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David Tabor (sailordave)
01-21-2008, 10:09 AM
http://cityroom.blogs.nytimes.com/2008/01/16/forced-rectal-exam-stirs-ethics-questions/
:eek::eek::eek:


Forced Rectal Exam Stirs Ethics Questions

By Sewell Chan (http://cityroom.blogs.nytimes.com/author/schan/)
Under what circumstances can a patient in an emergency room be forced to submit to a procedure that doctors deem to be medically necessary? That question — and the notion of informed consent — is at the heart of a civil case that is about to go to trial in March in State Supreme Court in Manhattan.

Brian Persaud, a 38-year-old construction worker who lives in Brooklyn, asserts that he was forced to undergo a rectal examination after sustaining a head injury in an on-the-job accident at a Midtown construction site on May 20, 2003. Mr. Persaud was taken to the emergency room at NewYork-Presbyterian Hospital/Weill Cornell Medical Center (http://www.nyp.org/), where he received eight stitches to his head.
According to a lawsuit he later filed, Mr. Persaud was then told that he needed an immediate rectal examination to determine whether he had a spinal-cord injury. He adamantly objected to the procedure, he said, but was held down as he begged, “Please don’t do that.” As Mr. Persaud resisted, he freed one of his hands and struck a doctor, according to the suit. Then he was sedated, the suit says, with a breathing tube inserted through his mouth.
After Mr. Persaud regained consciousness, he was arrested, then taken — still in his hospital gown — to be booked on a misdemeanor assault charge. Gerard M. Marrone, who was Mr. Persaud’s lawyer, got the criminal charges dropped, then helped Mr. Persaud file a civil lawsuit against the hospital.
“Psychologically, it changed his life completely,” Mr. Marrone said of the episode. “He hasn’t been able to work. He has absolutely no trust in the system at all: doctors or the police. He has post-traumatic stress syndrome.” Mr. Persaud has been under the care of a psychiatrist who made the diagnosis, Mr. Marrone said.
After several years of legal wrangling, discovery and dueling motions, a State Supreme Court justice, Alice Schlesinger, this week refused to grant the hospital’s petition to dismiss the lawsuit.
The hospital is contesting the lawsuit. “While it would be inappropriate for us to comment on the specifics of the case, we believe it is completely without merit and intend to vigorously contest it,” said a hospital spokesman, Bryan Dotson.
In an interview today, Nancy Berlinger, deputy director at the Hastings Center (http://www.thehastingscenter.org/), a bioethics research institute based in Garrison, N.Y., emphasized that she was not familiar with the specifics of the case but said it appeared to raise important questions about the doctrine of informed consent.
In general, patients may decline medical treatment if they are informed of the consequences of doing so and capable of making such a decision.
“There are special considerations in emergency medicine because of the need to make rapid assessments,” Ms. Berlinger said. “You could have an evident life-threatening injury — someone bleeding out of a carotid artery — or the potential for a life-threatening injury that you can’t see, such as a stroke or spinal-cord injury. It is not always clear what is the patient’s capacity to make decisions, especially if the doctor suspects a head injury.”
A jury or judge evaluating the case, Ms. Berlinger said, might have to answer these questions about the procedure: “Was it medically necessary? Was the patient capable of understanding what was going on and making a decision about it and understanding the consequences of refusal?”
To successfully demonstrate that the hospital was negligent, Ms. Berlinger said, the plaintiff would have to show that the treatment involved a departure from the “standard of care,” that the patient was harmed and that the harm resulted from the departure from the standard.
Lawyers for both sides — the hospital and Mr. Persaud — have lined up doctors to testify. In an Aug. 9, 2007, seven-page medical evaluation, Dr. Irving Friedman, a neurologist and psychiatrist hired by Mr. Persaud’s lawyers, wrote:

Although a rectal exam is part of the routine E.R. evaluation, this patient clearly refused. His life was not in danger. He did not have any signs of abdominal trauma. He had full range of motion and movement of all four extremities. A reasonable analysis of his situation could have been obtained without checking for “rectal tone.”
Dr. Friedman concluded that Mr. Persaud “has been left with extreme anxiety, agitation and depression due to the events at the emergency room.”
But there are complicating factors. Mr. Persaud was evidently driven to the hospital; doctors might have suspected he had injuries despite his ability to walk. He did not have family members present who could have helped him to articulate his medical preferences. Finally, the head injury — requiring stitches — might have led doctors to question Mr. Persaud’s capacity for making an informed decision.
Now the case goes to court. The judge set a trial date of March 31.



I personally hope he cleans them out! I once saw a doctor who was the epitome of ARROGANT GOD COMPLEX. Doesn't sound like they really made an effort to explain things to him, nor did they consider other options of ascertaining if he was alright.:eek::(

Michael s/v Sannyasin
01-21-2008, 10:19 AM
True, it is unconscionable that they should have forced any "procedure" on him against his express wishes. He should probably bring rape charges against them.

However, I get a little suspicious when someone says they haven't been able to work for the past 4 years because of something like this... gotta wonder if they aren't just looking for an early retirement on someone else's dime.

Milo Christensen
01-21-2008, 10:25 AM
Only eight stitches? And they did a forced rectal exam? Maybe I can sue for negligent malpractice. I've had had head stitches four times: 7, 7, 12, 14 -- the first two were stitched up without benefit of any numbing and the last two were ER visits and nobody ever asked me about my rectal tone, although on rare occassions I've managed a basso profundo.

James McMullen
01-21-2008, 10:38 AM
Doctors have a really hard job. They have to make snap judgements on matters of extreme urgency, and if they guess wrong (and sometimes even when the guess right) they get sued right and left. If the supervising physician felt he needed to check spinal integrity before clearing a patient then he was correct to do so. This guy who is freaking out about a rectal examination clearly has psychological problems in addition to his physical injury. Probably a homophobe too. A well-adjusted individual wouldn't get so freaked out having a trained medical professional check out anything while said doctor was working to make sure everything's ok. I feel no sympathy for that doofus at all. I hope he loses his frivolous lawsuit!

Michael s/v Sannyasin
01-21-2008, 10:47 AM
I might agree with you James, in a situation where the doctor couldn't get the patient's consent, say, he was unconscious for example. But when the patient is able to give consent and clearly does not, the doctor has no right whatsoever to proceed.

I still think the lawsuit is pretty ridiculous.

David Tabor (sailordave)
01-21-2008, 10:58 AM
Well, as someone who on more than one occasion was hassled by the police (never did anything wrong, never was even arrested) for years afterwards my stomach would knot up and I would avoid any contact whatsoever w/ them. STILL have a huge amount of distrust for LEO's.

If this guy thought what they were proposing to do was not something he wanted done, REFUSED to consent and had it forced upon him... He probably is traumatized. Has NOTHING to do w/ being a homophobe. He was FORCIBLY restrained and had something done TO him that he obviously felt wasn't necessary.
Hell, I'd be pissed too. I question EVERYTHING a doc says.

And James, you and I might listen to why a doc says he needs to do something, but let's face it, the vast majority of blue collar construction workers are probably NOT used to listening to a doctor explain medical procedures.

Think about it in the context of not having control over what someone else does to your body when you've said "NO". If this was a woman that had a doc say he needed to do a vaginal exam for the same reason you can bet the cops would have gone after the doc!

Tylerdurden
01-21-2008, 11:40 AM
I have to PM Keith about this, he has fantasies you know.http://www.woodenboatvb.com/vbulletin/upload/images/icons/icon12.gif

Bill R
01-21-2008, 11:51 AM
Rectal exam for a head injury?!

If the guy was in upper Management or a politician, I could understand that...

It would be the proper place to look for the head...

Phillip Allen
01-21-2008, 11:59 AM
what jumps to my mind is that the doc was directly answerable to an insurance company and not his patient...

Spin_Drift
01-21-2008, 12:12 PM
Sorry to butt in on your "men only" thread...

It was an invasive procedure and they were wrong to do it under these circumstances. He said NO!!! and that should have been enough. The injured man was not incapacitated.

My husband says if they would have done it to him, the doctor would have had more to worry about than a law suit... He would have returned the doctors rectal exam with a 45-70 Govt...:eek:

The arresting police officers should not have arrested him as he was only trying to defend himself against an invasive procedure he had forbidden.

I also think the man is a loser and playing a victim and trying to get a free meal ticket out of this...

ishmael
01-21-2008, 12:36 PM
"what jumps to my mind is that the doc was directly answerable to an insurance company and not his patient..."

That sounds spot on to me. Because of insurance oversight the doc isn't really looking at the patient, he(she) is trying to protect himself, and there's a protocol that has to be followed.

Brian Palmer
01-21-2008, 12:42 PM
So the docs are worried about a spinal injury, and they forcibly wrestle him down to do a rectal exam? That seems it could be counterproductive.

--Brian

George Jung
01-21-2008, 01:55 PM
I made the mistake of entering that 'discussion' at the Times - and I'd say only that, there really isn't enough information in that article to decide, one way or the other 1)the extent of this guys injuries (it's not proportionate to the length of the laceration, btw - think javelin falling from the 6th floor YMMV) 2)his actual mental state (unless you've worked in an ER, you have no idea.... but you might think 'closing time' at the bar - are all of your customers fully oriented? If they say 'I can drive, occifer', do you always believe them? Poor analogy, but all I'm prepared to offer at this time). 3) I don't think this guy was held down for the purposes of a rectal (but I can't tell from the article); I think he was combative, was restrained while an IV was placed, sedated/intubated for imaging studies, such as an MRI or CT scan. I'm only guessing - but the other scenario makes no sense to me.

The problem we have here, with this discussion group, is that you're all projecting this scenario on yourselves - how would 'I' feel about it - not recognizing that most of you are sensient beings :D, well able to make an informed decision. This guy may not have been. I'm anxious to see the details come out. BTW, the Dr.s didn't call the police on this guy; the security folks did. Been there, had that done.

In the unlikely event that what happened is as base as what the original article says - that medical facility will get nailed, and rightfully so.
But my feeling is, the Times posted an inflamatory story, devoid of significant details, simply to help their ol' bottom line. Everyone likes to bash Drs. - but if you ask folks about their 'own' Dr., well, they're just great! Think about it.

David Tabor (sailordave)
01-21-2008, 05:25 PM
George, I'll have to say, I agree w/ EVERYTHING you've written. We all *know* that a story reported in the press is not always the WHOLE story. And this guy may very well be a drotard (what an ER nurse friend of mine calls the stupid, illiterate, trash that comes in their ER for every stupid thing...) Then again maybe he's NOT.

When I read bizarre stories like this I always try to change something about the people involved before I pass judgement and the point I tried to make earlier is that IF this had been a WOMAN, holy hell would have broken loose, the doc probably would have been brought up on charges or at least fired. Women's groups would be calling for HEADS to roll.
Think about it, if there is ANY semblance to the truth in this story.... we'd all be outraged if it happened to a woman.

And if the doc is just trying to CYA w/ the insurance company that needs to be addressed also. Would not have been hard to get the guy to sign a release saying he refused recommended treatment.

Paul G.
01-21-2008, 08:40 PM
gee what are you guys on about? every time I bump my head I ask a bystander to examine my butt....it s the perfectly natural thing to do!

"Hey Doc my head hurts"
"Well son just bend on over and lets have a looksee up yer ass!"

JBreeze
01-21-2008, 08:59 PM
Hey, I had a doctor, employed on behalf of one of the major multi-national oil companies, grab my balls while he told me to cough! How much money can I get out of this? :D

As far as the tough guys and gals go, just say no to trips to the hospital (especially ER departments). They are usually busy and don't need the customers. The attitudes of some patients is sometimes worse than 2nd graders with temper tantrums, so avoid the ER for your sake, and the good of the hospital staff:)

tattooed john
01-22-2008, 01:20 AM
Think of the possible consequences of an undiagnosed partial fracture of a vertebrae. The doctor made the right call. Besides- he might have had a cute arse.

What was he worried about- discovering that he enjoyed it?

JimD
01-22-2008, 02:08 AM
gee what are you guys on about? every time I bump my head I ask a bystander to examine my butt....it s the perfectly natural thing to do!

"Hey Doc my head hurts"
"Well son just bend on over and lets have a looksee up yer ass!"

:D

One time I stuck myself on a thorn while trimming our rose bushes. Fortunately there was a construction crew working on the road in front of our house so I went over and said "My little prick hurts. Will you look up my butt and see if everything looks OK?" Anyway, to make a long story short, when I got to the emergency room to have the blunt force skull trauma looked at the doctor told me I should have a rectal exam just to be safe. So I told him, "That won't be necessary,doc. I just had one."

Tylerdurden
01-22-2008, 07:10 AM
I have to say I took a particular nasty fall some years back and they were so worried about my kidneys they missed three fractured vertebrae. I suffered for over a month with it until one smart doctor ordered a bone scan. Whoops.

I had a great basis for a malpractice lawsuit but I declined. I don't think its was negligence on the doctors or nurses part. I blame the insurers for forcing them to hold back. They did the same exam to me but it was a young and pretty redhead doctor. I was hoping she would linger.http://www.woodenboatvb.com/vbulletin/upload/images/icons/icon12.gif I think thats why this guy is bitching is because some guy did it to him.

Spin_Drift
01-22-2008, 11:41 AM
Think of the possible consequences of an undiagnosed partial fracture of a vertebrae. The doctor made the right call. Besides- he might have had a cute arse.

What was he worried about- discovering that he enjoyed it?

Geezzz John... :eek: :eek: :eek:

Woxbox
01-22-2008, 08:20 PM
I'm surprised no one has yet suggested that hospitals have a list of routine ER proceedures designed primarily to run up the bill. Head injury? Then do this... and this... and this... and this..... and so on. Just like when you take your car in for an inspection sticker. Any excuse to manufacture more profit.

johnw
01-22-2008, 08:31 PM
Wouldn't an x-ray have done the trick?