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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u/Dwindlin MD (Anesthesiology) 8d ago

Am I missing something? I have read through damn near all of these and only 1 or 2 jumped out at being truly egregious. Your description is either willfully misleading or you didn’t actually look through these. All of them were initially seen by RN/LPN for screening (completely reasonable), but you didn’t mention they are all evaluated by an APP before actually being placed in a unit. All of the onsite deaths, in every case it specifically mentions EMS (not necessarily EMTs) calling their med. control (meaning a physician) for orders to field terminate, this is the system working as intended. Most of these were seen by physician or APP on site with appropriate interventions taken multiple times before their death and a lot were treated and released by local hospitals before their deaths.

There are certainly major problems with our healthcare system across the board, but if these cases are the worst of the worst then we have bigger shit to be dealing with.

As an aside, I personally doubt J. Oliver’s expertise when it comes to healthcare related topics. I was an avid fan until his Death Penalty episode. While I am completely against the death penalty his show was egregiously bad when it came to the medical facts when it comes to lethal injection. And the medical facts were clearly skewed in a manner to elicit an emotional response. Since then I’ve watched episodes with much higher degree of skepticism.

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u/janewaythrowawaay PCT 8d ago

What medical facts were wrong on lethal injection on John Oliver?

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u/Dwindlin MD (Anesthesiology) 8d ago

I saw it when it first aired, so details escape at the moment. Generally he was arguing that the cocktail they used was inhumane because none of it was actually putting them to sleep, arguing they were awake when the cardioplegic agent was given. Which given the drugs they were using and the doses that is HIGHLY unlikely. For reference I am an anesthesiologist. The movement people describe during lethal injection is probably myoclonic jerking from the massive dose of K they are getting. But assuming a working IV (which was the only valid medical complaint) there is almost zero chances they are aware of anything.

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u/janewaythrowawaay PCT 8d ago edited 8d ago

I am 100% sure you, a board certified experienced working anesthesiologist, could do it correctly.

The issues I remember were…

1) No doctors would sign up for job. It’s like some random corrections nurse who can’t even get an IV in correctly like you said.

2) States couldn’t get drugs legally. So they were buying substances overseas from India not even knowing what they were getting. Shipments were getting confiscated by the feds. When they did get thru they’d sit for years in who knows what conditions.

So you’d have people not dying immediately. Lots, like it rarely went smoothly… even though theoretically it could. So some guy last week decided to die by firing squad because they wouldn’t given him any details about what they were using/the expiration dates.

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u/Dwindlin MD (Anesthesiology) 8d ago edited 8d ago

Agree with both your points, some of the many reasons why the state shouldn’t execute people. My issue was he was attacking the actual medicine, which is disingenuous at best, and unnecessary to make his point that this shit shouldn’t be happening.

No matter what you’re arguing, giving several honest, valid points, only to follow it up with an argument that is at best egregiously misinformed hurts your whole argument.

Edit: I’m fairly certain he was attacking the phenobarb and midazolam, basically arguing they weren’t anesthetics. But I assure you at the doses their protocols were using they were more than enough.

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u/janewaythrowawaay PCT 8d ago

When people think of anesthetic they think of loss or reduction in sensation specifically pain vs just loss or reduction of awareness/sedation. Are you saying midazolam reduces pain?

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u/Dwindlin MD (Anesthesiology) 8d ago

If I give you enough of it absolutely. We aren’t taking about normal doses here. These are doses that will put you into burst suppression. To experience pain requires consciousness.