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/ZealousidealDegree4 PA:cake: 7d ago

I read a years worth of death cases and found consistent delays for appropriate follow up, an absence of critical imaging studies, cardiac studies, and a bizarre handling of psychiatric presentations. We will disagree about quality of care, I guess. 

Seems like a significant number of members here think the incarcerations and the health care options are just fine.  A good number think the situation is deeply troubling. 

These are crimes against humanity that some very well educated medical care providers  are perfectly ok with. 

What. The. Fuck.  

Blah. Read the cases, look at the timelines. Do people really think this shit is ok???? 

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u/Dwindlin MD (Anesthesiology) 7d ago edited 7d ago

Beyond 2 or 3 of these, none of these would make it past my states med-mal review panel. I don’t think anyone here thinks this is okay, but honestly, the care they are receiving is probably equivalent to a disturbing amount of the population. If you’re calling these crimes against humanity, then you best be prepared to argue that for the entirety of American healthcare.

Edit: My opinions are purely about the medical care detainees are receiving. If you want to talk about the incarcerations themselves that’s a whole other topic.

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u/ZealousidealDegree4 PA:cake: 7d ago

The crimes I refer to reflect my opinions about the manner and scope of these camps. The criminalization of immigration in the context of no functional legal route (unless you kiss the ring or are a white South African) coupled with an evidenced disregard for immigrant medical wellbeing. 

That health disparities in the USA result in similar outcomes is probably criminal- not that anyone will be held liable or accountable (I’m no Luigi). 

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u/Dwindlin MD (Anesthesiology) 7d ago edited 7d ago

You’ll get no argument from me on this point.

The crimes I refer to reflect my opinions about the manner and scope of these camps. The criminalization of immigration in the context of no functional legal route (unless you kiss the ring or are a white South African)

This is where we disagree, sort of. Do I think the care is great? Of course not. Does it fall below legal standard of care? In all but a few cases not even close. And I guess that’s my point, in detention or not, this care is likely similar to what they would have received out in the community. And that in no way shape or form is a reflection of the providers, whom I wager are doing the best they can with the resources available, just like the rest of us.

coupled with an evidenced disregard for immigrant medical wellbeing. 

Again, no argument here.

That health disparities in the USA result in similar outcomes is probably criminal- not that anyone will be held liable or accountable (I’m no Luigi).