Comments on: Righteous outrage Medical Tragicomedy Sun, 13 Jul 2014 17:26:14 +0000 hourly 1 By: pgyx Sun, 13 Apr 2014 04:18:29 +0000 +1

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By: kitty Wed, 05 Mar 2014 19:45:14 +0000 I wonder if you also support the doctors in Mr Eckert case and Timothy Young case where NO DRUGS WERE FOUND and innocent people were subjected to anal searches, enemas and in Mr Eckert’s case – colonoscopy? How about “Jane Doe”‘s case where she was subjected to multiple searches, enemas, X-rays and a CT scan – again no drugs found? Is it OK according to you to subject people to degrading and potentially harmful procedures because it “might” be needed? What exactly was the benefit in any of these cases to justify emotional harm, potential risks and in Jane Doe’s case risks of cancer because of completely unnecessary CT scan?

Oh, and in all of these cases the “patients” were billed for the ‘services’…

By: Michael Wed, 08 Jan 2014 10:02:22 +0000 I want to preface by saying I’m an ER doctor in Canada where statutes/laws/etc. may be different but I certainly would hope doctors in the States would have the comparable idea of keeping the patient’s best interests in mind.

I’ve seen hundreds of drugged out patients (some brought in by police, most not) and my impetus to act is clear – if they verbally tell me no to a test or procedure, I will back the fuck off until 1) a medical emergency requires me to act (usually they fall into a coma / become severely obtunded) or 2) a warrant requires me to act or 3) they are so agitated because of their psychosis/etc. that they can be treated under a mental health law (which allows doctors to ONLY give medications/restraints to calm the agitation – antipsychotics/sedatives/etc. or treat acute medical emergencies, until they are assessed by a psychiatrist).

Furthermore, I will specifically NOT test for things that may incriminate my patients in the courts unless absolutely necessary – most certainly not even OFFER a rectal exam for a suspected packer (unless they specifically request it, not under duress of law). Are we working on the same planet? Do you work in some wonderland hospital where drug mules become future saints of society thanks to the kind ER doctor who forcibly removed what they themselves decided to insert 2 days earlier? Yes, there’s the (potentially fatal) risk of perforation, but that risk did NOT suddenly increase because they were brought in to the ER by police (as opposed to say, by EMS because they were complaining of acute chest pain).

Of course this is different if someone wants it out (e.g. bowel obstruction because of the multiple packs) or it has perforated – a true medical emergency. I’ve only seen one true perforated pack in my time, barely touched my hands (enough for me to get the scoop from EMS) before being whisked off by surgery and ICU afterwards. This guy? He sounds like 90%+ of addicts brought in by police. And yes, some of those are packing. And no, I don’t give a shit without a warrant. Even if there is a string hanging out of his ass, if the addict doesn’t want it out, the police can get a warrant or fish it out themselves.

So the idea that a guy is brought in by police and because of “suspicion of packing” that a doctor would forcibly subject a patient to those tests, in the LACK of an emergency situation, is certainly barbaric to me. And yes, I get it, it could turn into an emergency, it may have been an impending emergency, sure. Every time I send back home a failing-to-cope 80 year old with COPD and CHF I may be sending home an impending emergency. But to me it’s pretty clear – there was no ACUTE medical emergency; therefore regardless of consent there should have been ASSENT for any medical procedures (which there was not).

The fact that this same doctor did the EXACT SAME THING a few years ago to a person with an ultimately NORMAL rectal exam makes me seriously doubt he had the patient’s (as opposed to the police’s) best interests in mind.

By: Zac Wed, 08 Jan 2014 02:07:35 +0000 I don’t dislike either of your posts, I’m simply trying to argue a point. That said, if I reviewed the medical records and felt that they supported my version, I would absolutely argue against you on the stand that there is “clearly time to obtain a warrant.” That process can take a very long time; time which this patient may not have had.

I know that you have had your share of surgical emergencies throughout your career. I suspect some of those were exploratory laps for drug ingestions, either from packers or stuffers. I hope none of those patients died while you were waiting for a warrant before you got the ruptured packet/condom/baggie out.

I should also mention; I’m aware that the court seems to have decided against Dr. LaPaglia in this particular brief. That’s a legal opinion though, not a medical one. Just remember, these are not medical personnel and may not understand the decisions we have to make.

By: Skeptical Scalpel Tue, 07 Jan 2014 21:47:51 +0000 I am the surgeon who wrote the post you refer to in your first paragraph.

You are right that there are usually two sides to every story

I admire your loyalty to your colleague, but I must call your attention to page 4 of the narrative of the court case. It says, “At 2:50 p.m., the cruiser arrived at the hospital. Although Booker denied having anything in his rectum, had no physical symptoms, and had normal vital signs, LaPaglia proceeded without waiting.”

There was clearly time to obtain a warrant. Also, the presence of something in the rectum could have been determined with a plain x-ray of the pelvis.

You probably aren’t going to like my post from yesterday either. It’s about some even more dubious searches in New Mexico and Texas. Here’s the link:

By: Zac Tue, 07 Jan 2014 19:43:18 +0000 I agree with several of your points, Christopher, but the lynchpin here is the patient’s competence. If he was as wild as the police statements make him out to be, I don’t think you’d be able to argue that he was in his right mind – and thus, not able to make decisions for himself.

If the doc refused to do the DRE on ethical grounds, and the patient later died in custody, I guarantee you that the prosecuting attorney would argue that Booker was not competent/capable of making decisions. How could he be? There were 5.7 grams of coke working through his system!

“Informed consent” really only comes into play when the person is capable of making that decision themself. When you’re on a scene call and a patient has a GCS of 3, do you stop to consent them before you intubate? It’s the same general concept.

By: Christopher Tue, 07 Jan 2014 19:10:53 +0000 I have a hard time sympathizing with the EP on this one…yeesh. RSI for a DRE of a suspected drug mule is ridiculous, and if anything more charges need to be brought against the police and the physician (and hospital, and any actor who was complicit in these actions). I put these actions on par with rape.

If they’re competent to refuse care, they are able to refuse care. Even if the EP thinks the care is medically necessary.

Considering how poor the informed consent appears to be from the court records, I doubt the EP would have done a stellar job with an informed refusal of treatment…but whatever. He made his mind up about searching the man’s rectum prior to the police bringing him in.

If the police would like to search your anus, they need a warrant plain and simple.

By: Gbella Tue, 07 Jan 2014 18:26:12 +0000 *Good to see you are back!

By: Gbella Tue, 07 Jan 2014 18:25:44 +0000 Go to see you are back! I think, either way emergency doctor was just doing his best to help the patient/suspect, why is being put the circus of justice system? It doesn’t make sense.