Texas legislators force physicians to provide substandard medical care

Texas Abortion Laws Pose Dangerous Implications for All of Medicine

 
Much like expensive red wines, many Facebook relationships, and Kanye West’s psychological state, the case of Texas House Bill No. 2 is complicated.

Last week the Supreme Court heard oral arguments for Whole Woman’s Health v Hellerstedt, one of the most pivotal cases in abortion law in decades. The plaintiff seeks to strike down Texas House Bill No 2, commonly referred to as HB2, legislation that was passed in 2013. It’s legislation that, under the guise of protecting the health of Texan women, has actually endangered their well being by restricting access to abortion services in Texas.

It will set a dangerous legal precedent if found constitutional. Not only will it impact abortion access, it could change the way we practice all of medicine.

HB2 is the most medically intrusive legislation that has ever been written. It placed several restrictions:

  • Limits the gestational age of procedures to 21 weeks
  • Requires that abortion centers must meet the standards of ambulatory surgical centers
  • Requires that all abortion providers must have admitting privileges at a local hospital
  • Requires that the medications that are used for medical abortion are given exactly as the FDA approved

HB2 is like Mylie Cyrus talking about race in America. At first blush her statements don’t seem completely unreasonable, but then you realize that she’s simply hiding her own sanctioning of a racist musical industry underneath a thin veneer of false caring, rainbows, and appropriated yoga mantras.

Similar nonsense is generated when legislators regulate abortion. The areas of expertise that most legislators have are writing rambling documents, shaking hands, and distributing little signs with their names on them. Nowhere in that list is medical care. HB2 is an attack on the rights of women under a thin veneer of false caring and flawed medical reasoning.

Supporters of HB2 say it’s meant to protect the well being of women, but the language of the bill demonstrates its true intent. The number of times the bill uses the word fetus, zygote, or embryo? Zero. The number of times it uses the phrase “unborn child” or “unborn children?” Twenty-seven. The number of times I heard a lecturer in medical school say the phrase “unborn child/ren?” Zero. The number of times I heard a lecturer in medical school say fetus, zygote, or embryo? Countless.

  
Furthermore, it is an attack on every American’s right to high quality healthcare.

Nowhere else in medicine are doctors told by the law exactly how to practice in such detail, and for good reason. Certainly there are quality measures that must be met such as standards around sterility, safety, and first aid, but there are no laws that get into the minutiae of when and how to prescribe a medication. Even when it comes to potentially lethal controlled substances such as methadone, the details of dose and timing is left up to a provider’s judgement.

White power and the 'model minority' myth

Officer Peter Liang Highlights the Asian American Identity Crisis

 
The conviction of Peter Liang is the best thing that has happened to Asian Americans since the Immigration and Nationality Act of the 1960s. It’s also an embarrassing example of how bewildered the minds of some Asian Americans are when it comes to race.

The conviction is a much-needed wake up call to those who have been brainwashed to believe the model minority myth. It’s clear evidence that white America still views Asian Americans as “other.” The “Blue wall of silence” does not cover yellow.

Peter Liang’s conviction makes painfully obvious three crucial facts that are necessary to understand the racial circumstances of Asian Americans. (1) American racism includes Asian Americans. (2) Through intentional legislation and campaigning, the white majority has utilized the educational and financial privilege of a portion of Asian Americans to convince society that racism is no longer an issue. (3) Asian Americans themselves have fallen prey to this message, driving a wedge between the Asian American community and other communities of color and weakening our collective power to change the status quo.

The model minority myth has led much of America to believe that through hard work and an unwavering dedication to academic achievement, Asian Americans have achieved the true American dream, supposedly showing that it is not systemic racism but lack of adherence to American work ethic that holds back other communities of color.

While the falsehoods that make up the model minority stereotype and its toxic impacts are too complex and numerous to unpack in their entirety here, exploring a few the issues is necessary. A key misunderstanding is the origin of stereotypes. While most of us recognize that stereotypes are generalizations that cannot be applied to any one individual, we also believe that they spring from a small grain of truth. They represent a generalization of a true trend in behavior or characteristic that is common amongst a group of people.
  
This is nonsense on so many levels. If you have a gun, you are held to a higher standard. There are no mistakes, just tragedies.This is nonsense on so many levels. If you have a gun, you are held to a higher standard. There are no mistakes, just tragedies.

Prison health care in America is a crime:

Even with treatment for Hepatitis C, Abu-Jamal’s health not guaranteed

This is the final part of a series on Mumia Abu-Jamal’s fight for appropriate health care for himself and for over 2 million prison inmates across the country. (Click here for Part I, here for Part II, or here for Part IIIa)

In Abu-Jamal’s case, most of the legal and media discussion has focused on the denial of hepatitis treatment to him and inmates across the country. And while that alone is malpractice, what is even more appalling was the failure to diagnose and then treat his diabetes. Diabetes care is a cornerstone of basic healthcare. Abu-Jamal’s case illustrates that inmates are denied not only expensive medical treatments but also widely available, inexpensive treatments. Moreover, it demonstrates a failure of correctional healthcare systems to provide even the most basic health care for its patients.

Abu-Jamal, nearly a year ago tested positive for diabetes while imprisoned, and yet his case was intentionally left untreated. In his medical records, blood tests taken on March 8, 2015 showed a glucose level of 419, well exceeding the diabetic level of 200.

There are two major forms of Diabetes. Type 1 Diabetes is the kind that frequently presents young in life. While it is very common for this form of diabetes to be initially diagnosed in a crisis setting (coma, severe dehydration, electrolyte disturbances), Type 2 Diabetes, the form that typically starts in adulthood and the form that Abu-Jamal has, very rarely gets to that point because it develops more slowly and is discovered early before it ever reaches that level of severity.

In his chart, someone circled the blood sugar value and wrote by it “on steroids.” What this note suggests is that the provider felt that since there was an explanation for his high blood sugar, there was no need to treat it. That lack of action is equivalent to looking at a patient whose pneumonia is so severe that they need a breathing machine and then saying, “We know why they’re not breathing well. They have pneumonia.” Just because you know the cause of a finding doesn’t mean it doesn’t have to be treated.

Lab results from Abu-Jamal's medical recordLab results from Abu-Jamal's medical record

Standard of care for a blood sugar that high is to immediately give medication to lower it, or at least monitor three times a day. One of the main medications for the treatment of diabetes is metformin. It costs $4 a month. But because prison doctors didn’t provide any treatment, his sugars climbed to levels so toxic that his brain stopped functioning and he went into a diabetic coma.

Countrywide epidemic of neglectful healthcare

Sadly, Abu-Jamal’s healthcare is not an exception. It’s an example of the poor healthcare that is rampant in prisons and jails across the country. Cases of this felonious level of healthcare are so numerous that it would be impossible to list them in their entirety. However a few examples illustrate the severity of the negligence.

Abu-Jamal’s case illustrates widespread neglect of prisoners’ health nationwide

Mumia faces possible second death sentence

 
The third in a three-part series on Mumia Abu-Jamal’s fight to force the Pennsylvania prison system to treat his active Hep-C infection, and that of thousands of other infected state inmates, and on the raging Hepatitis-C epidemic in the nation’s prisons. (Click here for Part I or here for Part II)
  
Seattle, WA – Physicians are held to professional expectations dictating that the failure to provide standard healthcare is malpractice. There is no difference between failing to provide a service and performing a liable medical mistake.

A recent study revealed that out of the top three reasons why OBGYN physicians are sued for malpractice, two of them are related to inaction: 1) delays in intervention when there are signs of fetal distress and 2) the improper management of pregnancy including failing to test for fetal abnormalities when indicated, failure to address complications of pregnancy, and the failure to address abnormal findings. As a family medicine physician, I have been warned countless of times that one of the most common lawsuits relates to not identifying cases of skin cancer. In each of the instances, an inaction that results in a patient not receiving standard care is considered malpractice.

Given that not providing standard of care is malpractice, Mumia has been a victim of malpractice at the hands of the prison health system in two major areas:
• Even though Hepatitis C treatment is not always required, the failure to provide it for Mr. Abu-Jamal would be medical negligence. By even the most conservative standards, he meets criteria for treatment.
• Failing to treat his elevated blood sugars until he was unconscious is clear malpractice and gross negligence.

Unfortunately, Mr. Abu-Jamal’s case is not an isolated incident. Across the country inmates are not only being denied necessary Hepatitis C treatment, but they are also being denied other basic healthcare needs.  

Blacks to be treated differently with blood pressure medication

Racism Alive and Well in New Medical Guidelines

With this article, ThisCantBeHappening! welcomes Dr. Jess Guh to our collective. You can read about her background by clicking on the “Who, and What, Are We?” button above, just below our masthead.
 

Going to the doctor is like going to the car mechanic. It falls right between “trip to DMV” and “post office during the holidays” on the list of errands that we all hate doing. Just like the car mechanic, it can be expensive and even if they don’t fix the problem, you still have to pay. When they do find something wrong, you have to take their word for it and assume that whatever course of treatment they suggest is best. If you try to go against their recommendation they give a condescending stare and then ominously warn, “OK, it’s your life do whatever you want, but it really isn’t safe.”

But at least some people know something about cars that can give some advice. We all have a friend who spends the weekend with their buddies fixing cars. I don’t know anyone who sits around on a Sunday with friends working on each other’s hypertension.

Whether it’s your health or your transportation, it’s disconcerting to have such critical parts of your life in a black box of decision making. You don’t know how physicians are making their decisions. Surely they are thinking about what will make the best health impact, but what else are they considering? Cost? Pharmaceutical advertisements? Convenience? What about race?

In a time where white supremacy is no longer acceptable, a far more insidious form of racism is at play: unconscious bias. Implicit bias and microaggressions are difficult to describe and almost uniformly unintentional, but their impact is tremendous. Because medical decision-making is far more ambiguous than most people realize and involves the evaluation of subjective and incomplete data, it’s particularly prone to unconscious bias.

The CDC estimates that two thirds of adult Americans have either hypertension or pre-hypertension. Deciding the best way to treat this disease impacts over 70 million people. So when the Joint National Committee, a panel of experts on hypertension, released their updated guidelines at the end of 2014, it caused quite a controversy. While the guidelines included a plethora of recommendations, the debate has largely surrounded their recommendation that patients over the age of 60 have a more relaxed blood pressure goal of 150/90 instead of 140/90.

It’s been over a year since the new guidelines were released, but the debate continues. What’s so baffling to me is not that we keep discussing the 150/90 thing, I agree it is important, but that in all this time the most controversial part of the guidelines hasn’t been mentioned in public debate or the media: that physicians should treat black patients and non-black patients differently.


 

Coming next: Year-round worker protests at Walmart

Walmart Black Friday Strikes Become a Thanksgiving Holiday Tradition

Bellevue, WA — Yesterday marked the third annual Black Friday protests and strikes at Walmart, the largest private employer in this country. The Walton family, controlling owners of the company, is America’s richest family, with holdings valued at almost $150 billion dollars. For decades, Walmart has remained an employer powerhouse based upon a business model of low wages, poor benefits and union busting.

Walmart officials categorically deny any efforts to squelch workers’ organizing. At the protest at Bellevue, WA, yesterday, officials are quick to argue that the small percentage of employee participation in the strikes proves that the vast majority of workers are happy. When I asked their public relations representative to comment on the counter interpretation that limited employee participation could be due to an intimidating environment that scares would-be strikers into silence, she had no comment.

And though the spin-doctors of Walmart would have you believe that these protests and strikes are simply exaggerated demonstrations from a very vocal minority, the growing number of petitions, strikes, and studies say otherwise.

Walmart’s abuses are too numerous to catalog in their entirety. The most famously egregious includes a company-backed Walmart employee food drive during Thanksgiving last year for other Walmart workers living on Food Stamps and too poor to buy food for the holiday. In 2011, a class action lawsuit was filed alleging that women are paid, on average, $5,200 less per year than their already low-paid male counterparts. In 2005, Walmart shut down a profitable store in Quebec simply because it successfully unionized. In 2012, Walmart helped sabotage a safety improvement movement in their contracted overseas sweatshops, including a building that collapsed in Bangladesh and killed over 1,000 people.

It’s not just the Walmart workers who suffer. While folks might think that they’re saving money by shopping at Walmart, a 2013 a congressional report found otherwise. Walmart’s wages are so low that many of their employees require public assistance such as food stamps. The report calculated that a single “Walmart Supercenter” cost taxpayers anywhere from $904,542 to nearly $1.75 million dollars a year in taxpayer subsidies for employees. Another study estimated that that total annual cost to tax payers nationally was a staggering $6.2 billion dollars. And the kicker? Eighteen percent of the food stamp distributions are spent at Wal-Mart stores; that means that taxpayers essentially subsidized the $16 billion dollars in profits that Walmart made last year twice—once to subsidize wages, and once to subsidize the shoppers buying company products on sale in the stores.

Walmart protesters in Bellevue, WA on Black Friday, part of a nationwide movement against the giant chain (photos by Stefan Moritz)Walmart protesters in Bellevue, WA on Black Friday, part of a nationwide movement against the giant chain (photos by Stefan Moritz)
 

Occupy Hyatt: Harassed Hotel Workers (the 99%) Fight Back against Management (the1%)

The mainstream media likes to claim that Occupy Movement is comprised of aimless activists without concrete goals. They should go ask Martha and Lorena Reyes, two recently fired Hyatt housekeepers who know exactly why the 1% who run everything need to be occupied and what the 99% is demanding.
Until recently, the two sisters worked for the Hyatt Regency in Santa Clara, CA. On October 14th, after 30 years of combined service, they were abruptly fired.

According to the Hyatt, they were terminated for “stealing company time.” The hotel alleges that they took ten minutes too long on their lunch breaks. The Reyes sisters explain that housekeepers are assigned so much work that they frequently do not have time to take their legally-mandated, 10-minute break in the morning. It is routine and long-accepted by management for them and their coworkers to take an extra ten minutes during lunch to replace their missed break.

The Reyes sisters believe that they were actually fired for a different reason.

Their story begins in September during “Housekeeping Appreciation Week.” On arrival to work, Martha was greeted with a collage of her and her coworkers’ faces digitally altered onto the bodies of women in bikinis. She was horrified and took down the picture of herself and her sister, Lorena.

Though it’s commonplace to see images of scantily clad women in the media, Lorena explains, “In my culture I was raised to be conservative with my body. I don’t like bikinis… I felt very uncomfortable knowing my male coworkers were looking at that.”

Shortly afterwards, both women were fired.
 Marta (l) and Lorena (r) ReyesStanding up to the boss: Marta (l) and Lorena (r) Reyes

DADT: A Repeal of Convenience

Am I the only queer person in the country that is sad about the repeal of “Don’t Ask Don’t Tell”? I know the long-delayed bill just signed into law has destroyed my plan to avoid any future military conscription.

Let me explain. Many of my male friends in college photodocumented their participation in pacifist activities.  They explained that this was their insurance policy against any eventual military draft: solid proof to support a history of conscientious objection.  As a queer person, I had another plan, though:  If anyone tried to compel me to serve in the military, before anyone could even “ask,” I planned to “tell” by yelling, “I’m gay, and not in the happy way!” loudly and repeatedly, until no branch of the military would want me. Just for extra measure I would threaten to convert any and all women that I ran across.

Now, in the wake of another victory for queer rights in this country, it seems silly to not have taken pictures of myself at anti-war protests anyway.

But I have mixed feelings about the repeal of DADT for other reasons, too.  With queer folks now allowed to serve openly, it seems that yet another oppressed minority group has been pulled into being exploited by the American military-industrial complex.
 Jess GuhThe Author: Jess Guh