Torture In America

By Jerry D. Haight

No real American can tolerate or condone torture. It is forbidden by the Constitution, and only those who secretly wish for our nation to abandon its principles and Constitutional protections could ever support it. Torture, by definition has two parts. The first part is the objective for which the torture is applied such as a confession, punishment, recantation or to obtain information deemed important to the torturer. The second part is the method. Methods also fall into two categories including active or passive. Examples of active would include the rack of medieval times that stretched a body until the limbs pulled apart or ancient Chinese torture using a very sharp blade of a small dagger by which the torturer would make one cut at a time. A thousand cuts were not enough to kill a person so the torture could go on indefinitely. Modern methods use devices like electric probes or water boards devices that simulate drowning. Passive torture includes deprivation of necessities of life like sleep, food, water, light, companionship or withholding treatment of injury or disease. Regardless of method, death is usually not the goal of torture.  

Can one consider the inaction that occurs within the confines of an emergency room as passive torture? Take the case of a man, who for the sake of anonymity we will call Bob, not the author. He has a long history of kidney stones. On a recent Thursday evening, one of them made an appearance. It was about a 9 on the pain Richter scale. Having little more than aspirin in the medicine chest, he went to the ER for help. First, they needed papers completed, id ascertained and, most importantly, insurance information. Then they asked “what number would you give your pain right now?” Grimacing with pain, he responded “I don’t know?”. “What number on a 0 to10 scale would you give your pain when it is at it’s worst?”, they asked. He replied, “I don’t know how it could be worse so I guess it is a 10”. “Does it interfere with your ADL?”. “What is ADL”, Bob replied, mystified. “ADL refers to Activities of Daily Living including eating, dressing, getting into or out of a bed or chair, taking a bath or shower and using the toilet.” Frustrated, and holding back tears, Bob told his inquirer, “I am not doing any of those things. I am here instead trying to get relief from this pain.” Then to the question “What number is acceptable to you?” Bob really had no answer.   

Bob was told the ER is very busy and directed to the waiting room.

He had no interest in eating, only dressed to avoid entering the ER naked, could barely manage to get on a gurney for examination and could not hold still while laying down or sitting. Neither bath, shower nor toiled was in the cards right now as his main goal was relief. Apparently, sitting down in the waiting room was enough determinant of his ADL to warrant an automatic pain scale rating of 3, thus relegating him to last place in the triage order.

Almost five hours later, he was seen by a doctor who after thirty minutes of questioning determined that maybe he was passing a kidney stone and an injection of pain relief might be in order so finally, after nearly five and one-half hours, Bob received some relief and told to contact a urologist. The doctor also gave him a prescription for some oral pain relief as well. The next morning, Bob woke up after the injection wore off, the pain returned, the pills were ineffective and the urologist couldn’t see him for over a week.  Nearly everyone having gone to the emergency room with pain has such an experience. This writer recently underwent an out-patient surgery, sent home with some oral medication, suffered from uncontrollable post operative pain and spent over six hours in the ER before receiving any help. It appears that pain, in itself is not fatal and, of course, torture is not intended to kill.

But then, if it really is torture, there must be some purpose. Ah ha. It must be a form of punishment.  It appears the torture is punishment for bringing pain which is not life threatening or severe by virtue of the 0 to 10 system to the ER. Therefore if one can perform any of the ADLs like coming to the ER dressed, sitting down, standing up, going to the bathroom, using a cell phone, taking a drink or having something to eat, by definition can not possibly be in severe pain and therefore should not be at the ER in the first place. Hence the offence worthy of torture.  

Delay has always been an effective tool of management. A good manager will leave a matter in his in-box untouched until someone yells for action, something collapses or the matter gathers cobwebs. It would appear ER triage follows somewhat he same principal. It may go something like this. At the end of five hours, if the patient has not given up or died maybe he really did need help. Or, if the patient was in such dire need of emergency help, how could he have survived five hours. Sooner or later, mostly later, patients will probably have cobwebs on them and so they receive some help just to make room for the next victim.

Unfortunately, long waits are not unique to pain sufferers only. For example a 40 year old woman collapsed onto the waiting room floor of the ER at Martin Luther King-Harbor Hospital in Los Angeles, while janitorial staff literally mopped the floor around her. Overburdened staff ignored her pleas for help and her boyfriend—desperate for assistance—dialed 9ll from the hospital. He was told to find a nearby nurse. His girlfriend died 45 minutes later.

Across America our ERs are at the breaking point finding it impossible to manage growing and competing demands for trauma care. ER’s are a mandated safety net care for the uninsured, the undocumented, public health surveillance and disaster readiness. A panel found ERs suffering from overcrowding, with patients parked or boarded in hallways waiting for admission or treatment. Ambulances are routinely diverted to more distant facilities and while demand for ER services grows, the number of facilities shrinks and they find it increasingly difficult to retain on-call specialists to meet high standards for timely care. The inevitable tragic result? Preventable deaths as critically ill patients literally die from neglect in hallways and in ambulance spaces waiting for the life saving help that never comes.

For extreme pain sufferers, there is a tactic that seems to work (regardless of the pain chart). A 911 call will bring immediate assistance.  Since the ambulance has direct access to a doctor by radio and the paramedic can administer an injection for pain while en route to the ER, the patient can arrive somewhat comfortable. But then comes a caveat. “what number would you give your pain right now?”