Comments on: Beaumont ER Doc and a Warrant: Good for the doc Updated http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html Ramblings of an Emergency Physician in Texas Fri, 10 Feb 2012 00:40:33 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Grontijb http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html/comment-page-1#comment-5067 Grontijb Sat, 13 Jan 2007 17:24:10 +0000 http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html#comment-5067 I know it's late, but I wonder if the authorities "released him from custody" so they wouldn't have to pay the bill. I know it’s late, but I wonder if the authorities “released him from custody” so they wouldn’t have to pay the bill.

]]> By: ppowell http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html/comment-page-1#comment-5066 ppowell Fri, 29 Dec 2006 13:23:41 +0000 http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html#comment-5066 Pre-Op was done at UTMB Galveston. SE (Beaumont) ER was selected for initial surgery because pre-op indicated that the bullet was not confined by any bone and would be "cosmetic". The bullet (9mm solid ) entered the skin at the hairline, caused a "divot" in the skull. The bullet deformed slightly and "slid" down about an inch, with two small bone fragments (.05 ") of the frontal sinuses capturing the deformed portion of the slug. I suppose that the statement that hospitals are all about money is a little broad. I should have said that privately owned hospitals in Texas are "all about money". Surgeons are eager to perform the procedure, but are bound by contracts to the hospitals. The hospitals feel as though there is nothing to gain by allowing the surgery to occur in their facilities. It is not a moral issue to them, it is a money issue. In that aspect, I have to agree. General vs. local anesthesia is the issue. Weighing the right of the public to be safe vs. the individual rights of the suspect. Pre-Op was done at UTMB Galveston. SE (Beaumont) ER was selected for initial surgery because pre-op indicated that the bullet was not confined by any bone and would be “cosmetic”. The bullet (9mm solid ) entered the skin at the hairline, caused a “divot” in the skull. The bullet deformed slightly and “slid” down about an inch, with two small bone fragments (.05 “) of the frontal sinuses capturing the deformed portion of the slug.
I suppose that the statement that hospitals are all about money is a little broad. I should have said that privately owned hospitals in Texas are “all about money”. Surgeons are eager to perform the procedure, but are bound by contracts to the hospitals. The hospitals feel as though there is nothing to gain by allowing the surgery to occur in their facilities. It is not a moral issue to them, it is a money issue. In that aspect, I have to agree.
General vs. local anesthesia is the issue. Weighing the right of the public to be safe vs. the individual rights of the suspect.

]]> By: GruntDoc http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html/comment-page-1#comment-5065 GruntDoc Thu, 28 Dec 2006 20:34:36 +0000 http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html#comment-5065 IF that's all true, then it's a different story altogether, which would be a good thing. The article certainly didn't explain any of that. Not sure if I buy that the ED was chosen for 'pre-op examinations', it was chosen for convenience; the statement that 'Hospitals are all about money' is a non-sequitur in this paragraph, and its inclusion is odd. IF that’s all true, then it’s a different story altogether, which would be a good thing. The article certainly didn’t explain any of that.

Not sure if I buy that the ED was chosen for ‘pre-op examinations’, it was chosen for convenience; the statement that ‘Hospitals are all about money’ is a non-sequitur in this paragraph, and its inclusion is odd.

]]> By: ppowell http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html/comment-page-1#comment-5064 ppowell Thu, 28 Dec 2006 18:53:42 +0000 http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html#comment-5064 This was a scheduled surgery, conducted by a (very) qualified truama surgeon. He did the surgery as a public service and was not compelled in any fashion. HE chose the ER as the surgery location because of pre-op examinations. The soft bones of the frontal sinuses had begun to encapsulate the the deformed projectile...a fact that X-ray and catscan did not reveal. The only reason that the second surgery has not been done is that hospitals are frightened of law suits. Surgeons are easy to find, most are committed to helping humanity. Hospitals are all about money...period. This was a scheduled surgery, conducted by a (very) qualified truama surgeon. He did the surgery as a public service and was not compelled in any fashion. HE chose the ER as the surgery location because of pre-op examinations. The soft bones of the frontal sinuses had begun to encapsulate the the deformed projectile…a fact that X-ray and catscan did not reveal. The only reason that the second surgery has not been done is that hospitals are frightened of law suits.
Surgeons are easy to find, most are committed to helping humanity. Hospitals are all about money…period.

]]> By: kg2v http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html/comment-page-1#comment-5063 kg2v Tue, 26 Dec 2006 21:21:56 +0000 http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html#comment-5063 Well, I think there might be another factor no one I've seen discuss yet Let's say the LEO does NOT serve the warrent, and the hospital decides to remove the bullet - there is nothing to prevent the bullet from being tossed - or NOT treated as evidence So, you file the paperwork, so if the bullet IS taken out, it goes right into evidence Think of it as the LEO doing a CYA exercise Well, I think there might be another factor no one I’ve seen discuss yet

Let’s say the LEO does NOT serve the warrent, and the hospital decides to remove the bullet – there is nothing to prevent the bullet from being tossed – or NOT treated as evidence

So, you file the paperwork, so if the bullet IS taken out, it goes right into evidence

Think of it as the LEO doing a CYA exercise

]]> By: GruntDoc http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html/comment-page-1#comment-5062 GruntDoc Sun, 24 Dec 2006 21:13:48 +0000 http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html#comment-5062 NewGuy, I'd disagree that we're already an 'arm of the state' because we are licensed and regulated by same; so are beauticians. (Nothing disparaging to beauticians, BTW). Yes, we are occasionally asked to participate in the collection of evidence against a patient's will (legal blood draws), but that's a truly minimally invasive procedure, and I've never seen it done to a subject who was actively unwilling (though I've see people intimidated / cajoled into complying by the police). Were I an arm of the law I'd be reporting people for drunk driving (a lot of people), but I'm not a cop, I'm a physician. Different rules, different standards and expectations. NewGuy,
I’d disagree that we’re already an ‘arm of the state’ because we are licensed and regulated by same; so are beauticians. (Nothing disparaging to beauticians, BTW).

Yes, we are occasionally asked to participate in the collection of evidence against a patient’s will (legal blood draws), but that’s a truly minimally invasive procedure, and I’ve never seen it done to a subject who was actively unwilling (though I’ve see people intimidated / cajoled into complying by the police).

Were I an arm of the law I’d be reporting people for drunk driving (a lot of people), but I’m not a cop, I’m a physician. Different rules, different standards and expectations.

]]> By: TheNewGuy http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html/comment-page-1#comment-5061 TheNewGuy Sun, 24 Dec 2006 15:21:12 +0000 http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html#comment-5061 It seems to me that we're already an arm of the state (and law enforcement) to some degree. We're licensed by the state, we're required to take certain types of CME by the state (mandatory hours in domestic violence, HIV, etc), and many of us have mandatory reporting requirements for certain types of violence. Our charts are considered legal documents, and given significant weight in legal procedings. We already assist law enforcement in gathering evidence, often in ways that are uncomfortable and sometimes traumatic for the patient (think about some of your worst rape examinations). That said, I completely agree that no physician should be compelled or bullied into helping these officers in violation of their own ethics (and boo on those officers for trying to Bogart the ER doc into doing it)... but I certainly understand the other side. It seems to me that we’re already an arm of the state (and law enforcement) to some degree. We’re licensed by the state, we’re required to take certain types of CME by the state (mandatory hours in domestic violence, HIV, etc), and many of us have mandatory reporting requirements for certain types of violence. Our charts are considered legal documents, and given significant weight in legal procedings.

We already assist law enforcement in gathering evidence, often in ways that are uncomfortable and sometimes traumatic for the patient (think about some of your worst rape examinations).

That said, I completely agree that no physician should be compelled or bullied into helping these officers in violation of their own ethics (and boo on those officers for trying to Bogart the ER doc into doing it)… but I certainly understand the other side.

]]> By: DisappearingJohn http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html/comment-page-1#comment-5060 DisappearingJohn Sun, 24 Dec 2006 14:36:23 +0000 http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html#comment-5060 I have to agree, I would hate to see that person walk into my ED. Sounds like a problem for a surgeon in a scheduled procedure, but that would require "informed consent", which I don't know what the legalities of that would be.. On the other side, being a nurse, I have no problem drawing blood for the Police if asked "while I'm drawing blood for medical purposes". If they just want blood, and I don't need any, they can (and do) bring their own phlebotemists.. On a totally side note, Merry Christmas, Grunt Doc! I have to agree, I would hate to see that person walk into my ED. Sounds like a problem for a surgeon in a scheduled procedure, but that would require “informed consent”, which I don’t know what the legalities of that would be..

On the other side, being a nurse, I have no problem drawing blood for the Police if asked “while I’m drawing blood for medical purposes”. If they just want blood, and I don’t need any, they can (and do) bring their own phlebotemists..

On a totally side note, Merry Christmas, Grunt Doc!

]]> By: Derrick http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html/comment-page-1#comment-5059 Derrick Sun, 24 Dec 2006 12:50:53 +0000 http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html#comment-5059 I have to agree with gruntdoc on this one. The role of the physician is to serve the medical needs of the patient - and perhaps the medical needs of society. It is NOT to serve the law enforcement needs of the state, although these two roles sometimes overlap. If we do not make a clear distinction between these two roles, when do we draw the line? Should physicians report every person who has evidence of illegal substances in their body to the police? What about interrogating patients about their residency status to help the immigration officers out? Should we mount radar guns in our vehicles and catch a few speeders on the way to work too? Where does it stop? I would also suggest that a risk benefit analysis be done here. Yes, the risk is minimal that you will cause some horrific problem by removing this bullet, but the risk is still there. Suppose a horrible infection occurs after the excision - why should physicians' malpractice insurance have to be exposed to this unnecessary risk? I have to agree with gruntdoc on this one. The role of the physician is to serve the medical needs of the patient – and perhaps the medical needs of society. It is NOT to serve the law enforcement needs of the state, although these two roles sometimes overlap.

If we do not make a clear distinction between these two roles, when do we draw the line? Should physicians report every person who has evidence of illegal substances in their body to the police? What about interrogating patients about their residency status to help the immigration officers out? Should we mount radar guns in our vehicles and catch a few speeders on the way to work too? Where does it stop?

I would also suggest that a risk benefit analysis be done here. Yes, the risk is minimal that you will cause some horrific problem by removing this bullet, but the risk is still there. Suppose a horrible infection occurs after the excision – why should physicians’ malpractice insurance have to be exposed to this unnecessary risk?

]]> By: TheNewGuy http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html/comment-page-1#comment-5058 TheNewGuy Sun, 24 Dec 2006 11:42:15 +0000 http://gruntdoc.com/2006/12/beaumont-er-doc-and-a-warrant-good-for-the-doc-updated.html#comment-5058 <i>I’m not against the prosecution of crime or criminals.</i> No no... of course not. I hope I didn't imply otherwise. This is simply one of those cases where removing the bullet is minimally invasive, and likely to be accomplished with very little risk to the patient. In my mind, this is only slightly beyond a forced blood draw, or a forced DNA sample; it's certainly not the same as digging into the patient's brain or abdomen for the same bullet. The state has a compelling interest in keeping this actor behind bars for a very long time, and a court has already ruled that the evidence can be obtained against the patient's will. So what now? I don't think any physician who finds this ethically or morally objectionable should be forced to participate. On the other hand, I wouldn't look sideways at a physician who <i>did</i> take it out. This is a felon witholding evidence, not a euthanasia case, or anything similarly odious. I also think I' d have a problem with a state board sanctioning such a physician. I’m not against the prosecution of crime or criminals.

No no… of course not. I hope I didn’t imply otherwise.

This is simply one of those cases where removing the bullet is minimally invasive, and likely to be accomplished with very little risk to the patient. In my mind, this is only slightly beyond a forced blood draw, or a forced DNA sample; it’s certainly not the same as digging into the patient’s brain or abdomen for the same bullet.

The state has a compelling interest in keeping this actor behind bars for a very long time, and a court has already ruled that the evidence can be obtained against the patient’s will.

So what now? I don’t think any physician who finds this ethically or morally objectionable should be forced to participate. On the other hand, I wouldn’t look sideways at a physician who did take it out. This is a felon witholding evidence, not a euthanasia case, or anything similarly odious.

I also think I’ d have a problem with a state board sanctioning such a physician.

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