Hospital Hostage: A Cautionary Tale

Hospitals rarely keep patients longer than absolutely necessary. In fact, hospitals faced with a shortage of beds, sometimes resort to prematurely discharging a patient who may not be not stable enough to go home. While that can be a problem for patients and their families, failure to discharge a patient against the wishes of the patient and family poses a serious threat to patient rights that may require effective advocacy and action. That is exactly what happened with a Minnesota teen.

A recent CNN two-part series called “Escape from the Mayo Clinic,” chronicles the dramatic “rescue” of a teen daughter from the Mayo Clinic by her parents when the hospital refused to respect the young adult patient’s request for discharge or a transfer.

From Miracle to Mess

Alyssa, an 18-year-old Minnesota farm girl, suffered a brain aneurysm on Christmas Day 2016. Mayo Clinic neurosurgeons saved her life after initially giving her a 2% chance of recovery, and she later was transferred to the rehabilitation unit. That’s when the medical miracle turned into the Mayo mess.

According to the article, Alyssa’s parents noticed several aspects and incidents about their daughter’s care that caused them concern. They communicated these concerns but did not feel that the rehab staff listened to them or took any responsive action. The interactions between Alyssa’s parents and the rehab unit staff deteriorated to the point that the doctor who claimed to run the unit allegedly told Alyssa’s mother that she was not allowed to participate in Alyssa's care or even to set foot on Mayo property. She was escorted off the premises. The article says that when Alyssa’s parents asked to speak with a patient advocate, they were told there was no patient advocate. The family, and Alyssa, repeatedly requested that she be discharged or transferred to a different hospital. Mayo denied all those requests.

During the entire course of Alyssa’s hospitalization, she was legally an adult. And she had been participating actively with the staff in decisions about her care. However, Mayo sought to have an “emergency guardian” appointed for Alyssa without the family’s knowledge. Those efforts were unsuccessful.

Alyssa’s parents believed that their only practical recourse to protect their daughter, carry out her wishes, and not have Alyssa lose her right to make her own decisions was to break her out of the hospital. The family recorded a video of the dramatic escape.

Mayo reacted by calling 911 and reporting a “patient abduction,” the article says. A police chase ensued as Alyssa and her family made a “run-for-the-border,” west from Rochester, Minnesota, to South Dakota, where they hoped to find a non-Mayo hospital.

Ultimately, they succeeded. Non-Mayo doctors in a Sioux City hospital examined Alyssa, and concluded that she did not need to be hospitalized but could go home. The new doctors also found her capable of making her own decisions about her care. That was good enough for law enforcement to end their involvement.

As a certified guardian required to follow a code of ethics and minimum standards, I find several of Mayo’s alleged actions disturbing.

Relationship with Family

According to the CNN article, Mayo Clinic restricted Alyssa’s access to her family, banning her mother from the hospital, and even taking away Alyssa’s cell phone at one point. Under ethical standards like those created by the National Guardianship Association, guardians must promote social interactions, encourage and support the person in maintaining contact with family and friends, and not interfere with established relationships unless necessary to protect the person from substantial harm.

Conflict of Interest

Why would the Mayo Clinic want to keep Alyssa as a patient rather than discharge her or transfer her as both she and her family requested, especially when a second opinion from another hospital concluded she did not need to be hospitalized at all? Alyssa’s mother believed that the hospital retaliated because of her active involvement in Alyssa’s care, which the hospital saw as irritating interference with her daughter’s care. Maybe. But another reason might be that the Mayo Clinic doctors felt a divided loyalty. While a physician’s paramount responsibility is to the patient, at the same time, the doctor also owes a duty of loyalty to his or her employer. That divided loyalty can create a conflict of interest that could lead to either under-treating or over-treating a patient. So, a longer hospital stay for a patient can mean more revenue for the hospital.

Misuse of the Guardianship Process

In Alyssa’s situation, the hospital sought the extreme remedy of guardianship based on an allegation that Alyssa’s mother was mentally ill and Alyssa lacked capacity to make decisions about her own care. Neither was proven to be true.

In most states, the law permits guardianships to be created only when no other less restrictive alternatives exist in terms of impacting the person’s rights. Guardianship is the last resort precisely because it can deprive people like Alyssa of the right to make decisions about their own medical care, as well as other aspects of their life.

In Alyssa’s case, the guardianship appointment process apparently worked. No guardian was appointed for Alyssa. She didn’t need one. The irony here is that, had the hospital been successful in having a guardian appointed for Alyssa, the guardian then would have a duty to make sure that Alyssa’s relationship with her family was encouraged and supported, and to not interfere with that relationship in the ways that appeared to occur with Alyssa.

Alyssa’s mother was a strong advocate. She used strong language to be heard. She and her husband questioned aspects of their daughter’s care that they believed were inappropriate. As their daughter’s representatives and advocates, they insisted on accountability from the staff. Alyssa’s mom and step-dad were exactly the kind of patient advocates we all would want to have if we were in a situation like Alyssa’s.

A hospital stay leaves a patient vulnerable to potential violations of that person’s right to dignity, autonomy, respect, and emotional and psychological well-being. The lesson here is to make sure that, when a loved one is hospitalized, someone — a capable family member or friend — will take responsibility for staying informed and asking questions about the patient’s care, making sure that the patient’s connection and communication with family and friends are supported, and serving as an effective advocate when necessary.