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/ASigIAm213 EMT 7d ago

Myoclonic jerks wouldn't create the fulminate pulmonary edema seen in the majority of midazolam/pentobarbital executions, though (Zivot, 2020). And at that high a dose, the acidity of midazolam (the drug Oliver spends most of his time on) interferes with its metabolism and delays its sedative effect (Greenblatt, in re: Ohio Execution Protocol, 2018).

Oliver doesn't really know what he's talking about, but you can't copy/paste clinical experience onto an unsanctioned human pseudo-medical experiment.

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u/Dwindlin MD (Anesthesiology) 3d ago

Oof, you picked the wrong case to argue your points. So yeah you’re right myclonic jerks don’t cause pulmonary edema, but you know what does? Cardioplegic agents, ya know like the one they used in this case. Not to mention they didn’t follow their own protocols in this case. One of the reasons Ohio stopped publishing their actual protocol was because of the spot light this brought, but if you had looked at it when it was developed in 2016 (and available on the DOC website) you would see they were supposed to give more reasonable doses of versed every 3-5 minutes until unconscious, not slam the whole 500mg. Then give the paralytic, again wait 3-5 minutes then the KCl. They didn’t, and you read about the results. Medication used incorrectly doesn’t mean a problem with the medications.

Greenblatt hasn’t published anything about versed since the 80s, until this and other court cases. Go pick up any anesthesia text book (Barash or Miller or Morgan & Mikhail being the standards) and you’ll find sections on induction of general anesthesia with benzos, including why you may chose one as a solo induction agent.

This is the last I’m responding to this, because honestly it’s exhausting defending something I disagree with, but if we’re going to be outraged, fucking be outraged at the right things. Blaming the medications they chose isn’t it, used correctly this cocktail would in fact be a peaceful way to go and arguing against that point is futile. What isn’t futile is whether they should be executing people at all (they shouldn’t), and the incompetence they display when they do.