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.
It's better when you hold the Mayo instead of the other way round.
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."
Sure. Could you look up how to spell the name of the doctor from Airplane! and make it from him (opinionated)?
You're doing so good! Now make it opinionated.
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.
In capitalist America, Mayo hold you!
Just repeating the corrected joke in a new comment is something different, altogether.
Just repeating the corrected joke in a new comment is something different.
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.
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.
This was some hospital in Massachusetts. There's more to the story but maybe later...
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.
17: Barry - e-mail me the name.
19 It was 15-16 years ago and I can't recall the name of the hospital. It was in Springfield.
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.
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.
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.
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.
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.
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.
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.
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.
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.
You just need to get a new piece of bread.
I'm going to say something controversial: Duke's mayo is the best mayo.
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.
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.
36: That's sort of what I was getting at in the last paragraph of the OP.
32: the rebuttal says that they had someone who had been a lawyer write up a request for a transfer.
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.
In my experience, you can tell by when they just give you a box of morphine to take home.
I think you were supposed to sign for that.
I absolutely believe that they're [the family] entirely correct and the Mayo clinic did all this crazy shit.
The medical establishment's inertia and insistence on its own authority and rectitude are among the strongest forces known to man.
PEOPLE GET ALL ANTSY WHEN YOU CHANGE YOUR DIAGNOSIS HALFWAY THROUGH.
To be fair to Mayo, the rest of Minnesota's contribution to human health is Spam.
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.
34. That from a yahoo wahoo is high praise.
Those Kinds of People have earned my disregard.
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.
The Baroness of Egg and the Duke of Soybean Oil married for love and had a whirlwind relationship.
...until one day when they had a jarring encounter with the Earl of Sandwich.
When they found their spread on grain futures widening alarmingly.
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.
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).
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.
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?
IME yes in narnia, no in the good old USA.
there must be some amount of crazy for a US doctor to be able to do the same; I guess I'm not trying.
I told you, putty knives are too blunt.
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.)
Also she wasn't (being accused of being) "crazy", she was allegedly cognitively unable to manage her own care due to the aneurysm.
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.
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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