Re: Guest Post - Medical Kidnapping

1

I am predisposed to be incredibly suspicious of medical institutions - there is entirely too much belief in their authority over patients and emphasis on compliance. No matter how wacky the family is - if an adult wants to leave a medical facility there should be a very high bar to go against that. I remember the intense pressure to stay in the hospital after my 2nd uncomplicated, unmedicated vaginal delivery - it felt like jail.


Posted by: RebeccaS | Link to this comment | 08-17-18 11:30 AM
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It's better when you hold the Mayo instead of the other way round.


Posted by: Moby Hick | Link to this comment | 08-17-18 12:17 PM
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3

Ha.


Posted by: heebie-geebie | Link to this comment | 08-17-18 12:29 PM
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4

Can I edit your joke please? I think next time you should use this delivery: "Sometimes you hold the Mayo, sometimes the Mayo holds you."


Posted by: heebie-geebie | Link to this comment | 08-17-18 12:30 PM
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Sure. Could you look up how to spell the name of the doctor from Airplane! and make it from him (opinionated)?


Posted by: Moby Hick | Link to this comment | 08-17-18 12:32 PM
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Dr. Jabbar, I'm pretty sure.


Posted by: heebie-geebie | Link to this comment | 08-17-18 12:40 PM
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Rumack. I looked it up myself.


Posted by: Moby Hick | Link to this comment | 08-17-18 12:42 PM
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You're doing so good! Now make it opinionated.


Posted by: heebie-geebie | Link to this comment | 08-17-18 12:44 PM
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I often don't click through and haven't read most of the links yet, but CNN's rebuttal link is a piece of work.


Posted by: Cyrus | Link to this comment | 08-17-18 12:44 PM
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In capitalist America, Mayo hold you!


Posted by: Opinionated Yakov Smirnoff | Link to this comment | 08-17-18 1:01 PM
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11

Just repeating the corrected joke in a new comment is something different, altogether.


Posted by: Opinionated Dr. Rumack | Link to this comment | 08-17-18 1:02 PM
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12

Mayo is killing Millennials.


Posted by: dalriata | Link to this comment | 08-17-18 1:03 PM
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Just repeating the corrected joke in a new comment is something different.


Posted by: heebie-geebie | Link to this comment | 08-17-18 1:04 PM
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Thank you.


Posted by: Moby Hick | Link to this comment | 08-17-18 1:05 PM
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I've had far too much bourbon to write details but around 16 years ago I had a medical incident where the hospital almost killed me, they wanted to keep me overnight but I got the hell out of there as soon as I could because I knew I'd end up on a cold slab if I'd stayed. I had a 105 temperature, after they measured it about 3 hours after I begged them to take my temperature because I knew I was running a high fever, they thought I was having some kind of psychotic break and wanted to put me on valium and some other psychiatric meds. Motherfuckers, take my temperature first!
I guess that's a lot of details. Maybe I should have more bourbon.


Posted by: Barry Freed | Link to this comment | 08-17-18 1:18 PM
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CNN's rebuttal also leaves down at the very bottom that the mother recently had a meth conviction. Maybe that explains some of Mayo's standoffishness, but I don't think it excuses the level of behavior described.


Posted by: Minivet | Link to this comment | 08-17-18 1:19 PM
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This was some hospital in Massachusetts. There's more to the story but maybe later...


Posted by: Barry Freed | Link to this comment | 08-17-18 1:20 PM
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Doctors and other medical staff in the US get completely tied up in knots when patients refuse to do what the "standard of care" dictates. A huge amount of research goes into the boards of top specialists getting together and establishing the standard of care which is then supposed to be followed, trying to create a "checklist", trying to reduce the number of decisions that have to be made. And it's worse of course when it's not the "patient" refusing, but a parent refusing the standard of care for a child.

Like many negative aspects of doctor behavior (e.g. being unable to apologize or admit mistakes), this is mostly because of fear of getting sued. The same patient who refuses to do something that is 100% the consensus can come back after the condition gets worse and say that if it was explained to them better, then of course they would have taken the doctor's advice. And from the perspective of medical staff who feel bound by duty to follow the standard of care, they think it's extremely likely that the condition will get worse if the standard of care is ignored, and they think it's then extremely likely that the patient will get mad at the hospital. And just about any amount of stalling until the patient agrees to do the recommended treatment is preferable to that.

I think electronic medical records make it worse too. Things pop up in the record reminding the medical staff that if you did this thing, you really need to do this other thing or you will keep getting reminders that you're doing the wrong thing.


Posted by: Cryptic ned | Link to this comment | 08-17-18 1:26 PM
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17: Barry - e-mail me the name.


Posted by: Bostoniangirl | Link to this comment | 08-17-18 1:38 PM
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19 It was 15-16 years ago and I can't recall the name of the hospital. It was in Springfield.


Posted by: Barry Freed | Link to this comment | 08-17-18 1:46 PM
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it's worse of course when it's not the "patient" refusing, but a parent refusing the standard of care for a child.

In this case (a) the patient was 18 when admitted, although this does not seem to have penetrated with the Mayo doctors as per the meeting narrated by CNN - possibly because she was still in high school? - and (b) it seems less likely it was the standard of care if a different hospital (also a teaching hospital) agreed inpatient care was not called for.


Posted by: Minivet | Link to this comment | 08-17-18 1:48 PM
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The patient was 18, but in CNN's rebuttal, they say something like "The Mayo clinic said that her condition was potentially dangerous, and yet she's going to start college a year and a half later!" which I found not particularly convincing as to whether or not she was impaired in the months immediately after the aneurysm.


Posted by: heebie-geebie | Link to this comment | 08-17-18 2:15 PM
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If CNN reported the story over a period of 17 months, including extensive contacts with law enforcement, how could they possibly not have known about the kids being removed from the house? If they are arguing that it was irrelevant, that would be one thing, but it really strains credulity to the breaking point to say that the Mayo press release was the first they had heard of it.


Posted by: Natilo Paennim | Link to this comment | 08-17-18 3:06 PM
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FIREBALL


Posted by: OPINIONATED PITBULL | Link to this comment | 08-17-18 3:16 PM
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She was an adult. Why would her mother's perceived bad behavior mean that Alyssa was kept in the hospital against her will? She said it just doesn't make sense

Oh, hmm, because your mom is a methamphetamine addict and child abuser who has a habit of grabbing and yelling at the staff? Yeah, how could they possibly have been worried? And it's more than a little bit disingenuous to talk about the allegedly better care that she got at another hospital (in South Dakota?!? give me a freaking break) when Mayo had no way of knowing where the parents were going to take her. From the interactions they'd had with the mother, I think a reasonable person would have questioned whether the young woman was going to get any further medical treatment at all.


Posted by: Natilo Paennim | Link to this comment | 08-17-18 3:19 PM
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18: A good friend freaks out when anyone suggests that doctors insist on treatments over patient or insurance company objections because they are afraid of getting sued. Dr. Friend is adamant that he doesn't give a shit about getting sued, but cares quite a lot about patients getting the best possible care.

If a patient or a patient's parent rejects the standard of care, and it's properly documented, a medmal case probably won't get anywhere anyway. But the patient is still unnecessarily dead. Avoiding that is worth arguing with the patient/parent/insurer.


Posted by: unimaginative | Link to this comment | 08-17-18 4:01 PM
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I'm not going to read enough to form an opinion about Mayo's behavior, but in general I think you should avoid bleeding into or out of your brain. I will stand by that.


Posted by: Moby Hick | Link to this comment | 08-17-18 4:43 PM
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The Justina Pelletier case in MA sounds somewhat similar. The child had "mitochondrial disease." Got a lot of press coverage locally and a fair amount nationally, and was referred to as "medical kidnapping."

Neither Children's Hospital nor the parents come across well.


Posted by: DaveLMA | Link to this comment | 08-18-18 5:34 AM
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When Sharlene Cheng (程劭儀) told her patient that her breast cancer had metastasized to her lungs, the doctor and members of the patient's family nearly came to blows.


Posted by: Mossy Character | Link to this comment | 08-18-18 7:07 AM
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My good friend is a medical ethicist who specializes in power relations between both patients and doctors and doctors and researchers/other doctors. None of this surprises me at all.

My guess is the whole family was a piece of work so Mayo thought they could get away with holding the daughter against her will and likely not have to face serious repercussions. I think there's some interesting class/race/rurality stuff occurring, in that in Minnesota being poor vulgar locally-rooted rural white people gets you treated like garbage by Mayo staff but carries some prestige/support with other powerful institutions like the police or members of the community. By contrast homeless drug addicts of color and single elderly poor women with internet self-diagnoses generally end up on the wrong side of all sorts of institutions and don't tend to get CNN stories about their medical kidnapping.*

*One case my friend dealt with was a homeless alcoholic who was actively dying. He asked to be discharged to die in the fresh air, and the hospital refused, claiming they didn't let people die in the streets. Instead they locked him in a darkened room against his will where he died two days later. It was framed as the patient irrationally rejecting care, although given that the care was to wait for him to die, it's hard to see how his desire to die outside rather than in a locked room was irrational.


Posted by: Buttercup | Link to this comment | 08-18-18 10:31 AM
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30.last That's awful.


Posted by: Barry Freed | Link to this comment | 08-18-18 10:33 AM
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It is widely known that surgeons do not have people skills. They have mad skills doing surgery and that's it. The surgeon who (in Part I) was in charge comes across that way.

If there is one rule that Amber did not properly follow, other than "don't be a PITA even if you are justified," it's "put/get everything in writing." Asking to have Alyssa discharged or transferred counts for nothing if it's verbal and the staff wants to ignore it.

I think Mayo comes off pretty badly.


Posted by: DaveLMA | Link to this comment | 08-18-18 11:53 AM
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33

You just need to get a new piece of bread.


Posted by: Moby Hick | Link to this comment | 08-18-18 12:01 PM
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34

I'm going to say something controversial: Duke's mayo is the best mayo.


Posted by: Stanley | Link to this comment | 08-18-18 12:05 PM
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32: I think a lot of stuff was in writing, based on the CNN rebuttal. The one where I thought the mom probably came off the worst is when she saw 3 staff members talking in another room, through a window panel in the door or something, and was convinced they were discussing her daughter, so she barged in and wouldn't leave, and I think that's when she got ejected and barred from the hospital.


Posted by: heebie-geebie | Link to this comment | 08-18-18 1:13 PM
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I have thoughts about lower middle class rural white people that I'm trying to avoid projecting into this story by not reading the links.


Posted by: Moby Hick | Link to this comment | 08-18-18 1:17 PM
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37

Also, same for doctors.


Posted by: Moby Hick | Link to this comment | 08-18-18 1:21 PM
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36: That's sort of what I was getting at in the last paragraph of the OP.


Posted by: heebie-geebie | Link to this comment | 08-18-18 3:35 PM
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39

Get out of my head.


Posted by: Moby Hick | Link to this comment | 08-18-18 3:49 PM
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32: the rebuttal says that they had someone who had been a lawyer write up a request for a transfer.


Posted by: Bostoniangirl | Link to this comment | 08-18-18 4:55 PM
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29: Interesting. Thanks for linking it. I'm pretty sure I wouldn't be able to find the stat, but in the US, doctors are bad at telling people there is no remaining treatment for their terminal condition. Some alarming percent of patients and their families don't understand the odds/timelines, even when the doctor feels communication was clear.


Posted by: ydnew | Link to this comment | 08-18-18 5:46 PM
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In my experience, you can tell by when they just give you a box of morphine to take home.


Posted by: Moby Hick | Link to this comment | 08-18-18 6:10 PM
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43

I think you were supposed to sign for that.


Posted by: Mossy Character | Link to this comment | 08-18-18 6:12 PM
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I absolutely believe that they're [the family] entirely correct and the Mayo clinic did all this crazy shit.


Posted by: E. Messily | Link to this comment | 08-18-18 6:13 PM
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The medical establishment's inertia and insistence on its own authority and rectitude are among the strongest forces known to man.


Posted by: E. Messily | Link to this comment | 08-18-18 6:15 PM
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PEOPLE GET ALL ANTSY WHEN YOU CHANGE YOUR DIAGNOSIS HALFWAY THROUGH.


Posted by: GREG HOUSE MD | Link to this comment | 08-18-18 6:19 PM
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To be fair to Mayo, the rest of Minnesota's contribution to human health is Spam.


Posted by: Moby Hick | Link to this comment | 08-18-18 6:27 PM
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What a shit show. I'm pretty shocked at the "yeah but the family's kind of trashy, so, who knows what really happened?" undertones. On the one hand, multiple layers of Mayo staff behaved atrociously over months and blatantly lied about a bunch of verifiable facts. On the other hand, the mom doesn't really seem like Our Kind of People. Oh, well, there's probably some truth to both sides.


Posted by: E. Messily | Link to this comment | 08-18-18 6:48 PM
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34. That from a yahoo wahoo is high praise.


Posted by: md 20/400 | Link to this comment | 08-18-18 10:22 PM
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Those Kinds of People have earned my disregard.


Posted by: Mossy Character | Link to this comment | 08-18-18 10:25 PM
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49: Totally different Duke (fuck Duke!). The Duke of Mayonnaise started in South Carolina before settling in Richmond, Va., far from the Douchebags of Durham.


Posted by: Stanley | Link to this comment | 08-19-18 6:13 AM
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The Baroness of Egg and the Duke of Soybean Oil married for love and had a whirlwind relationship.


Posted by: Moby Hick | Link to this comment | 08-19-18 6:28 AM
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...until one day when they had a jarring encounter with the Earl of Sandwich.


Posted by: Stanley | Link to this comment | 08-19-18 7:05 AM
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When they found their spread on grain futures widening alarmingly.


Posted by: Mossy Character | Link to this comment | 08-19-18 7:15 AM
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40. Didn't the article say that Mayo only received the written request after she escaped/left/was "abducted"? (Then Mayo ridiculed the lawyer during the CNN interview. Very professional of them.) The situation had been going on for a long time before the family had that letter prepared. That was the only written communication asking for a transfer/release I recall being mentioned in the articles.


Posted by: DaveLMA | Link to this comment | 08-19-18 5:46 PM
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If you are an adult patient in a medical care setting in the US, you do not have to submit every request you make in writing. This is a crazy expectation. Patients are allowed to say "I am going to leave now", and, barring really unusual circumstances, the hospital doesn't get to physically restrain you (or call the cops).


Posted by: E. Messily | Link to this comment | 08-19-18 6:17 PM
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On February 27, [attorney] Rego spoke on the phone with Joshua Murphy, Mayo's chief legal officer, and faxed him a letter urging Mayo to transfer Alyssa to another facility.

The "escape" was on February 28, per part 2.


Posted by: Minivet | Link to this comment | 08-19-18 7:09 PM
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Patients are allowed to say "I am going to leave now", and, barring really unusual circumstances, the hospital doesn't get to physically restrain you (or call the cops).

Is "a psychiatrist has examined this patient and found that she is not mentally competent" one of those circumstances?


Posted by: ajay | Link to this comment | 08-20-18 3:06 AM
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IME yes in narnia, no in the good old USA.


Posted by: alameida | Link to this comment | 08-20-18 5:56 AM
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there must be some amount of crazy for a US doctor to be able to do the same; I guess I'm not trying.


Posted by: alameida | Link to this comment | 08-20-18 6:00 AM
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I told you, putty knives are too blunt.


Posted by: Mossy Character | Link to this comment | 08-20-18 6:03 AM
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58- nope. There are special involuntary-hold procedures. (also that was one of the most extremely sketchy parts of the story- it is pretty clear that in fact she was not incompetent, and that if she had been the hospital had been grossly mismanaging her case on that basis anyway, because they'd been allowing her to make her own decisions and sign her own legal documents for months.)


Posted by: E. Messily | Link to this comment | 08-20-18 7:23 AM
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Also she wasn't (being accused of being) "crazy", she was allegedly cognitively unable to manage her own care due to the aneurysm.


Posted by: E. Messily | Link to this comment | 08-20-18 7:25 AM
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Right. Taking away someone's decisionmaking capabilities requires a lot more procedure than "our psychiatrist examined her and says this" in the medical record, and very rightly so.


Posted by: Minivet | Link to this comment | 08-20-18 8:01 AM
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The other thing is: why isn't the involuntary administration of ketamine to MPLS arrestees a cause celebre? That was dozens of people and it's just being swept under the rug. I am sure that the race of the affected people could not possibly be a factor.


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