First, let’s dispense with political correctness. I will not use the words “alleged” or “suspect.” We’re all adults here. Dzhokhar Tsarnaev is the younger brother whose bombs killed 3 innocents or maimed scores of participants or bystanders in the Boston Marathon.
I was proud to be called a physician that day. Not because of anything I did. I did nothing. But because of the gut-wrenching work my colleagues in Boston did. Without their work (and the work of EMTs, nurses, scrub techs, helpful Good Samaritans, and so many others), many more would have perished. These colleagues deserve our collective gratitude. They are exemplars of what make civil society function. Some say they rose to the occasion. Others say they fell back on their training. The actual explanation is probably – a little of both.
Dzhokhar Tsarnaev is in custody, in a hospital bed. He has doctors and nurses who care for him. What does that mean? Most doctors, over the course of their career, have taken care of people who committed a crime. That’s not news. We do what we do. Render urgent care to the patient (whether or not he’s a criminal) and then let the justice system address the crime.
Most of us (in the U.S.) have never taken care of those hell-bent on mass destruction. It seems different. It almost certainly is different. I commend our colleagues for having the discipline to continue caring for such individuals. It must take discipline. Because those who wish to kill and maim so many innocents are beyond contempt.
In North Carolina, state law requires a physician be present at all judicial executions. In January 2007, the North Carolina State Medical Board adopted the policy that the physician’s code of ethics would be violated by a doctor taking part in an execution. This could subject the doctor to having his or her medical license revoked.
Because of this policy, physicians declined to participate in executions in any manner, which has resulted in a de facto moratorium on executions in North Carolina. The North Carolina Dept. of Corrections sued the Medical Board over the statute mandating a doctor’s presence at an execution. The Medical Board apparently did not object to doctors’ presence at executions, only to their participation through the monitoring of the condemned inmate’s vital functions.
The Board recognizes that N.C. Gen. Stat. § 15-190 requires the presence of “the surgeon or physician of the penitentiary” during the execution of condemned inmates. Therefore, the Board will not discipline licensees for merely being “present” during an execution in conformity with N.C. Gen. Stat. § 15-190. However, any physician who engages in any verbal or physical activity, beyond the requirements of N.C. Gen. Stat. § 15-190, that facilitates the execution may be subject to disciplinary action by this Board.
In 2009, the North Carolina Supreme Court ruled 4-3 that while the North Carolina Medical Board does “retain disciplinary power over a licensed medical doctor who participates in an execution,” the Board “may not discipline or threaten discipline against its licensees solely for participating in the execution alone.” Consistent with the Supreme Court’s ruling, the Board cannot take any disciplinary action against a physician for participation in an execution. While this ruling only applies to North Carolina, it will be considered “persuasive” if and when the issue arises in other jurisdictions.
What does it mean to be Dzhokhar Tsarnaev’s doctor? Probably many things.
How many of us have ~not~ asked ourselves what we’d do if we were somehow in the Third Reich and Hitler was on our OR table? Of course, to complete the gedankenexperiment, we’d have to know that we could get away with whatever we did.
Ira Levin asked the question–albeit obliquely–in The Boys From Brazil. Lieberman, the Nazi hunter, has a list of the boys who were Hitler clones, and whose lives were, as best they could be, made similar to Hitler’s. He knows that they’re genetically essentially identical to Hitler. One faction is pressing him mightily to use the list and kill the boys. In the penultimate chapter (if I recall correctly–it’s been a few years since I’ve read it), he goes to the head, rips up the list and flushes it, reasoning that Jews don’t kill children.
And in the final chapter, one of the boys is daydreaming: he’s an architect, and he’s built a huge building. And there are legions of people whose voices he hears cheering him….
Think Minority Report: in it, there is a federal program called “Pre-Crime,” which purports to enjoin people who are about to commit violent crimes from committing them, incarcerating them for life. Clearly this is different from the current question: the crimes have ben committed already, so there’s no “would I have been able to prevent it?” asked.
What would you do? What would ~I~ do? Dunno. Glad someone else is wrestling with it. I’d probably take care of the guy, then hate myself for it.
JH
Dr. Segal-
Dzhokhar is innocent. Until proven guilty by a jury of his peers. Which has not happened yet.
This is not a technicality nor a matter of “political correctness”. It is the American way and our fundamental right. Are you advocating that we just let the media and federal government summarily decide our guilt?
I do take exception for a JD making a judgment about a person who has not been tried. This bodes badly for all of us in this country. Just because CNN coverage makes it all seem very cut and dried, media manipulation of facts is a staple of everyday life in the U.S. now, and if the JDs don’t insist on innocence until proven guilty, our collective goose is cooked. I speak both as a man who has been unjustly accused of things I never did, and although in the end I will be acquitted, during the entire time I was treated as if already convicted and sentenced. This is Stalinist jurisprudence, not American jurisprudence. I suggest that first comment be modified.
I also speak as a physician who took care of a DEA agent that was pistol-whipped by a suspect, and then had to go attend to the suspect who the DEA filled with bullet holes after regaining his sensorium, but I did not position myself as the DA, PI, Judge and jury while at these tasks.
Yes, let’s do our jobs, and not allow the slippery slope of corporate or Board pressures, or media coverage dissuade us from doing our jobs.
Scott Nelson, D.O.
I am not one of the doctors caring for the bombers, and live no where near them. So i will not pretend to be in their shoes. I went into mediclne to care for people. I will not speak for others, but just my very OWN inner feelings and gut thoughts. I would like to imagine I could compartmentalize the situation and realize the patient is a person, whether I like that person or what they did… Whether it be bomb, molest, or whatever it may be that hurt innocent persons. If it was my own child that was killed by a bomber or molested or abducted or whatever it may be…. The human part of me would want that person to … Disappear! The doctor part of me and the oath I took must be compartmentalized to provide care to those persons. If I found myself unable to do that, for example , care for a guy that just hurt my own child or family member… I would ask another doctor to take over so the patient could receive the care that we, as physicians, took an oath to do our best to provide. But please don’t misunderstand me… If it was my child or family member… I pray that I would have enough time to transfer care to another physician before I did something really stupid reacting on my emotional feelings. Afterall, doctors are humans, too. If someone came in on my call and I found out they had hurt my family, I would probably lose my medical license and be sued, and a patient may be unaccounted for and the sniffer dogs would be called out! I think I would say that my family would come first and they could have my license! But again, all hypothetical and I hope and pray I never face that situation. Mark
Dr. Nelson:
Since you’re not a J.D., I’ll explain how this works. The legal system treats criminal suspects as presumptively innocent until proven guilty beyond a reasonable doubt by a jury of his peers . Note: that is the “legal system” which is determining how justice will be meted out – either fines, loss of freedom, or life.
Take note: I am not the legal system. I am an observer. I am free to presume what I want. I am free to write about it also. If I get it wrong, and I have defamed this person, he’s free to sue me civilly for defamation. I do not believe that will happen.
Daryl:
Same point. Americans are free to presume what they want. THAT is the American way. Are you suggesting that I give up my ability to use reason to make a conclusion on a blog? Your point really applies only to the criminal justice system, a system I am not part of.
To All:
The underlying point is that we all do what we do. I have little doubt that every doctor taking part in his past and current care will treat him just as they would treat any other patient. I would be no different.
Justice will be eventually delivered through the criminal justice system – and in that system, he is presumptively innocent.
Seems to me the best treatment would have been warfarin
Ps… To my last comment… I meant to add when it comes to MY family and this issue, I would be willing to add “creating license plates” to my list of talents!
Also, Dr. Segal is allowed to express his opinion just like everyone else. Whether a JD or MD/DO or John Doe or CNN. Like it or not, it is an opinion.
A greater dilemma faces the doctor attending the execution. The proceedure is supposed to be humane but there are some reports of botched jobs such as infiltrating IVs, paralysed patients not getting a lethal dose of drugs etc. A humane physician should step in on those occasions
Ignorance is Bliss
During my residency, I served a rotation at Munson Army Hospital. I often saw prisoners there because it was right next to the “disciplinary” barracks. One time, an escort of three (armed) men were escorting a fully shackled prisoner to my clinic. I had never seen an armed escort before. That was the first and only time I encountered it.
He had a severe cutaneous infection on his ankle joint. I did not ask how he got it. I did ask what “he was in for.” The escorts said: “Doc, you don’t want to know.” I didn’t question any further, but proceeded to do what I had to do.
I also wrote orders for RN observation and periodic measurement of the size of the lesion. I asked if it was possible to prescribe IV antibiotics, and was told: “Anything I needed to do, I should go ahead.”
I saw the patient twice more as he gradually improved. His shackles were never removed in my presence. I have to admit I didn’t say very much to him, and I asked him only “general questions” relating to my examination. (I had to move the shackles aside to place my dressings. It was not an optimal therapeutic situation.)
According to my contract, THIS was my job. I’m sure I would have been disciplined or even discharged if I refused to treat him, but that never crossed my mind.
Michael M. Rosenblatt, DPM
I am sorry to keep posting on this interesting topic, but I am concerned our nation has become too sympathetic for criminals. Maybe it is because I am just a poor young dumb country doctor! Those being executed that have cost our country millions of dollars , and years of agony to the family members of those they hurt….before the lever is finally pulled on them… but if a “feller” that is being executed because he/she raped, tortured, dismembered, boiled and ate the body parts of a human being(s), and again especially if it was MY friend or family member, I would flunk the humanity test and say “pull out the popcorn and 3D glasses and enjoy the show.” C’mon folks, the legal system stinks, malpractice stinks and has changed the direction of medicine forever, but for goodness sakes, even as a physician/surgeon, don’t pretend you would “hope a humane physician would step in…” Let their defense attorney step in and help during “a botched execution”; oh… Wait a minute…. NOW that scumbag and their attorney needs the doctors help? Ahhhh, how about they tell their colleagues to leave us alone then and quit suing us.
We have become way too tolerant as a nation and I am thankful at least when it comes to medicine I have Dr. Segal and his team at Medical Justice on my side.
The guy being juiced needs a much more “humane” doctor at the occasion than I could ever be I guess.. I didn’t go to medical school and become a doctor for that… So let some docs take a test, again, determined by our legal system THEN approved by the states Medical Board to approve them to be “execution attending doctors” and whatever happens happens and the doctor can live without a guilty conscious or the fear of being sued. Case closed, bad guy gone. If they need someone who wouldn’t shed a tear, they can call me for free. Sorry. Just watched a “Rocky” movie with Sly Stallone and a John Wayne (RIP) Movie. 🙂
I would compartmentalize this as Dr. Mark Williams opined. My internal fabric is set to help.
Having spent many years at The Univ of Maryland and The Johns Hopkins Hospital for medical school and residency, and eight years full time primarily at Denver General Hospital, I have seen many “criminals.” I can frankly only remember one, who was shot and rendered a quadriplegic while robbing a store. I don’t recall any of the crimes of the many others…shackled, guarded by gun and law officer, plus many victims of crimes (over 400 gunshot wounds of the head).
I agree with Dr. Segal and his right to give an opinion. Seems a reasonable opinion, as the “alleged” victim was seen in a gun battle where hi brother was shot and the “alleged” criminal was multiply wounded.
But, Darryl, I don’t agree with you. As a physician I have never been treated to a jury of my peers…which would mean six neurosurgeons who understand the case. I was “convicted” by a jury of six people, NONE of whom, I believe (could be one exception), even completed college. And the person who served as jury foreman said that he felt that both of his parents had been injured by doctors. And this was after I had been fully cleared by a “jury” of four doctors picked by the hospital for review. So, no, I have little faith in the jury system as it relates to medical acts, which are called “malpractice.” So many doctors have been “convicted” by a jury when we are innocent, that we have varying degrees of little faith in the legal system.
If the Boston hospital where Dzhokhar Tsarnaev was cared for is anything like the hospital I trained in, most of Dzhokhar Tsarnaev’s daily physician care was likely delivered by residents after morning and evening rounds with the attendings.
We cared for cop-killers, and bodega-blasters in NYC. When these ICU patients were intubated and sedated on a ventilator, some found it best to increase the succ., and dial down the fentanyl and versed. Incredibly, the most callus of criminals were the most likely to survive.
I agree with MedicalJustice. Please leave the PC behind. This was another of the 5 episodes of Islamic Jihad on Mr. Obama’s watch: this one and Dr. Hasan’s were unfortunately successful. Maybe Dr. Hasan’s should be called work place violence. Really?
The DOJ and Holder should be ashamed of themselves for interfering with the FBI’s investigation.
May God bless America.
Eric
So i think many if us agree we need to allow ourselves and our children to start watching more old John Wayne movies and less Barney the Purple Dinosaur ?!! And only if Ronald Reagan was still around . Thanks MedicalJustice for speaking up and not submitting to political correctness.
By the way, I HAVE been sued for a BS case… And usually good rapport with a patient doesn’t save u, because their crazy family members that do not know you see money and freedom from their OWN guilty conscious…. And the old lady that brought the lawsuit should have to pay (i am not that mean and inhumane…. i mean money/reimburse financially ) for MY (and my family’s) pain and suffering for the worst freaking 5 long years of my life. If u think our legal system is NOT screwed up…. You simply are oblivious and haven’t been sued or threatened with a malpractice case. After that case I found out about MedicalJustice and about a year later i responded to a code in the hospital, my duty. I simply just showed up and the ER doc was there and the code team and several other docs. The nurse wrote down who responded to the code. I think to show good effort by hospital staff to help. I didn’t even enter the room and many of us docs left since it was under control. I was listed and other John and Jane Doe docs in the suit. MJ was the first folks I called after my malpractice carrier. I was dropped from the case. But now, i am a little gunshy to respond to a code… I take the stairwell, and walk, maybe get a cup of coffee… Use the bathroom, for a long time…. Seriously… U are darned if u do and darned if u don’t. Now I feel more protected doing my ethical duties with MJ on my side. It amazes me how doing the right thing can result in a lawsuit.
And NOT doing the right thing can result in the lawsuit. Now all patients agree that if there is a legitimate dispute, each side will use as experts those are accountable and reputable; experts who are board certified in my specialty. This is the reasonable template Medical Justice provides to its members. … I have had 4 lawyer patients in the last 6 months who took it home to read it, signed it, brought it back and we proceeded into a great patient / doctor relationship.
Cut out about 75% of law schools and their graduates, so those persons can find real jobs instead of being desperate ambulance chasers. I would rather see them flipping burgers, but not at a diner where I and other doctors eat.
So, Darryl, do you REALLY have that much faith in our legal system? Think again…..
As a doctor for 30 years now, I have been able to maintain some sanity throughout my career by remembering that I do not decide who lives or dies. That is beyond my control. I care for each patient before me to help that patient continue to live regardless of past problems or crimes. Doctors should never contribute to the demise of a patient and, to me, that means we have not the right to retaliate for the crimes of a patient; but also doctors should not take part in abortions or euthanasia. SShort
I couldn’t help being moved by Dr. Stecher’s anger about being “convicted” of malpractice by medically unsophisticated jurors. Understanding the intricacies of neuroanatomy and neurophysiology puts me back to my (admittedly limited) training in that field. It is not a “good” subject for the uninitiated.
I sometimes wonder how much a bad experience with the liability system affects doctors’ willingness to take on difficult or complex cases. I don’t know if there is any research on this subject. Ostensibly, plaintiffs’ attorneys would dismiss this out of hand. (That is, until a member of their family gets in a serious accident or needs a neurologic surgery.)
We need professionals like Dr. Stecher; and we need their services.
This is where compartmentalization may help. I could never judge any physician who, after being burned by the system decides to delete tough cases. As I got older, I did that naturally out of understanding that my energies and competence for very detailed surgery diminished as I aged. It was a matter of facing reality.
I thank Dr. Stecher and am grateful we have talented and brilliant people like him still willing to do it. I hope he decides to continue.
Michael M. Rosenblatt, DPM
With a large CA state prison nearby, I have treated lots of inmates. I once treated a police officer in one hospital in town for an arm laceration suffered during the arrest of a violent criminal. Later that day I got a call from the county hospital across town to treat the same violent criminal for a flexor tendon laceration. My office actually had to “fight” with the local county jail in order for them to bring him for surgery several days later to repair the tendon. My SOLE motivation for fighting to fix this tendon on this criminal was to prevent him from having a legal case for not providing medical care. I had absolutely no respect for this violent scumball and would not have had any problem with him serving out his life term with a finger that wouldn’t bend. As a funny aside to this case, as he was finally drifting off to sleep for his surgery, the song on the radio was “I Shot the Sheriff” by Eric Clapton.
It is impossible not to have negative feelings about patients when you know what they have done. As a consequence, when I treat inmates, I make it a point to never ask the guards what the prisoner has done because I don’t want it to affect my judgement about the medical care that I provide.
We can’t imagine the heavy weight that falls on the heart of the doctor of this man.
This is definitely not a place I would want to be in, but as a doctor, I’m sure his career and his oath take precedence over all other personal feelings.