A Doctor Confronts Medical Errors — And Systemic Flaws That Create Mistakes : Shots

Dr. Danielle Ofri, author of When We Do Harm: A Doctor Confronts Medical Error, says medical mistakes are likely to increase as resource-strapped hospitals treat a rapid influx of COVID-19 patients.

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Dr. Danielle Ofri, author of When We Do Harm: A Doctor Confronts Medical Error, says medical mistakes are likely to increase as resource-strapped hospitals treat a rapid influx of COVID-19 patients.

Justin Sullivan/Getty Images

For more than two decades as an internist at New York City’s Bellevue Hospital, Dr. Danielle Ofri has seen her share of medical errors. She warns that they are far more common than many people realize — especially as hospitals treat a rapid influx of COVID-19 patients.

“I don’t think we’ll ever know what number, in terms of cause of death, is [due to] medical error — but it’s not small,” she says.

Ofri’s new book, When We Do Harm, explores health care system flaws that foster mistakes — many of which are committed by caring, conscientious medical providers. She notes that many errors go unreported, especially “near misses,” in which a mistake was made, but the patient didn’t suffer an adverse response.

“Near misses are the huge iceberg below the surface where all the future errors are occurring,” she says. “But we don’t know where they are … so we don’t know where to send our resources to fix them or make it less likely to happen.”

Ofri says the reporting of errors — including the “near misses” — is key to improving the system, but she says that shame and guilt prevent medical personnel from admitting their mistakes. “If we don’t talk about the emotions that keep doctors and nurses from speaking up, we’ll never solve this problem,” she says.

Interview Highlights

On Ofri’s experience of making a “near miss” medical error when she was a new doctor

I had a patient admitted for so-called “altered mental status.” There was an elderly patient from a nursing home and they were sent in because someone there thought they looked a little more demented today than they looked yesterday. And of course, we were really busy. … And the labs were fine. The radiology was fine. And so I just basically thought, let me get this patient back to the nursing home. It’s all fine.

So I sent the patient to kind of an intermediate holding area to just wait until their bed opened up back at the nursing home. Well, it turns out that the patient was actually bleeding into their brain, but I missed it because I hadn’t looked at the CAT scan myself. Somebody said to me, “radiology, fine.” And so I took that at their word, and didn’t look at the scan myself as I should have.

Now, luckily, someone else saw the scan. The patient was whisked straight to the [operating room], had the blood drained and the patient did fine. So in fact, this was a near-miss error because the patient didn’t get harmed. Her medical care went just as it should have. But, of course, it was still an error. It was error because I didn’t do what I should have done. And had the patient gone home, they could have died. But, of course, this error never got reported, because the patient did OK. So we don’t know. It never got studied or tallied. So it was missed, kind of, in the greater scheme of how we improve things.

On the effect of having made that ‘near-miss error’ on Ofri’s subsequent judgement

In the short run, I think I was actually much worse, because my mind was in a fog. My soul was in a fog. I’m sure that many errors were committed by me in the weeks that followed, because I wasn’t really all there. I’m sure I missed the subtle signs of a wound infection. Maybe I missed a lab value that was amiss because my brain really wasn’t fully focused and my emotions were just a wreck [after that serious near-miss]. I was ready to quit. And so I’m sure I harmed more patients because of that.

Now that it’s been some time, it’s given me some perspective. I have some empathy for my younger self. And I recognize that the emotional part of medicine is so critical, because it wasn’t science that kept me [from reporting that near-miss]. It was shame. It was guilt. It was all the emotions.

On the source of medical errors in COVID-19 treatment early on in New York and lessons learned

We did pull a lot of people out of their range of specialties and it was urgent. But now that we have some advance warning on that, I think we could take the time to train people better. Another example is we got many donated ventilators. Many hospitals got that, and we needed them. … But it’s like having 10 different remote controls for 10 different TVs. It takes some time to figure that out. And we definitely saw things go wrong as people struggled to figure out how this remote control works from that one. And so trying to coordinate donations to be the same type in the same unit would be one way of minimizing patient harm.

The other area was the patients who don’t have COVID, a lot of their medical illnesses suffered because … we didn’t have a way to take care of them. But now we might want to think ahead. What do we do for the things that are maybe not emergencies, but urgent — cancer surgeries, heart valve surgeries that maybe can wait a week or two, but probably can’t wait three months?

On how patient mix-ups were more common during those peak COVID-19 crisis months in NYC

Dr. Danielle Ofri is a clinical professor of medicine at the New York University Medical School. Her previous books include What Doctors Feel.

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Dr. Danielle Ofri is a clinical professor of medicine at the New York University Medical School. Her previous books include What Doctors Feel.

Rogelio Esparza./Beacon

We had many patients being transferred from overloaded hospitals. And when patients come in a batch of 10 or 20, 30, 40, it is really a setup for things going wrong. So you have to be extremely careful in keeping the patients distinguished. We have to have a system set up to accept the transfers … [and] take the time to carefully sort patients out, especially if every patient comes with the same diagnosis, it is easy to mix patients up. And so, thinking ahead to what does it take to have enough time and space and resources to make sure that nobody gets mixed up.

On how the checklist system used in medicine was adapted from aviation

In the aviation industry, there was a whole development of the process called “the checklist.” And some people date this back to 1935 when a very complex [Boeing] B-17 [Flying] Fortress was being tested with the head of the military aviation division. And it exploded, and the pilot unfortunately died. And when they analyzed what happened, they realized that the high-tech airplane was so complex that a human being could not keep track of everything. And that even if he was the smartest, most experienced pilot, it was just too much and you were bound to have an error. And so they developed the idea of making a checklist to make sure that every single thing you have to check is done. And so it put more of the onus on a system, of checking up on the system, rather than the pilot to keep track of everything. And the checklist quickly decreased the adverse events and bad outcomes in the aviation industry.

And that’s been adapted to medicine, and most famously, Peter Pronovost at Johns Hopkins developed a checklist to decrease the rate of infection when putting in catheters, large IVs, in patients. And the checklist is very simple: Make sure the site is clean. Put on a clean dressing. Make sure you’re wearing the right PPE. Nothing unusual; it’s kind of like checklisting how to brush your teeth. Yet the rate of infections came right down and it seemed to be a miracle. Once you start paying attention to the steps of a process, it’s much easier to minimize the errors that can happen with it.

On how the checklist system did not result in improved safety outcomes when implemented in Canadian operating rooms

The problem is, once you have a million checklists, how do you get your work done as an average nurse or doctor? … They just get in the way of getting through your day. And so we just check all the boxes to get rid of it. And that’s what happened with this pre-op checklist in Canada. And, again, the preoperative checklist was making sure you have the right patient, the right procedure, the right blood type. Very simple. And [the checklist] showed impressive improvements in complication rates in hospitals — both the academic and high-end and even hospitals in developing countries. So, in 2010 the minister of health in Ontario mandated that every hospital would use it — plan to show an improvement in patient safety on this grand scale. And … the data did not budge at all, despite an almost 100% compliance rate. And that lets you know that at some point people just check the boxes to make them go away. And they’re not really gaming the system, per se, but it lets you know that the system wasn’t implemented in a way that’s useful for how health care workers actually work.

On why electronic medical records are flawed and can lead to errors

[Electronic medical records] really started as a method for billing, for interfacing with insurance companies and medical billing with diagnosis codes. And that’s the origin. And then it kind of retroactively was expanded to include the patient care. And so you see that difference now.

For example, … [with] a patient with diabetes … it won’t let me just put “diabetes.” It has to pick out one of the 50 possible variations of on- or off- insulin — with kidney problems, with neurologic problems and to what degree, in what stage — which are important, but I know that it’s there for billing. And each time I’m about to write about it, these 25 different things pop up and I have to address them right now. But of course, I’m not thinking about the billing diagnosis. I want to think about the diabetes. But this gets in the way of my train of thought. And it distracts me. And so I lose what I’m doing if I have to attend to these many things. And that’s really kind of the theme of medical records in the electronic form is that they’re made to be simple for billing and they’re not as logical, or they don’t think in the same logical way that clinicians do. And it’s very fragmented. Things are in different places. Whereas in the chart — in the old paper chart — everything was in one spot. And now they’re in many spots.

On her advice for how to stay vigilant when you’re a patient

Be as aware as you can. Now, of course, you’re busy being sick. You don’t necessarily have the bandwidth to be on top of everything. But to the best that you can, have someone with you, keep a notebook, ask what every medication is for and why you’re getting it. What are the side effects? And if people are too busy to give you an answer, remind them that that’s their job and it’s your right to know and your responsibility to know. And if you can’t get the information you want, there’s almost always a patient advocate office or some kind of ombudsman, either at the hospital or of your insurance company. You should feel free to take advantage of that.

The information in the chart is yours. You own it. And so if someone’s not giving you the time of day or the explanation, it’s your right to demand it. Now, of course, we recognize that people are busy and most people are trying their best. And you could certainly acknowledge how hard everyone’s working. But don’t be afraid to speak up and say, “I need to know what’s going on.”

Sam Briger and Thea Chaloner produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.

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Breaking New

Manuel Ellis of Tacoma died ‘due to physical restraint’ while in police custody, medical examiner says

Manuel Ellis died March 3 after police saw him trying to get into vehicles that had people in them, according to a news release from the city’s police department. When officers approached Ellis, there was a physical altercation and Ellis was physically restrained because he was combative, police said.

The officers called for medical help when they saw he needed help, but Ellis died.

The Pierce County Medical Examiner’s Office determined Ellis died of respiratory arrest due to hypoxia caused by physical restraint. Hypoxia is a condition in which the body is deprived of adequate oxygen supply.

The sheriff’s department is investigating Ellis’ death, a statement from the Tacoma mayor’s office said.

“We pause amidst our struggle with the current public health and economic crisis, as well as the flood of emotions stirred up by the tragic and unacceptable death of George Floyd in Minneapolis, and reflect on the grief and sadness of Manuel Ellis’ family and loved ones,” Mayor Victoria Woodards said. “We pause and share their grief, because every loss of life matters.”

She added that she knows that the city wants answers and justice.

“And so do we,” she said.

Swift and decisive action has been taken against police in major US cities in the past week

The announcement about the death investigation comes during a time of massive protests and national conversations about the treatment of African Americans at the hands of police.

Floyd, a black man, died in custody May 25 and four now-fired officers face charges, including one who is accused of second degree murder.

There have been protests in Tacoma over Ellis’ death.

Ellis was black; two of the four officers in his case are white, one is African American and one is Asian, according to police.

Those officers were placed on administrative leave immediately after the incident, but the department ruled there were no departmental violations. They had been on full duty until Wednesday when they went on leave again, the Tacoma police statement said.

Ellis’ cause of death was initially listed as pending while medical examiners awaited toxicology tests, the office told CNN.

The death certificate also lists contributing factors of methamphetamine intoxication and dilated cardiomyopathy, commonly known as an enlarged heart, the office said.

Gov. Jay Inslee said the case is a priority for him and the mayor.

“We will be pushing to make sure there is a full and complete investigation,” Inslee said at news conference Wednesday.

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Breaking New

What Matters: The medical experts stay with Trump, but for how long?

Even if you can believe his attempt to say his bad medicine was actually sarcasm (but, really, you shouldn’t), let’s all agree the time for sarcasm ended sometime around the time the pandemic happened.
She and infectious disease expert Dr. Anthony Fauci had earlier gotten him to back social distance guidelines by using large charts, according to CNN’s report on April 2, which seems like an eternity ago.
Trump’s original generals all left. The should-I-stay-or-should-I-go question has been a theme of the Trump presidency. All of the generals he touted having in his administration early on were either kicked out or resigned.
Remarkably, there are moments when standing up ultimately works out in Trump’s government: The Navy has recommended reinstating the USS Theodore Roosevelt captain who was relieved of duty after raising concerns about coronavirus on his ship. Hundreds of sailors were ultimately infected.

The doctors, so far, have stayed. The question of what the experts should do here seems more acute during this pandemic, when tens of thousands of Americans are dying.

Read this story by CNN’s Jim Acosta and Kevin Liptak on what it’s like to stand up there on the podium next to Trump when he says something completely wrong:

Caught off-guard: “Members of the panel are often caught off-guard by Trump’s comments, a source close to the coronavirus task force said, adding the President’s remarks sometimes seem ‘surreal’ to the experts sharing the podium at the daily news conferences. One official said task force members can never tell what precisely Trump will absorb from their briefings, often picking something small and fixating on it during the televised news conference afterward.”

Don’t be seen: “Some members of the task force have become aware that their reactions to Trump are being captured on camera, leading the experts and administration officials to either remind themselves to remain expressionless as the President is speaking or to stay away from the podium in order to avoid the camera.”

You don’t get a win unless you stay in the game: “Through it all, the health officials have been required to balance their professional and medical integrity with an imperative to not run afoul of the President, who is notoriously attuned to loyalty and often does not take well to being publicly undermined. Mindful that their recommendations on social distancing — which Trump ultimately adopted and later extended — have helped mitigate the crisis, health officials on Trump’s team have endeavored to remain in good standing in order for their advice to be heard.”

Trump’s weird science

Trump is incredibly powerful and he’s leading the national government during a 100-year pandemic that has threatened, potentially, to kill millions of Americans.

But — and this should be painfully obvious — he is not a doctor. Please don’t take medical advice from him.

You can read about his theories of UV light and disinfectant to clean people’s bodies of coronavirus from within. I won’t reprint them here. Many hours later he said he was being sarcastic.

In fact — if you see anyone on TV try to give you specific medical advice, turn it off. Call an actual doctor. Your doctor. And talk to them about your situation.

Before anyone cries hypocrisy — “Newsletter writer is trying to criticize Trump telling me about health!!!” — stop it. This is not medical advice. It’s just common sense. And Trump has very little of it when it comes to medicine.

He is President, so real doctors sit, as Birx did Thursday, stony-faced (seriously, watch her face) as he peddles snake oil while millions of Americans look on.
She wasn’t there at Friday’s very brief briefing, and neither was Fauci, who hasn’t attended a Trump-led briefing for more than a week, though he appeared by video at the NFL draft (yes, really!). Would Trump’s suggestion of sunlight under the skin have led him to leap up and grab the microphone from Trump, as he has suggested he probably shouldn’t do?

President vs. public health. Public health policy is what the government does in the common good for everyone’s health and Trump, as President, is unquestionably a threat to the idea that underpins it.

Bad advice created a hydroxychloroquine black market. His new ideas come after he initially pushed hydroxychloroquine as a Covid-19 treatment. He did that against the advice of actual doctors, like Fauci, who said to wait for testing.
Hydroxychloroquine doesn’t work against the virus. Actual testing has shown no benefit and that it could hasten death. Or speed up heart rates. The Food and Drug Administration has said it’s not safe or effective for treating Covid-19. But Trump’s endorsement, helped by conservative media, has led to a run on the drug and people who need it for other ailments can’t get it.

Bad advice led to calls about injecting disinfectant. After Trump spouted about using disinfectant as a treatment, the Maryland Emergency Management Agency got more than 100 calls asking about it as a Covid-19 treatment.

They issued an alert: “This is a reminder that under no circumstances should any disinfectant product be administered into the body through injection, ingestion or any other route.”

Fake news vs. “natural ability.” Pushed by reporters about his quack theories endangering public health, Trump calls them fake news. He acts as though he truly believes in his own abilities on the subject of medicine.

“I like this stuff,” he said during an appearance at the Centers for Disease Control and Prevention back in March. “I really get it. People are surprised that I understand it. Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for president.”

Dig yourself out of imagining that alternate universe to consider that his wild theories and peccadilloes extend to his own health.

Energizer bunny theory. This is the man who thinks he’s got a finite amount of energy and so, by not exercising, he’ll live longer.

Doctor-patient relationships. He wanted the Navy doctor who publicly praised his health to be veterans affairs secretary. Ronny Jackson has since retired and lost a Republican congressional primary in Texas.

His previous doctor — the long-haired guy with the John Lennon sunglasses — says Trump dictated a letter claiming superior health during the 2016 presidential campaign.

Vaccine conspiracy theories — In tweets and during a 2016 presidential debate, Trump stoked skepticism of vaccines and suggested an disproven tie to autism.

It goes so much further than that, however. Trump’s war is not on medicine. It’s on science itself.

Scientific method vs. Trump’s method. This journalist can tell you a very, very little about the scientific process from watching his middle schooler’s distance learning class. You’re supposed to use evidence and data to test hypotheses. Trump uses whims and gut feelings to throw real science away.

He’s previously said climate change is a Chinese plot.
He buried a massive climate change report assembled by 300 government agencies because “I don’t believe it.”
He pushed raking forests as the antidote for wildfires.

This goes beyond science, too. He’s skeptical of economics, of intelligence, of computers, of technology.

He’s got his own theories. That’s one thing when it comes to economics. There’s room for debate.

On medicine, for your own safety, get a second opinion.

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Breaking New

Bodies transported to Philadelphia medical examiner in the open back of a pick-up truck

The Philadelphia Department of Health confirmed the incident and the number of bodies in the truck.

“The transportation of the bodies in that manner is a breach of protocol,” said James Garrow, spokesman for the Department of Public Health.

“The Medical Examiner’s Office regularly works with hospitals throughout Philadelphia to ensure that bodies are treated with the utmost dignity and respect,” Garrow told CNN on behalf of the Medical Examiner’s Office. “The Health Department is appalled that this happened, and strongly reminded the referring hospital of the existing protocols. This is not normal or acceptable.”

The bodies were being transported from Einstein Medical Center Philadelphia to an overflow storage area, according to a spokesman from the hospital. The cause of death of the deceased is not known at this time.

The pickup truck arrives, with bodies under the mats in the cargo bed, at a space near the Joseph W. Spellman Medical Examiner Building in University City on April 19
The photos, taken by Elizabeth Robertson with the Philadelphia Inquirer, show bodies stacked in the flatbed of a pick-up truck outside of the Philadelphia Medical Examiner’s Office overflow storage area. In one of the pictures, individuals wearing masks are moving a body to the edge of the flatbed where a gurney waits to transport the body.

DOH spokesman Garrow confirmed that these pictures are, to the best of his knowledge, of the incident.

“Upon learning of this incident, Einstein immediately launched an investigation to understand all the details related to this matter,” a spokesman for Albert Einstein Healthcare Network told CNN. “As a result of that investigation, we swiftly ended our contract with the funeral home responsible for this occurrence.”

The spokesman did not name the funeral home that Einstein says is responsible for the transportation of the bodies, but confirmed they did question Einstein employees as well as their contacts from the funeral home and the medical examiner’s office.

“We are equally appalled by these photographs and as a hospital in the epicenter of the Covid-19 pandemic in Philadelphia, we understand these unprecedented healthcare challenges, and all patients should be treated with respect and dignity at every stage and this should never happen,” said the Einstein spokesman, adding that the individuals depicted in the Philadelphia Inquirer’s pictures are not Einstein employees.

The City of Philadelphia is not investigating this incident as the protocol on the transfer of bodies is clear, said Garrow.

“The transferring hospital was reminded of the long-standing protocols for body transport and they are working with their contractor to ensure this doesn’t happen again.”

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Breaking New

This 16-year-old student pilot delivers medical supplies to hospitals

At an age when most teens are pursuing a driver’s license, TJ Kim is working towards a student pilot’s certificate, and making a difference along the way.

Kim is a sophomore at the Landon School in Bethesda, Maryland. The pandemic forced his campus to close for the year. It ended his lacrosse season and put a crimp in his studies. But the school still expects students to do academic work at home, and also to do good works for others.

“At Landon School, community service is really emphasized,” the soft-spoken 16-year-old said. “And so I wanted to find a way to serve.”

With help from his family, he found out about seven critical small, rural hospitals low on supplies to treat coronavirus patients.

“They kind of conveyed to me that they were really forgotten about. Everyone was wanting to send donations to big city hospitals,” Kim told the AP.

By road, the hospitals are far away from any large cities.

But Kim had a plan

“In my flight training, we’re in a stage that’s called cross-country flights, which means flights that are more than 50 miles.”

A Cessna doesn’t require a particularly long landing strip, and despite his relative inexperience in the cockpit, Kim (along with his instructor) started making deliveries from an airport in Maryland.

A view from the cockpit as TJ Kim flies medical supplies from a Maryland airfield to a critical hospital in Virginia.

“We hop in the plane and we go. Flying is the easy part. Collecting supplies is what makes the process a week long.”

Operation SOS

Kim calls his project “Operation SOS.” It stands for “supplies over skies.” Throughout the week, he stays in touch with the hospitals to see what they need. His father coordinates the donation of supplies: gloves, masks, gowns and other essential equipment like shoe covers and protective eyewear.

On delivery day, Kim loads up the plane and goes over his flight plan.

“My flight instructor makes me chart things the old school way. We have to set benchmarks, set course headings, calculate adjustments for winds.”

TJ is caries essentiel supplies to his plane. He hopes to attend the US Naval Academy after high school.

Kim is, after all, still a student. He was a mild-mannered, all-American boy before he got bit by the aviation bug. Now he’s a young man with a high purpose.

Some superheroes really do fly through the air.

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Breaking New

NYU allows senior medical students to graduate early to help fight coronavirus

NYU’s Grossman School of Medicine announced Wednesday it’s planning to allow senior students to graduate early in response to New York Gov. Andrew Cuomo’s “directive to get more physicians into the health system more quickly,” the school said in a statement.

Steven B. Abramson, an executive vice dean at the medical school, said the university asked about 122 students who are set to graduate this year whether they would be willing to start their internship at New York hospitals in April instead of waiting until July.

As of Wednesday afternoon, 69 students had volunteered to graduate, Abramson said.

“It is awe-inspiring and just says a lot about our students and their dedication to take care of people who are sick and to be part of a team of doctors taking care of these patients,” he said.

Gabrielle Mayer, a fourth year medical student who is planning to join the primary care/internal medicine program at NYU’s Bellevue Hospital, said it was an “easy decision” for her.

“Knowing that we are waiting to graduate and join the workforce, that we have the skill set that seems needed and valuable right now, it was such an easy decision to join my co-residents, co-interns,” the 26-year-old student said.

The school is now waiting for final approval from the New York State Department of Education, the Middle States Commission on Higher Education and the Liaison Committee on Medical Education.

If NYU’s plan is approved, students will be placed in internal medicine programs or emergency rooms at NYU-affiliated hospitals in the area.

The students will be part of a team and “will never be asked to do something that is above their level of competence,” Abramson said.

More than 30,000 cases have been confirmed in New York and the majority of the state’s cases are in New York City. Plans are underway to build emergency hospitals and thousands of doctors and nurses, who are either retired or no longer see patients, have signed up to assist.

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Breaking New

Biden: Trump should ‘stop talking and start listening to the medical experts’

Trump set the Easter goal earlier Tuesday on Fox News. It’s a date that few health experts believe will be sufficient in containing the spread of coronavirus.

“Look, we all want the economy to open as rapidly as possible. The way to do that is let’s take care of the medical side of this immediately,” Biden said in an interview with CNN.

The former vice president said he could envision some parts of the country and some sectors being ready to return to work on Trump’s timeline.

“But the idea that we’re in a position where we’re saying, by Easter, he wants to have everybody going back to work? What’s he talking about?” Biden said.

Biden said Trump is “not responsible for the coronavirus” but that the President is “responsible for the delay in taking the actions that need to be taken.”

He said Trump should have invoked the Defense Production Act earlier and used its powers to require companies to rapidly ramp up production of medical equipment like masks and ventilators.

“He says he’s a war-time president — well God, act like one. Move. Fast,” Biden said.

Biden has been off the campaign trail for two weeks as the pandemic has forced candidates to cancel rallies and fundraisers and order staff to work from home. His campaign converted a room in his Wilmington, Delaware, home into a broadcast studio, and Biden began a media blitz Tuesday.

In the interview, Biden said he has not been tested for coronavirus because he has not exhibited any symptoms, and that he is following medical experts’ advice — including keeping distance from his grandchildren when they visit and ensuring everyone who enters his house, including the Secret Service, wears gloves and masks.

At one point in the interview, Biden coughed into his hand. Tapper told Biden that doing so was “kind of old school” and that he should cough into his elbow.

“Actually that is true,” Biden said. “But fortunately I’m alone in my home. But that’s OK. I agree. You’re right.”

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Breaking New

Amy Klobuchar releases medical records; doctor says she is in ‘very good health’

“She does not have any health conditions that would impair her ability to perform the duties of the Presidency,” wrote Dr. Jennifer McKeand of Women’s Health Consultants in Minneapolis, Klobuchar’s home city.

Klobuchar, 59, is among the youngest candidates running for the 2020 Democratic nomination. In a departure from some of her competitors, she released her blood test results, allowing the public to see the mundane yet deeply personal details of the levels in her blood such as cholesterol and glucose.

Klobuchar’s routine physical was administered on January 6 of this year, according to McKeand, and included screenings for diabetes, thyroid disease, anemia and colon and cervical cancer. The report says Klobuchar had “excellent” blood pressure at 110/68 and a normal breast exam.

The doctor noted persistent mild hyperlipidemia, which means high lipids, such as cholesterol and triglycerides, in the blood. The senator underwent hip replacement in 2006 and takes ibuprofen for intermittent hip pain, noted her doctor.

The letter was written not by a primary care physician or cardiologist but by an OB-GYN at a practice where Klobuchar has been a patient for more than 20 years, according to the letter.

Notably missing from the report was Klobuchar’s height, weight and body mass index. Other candidates, including fellow Sen. Elizabeth Warren of Massachusetts, included those details in their medical reports.

On the campaign trail, Klobuchar has included her height — 5 feet 4 inches — in her stump speech. She’s often talked on the trail about President James Madison, who also was 5-foot-4. That’s a “pretty good height to be president,” she’s joked.

Recently, she’s brought in her height to talk about President Donald Trump inaccurately mocking Michael Bloomberg as being 5-foot-4. “I am the only one that is truly 5-foot-4,” said Klobuchar, during an interview on HBO’s “Real Time With Bill Maher” earlier this month.

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Breaking New

Mentally ill woman dies in custody, lawsuit alleges deprivation of medical care

The death of Damaris Rodriguez, who was suffering from symptoms of psychosis, followed four days of “inexcusable neglect and appalling conditions at the South Correctional Entity Jail,” the lawsuit says.

On December 30, 2017, Rodriguez suffered from a mental health episode while at her home in the Washington city of SeaTac, a suburb of Seattle, according to the lawsuit. Rodriguez’s husband, Reynaldo, called 911 and requested medical assistance.

Damaris Rodriguez had previously suffered from bipolar disorder, and had recently developed a metabolic disorder that caused “psychosis symptoms,” the lawsuit says.

However, according to the family’s attorney, Nathan Bingham, law enforcement arrived before an ambulance and Rodriguez was arrested on suspicion of fourth degree assault against her husband. While officers were at the home responding to the call, her husband, however, insisted Rodriguez’s actions had not been intentional and that she was having a mental health crisis, repeatedly telling police that he did not want her to be arrested.

According to the lawsuit, Reynaldo “has trouble communicating about complex topics in English.”

The King County Sheriff’s Office had determined the incoming call to be a domestic violence call and, according to Ryan Abbott with the King County Sheriff’s Office, with all domestic violence calls, Washington state law requires law enforcement to make an arrest if responding officers determine there is any kind of complaint of pain, or that an assault has occurred.

King County Sheriff’s deputies arrested Rodriguez and took her to the South Correctional Entity Jail (SCORE).

‘Starvation and sleep deprivation eventually took their toll’

Rodriguez spent four days alone in a cell, where video surveillance footage shows she was largely naked, surrounded by her own urine and vomit, and having what appear to be hallucinations, according to the lawsuit.

Attorney Nathan Bingham said though Washington court rules dictate that an arraignment take place before the end of the next business day, Rodriguez was never taken to court.

The lawsuit alleges that “starvation and sleep deprivation eventually took their toll,” and Rodriguez developed a metabolic condition called ketoacidosis, which leads to water intoxication.

According to the complaint, corrections officers and medical staff knew of the danger of water intoxication, but did not conduct proper welfare checks, instead moving Rodriguez to a cell without a sink, where she later died on January 4, 2018.

The lawsuit alleges that Rodriguez died as a result of water intoxication. The King County Medical Examiner’s Officer determined her death to be a sudden death during excited delirium and has classified it as natural.

A Denver woman is suing after giving birth in a jail cell. The sheriff's department says it acted by the book

Attorney Nathan Bingham said there were numerous log entries on welfare checks that corrections officers signed off on which the lawsuit alleges never occurred, including an entry claiming that Rodriguez was offered and refused water almost an hour after she had stopped breathing.

The lawsuit claims that Rodriguez died, because the facility and their healthcare provider NaphCare, operate under “the perverse economic incentives of a for-profit jail. SCORE and NaphCare cut corners and make staffing policies and medical decisions based on their financial interests — not the health of their inmates.”

NaphCare, the company that helps correctional facilities like SCORE “manage their healthcare needs by offering an exceptional team of medical professionals,” responded with a statement saying, “Due to limited community resources, jails have become the largest providers of mental health care in the country. The correctional system is a difficult environment in which to treat or rehabilitate individuals living with serious mental illness. (…) Unfortunately, the jail population, particularly those with serious mental illness, are highly prone to sudden, unpreventable cardiac events. The King County Medical Examiner determined the cause of death in this instance to be sudden and natural. To date, there is no evidence in support of the statements regarding cause of death made by lawyers of the family.”

In a statement provided to KIRO, SCORE said that while in custody, Rodriguez “had been seen by medical and mental health personnel and was observed over the course of her stay by corrections staff and medical personnel. Upon finding her unresponsive, staff immediately initiated emergency procedures and began CPR. Unfortunately, the individual did not survive and was pronounced dead in the facility.”

According to the facility’s statement, an investigation into Rodriguez’s death was conducted by the Des Moines Police Department, which concluded that “no malicious criminal act” contributed to her death.

In their court filings, defendants have asked the court to dismiss the complaint, which they claim “provides a confusing, distracting, inflammatory, and unduly prejudicial backdrop.”

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South Dakota state Rep. Fred Deutsch says he regrets drawing comparison between transgender medical procedures and Nazi doctor experiments

Republican state Rep. Fred Deutsch first made the comments during an interview last week with the Family Research Council, a conservative Christian group that lobbies on a number of issues both cultural and political from “a biblical worldview.” In the interview, the lawmaker discussed a bill he’s sponsoring that would make it a misdemeanor for physicians or any other medical professionals to perform gender reassignment surgeries on minors or to provide patients 16 and younger with hormones, even if the minor is emancipated.

“Well, you know, if you care about kids I think you have to prioritize them. And, you know, in South Dakota we don’t allow mutilation of our children — I don’t care if it’s doctors, I don’t care if it’s parents. … These kids on the internet, they share these pictures of themselves that just blow you away — of all these surgical scars and it’s terrible. That should not ever be allowed,” Deutsch said.

He continued: “To me, that’s a crime against humanity, when these procedures are done by these so-called doctors, you know, that dance on the edge of medicine. I just don’t think it should be done. I think — you know, I’m the son of a Holocaust survivor. I’ve had family members killed in Auschwitz. And I’ve seen the pictures of the bizarre medical experiments. I don’t want that to happen to our kids. And that’s what’s going on right now.”

Deutsch said in a statement to CNN on Tuesday that he regrets making the comparison.

“Comments I made based on my history of being the son of a Holocaust survivor are regrettable,” he wrote.

The Democratic minority leader of the state’s House of Representatives told CNN Tuesday that Deutsch’s comparison was untrue and “unfortunate.”

“That’s not what’s happening in the state of South Dakota or anywhere in our country,” state Rep. Jamie Smith said. “I totally don’t agree with him.”

During the Holocaust, some concentration camp prisoners were forced to undergo cruel experiments by Nazi doctors that sometimes resulted in death. The experiments horrified the global community and, following World War II, resulted in the establishment of the Nuremberg Code, which provides ethical standards for scientific and medical research involving human subjects.

The South Dakota House State Affairs Committee approved Deutsch’s bill, House Bill 1057, last Wednesday by 8-5. It now moves to the full state House for a vote.

Nearly half of the 105 members of South Dakota’s Republican-controlled Legislature sponsored the bill, including Republican House Speaker Steven Haugaard.

The speaker did not respond to CNN’s request for comment on Tuesday.

Deutsch, who in 2016 proposed restricting transgender students’ bathroom access in public schools, recently told CNN he proposed the new measure after some studies on the safety of puberty-blocking hormones were inconclusive. “The bill will serve as a pause button until the minor is old enough to make informed decisions,” he said.

The bill does, though, allow doctors to operate on infants who are born intersex, an umbrella term used to describe people born with bodies that are perceived as differing from typical male and female categories.

Smith, who opposes the legislation, said he hopes the bill is blocked and that his party is “doing everything we can to stop it.”

CNN’s Scottie Andrew contributed to this report.

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