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Silence vs
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Silenced
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Mobbing and
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Trust Us
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Injured patients who want to help and be heard, click here.

 

Thomas Jefferson said that given the choice between government without newspapers and newspapers without government, he would choose to have newspapers.

In medicine we have government without newspapers. Patients cannot find out what they need to know to make informed choices. No one in medicine records or reports the information patients need to know the most. So patients will have to.

Crime in Medicine

Rough Draft / Under Construction

A normal patient does not expect to be abused and disabled intentionally by caregivers.

The least a person should be able to expect in healthcare is not to be intentionally injured. But in health care disloyalty is almost the only thing that the community punishes. Virtually anything else they cover up. So people get away with murder there. For most of the rest of his life, Aaron would wish that had been what they had done to him.

As he laid on the operating table waiting for the operation to begin, just below his right hip stood a nurse, right where diagrams in medical text books would later show she was supposed to stand for this procedure. It was a story that he would be called upon to repeat time and again. Every time he was required to it became more painful to tell. Every time he made the story shorter. Sometimes it was the same people asking him to repeat it yet again. Finally he decided to write it down, in part so that when people required him to repeat it he could tell them just to read it. But also because he now had a larger duty. When you know the building is on fire, you have a duty to warn the occupants. His story needed to be written down so that other patients could see what is wrong with healthcare. But writing it down meant he had to return it to its original length and detail, which felt like having to reach down his own throat to rip out his own esophagus.

He once read the account of a farmer who had slipped on his tractor while it was running. The farmer was hanging between the tractor and the machine it was towing seeing that if he stayed where he was he would be crushed to death, but if he let go and dropped to the ground his legs would get amputated. With complete clarity he decided to let go. Years later he could recount the event with no special emotion attached. But he was not routinely beaten up for it. He was not denied healthcare for his injuries. He did not have doctor after doctor manipulate the record to make it look as though he had no injuries and was evil for trying to make it appear as though he did. In addition, he was not asked to repeat it except on a few occasions. So it did not become more painful to tell each time he was asked to repeat it. He would have liked to have repeated it a few more times.

Most of the people asking Aaron to repeat his story asked sinister questions. Like if the surgeon was right or left handed. He said he didn't know. So they asked him to give his best guess. He could only sigh. If he guessed and was wrong, they would beat him up with that. Why would they ask him to guess if they were not trying to set him up for that? Once again would repeat that he never saw the surgeon's hands. They would ask how he could know the surgeon assaulted him if he couldn't see the surgeon's hands?

"Close your eyes. . . . If I kicked you where it counts right now, how would you know if you didn't see it?"

Often they said, "but you were under anesthesia." For the umpteenth time he would repeat, often to the same people who had been over this before, that he was not. He was fully conscious as he was supposed to be. During the operation he joked with the staff in the operating room. He was alert enough to follow the conversation and make appropriate jokes that caused laughter. Making jokes requires more clarity of thought than almost any other form of conversation. He was alert and aware and knows what happened.

Then why didn't anyone report it?

"Do criminals usually file reports on the crimes they commit?" he would want to ask. People in medicine rarely report anything negative. The worse the event is the less likely they are to report it. Hadn't they yet read his own study on nurses and reporting? One time he responded to his insurance company's attorney by telling him to subpoena every nurse at St. Virgin and ask if any of them ever have reported anything to a state board or agency. Collectively they will represent thousands of years of nursing and you can bet money that in that time not one of them had filed such a report.

Sometimes Aaron would mutter that we will not have taken the first step on the path to making healthcare safe for patients as long as there is anyone left who asks that question. People in medicine don't report things that don't make them look good.

They would ask, "Why would a surgeon intentionally injure a patient?"

He would wonder how long a list of reasons they would listen to? This question always was asked as though any answer would be insane. Why had Xerxes had the water whipped when his bridge was washed away. Why did Xerxes command his soldiers to give the water three hundred lashes and then brand it with red-hot irons while berating it? Was it the fault of the water that a wind whipped it into the waves that washed out his bridge? Such behavior is as old as history itself.

More recently, why did the father beat the 2-year-old friend of his daughter until she suffered a bleeding brain, bleeding around her heart, partial collapse of both lungs and deep bruising over her pelvis. Until she spent 52 days in a hospital? Until a piece of her skull could not be reattached to her body until three months later? What could a 2-year-old do to cause that? According to the man's lawyer, "One night he lost his patience for a few minutes."

In Aaron's case, the nurse taunted the surgeon and he lost his patience and took it out on the patient. How is a patient tied down and helpless different than a 2-year-old girl or a patch of water under someone's bridge?

It wasn't just the nurse's taunting him with her groping Aaron that irked the surgeon - a kind of game many women play in different arenas, to get rises out of one man by showing interest in another. Aaron had been funny, even charming, and had gotten more attention from the staff than the surgeon. This surgeon was one of those men who had to be the alpha male. Attention had to revolve around him. People had to see that he was the best, smartest, strongest, most attractive, etc. It is not as though he had no social skills. He was good at hiding his ugliest sides. But if he was not the center of attention and respect, people were punished. At this moment, Aaron was the water under that bridge. He was not the first patient intentionally injured by Sales. He would not be the last. But he would be the one who would try hardest to protect other patients. To Aaron it was clear that he was a victim because no previous victim had done what was necessary to protect future patients. He felt a duty to protect those that came after him. Unfortunately, the mechanisms in medicine are set up to protect caregivers from patients, not to protect patients from untrustworthy caregivers. And since he only was a normal patient, he still was under the impression that someone in medicine would help him. He imagined someone in medicine would care about him. Part of the learning curve for injured patients is that the reality is exactly the opposite. Medicine hates its victims. An injured patient is lucky if he or she experiences only the facade of indifference. Poke through that and what explodes back at you is absolutely hateful and destructive.

Later, when searching for answers, he spoke to one of the victims of Dr. James Burt. She asked what had happened to him. He told her. She said, "This was in a Catholic hospital, wasn't it?" It was, but he no notion about how that could be relevant. She said that he was in for more torment and damage than he could imagine. She herself had had to hire body guards. Dr. Burt had conducted operations on patients for a couple of decades without even having a license to operate, and no one in that Catholic hospital reported him or listened to the complaints of his victims. When she started complaining, she received death threats. "Why do you think no other religion on earth is known for protecting pedophiles at the expense of its own children?" she asked. "This is how they operate. I cannot even warn people about it without getting sued. I had to sign papers saying I would never discuss my case. So I'm discussing only yours. Not mine. From what you've said it sounds like you still can discuss yours, can't you?"

"I think so."

"Good luck with that. We've been stopped. They will get you too." And they did.

A urologic surgeon asked how Aaron got injured. When Aaron told him the surgeon visibly and purposely looked at Aaron with disdain and disbelief. "And why would a surgeon do that?" Yet again. The same questions. Hearing the answer only increased the surgeon's disdain and his display of disbelief. The questions only got worse. And they were what comprised the rest of the appointment, rather than diagnosis and treatment. Years later Aaron wished he could go back to him and say, "Shame on you. Shame, shame, shame on you. For treating a patient like that when he came only for help. You weren't the first place he went for help. He arrived feeling as though it was the third day without sleep during an interrogation by errant cops beating him with phone books. This patient was too tired and defeated to survive the onslaught of the medical profession's refusals and barriers even to try. Shame on you for marching in lockstep with a community that has no interest, not even a vestige of an interest, in helping patients who have been injured in medicine, only an interest in protecting those who injure patients. Shame on you. Shame on your entire community."

The next time he was asked how he got injured, he handed the physician a written account. It was brief and generated more questions that he answered for the next person ahead of time by including more in the written account. Eventually, the document grew beyond a mere retelling of the events and included explanations, and then supporting documents. It got thick.

For instance, he began by saying that if Dr. Sales was driving a car and felt road rage, he might be inhibited by the possibility of witnesses or retaliation. But when he's got a patient tied to an operating table, there will be no retaliation and there will be no witnesses. No consequences. When you are on his operating table, you better not cause him to worry that one of his nurses (perhaps one in particular) might be paying more attention to you than to him. There is nothing there to inhibit him from proving to you who is king in a way that you will be reminded of everyday for the rest of your life.

Remember Dr. Allan Zarkin [02], the surgeon who carved his initials in a patient after delivering her baby? Isn't that a crime? Do you think anyone filed a report on that incident? Do you think anyone turned him in? Do you think anyone asked that victim-of-stab-wounds if she was all right? Do you think anyone called the police? She'd just been carved up in front of witnesses. Do you think anyone even told her, the patient, what had been done to her? If anyone had it would have violated their loyalty to their colleagues and it would have violated risk management policy. Careers are ended for doing what it would be normal and right to do anywhere else in the world.

A parade of hospital personnel came through her room to lift her sheets to look at the Zoro-like laceration, but no one told her what they were looking at, not even when she asked. Finally she demanded that someone bring a mirror so that she could see for herself what was between her legs that was so interesting to everyone.

That's the way operating rooms and hospitals work. They say they would call the police if they saw someone intentionally injure a patient, but they don't. They are trained that way. When things go wrong their goal is to cover up and avoid liability no matter what it costs the patient. They are to give the patient nothing to go on. According to JCAHO assault, rape and homicide comprise roughly 4% of sentinel events in medicine and people who work in health care are the least likely of all people to report it.

That's why Dr. Sales could know that he could get away with what he did.

He wrote that he knew little about Dr. Sales when he was admitted for surgery at St. Virgin that morning. In the beginning they knocked him out for a short time as they injected a local anesthetic. The injection of that stings, so they anesthetize patients for that, but let them regain consciousness for the operation.

When he regained consciousness he was lying on the table in the operating room waiting for the operation to begin. He looked at, spoke to, and joked with people. He had had a colonoscopy once during which they had put him into a twilight. He knew what a twilight was. This was not a twilight. During this operation he was conscious and lucid.

The anesthesiologist leaned over him so that he could see him during the explanation about what was going happening. At the time he thought the anesthesiologist was a black man. He wrote that in his account. Later he learned that his pupils would have been dilated by the drugs they had him on. He was lying on his back with lights shining in his eyes. When the anesthesiologist inserted himself between him and the glare of the lights, his eyes were like a camera on the wrong exposure and did not adjust for the darkness of his face. Years later when got to see him testify in court he was a white version of the person he had described.

Aaron asked the anesthesiologist what drugs they had him on. After the explanation he asked if this was what was like to be high. The anesthesiologist chuckled and said, "I guess." Aaron realized it was sill to ask such a question in front of his colleagues. The answer would require him to admit familiarity with what it is like to be high. Of course pharmacology and anesthesiology students have greater access to mind altering substances than most people and, as students, experiment with them. But for a moment he had not stopped to consider the social aspects of asking that question in front of his colleagues.

Aaron said that he had gone all the way through high school and college without finding out what it was like to get high. The anesthesiologist chuckled again. Two laughs from the anesthesiologist with the surgeon listening. That can be all that it takes to make an enemy.

Who, while lying on an operating table, worries about the ego of the surgeon?

HJ was standing at his right hip. At first he did not know what she was doing there, but at some point she moved in a way that made him aware that she was in contact with his private parts. His perception during the operation was that it was her hands that were in contact with his private parts. This operation is in such close proximity to a patient's private parts that pubic hair is shaved in order to make room for the incision.

Later in court, Wiley, her attorney, would say that Aaron claimed in writing that she masturbated him. That word did not appear in anything he wrote. What it said was that at first he did not know what she was doing there, but at some point she moved her hand in a way that made me feel what she touching. She had what he supposed was a towel wrapped around his private parts. A nurse later told him that sometimes the nurse in that position holds the patient's private parts out of the surgeon's way. So he wrote down that that was what she was doing. Even if that was not the reason for the contact, contact with his private parts was continual.

Wiley said that Aaron wrote that in full view of the other personnel in the operating room she took his penis out and masturbated it. Aaron waited for his attorney to correct that. The text was in evidence to show the jury. It said that he worried that he momentarily might have been uncovered.

Wiley demonstrated for the jury by running his hand up and down an imaginary phallus several feet long and bigger around than an arm saying that this is what Aaron said she did right in front of everyone else.

Aaron's attorney, Dueter, did not correct these lies. He could have pointed out to the jury that they didn't have to take anyone's word for it. The jury could read the document Aaron showed doctors, or Aaron's web site and see for themselves what it said. It had had been printed out and entered in evidence. But Dueter didn't tell them that and they didn't do it on their own. The only version of the story they ever learned was the fowl, salacious lie told by Wiley.

What Aaron had written was that in the operating room was going sailing. He said something about it that made everyone laugh. HJ laughed and moved in a way that made every fiber in Aaron aware of where her hands were. More was said about the upcoming sailing trip. The nurse never had been sailing before. Aaron said something else that made everyone laugh. HJ moved her hands again. The sensation caused by her movement centered him in a way that surprised me.

This is a sensitive part of a male. Nothing that happens there goes on in the background. Men know the difference between being accidentally brushed against and getting taken advantage of. He was afraid she was going to cause him to have an erection. Afraid because this there was a male cutting him open too close to parts of himself that he didn't want a male near. And there was an audience in the room. He hoped the towel was positioned to keep him covered. As they continued to chat there continued to be these movements from her. He did get an erection. She did keep it hidden. But only for a while.

Dr. Sales was not sharing in the laughter. He interrupted Aaron more than once so Aaron stopped cracking jokes for a while. It sounded like two people began having a conversation behind the surgeon while the rest continued talking about the sailing vacation. Dr. Sales began reciting something nonsensical about sailing. His tone changed. He was not chatting. He was delivering a sermon. The people behind him continued chatting and this time he did not just interrupt, he commanded attention. He stopped in the middle of what he was explaining, raised his voice, sternly said, "Iím serious," and demanded that everyone listen. Everyone became dutifully quiet. He then delivered a sermon on how to sail. In court he later said that he knows nothing about sailing. Aaron already knew that.

When he finished his sermon, Aaron was conscious of Sales negative response to his joking, but thought that he was making a joke that was inclusive, one that complimented sales in a way, and so said, "This is great. Get sailing tips and get operated on all at once."

It seemed as though everyone but Dr. Sales cracked up, especially HJ who laughed so hard that she rocked backwards. During her initial and biggest laugh, in spite of rocking backwards, she managed to keep him covered. But then she shifted. Aaron felt part of himself break free from the covering and move. Even if it still were covered, his condition would have been apparent under the drapes. He wondered why she would have done that. Who would she have wanted to know about what she was doing? Was she showing off for another nurse? Trying to make Dr. Sales jealous? He hoped that Dr. Sales had not seen that she was in contact with an erection.

It was then that Aaron was knocked across the operating table as though a car had hit him between the legs. The ferocity of this would be difficult to exaggerate. All chatter stopped. Every face he could glimpse appeared to be in shock as Dr. Sales lunged into him. Aaron could not see him. Aaron thought from the way that he was being struck that Sales must be standing between my legs. Later he would be informed that Sales was standing at his left. The angle of trajectory of the injuries lines up with that. The x-rays of the injuries shows them running from left to right as though a bullet had been shot through there: damage to the penis, damage to the urethra, damage to the common penile artery and damage to the pudendal artery - all on the right side. The blows were coming from the left and so damaged the right.

At first there was a sideways motion to the blows, his head careening from one side of the table to the other with each one. It felt as though some instrument might be shoved inside him. He didn't know. He had been numbed. It also could have been that the instrument was not in the incision and was pressed against his external flesh. X-rays later would show that the injuries were inflicted directly on his penis, and that it was done with so much force that organs on the other side of it were smashed as well.

Thereís a chance that it was just his elbow or fist, though it didnít feel like it. Whatever it was, Sales was really getting his weight behind it. Hitting someone with a hammer does not move their entire body. If you hit a car with hammer you don't rock it. You merely dent it. Rocking it requires bending knees, learning over and lunging with ones full weight to deliver that much force, the amount of force that sends a person's body lurching like this. As Aaron's head careened from one side of the table to the other, he looked frantically around for anything with which his head might collide, worried about head injuries. Then the blows began knocking him lengthwise. He didnít know what was keeping him from being knocked off of the table and on to the floor. At the time he didnít know that he was tied down. And the blows kept coming.

When it stopped, he looked around. Everyone was hushed and, even behind their surgical masks, appeared to be slack-jawed. Something routine for him is to respond to terror or trauma with humor. He opened his mouth to say, "Has anyone ever gotten a head trauma from a hernia operation?" but stopped, worried that no one would think it was funny this time, and worried about what might happen next as a result of making people laugh. No one chatted for a long time. Everyone seemed sullen. Aaron was so ignorant about medicine that he wasnít sure that what had happened was inappropriate. He was not certain that pounding on the patient was not an appropriate part of an inguinal hernia repair.

He also did not know that people in medicine learn not to make what is known as an excited utterance. And excited utterance is a gasp or a yelp. That is something that can be brought up in court later to suggest that something was not right. So no one asks patients if they are all right after things like this. No one says or does anything that could give any indication that something unusual might have happened. The first goal of medicine is to avoid liability at such times, not to protect patients.

Three weeks later Dr. Sales wrote up the post op report. It said that the operation was perfect with no complications.

The people in the operating room witnessed a violent crime, yet not one of them filed a report. Aaron did not know that is the normal response to adverse events of all kinds in medicine.

When Aaron when to the police, they said there was no point in filing a report because there wouldn't be any witnesses. There never are in medicine. They also said they wouldn't let him file a report until he got diagnosed. Did you ever try to get injuries diagnosed when they were caused by someone in medicine?

"The surgeon beat the hell out of me."
"Why would he do that?"
"The nurse was groping me."
"Why would she do that?"
"She's a sex predator."
"Why are you here?"
"For treatment."
"That can't be why you are here."
"I'm in pain and deteriorating. You're a doctor. Why do you think I'm here?"

You don't leave with diagnosis and treatment.

A healthcare system that actually had the best interests of its patients at heart, at the very least, would have in place a system to deal with crimes committed by caregivers against patients. Instead they are dismissed as one-offs. It is as though a woman, who had just been raped outside, ran into the police station but was told that rape happens so rarely on the street that they don't do anything about them.

Unfortunately, for the victims of adverse events in medicine, whether accidental or intentional, the event is only the beginning.

Patients think someone is watching out for them.

Places, events, and situations in this story are purely fictional.
Any resemblance to actual persons, living or dead, is coincidental.


 

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Home | Table of Contents | It's a Path
Silence versus Patient Safety
Loyalty versus Patient Safety
The White Wall of Silence versus Patient Safety
Blacklisting Patients
Freedom of Speech for Patients
Medical Complaints - How to

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It's a path

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