Don't let vengeance seep into medicine as it has in politics

Don’t let vengeance seep into medicine as it has in politics

The callous and inhumane dislocation of migrants recently perpetrated by the state governors of Florida and Texas reminded me of an equally dismissive and appalling tactic used by healthcare workers since the 1960s: “Greyhound therapy”.

Greyhound therapy refers to attempts by health workers and administrators to remove unwanted patients from emergency rooms, hospitals and other types of facilities by providing them with one-way tickets on one Greyhound Lines bus to another distant place, hoping that they will never return. . Some of the patients are troublemakers and agitators known to frequent emergency departments, but the majority are destitute, homeless or mentally ill – or all three – and deserve our compassion.

Greyhound therapy is still in play in some medical and mental health circles. Between 2013 and 2018, a public psychiatric hospital in Nevada routinely bused patients to places they had never been or had no connection with, providing only a few days’ worth of food rations and medication for the trip. A class action lawsuit was filed against the hospital on behalf of approximately 1,500 patients who were dismissed, and a Las Vegas jury returned a unanimous verdict in favor of the patients, awarding each person $250,000 for the egregious treatment of the hospital.

A much more common but no less derisory practice is patient “dumping” – dumping uninsured and unwanted patients onto the streets or transferring them to another facility. Patient dumping was – and still is – such a huge problem that it literally took an act of Congress to stop it: the federal anti-dumping law passed in 1986 known as the Medical Treatment Act of Emergency and Active Labor (EMTALA).

Under EMTALA, patients must undergo a medical examination and be stabilized before discharge or transfer. If a hospital is unable to stabilize a patient given its resources, or if the patient requests it, a transfer can be made with the agreement of the receiving hospital.

Greyhound therapy, dumping, and busing migrant workers have their roots in the Freedom Riders. The Freedom Riders were civil rights activists who rode interstate buses in segregated southern states in 1961 to challenge Jim Crow laws that remained in effect despite Supreme Court rulings banning segregation in schools and buses and public depots.

To embarrass northern liberals and humiliate black people, southern white citizens’ councils and other groups countered the Freedom Riders. “Reverse Freedom Riders” issued black people with one-way tickets to northern cities with false promises of jobs, housing and better lives. The Kennedy White House received a letter from the leaders of the targeted states asking the federal government to intervene in the cruel trafficking of people of color.

The behavior of fanatics in the past is remarkably similar to the behavior of governors in Florida and Texas today. As one columnist observed, the two governors simply followed an old playbook in shipping migrants north. The governors weren’t smart. They were racist. At least Arizona officials coordinated their efforts to relocate the migrants.

The recent show of vindictiveness shown by governors cannot be attributed to implicit bias. Implicit biases are rooted in biases that unknowingly influence the way people are treated, especially minorities. Yet there is nothing unknown or unconscious in the minds of those who orchestrate and condone the trafficking of vulnerable populations.

Exploiting people’s misery for political ends is shameful and no more acceptable than sending patients to dead ends. JFK called the Reverse Freedom Rides a “pretty cheap shot”. He envisioned that government contractors would treat their employees without regard to their race, creed, color, or national origin. Shouldn’t it be the same for health professionals?

The notion of equal medical treatment dates back to Hippocrates. He said: “In all the houses I go to, I will enter for the sake of the sick…whether they are free men or slaves. In many American medical schools, it has become customary for new medical students to write and recite their own versions of the Hippocratic Oath. Many variations include language that specifically prohibits discrimination or bias in the practice of medicine.

I’ve often wondered about the mindset of health care providers who endorse one-way travel as a solution to homelessness, addiction, and mental illness. Nevada health officials have assembled a thin veil of excuses, ranging from denial to arguing that they are sending patients directly to family members and other mental health facilities — possibly true in a few cases but totally false in the majority of them. Clearly, there was a blatant disregard for human rights fueled by prejudice and stigma against the mentally ill.

Nevada isn’t alone in its brazen treatment of psychiatric patients — nor do Southern states possess exclusive rights to export their citizens. New York City secretly sends homeless people to Hawaii and other states. Only in rare cases is travel therapy intended to be truly therapeutic.

For example, Hawaii has attempted to reunite homeless people with relatives on the mainland, known as fly-in therapy. But due to the high cost of running such a program and the fact that approximately one-third of Hawaii’s population is transient or from out of state, the number of people in need who actually benefit is very small.

The American Medical Association is concerned about “scope creep” that threatens patient safety, that is, the infusion of advanced practice providers into medical practice. I’m more concerned about the impact of crude politics. Anyone – politician, health care provider or administrator – who uses human beings as pawns for personal pressure or gain, or who shifts or interrupts their medical treatment for harmful reasons, should be guided by careful thought. serious personal about how racism entered her life and, more importantly, affected the lives of innocent people and underprivileged patients.

Politics, whether inside the Capitol or the hospital’s C-suite, should never take precedence over people. Leaders and carers must never forget the welcome inscription engraved on the base of the Statue of Liberty – “give me your weary your poor” – and especially the words which follow: “Send me these, the without -shelter, storms-tost.”

Migrants, like many of our patients, are overwhelmed by the circumstances of life. We are, and always have been, a nation that opens its arms to vulnerable people rather than sending them to a destination far worse than where their journey began.

Arthur Lazare is a psychiatrist.

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