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[–] 143 points 7 months ago (4 children)

....wow

That timeline reads to me like he was in withdrawal, vomited, and likely aspirated on his own vomit. All due to lack of actual human care in a supposed ICU. I say "supposed", because that shit shouldn't even be legal for tele-health in the first place.

Marketing be like "this service pairs expert remote monitoring with skilled bedside care" and I translate that bullshit as "we farm monitoring jobs to cheaper labor markets and they watch people die, on Zoom".

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  • [–] 12 points 7 months ago* (3 children)

    I'm willing to bet his family can likely win their lawsuit . Hopefully that will be costly enough to reverse this bullshit.

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  • [–] 14 points 7 months ago

    Unlikely, without regulation against this. Fines are just a cost of business, since they are never, ever costly enough. Either a true penalty fine, or executives in prison, or both, are the only response to ensure change, here.

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  • [–] 10 points 7 months ago (1 child)

    You mean five percent of the money they make when they decide these immoral choices? Which then gets appealed to a high court and reduced to one-tenth of one percent?

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  • [–] 5 points 7 months ago

    Totally depends. Usually in medical cases like this the margins for a hospital are thinner than you think. Healthcare gets so expensive thanks to all the middlemen.

    It's a bit different than a company pollutes river and it costs 10 million in fines but they save 30 million.

    In this case if the family wins the suit it can open up even more until it becomes unsustainable. It all depends on what is established in this case, the precedent alone could be effective in banning it.

    I'd prefer legislation of course

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  • [–] 238 points 7 months ago (29 children)

    How is it legal to have an ICU that isn’t staffed by a single doctor?

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  • [–] 73 points 7 months ago (20 children)

    It's probably staffed by Nurse Practitioners. They do a lot of stuff that used to be handled by doctors, even my primary care provider is a NP and not a Dr.

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  • [–] 39 points 7 months ago* (last edited 7 months ago) (2 children)
  • [–] 21 points 7 months ago (1 child)

    More like dr make twice the pay than np because dr requires 10x more hours to be certified over a np. Also the family will be sueing the dr not the np for medical malpractice here.

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  • [–] 12 points 7 months ago (15 children)

    You consider that you may be getting fucked, then?

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  • [–] 4 points 7 months ago (14 children)

    The best experience I’ve had with a family practice doctor was the few years that I had a nurse practitioner, much more thorough and attentive.

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  • [–] 11 points 7 months ago (13 children)

    I am getting fucked tho, but it's not the NP's fault. It's the goddamn admins that decided patients should only get fifteen minutes for a yearly physical, including pap smear.

    They've turned primary care into a referral machine, but there's nobody to coordinate care or collate results. I've got a stack of diagnoses from multiple specialists, but they give out conflicting advice. Like, I've got an EDS diagnosis from a rheumatologist who told me to take ibuprofen for my joint pain because tylenol doesn't help with inflammation, but I've also got intestinal ulcers that my gastroenterologist says comes from taking NSAIDs, and I should take tylenol instead. Fucking kill me.

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  • [–] -2 points 7 months ago (11 children)

    Neither of them was wrong, really. The best option was ibuprofen, since it's pain relief and anti-inflammatory. But because you developed ulcers that ibuprofen can irritate, the best option is just pain management with something like Tylenol.

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  • [–] -1 points 7 months ago (9 children)

    No, the rheumatologist should have known that nsaids cause gastro ulcers and not to prescribe them. They committed malpractice.

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  • [–] 1 point 7 months ago (8 children)

    Lol. You fucking idiot, it doesn't do that to everyone. "Malpractice for prescribing ibuprofen" hahaha

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  • [–] 0 points 7 months ago (7 children)

    And this is why you're not in medicine.

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  • [–] 0 points 7 months ago (6 children)

    How do you know I'm not ;-)

    Also, you can hop right on the mayo clinics website and look up eds. Go to treatments and look right there. IBUPROFEN. Not everything is rocket science. You just can't be too stupid. It's also blasted all over the rest of the internet, but the mayo clinic is one of the most trusted sources around.

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  • [–] 1 point 7 months ago* (last edited 7 months ago) (5 children)

    go ahead and look up gastro disease. nsaids are contraindicated for all of them. use cleveland clinic since they are better than mayo for anything GI.

    if you are wondering how i know you're not in medicine, it's the fact that you didn't know the above fact. or, if you are in medicine, you really should find some other field. fucking 80% of practitioners are idiots anyways.

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  • [–] -1 points 7 months ago (4 children)

    I think you might be the idiot, yourself. Go re+read faythofdragons post a couple of times and then try to explain where you got the idea that they had any sort of gastro disease or stomach ulcers before they started taking ibuprofen.

    Since they literally and specifically say in it that their ulcers (according to the specialist) were caused from the ibuprofen they were taking.

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  • [–] 1 point 7 months ago (3 children)

    Since you want to argue this, instructing a patient to use nsaids to the point of ulcers is what they call in medicine malpractice.

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  • [–] 3 points 7 months ago (1 child)

    Is it? The Ehlers Danlos plus a car accident has caused bone spurs to form in my neck, and NSAIDS are the first-line treatment for that too, because the swelling does put more pressure on my spinal cord. I've switched to tylenol, but the dizziness has gotten worse so maybe the rheum was right.

    The ulcers happened after a period of intense stress. My stepfather, both grandparents, and cat all died within a year and a half, then I got fired because my work started to slip. The gastro pain also came with nausea/vomiting, loss of appetite, tachycardia, post-exertional malaise, and shortness of breath. I went from doing 20k steps at work to not being able to walk around the grocery store without feeling faint. I don't feel safe driving any more. I sweat and get shivering chills when I gotta poo. Since quitting NSAIDs, the nausea has resolved, but not the rest of it, and my gastro says they can't do anything more.

    My cardiologist has determined that there's nothing physically wrong with my heart. It's just randomly jumping from 70 to 180 for a short amount of time before going back to normal. Beta blockers make my resting heart rate too low, and the PSVT isn't dangerous, so there's nothing the cardio can do.

    My neuro thinks that my vagus nerve is also trapped in the disc osteophyte complex, plus they've found a glioma in my thalamus and a hemangioma in my T9 vertebrae, and those can also cause my symptoms. But the only thing they can do about it is pass me up the chain to a different specialist.

    The autonomic function clinic finally has an opening for me this summer, so maybe they can do something. If not, I'm jumping off a bridge.

    There is more going on, but this is what I mean when I complain that I've got an assorted list of diagnoses, with no coordinated care. My functionality has slowly been getting worse since the car accident in 2018, it sped up after the funerals and getting fired in 2024, and nobody has been able to actually help me. The only advice I've gotten so far is "Go see this other person", "take ibuprofen", and "don't take ibuprofen".

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  • [–] 0 points 7 months ago

    You're making a metric fuck ton of invisible leaps based on information this person never provided here. Lol. You don't have to be a doctor to figure this out, but you probably need at least the reading comprehension level of a ten year old.

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  • [–] 2 points 7 months ago

    Not American nor am I lacking my own doctor but I generally choose to see a specific NP at my clinic over my doctor since she's able to do everything I'd need my doctor for as well as actually caring to look into my health issues. I went over a decade with crippling digestive issues that I complained about constantly to my doctor but it was always dismissed as anxiety related. It was only the NP who actually cared to get me checked for celiac disease

    Not exactly that related of a tangent but just wanted to say bless nurse practitioners 🫡

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  • [–] 22 points 7 months ago (2 children)

    teledocs, and equity firms have been snatching up doctors all over the place, this hospital is likely part of a firm that does this, they can just staff 1 or few doctors in a hospital, and use teledoc soley.

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  • [–] 81 points 7 months ago (3 children)

    Fun story:

    I once got blocked from a flight by TSA because the inspector said my portable hard drive was an explosive device by looking at it via Facetime over an iPad while they were at an Arnold Schwarzenegger's body building conference instead of at work in the airport.

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  • [–] 4 points 7 months ago

    I almost got detained for bringing Exploding Kittens in my luggage. The game meows when you open the lid, so the device looked really suspicious. And the name on the front didn't help.

    Shit fucking game, by the way.

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  • [–] 77 points 7 months ago* (3 children)

    Great. We pay into health care that doesn’t offer physical care anymore.

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  • [–] 6 points 7 months ago (1 child)

    It makes me wonder how much can actually be taken from the American people before they'll do something.

    Before, it was a necessary cost that could bankrupt someone's livelihood. Now it's pretty much just a Kubla Kraus tax.

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  • [–] 54 points 7 months ago

    People need to be jailed over this

    As in the CEO, leadership, management, all involved in setting up and authorizing these procedures, should be jailed

    If not, this will just become the norm

    And of course it will just become the norm because again, somebody died needlessly and we're not doing shit about it because all the other CEO's still need a gold plated bathtub

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  • [–] 51 points 7 months ago* (14 children)

    I've been waiting for this since the 1990s, surprised it took so long.

    Starting in the 90s, much of the administrative duties of a hospital are now done overseas, including chart notes.

    The doctors being overseas? Worst case scenario is just starting.

    Why would a hospital pay a US physician 200K a year when they can get a doctor from Pakistan to do the same work for 50K a year? They even have surgical robots that can be remotely piloted from anywhere.

    It's not prevalent yet, but it will be.

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  • [–] 25 points 7 months ago* (3 children)

    This should have been such a straightforward case too.

    Mr. Hylton's condition deteriorated in the ICU, and despite orders, there are no CIWA assessments, no intake/output monitoring, and no MD assessments for pain and/or change in mental status despite the RN's non-contemporaneous note indicating mental status change in a patient diagnosed with alcohol withdrawal and a history of alcohol withdrawal seizures for which he had "previously been given Keppra."

    Hylton, who was admitted around 11 a.m., became unresponsive early the next morning around 4:30 a.m., the complaint says.

    "Mr. Hylton slid down in bed, his eyes rolled back and he … exhibited seizure-like activity, vomited, became bradycardic and code was called," the complaint alleges. "He was intubated, but he could not be resuscitated, and he was pronounced dead."

    What the fuck were they even trying to do? Some kind of tough love/cold turkey approach? Honestly wouldn't be surprised bc I've heard a lot of ignorant pieces of shit suggest that should be standard protocol for opiate withdrawal.

    Aside from that being intentionally and unnecessarily cruel, there's this tricky thing about alcohol withdrawal vs withdrawal from other "more serious" substances, where you can literally fucking die. That's exactly what happened.

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  • [–] 4 points 7 months ago* (last edited 7 months ago)

    ...the designer benzodiazapines are taking the symptoms your describing to a whole new level.

    The equivalent of thousands of alprazolam tablets can be acquired for a few hundred bucks. Addicts think they hit the jackpot when they get access to them, but they can be outright killed by the withdrawal. There is no ceiling for GABA A tolerance, so there is no ceiling for the withdrawal.

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  • [–] 1 point 7 months ago*

    He wasn't going through opioid withdraw, he was going through alcohol withdrawl, which can be just as dangerous cold turkey quitting. Alcohol has non specific effects in the brain, inhibiting excitatory neurotransmission by acting on NMDA receptors, and accentuating inhibitory transmission by acting on GABA receptors. Stopping cold turkey causes hallucinations and seizures due to the jump in excitatory neurotransmission. Keppra is an anticonvulsant that blocks high voltage gated calcium channels, which I sort of feel is an inappropriate medication on it's own, might have been better to pair it with a low does of memantine/ketamine or a benzodiazapine class drug.

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  • [+] 21 points 7 months ago (5 children)
  • [–] 9 points 7 months ago (2 children)

    See you're just thinking of pro-social applications for tech. Nothing wrong with that. One day the world will be better and we'll need creativity and positivity rather than nihilism. In the meantime, some cynicism is warranted.

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  • [+] 9 points 7 months ago (2 children)
  • [–] 5 points 7 months ago (1 child)

    I'd wager a guess that the designer had what you described in mind, but someone else did not.

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  • [–] 3 points 7 months ago

    Based on what I'm reading, the problem was he wasn't administered benzodiazapines for the withdrawal symptoms. This combined with alcohol induced organ damage were contributing factors.

    I feel as though most doctors would have been reluctant to prescribe a sedative. The more liberal they are with prescribing sedatives, the more likely their practice is to be overwhelmed with drug addicts.

    ...it will be interesting to see how this plays out in court.

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  • [+] 5 points 7 months ago* (last edited 6 months ago) (1 child)
  • [–] 2 points 7 months ago

    The issue is that these surgical robots are a goldmine for companies specializing in medical devices. I work for one. They look fancy, they're available to buy on loan if you can't afford the several million dollars, and they sound modern.

    Meanwhile, the instruments are not cross-compatible (meaning you can't run Medtronic instruments on a US Medtech robot, for instance), so while they're reusable and sterilizable (unlike most other handheld devices which are designed to be one-case-only), you have to buy a whole suite of endocutters, staplers, and whatever else you want that robot to be able to do in order to make it do that. PLUS there's a proprietary computer system, an imaging system, the software to run those, often a televisual rig at the other end for the surgeon to run...you can get really pricey for these, real quick, and that's not to mention the staple cartridges, the trocars, all sorts of stuff that can be proprietary.

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  • [–] 2 points 7 months ago

    Why would a hospital pay a US physician 200K a year when they can get a doctor from Pakistan to do the same work for 50K a year?

    Liability to the hospital if a remote doctor fucks up? Just for starters.

    It's also very difficult to manage remote workers. As a result, that $50k Pakistani doctor needs another $50k Pakistani contract manager and a Pakistani HR manager and a nurse who can communicate fluently with both patient and doctor and software that an IT firm needs to maintain and a lawyer to sort out all the messy details of licensing and practice.

    At the end of the day, it isn't nearly the cost savings you're promised.

    Every outsourcing gambit plays out this way. Which makes it more of a negotiating ploy against local workers. Threatening to outsource is far more profitable than actual outsourcing.

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  • [–] 2 points 7 months ago (2 children)

    I think now as things advance with AI and the US government is completely corrupt/dysfunctional some company is going to make a med bed with an array of sensors and AI.

    One of the oligarchs will bless us with this technology and they will get a shit ton of money from the government, so long as the big guy gets his cut.

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    [–] 46 points 7 months ago (8 children)

    "But people fly here from other countries for healthcare."

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  • [–] 3 points 7 months ago (4 children)
  • [–] 6 points 7 months ago* (3 children)

    Extremely wealthy people do come here for unparalleled healthcare no normal American can afford.

    The fact that they fly here for healthcare is often touted by conservatives as evidence of the quality of our healthcare system.

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  • [–] 5 points 7 months ago* (2 children)

    The opposite happens as well, I have a family member with MS that left the U.S. twice for treatments. The first one he flew to Russia to get a stem cell treatment where even though they use the stem cells from his own body, was still considered illegal in the U.S. at the time. (May still be). That slowed/paused his MS and he didn't have any large degredations for 15 years after that. The second time he flew to South America, can't remember where for a different experimental surgery. That was about 5 years ago. All in all it took about 30 years post diagnosis to finally put him in a wheelchair, though I believe he still can stand up for short stints.

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  • [–] 5 points 7 months ago

    MS varies widely. My mother has MS but it was caught extremely early due to a freak accident. She's had very little degradation since diagnosis because it was caught early. No need for experimental treatments.

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  • [–] 1 point 7 months ago

    Trans people all over the US still go to Thailand and similar markets because to literally fly to another country, get bottom surgery, spend the 3-6 month recovery period there, and THEN fly back to the US is STILL cheaper and faster than trying to get it done here.

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  • [–] 43 points 7 months ago (5 children)

    How is is legal to pronounce death without directly checking their pulse in person?

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  • [–] 36 points 7 months ago

    RNs can get the vitals that allows a pronouncement. I do it regularly for hospice folks and it certainly ain't my name on the death certificate. Having an RN verify vitals for an active code is a bit weird though. But so is running a code through telehealth.

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  • [–] 13 points 7 months ago* (2 children)

    Paramedics (at least in NJ) aren't allowed to pronounce, but they're what's called online care (maybe, it's online something), and so they feed vitals to a doc over the phone, and the doc says okay call it.

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  • [–] 1 point 7 months ago (1 child)

    Medics can pronounce in the field in Florida for "injuries incompatible with life", think rigor mortis, decapatations, already rotting corpses, etc

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  • [+] 35 points 7 months ago* (4 children)
  • [–] 14 points 7 months ago (3 children)

    So you got the platinum special. I got injected with some unknown disease and tagged for scientific research at a later date for $1,000 after insurance.

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  • [–] 8 points 7 months ago

    Same it ;was Gardasil the HPV vaccine given to me in my teens but NEVER told my mom I was a guinea pig and we were the first to test.

    I got PSOS and my other friends either got that or endometriosis!

    The American healthcare system is fucked! Never got any compensation or anything for it just a lifetime of health issues. Also, found out the drug I need is $500 a month and takes $3 to make! Fuck the pharmaceutical companies they’re just as bad as the government. They are basically legal drug cartel!!!

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  • [–] 4 points 7 months ago (1 child)

    Now that's a whole differenr tier of fucked.

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  • [–] 2 points 7 months ago*

    thats not even the half of it, some insurance put different drugs on tiers, generics are usually the cheapest one, then brand name of those generics. and then expensive generics, and specialty like biologic, cancer drugs,,,etc. drastically increase in cost. they can unilaterally not cover certain ones too.

    like alot of drugs, topicals are made from INDIA manufactured there, but a 200$ wholesale cost for a 30g tube for a topical immunosuppresant that is GENERIC, with insurance its either no cost or a small copay. probably look for online coupons if your insurance wont cover it, and you need it.

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  • [–] 30 points 7 months ago

    That is fucking horrifying.

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  • [–] 21 points 7 months ago (2 children)

    Non contemporus notes don't really matter (ICU nurse isn't going to write a note while they're peeling this guy off the ceiling) and I'm not familiar with ICU level withdrawal care but I doubt CIWA is helpful in someone like this who's in full blown withdrawal already and going brady with current interventions. CIWA is good for preventing him from getting where he already obviously was.

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  • [–] 18 points 7 months ago

    Once again the Bigly Beautiful Bill encourages survival of the fittest, puh-raise JEE-zuz-ah!

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  • [–] 12 points 7 months ago

    First thought: "Must be USA". opened the link just to check and was not dissapointed wrong

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  • [–] 11 points 7 months ago

    Meanwhile in in the rest of the world we've got conservatives telling us how much more efficient it would be and how much quicker you'd see a doctor if we adopted America's for-profit healthcare system.

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  • [–] 11 points 7 months ago (3 children)

    I know this is fucked up in general, but am I the only one who's slightly bothered by the description of him as a "dental student"? Maybe I'm overthinking things, but I worry that reporting would look different if it didn't happen to a person of high status.

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  • [–] 5 points 7 months ago (2 children)

    While you were dicking around, he was studying the tooth!

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  • [–] 6 points 7 months ago