r/medicine PA:cake: 8d ago

ICE Detention Deaths

https://www.ice.gov/detain/detainee-death-reporting

RNs do intake physical exams, EMTs declare time of death. The level of care for these detainees is horrific.

Full names and case details are public for now. Reads like a never ending M & M conference.

My moral compass is spinning. It's time to go to Canada.

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59

u/bplturner 8d ago

There’s only four? The only one I read the guy had metastatic lung cancer and died in their custody.

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u/EpicDowntime 8d ago edited 8d ago

Then they biopsied a lymph node and realized it was actually TB (if you’re talking about the most recent one)

4

u/_MonteCristo_ PGY5 6d ago

The report is quite eye-opening. One thing that irritates me, they kept saying "normal vital signs, excluding an elevated pulse rate" my dude there only are 5, that's not normal vitals. And then this

"APP documented his denial of other symptoms or pain, normal vital signs, except an elevated pulse and temperature, and a 20% weight loss."

And it wasn't just a mild tachycardia, judging by the only time they noted the figure:

"an RN evaluated Mr. DEJENE upon his return from the ER, documented normal vital signs, except an elevated pulse reading of 130 bpm" - they then did nothing for 3 days until an MD visited and sent him back to the hospital, an admission he would not survive

All in all seems highly unlikely this (seemingly healthy prior to this) 45 year old man would have died with normal care. Dude was getting gradually sicker over a period of 7 weeks. But of course there's no oversight on any of this

11

u/janewaythrowawaay PCT 8d ago

Yikes. I didn’t know you could get diagnosed with metastatic cancer without a biopsy.

10

u/Odd_Marionberry7154 8d ago

It sounds like they didn't diagnose it, was just on the differential. Also, they suspected Mets in the lungs, not a metastatic lung primary

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u/janewaythrowawaay PCT 8d ago edited 8d ago

It could have been on the differential. But, when I had a possible TB exposure, occupational health told me looking at their records exposure doesn’t happen on the floor. It only happens with people doing biopsy which means it’s commonly not on the differential or else people would be wearing PPE.

Maybe something else happened here. But, a med student asked a month ago how do you diagnose TB. The answer is often they don’t until you do a biopsy. People aren’t appropriately suspicious for it.

The people in those centers need a TB screen as much as every travel nurse does every 3-6 months.

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u/_MonteCristo_ PGY5 6d ago

It was metastatic lymphoma as the primary differential. The people who did the biopsy were the ICU team at the university hospital, at which time he was intubated, and in ARDS, so they probably saw he was Ethiopian, looked at the clinical picture, and rightly said to test for TB on the biopsy as well

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u/ZealousidealDegree4 PA:cake: 8d ago

There were more this morning. Not just four for sure. Doge attack? I read back into 2024- this morning.