Critical Care Medicine - List
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Back to the Classic Cases: Willie and the Hospital Hand Jive

By David Crippen

Willie is currently ensconced in the State Pen for a number of violent crimes. Willie is an exceedingly bad actor and, as his bad luck would have it, scheduled to die by lethal injection one month hence. However, Willie has chronic liver disease as a result of longstanding intravenous drug abuse and hepatitis from numerous less-than-aseptic tattoo applications. His liver is finally giving up the last of it's numerous lives and Willie is becoming encephalopathic and jaundiced. His team of lawyers have committed to a plan of constant legal argument aimed toward the reversal of Willie's execution, including nonstop bevies of briefs and an orchestrated telephone campaign to State bureaucrats aimed at clemency. Willie is the sole surviving son of his saintly white haired mother, a fixture at his numerous trials......weeping softly in a wheelchair near the rear exit.

Willie's lawyers plan to push hard right to the last breath....or lack thereof. Premature death from organ failure doesn't fit into these plans. Suit is quickly filed to force the Penal System to transfer Willie to Your State Medical Center (YSMC) for an emergency liver transplant evaluation. The Warden grumbles but transfers Willie, hoping the bus will crash on the way. After an appropriate eval, Willie clearly meets the criteria to be an emergent recipient. A letter is drafted to the Warden, stating that Willie meets the qualifications for an emergency recipient and he will probably get the next available liver, and the State will get a bill for about one half million dollars........no pennies. After the transplant, Willie will be transferred back to the Pen where he will die by lethal injection (at State expense as well) , with his lawyers and other assorted hangers-on clutching candles and murmuring "we shall overcome".

The State leaps into action. A full transcript of Willie's latest trial is poured over meticulously by an elite cadre of legal eagles. Technical glitches are found and the US District Attorney sadly announces that Willie did not receive a fair and impartial trial, and he should be released pending new proceedings, which would be scheduled according to the current docket.....maybe in a year or so. The cuffs are removed from the bed. Technically Willie is now no longer a ward of the State pending re-evaluation of his crimes. He is now a free agent....with no resources. If/when the Med Center provides the transplant, they can eat the bill, and the lawyers can eat the fees as well.

Lawyers hit the bricks running. The relatives of Willie's latest victim quickly file suit to have Willie immediately arrested and incarcerated. The charge? In addition to stabbing (and killing) his last victim (their relative) 114 times in the thorax and neck, Willie also inadvertently violated his civil rights by circumventing any further constitutionally guaranteed "pursuits of happiness" and so on. Since Willie has a history of career criminal activities of a violent nature, he should be immediately (re)-incarcerated (become a ward of the State) until such time as a Grand Jury would make a determination as to whether a case exists; in a couple of months or so. During this time, the State would be, of course, responsible for all his medical needs. Justice would not be served if Willie died of some treatable disorder before it could be determined whether the Justice System should have first rights to him. The judge takes it under advisement and Willie is re-cuffed to the bed.

After a brief interval, an assortment of hospital managers gather in a secret meeting in a secure part of the hospital. No secretaries, no minutes, each member checked for recording devices. Phone calls are made over secure lines. Inexplicably, Willie's blood serum is found to exhibit evidence of AIDS. The first screening had inadvertently used a wrong sample and, the sad fact is that Willie has AIDS and so therefore is not a candidate for transplant. Willie's attorneys immediately file suit to have a second opinion from another lab. However, the hospital rejoins that Willie is now incompetent to give informed consent and so they must respect his rights. No one will commit battery in their institution. No further blood manipulation or invasive procedures can be performed. They recommend transfer to the YSMC hospice (as a ward of the State) where his rights against battery will continue to prevail. Willie's attorneys quickly file for a court appointed surrogate to give consent for further blood tests. Attorneys from both sides convene in the judges chambers for a two hour argument, following which the judge retains counsel for himself and states that he will take their arguments under advisement.

Shortly thereafter, the hospital administrator receives a visit from Willie's soon-to-be-surviving family and several attorneys. They demand Willie be transferred to another hospital forthwith. The reason? Verbal Battery, Defamation (and of course)....... Discrimination. Several days before, a family member observed a hospital employee verbally abusing Willie after having been kicked in the teeth. Told Willie he was a "big, fat, stupid asshole". The attorneys filed a writ decrying how the vicissitudes of life had turned Willie into mean person. Were it not for the fact that he had been discriminated in a non-stop fashion from birth, Willie could have been......dare I speculate........President? But, be that as it may, the ignominy being called derogatory names by those charged with the responsibility of helping him cried out for money damages. During the initial stages of legal formalities, they demanded immediate removal from the offending Your State Medical Center to the nearest center capable of rendering him a transplant. State Hospital quickly facilitates such a transfer by their helicopter service.

Willie is fading fast.

You are the Head Transplant Surgeon on call for Elsewhere Occasional Transplant Hospital. You get a call from the Head Transplant Surgeon at Your State Medical Center, who explains the situation: "Hi...we have a 37 year old prisoner here that needs a liver transplant but he has an obnoxious family..........they don't like YSMC and want him to be transferred elsewhere. He meets the qualifications for emergent consideration. His condition is currently stable hemodynamically but he is encephalopathic and on lactulose. He can be hyperactive at times but well controlled in leather restraints. Want him?"

Comment:

This case is built around a kernel of truth. Here in the Pittsburgh area several years ago, a jail inmate was released from incarceration when it was discovered that the City would be responsible for the financial cost of a heart transplant necessary to keep him viable until the end of his sentence. I took that scenario, marinated it with two parts managed care, one snifter of scarce resources and a dash of human nature, then pushed the cruise mode button of my imagination and let it ride.

Freeman Dyson says if an otherwise unlikely event is possible in nature (ie: no physical laws preventing it), it will eventually happen if given enough time.