I strongly suggest that you read this frequently distressing article at The New Yorker recounting a young Oakland woman’s journey from more-or-less good health through insufficiently attentive care to being pronounced dead to maintaining something just a bit more than vegetative life and the effect of that journey on her family. The article raises all sorts of difficult questions, not the least being are the girl’s parents correct? Did the color of her skin influence the care she received? Does her parents’ conviction that’s the case influence the care they want provided?
Not the least disturbing question and unquestionably the thorniest: who pays?
Fat kids having a T&A are a high risk procedure, though she may have actually had a UP3. Cant tell from article. I suspect she got less that great care because she is poor and on Medicaid. In Oakland, I would expect that to be a bigger factor than race. (Lot of red flags here. If they are correct and the surgery took 4 hours, that is highly unusual.) Who should pay? Sounds like there is a good case for malpractice, so a payment on that could be made, but it should not include care for after the patient was dead. Family should pay for that.
Steve
That’s actually the thrust of the article. They’ve got experts who are saying that she’s not dead. They’re calling the standard technical definition of death into question.
I’m tempted towards the view that the array of service covered by either Medicare or Medicaid should be much more limited than at present and people should be aware of what they are. Ambiguity and opacity are in the interests of politicians.
Let’s see. Is California racist? Was Terri Schiavo a minority?
Texas had a law allowing hospitals to pull-the-plug as soon as they were not paid, and interestingly, Governor George W. Bush signed it. (Yeah, the same Governor that became the President defending life-support. I guess his support of life was the monetary kind.)
If you are poor, you will get f*cked-over, and if you are poor and a minority you will get f*cked-over a little more.
I think @steve is probably right.
who pays for her care?
If the parents and doctors sympathetic to the patient claim’s are true; then it’s one of the easier questions; the hospital should pay. The hospital’s position rests on one assumption — that a diagnosis of brain death is as final and irreversible as biological death.
Misdiagnosis of biological death is very hard; not so with “brain death” or “vegatable state”. The NIH has studies that show 40% (https://www.ncbi.nlm.nih.gov/pubmed/19622138) of people thought to be in persistent vegatable state on re-examination could be in a minimally conscious state. And there’s no clear “live” / “dead” criteria like biological death (no pulse), its a continuum between vegatable state to minimally conscious state (as the bioethics expert says).
Given we know very little about the ability of the brain to repair itself; its possible that the 40% wasn’t misdiagnosis but just the brain repairing itself over time.
A misdiagnosis means the patient never died so the hospital is liable.
After reading this article, I wonder how long before its standard practice for doctors / hospital interactions with patients to be taped via bodycam like police.
I found the discussion confusing. I have mild sleep apnea and the surgical treatment sounded horrifying and I was told that insurance wouldn’t pay for it without a record of failure at less invasive alternatives and even then IIRC coverage was iffy and the success rate was low. This was all presented as precautionary information to prevent me from hearing about surgical alternatives to CPAP or weight loss.
@steve, I’m pretty sure I was told about UPPP for apnea; I don’t know what T & A is, but the article says the right carotid artery appeared abnormally close to the pharynx, and I think one of the Ps in UP3 refers to the pharanx. Frankly, there are a lot of unpleasant questions about the decision, and I do question whether private health care insurance would have paid for it, and if it would, there is other information that bore on the decision that’s not in the article.
PD- T&A is tonsillectomy and adenoidectomy. Since they report bleeding from the nose, and a UP3 (uvulopalatopharyngoplasty) is uncommon at age 13, that would be my first guess, however I have never seen or heard of one lasting 4 hours. Never take advice over the internet from someone claiming to be a doctor, but I wouldn’t have surgery for mild sleep apnea. (The carotid can be close for a tonsillectomy also, not just a UP3.)
Steve
In my family we have a simple rule of thumb: no elective surgery. Don’t put yourself into the hands of the medical system without dire necessity.
One of the reasons for that might be that atypical responses to medication are a commonplace among me and my siblings. You know those warnings that say “In very rare cases…”? That’s us.
Personally knowing the medical team that took care of this child I doubt there was any racial bias. Children’s Hospital in Oakland serve a very poor population. Unfortunately things go wrong. The practice of medicine is an art not an exact science.
Statistically, blacks are more likely to opt for heroic measures than, say, white Catholics. I have long believed that’s a consequence of distrust of the health care system, of hospitals, or of physicians. I think this article provides some confirming evidence of that view.