In an astonishing story, CNN claims that the famed Mayo clinic imprisoned an adult patient there against her will. In an unusual move, the patient's family signed a consent form for the hospital to respond without concern for HIPAA privacy protections, and even more unusually Mayo released a statement so scorching that it all but accused CNN of committing blood libel. CNN stood by it's story and claimed multiple Mayo spokespeople were shown to have no grasp on the details of the case, and spent an inordinate amount of time accusing Mayo of significant shadiness with whether a meeting was "on-the-record". But, as with so many problems in medicine, this situation too boils down to a failure to communicate on Mayo's part, and a failure to understand medicine on the part of CNN.
The lead-up itself is remarkable: a perfectly healthy 18 year old girl named Ashley suffered an extremely lethal ruptured brain aneurysm- but she miraculously survived with good neurological function, thanks to the heroic efforts of Mayo's neurosurgeons- truly some of the best in the world. This is what their specialty lives for, the glory when one patient does well amidst a sea of terrible outcomes (Ashley reportedly had a less than 2% chance of survival), a heavy burden to bear and one for which neurosurgeons will always have my admiration.
However, problems started once the young girl was transferred to the rehab floor for the long course of therapy that would let her regain a normal life. Significant conflicts between the parents and the doctors, nurses, and allied health staff broke out- Amber (the mother) claimed that the hospital did not give her daughter enough opioid pain medication, and did not address their (numerous) concerns. The hospital's response noted that Amber was physically aggressive to staff, verbally abusive, and would not learn how to care for her daughter. Underlying all of this was the hospital's concern that the mother was abusive. Not only did another family member tell Mayo that Amber was abusing Ashley (though CNN reports that this family member had dementia), Amber's other children were removed from her home after she tested positive for methamphetamines. If Ashley were 17 years and 364 days old, every action the hospital had taken would be normal and expected to protect a child. But because she was older than 18 years and one day, even though the brain aneurysm and 4 neurosurgeries had left her significantly incapacitated, an entirely different set of rules applied. Under those rules, even if Ashley was incapacitated, and despite the hospital suspecting she was being abused, her mother retained all abilities to make decisions for her unless a court took away the guardianship.
The family claims that they repeatedly asked Mayo for a transfer, which was refused, while Mayo flat out denied ever refusing a request for transfer. But, both CNN and the family clearly never understood what a transfer entails. Ashley had significant needs at the time- a feeding tube, and other care requirements that if not properly managed, could lead to her death. Mayo had no confidence in the mother's ability to carry out these care requirements (and considering that the mom was later found to be high on meth, this lack of confidence was probably justified). So the only place Ashley could safely go in Mayo's opinion was to another treatment facility. But there was no medical reason for this transfer to take place- Mayo had more capability to treat Ashley than any other hospital in Minnesota, possibly the entire Midwest. If the family wished for a transfer, it was their responsibility to find an accepting physician, accepting hospital, AND THEN come to Mayo with the details, after which Mayo would have no ability to stop an ambulance crew from picking up the patient and spiriting her away. Now, if there was a medical reason for transfer, or if an insurance company contacted Mayo asking them to transfer a stable patient to an in-network hospital, it would have been Mayo's responsibility to arrange all the details. But, if the family wants a medically unnecessary transfer, that is their right- and they have to make all the arrangements.
Thus, CNN's claim of a "refused demand for transfer" is nonsensical- there was no real demand for transfer because the family didn't find a hospital to send the patient to that Mayo could refuse. Of course, if Mayo had actually explained this to the family at the time, much of this situation could likely have been avoided- but I suspect by that point, Mayo was convinced that any help given to the family to carry out that transfer would put Ashley in more danger.
Finally, Ashley's parents managed to elope Ashley from the hospital, getting her into the lobby to see a non-existent grandma, and then driving away. After several days of pursuit by law enforcement, they took Ashley to Sanford Hospital in South Dakota, which determined that Ashley could safely recover at home. At that point, law enforcement ceased to pursue the matter. Ashley recovered well, and is now attending college.
CNN harps on this fact- using Ashley's good outcome to claim that Mayo's refusal to discharge Ashley was unjustified. But this misses the point- just because a person drives drunk and doesn't crash doesn't mean driving drunk is risk free and was a good idea. Mayo had to decide if releasing a mentally incapacitated patient to home to be taken care of by an adult who was suspected of abuse was in the best interests of Ashley- and their decision was that the risk was too high. Sanford hospital, probably unaware of the abuse allegations against Ashley's mother, decided the risk was okay. Hindsight is 20/20, while decisions must be made in uncertainty.
The practice of medicine is an exercise in partnership. The patient, doctor, and often-times the family must work together- when that relationship breaks down, disaster can result as it did in this case. I doubt Mayo took the actions it did because of some nefarious plot- it did what it felt was necessary to act in Ashley's best interests. But the family's actions, borne of frustration and lack of understanding, fortunately had no ill-effect. In the end, Ashley has done well- and that is the only outcome out of this unfortunate situation that truly matters.
The lead-up itself is remarkable: a perfectly healthy 18 year old girl named Ashley suffered an extremely lethal ruptured brain aneurysm- but she miraculously survived with good neurological function, thanks to the heroic efforts of Mayo's neurosurgeons- truly some of the best in the world. This is what their specialty lives for, the glory when one patient does well amidst a sea of terrible outcomes (Ashley reportedly had a less than 2% chance of survival), a heavy burden to bear and one for which neurosurgeons will always have my admiration.
However, problems started once the young girl was transferred to the rehab floor for the long course of therapy that would let her regain a normal life. Significant conflicts between the parents and the doctors, nurses, and allied health staff broke out- Amber (the mother) claimed that the hospital did not give her daughter enough opioid pain medication, and did not address their (numerous) concerns. The hospital's response noted that Amber was physically aggressive to staff, verbally abusive, and would not learn how to care for her daughter. Underlying all of this was the hospital's concern that the mother was abusive. Not only did another family member tell Mayo that Amber was abusing Ashley (though CNN reports that this family member had dementia), Amber's other children were removed from her home after she tested positive for methamphetamines. If Ashley were 17 years and 364 days old, every action the hospital had taken would be normal and expected to protect a child. But because she was older than 18 years and one day, even though the brain aneurysm and 4 neurosurgeries had left her significantly incapacitated, an entirely different set of rules applied. Under those rules, even if Ashley was incapacitated, and despite the hospital suspecting she was being abused, her mother retained all abilities to make decisions for her unless a court took away the guardianship.
The family claims that they repeatedly asked Mayo for a transfer, which was refused, while Mayo flat out denied ever refusing a request for transfer. But, both CNN and the family clearly never understood what a transfer entails. Ashley had significant needs at the time- a feeding tube, and other care requirements that if not properly managed, could lead to her death. Mayo had no confidence in the mother's ability to carry out these care requirements (and considering that the mom was later found to be high on meth, this lack of confidence was probably justified). So the only place Ashley could safely go in Mayo's opinion was to another treatment facility. But there was no medical reason for this transfer to take place- Mayo had more capability to treat Ashley than any other hospital in Minnesota, possibly the entire Midwest. If the family wished for a transfer, it was their responsibility to find an accepting physician, accepting hospital, AND THEN come to Mayo with the details, after which Mayo would have no ability to stop an ambulance crew from picking up the patient and spiriting her away. Now, if there was a medical reason for transfer, or if an insurance company contacted Mayo asking them to transfer a stable patient to an in-network hospital, it would have been Mayo's responsibility to arrange all the details. But, if the family wants a medically unnecessary transfer, that is their right- and they have to make all the arrangements.
Thus, CNN's claim of a "refused demand for transfer" is nonsensical- there was no real demand for transfer because the family didn't find a hospital to send the patient to that Mayo could refuse. Of course, if Mayo had actually explained this to the family at the time, much of this situation could likely have been avoided- but I suspect by that point, Mayo was convinced that any help given to the family to carry out that transfer would put Ashley in more danger.
Finally, Ashley's parents managed to elope Ashley from the hospital, getting her into the lobby to see a non-existent grandma, and then driving away. After several days of pursuit by law enforcement, they took Ashley to Sanford Hospital in South Dakota, which determined that Ashley could safely recover at home. At that point, law enforcement ceased to pursue the matter. Ashley recovered well, and is now attending college.
CNN harps on this fact- using Ashley's good outcome to claim that Mayo's refusal to discharge Ashley was unjustified. But this misses the point- just because a person drives drunk and doesn't crash doesn't mean driving drunk is risk free and was a good idea. Mayo had to decide if releasing a mentally incapacitated patient to home to be taken care of by an adult who was suspected of abuse was in the best interests of Ashley- and their decision was that the risk was too high. Sanford hospital, probably unaware of the abuse allegations against Ashley's mother, decided the risk was okay. Hindsight is 20/20, while decisions must be made in uncertainty.
The practice of medicine is an exercise in partnership. The patient, doctor, and often-times the family must work together- when that relationship breaks down, disaster can result as it did in this case. I doubt Mayo took the actions it did because of some nefarious plot- it did what it felt was necessary to act in Ashley's best interests. But the family's actions, borne of frustration and lack of understanding, fortunately had no ill-effect. In the end, Ashley has done well- and that is the only outcome out of this unfortunate situation that truly matters.
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