Pediatrician refuses to treat child

Reading this story I couldn't help but think of the famous poem, First they Came, but with a few modifications.  

First they refused to treat victims of rape, and I didn’t speak up, because I wasn't a victim.

Then they refused the see gays and lesbians, and I didn’t speak up, because I wasn’t gay or lesbian.

Then they refused treatment to all but Christians, and I didn’t speak up, because I was a Christian.

Then they refused me, and by that time there was no one left
to speak up for me.

The Christian Right is going to learn a hard lesson. When it's legal to refuse treatment based on a Doctors beliefs, they themselves could be denied.  

Meet Dr. Gary Merrill, a pediatrician who refused to treat a young patient because her mother had tattoos.

That's right. Tattoos. They offend his Christian beliefs and he wants to make sure his practice has the right Christian atmosphere. He also won't treat you, or your family, if you have body piercings or chew gum in his waiting room. And..this is all legal according to the AMA.

"In the same sense that any other business person has the opportunity to decline service, be it a restaurant if they’re not dressed properly, be it any other type of business," said Dr. Ronald Morton, Kern County Medical Society.

Seriously. I'd love to be a fly on the wall when the first tattooed, pierced, born again wanders into that office.

What comes around goes around and we could have told them that long ago!

UPDATE: OOps...forgot the link.

The Story

•  Just to push you an inch

  What if mom's tattoo were of a swastika, and the doctor, whose parents died in the Holocaust, refused to treat the patient?

  by Adam B on Thu Mar 01, 2007 at 06:28:41 AM PDT

  •  Sue the nut job

    I'd like to see that defense in court.  That's the kind of PR that Christofascist deserves.  

    by deepsouthdoug on Thu Mar 01, 2007 at 06:32:11 AM PDT

    •  The defense is

      "i don't want to and I have no obligation to."  The more interesting question is what would the cause of action be?

      by Drgrishka1 on Thu Mar 01, 2007 at 07:08:42 AM PDT

      •  Malpractice

        not for denying treatment, but for denying treatment at the end of the day, leaving the child in pain overnight.  I am willing to guess that does not meet the "standard of care."

        I would also be curious to see whether the doctor is a preferred provider with the insurer, and what the contract says. The patient is a third party beneficiary of that contract.

        by dhonig on Thu Mar 01, 2007 at 07:57:08 AM PDT

        •  It is malpractice only if

          you are obligated to provide care.

          As to the third-party beneficiary, that is a rather complicated doctrine and hard to invoke.  Suffice it to say that if the insurer-MD contract does not obligate the MD to see all insureds (unlike an HMO contract) it would be hard to show that a particular patient is a third party beneficiary.

          by Drgrishka1 on Thu Mar 01, 2007 at 08:27:11 AM PDT

        •  in my limited experience..

          Most physicians who have decided to go down this road of having a highly selected practice have already taken the steps of leaving the managed care system.  They've taken themselves off most of the HMO rosters and are also not Medicare/Medicaid providers either.  

          That would likely take care of the second paragraph.  The first one would be dealt with by them: A) not being an emergency room, and B) not having a prior relationship with the patient.

          by desertbug on Thu Mar 01, 2007 at 08:29:05 AM PDT

    •  bingo

      when enough lawsuits happen, you'll have malpractice insurance companies charging hefty premiums for jerk MDs who insist on dragging their faith into their medical practice.  

      government shouldn't suppress religion.  business is perfectly capable of doing it without government support.

      Remember, the Rehnquist court has said that discrimination is OK if there is a rational basis for it.  Since jesus freaks are more likely to get sued for wrongfully denying coverage to deserving patients, they should pay more for insurance.  

      by the abominable snowman on Thu Mar 01, 2007 at 07:38:56 AM PDT

      •  What precisely the cause of action

        would be?!

        What's the legal duty?

        by Drgrishka1 on Thu Mar 01, 2007 at 07:47:22 AM PDT

      •  and your middle paragraph says much

        Business and the free market will be capable of managing this situation.  His decisions are now widely known.  People who are offended will leave.  There are plenty of other pediatric medical options in Bakersfield and there are plenty of emergency room options for those in need of emergency medical care (not an ear infection, btw)

        If there are enough like-minded people for him to continue to run his practice, then so be it.  It just wouldn't be my kid that he would be treating.  I happen to be an earring-wearing pediatrician (and a Catholic one at that).

        by desertbug on Thu Mar 01, 2007 at 08:32:49 AM PDT

  •  Totally immaterial

    after all, it's the child that needs treatment.

    Why do you ask?  Would that be acceptable to you?

    by xyz on Thu Mar 01, 2007 at 06:32:55 AM PDT

    •  Dunno what medical ethics are

      Let's suppose the patient himself had a swastika.  I'd like to believe the line is "if it's an emergency, you treat", but if not...

      by Adam B on Thu Mar 01, 2007 at 06:39:12 AM PDT

      •  All I can hope is

        that you are not a doctor, since you don't know the meaning of the Hippocratic oath.

        by xyz on Thu Mar 01, 2007 at 06:40:33 AM PDT

        •  I'm not.

          Show me where the Oath requires treating all non-emergency patients.

          by Adam B on Thu Mar 01, 2007 at 06:49:10 AM PDT

          •  The Oath is not the end-all of medical ethics.

            My wife's a pediatrician and she would be horrified.

            The only time she and her colleagues have ever been reluctant to treat a patient is when they've repeatedly ignored their direction and advice.  Like the mother who decided her Crone's disease kid should advance from an all liquid diet directly to a cheeseburger, fries, and a shake.

            But they did treat the kid.  Called DCFS, too.

            by nightsweat on Thu Mar 01, 2007 at 06:53:25 AM PDT

            •  Good for them

              When I worked for DCFS, the one referral I trusted the most was a doc's referral.  They don't do it lightly, and they actually gathered facts before making accusations.

              by marykk on Thu Mar 01, 2007 at 07:15:49 AM PDT

        •  Hippocratic Oath does not require

          an MD to do anything.  It only requires him to  refrain from doing things.

          by Drgrishka1 on Thu Mar 01, 2007 at 07:10:03 AM PDT

        •  Hippocratic oath

          Has no legal relevance whatsoever.  If you want to look at its wording, it's here .

          My medical class didn't take it because of the many archaic and controversial items within it.  There are many other oaths that medical school classes take upon graduation in these modern times.  

          That particular oath is more about telling you what not to do anyway.

          Don't get me wrong, I disagree with his decision on a religious basis, a moral basis, and I don't think it's particularly a good business plan (but I don't know Bakersfield).

          We aren't discussing this on a "medical" basis, because no medical decision-making actually occurred.  

          But on a legal basis, I think he has the right to do this.

          by desertbug on Thu Mar 01, 2007 at 08:41:45 AM PDT

      •  You're supposing progressively stupider things.

        The patient in this case is a child. Without swastikas. Without tattoos. And you're busy trying to twist the case into a situation where this child would be left untreated due to the doctor's prejudices against the child's parents.

        Why?

        by Diaries on Thu Mar 01, 2007 at 06:40:53 AM PDT

        •  Adam asks a valid question

          My stance is that it should be illegal to deny treatment to anyone who needs it, regardless of what they look like, what their beliefs are.

          Should we support an athiest doctor who refuses to treat people who are religous?

          These are tough questions and they need to be asked.

          by MsLibrarian on Thu Mar 01, 2007 at 06:43:57 AM PDT

          •  Yes we should

            An MD is an independent entity and need not treat whomever he does not want to treat.

            by Drgrishka1 on Thu Mar 01, 2007 at 07:10:52 AM PDT

          •  It is illegal

            for emergency rooms to deny treatment to anyone who needs it.  That's what EMTALA is about.

            This was not emergency care.

            Yes we should support an atheist doctor who refuses to treat people who are religious if that refusal is clearly stated as a precondition for entering into a private practice doctor-client relationship.  

            To go further, supposing that an atheist doctor was taking care of a patient who was originally atheist, but then "found religion", mechanisms exist whereby, with sufficient notice, he can "fire" the patient.  He is under medicolegal obligations to help the patient to establish medical care with a new provider and to ease that transition, but he can do it.

            I agree that these are tough questions.  They have been asked and they have been answered.  None of this is new territory.

            by desertbug on Thu Mar 01, 2007 at 08:48:31 AM PDT

        •  This wasn't an emergency

          it's a private practice. If both parents were obese, and the child was obese, and they came in for obesity-related problems to the child, and they didn't follow his recommendations, would you complain about the family's rights if he doctor offered to refer them to another doctor?

          I hate the issue of health providers deciding, based on religion, how they want to practice, but this is an ethical questions with 2 valid sides.

          by JohnGor0 on Thu Mar 01, 2007 at 06:51:02 AM PDT

          •  How did he know it wasn't an emergency?

            That's what is being lost here. IF a Doctor refuses to even look at a patient, how does he/she know it's not a life or death matter?

            by MsLibrarian on Thu Mar 01, 2007 at 06:53:24 AM PDT

            •  Even if it IS an emergency

              unless the parents showed up in the ER, the doctor is not obligated to see anyone.  It is his PRIVATE practice.  In the ER he woudl be obligated under EMTALA.

              by Drgrishka1 on Thu Mar 01, 2007 at 07:11:47 AM PDT

            •  Maybe he asked them

              and they told him it wasn't.

              by JohnGor0 on Thu Mar 01, 2007 at 07:25:08 AM PDT

              •  If people were that good

                at diagnosing themselves, we wouldn't need doctors.

                by MsLibrarian on Thu Mar 01, 2007 at 07:30:54 AM PDT

                •  We are just loaded for bear, today

                  aren't we? Did something happen recently to make us all so edgy?

                  by JohnGor0 on Thu Mar 01, 2007 at 09:41:25 AM PDT

            •  that's what triage nurses are for

              The article does not give details as to where in the process the patient was "turned away".

              Did the mom walk in, see the sign, ask what it meant, and then leave before even registering the child?

              Or did she register, and then the child got taken back to get vital signs, etc., and then someone noticed her tattoos?

              The story only gives half of the story.

              by desertbug on Thu Mar 01, 2007 at 08:55:21 AM PDT

      •  I think that's the point.

        In an emergency a doctor is obligated to act, but while I don't agree with selectively stacking your waiting room with patients you would prefer to treat, its not a crime.

        by nupstateny on Thu Mar 01, 2007 at 06:43:01 AM PDT

        •  What if

          there was a doctor that only treated white people?

          And why is this different than the Minnesota cab drivers that refused to carry passengers who had alchohol?

          It's all unwarranted discrimination.

          by ryan t on Thu Mar 01, 2007 at 06:52:25 AM PDT

          •  Do you presume that there are no doctors who

            only treat white people?

            When all is said and done, would you want to have a doctor treat you who didn't really want to be treating you?

            by nupstateny on Thu Mar 01, 2007 at 07:01:27 AM PDT

          •  Racial discrimination is prohibited

            by the Civil Rights Act of 1964 as amended.  Race is a suspect classification.  Other forms of discrimination (including against lifestyle) is not prohibited.

            by Drgrishka1 on Thu Mar 01, 2007 at 07:13:20 AM PDT

            •  What's the difference?

              Seriously. Why should it be illegal to discriminate against race, but not lifestyle or religion?

              by MsLibrarian on Thu Mar 01, 2007 at 07:17:51 AM PDT

              •  Well

                there really isn't a difference ethically/morally but there is a difference legally. Not right but it is different.

                If this were my doctor it would cause me to seek a new doctor.  And anyone who is in his practice who is offended by this should move on.  But I think there are enough assholes in this country who would be drawn to this kind of discrimination.

                by newfie on Thu Mar 01, 2007 at 07:21:52 AM PDT

                •  but we're lucky

                  As a Newfie (and I am assuming you are from Newfoundland), you and I can go to another doctor pretty easily. It's not the same in the US where only certain doctors will see certain patients because of who their HMO is.

                  by MsLibrarian on Thu Mar 01, 2007 at 07:24:05 AM PDT

                  •  Not

                    I chose the moniker to honor my father and his newfie family.  I am a US citizen.

                    by newfie on Thu Mar 01, 2007 at 07:38:27 AM PDT

                  •  As i said before, as an HMO doc

                    you are contractually obligated to see all HMO's subscribers.  So that is not an issue.

                    by Drgrishka1 on Thu Mar 01, 2007 at 07:40:13 AM PDT

                    •  I think she is

                      referring to an HMO that may not have a robust network.  I guess it still happens but HMO is a waning platform. The big players have pretty robust networks in most areas.  

                      by newfie on Thu Mar 01, 2007 at 07:45:59 AM PDT

                  •  My mom is a

                    Newfie!

                    small world these days.

                    Of course newfies turn up in the darnedest places...
                    like little coffee shops in the middle of bumblef'enng wisconsin.

                    by rowanleigh on Thu Mar 01, 2007 at 05:39:34 PM PDT

            •  I really want to get this straight

              You have no problem then with doctors or pharmacists refusing to hand out the pill.

              You have no problem with doctors refusing to treat Jews, or Catholics, or gays.

              Because, with your logic, that's what you're saying.

              by xyz on Thu Mar 01, 2007 at 07:36:07 AM PDT

              •  To answer: Yes and No

                First is a decision how to run their medical practice.  Doctors are not obligated to provide elective treatment simply because the patient wants it.

                Second is a discriminatory decision explicitly prohibited by teh Civil Rights Act of 1964 as amended.

                by Drgrishka1 on Thu Mar 01, 2007 at 07:39:21 AM PDT

                •  I know the civil rights law

                  which is why I asked what I asked.

                  None of those meet the criteria, so we can assume you're OK with that.

                  by xyz on Thu Mar 01, 2007 at 07:41:41 AM PDT

                  •  Actually religion is covered

                    under the Civil Rights Act.

                    As to gays, it is legally (federally, but not necessarily on state level) permissible, though I, obviously, do not support such an exclusion.

                    But as a general matter, I fully support MD's right to choose his patients.

                    by Drgrishka1 on Thu Mar 01, 2007 at 07:44:05 AM PDT

                    •  I'm with

                      the author of this diary.  You're no doctor I'd ever want to visit, and quite frankly, you make me sick to my stomach.

                      You are also incorrect on the Civil Rights Act covering religion.  It covers it only for employment purposes.

                      by xyz on Thu Mar 01, 2007 at 07:47:11 AM PDT

                      •  Perhaps some reading lessons

                        would be in order

                        SEC. 201. (a) All persons shall be entitled to the full and equal enjoyment of the goods, services, facilities, and privileges, advantages, and accommodations of any place of public accommodation, as defined in this section, without discrimination or segregation on the ground of race, color, religion, or national origin

                        by Drgrishka1 on Thu Mar 01, 2007 at 07:51:39 AM PDT

                        •  Still doesn't change

                          my opinion of you.

                          by xyz on Thu Mar 01, 2007 at 08:00:07 AM PDT

                          •  It only confirms my opinion.

                            I smell troll.

                            by homogenius on Thu Mar 01, 2007 at 08:17:58 AM PDT

                            •  why troll and who troll

                              I think that this whole discussion is confused by people not separating two clearly different issues.

                              There are medicolegal obligations that this physician does not seem to have violated.

                              There are moral obligations that are only enforceable in a higher court, if you know what I mean.

                              I disagree with this physician's interpretation of Christianity and object to his use of it to justify this decision.  But I think that he has the right to conduct his private practice medical business under the rules that he establishes.

                              by desertbug on Thu Mar 01, 2007 at 09:03:24 AM PDT

                              •  Because all I ever read from him...

                                Is being contrarian and disruptive. On numerous occasions it has seemed to me that all he wants to do is be oppositional for it's own sake. I could be wrong, but that's my subjective opinion.

                                by homogenius on Thu Mar 01, 2007 at 09:15:09 AM PDT

                                •  I haven't read

                                  outside of this thread to see whether he is trollish elsewhere, but I think that his comments through this thread seem to be logically consistent.  He is viewing this decision purely through the lens of the medico/legal/business rights of this physician.  Other people (myself included) are rightfully castigating this physician's decisionmaking on moral/religious/ethical grounds, but these are two totally different starting points.  

                                  People are proposing that this physician is open to punishment from the courts on malpractice, etc., grounds.  My understanding of these issues is reasonably well-informed (I am a pediatrician myself) and I think that he is within his legal rights.  

                                  That doesn't make it right.

                                  by desertbug on Thu Mar 01, 2007 at 09:23:56 AM PDT

                              •  IANAL

                                But I think that he has the right to conduct his private practice medical business under the rules that he establishes.

                                But I agree with this.  It's not illegal to be a hypocrite or an a$$hole.  Morality and ethics are subjective values.  Depends on the person.

                                I'd file a complaint with the AMA and the medical databases and find a new physician.  JMO, YMMV.

                                by Heiuan on Thu Mar 01, 2007 at 09:50:01 AM PDT

                            •  I don't think he's

                              a troll, at least by my definition.  

                              Certainly he's obnoxious, and pretty well uninformed, since he didn't read the civil rights law.

                              But I do like him telling me I needed a reading lesson, when in point of fact, he's the one with the problem.  

                              by xyz on Thu Mar 01, 2007 at 10:40:28 AM PDT

                              •  I may be way off base here

                                but I don't think that this boneheaded "Christian" pediatrician's decisions rise to the level of a civil rights violation.  

                                I'm in no way a lawyer.  I'm a pediatrician.  

                                But I wasn't going down the civil rights interpretation discussion pathway because I didn't really think it was applicable here.  It's a non-emergent medical care, private practice setting.  It's not a state- or federally-funded setting.

                                As I've said elsewhere here, I think he is wrong on almost every level, but within his legal rights and his medicolegal responsibilities.

                                by desertbug on Thu Mar 01, 2007 at 10:55:06 AM PDT

                        •  And maybe you

                          should read that section.

                          Do you see that public accomodation?

                          Go down a little further, and read the definition there.

                          There's zip, zero, nada on establishments such as a doctor's office.

                          by xyz on Thu Mar 01, 2007 at 08:04:35 AM PDT

                          •  Of course that list is not an exclusive

                            one.  And civil rights laws are alwyas broadly construed.

                            by Drgrishka1 on Thu Mar 01, 2007 at 08:23:35 AM PDT

                            •  I don't think

                              the hole you dug is quite deep enough.

                              Fool.

                              by xyz on Thu Mar 01, 2007 at 10:41:26 AM PDT

                              •  Ah, yes... that is a sound legal argument

                                if I have ever seen one.

                                by Drgrishka1 on Thu Mar 01, 2007 at 10:50:28 AM PDT

                                •  Ya know, pal

                                  you don't know the meaning of a legal argument, if you  hilariously think you know more about the civil rights law than I do.

                                  Now, shoo.  

                                  Don't you have some patients to insult?  LOL

                                  by xyz on Thu Mar 01, 2007 at 12:08:28 PM PDT

                                  •  Given teh fact that I currently work

                                    for a U.S. Circuit Court of Appeals, I would venture to say that I know quite a bit about civil rights law.

                                    And if you honestly believe that the Civil Rights Act does not apply to the provision of medical services, I worry that your clients are not getting sound legal advice.

                                    by Drgrishka1 on Thu Mar 01, 2007 at 12:17:44 PM PDT

                                    •  Gee,

                                      further up, you said you were a doctor.

                                      Being a doctor is EXACTLY like any other business.  When I got my diploma, I never signed away my right to work the hours that I want, charge the fees that I like, and see as many or as little patients as I desire.

                                      You are neither a doctor, nor a lawyer.  You are a troll.

                                      Pretty stupid to say you were both in the same goddamn diary.

                                      by xyz on Thu Mar 01, 2007 at 12:38:45 PM PDT

                                      •  I guess you have never met people

                                        who have gotten both an MD and a JD?!  Well, now you have.

                                        by Drgrishka1 on Thu Mar 01, 2007 at 01:38:02 PM PDT

                                      •  sorry, but it does happen

                                        and I'd say it's pretty stupid to presume that it's impossible that he is what he says he is.  I happen to know of more than a couple.

                                        by desertbug on Thu Mar 01, 2007 at 04:44:23 PM PDT

        •  Only in a hospital ER, not anywhere else n/t

          by Drgrishka1 on Thu Mar 01, 2007 at 07:12:11 AM PDT

  •  That's an interesting question...

    Not the same as this case at all. This wasn't a one off, these are his rules...posted on his office wall. He will treat you based on your appearance.

    But, in the situation you mentioned, I would not support a doctors right to refuse treatment.

    But if we are being hypothetical, what if the woman got that when she was 16 and couldn't afford to have it removed?

    by MsLibrarian on Thu Mar 01, 2007 at 06:33:19 AM PDT

    •  then I would hope

      that this "Christian" physician would provide charitable care to her to help her have it removed either free of charge, or at a cost that she could afford.  

      Somehow I doubt his beliefs go that far.

      by desertbug on Thu Mar 01, 2007 at 09:05:24 AM PDT

  •  There was an episode of ER like that.

    A man is brought into the emergency room, a white guy, skinhead, with tattoos of swastikas and also slogans of "White Power."  The staff reads these tattoos on his chest, then the camera pulls back--not a single staff member surrounding that person is white.

    Immediately after speaking their outrage, they start to work on him and save his life.

    Frankly, I think this doctor is way off base.  If Jesus had had that attitude, he would not have healed the Centurion's servant.  Roman officers, uncircumcized pagans that they are, are not the proper type of people to oblige with the healing arts, for themselves or their households, right?

    by Dar Nirron on Thu Mar 01, 2007 at 06:35:30 AM PDT

    •  asdf

      I was just about to write the same thing.  Glad I read through the comments first!

      by BDA in VA on Thu Mar 01, 2007 at 06:42:01 AM PDT

    •  You have to remember, ER is

      a television program and is not necessarily what would happen in some emergency rooms.

      by nupstateny on Thu Mar 01, 2007 at 06:45:33 AM PDT

      •  True, it's a TV show,

        but I think it was portraying, in that incident, what should be.

        by Dar Nirron on Thu Mar 01, 2007 at 06:48:09 AM PDT

      •  Won't say that

        you could not have a case that a person was refused treatment in an emergency but it would be illegal and unethical.  And having been in the business for a while I can say I know of no one in the emergency medicine world who would not treat the patient.

        by newfie on Thu Mar 01, 2007 at 07:24:15 AM PDT

        •  I work in an inner-city trauma hospital

          We get all sorts of gunshot wounds. It's not infrequent that we get both the wounded cop and the person who shot the cop. The nursing director is fond of saying, "You are my guest when you come into my house and are treated the same as any other guest. I don't care how you got here. It's my job to help you live. It's the law's job to hold you accountable".

          by frey60 on Thu Mar 01, 2007 at 03:35:24 PM PDT

    •  And what makes you propose a relationship ...

      ... between the historical Jesus and TCR (The Christian Right(tm))?

      /rhetorical question.

      by Yellow Canary on Thu Mar 01, 2007 at 06:47:07 AM PDT

    •  Rx-cellent point, Dar

      Virtually everyone Jesus healed was in one way or another unwelcome in His society.  And the overwhelming majority of His miracles involved health care, with the next largest group being sustenance.  Think He was making a point about fundamental human rights?

      by marykk on Thu Mar 01, 2007 at 07:19:31 AM PDT

  •  well, let's push it further. what if the child

    then died on the sidewalk right in front of this shallow fool's office? that is more relevant.

    by stodghie on Thu Mar 01, 2007 at 06:36:05 AM PDT

    •  It appears that Adam

      believes in collective punishment.

      by xyz on Thu Mar 01, 2007 at 06:38:47 AM PDT

      •  Geez. I asked a question.

        That doesn't mean you can assume how I'd answer it, though it is ironic that you'd accuse of "collective punishment" someone who invoked a hypo involving someone who believed that Jews, homosexuals, et al deserved collective punishment.

        by Adam B on Thu Mar 01, 2007 at 06:40:50 AM PDT

        •  Well, your

          answer to my question above appears to prove my assumption, doesn't it?

          Irony abounds.

          by xyz on Thu Mar 01, 2007 at 06:43:34 AM PDT

          •  no, it doesn't

            I'm not really offering any opinion here; I'm just asking questions to suss out the principles underlying your instincts.

            by Adam B on Thu Mar 01, 2007 at 06:50:14 AM PDT

            •  Sure ya did

              with your 'well, if it wasn't an emergency.....'

              by xyz on Thu Mar 01, 2007 at 07:09:51 AM PDT

    •  That would be unfortunate, but it still

      imposes no legal obligation on the MD.

      by Drgrishka1 on Thu Mar 01, 2007 at 07:14:40 AM PDT

      •  Perhaps

        unless the child was in obvious medical distress and required immediate attention.  His malpractice insurer would settle this one with some big numbers.

        by newfie on Thu Mar 01, 2007 at 07:28:56 AM PDT

        •  No he wouldn't because there is no

          legal duty.

          Unless the child has previously been a patient (and thus expected to get help from this particular doctor) the mere fact that he happens to be writhing in pain on the sidewalk adjacent to the office does not impose any legal duty on the MD.  (Whether a moral MD should help is a different question entirely).

          by Drgrishka1 on Thu Mar 01, 2007 at 07:32:22 AM PDT

          •  I'm looking at it from a malpractice suit

            view.  Parent comes in with an obviously sick child and is refused and sent out.  Child expires outside the Doctor's office. Dr's malpractice insurer settles as quickly as possible because there is no way a jury does not empathize and side with the child's family.

            But this is all for naught since that is not what happened.  What I guess happened is the patient was refused routine treatment or refused entry into the Dr's practice and that is that.  Bad (?) publicity for the Dr's practice perhaps but that is all.

            by newfie on Thu Mar 01, 2007 at 07:43:28 AM PDT

            •  The thing is teh question won't get to a jury

              The existence of a legal duty is a legal question to be decided by a judge.  In the propounded hypothetical, the parent would not be able to establish a legal duty towards the child (unless the child has already been a patient).  thus, since tehre is no duty, there can be no breach, and if there is no breach, tehre can be no recovery.

              by Drgrishka1 on Thu Mar 01, 2007 at 07:46:00 AM PDT

          •  unless

            the doctor is a preferred provider with the insurer, part of the network.  The patient is a third party beneficiary of that contract.

            by dhonig on Thu Mar 01, 2007 at 07:58:46 AM PDT

    •  Then the Doctor

      has potentially committed malpractice.  The difference being not treating a patient for routine care and not treating or recognizing a patient in life threatening emergency.  Can't answer ofr this schmuck but I would hope that he would still treat a person in distress regardless of his beliefs.

      by newfie on Thu Mar 01, 2007 at 07:26:42 AM PDT

  •  How is this related to the health of the child?

    Because that kid sure as hell didn't choose to be sick. Since when did collective punishment become apropos in the doctor's office?

    by Diaries on Thu Mar 01, 2007 at 06:38:50 AM PDT

    •  I think there may be degrees

      Again, not knowing anything about medical ethics, but can't we distinguish emergency care needs from cases in which other treatment is readily available?  As an attorney, I can refuse a client for all sorts of reasons.

      by Adam B on Thu Mar 01, 2007 at 06:44:21 AM PDT

      •  But Adam...

        Look at the little boy who died from a toothache. Without even looking at the child how can they tell if it's an emergency or not?

        by MsLibrarian on Thu Mar 01, 2007 at 06:46:23 AM PDT

        •  to be sure

          I don't believe one should be able to decline treatment unless one can confirm that another doctor will treat the patient.

          by Adam B on Thu Mar 01, 2007 at 06:51:08 AM PDT

          •  Why not?

            What if I don't want to treat you just because a) my roster is full and b) I have a golf game waiting?  (Now, we are assuming you are not my patient yet).  Why do I have to provide you with a service?

            by Drgrishka1 on Thu Mar 01, 2007 at 07:15:56 AM PDT

      •  But Adam, if you refuse a client

        Is that client likely to die because you refused to accept him/her as a client? Being a doctor is not like being in any other sort of business. There are very few (if any) other businesses where a denial of service could result in a person dying.

        by LynneK on Thu Mar 01, 2007 at 07:14:37 AM PDT

        •  Being a doctor is EXACTLY like any other

          business.  When I got my diploma, I never signed away my right to work the hours that I want, charge the fees that I like, and see as many or as little patients as I desire.

          by Drgrishka1 on Thu Mar 01, 2007 at 07:16:56 AM PDT

          •  I'm really glad

            that I'm not one of your patients.

            I don't want to be rude, or hateful, just saying what I feel. I had a Doctor who was like this and leaving him saved my Mom's life.

            by MsLibrarian on Thu Mar 01, 2007 at 07:20:23 AM PDT

            •  It goes both ways

              patients can choose their doctors and doctors can choose their patients.

              by Drgrishka1 on Thu Mar 01, 2007 at 07:21:07 AM PDT

              •  No it's not

                Not in rural areas or for people with HMO's who dictate where they can go.

                by MsLibrarian on Thu Mar 01, 2007 at 07:25:12 AM PDT

                •  Yes it is..

                  HMO issue is a canard because once you (as an MD) sign with an HMO, that contractually obligates you to see all HMO's patients until your roster is full.

                  We are talking about private practice and private office.

                  by Drgrishka1 on Thu Mar 01, 2007 at 07:26:56 AM PDT

          •  No, it's not

            Name one other business where refusing a client could lead to the death of said client.

            by LynneK on Thu Mar 01, 2007 at 07:20:41 AM PDT

            •  Attorney in a death penalty case n/t

              by Drgrishka1 on Thu Mar 01, 2007 at 07:21:50 AM PDT

              •  On ya...next time

                we see a small child on death row....

                by MsLibrarian on Thu Mar 01, 2007 at 07:26:18 AM PDT

                •  Only small children can die now?!

                  You asked for a profession where inaction can lead to death.  You did not specify that death must be of small child.

                  How about a private security officer authorized to carry a gun?  An inaction by him can lead to death.  That does not obligate him to act outside of his own contractual obligations to the employer.

                  by Drgrishka1 on Thu Mar 01, 2007 at 07:28:56 AM PDT

                •  then.... attorney in a death penalty case...

                  where a minor is being tried as an adult.  But I'm not sure where this discussion is going?  Are we laying the grounds that children's lives are worth more than adult's lives?  I'm confused.

                  by desertbug on Thu Mar 01, 2007 at 09:18:50 AM PDT

                  •  To be sure minors can no longer

                    be subject to death penalty (see Roper v. Simmons) but that is of relatively recent vintage.

                    (Just an aside).

                    by Drgrishka1 on Thu Mar 01, 2007 at 12:39:20 PM PDT

            •  but refusing a client

              in an outpatient pediatric practice does not preclude the concerned parent from taking their child to: A) another pediatric practice, B) an urgent-care center, C) an emergency room.

              I'm wondering why it is that this mother is just now coming to this physician for medical care.  Shouldn't she already have a pediatrician or FP for her child?  One that she is comfortable with?  If the child was born there, she should already have a doc who has previously seen the child for well-child visits.  I suppose it's possible that the family just recently moved there and hadn't established care yet.... but I would think that that "tragic" aspect of the story would have been played up in the newsarticle.  If they've been there for sometime and "just hadn't gotten around to it yet", then I wonder why it is that the doctor is being criticized, but the family isn't being criticized for their failure to establish such relationships.  

              You know that old line about "Failure to plan on your part does not constitute an emergency on my part."

              by desertbug on Thu Mar 01, 2007 at 09:31:58 AM PDT

              •  It's possible that...

                her previous doc was a bigger asshole than this guy.

                by itsjim on Thu Mar 01, 2007 at 05:12:08 PM PDT

          •  You are fighting

            a losing battle.  You can see the business side.  Others will immediately leap to the emotional side.  I'm guessing that you believe that the physician has a right to set up his private practice as he/she sees fit.  I'm also guessing that you do not necessarily think it is morally right to refuse treatment of a child based on something like a parental tattoo.  This doctor is in his legal right but not necessarily morally right.

            by newfie on Thu Mar 01, 2007 at 07:34:23 AM PDT

            •  Exactly. n/t

              by Drgrishka1 on Thu Mar 01, 2007 at 07:37:39 AM PDT

          •  Troll rated

            This nincompoop has said in just this diary that he is a doctor, and a lawyer working on a Court of Appeals.

            What a nitwit.

            by xyz on Thu Mar 01, 2007 at 12:46:57 PM PDT

            •  Welcome to the world where people have

              multiple professional degrees.

              Like for example this guy:

              http://www.medicalnegreview.com/

              Or this guy

              http://themdjd.com/

              Or this guy

              http://www.mydoctorlawyer.com/

              by Drgrishka1 on Thu Mar 01, 2007 at 01:43:48 PM PDT

            •  unless you're sure

              that he's full of shit, I'd suggest that you back off on the criticism of those diplomas.  I happen to know of several who hold both MD and JD diplomas.

              by desertbug on Thu Mar 01, 2007 at 04:43:19 PM PDT

              •  You may,

                but he is not one of them.

                His lack of knowledge, and even lying, about civil rights law is the kicker.

                by xyz on Thu Mar 01, 2007 at 07:17:35 PM PDT

          •  Really?

            I don't know any other business people who regularly make appointments with clients, then keep them waiting well past the appointed time in a room full of sick people.

            by itsjim on Thu Mar 01, 2007 at 05:17:29 PM PDT

      •  Yes, we can

        but the Canons advise us to do it with great care.  Fact is, if most lawyers actually followed the Canons with respect to our obligation to provide legal services, we might not need a Legal Services Corp.

        by marykk on Thu Mar 01, 2007 at 07:21:22 AM PDT

      •  Let me get this straight then

        You have no problem with a doctor refusing to treat Jews, or Catholics, or gays.

        You have no problem with doctors and pharmacists with refusing to give the pill.

        Because, with your logic, that is what you're saying.  Provided, of course, that it isn't an 'emergency'.

        While you're at it, maybe you could define 'emergency'.  Is it death's at the door, don't see blood, or just what criteria?

        by xyz on Thu Mar 01, 2007 at 07:40:07 AM PDT

        •  The distinct

          I think would be that Drgrishka1 is answering from the legal point of view.  What he/she feels is legally "right" doesn't necessarily mean that is what Drgrishka1 feels is morally right.  And he/she is correct.  There is no legal obligation for this physician to provide care.  The practice is a private business and the physician can run the practice in whatever manner desired (provided that manner does not violate law).  Morrally offensive (to us) yes but not legally wrong.

          by newfie on Thu Mar 01, 2007 at 07:55:19 AM PDT

          •  exactly (n/t)

            by desertbug on Thu Mar 01, 2007 at 09:34:15 AM PDT

    •  Do you know

      that you can't donate blood for up to a year, in some cases, if you've gotten a tattoo?

      This wasn't the doctor's reason, but if he decided that he didn't want to treat people who looked like they led "unhealthy" or "dangerous" lifestyles, that is his decision. A nice decision? No.

      by JohnGor0 on Thu Mar 01, 2007 at 06:55:24 AM PDT

      •  "Unhealthy" ? "Dangerous" ?

        Only if you don't do your homework and choose your tatoo artist wisely. My husband's spirit lives on in my heart and the physical reminder of that will be with me forever in the tatoo of his symbol over my heart.

            Just my two cents,
            Heather

        by Chacounne on Thu Mar 01, 2007 at 08:15:41 AM PDT

  •  Doesn't make a difference

    My aunt and uncle are nurses and even when they worked at private practices, they've treated the children of flat out racists.  People who were calling them names and/or threatening them.  It was about the child.  

    by fabooj on Thu Mar 01, 2007 at 06:54:13 AM PDT

    •  Which makes them

      good and moral people.  This particular Doctor is neither in my opinion but is well within his legal right to do so.

      by newfie on Thu Mar 01, 2007 at 07:56:52 AM PDT

    •  In pediatrics...

      It's always about the child.  That's the only way you can keep trying in some situations.  You have to work past obstructionist parents in some situations.  You have to tilt at windmills and fight with insurance plans or medicaid rules.  You have to be creative.

      If this physician was truly a Christian pediatrician, he wouldn't be limiting the child's access to medical care on the basis of the mother's decisions.

      by desertbug on Thu Mar 01, 2007 at 09:38:27 AM PDT

  •  And what if the mother

    was born again but got the tattoo's in her previous life?

    Sorry, Adam, the argument doesn't carry water.

    by zic on Thu Mar 01, 2007 at 06:57:34 AM PDT

  •  another inch

    What if that pediatrician is the only one within 50 miles, or the only one that honors the child's family's insurance? It's not like choosing a different grocery store.

    by musicsleuth on Thu Mar 01, 2007 at 07:04:05 AM PDT

    •  but it wasn't

      That makes for a more dramatic argument, but doesn't change the underlying question.  As a pediatrician, I thoroughly disagree with this physician's decision, but I totally uphold his legal right to make this (imho) morally incorrect decision.

      He is not an emergency room, so EMTALA doesn't apply to him.  

      The laws of the market will apply to him though, and the negative publicity surrounding this case may well drive many away from him.  Those on HMOs in Bakersfield surely have other choices.  If I had the time and knew the plans in the area, I could surely pull up the roster of available physicians there.  I would take my own kids to a different practice.  I'm sure many others will and that his decision will adversely affect his practice.

      He is not the only one within 50 miles, he was in Bakerfield.  

      by desertbug on Thu Mar 01, 2007 at 08:06:50 AM PDT

      •  how doesn't it change the question for you

        It's not a criticism as much as it is a question of where is the line drawn -- when does someone's personal   criteria for choosing patients become a real liability to the community? Should we as a society accept that any child that doesn't fit the acceptance standards of the one pediatrician (or have the right insurance for coverage) should just use emergency room services and be satisfied that? I admit that having several choices in the area allows patients to be better consumers, and hopefully has the information needed to make a good choice. If it is not illegal to refuse patients based on superficial criteria, it should also be public knowledge. I also question whether the standards should be different where there is no reasonable choice.

        by musicsleuth on Thu Mar 01, 2007 at 12:41:19 PM PDT

        •  The societal issue cuts both ways

          As a society, I would hope that we would also be concerned about a doctor's right to run his practice as he sees fit and not impose on him a duty to see everyone who happens to come through the door.

          In some ways, this is like a First Amendment argument.  No one likes the philosophy of such groups as the Klan, but we as a society support their right to exist.  So too here.  We do not like doctors turning down childres because their parents have tatoos, but we may want to think long and hard about such practices.

          by Drgrishka1 on Thu Mar 01, 2007 at 02:22:25 PM PDT

        •  actually, I still don't think it does.

          I think the rules still apply equally, at least the medicolegal ones.  The weight of the moral and ethical responsibilities to provide care will fall more heavily upon the sole practitioner in a rural area and I have trouble believing that the situation would arise in those areas.  Smaller community.  More likelihood of "out-of-clinic-interaction" makes for less likelihood of such a situation occurring.  I'm familiar with those medical settings as well and the societal pressures that would fall on that physician trying to take such a stance in that environment would be much stronger.

          But I don't think it changes the medicolegal rules.

          by desertbug on Thu Mar 01, 2007 at 04:49:08 PM PDT

          •  makes sense

            Thanks -- I just needed to get my head around the issue better. It is more like a First Amendment argument and I would think the societal pressure would be greater in rural areas. Sunshine is the best remedy ;-)

            by musicsleuth on Fri Mar 02, 2007 at 07:47:55 AM PDT

  •  So just to make it clear: