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Soulive

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Before the injection knocked me out, I would've knocked them out by inserting my foot in their ass...
 

EdWort

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That guy just hit the lottery. That fricking hospital is going to pay and pay through the a$$ (yes, pun intended) :D

Man the money he will get for being jailed and violated.

Reminds me of this shirt.

 

e lo

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Wow. I absolutely disagree. The doctors were performing an important test, and they had a suddenly combative patient, endangering them all. I strongly feel that they behaved appropriately. DRE is standard procedure for Trauma secondary screening. It's potentially diagnostic for spinal cord injury, GI bleeds, and urethral disruption. If the Pt. was incapacitated enough that the Drs. suspected a spinal cord injury, they could very well be sued for NOT performing the DRE. What we learned in med school is that there are only two reasons for not performing the DRE: 1) You don't have a finger or 2) the Pt. doesn't have an anus.
 

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E lo, that's all well and good, but until today I have never heard of such a procedure. How much you wanna bet that most of the public would never equate "Check to see if my spine is broken" with "Hey the best way to check that is to sodomize me!" It's very counter intuitive to me, Mr. Joe Public. I'm actually curious, how does a finger up the butt check for spinal injury? Urethral disruption I kinda get because you can check the prostate that way, and is GI bleed mean gastrointestional bleeding?

Also, a patient has the right to refuse treatment for anything even if it's at their detriment. He told them not to do that, and they beat him, handcuffed and sedated him to do it anyways. I believe that's what he's suing them about.
 
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e lo said:
Wow. I absolutely disagree. The doctors were performing an important test, and they had a suddenly combative patient, endangering them all. I strongly feel that they behaved appropriately.
Honestly, I can see it either way, but we don't know nearly enough about what actually transpired to make that judgment. Melana is right...not enough information!
 

the_bird

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EdWort said:
Reminds me of this shirt.

The "before" picture still looks a little bit on the large side, no?

Incidentally, how immature is it of me that when I was listening to the astronomy show on NPR, I couldn't stop laughing when they said "Uranus looks like a little star"... :D
 

e lo

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EvilTOJ said:
E lo, that's all well and good, but until today I have never heard of such a procedure. How much you wanna bet that most of the public would never equate "Check to see if my spine is broken" with "Hey the best way to check that is to sodomize me!" It's very counter intuitive to me, Mr. Joe Public. I'm actually curious, how does a finger up the butt check for spinal injury? Urethral disruption I kinda get because you can check the prostate that way, and is GI bleed mean gastrointestional bleeding?

Also, a patient has the right to refuse treatment for anything even if it's at their detriment. He told them not to do that, and they beat him, handcuffed and sedated him to do it anyways. I believe that's what he's suing them about.
I sincerely doubt that they beat him, handcuffed him and sedated him in order to perform a DRE, which, buy the way, is NOT SODOMY. It's uncomfortable and emotionally difficult, yes, but it's not sodomy. One is intended to help a patient, the other is ... well, is sodomy. In all likelihood, he was combative, and was injured in a struggle with security or other staff, which necessitated the handcuffs and sedation. I'm not sure as to the procedure for DRE in terms of spinal injury assessment; I've never performed one for that reason, but I do know it is SOP in many ERs. That may change, however, as new studies indicate that it doesn't change the outcome of treatment as much as once though. However, I'd imagine it's probably similar to a normal prostate exam.

Combative patient behavior is extremely unpredictable, and is based on the choices of one injured person at the spur of the moment. ER (and elsewhere in the medical field) SOP is based either on outcomes based research or many many cumulative person-years of clinical experience. You tell me which one is likely to be in the wrong here.

Oh, and yes, GI is gastrointestinal.

Sorry, by the way -- this came off sounding snarkier than I meant it to. I just get tired of people assuming medical personel are always in the wrong, or have some sinister motivation when they do emotionally and physically uncomfortable things like a DRE. Jeez... even that sounded snarky. I think I need to RDWHAHB. :mug:
 
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c.n.budz

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the_bird said:
Incidentally, how immature is it of me that when I was listening to the astronomy show on NPR, I couldn't stop laughing when they said "Uranus looks like a little star"... :D
Don't feel bad. I was watching How It's Made tonight during dinner. They were showing how ball bearings are made. The guy kept saying balls, and ball spacer, and ball dispenser, and ball this, and ball that. I was laughing so hard I nearly shot spanish rice out my nose
 

Dr_Deathweed

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EvilTOJ said:
E lo, that's all well and good, but until today I have never heard of such a procedure. How much you wanna bet that most of the public would never equate "Check to see if my spine is broken" with "Hey the best way to check that is to sodomize me!" It's very counter intuitive to me, Mr. Joe Public. I'm actually curious, how does a finger up the butt check for spinal injury?

Technically, its possible. A rectal exam can give a Dr. information that could suggest nerve damage that would suggest a spinal injury. But personally I think I would just take x-rays......

But I'm just a vet student, what do I know about people medicine?
 

eriktlupus

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hello he got eight stitches above his freakin eyebrow!! how is sticking a finger in his a## helping him? or finding spinal damage?
 

srm775

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e lo said:
Wow. I absolutely disagree. The doctors were performing an important test, and they had a suddenly combative patient, endangering them all.
True, they were doing a completely legitimate test ... THAT HE REFUSED. The patient, of sound mind, has absolute right of refusal for ANY treatment. A voluntary patient refused the procedure was restrained and given a procedure against his will.

Isn't the first part of the hippocratic oath "to first do no harm"?
 

Evan!

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From the article, it seems the reason he was "combative" in the first place was because they wouldn't accept his refusal to have people poking around in his anus because of a bump on the forehead. I think I'd get combative too.
 

homebrewer_99

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I think he's going to win big for the simple fact that it seems they did not tell him up front that it was part of the normal procedure BEFORE they tried to perform it...it looks like they just forced themselves upon him.

What would you have done in a similar situation? I'd probably have stitches in my forehead also...:mad:
 

e lo

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srm775 said:
True, they were doing a completely legitimate test ... THAT HE REFUSED. The patient, of sound mind, has absolute right of refusal for ANY treatment. A voluntary patient refused the procedure was restrained and given a procedure against his will.

Isn't the first part of the Hippocratic oath "to first do no harm"?
Again.... whether the patient was in fact of sound mind is the thing in question here from my (admittedly biased) viewpoint. If the doctors had a legitimate reason to suspect lower spinal injury and a patient of questionable mental status (which, after head trauma, he most likely was), then they were acting in the best interest of the patient in accordance with their medical judgment and SOPs.

And no, technically that phrase appears nowhere in the Hippocratic oath. Feel free to look it up. It is, of course, one of the guiding tenets of medical care. However, if that phrase was in the oath, not assessing a Pt for an injury with paraplegia as a potential sequella would, without question, violate that portion of it.

Don't get me wrong -- patient autonomy is paramount in medical treatment. However, the ER is the one place where Pt autonomy is most difficult to come to, because of the injury and, more often than not, intoxication status of most of the Pts who come through.
 

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I don't care what the doctors say, if I refuse a treatment and do not give consent and they go ahead and force it anyway, they are going to lose big time. Make me sign the refusal, but don't bend me over for an exam where I can feel two hands on my shoulders at the same time.

This got way out of hand and could have been resolved with a signature, but nooooo, the guy ends up violated, injured and imprisoned against his will. I can hear the ka-ching ka-ching of the jackpot right now.

The real winner of this sad event will be the guys lawyer.
 

Jester369

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EdWort said:
This got way out of hand and could have been resolved with a signature, but nooooo, the guy ends up violated, injured and imprisoned against his will. I can hear the ka-ching ka-ching of the jackpot right now.
Yeah, but if a patient signs the form and the hospital doesn't do the procedure and it turns out they do have a spinal injury, how many would sue anyway, saying they should have known that he was not capable of making the decision due to the head injury?

A signature on a form means zero if the signer is not in a condition to decide. It all comes down to assessing the patients current ability to make reasoned decisions, and even then people always seem to be looking for the malpractice lottery. It's a damned if you do, damned if you don't. I wonder why people even want to become doctors anymore.

I seriously doubt the hospital staff looked at this guy and said "hey, lets have a little fun with him!"
 

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EdWort said:
I don't care what the doctors say, if I refuse a treatment and do not give consent and they go ahead and force it anyway, they are going to lose big time. Make me sign the refusal, but don't bend me over for an exam where I can feel two hands on my shoulders at the same time.

This got way out of hand and could have been resolved with a signature, but nooooo, the guy ends up violated, injured and imprisoned against his will. I can hear the ka-ching ka-ching of the jackpot right now.

The real winner of this sad event will be the guys lawyer.
Although I definitely see e lo's viewpoint in that the hospital staff was doing what they thought was best in the situation, your statements here are really the crux of the matter. If indeed the patient was not a minor and able to provide verbal refusal of a procedure, the hospital could easily have given him some form of written refusal to sign. The 'it's for your own good' mentality should never apply to an adult who is fully capable of rejecting the procedure and realizing what he/she is doing, imo.

I have found though that hospital staff are very much against when you don't just say "yes" to whatever they tell you. On one hand I understand where they are coming from, they are indeed the experts....however, this needs to be balanced with the actual wishes of the patient. I mean otherwise, whatever medicine can do to preserve life would automatically be applied regardless of the patient's desire. Some science fiction writing and/or movies have hit on this before where medicine of the future can extend life well beyond the natural cycles. Where does one draw the line between what the institution says is right and choices of the individual.
 

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Jester369 said:
Yeah, but if a patient signs the form and the hospital doesn't do the procedure and it turns out they do have a spinal injury, how many would sue anyway, saying they should have known that he was not capable of making the decision due to the head injury?

A signature on a form means zero if the signer is not in a condition to decide. It all comes down to assessing the patients current ability to make reasoned decisions, and even then people always seem to be looking for the malpractice lottery. It's a damned if you do, damned if you don't. I wonder why people even want to become doctors anymore.

I seriously doubt the hospital staff looked at this guy and said "hey, lets have a little fun with him!"
I agree, they were just following procedure. You make a good point in that the condition of the patient has to be assesed. I for one am tired of how commitments are viewed in our society. "I signed it but I really wasn't in a condition to sign it" seems like bunk to me because let's face it, if you were in that bad of a condition it would be really apparent. I think the line of where one becomes 'incapable to make rational decisions' has been artificially dropped out of fear of litigation. It is a problem with our system and society really in that people aren't willing to stick to their own word anymore.

Someone like EdWort probably would say "well hell I signed it, that was my choice" where other people could easily see the get-something-out-of-the-deal aspect and be like "I was incapable of making a decision".

It's no wonder why we have such a screwed up medical system. :(
 

srm775

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e lo said:
Again.... whether the patient was in fact of sound mind is the thing in question here from my (admittedly biased) viewpoint. If the doctors had a legitimate reason to suspect lower spinal injury and a patient of questionable mental status (which, after head trauma, he most likely was), then they were acting in the best interest of the patient in accordance with their medical judgment and SOPs.
It appears, based off the article, that a judge believed he was of sound mind and acted within the law, which is why he dismissed criminal battery charges.

I'm no doctor, but wouldn't the fact that he actively resisted (including punching out one of the doctors), enough to have to be restrained and sedated, kind of prove the fact he didn't have a serious spinal injury? At least, one that wasn't threatening immediate paralysis?

e lo said:
And no, technically that phrase appears nowhere in the Hippocratic oath. Feel free to look it up. It is, of course, one of the guiding tenets of medical care. However, if that phrase was in the oath, not assessing a Pt for an injury with paraplegia as a potential sequella would, without question, violate that portion of it.
Yeah, I realize that, but, as you mentioned, it is one of the keystones of the medical profession, which is good enough.
 

EdWort

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zoebisch01 said:
Someone like EdWort probably would say "well hell I signed it, that was my choice" where other people could easily see the get-something-out-of-the-deal aspect and be like "I was incapable of making a decision".
Darn right! Cause I'm a principle based kind of guy. Too many folks sue for whatever. Accidents happen, but still, if I was that guy and I told them to stay away from my rear and they forced me they would be looking at a court date no matter what.
 

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srm775 said:
I'm no doctor, but wouldn't the fact that he actively resisted (including punching out one of the doctors), enough to have to be restrained and sedated, kind of prove the fact he didn't have a serious spinal injury? At least, one that wasn't threatening immediate paralysis?
No, the injury could easily be there that could cause paralysis without actually having done so yet.

However, the fact that he refused a medically necessary check that could potentially save him from being crippled for life to the extent of becoming physically violence- for no other apparent reason than homophobia and lack of confidence in his manhood- IMHO does lend credence to the theory that he was not of sound mind or capable of making his own decisions.

Frankly, if you'd rather be a cripple for life than have a doctor do a simple check, then you DO have some serious problems with your decision making ability.

It sounds to me like he was too drunk or high to be capable of sound judgement (we KNOW he had a head injury)- hence the hospital staff decided to treat him without consent after he basically PROVED he did not have sound judgement.
 

Docapi

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EdWort said:
Darn right! Cause I'm a principle based kind of guy. Too many folks sue for whatever. Accidents happen, but still, if I was that guy and I told them to stay away from my rear and they forced me they would be looking at a court date no matter what.
You might be- but what about the next guy? Or, were he to die due to the inactivity, his wife? Or his spoiled rotten kid that sees a way to double his inheritance?

Problem is, stand up guys are a rarity any more. If they fail to treat, there is a much larger chance of a suit than if they treat against the patients wishes.

Even if they are wrong, at least they would be getting sued for doing the right thing (taking care of the patient) instead of the wrong one.

Think about it- who would YOU rather have for a doctor? The one that says "I'm going to save this person no matter what it takes" or the one that says "Well, gee whiz- I could try this and save him, but that treatment might possibly let me in for a lawsuit- better off to let him die"?
 

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srm775 said:
I'm no doctor, but wouldn't the fact that he actively resisted (including punching out one of the doctors), enough to have to be restrained and sedated, kind of prove the fact he didn't have a serious spinal injury? At least, one that wasn't threatening immediate paralysis?
I agree and futhermore, if they were willing to heavily sedate the guy, they couldn't have been TOO worried about his skull.

All to often exerts in any given field think they know better than their customers and those with any amount of authority or power over another person will trend toward exercising that authority as much as possible. In my experience doctors in ERs are among the worst (with police being the leaders in that area). I've not only been subject to their behavior but watched them do the same to other people.

It's a tough job, yeah, I get that. And they are very skilled, I get that. However, the level of calousness and bullying that goes on in an ER is, frankly, a bunch of crap.

I wish there was more competition in the medical field so that ******* docs could feel the pinch when their behavior drove off customers.
 
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Docapi said:
However, the fact that he refused a medically necessary check that could potentially save him from being crippled for life to the extent of becoming physically violence- for no other apparent reason than homophobia and lack of confidence in his manhood- IMHO does lend credence to the theory that he was not of sound mind or capable of making his own decisions.


It sounds to me like he was too drunk or high to be capable of sound judgement (we KNOW he had a head injury)- hence the hospital staff decided to treat him without consent after he basically PROVED he did not have sound judgement.
Assuming he didn't want the exam due to homophobia is going a bit far. It seems that he felt the exam wasn't necessary for his injury. He may have been wrong about that, but that was point of view.

And, it seems from the article, that the injury happened on the job so he most likely wasn't drunk or high
 

Docapi

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kornkob said:
All to often exerts in any given field think they know better than their customers
They do- hence the term "experts". If they didn't know more, then they wouldn't be experts.

This statement, coupled with the sentence prior, is a perfect example of the problem.

You have no clue what you are talking about (referring to the person being able to move, thus they must be fine), yet you insist that you know more than the people that have been studying, training, and working in the field for 12 years (minimum).


kornkob said:
I wish there was more competition in the medical field so that ******* docs could feel the pinch when their behavior drove off customers.[quote/]

Open up a phone book once. Check out the number of doctors,hospitals, clinics, specialists, etc. I don't think it is possible for one statement to be more wrong.
 

Docapi

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c.n.budz said:
Assuming he didn't want the exam due to homophobia is going a bit far. It seems that he felt the exam wasn't necessary for his injury. He may have been wrong about that, but that was point of view.

And, it seems from the article, that the injury happened on the job so he most likely wasn't drunk or high
If not homophobia, then what WAS the reason to not let them do this very simple test?

I wonder- did he punch out the nurse when she asked to put a thermometer in his mouth? Pretty much the same thing- sticking something in a bodily orifice.

Frankly, homophobia aside, the reason for his refusal is really irrelevant.

He was violently refusing a very simple check that could save him from being crippled for life.

THAT- no matter what his reasons were- shows an acute lack of ability to make sound decisions. Coupled with a head injury, I can't fault the hospital staff for deciding he was incapable at all.
 

srm775

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Docapi said:
No, the injury could easily be there that could cause paralysis without actually having done so yet.
Maybe, but if that were the case then there are several other non-invasive, and quite frankly better, procedures for detecting that injury, such as x-ray, MRI, etc. And, if the injury wasn't presenting then it seems like using that type of "emergency" procedure wouldn't tell you anything anyway.

Docapi said:
However, the fact that he refused a medically necessary check that could potentially save him from being crippled for life to the extent of becoming physically violence- for no other apparent reason than homophobia and lack of confidence in his manhood- IMHO does lend credence to the theory that he was not of sound mind or capable of making his own decisions.
So, if you fall and bump your head then go get stitches, do you expect to have your anus probed? Because he refused a medical procedure that involved having his anus explored doesn't make him necessarily homophobic or insecure in his manliness. Maybe he felt like he didn't have a spinal injury and just wanted to have his head stitched and go home and put an ice-pack on it. Or, maybe he wanted to follow up with his OWN physician. Perhaps, he wasn't comfortable with the medical staff's knowledge or ability and wanted a different opinion. Maybe he just wanted the lights turned down low and some Marvin Gaye put on before. It doesn't matter, he said no, and from the sounds of it, meant it.

It sounds to me like he was too drunk or high to be capable of sound judgement (we KNOW he had a head injury)- hence the hospital staff decided to treat him without consent after he basically PROVED he did not have sound judgement.
Actually, it sounds like you didn't read the article. It was a work related injury.
 

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Melana said:
Something tells me that there is more to that story....

Still, there is NO excuse for their actions.
My thoughts exactly. Bottom line though, (pun intended) no hospital can force somebody to receive unwanted tests or treatment.
 

Docapi

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srm775 said:
Actually, it sounds like you didn't read the article. It was a work related injury.
Work related certainly doesn't preclude drunk or high.

Nonetheless, I admit I missed that.

I'd still like to know- other than homophobia- what reason is there for refusing a simple procedure that could save you from being crippled for life?

Can you come up with one? I can't.

If not homophobia, then what? Did he have the same problem with getting his temperature taken?

The homophobia comment really comes from this thread- where phrases like "sodomized" "violated" and "Tested with 2 hands on his shoulders" appear to be the norm.

Maybe the person in question wasn't refusing due to homophobia (I doubt it though), but it is where an awfully large portion of this discussion is coming from.
 

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Docapi said:
Think about it- who would YOU rather have for a doctor? The one that says "I'm going to save this person no matter what it takes" or the one that says "Well, gee whiz- I could try this and save him, but that treatment might possibly let me in for a lawsuit- better off to let him die"?
I don't think (to me at least) that's the point though. I'd rather have neither. I'd like to have a doctor that says "Sir if we don't do a rectal exam there is a possibilty we could overlook a major problem. But if you choose to not have the procedure done then that is your choice and you alone will bear the responsibility. As a professional we believe it is crucial you have it done"

It would have been a different case if the guy had fallen two stories and landed on his backside. But the article says he was hit in the forehead, which indicates to me a possible case of protocol-over-logical procedure that is very common. Or if the guy was not cognitive, then I could see them escalating the issue.

Think of it this way. You go into the ER for a cut on your forehead and they say "well we gotta give you a Rectal Exam". To me that seems like...wtf...(pardon the language). Of course, this is based on what details we have. If there was something in the article like, the guy fell down two flights of stairs after having recieved the blow to the forehead and that he had to be taken by Ambulance to the hospital and he was in a state of shock, well then I'd say the hospital did the right thing. But if he just got hit in the forehead then that indicates to me they were just doing a COA.
 

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Docapi said:
He was violently refusing a very simple check that could save him from being crippled for life.

THAT- no matter what his reasons were- shows an acute lack of ability to make sound decisions.
You are making a value judgement, not a medical judgement. Strict medical/legal criteria apply when determining if a patient is incompetent and merely disagreeing with the doctors' recommendations is not enough to qualify.

If your criteria were applied to all medical decision making then patients would not have any right of refusal at all. There would be no living wills, no Do Not Resuscitate orders, no hospice care.

From the Stanford Law Center,Competency to Make Medical Decisions

"Incapacity is present if a mental status defect renders the individual unable to understand and knowingly and intelligently act upon consent information using rational processes. This is a determination made in the first instance by the treating doctor. A competent decision remains valid even after the patient lapses into incompetence. The law, in its simplicity, however, presumes the incompetent patient is unconscious or demented rather than impaired yet still capable of acting. When this is not the case, psychiatric consultation may be requested to opine on competency by assessing mental status defects and their impact on capacity to give or withhold consent.

A patient is incompetent if unable to do the following: (1) respond knowingly and intelligently to questions about recommended treatment; (2) participate in treatment decisions by means of rational thought processes; and (3) understand the items of minimum basic medical treatment information with respect to that treatment. Basic medical treatment information includes: the nature and seriousness of the illness, the nature of the treatment, the probable degree and duration of any benefits and risks of any medical intervention that is being recommended by the person's health care providers, and the consequences of lack of treatment, and the nature, risks, and benefits of any reasonable alternatives."
 

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The suit is going to come down to whether or not he was in a frame of mind in which he could deny treatment, which is the right of every patient in the US. If the hospital can show that it did not deviate from the standard of care they typically give for this type of injury and that due to the nature of the head injury they did not believe the patient was able to understand why they wanted to perform the exam (thereby eliminating his right to refuse) they will be in the clear.

Of bigger concern to me is that when they arrested him they took him to the courthouse in the hospital robe rather than allowing him to dress.
 

e lo

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kornkob said:
I agree and futhermore, if they were willing to heavily sedate the guy, they couldn't have been TOO worried about his skull.

All to often exerts in any given field think they know better than their customers and those with any amount of authority or power over another person will trend toward exercising that authority as much as possible. In my experience doctors in ERs are among the worst (with police being the leaders in that area). I've not only been subject to their behavior but watched them do the same to other people.

It's a tough job, yeah, I get that. And they are very skilled, I get that. However, the level of calousness and bullying that goes on in an ER is, frankly, a bunch of crap.

I wish there was more competition in the medical field so that ******* docs could feel the pinch when their behavior drove off customers.

Wow. Just ... wow.
 

Docapi

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Beerthoven said:
From the Stanford Law Center,Competency to Make Medical Decisions



A patient is incompetent if unable to do the following: (1) respond knowingly and intelligently to questions about recommended treatment; (2) participate in treatment decisions by means of rational thought processes; and (3) understand the items of minimum basic medical treatment information with respect to that treatment. Basic medical treatment information includes: the nature and seriousness of the illness, the nature of the treatment, the probable degree and duration of any benefits and risks of any medical intervention that is being recommended by the person's health care providers, and the consequences of lack of treatment, and the nature, risks, and benefits of any reasonable alternatives."
1. We dont know. We weren't there, and the article doesn't really give any clues.

2. I have to say he does not meet. If his response to "we need to do a DRE" is "F no" and punching the doctor, that does not sound like he participated with anything close to a rational thought process. A rational response would have been "Why do you have to do that?"

3. According to his own lawyers statements he didn't meet this. Supposedly, he had no idea what the DRE was for.

From what I see, we have 2 "no"s, and one "don't know".
 

zoebisch01

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Well for all we know, maybe the guy was abused sexually by a male as a child, or maybe he was put in prison and had been raped and hence his resistance to the procedure. Hey it's not far fetched imo. What we do see from the article was that he only started getting violent after they forcibly attempted to perform the probe.

What it looks like to me though was the guy was at work, gets wailed in the head with a beam (we don't know what the 'beam' was), goes to the ER, they give him 6 stitches, and try to give the guy an anal exam. Now if it were me, and I wasn't seeing double or feeling sick, etc and just needed stitches and they tried to give me an anal exam....well I don't think I'd be like "Hey great guys, thanks for that" :D. You'd have to convince me of a need first.

Couple that with the possibility (although he was at work doesn't mean he's covered) that he may be thinking "another procedure I gotta flip the bill for...no way". *shrug*

There are a lot of aspects to this. :tank:
 
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