Posted on October 29, 2019 at 2:48 AM
by Craig Klugman, Ph.D.
Two sisters, Jasmine and Paz, sit in Sharpe’s office. Paz is in treatment for uterine cancer. Her sister offered to be her reproductive surrogate and one day from implantation, the insurance company changed the rules and will no longer cover the procedure. Goodwin takes on the insurance company, finding himself in a Byzantine maze. Even more bizarre, the insurance won’t cover surrogacy but it will cover a uterine transplant which is ten times more expensive. At the end of the day, Goodwin learns that a member of the board of trustees can make an exception. As this show often says, you can’t always change an entire system, but today you had a good outcome for one patient and tomorrow you work for the next one. In reality, contracted surrogacy is illegal in New York, but this is a case of unpaid familial surrogacy. However, a new law in New York requires insurance plans that cover more than 100 people to cover surrogacy. Depending on her employer,
Calvin is a boy who comes to the ED with bruises around his throat—done by hands. An investigation reveals the mother’s claim that he had tied a rope around his own neck and she cut him down. No cord or scissors could be found. The father finally confesses that it’s his fault—that he did it. At the same time, his wife confesses to choking the boy as well. The marks show hands too small for it to be the father, and the mother’s hands lack defensive wounds. The culprit is his sister, Juliette, who wanted her brother’s cell phone. Frome diagnosis Juliette as a psychopath (she has no emotional reactions; wants to hurt her family; and finds people easy to manipulate) and family services says she needs to be removed from the family and hospitalized. Frome tries working with her and figures out a game that allows her to interact with others without hurting them, but she will never feel empathy. Protective services seem unconvinced at the end of the episode. In reality, health care providers are required reporters when it comes to child abuse, no matter who has done the abusing, even if it is another child. Frome seems to be overestimating his abilities and ignoring the advise of his colleagues. His hubris is likely to get someone hurt.
Col. Mackenzie Adams is an astronaut scheduled to go up on the next mission. She lost control of her bladder and Reynolds wants to do a cardiac assessment. She has supraventricular tachycardia which led to her bladder issue. NASA never discovered the problem. Reynolds tells her the condition could cause her to lose consciousness and put herself and her crew at risk. He can perform a noninvasive ablation which should solve the problem. Reynolds finds that she has two pathways and ablating both would weaken her heart over time. He says she needs surgery but that would ground her. After Adams gives him a story of her dream of space travel, he says he will do the double ablation on the condition that she undergo a risky stress test (that could kill her). She agrees and Reynolds does the procedure. Reynolds gives her adrenaline to stimulate the stress of space launch: She passes the test. While the chosen procedure may not be the gold standard, sometimes a physician needs to work with a patient’s needs and interests to choose a treatment that works for them. Patients have a right to make their medical decisions even if it puts them in harm’s way, but a physician does not have to perform a procedure that they feel harms a patient. The line is fine.
Lucas is an infant whose parents brought him to the ED. He’s been sick all summer with a cough, bloody nose and a rash. The parents assume allergies. Manning wants to run some tests but the parents are taking a naturopathic approach to their child’s healthcare. They agree to allow some simple tests. Lucas has a bacterial sinus infection and is dehydrated. The parents start talking about giving him coconut water and refuse Manning’s offer of an antibiotic. She says that she can give him an IV saline drop. After, the parents want to take him home, but Manning is pushing back against their naturopath approach, suspecting pneumonia. Halstead steps in and talks them into consenting to an x-ray. The x-ray is clear and the parents want to take him home. Manning refuses, locking herself in the treatment room and administering antibiotics with the parents outside the door yelling “no”. In reality, this is a clear case of battery. The parents are not giving consent and the child’s life is not endangered by their choice. Manning should be suspended, perhaps arrested, and an investigation could lead to a suspension or revocation of her medical license.
Neal comes to the ED after waking up with a swollen calf and pain. Halstead diagnoses a blood clot. Later the foot is worse and Neal is having trouble breathing. After putting Neal on oxygen, Halstead offers to call Aubrey, the man’s fiancée, but he gets distracted and never does. The man dies. Cut to Aubrey in the ED and no one telling her anything. If a health care provider makes a patient a promise or offers to do something, it is important that they follow through—anything less a violation of trust in the fiduciary relationship. If one fears that they can’t complete a task, then they shouldn’t offer to do it in the first place.