On the other hand we have Anna Watson, a medical professional which was fired by said owner after raising concerns about their disregard for the patients' well-being. She's making very serious allegations and is risking a lot by blowing the whistle...
We have several (ex)-employees coming forward and claiming that their injuries were allegedly downplayed. There's no fucking way that one should take a Lyft to the hospital if they can't walk, sit or stand straight -> this indicates a potential spinal injury. Same goes for mangled hands. And yeah, even for amputated fingertips, the person is probably under shock!
And as always temps are getting screwed. They were allegedly turned away when requesting medical care.
There's even more criticism from anonymous employees, including medical assistants.
This smells to me like typical corporate bullshit, whatever the corporate doc says.
Disclaimer: I work for a Tesla competitor. Usually I try to stay away from this topic, but corporate callousness makes me angry. I don't care if Tesla suceeds or not, but they should treat their employees properly and obey the law.
Edit: there's obviously downvote brigading taking place on this topic. I've posted several relevant pieces of information, which according to the site rules should not be downvoted.
No, it is Basil Besh who is the medical professional. Anna Watson is a physician assistant. Basil Besh is a doctor. Part of having your doctor's license is being subject to an oversight board of your peers. As a patient you can complain to this board and if the doctor cannot prove that he has provided adequate care, he can lose his very expensive livelihood.
They key here is that he has to justify himself to his peers, ie doctors who would look at the patient records and his notes and judge whether he provided a standard of care by calling or not calling an ambulance, etc. Randos on the internet speculating about patients they know nothing about is PR, not medicine.
The way you will know whether this story is real or another one of the endless Telsa hate pieces is that this guy will lose his license if it is real.
Additionally PAs can prescribe many drugs in most states, but the supervising physician is ultimately responsible for the patients care.
Finally there are numerous subspecialties that simply aren’t available to PAs.
A PA degree only requires 2 years of post-bachelor training. An MD requires 4 years of medical school and a minimum of 3 years in residency (most specialties require 4, but some require more — e.g. 7 years for neurosurgery, or even more for oral & maxillofacial surgery since that also requires a 2-year DDS and a 6-year residency).
So 2 years for PA vs. between 7 and 11 for MD.
They are different from physicians, but they're still medical professionals.
I'm not sure I'd say that PAs are not "professionals" but I would say that they are only in a broader sense of the word.
Example?
(added emph) Um, yeah, I would be.
> it isn't stuff you need to call an ambulance for
If you crush or sever your fingers, you really do need to call an ambulance.
Paramedic here... If the bleeding is controlled, there's not really anything an ambulance is going to do other than give you an expensive ride to the hospital. Counting dispatch/response/on scene time, you'd likely get to the hospital just as quickly if someone drove you in their personal vehicle.
I'm not defending Tesla's practices here... I'm far more concerned about the other cases mentioned (workers passing out, feeling dizzy, etc).
The stuff Tesla is doing, allegedly, is only done by really shaddy companies.
Yes, medical care availability and quality suffer as the consequence of the European model, and that everybody regards it as "free" (despite having been taxed through the roof) doesn't help. On balance, it's probably better than the US system, but it's not the rose garden a large chunk of HN seems to think.
And nobody thinks health care is free, just universal. It might seem free as everybody is used to pay part of his salary every months but health care cost is a recurring topic over here.
Availability for emergencies, and ambulances are for emergencies, is by no means bad. There are medevac helicopters placed in a way to minimize response times. And they are covered by your basic insurance.
Availability can be an issue compared to private insurance due to budget constraints in the public model and the fact that doctors and hospitals have to live. Again, emergency services don't suffer from that. Could overall availability be better? Yes. Is availability overall satisfactory? I would say yes as well (point in case, general doctors in the countryside, there are not enough of those for a variety of reasons).
Ambulances are low risk and cheap somthey really should be used even down to ~0.1% chances of serious issues.
If the injury is higher (with the potential for compartment syndrome distal to the injury site, or closer to major blood vessels), then sure, I may be in a bit more of a hurry (a "bit" being the operative word there... slow is smooth, smooth is fast).
> If you crush or sever your fingers, you really do need to call an ambulance.
Why? It's not life threatening, you're diverting critical life-saving public resources from someone else, you can definitely get to a hospital faster on your own and probably faster with a ride share, and you are incurring a very high cost.
Furthermore, it's not like they get to the hospital and then are seen immediately because they showed up in an ambulance. They still have to wait in line because the injury is simply not severe
If they have first responders on site, there's no reason they can't get gauze and then go see a surgeon.
Questionable
you're diverting critical life-saving public resources from someone else
Why, do we have a desperate shortage of such resources? Then maybe we should build more of them instead of guilt tripping people who have suffered severe and perhaps permanent maiming.
Furthermore, it's not like they get to the hospital and then are seen immediately because they showed up in an ambulance. They still have to wait in line because the injury is simply not severe
Of course it's severe. It's not the worst thing that can happen to someone, but then ERs aren't swamped 24/7 either, and to the extent that they are overburdened we should do something about that rather than minimize the problem.
This is not true. Patients arriving in ambulances are triaged and helped according to need, just like anyone else.
This is something rather commonly stated and it's observably not true. I wonder what that's about, but I suspect it's a case of the way things are supposed to work (triage in the emergency room is supposed to not suck, but it's usually so bad that it is the weakest link in a patient's emergency care, even at a good hospital) and the way things actually work (riding in on the ambulance gets you in front of a doctor faster very close to 100% of the time).
For stuff like that there's nothing a paramedic will do that someone with basic first aid can't do. Until the victim is in surgery, there isn't a whole lot to do. Staunch the bleeding. Put the severed finger on ice. That's about it. Maybe you don't have much experience working in factories and shops where these sorts of accidents happen several times a year, but it's a gross overreaction to call medical professionals in. Once, in this shop this guy was cleaning out a paint mixer, and it somehow turned on while he had his arm in there. The mixing blade ripped his arm open, down to the bone from his shoulder to his wrist. We called an ambulance for that. What a mess, lol.
The gas station right next to my house has EMT vehicles almost every night hanging out and waiting to interveene in the area.
What?
One or more SEVERED FINGERS absolutely does justify an emergency response like calling for an ambulance. You know, "severed finger?" Meaning a finger that's been detached, ripped ragged, caught from it's bone and pulled off - that's what a severed finger is.
People in here are seriously arguing that it doesn't merit a call to an ambulance. As if a person in that situation is going to deduce the pros and cons of the situation at the time.
Common sense is too often a stranger here. Logic can take you far, but as in the case of this thread, much too far out.
Isn’t the complaint that the doctor did exactly that, and decided against the ambulance? (with the issue being that the cons may not have actually been full with the patients best interests in mind); the defense being that the doctor wad exactly the person who should be making that decision, and there’s a decent chance he was correct (based on his potential capacity to seize any life-threatening aspect of it, and assuming he did so)
It seems like a lot of assumptions are being made to make the claim that an ambulance should be required under any circumstance, having lost a finger. But even a tiny amount of trust in the doctor actually doing his doctoring is enough to say... maybe an ambulance would be unecessary, and a medical professional is probably the best person to make that call. If you’re not assuming malice, that is
If I severed my finger and a doctor came and gave initial treatment, and said "now get yourself to a hospital, but it's no longer urgent", I would take a Lyft too.
Besides the dickishness of pressing a typical Uber/Lyft driver into emergency service, ambulances have other advantages, such as the legal authority to speed and clear roads, and on-board medical equipment to continue stabilizing the patient during the trip.
Can we agree that, even if an ambulance isn't the best choice, it's amazingly callous to make a person with a severed finger sit around and wait for a fucking taxi rather than pull someone else off the line?
I'm sorry, what is this "indirect cost" of using an ambulance, when the purpose of them is to service severe injuries? Maybe you think a severed finger is no big deal, but how common do you think severed fingers are, to think that victims constitute a serious threat to the supply of ambulances on any given day?
It depends on the case. The problem is that people has a stereotyped vision of what is an ambulance. One vision that is typically urban and adapted to their country. The truth is that there are at least three types of ambulances and they are very different when in isolated areas or in big cities.
> how common do you think severed fingers are, to think that victims constitute a serious threat to the supply of ambulances on any given day?
Emergencies happen in clusters much more often than you could think.
If a patient has a pain in his foot, but the doctor cannot understand the pain, then, according to Basil Besh, the patient doesn't have a pain in his foot.
This seems to advocate minimizing the importance of the patient's reporting of pain. Patients are experts in how they feel, and while they may not always be accurate, what a patient tells his doctor, should be fundamental in diagnosis & treatment.
Sorry, where does he say this or are you misunderstanding and making an huge assumption that the doctor's objective examination wouldn't include ultrasound, x-ray, and/or MRI diagnostics - which would all be part of determining objective cause? For example, if pain exists in an area - say in the feet - even if there's nothing visibly broken, fractured, or torn, an inflammatory process (which causes pain in itself) will show up as extra fluid in areas where there shouldn't be fluid noticeable.
He didn't state that. That's my interpertation of his well written and very reasonable (at face value) statement. His central messages are "the doctors know best, and we shouldn't listen to patients as they are work-shy and/or drug addicts", and "I won't talk about the whistleblower, Anna Watson, except to say that she's a trouble-maker, whom we had to fire, and is being investigated for malpractice".
I'm not a medical professional, but I don't agree that machines can always diagnose pain. If a patient says he's in pain, then the doctor should take his word for it. It becomes more complicated if the patient is potentially addicted to pain medication, but fundamentally the word of the patient needs to be central in medicine.
I know nothing specific to Tesla's environment.
In the best case, I feel like he intents to say that even though people claim to be in pain, there’s nothing medically wrong with them, and it’s fine to send them back to work.
Whether or not that is actually the case, as you say, is hard to prove.
It seems a lot of assumptions are being made by everyone - or context not being controlled for enough during responses - and it's too much effort to counter it all, some assumptions more or less reasonable than others; it's reasonable that they likely don't have an MRI, more likely they have x-ray and ultrasound - more likely reasonable to assume that based on the incident itself, what happened specifically, they can determine a reasonably safe course of action.
If there was an injury at work, and pain resulting from that, it's reasonable to assume that there was just an event that occurred to cause that injury/pain, right?
Basically missing from everyone's arguments are the specific contexts of different scenarios being argued around:
If someone hurts their hand and it visibly needs care, you send them to the hospital - that likely doesn't need to happen in an ambulance unless they're bleeding out and can't be stabilized.
If someone's just walking along or makes a twisting movement that that causes them immense back pain - and say, it wasn't from getting hit by any machinery moving quickly - then that sounds more like an inflammatory response the body does to stabilize an area that just had a nerve pinched than something more potentially devastating; a doctor should be able to based on the situation described by the person decide if they need to be mobilized and taken by ambulance or if taking a Lyft would be quicker getting them to full care. Likewise, that twisting movement should then be addressed to make sure their body can handle it or that their movement is proper for the task at end - that we could assume they're repeating often.
I've hurt my back before where I was walking like a hunchback 90 year old man, where I had to walk bent over a bit to stop the pain from getting worse; it was twisting from playing floor hockey after having just before done a hot yoga class, so my body was open and muscles weren't as tight/supportive - and it was only actually the next morning when the inflammatory reaction had kicked in/stabilized the area; I didn't go to the hospital, I did however call my chiropractor who I'd been seeing for other issues who could see and access me. She used heat and laser light to help reduce inflammation in the area (which helped), and told me to rest and not do yoga for a few weeks - and suggested anti-inflammatories if I wanted to take them. I half-jokingly pressed her to let me go after a week, to which I had a followup with her, went to the same hot yoga class 6 days later - and that heat, blood flow, stretching/strengthening - completely cleared whatever inflammation/pain process was happening in my spine and I felt 100% better afterward.
If someone was hit by machinery, say in the head, your decision making process will be different then if they're just walking and sprained an ankle. We can assume that if the on-site doctors are trained well then they're making good judgement calls based on the information presented to them, based on whatever diagnostics they may have available; the fail-safe to this is however why there are organizations like OSHA, to hopefully make sure good/acceptable decisions are being made.
My biggest concern in all of this would every doctor's ability for critical thinking, including having strong situational awareness, however that would come with proper/adequate training - and that would be required for any on-site doctors, ambulance attendants, or doctors working at hospitals.
EDIT: Just to point out - there was also an assumption made that my response was talking about this doctor's response/behaviour if he was at the Tesla facility and in the context of a worker coming to them on-site at Tesla, when in fact the context was never set and I wasn't specifically referencing what diagnostic tools they may have at Tesla.
No, I'm not saying that in all cases pain can be attributed to something observable. There are different causes that can be from an immediate larger injury, to repetitive stress injuries - and likewise not excluding holistic influences, whether it being a source of pressure on nerves in the spine or even a diet that causes high inflammation in the body; different medications can certainly cause people problems too, whether increasing the sensation of pain and/or allowing them to cope until a minor injury becomes worse.
The person commenting above made a general statement that was actually wrong - they made a false assertion, saying that because it can't be objectively found (in the foot) it must mean the doctor doesn't believe it's there - when in fact the doctor simply said it can't be proven: that doesn't state whether the doctor believes the pain is there, nor what action for care would happen or recommend. If there's pain in the foot and nothing shows up on ultrasound, X-Ray (or motion X-ray), MRI - then you'd need to move up the body to see where else pain may be coming from - the spine being a stronger possibility as pain can radiate down. Likewise, as you said, many people with chronic pain can attest to there not perhaps being a physical cause - and we know that emotional pain/stress can manifest into the physical body; and because of plant medicines, higher use of psychedelics and their ability to help people reconnect and process repressed/suppressed emotions, people often report physical pain (arthritic type pain on all their joints, "heart pains", etc) going away often after one or a few Ayahuasca ceremonies, etc.
From my own experience doctors and the medical system have a really terrible understanding of pain, perception of pain. Luckily regenerative medicine (with stem cells et al) is giving options for people in pain to "experiment" - and with great success in many cases, assuming the process/protocol followed is from a research/evidence-based process (e.g. you're not getting treated by someone who only kind of knows what they are doing).
He identified a problem with my wife's thumb that was causing pain for years. He root caused it and put a plan in place in our first meeting. He was excellent, professional, fast, and very reasonable.
What a load of absolute garbage. Shame. There are plenty, PLENTY of ambulances to go around. This isn't some wartime situation where medical care should only go to those about to die.
A few years back my wife had a back injury that prevented her from walking. We called an ambulance, and it was the best decision both according to her (who couldn't move) the ambulance paramedics, and the doctors at the hospital. Her injuries WERE NOT LIFE THREATENING, but she still required an ambulance to transport her without further injuring her back and potentially causing paralysis. Again, not life threatening, just paralysis - no big deal right?
Basil Besh should step down from whatever position they hold.
Most workplace injuries are not emergencies. Even the example given of a broken hand is not an injury that is helped by an ambulance ride, if anything you are delaying treatment by calling 911 and waiting for an ambulance to be dispatched for a very low priority injury. Most companies have a policy of calling 911 only to avoid liability -- they care more able getting sued for the result of a car accident on the way to the hospital than the employee. In this case Tesla has medical personnel on site who can make subjective judgements and do so with their license at risk.
The other thing being missed is once you're admitted to the hospital for a workplace injury, you're stuck in the Worker's Compensation system and end up in a kafka circle of bureaucracy where as an employee you end up wasting alot of time and potentially alot of money as the insurance companies, independent doctors, etc all fight over pennies.
As far as "there are PLENTY of ambulances to go around" that often is not true, especially when you're talking about a big workplace like a factory where getting in and out will take a long time. My brother is a fireman paramedic who gets bullshit ALS calls all of the time. It's really frustrating when September comes and people in car accidents or serious injuries are left waiting because some panicked coed calls 911 for a passed out drunk friend who is "dying, I don't think she's breathing" every Friday.
I'm no Tesla fanboy, if you look at my comments I'm often harshly critical of them. But IMO this is an article on a boring topic that nobody understands that is ginned up and novel because we're talking about Tesla.
The thought processes of some of you genuinely scares me. What happens if the person goes into shock from the pain and loses consciousness in the taxi? How the f do they even put the seatbelt on, if their hand is broken? What kind of small talk will the Lyft driver make with them? "Is that a piece of bone I see peeking there you naughty naughty boy!"
If the person loses conciousness on the way to the hospital, the driver can either call 911 on the way and arrange a transfer to the ambulance or just pull up to the emergency room and yell / honk / go in to get help getting the person out. Hopefully the onsite clinic would call ahead so that the ER / urgent care knows what to expect.
If the patient is in fairly stable condition, and it's quicker to get them to the hospital with a taxi than an ambulance (because of ambulance priorities), it seems prudent to take a taxi.
I see further in the thread that an ambulance was denied for a back injury, which seems less prudent.
Driver has no duty to alert ER staff or arrange supplemental transport.
Lyft and Uber could offer medical transport service at an appropriate rate where the driver would get trained and tasked with additional duties.
Navigating into Tesla factory from the freeway takes time. Most drivers will get pinged from the freeway. Unless the driver has been to that facility many times, finding the right pickup point on any large corporate campus is a challenge.
I have transported several people to ER. Those were demanding rides due to elevated risk of passenger causing damage to my car.
Ambulance priority - patient stability Rideshare priority - no damage to the vehicle
As you can see, they are not aligned.
~30 people, including several employees have been killed by private garbage haulers unsafely operating in NYC since 2014. That's a pretty serious workplace safety problem that affects the public, but lacks the Tesla clickbait factor and associated hand-waving.
The article describes medical professionals making medical judgment calls, and getting censured or fired for it.
This is very strange advice. It sounds like you’re arguing that when you’re seriously injured at work, you shouldn’t seek appropriate medical care.
That’s the kind of right out of The Jungle isn’t it?
Your anger seems grossly misplaced and based on a deliberate misreading or uncharitable reading.
And your response is some anecdotal story about calling an ambulance when it wasn't really needed?
Do you think ambulances (and trained medical professionals to staff them) come in plentiful supply?
Do you know that many people die every year waiting for an ambulance and due to ambulance non-availability all around the world?
“It’s shocking how close or how often the ambulance level
gets to ‘Level Zero’ or close to ‘Level Zero.’ What this
means is there are no ambulances left in the city,”
Joseph Ross told the committee.
https://globalnews.ca/news/3995973/hamilton-code-zero-ambula...
https://www.boston25news.com/news/someone-is-going-to-die-25...
https://www.npr.org/sections/health-shots/2017/04/11/5230259...
https://www.cbc.ca/news/canada/new-brunswick/david-harvey-de...
https://www.pressreader.com/south-africa/daily-dispatch/2018...
https://www.bmj.com/content/321/7270/1176.2
https://www.theguardian.com/society/2018/jan/18/ambulance-cr...
https://www.theguardian.com/society/2018/mar/31/ambulance-cr...
https://www.theguardian.com/society/2017/dec/17/alarm-sharp-...
>Basil Besh should step down from whatever position they hold.
Perhaps, but not because of an ignorant rant.
Note also that Basil mentions "life OR LIMB threatening" -- not just life threatening. And that can easily include risk of paralysis...
I think you missed the point. My anecdote was meant to outline how the ambulance WAS really needed despite my wife not in a life threatening situation.
Back injuries are very, very, very serious. I spent a few days considering the possibility that my wife wouldn't ever walk again. If someone even suggested we took an ambulance needlessly I (and the doctors treating my wife) would have gone ballistic. I'm checking out from this thread as it's clearly effecting me emotionally.
>Do you know that many people die every year waiting for an ambulance and due to ambulance non-availability all around the world?
We're talking about Nevada, not the world.
Well, I gave examples from Boston, California, and elsewhere. And it's not like parts of Nevada fair better:
Despite such efforts, the shortage of medical
professionals is so serious in the Esmeralda County town
of Goldfield that 32-year-old Danie Johnson and her 55-
year-old mom, DeEtta Sligar, run a volunteer ambulance
service for the town’s roughly 300 residents.
With no medical clinic in town and the nearest hospital
more than 110 miles away in Bishop, California, Johnson,
Sligar, two other EMTs and four drivers spend hours at a
time ferrying ill residents across the border. They
receive $132,058 a year from the county to keep their
ambulance and an old backup running.
If your friend fell off a ladder and hurt his/her back in a way that prevented them from moving, what would you do? The chances are that you don't know how to assess that injury. It's prudent for you to call 911 and have an EMT and/or Paramedic assess and make the call on the next action.
It's different if you are a doctor, working at a factory, and have an injured employee brought to your infirmary.
The shortage might be at the root of the problem, but it also might be unavoidable. It's not always a given that a shortage can be fixed (or when it will be fixed). And given a shortage, people who call ambulances for no reason (which very much exist) make things worse.
You literally can't imagine a medical doctor, responsible for the patient in question, advising on whether an ambulance is indicated or not? Because that's what you appear to be saying.
It's quite clear Basil would be calling an ambulance in your wife's situation - as there was significant risk in additional injury (the "limb" part of his statement) if not otherwise done.
Knowing medical professionals who actually work in the ED overuse of all emergency services - including ambulances - is embarrassingly common.
Sure about that?
It's sad that we're debating whether an ambulance is needed for people with back injuries or mangled/broken fingers.
Do you have a citation/source/link for statement?
>“And when we told them, ‘No, we really want to do what’s best for you’ … it’s taking some time to get buy-in.”
How fortunate Tesla employees are to have somebody making the unpleasant decisions to save them from becoming heroin addicts!
Also, this sounds like something my grandparents would say about life in the USSR:
>“I have spoken again with (the workers’ compensation official) at Tesla and he informed that the forklift did not have electric current running. With that said, in my medical opinion, the patient does not have an industrial injury attributed to an electrical current,”
“I spent nearly one hour with Reveal detailing Tesla’s decision earlier this year to bring me and my medical team on site at Fremont, providing its employees with state-of-the-art occupational and musculoskeletal health care. I detailed our vision for exemplary patient care and I gave specific examples of protocol improvements and subsequent successes in outcomes in only four short months, including accurate diagnoses and reducing needless delays for advanced testing and treatment. I patiently educated Will Evans on how Tesla allowed me to give the same care to Tesla employees that I do to my private patients including ones who are professional athletes, with the ability to get necessary testing and treatment in a timely manner without being hindered by an often cumbersome California Worker’s Compensation System that sometimes negatively effects injured workers.
I counseled Will on the difference between subjective complaints of pain, which cannot be proven and are often magnified, and objective signs found only on careful clinical examination by an experienced physician. I even mailed Will a copy of a relevant chapter from the American Medical Association Return to Work Guidelines and offered to make myself available for additional questions. Research and evidence-based medicine indicate that deconditioning injuries involving sore muscles should not be treated with inactivity as this only exacerbates the problem, but should instead be treated by proactive conditioning, ergonomic modifications and supportive care. Not all patients in pain should be off work, at home and on opioids. In fact, it is most often in these patients’ best interest to have supportive care that enhances their activity, their function, and their well-being.
As a physician, my foremost obligation is to perform a careful history and physical examination, order additional tests when clinically indicated, make an accurate diagnosis, and deliver the absolute best care possible. If patients are injured and continued work presents safety issues for the patient, myself and my fellow physicians prescribe the appropriate work restrictions. Any suggestion that myself or any of my medical team at AOC allow external factors to influence our medical care in any way is false and inaccurate.
I advised Will on why ambulances should be reserved for life or limb threatening injuries and that every ambulance that is thoughtlessly called for a non-life-threatening injury is one less ambulance that is available to actually save a life rather than be used as a convenience. Most importantly, all members of my team are empowered to call 911 for any limb or life-threatening condition.
Rather than deliver an informative and balanced piece of journalism, Reveal has instead chosen to hitch its wagon to Ms. Anna Watson, a provider with whom we severed ties after less than two weeks at our clinic and about whom I cannot provide any additional comment as she is currently the subject of an investigation by the California Medical Board. Instead of highlighting the tremendous progress being made in both patient safety and patient care at Tesla, this report uses poor sourcing to tell a story consistent with a predetermined agenda.”