 and more people in one room, of course no AC, one shower and 2 toilets for ~10 rooms, one electrical socket for the whole room, of course no internet, TV always on at full volume, food that couldn't even be considered leftovers from neighboring low-tier restaurants, total disinterest of nurses and straight-up anger towards patients that need anything, people often need to have their beds in the hallway because there are not enough rooms, etc).
If you're pregnant, tough luck, there are literally 5 year-long queues to get into a "good" hospital (very low quality by US standards) and if you want something that is at least of average quality by US standards, you have only two options: Corruption or private - I have a whole savings account for that, but I'm a high income individual (it costs around US$50k in a private "high quality" hospital that'd be considered below average in the US, and there is no way to insure yourself against expenses in private hospitals, and even if there was, it'd be on top of the US$1500 I'm already paying).
My grandfather died because of these low quality services, but of course tough luck suing anyone or getting any compensation, that's simply not possible because "that's just how it is" is considered to be acceptable defense of the hospital and the system. Even if you're successful, the biggest compensation ever granted (and that happened just once) was around US$10k.
The only thing that is "good" (average compared to the US) is what we call "high-intensive hospital care", but you don't get into that very often - that's a completely separate department for people with very severe illness or very severe other problems, and of course even if you really need it, qualifying for it is very hard because there are not enough places.
Fuck public healthcare services. I'm completely okay with donating (even through taxes) some sum of money so everyone can have access to healthcare, but I want to buy my own healthcare services on a free market.
I live in Central Europe, btw. I expect downvotes to flow, but it'd be nice to have a discussion, so please, reply instead of downvoting if possible.
That sounds like incredibly awful implementation. I live in Uruguay where we have a hybrid system, it's single-payer in that everything is funded through the state, but you have a choice of medical systems, mostly are Mutual Organizations ("Mutualistas").
And, while there are some bad wait times for non-life threatening surgery, I consider the overall system really good. My sister-in-law had major surgery and hospitalization and care was very good.
It's not so strict as a pure "public" service, and there are state-managed hospitals where you can get bad experiences like crowding and bad care, but never to the level you're describing.
And I can (and did) choose to have some better services on top of the basic ones so I have amazing emergency services and same-day specialists, for an extra 200 dollars (on top of my mandatory health tax bill which is also like 500 dollars).
http://www.expatfinder.com/uruguay/expat-guides/article/heal...
And, while there are some bad wait times for non-life threatening surgery, I consider the overall system really good. My sister-in-law had major surgery and hospitalization and care was very good.
It's not so strict as a pure "public" service, and there are state-managed hospitals where you can get bad experiences like crowding and bad care, but never to the level you're describing.
And I can (and did) choose to have some better services on top of the basic ones so I have amazing emergency services and same-day specialists, for an extra 200 dollars (on top of my mandatory health tax bill which is also like 500 dollars).
http://www.expatfinder.com/uruguay/expat-guides/article/heal...
As someone who lives in the US, its frustrating to me that many people will read your anecdote and simply think that any public funding of healthcare equals communism, "death panels", delayed care, and abysmal levels of service.
My anecdote is that here in the US, if you lose your job and find yourself without insurance, you can literally go bankrupt from a relatively minor injury or sickness due to the extreme cost of medical care. There are plenty of long lines, bad doctors, and low quality hospitals here too so its not like you get rid of those things by going private. People decline to call the ambulance because they are afraid of getting charged thousands of dollars for it if their injury is not covered by insurance which sometimes ends in their death.
I watched my mom die in the hospital and if it weren't for a recent law passed by Obama, we would have had to dip into what little savings we had just to keep her comfortable for her last few days. There is a lot of space for a middle ground that does not need to be limited by your experience or mine.
My anecdote is that here in the US, if you lose your job and find yourself without insurance, you can literally go bankrupt from a relatively minor injury or sickness due to the extreme cost of medical care. There are plenty of long lines, bad doctors, and low quality hospitals here too so its not like you get rid of those things by going private. People decline to call the ambulance because they are afraid of getting charged thousands of dollars for it if their injury is not covered by insurance which sometimes ends in their death.
I watched my mom die in the hospital and if it weren't for a recent law passed by Obama, we would have had to dip into what little savings we had just to keep her comfortable for her last few days. There is a lot of space for a middle ground that does not need to be limited by your experience or mine.
I agree completely, neither extreme is ideal. As I said, I think that given current system it's desirable to fund basic healthcare from taxes, but I think there should be an option to avoid state services if I decide to do so. The major problem in my story isn't insurance itself even though it's expensive as hell, it's that the hospital isn't a business and I'm unable to use my mandatory insurance to cover private healthcare costs. I personally think the Swiss system is good.
I never wanted to imply that private services are always high quality, but there definitely is more motivation and it shows - while there might be a considerable portion of bad hospitals in the US, here are literally just a handful below average ones (compared to the US) in my country and it's impossible to get there legally.
Of course low quality hospital beats no hospital, but you should be able to fix that with some kind of mandatory insurance that is state-sponsored if the person is poor, for example, no? Don't forget that I'm reacting to a comment praising public hospitals from control reasons, not about absence of social safety.
I don't understand why people in the US can't or don't pay their insurance themselves instead of through their employer, though. Seems like a huge risk - well you described it.
I never wanted to imply that private services are always high quality, but there definitely is more motivation and it shows - while there might be a considerable portion of bad hospitals in the US, here are literally just a handful below average ones (compared to the US) in my country and it's impossible to get there legally.
Of course low quality hospital beats no hospital, but you should be able to fix that with some kind of mandatory insurance that is state-sponsored if the person is poor, for example, no? Don't forget that I'm reacting to a comment praising public hospitals from control reasons, not about absence of social safety.
I don't understand why people in the US can't or don't pay their insurance themselves instead of through their employer, though. Seems like a huge risk - well you described it.
Because insurance is a private industry and there are few goverment assisted options if you are very poor its very expensive to purchase it by yourself in the US. Private insurance has every incentive to keep raising prices and to keep lobbying the government to stay away from the market.
Your employer can group all of their employees into a single risk pool, so each employee gets a discounted rate. When you purchase insurance on your own you are no longer in a group and so the cost is far more. Doctors are also incentivized to prescribe you drugs you don't need and drugs that insurance covers instead of the correct medication.
My wife had to wait to get surgery on her leg because she just signed up with a new employer and didn't have insurance yet. If she had gotten the surgery without insurance it would have cost somewhere around $100k US.
Your employer can group all of their employees into a single risk pool, so each employee gets a discounted rate. When you purchase insurance on your own you are no longer in a group and so the cost is far more. Doctors are also incentivized to prescribe you drugs you don't need and drugs that insurance covers instead of the correct medication.
My wife had to wait to get surgery on her leg because she just signed up with a new employer and didn't have insurance yet. If she had gotten the surgery without insurance it would have cost somewhere around $100k US.
> Because insurance is a private industry and there are few goverment assisted options if you are very poor its very expensive to purchase it by yourself in the US. Private insurance has every incentive to keep raising prices and to keep lobbying the government to stay away from the market.
This is proven to be false by Switzerland, where people purchase their private health insurance themselves.
This is proven to be false by Switzerland, where people purchase their private health insurance themselves.
Yes, lots of things are possible. I imagine there are both cultural and regulatory differences between the health insurance market in Switzerland vs the US.
Yes, I agree. I suspect it's a regulatory problem, that's why I asked - I'd like to know the specifics.
This link seems to cover a lot of the differences. It sounds like a decent system, but not one that would ever work in the US. The private healthcare companies have too much to money to lose and would use the media to frame such as system as communist and dangerous.
https://www.quora.com/What-is-the-difference-between-the-US-...
https://www.quora.com/What-is-the-difference-between-the-US-...
If that's true, then literally any plans for public hospitals or healthcare insurance are doomed from the beginning, isn't that right?
Basically. That is a good summary of the political debate over healthcare for the last few decades in the US.
Obviously you haven't been to many US hospitals if you think the care is much better than that here.
I was always given an opportunity of choice in the US and I never paid that much. I can't really choose a hospital here, the public ones are all the same and the mandatory insurance makes private care unavailable. I was also never met with such bad behavior towards patients, yeah it wasn't perfect, but it was helpful and I was treated as a person, not a piece of shit that is disturbing and isn't worth a look.
I'm in no way praising the US system though. Just saying that public hospitals have been tried and it's really bad. I think the Swiss system is good.
I'm in no way praising the US system though. Just saying that public hospitals have been tried and it's really bad. I think the Swiss system is good.
We can't commit them because mental hospitals keep getting closed.
Justifiably so. When a "hospital" has more power over penal settings and indefinite imprisonment combined with no oversight, its time for them to go.
I'm sure there is a good balance here, somewhere. But what we had and now have isn't it. A better balance feels like it should include a judge, 2 doctors with at least 2 hr patient time for each, and someone else that the patient knows.
I'm sure there is a good balance here, somewhere. But what we had and now have isn't it. A better balance feels like it should include a judge, 2 doctors with at least 2 hr patient time for each, and someone else that the patient knows.
The hospitals aren't being closed due to some guilt over them bearing too many similarities to the prison-industrial complex. They're being closed to save money, and the patients are thrown out on the street. Quite the opposite direction of paying more doctors to help these people.
Am doctor in an overwhelmed county hospital in the South. We are so overcapacity that most patients spend 12+ hours in a hallway waiting to be roomed. We have every motivation to discharge patients fast.
Hospitals are dangerous. You lose your sense of autonomy, are woken up throughout the night for blood draws or medication management, and are at risk for nomosocomial infection or delirium.
It’s an emotionally charged place and conflict between families and doctors happens often. Hard ethical questions happen. For instance a young man may come into the ED with massive polytrauma and require immediate blood transfusions to keep him alive. There’s a chance he would be the person to refuse a transfusion on religious grounds, and the family would be upset with our team for ‘violating his body’.
Because of situations like this, or the one described in the cnn article, ethic committees are an essential part of hospital care.
Hospitals are dangerous. You lose your sense of autonomy, are woken up throughout the night for blood draws or medication management, and are at risk for nomosocomial infection or delirium.
It’s an emotionally charged place and conflict between families and doctors happens often. Hard ethical questions happen. For instance a young man may come into the ED with massive polytrauma and require immediate blood transfusions to keep him alive. There’s a chance he would be the person to refuse a transfusion on religious grounds, and the family would be upset with our team for ‘violating his body’.
Because of situations like this, or the one described in the cnn article, ethic committees are an essential part of hospital care.
This is why Hospitals should be run as public services instead of private companies.
But public healthcare service is much worse in my experience. I'm forced to be a part of a public system but I'd very much prefer to be able to pay private insurance and use private hospitals. We have private hospitals, but the government insurance isn't accepted there (because the law and the system doesn't allow it) and that makes it prohibitively expensive to me even though I'm a software developer for a USA company making nearly 6 figures - I'd have more than enough money for private services, but the government demands so much that I simply don't have enough left, and so I'm forced to take the "free" services (very huge quotes as I'm paying US$1500 per month for my government health insurance specifically - it's a separate line on my tax report).
Anecdotal story: One time I've driven my girlfriend to a major hospital (in the capital city of the country) because she had acute abdomen pains and the ambulance wouldn't even get there within 20 minutes (again, I live in the capital city). We spent more than 4 hours waiting before somebody even looked at her even though I tried really hard to get someone to look at her immediately, it simply wasn't possible; during our journey from the main gate to the emergency room, we were met with extreme disinterest in anything regarding our well being or providing good services at all. They sent me to a wrong building THREE TIMES while I was carrying her in hands even though I asked VERY CLEARLY where the emergency service is. When we got there, I had to pay around 100 CZK (5 USD) to even get into a queue, but no one told us, with no signs or anything around - the problem is that I specifically asked THE GUY THAT I LATER PAID TO if we need to do something. He didn't even look at me and he didn't even know where is the emergency room in his own building. And then I had to pay around 50 USD for parking there for so long.
I have many first-hand experiences like that, e.g. you wouldn't believe the conditions and treatment that awaits you if you need to be hospitalized (5 and more people in one room, of course no AC, one shower and 2 toilets for ~10 rooms, one electrical socket for the whole room, of course no internet, TV always on at full volume, food that couldn't even be considered leftovers from neighboring low-tier restaurants, total disinterest of nurses and straight-up anger towards patients that need anything, people often need to have their beds in the hallway because there are not enough rooms, etc).
If you're pregnant, tough luck, there are literally 5 year-long queues to get into a "good" hospital (very low quality by US standards) and if you want something that is at least of average quality by US standards, you have only two options: Corruption or private - I have a whole savings account for that, but I'm a high income individual (it costs around US$50k in a private "high quality" hospital that'd be considered below average in the US, and there is no way to insure yourself against expenses in private hospitals, and even if there was, it'd be on top of the US$1500 I'm already paying).
My grandfather died because of these low quality services, but of course tough luck suing anyone or getting any compensation, that's simply not possible because "that's just how it is" is considered to be acceptable defense of the hospital and the system. Even if you're successful, the biggest compensation ever granted (and that happened just once) was around US$10k.
The only thing that is "good" (average compared to the US) is what we call "high-intensive hospital care", but you don't get into that very often - that's a completely separate department for people with very severe illness or very severe other problems, and of course even if you really need it, qualifying for it is very hard because there are not enough places.
Fuck public healthcare services. I'm completely okay with donating (even through taxes) some sum of money so everyone can have access to healthcare, but I want to buy my own healthcare services on a free market.
I live in Central Europe, btw. I expect downvotes to flow, but it'd be nice to have a discussion, so please, reply instead of downvoting if possible.
Anecdotal story: One time I've driven my girlfriend to a major hospital (in the capital city of the country) because she had acute abdomen pains and the ambulance wouldn't even get there within 20 minutes (again, I live in the capital city). We spent more than 4 hours waiting before somebody even looked at her even though I tried really hard to get someone to look at her immediately, it simply wasn't possible; during our journey from the main gate to the emergency room, we were met with extreme disinterest in anything regarding our well being or providing good services at all. They sent me to a wrong building THREE TIMES while I was carrying her in hands even though I asked VERY CLEARLY where the emergency service is. When we got there, I had to pay around 100 CZK (5 USD) to even get into a queue, but no one told us, with no signs or anything around - the problem is that I specifically asked THE GUY THAT I LATER PAID TO if we need to do something. He didn't even look at me and he didn't even know where is the emergency room in his own building. And then I had to pay around 50 USD for parking there for so long.
I have many first-hand experiences like that, e.g. you wouldn't believe the conditions and treatment that awaits you if you need to be hospitalized (5 and more people in one room, of course no AC, one shower and 2 toilets for ~10 rooms, one electrical socket for the whole room, of course no internet, TV always on at full volume, food that couldn't even be considered leftovers from neighboring low-tier restaurants, total disinterest of nurses and straight-up anger towards patients that need anything, people often need to have their beds in the hallway because there are not enough rooms, etc).
If you're pregnant, tough luck, there are literally 5 year-long queues to get into a "good" hospital (very low quality by US standards) and if you want something that is at least of average quality by US standards, you have only two options: Corruption or private - I have a whole savings account for that, but I'm a high income individual (it costs around US$50k in a private "high quality" hospital that'd be considered below average in the US, and there is no way to insure yourself against expenses in private hospitals, and even if there was, it'd be on top of the US$1500 I'm already paying).
My grandfather died because of these low quality services, but of course tough luck suing anyone or getting any compensation, that's simply not possible because "that's just how it is" is considered to be acceptable defense of the hospital and the system. Even if you're successful, the biggest compensation ever granted (and that happened just once) was around US$10k.
The only thing that is "good" (average compared to the US) is what we call "high-intensive hospital care", but you don't get into that very often - that's a completely separate department for people with very severe illness or very severe other problems, and of course even if you really need it, qualifying for it is very hard because there are not enough places.
Fuck public healthcare services. I'm completely okay with donating (even through taxes) some sum of money so everyone can have access to healthcare, but I want to buy my own healthcare services on a free market.
I live in Central Europe, btw. I expect downvotes to flow, but it'd be nice to have a discussion, so please, reply instead of downvoting if possible.
Why not name the country?
The Czech Republic, it's even worse in Poland, Hungary and Slovakia (personal experience); I also have even more horror stories about the Czech system - right now I'm waiting for the third month to finally get a bad tooth checked (and I will have to pay around $500 if I don't want the tooth simply extracted, no other option covered by insurance is available).
On the other hand I had extremely good experience with cheap private healthcare in Ukraine. I wasn't brave enough to test their public system.
Sorry I didn't mention it, I thought I did but I mentioned just the currency.
On the other hand I had extremely good experience with cheap private healthcare in Ukraine. I wasn't brave enough to test their public system.
Sorry I didn't mention it, I thought I did but I mentioned just the currency.
Sorry to hear about your experiences. On the other hand, I'm from Australia, and it's absolutely not the case here.
Healthcare could always be better funded, but here it's honestly amazing compared to other places I've seen.
Healthcare could always be better funded, but here it's honestly amazing compared to other places I've seen.
I'm not denying that certain public systems work good or even great - there is Germany just next to my country with their excellent system (it's getting worse according to my German friends though, but I'm not sure about that, I don't have enough first-hand experience). I'm arguing that there is less motivation in a public system so it could easily lead to bad situations, but of course sometimes it doesn't.
The main issue here is the lack of a fundamental right: the right to get a second opinion from a licensed MD. In The Netherlands, you have this right. Apparently in the USA, you don't. And if all the MDs work for the same employer, there's a possible conflict of interest.
We've got this right in law as well (going to a higher court). The downside though is it costs both time and money.
We've got this right in law as well (going to a higher court). The downside though is it costs both time and money.
The article does not elucidate the complete circumstances of the girl's hospitalisation and due to confidentiality, can not.
That is enough reason for me to consider this article to be sensasional. It is impossible to say who is at fault.
In general, it often happens that people think they know better than doctors, and in this case she may simply be lucky that she did not get seriously ill. The article itself contains a lot of incoherent quotes and it is impossible to make any sense or argument from it.
That is enough reason for me to consider this article to be sensasional. It is impossible to say who is at fault.
In general, it often happens that people think they know better than doctors, and in this case she may simply be lucky that she did not get seriously ill. The article itself contains a lot of incoherent quotes and it is impossible to make any sense or argument from it.
The patient signed a privacy release form provided by Mayo allowing them to freely discuss the case with CNN. Despite this the hospital has chosen to continue to refuse to answer questions under the guise of patient confidentiality.
Since the hospital legally can present their side of the story and evidence to support it and have chosen not to, it is reasonable to accept the patient's account as accurate.
Since the hospital legally can present their side of the story and evidence to support it and have chosen not to, it is reasonable to accept the patient's account as accurate.
How certain is it that the patient privacy release form will hold up in court? If Mayo is arguing that the patient cannot make their own medical decisions, doesn't it inherently undermine their own argument to recognize the privacy release form as a legitimate decision made by the patient?
From the article, the hospital couldn't decide if the patient was competent. They claimed she wasn't when it suited their guardianship case, and claimed she was when they "discharged" her.
No one else has claimed she's incompetent. Other mmedical professionals have said she was and is. When patient signed the release, they were free to discuss the details of the case. Their refusal to do so is telling.
No one else has claimed she's incompetent. Other mmedical professionals have said she was and is. When patient signed the release, they were free to discuss the details of the case. Their refusal to do so is telling.
It’s not impossible to say who was at fault.
The facts of the case are that the hospital engaged with several judges and a police department all of whom ultimately concluded that they had no legal basis to hold her. Yet they had been doing so anyways.
As far as I can tell determining who is at fault is exactly what the legal system is for.
The facts of the case are that the hospital engaged with several judges and a police department all of whom ultimately concluded that they had no legal basis to hold her. Yet they had been doing so anyways.
As far as I can tell determining who is at fault is exactly what the legal system is for.
> In general, it often happens that people think they know better than doctors,
And people are allowed to make stupid decisions! It's not the state's responsibility to automatically defer all control to the residing 'expert'.
And people are allowed to make stupid decisions! It's not the state's responsibility to automatically defer all control to the residing 'expert'.
She signed a release form waving that confidentiality. Your dismissiveness is therefore no rebuttal.
However, guardianship or consevatorship (when the person is over 18,) imparts a fiduciary duty on the person/organization to provide for the needs of their ward. So the ability of Mayo to “financially benefit” could be subject to debate. They assume financial responsibility with the assumption of guardianship.
In terms of Mayo, they are one of the best hospitals in the world, current situation notwithstanding. It isn’t like the national monopoly one might find in the NHS. Remember a very similar situation happened with Alfie Evans — except Alfie was terminal and had a minimal chance of survival and the U.K. government still refused to allow him to leave the U.K.
In terms of Mayo, they are one of the best hospitals in the world, current situation notwithstanding. It isn’t like the national monopoly one might find in the NHS. Remember a very similar situation happened with Alfie Evans — except Alfie was terminal and had a minimal chance of survival and the U.K. government still refused to allow him to leave the U.K.
> xcept Alfie was terminal and had a minimal chance of survival and the U.K. government still refused to allow him to leave the U.K.
Permission to take him abroad was denied by the UK courts, not the UK government.
Permission to take him abroad was denied by the UK courts, not the UK government.
And who was arguing in court to deny him and his parents rights?
In what sense are the courts not part of the goverment? It’s not like they are private, are they?
In the UK "government" is used both very generally (as you're construing it) to mean institutions including courts, police, the Bank of England, a local municipal authority, and thus about half of everything, and specifically to mean the executive, which in the UK is run directly by politicians from the ruling party in the legislature. Unless it's clear from context people usually mean the latter, and the executive steered well clear of baby Alfie's case.
In the US the Head of State figurehead role and the executive leadership are merged into the President of the United States, while a legislature remains separate. In the UK the Head of State figurehead role goes to a monarch (currently Queen Elizabeth II) but the executive leadership is granted to whichever group controls the legislature as Prime Minister.
In the US the Head of State figurehead role and the executive leadership are merged into the President of the United States, while a legislature remains separate. In the UK the Head of State figurehead role goes to a monarch (currently Queen Elizabeth II) but the executive leadership is granted to whichever group controls the legislature as Prime Minister.
> In the UK "government" is used both very generally (as you're construing it) to mean institutions including courts, police, the Bank of England, a local municipal authority, and thus about half of everything
I'm British and I can't recall the term "government" being used in this way, even informally. I think most people, even if they're not interested in politics or our "unwritten constitution", would have some understanding that the courts, police, etc. are separate from the government that they elect. They may or may not have a word for what that thing is (the State) but nobody talks about people being "arrested by the government" or "convicted by the government".
I can imagine the people might think of the Civil Service as part of the government though.
I'm British and I can't recall the term "government" being used in this way, even informally. I think most people, even if they're not interested in politics or our "unwritten constitution", would have some understanding that the courts, police, etc. are separate from the government that they elect. They may or may not have a word for what that thing is (the State) but nobody talks about people being "arrested by the government" or "convicted by the government".
I can imagine the people might think of the Civil Service as part of the government though.
Interesting. Does the UK have another word other than “government” that has the US English meaning—any institution of or controlled by the state?
> Interesting. Does the UK have another word other than “government” that has the US English meaning—any institution of or controlled by the state?
In everyday speech, not really. We don't have a codified constitution so things are sometimes a little ambiguous. I guess people might use terms like "the state" or "the powers that be".
There is the legal concept of "The Crown" [1], which is kind of like the legal personality of the state. It sits at the root of a hierarchy, with the executive, legislature, courts, military etc. below it. The monarch, as head of state, exercises the powers of The Crown, although mostly in a ceremonial way on the advice of the government [2]. But nobody talks about The Crown in everyday speech.
[1] https://en.wikipedia.org/wiki/The_Crown
[2] https://en.wikipedia.org/wiki/Royal_prerogative_in_the_Unite...
In everyday speech, not really. We don't have a codified constitution so things are sometimes a little ambiguous. I guess people might use terms like "the state" or "the powers that be".
There is the legal concept of "The Crown" [1], which is kind of like the legal personality of the state. It sits at the root of a hierarchy, with the executive, legislature, courts, military etc. below it. The monarch, as head of state, exercises the powers of The Crown, although mostly in a ceremonial way on the advice of the government [2]. But nobody talks about The Crown in everyday speech.
[1] https://en.wikipedia.org/wiki/The_Crown
[2] https://en.wikipedia.org/wiki/Royal_prerogative_in_the_Unite...
Also that was a proxy war. Did you think Alfie's parents looked like they had piles of cash lying around to file spurious UK Supreme Court appeals? No "Christian Concern" bankrolls this sort of thing because apparently ensuring babies die as slowly as possible (preferably in agony) is what "Christian" means these days along with denying the ordinary civil custom of marriage to people for being Gay, shutting down access to abortion and making sure children are indoctrinated into Christianity under the pretence that it's part of the surrounding "culture" and not straight up religious brainwashing...
They're an unintentional advertisement for the benefits of secular government policies.
They're an unintentional advertisement for the benefits of secular government policies.
> However, guardianship or consevatorship (when the person is over 18,) imparts a fiduciary duty on the person/organization to provide for the needs of their ward. So the ability of Mayo to “financially benefit” could be subject to debate.
No, it's not: the ability of conservators/guardians to benefit financially from that relationship is well-known, and is the reason why a legal fiduciary duty exists. The existence of that duty doesn't remove the ability, it just provides a basis for corrective action if it is improperly exploited.
No, it's not: the ability of conservators/guardians to benefit financially from that relationship is well-known, and is the reason why a legal fiduciary duty exists. The existence of that duty doesn't remove the ability, it just provides a basis for corrective action if it is improperly exploited.
It's easy to attribute this whole situation to greed and/or malice but I think that fails Hanlon's razor. I can easily see this whole situation occurring because of poor communication and the culture of paternalism in medicine. It is not hard to imagine a team of healthcare providers that know or think they know what is good for their patient and do a poor job explaining why they are making the decisions that they are making whether that is because of poor communication skills or because they are simply too busy. I think the article proposes a good solution in calling up the hospital's ethics council. This should be standard operating procedure when a patient disagrees with medical staff and the presence of this resource should be communicated to the patient early on and by a employee who isn't directly involved with the patient's care.
Is there a need to attribute to malice when all the incentives are stacked against the correct behavior ?
Poor communication partly occurs because at no point does the Clinic have to go against its interest, there is that much less friction in the decisions taken.
Ethics is an issue but it seems that wouldn’t be sufficient as a focus for a solution.
Poor communication partly occurs because at no point does the Clinic have to go against its interest, there is that much less friction in the decisions taken.
Ethics is an issue but it seems that wouldn’t be sufficient as a focus for a solution.
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I agree that the monetary incentives are definitely incorrectly aligned in the current healthcare system as is. That said, I don't think that monetary incentives are the only incentives present here. Most physicians don't go into medicine only to make money. There are easier ways to make more money. From my experience, most healthcare providers genuinely care about the patients' well being. That is why I bristle whenever people rush to attribute a physician's actions to greed. I totally agree with you that a better incentive structure would improve the system.
While I agree this type of situation is likely most often due to miscommunication, that doesn't preclude certain instances from being malicious in intent (possibly including this one - we really don't have enough information to attribute motive and cause, but there are enough odd behaviors on the Mayo clinic's part that I hesitate to employ Hanlon's razor). The hospital's ethics council only works as a solution to greed and/or malice when the patient has prior knowledge of the council, as otherwise there is little reason to believe they would be informed - and even in the case of a knowledgeable patient, the integrity of the council may be compromised due to the same conflict of interest. An unaffiliated council might be effective in avoiding this, but that fails to solve the problem of dissemination of information. Perhaps the role could be foisted onto insurance providers, but they are not impartial (having financial incentives to reduce patient expenses, as well as strong relationships with hospitals). A potential solution is to use smaller, local clinics, rather than nationwide chains, as smaller companies are generally more pliable, both to non-contentious discussion and legal pressure, but such clinics are increasingly a rarity in many areas.
It's a thorny problem, that's made more so by its perceived rarity - if few are impacted by it and even less speak out over it, it's difficult to justify reform or review, especially if it increases the financial burden of the healthcare system.
It's a thorny problem, that's made more so by its perceived rarity - if few are impacted by it and even less speak out over it, it's difficult to justify reform or review, especially if it increases the financial burden of the healthcare system.
Ethics councils are often hybrid in nature, including members of the local community that do not stand to benefit financially from patient care. I agree that informing patients about the presence of these governing bodies is a difficult problem. However, many bad situations would be avoided if the information was disseminated as standard procedure at the earliest possible convenience (before disagreement has a chance to arise).
I was unaware of this design for the ethics councils. In that case, I agree that this would go a long way towards alleviating the problem - even if it's not completely unbiased, even a few unaffiliated members can be a major moderating influence.
Thank you for the information, your suggestion seems like a very effective way of minimizing future incidents.
Thank you for the information, your suggestion seems like a very effective way of minimizing future incidents.
> I can easily see this whole situation occurring because of poor communication and the culture of paternalism in medicine.
I can see it starting that way, but there is an absolute line the hospital should have never crossed: People have the right to chose what medical treatment they want.
They crossed the line.
I can see it starting that way, but there is an absolute line the hospital should have never crossed: People have the right to chose what medical treatment they want.
They crossed the line.
We don't know the full story and likely never will. What if the doctors were correct in their assessment that the patient was unfit to make medical decisions and that she was being coerced by parents to act against her own best interest? I would be interested in looking at her medical record to try and understand what was really going on but that is unlikely to ever happen. There is really bad information asymmetry here because the hospital is legally prohibited from releasing any medical information but the patient can choose to reveal as much or as little as they wish.
> What if the doctors were correct in their assessment that the patient was unfit to make medical decisions and that she was being coerced by parents to act against her own best interest?
The article asks that very question, and answers that she was making her own medical decisions on everything except being able to leave the hospital.
The hospital doesn't get to have it both ways.
Read here: https://www.cnn.com/2018/08/13/health/mayo-clinic-escape-2-e...
"That hadn't jibed with the captain of investigations for the Rochester police. Sherwin said it didn't make sense that Mayo staffers told police Alyssa had been making her own decisions, yet in the discharge note, they stated she wasn't capable of making her own decisions."
And the two Judges they went to both agreed, and refused to let the Mayo become her guardian. Not to mention the hospital could have tried to get a different family member to be her guardian - but that's not what they did, they wanted themself to be the guardian.
And on top of all of that when they went to a different hospital the Dr's there agreed with the parents!
> because the hospital is legally prohibited from releasing any medical information but the patient can choose to reveal as much or as little as they wish.
That's not correct: The hospital said they would talk if the patient signed a form consenting - so she did (which they were probably not expecting), and they still refused to talk. That's pretty damning.
> I would be interested in looking at her medical record to try and understand what was really going on but that is unlikely to ever happen.
The article makes it clear enough: The parents argued with a Dr. who got a hissy fit basically and decided to cut them out of all decisions as a form of revenge.
The Mayo is losing a TON of respect here, and they should publicly fire this Dr. before it gets worse.
The article asks that very question, and answers that she was making her own medical decisions on everything except being able to leave the hospital.
The hospital doesn't get to have it both ways.
Read here: https://www.cnn.com/2018/08/13/health/mayo-clinic-escape-2-e...
"That hadn't jibed with the captain of investigations for the Rochester police. Sherwin said it didn't make sense that Mayo staffers told police Alyssa had been making her own decisions, yet in the discharge note, they stated she wasn't capable of making her own decisions."
And the two Judges they went to both agreed, and refused to let the Mayo become her guardian. Not to mention the hospital could have tried to get a different family member to be her guardian - but that's not what they did, they wanted themself to be the guardian.
And on top of all of that when they went to a different hospital the Dr's there agreed with the parents!
> because the hospital is legally prohibited from releasing any medical information but the patient can choose to reveal as much or as little as they wish.
That's not correct: The hospital said they would talk if the patient signed a form consenting - so she did (which they were probably not expecting), and they still refused to talk. That's pretty damning.
> I would be interested in looking at her medical record to try and understand what was really going on but that is unlikely to ever happen.
The article makes it clear enough: The parents argued with a Dr. who got a hissy fit basically and decided to cut them out of all decisions as a form of revenge.
The Mayo is losing a TON of respect here, and they should publicly fire this Dr. before it gets worse.
The hospital is only legally forbidden from sharing the patient's medical records without the patient's consent. The patient legally granted permission for the hospital to release medical information to CNN and the hospital has continued to refuse to do so.
I don’t think being prohibited from seeking a second opinion could possibly be described as likely to just be the result of a miscommunication.
My mother in-law was kept at a facility when we wanted to transfer her to a better one, but we were given lots of run-around and people insisted everything was fine. She died. She might have died anyways, but we'll never get to know. We had serious concerns with her care and nobody was her advocate to getting better care, except my wife (her daughter) and she was dealing with a morass of bureaucracy that nobody should have to deal with when someone is in critical condition. I follow the age old advice of most of the older members of my family: stay out of hospitals as long as you can, once you go in, you don't have much control over when you come out again, if at all.
When I was a child, I was hospitalized for some issues. I spent a week there, and I only got worse. The Drs would dance around the questions when my parents asked to have me moved to a different hospital.
At the end of the 6th day, my dad told them he was going to take me to a better hospital whether or not they agreed. (There was more words, but that's besides the point).
Within an hour there was an ambulance taking me to the next hospital. If my dad didn't force their hand, I would have died later that night. All because they either didn't care, wanted the money, or were actually that shit of Drs.
This story makes me angry.
At the end of the 6th day, my dad told them he was going to take me to a better hospital whether or not they agreed. (There was more words, but that's besides the point).
Within an hour there was an ambulance taking me to the next hospital. If my dad didn't force their hand, I would have died later that night. All because they either didn't care, wanted the money, or were actually that shit of Drs.
This story makes me angry.
Yep, I was extremely strenuous in keeping up with nurses and doctor's about my father's condition, and luckily he only left with a blood clot that permanently changed his life due to their negligence.
Didn't sue because it was too hard to prove.
Didn't sue because it was too hard to prove.
Wow. That's really horrifying. Imagine losing your rights to decide your own medical treatment because overzealous doctors made up a 'mental health problem'.
I lost a huge amount of respect for Mayo clinic today.
I lost a huge amount of respect for Mayo clinic today.
It's especially scary if you have no trusted friends or relatives. There's an awful lot of people with asocial tendencies on the internet.
I have no friends or family here and am too socially crippled to make friends I would ever trust. I need a harmless procedure completed and doctors refuse to do it unless I have someone else with me who is willing to drive me home afterwards. Uber/Lyft/Taxi is not allowed either.
The last paragraph is pretty damning. Apparantly the mother had an argument with a senior physician, then they labelled her as having mental issues, and tried to take her daughter...
But luckily everyone (the biological father, the court, the police) refused to play along.
But luckily everyone (the biological father, the court, the police) refused to play along.
The medical profession really scares me. They have no respect or concern for patients and are largely going through the motions of providing care with no concern for successful outcomes. I find this to be consistently true in every encounter.
I fired my last PCP because they lied about treating me for depression complete with fictional prescriptions. I found out when I couldn't get disability insurance (at a sane price) because there was history of depression in my records I didn't know about.
I asked the PCP to correct it and they said they couldn't they might get sued for insurance fraud. What a joke!
So I avoided doctors for three years. Eventually I got to a new PCP and guess what I find when I check their notes? A herniated disk I don't have (I know, I have the MRI to prove it) and they claimed I was being treated for ADD even though I haven't been treated for that since I left my last PCP and we didn't talk about it beyond my mentioning I used to "have" it.
Believe it or not ADD is a thing insurance companies think can cease to be an ongoing issue. You just have to stop taking the medication. And then poof you go from being mentally ill to having a history of mental illness (yes ADD is a mental illness). It's critically important you not let medical professionals claim you are being treated for fictional things and how long it has been since you were treated matters a lot. If you let them claim they are treating you for a long ago resolved condition they revive it and suddenly you are a bigger liability.
If you go to purchase insurance on the open market or long term disability you will be dinged for the rest of your life for anything they claim as part of their insurance fraud. If it's an ongoing or recent issue you are dinged even worse.
PCPs in particular are financially incentivized to invent issues they are treating you for in their records because they can bill more for office visits if they can increase the number, complexity, and seriousness of the conditions they treat you for. And the insurance companies just take them at their word!
And the craziest part is that as part of HIPAA you can ask the doctor to correct the record, but they are under no obligation to do so. They make the final determination of medical fact, or fiction as it were. You can add a letter to your file pointing out how insane and contradictory their records are, but I can tell you from experience insurance companies aren't buying it and have no appetite for risk.
I fired my last PCP because they lied about treating me for depression complete with fictional prescriptions. I found out when I couldn't get disability insurance (at a sane price) because there was history of depression in my records I didn't know about.
I asked the PCP to correct it and they said they couldn't they might get sued for insurance fraud. What a joke!
So I avoided doctors for three years. Eventually I got to a new PCP and guess what I find when I check their notes? A herniated disk I don't have (I know, I have the MRI to prove it) and they claimed I was being treated for ADD even though I haven't been treated for that since I left my last PCP and we didn't talk about it beyond my mentioning I used to "have" it.
Believe it or not ADD is a thing insurance companies think can cease to be an ongoing issue. You just have to stop taking the medication. And then poof you go from being mentally ill to having a history of mental illness (yes ADD is a mental illness). It's critically important you not let medical professionals claim you are being treated for fictional things and how long it has been since you were treated matters a lot. If you let them claim they are treating you for a long ago resolved condition they revive it and suddenly you are a bigger liability.
If you go to purchase insurance on the open market or long term disability you will be dinged for the rest of your life for anything they claim as part of their insurance fraud. If it's an ongoing or recent issue you are dinged even worse.
PCPs in particular are financially incentivized to invent issues they are treating you for in their records because they can bill more for office visits if they can increase the number, complexity, and seriousness of the conditions they treat you for. And the insurance companies just take them at their word!
And the craziest part is that as part of HIPAA you can ask the doctor to correct the record, but they are under no obligation to do so. They make the final determination of medical fact, or fiction as it were. You can add a letter to your file pointing out how insane and contradictory their records are, but I can tell you from experience insurance companies aren't buying it and have no appetite for risk.
It seems pretty unfair to malign the entire field of medicine due to a single bad actor. I went to medical school prior to becoming an engineer and my impression was that most if not all of my classmates were genuine in their desire to help improve the lives of others. I'm sorry that you had a bad experience with your previous PCP but they don't represent the profession as a whole.
Also, if ADD is not a mental illness then what is it? I think this point is a conflation between medical definitions and social stigma.
Also, if ADD is not a mental illness then what is it? I think this point is a conflation between medical definitions and social stigma.
Single? I just gave two.
This not the only anecdata. Friends, family, and a family business. It’s not a scientific study.
I was trying to give practical advice. If things are hunky dory in your neck of the woods great!
This not the only anecdata. Friends, family, and a family business. It’s not a scientific study.
I was trying to give practical advice. If things are hunky dory in your neck of the woods great!
> It seems pretty unfair to malign the entire field of medicine due to a single bad actor.
Do a little research. Prescription fraud of this sort is widespread in the US.
Do a little research. Prescription fraud of this sort is widespread in the US.
I have definitely seen anecdotal stories of this occurring. Do you have any evidence to back up your claim that this type of behavior is widespread?
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You seem to have terrible luck finding PCPs. What area of the country are you in? Big or small city?
Big city. There are reams of them to choose from I just don’t invest much time in it because I am mostly healthy.
>And the craziest part is that as part of HIPAA you can ask the doctor to correct the record, but they are under no obligation to do so.
Couldn't you sue (or threaten to sue) them for libel? It's a written false statement that is injurious to your reputation.
Couldn't you sue (or threaten to sue) them for libel? It's a written false statement that is injurious to your reputation.
Maybe? I feel like interacting with lawyers is a losing proposition. I never consulted one to see what was possible.
I am not the kind of person who uses the legal system to make a point.
I am not the kind of person who uses the legal system to make a point.
Unless the parents were crazy abusive or actually unfit, Mayo basically stalled to steal their child and charge them more money. Also bad is a recent scam of random average people being involuntarily assigned conservatorship and having their assets stripped.
Seeing the Americans in this thread discuss their fear and mistrust of the medical system and the completely befuddling incentives that have been created in the US due to a for-profit medical system is straight up DISTURBING.
Healthcare is a human right in our modern prosperous civilization. What America has done to it is preposterous. You should be rioting, not starting lawsuits.
Healthcare is a human right in our modern prosperous civilization. What America has done to it is preposterous. You should be rioting, not starting lawsuits.
The Mayo Clinic is a Non-profit.
https://en.m.wikipedia.org/wiki/Mayo_Clinic
I agree that this particular case is egregious. But calling for riots based on unfounded speculation isn’t going to help fix healthcare.
https://en.m.wikipedia.org/wiki/Mayo_Clinic
I agree that this particular case is egregious. But calling for riots based on unfounded speculation isn’t going to help fix healthcare.
Yep, the market distortions the government has created here are terrible for everyone.
Who's going to take care of the people injured in the riots?
To me this sounds very much like the superiority complex many doctors and hospitals take when it comes to patient care. They are the doctors. They are the hospital. How dare you disagree. As stated, hospitals are not prisons and unless someone is an absolutely, clear and present danger to themselves or others, that person should be allowed to walk out. Even still, the law should err on the side of the patient's wishes.
>> To me this sounds very much like the superiority complex many doctors and hospitals take when it comes to patient care. They are the doctors. They are the hospital. How dare you disagree.
This is academia in a nutshell. They're told they are superior due to the time/resources spent in advanced schooling and only respect the opinions of people who have letters after their name. It is endemic amongst MDs and PhDs alike.
This is academia in a nutshell. They're told they are superior due to the time/resources spent in advanced schooling and only respect the opinions of people who have letters after their name. It is endemic amongst MDs and PhDs alike.
So, this looks awful. I would expect for the Mayo clinic to come out with a response sometime soon. In the meantime, I'm just trying to remind myself that news stories that stoke outrage often turn out to be telling the story in the way best tuned to get forwarded and clicked on, not always the most accurate way. But, really, this looks awful.
The fact that this happened a couple of years ago seems to make the "outrage of the week" angle a bit less likely? Since the patient has recovered, attended high school for another year to great success, and enrolled in college, it's pretty clear that she is competent to make health care decisions. She wanted a second opinion. Decision-makers (perhaps no longer?) at Mayo didn't want her to get that. (A bit rich, considering Mayo's reputation for second-guessing diagnoses across the Midwest...) When she got a second opinion, it was for a different and more successful course of treatment. If this report were false, threats from Mayo's lawyers would have prevented its publication.
There's little in this report to indicate that there is any sort of "culture" of false imprisonment at Mayo, and it seems likely that they're supervising the social workers a bit more closely now, so it's probably a fine hospital at which to receive health care...
There's little in this report to indicate that there is any sort of "culture" of false imprisonment at Mayo, and it seems likely that they're supervising the social workers a bit more closely now, so it's probably a fine hospital at which to receive health care...
Yeah, probably not Mayo clinic policy to imprison 18-year olds and take over guardianship, and the results afterwards make it clear their diagnosis was wrong. But, although the events were a couple years ago, the news article itself is pretty new, so I would be happy to see some comment from the Mayo clinic as to what they think went on here, and whether it was (or is) against their policy.
If actual events were largely as depicted in TFA, Mayo's interests would be best served by not addressing them at all. The publicity of the former board member's letter to a VP (but not his first name!) is a bit of a PR disaster...
As a HIPAA issue, the Mayo cannot defend itself here - it has no right to disclose any information on this patient’s stay or condition.
Key quote,
>“You’re only hearing one side,” cautioned Dr. Chris Feudtner, a professor of pediatrics, medical ethics and health policy at the University of Pennsylvania Perelman School of Medicine.
They “broke her out” while she still had a feeding tube in place, and had only just “The video shows Duane pushing Alyssa in her wheelchair down the hospital hallway. She has a bandage on her neck where her breathing tube had been removed a few days before.”
If you’re getting a feeding tube and a trache, you’re likely sick as shit. Even if one thinks the Mayo docs were wrong, that course of treatment suggests they earnestly thought she was extremely ill. Which makes their actions less evil than the article implies.
Key quote,
>“You’re only hearing one side,” cautioned Dr. Chris Feudtner, a professor of pediatrics, medical ethics and health policy at the University of Pennsylvania Perelman School of Medicine.
They “broke her out” while she still had a feeding tube in place, and had only just “The video shows Duane pushing Alyssa in her wheelchair down the hospital hallway. She has a bandage on her neck where her breathing tube had been removed a few days before.”
If you’re getting a feeding tube and a trache, you’re likely sick as shit. Even if one thinks the Mayo docs were wrong, that course of treatment suggests they earnestly thought she was extremely ill. Which makes their actions less evil than the article implies.
> Which makes their actions less evil than the article implies.
And accusing the mother of having a history of mental illness in an attempt to get conservatorship when no such history exists? Sounds pretty damned evil to me.
The road to hell is paved with good intentions. Even if they had their patient's best interests at heart, that doesn't excuse what they did.
And accusing the mother of having a history of mental illness in an attempt to get conservatorship when no such history exists? Sounds pretty damned evil to me.
The road to hell is paved with good intentions. Even if they had their patient's best interests at heart, that doesn't excuse what they did.
We don't have any information on the parents at all. I know its good to give parents the benefit of the doubt, but these people could have been ignorant, suspicious and contrary. Or 100 other things, that make a trained physician wary of trusting them with anything as important as a critically ill patient.
This episode didn't happen yesterday. The patient has since recovered, attended and graduated from high school, and enrolled in college. She is as competent to make health care decisions as any other 20yo. She is glad that her parents helped her escape, because she got better care that led to her recovery at a different hospital. She was clearly not critically ill, because she arrived at that hospital in a different state in fine shape. We consider the medical judgments of trained physicians (the untrained ones, not so much...) but only until they are clearly contradicted by reality.
Properly understood, the duty of physicians is also to serve those patients who are "ignorant, suspicious and contrary". They are also humans with dignity and autonomy.
Properly understood, the duty of physicians is also to serve those patients who are "ignorant, suspicious and contrary". They are also humans with dignity and autonomy.
> We don't have any information on the parents at all.
I'm not sure what you read, but there is plenty of information about the parents. They are quoted, they have videos, they have facebook posts.
There is no reason to see them as mentally incompetent.
> could have been ignorant, suspicious and contrary.
Makes no difference. They have the right to stop medical treatment whenever they want. They have the right to leave the hospital and take their daughter whenever they want.
Not to mention the patient was over 18 and wanted to leave, and the hospital didn't let them.
> wary of trusting them with anything as important as a critically ill patient.
Too bad. Then you explain to them how to help her. The hospital has no legal right to hold someone prisoner.
I'm not sure what you read, but there is plenty of information about the parents. They are quoted, they have videos, they have facebook posts.
There is no reason to see them as mentally incompetent.
> could have been ignorant, suspicious and contrary.
Makes no difference. They have the right to stop medical treatment whenever they want. They have the right to leave the hospital and take their daughter whenever they want.
Not to mention the patient was over 18 and wanted to leave, and the hospital didn't let them.
> wary of trusting them with anything as important as a critically ill patient.
Too bad. Then you explain to them how to help her. The hospital has no legal right to hold someone prisoner.
> these people could have been ignorant, suspicious and contrary
So if they were "suspicious" the hospital is justified in committing kidnapping, even after being turned down for conservatorship by two judges?
So if they were "suspicious" the hospital is justified in committing kidnapping, even after being turned down for conservatorship by two judges?
> has no right to disclose any information on this patient’s stay or condition
Except that according to the article the Mayo said they would if the patient signed a release form. So the patient did so (called their bluff basically), and they still refused to discuss it.
> they earnestly thought she was extremely ill. Which makes their actions less evil than the article implies.
Make no difference whatsoever. People have the right to stop medical treatment whenever they like. They have zero right to force anything on anyone.
On top of that a different set of Dr's said she was just fine to go home. So on top of everything else they were also wrong medically.
Except that according to the article the Mayo said they would if the patient signed a release form. So the patient did so (called their bluff basically), and they still refused to discuss it.
> they earnestly thought she was extremely ill. Which makes their actions less evil than the article implies.
Make no difference whatsoever. People have the right to stop medical treatment whenever they like. They have zero right to force anything on anyone.
On top of that a different set of Dr's said she was just fine to go home. So on top of everything else they were also wrong medically.
I'm sure their lawyer put the kibosh on that. How could they square their claim that she was not capable of making decisions with honoring a release also signed by her?
Since when do hospitals have the ability to unilaterally decide someone is not capable of making their own decisions?
If they believe that is the case they get a judge to give that person a guardian, they don't just make decisions for them.
If they believe that is the case they get a judge to give that person a guardian, they don't just make decisions for them.
That's literally what they were trying to do; read the article.
Exactly the same way they squared having her make her own medical decisions while claiming she couldn’t.
> A spokeswoman for the Mayo Clinic said hospital officials would be willing to answer CNN's questions if Alyssa signed a privacy release form giving them permission to discuss her case publicly with CNN. The spokeswoman, Ginger Plumbo, supplied that form to CNN.
> Alyssa signed the form, but Plumbo declined to answer CNN's questions on the record.
https://www.cnn.com/2018/08/13/health/mayo-clinic-escape-1-e...
> Alyssa signed the form, but Plumbo declined to answer CNN's questions on the record.
https://www.cnn.com/2018/08/13/health/mayo-clinic-escape-1-e...
Except on the same day another world-class hospital decided that she was healthy enough to go home..
You mean an ER physician who had no history of the previous hospitalization? The family had no discharge paperwork because they left AMA. I don't think they provided an adequate history including recommendations from neurosurgery, Pulm crit, GI, physical therapy, and speech therapy. Also I don't think the ER physician was going to admit a patient for an ultimate disposition for inpatient therapy either.
What I think is kind of funny is that there is a general pediatrician who was probably coordinating care and never really needed to get consent for treatment. I'm sure the neurosurgeon who did the clip got consent, GI/surgery got consent for the PEG, Pulm crit for the trach. Now this sad primary care/peds doctor is going down for not getting consent.
And one last thing, primary team pediatricians/hospitalists and their assisting case managers/social workers are not excited about long and protracted patient dispositions. No one likes to have a patient sitting on their list forever, especially one who really wants to leave and is aggressive about it. This story is incomplete without Mayo's side. I don't trust any of those comments from the medical ethicists when they don't have access to the full EMR at Mayo. I suppose they were enamored with the idea of providing a comment to the journalist.
What I think is kind of funny is that there is a general pediatrician who was probably coordinating care and never really needed to get consent for treatment. I'm sure the neurosurgeon who did the clip got consent, GI/surgery got consent for the PEG, Pulm crit for the trach. Now this sad primary care/peds doctor is going down for not getting consent.
And one last thing, primary team pediatricians/hospitalists and their assisting case managers/social workers are not excited about long and protracted patient dispositions. No one likes to have a patient sitting on their list forever, especially one who really wants to leave and is aggressive about it. This story is incomplete without Mayo's side. I don't trust any of those comments from the medical ethicists when they don't have access to the full EMR at Mayo. I suppose they were enamored with the idea of providing a comment to the journalist.
I have personally witnessed doctors order surgically implanted feeding tubes (aka gtube) for literally no sound reasoning other than “just incase”. I would not put it past an overworked, egotistical doc who spent all of 15minutes involved in the case and got his or her feelings hurt by a parent or relative who dared to question their medical treatment.
It’s nuts but I have seen this play out in my personal life and people around me: people have no idea that they are in charge of their own medical care, and on occasion accept terrible advice. Wish I had solutions other than “be informed and willing to assert your rights” - because in the situation, that is damned difficult.
It’s nuts but I have seen this play out in my personal life and people around me: people have no idea that they are in charge of their own medical care, and on occasion accept terrible advice. Wish I had solutions other than “be informed and willing to assert your rights” - because in the situation, that is damned difficult.
> If you’re getting a feeding tube and a trache, you’re likely sick as shit.
Or maybe you are being strongly sedated for some reason and are unable to breath and feed correctly by yourself.
Sedation is a famous infamous way to restrain and dominate a conflictive patient. Can be used for good reasons but opens a door to some abuses also. Being sedated when is not really necessary increases the probability of death by accidental suffocation.
Or maybe you are being strongly sedated for some reason and are unable to breath and feed correctly by yourself.
Sedation is a famous infamous way to restrain and dominate a conflictive patient. Can be used for good reasons but opens a door to some abuses also. Being sedated when is not really necessary increases the probability of death by accidental suffocation.
Can we change the URL to https://www.cnn.com/2018/08/13/health/mayo-clinic-escape-1-e... which is the original source?
Especially since your link points to part 1 of the article, not part 2 like this post. The article makes a lot more sense starting with part 1.
According to the article, the hospital had attempted to gain medical guardianship and that was rejected by a court. So unless I'm missing something here, how on earth does a hospital justify keeping someone prisoner when a judge has ordered you to allow them to transfer hospitals if they want? They went through the rigamarole and lost. That sounds criminal. Did they lie to the cops, too, and say they were allowed to keep her there? How did they get an entire hospital to go along with this?
Not just one judge, but two different ones. They didn’t like it when the first judge disagreed so they went to a different one who rejected them as well.
Nothing can make you feel powerless quite like a kafkaesque bureaucracy where the decisions are faceless and unaccountable.
This is one way to make a profit off the patient. I wonder if it would have happened if she had no insurance. Highly unlikely as the hospital wouldn't be able to milk the patient for money.
A second issue is these social workers whose main goal seems to want to remove children from parents and break up families in general for what I can only say is their own sick amusement. This is a fucked up job that gives way too much power to people who really don't care about others and often are unsuited to work with others. No one or even two individuals should have this kind of power. Removing someone's legal ability to make choices for themselves or their children should only be done by a consensus of multiple, independent parties that are not allowed to communicate with each other.
Finally, why did the DA not file charges of wrongful detainment / kidnapping against the hospital? This is not a mere disagreement. The article brushing this off as some petty doctor ignores the kidnapping and sending the police after the patient based on false statements to the police. At the very least the social worker, doctor, and nurse who contributed to this should all be fired and lose their licenses. These people should not be working on their respective fields and likely should be in jail. I hope the patient does sue but that won't prevent greedy or petty healthcare workers with too much power from doing this in the future.
A second issue is these social workers whose main goal seems to want to remove children from parents and break up families in general for what I can only say is their own sick amusement. This is a fucked up job that gives way too much power to people who really don't care about others and often are unsuited to work with others. No one or even two individuals should have this kind of power. Removing someone's legal ability to make choices for themselves or their children should only be done by a consensus of multiple, independent parties that are not allowed to communicate with each other.
Finally, why did the DA not file charges of wrongful detainment / kidnapping against the hospital? This is not a mere disagreement. The article brushing this off as some petty doctor ignores the kidnapping and sending the police after the patient based on false statements to the police. At the very least the social worker, doctor, and nurse who contributed to this should all be fired and lose their licenses. These people should not be working on their respective fields and likely should be in jail. I hope the patient does sue but that won't prevent greedy or petty healthcare workers with too much power from doing this in the future.
This is one way to make a profit off the patient. I wonder if it would have happened if she had no insurance. Highly unlikely as the hospital wouldn't be able to milk the patient for money.
I have no idea how to find it, but your comment reminds me of some horrifying article about the addiction treatment industry leeching all the money they could from patients with good insurance without really getting them better, not sincerely trying to do so.
I have no idea how to find it, but your comment reminds me of some horrifying article about the addiction treatment industry leeching all the money they could from patients with good insurance without really getting them better, not sincerely trying to do so.
They made a documentary about it as well: http://www.thebusinessofrecovery.com/phone/index.html
Hardly surprising. Every other medical specialty does the same and addiction treatment is essentially unregulated. Lots of suffering and misery to exploit here to make a ton of money for people with no morals (of which there are many).
Hardly surprising. Every other medical specialty does the same and addiction treatment is essentially unregulated. Lots of suffering and misery to exploit here to make a ton of money for people with no morals (of which there are many).
> This is a fucked up job that gives way too much power to people who really don't care about others and often are unsuited to work with others.
The problem is that CPS (or equivalent) jobs aren't nearly paid well enough, with an ever rising load of cases (for example due to morons calling CPS on their neighbors for letting their kids play in the garden). This results in underpaid, probably underqualified, and massively overworked employees. Which in turn often leads to employees preemptively taking kids out of families because they're afraid they might be on the hook if they leave the kids, but don't have the time to properly assess the situation.
The problem is that CPS (or equivalent) jobs aren't nearly paid well enough, with an ever rising load of cases (for example due to morons calling CPS on their neighbors for letting their kids play in the garden). This results in underpaid, probably underqualified, and massively overworked employees. Which in turn often leads to employees preemptively taking kids out of families because they're afraid they might be on the hook if they leave the kids, but don't have the time to properly assess the situation.
This is the second similar news story this month.
The thing in common is that both sets of parents were either divorced or not biological, and the hospital tried to use leverage to push them off balance with bogus law citations and police involvement.
The trump card that hospitals play in a dispute is to call police and have you arrested for trespassing.
The thing in common is that both sets of parents were either divorced or not biological, and the hospital tried to use leverage to push them off balance with bogus law citations and police involvement.
The trump card that hospitals play in a dispute is to call police and have you arrested for trespassing.
Really would like to know how it got to that point. I'm not far from Mayo and its of course a well ('world renown') known hospital. I haven't heard many good stories. I know of close friends who have gone there to get help and heard multiple stories about how the Drs ego got in the way of patient care and listening to what the patient was telling them. It's sad that this is reflected in this story to what I think is the extreme and then to boot what looks to be attempts to cover it up by adding stuff onto her records after she had already left.
Would like to hear Mayo's story on this, but I have a feeling it will be more excuse/finger pointing than explanation.
I do hope that they take this as a lesson on patient care especially the Doctors.
Would like to hear Mayo's story on this, but I have a feeling it will be more excuse/finger pointing than explanation.
I do hope that they take this as a lesson on patient care especially the Doctors.
What is shocking that Mayo legal department was contacted and there was no reaction, nobody cared to prevent this blowout.
Mayo vice president was contacted by the board member, and nothing was done.
Social worker who should've defended patient rights actually acted against patient's will.
Mayo Patient Experience office was contacted and nothing was done.
Basically every person and institution whose jobs are to protect patient rights, failed. I wonder if all departments so unaccountable and dysfunctional in Mayo?
If its a case of one bad doctor, why so many of the hospital departments failed to do their job?
Basically every person and institution whose jobs are to protect patient rights, failed. I wonder if all departments so unaccountable and dysfunctional in Mayo?
If its a case of one bad doctor, why so many of the hospital departments failed to do their job?
Imagine what happens to people like this who have no family.
They stay in a reputable medical institution and get better after a debilitating aneurism?
That demonstrates an ignorance of what the medical profession is like in practice.
People without family to watch them get terrible care.
There are exceptions (ICU for example is usually pretty good), but any care that doesn't have someone watching/caring for them 24/7 is going to be bad.
You NEED someone in the hospital watching out for you, unless you are in a unit where there is a permanent nurse on duty with you (not doing rounds). Typically family or friends fulfill this role because hospitals can not afford to do it.
People without family to watch them get terrible care.
There are exceptions (ICU for example is usually pretty good), but any care that doesn't have someone watching/caring for them 24/7 is going to be bad.
You NEED someone in the hospital watching out for you, unless you are in a unit where there is a permanent nurse on duty with you (not doing rounds). Typically family or friends fulfill this role because hospitals can not afford to do it.
Had a recent experience where there was no continuity of care. Every nurse did something different, despite specialists assuring us that instructions were on file. Were the nurses even reading the chart/orders?
Definitely worried things would have been worse if we weren't both present and lucid.
Definitely worried things would have been worse if we weren't both present and lucid.
We weren't talking county general here. This was the Mayo clinic.
I'm appalled at the anti-science luddite response to this yellow journalism that's called a news article, especially from HN folk.
I'm appalled at the anti-science luddite response to this yellow journalism that's called a news article, especially from HN folk.
LOL... my mother was in a hospital more famous than Mayo and it’s a lot different than you might think. My mother got 1000% better care than her roommates that didn’t have 24/7 family coverage.
Or till their insurance runs out...
This is way beyond Hanlon's Razor assuming this article is both complete and accurate. Mayo Clinic clearly acted in a way that would protect their income and not their patient, going as far as to try to use legal leverage to ensure neither the patient nor the parents could decide to get even a second opinion. Would you step foot into a Mayo Clinic the same ever again if this happened to you?
I am having a hard time understanding how Mayo was able to basically hold one of their patient hostage. Isn't that akin to kidnapping?
But also:
What prevented Alyssa from getting up her bed and walk out? When did her parents start "figuring out how to escape" and how long for? If they were at that point were they believed they needed to "escape" from the hospital, why didn't they call the police?
But also:
What prevented Alyssa from getting up her bed and walk out? When did her parents start "figuring out how to escape" and how long for? If they were at that point were they believed they needed to "escape" from the hospital, why didn't they call the police?
> What prevented Alyssa from getting up her bed and walk out?
They assigned two nurses to watch her day and night.
> why didn't they call the police?
They probably figured the police would automatically believe the hospital.
They assigned two nurses to watch her day and night.
> why didn't they call the police?
They probably figured the police would automatically believe the hospital.
> What prevented Alyssa from getting up her bed and walk out?
She needed to be pushed out in a wheelchair. She was presumably only provided access to one due to the pretext of "Grandma Betty" who (it was claimed) could not access Alyssa's room. Additionally, hospital staff attempted to physically restrain her from leaving, which may have been more successful without the ruse.
> If they were at that point were they believed they needed to "escape" from the hospital, why didn't they call the police?
This is a good question that's not fully addressed by the article, however, given that the police initially did side with the hospital when it came to a "our word vs theirs" situation, it may have been the correct choice.
She needed to be pushed out in a wheelchair. She was presumably only provided access to one due to the pretext of "Grandma Betty" who (it was claimed) could not access Alyssa's room. Additionally, hospital staff attempted to physically restrain her from leaving, which may have been more successful without the ruse.
> If they were at that point were they believed they needed to "escape" from the hospital, why didn't they call the police?
This is a good question that's not fully addressed by the article, however, given that the police initially did side with the hospital when it came to a "our word vs theirs" situation, it may have been the correct choice.
This reminds me of the film Unsane https://www.imdb.com/title/tt7153766/
They should definitely be taking Mayo to court. Absurd. But a good lesson and next time I check anyone into the hospital I will have legal counsel at hand.
know how I know this story has falsehoods?
"After the calls from police, Alyssa’s parents figured out that their phones were being pinged and took the batteries out."
90% chance they all had iPhones. can't take iPhone batteries out. if they didn't, what phones have removable batteries?
riddle me that.
"After the calls from police, Alyssa’s parents figured out that their phones were being pinged and took the batteries out."
90% chance they all had iPhones. can't take iPhone batteries out. if they didn't, what phones have removable batteries?
riddle me that.
>90% chance they all had iPhones
Not necessarily. Outside of tech and the wealthy android has pretty good market share. It wasn't mentioned what her parents did for work but among blue collar professionals cheaper Android phones are the norm because their work environment tends to be hazardous to phones with large, thin glass screens.
Not necessarily. Outside of tech and the wealthy android has pretty good market share. It wasn't mentioned what her parents did for work but among blue collar professionals cheaper Android phones are the norm because their work environment tends to be hazardous to phones with large, thin glass screens.
My phone does: a Samsung Galaxy.
I would consider this click bait and irrelevant on HN. The article is very long and contains very little factual information, making it impossible to understand the story or any of the arguments that could be made.
There is also a profound disrespect for human autonomy. Hospitals disrespect autonomy for many people in many ways, with the most common being when birthing mothers get locked in.
In this case, besides the parents, credit goes to a couple judges who denied the Mayo clinic's requests. You'd think one should be enough of course, and that seeking another judge should be prohibited. To give a doctor analogy: it's like hopping from doctor to doctor in search of pills.
Hospitals that do this sort of thing ought to take a fatal hit to their reputation. Nobody should accept being a customer. I suppose the news doesn't get out much, memories are short, advertising works, and most hospitals have a regional monopoly.