Down below a conversation with a physician's assistant who works at a hospital in Philadelphia about what her job entails, how people use the emergency room for their primary care, and preparing for the future of abortion care in uncertain times.
First a look at a devastating case of brutality by prison guards in Louisiana and what counts as something of a surprise ending in the case (grading on the horrific curve for how these things usually go.)
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Think about everything terrible you know about the police. The killings and the more routine brutality and the lying to the media and the lying in court and the indifference to the public welfare and the constant covering for one another on the rare occasions when one of them breaks the law in a malicious enough way that we actually hear about it. Despite all of that prison guards are arguably somehow even worse. In prison the bare minimum pretenses toward civil rights and public service that police (are supposed to) project in the streets are quite literally hidden from the public eye. Many cops style themselves as a vengeful Punisher character but it's inside where the punishing actually happens.
Take for example the killing of a man named Erie Moore inside of the Richwood Correctional Center. Richwood is a private prison in Louisiana operated by the for-profit company LaSalle Corrections. (The matter of private for-profit prisons is something we'll just have to gloss over for now although rest assured it is a huge problem and affront to the conscience.)
In 2015 Moore was arrested for disturbing the peace (a misdemeanor) and brought to Richwood where he was placed in a cell with what court documents describe as a "combative detainee" named Vernon White. The two men fought a few times but were not separated by the guards and were instead forced to remain together in the cell where they ended up fighting again. The next day White was found in medical distress. Guards removed him from the cell and he would die soon thereafter.
Now it's technically possible that out of nowhere the heretofore non-violent Moore became a deranged murderer here. It's also possible that guards routinely place prisoners in dangerous situations on purpose where they know they will have to resort to violence either out of perverted cop-mind glee or because they simply want to extra-judicially make them suffer.
Either way the punishment for fighting in prison is not meant to be execution by prison guards.
After White was taken away the guards turned their attention to Moore who they say ignored their commands so they pepper sprayed him in the face repeatedly then struck him the back of the head and body slammed him to the ground. Then while carrying him in a prone position while handcuffed they "tripped" again smashing his head into the ground.
As if that weren't enough they took him from there to an area known as the "Four Way" the one camera blindspot in the prison where for two hours they are believed to have further beaten him. One guard later testified that a colleague said that they had brought him there to “beat him [to] death” and “finish him.”
Video of the initial assaults can be seen in this report by WFAA in Texas from 2020.
Staff did the bare minimum to make sure Moore was still alive after the secret beating but offered no medical treatment and when another set of deputies arrived to transfer him to another jail they realized something was really wrong so they brought him to a hospital where he was found to have a fractured skull. He'd remain in a coma for a month before dying having never woken up.
As a reminder Moore was being held pretrial for a misdemeanor. He had been convicted of nothing.
All of these details come from a recent decision by the Fifth Circuit. There's more in there too about how a lot of this sort of abuse and torture was routine inside Richwood from former staffers including one named Yolanda Jackson.
She worked at the prison for about three years. According to Jackson, “[o]n many occasions she . . . witnessed [guards] including supervisors use chemical spray on handcuffed prisoners routinely, many, many times.” The practice was common enough for guards to have a name for it: “pepper spraying mode.” In fact, two Defendants admitted under oath to using chemical spray on multiple restrained detainees. And these practices persisted, too, despite Jackson “advis[ing] supervisors and others that they [were] not allowed to punish prisoners who are handcuffed.” Guards and supervisors alike advised Jackson that they’d “do what they want[ed]” with prisoners.
Unfortunately, guards doing what they wanted to prisoners extended beyond pepper spray, according to Jackson. Cameras at the prison abound— except in one twelve-by-twelve-foot area. Called the “Four-Way” by the parties, it’s the one area of the prison with no cameras. Per Jackson, “many” guards openly bragged to her about taking prisoners to the Four-Way to “teach them a lesson” off camera through “force.” Even an Assistant Warden at the prison admitted that both he and guards used the Four-Way to “interrogate” prisoners. And two prison guards have testified under oath that they used the Four-Way to interrogate and abuse multiple handcuffed detainees. As Jackson summarized in her testimony, these practices at the prison were “widespread.”
If my mention of the Fifth Circuit – who regularly turn up here in Hell World regarding absolutely fucked qualified immunity decisions – has you nervous hold on a second.
When Moore's family originally and justifiably sued the guards and prison and city and everyone for his death a District court did about what we might expect here basically saying sorry fuck you. They're immune from liability. As Public Justice describes it the court said "that there was insufficient evidence to show that the prison had anything to do with Mr. Moore’s death; that private prisons can’t be held liable for punitive damages; and that the City of Monroe can’t be held liable for delegating its authority to a private prison company."
There does tend to be insufficient evidence when there's an Official Secretly Abuse Prisoners Spot.
But – and this is kind of a shock – The Fifth Circuit actually reversed that decision in a ruling out in July saying that there was in fact sufficient evidence for the family to go ahead with their claims. What a win!
So now after seven years the family of this man who was beaten to death inside of a for-profit torture chamber will have their chance at some point later down the line to maybe prove in front of a jury that the people who very obviously did it should be held liable. Not criminally liable that's not on the table of course mind you but civilly liable. I guess in the American justice system that qualifies as a "happy ending."
The decision wasn't unanimous by the way. Justice James Ho a real reactionary piece of shit appointed by Trump and who was involved in the reasoning behind the infamous "torture memo" under George Bush said among other things that there would be no way to determine which of the blows to Moore's head was the one that actually killed him so how could blame on any individual guard be determined. More on this fucking guy here:
Oh and if the name LaSalle Corrections sounds familiar you may remember they also operated the ICE detention center in Georgia that was alleged by a whistleblower to be performing numerous forced hysterectomies on migrant detainees.
More on those allegations of abuse here.
In an interview with The Intercept on Tuesday, Wooten estimated that more than 20 women had undergone hysterectomies in the last six years. “People ask you why I got a hysterectomy,” Wooten said. “I couldn’t explain it. The only thing I have to say is that I’m sorry.” Wooten described one 23-year-old woman who wasn’t told what the operation entailed until after the procedure. In the Project South complaint to the inspector general, Wooten called the doctor “the uterus collector.” She told the human rights group, “Everybody he sees, he’s taking all their uteruses out, or he’s taken their tubes out.”
OK now here's me and the physician's assistant.
The name of your job seems self-evident but what is it that a physician’s assistant actually does?
It’s actually a relatively new position in healthcare. It started because there was a lack of primary care physicians. We started to fill that void, and have expanded to working in all areas of healthcare. We work under the auspices of a physician, but can work in any specialty a physician does. It’s really to help fill that role in healthcare that needs more providers.
And you can be a patient’s primary care, like a nurse practitioner often is?
Yes. We can function as a primary care provider. Nearly the same as a nurse practitioner. The difference is we need to work under a physician, whereas nurse practitioners sometimes do and sometimes don’t depending on the state.
You work in an emergency department. What do you spend most of your time doing?
I could see anything that comes through the door. Most of my time, as a PA, especially in an emergency department, it’s seeing people with stomach pain or chest pain that we think is probably not a heart attack related, those kinds of things.
Do you see a lot of serious trauma?
Depending on where I’m working. One of the hospitals I work at is a trauma center, so whenever I’m there, I would say on average, especially in the summer, we might get a gunshot victim a night.
There’s a growing awareness lately of how much the media talks about violent crime levels being up. You can’t even walk down the street in New York City! They do the same shit in Philadelphia I’m sure. What’s your perspective on that as someone who works in an ER?
It feels like it probably is going up, and I’m just going on the numbers being reported, especially gunshot wound victims. I did live in New York City prior to this, and felt incredibly safe there. Moving here there was a bit of a shift. I think it was just the difference in the cities. Also I moved here during Covid so it often felt like there were fewer people out at night. It just feels different. It’s all just anecdotal for me. I don’t actually know the numbers. Personally I think the way to stop it would be getting the guns out of Philadelphia, but unfortunately I don’t think that’s something that’s going to happen.
What is your general opinion on the healthcare industry? You mentioned you sometimes feel guilty telling patients to make sure to follow up with their PCP knowing that they probably don’t have one.
To be completely honest it’s a lot of covering my own butt. I have to provide follow up care and a lot of what I do is ruling out emergencies. If we don’t see a reason for the pain, the root cause of why you came in, but we know it’s not an emergency, I need you to follow up with someone. Whether that’s your primary or GI or whoever. As someone who has tried to get an appointment, even as a healthcare worker, I can’t get a GI appointment until like 2023. So I know it’s basically impossible.
It’s a bigger problem than just primary care physicians not seeing patients though. We have a primary care shortage in the country, and it’s not getting any better. I completely understand why doctors wouldn’t want to go $500,000 in debt and then go work in primary care in a rural community where they’ll be paying those loans off for the rest of their life.
I’m a big proponent of loan forgiveness. A lot of time you’ll hear someone say, oh, you’re gonna forgive the loans of some rich doctor too? And I think, sure, why not? I do believe there are people who go into medicine who want to help people. Similarly with lawyers. When you come out with hundreds of thousands in debt, the lawyer is going to be tempted to take the corporate gig instead of public defense, or a doctor is going to take the fancier city hospital job as opposed to going to work for less money in an underserved area where they’re desperately needed.
Absolutely. Unfortunately, physician’s assistant school isn’t cheap either. I have my undergrad loans, and my PA school, and I’m over $100,000 in debt and I’m thirty.
A big city job will pay more right?
It kind of depends. In general, if you want to work in primary care or pediatrics, those are going to be lower paying gigs, no matter where you work. You’re going to get a bigger paycheck in the city, but that also depends on where you work. If you’re working in North Philly they don’t really have the money to pay either. It’s something you have to really be willing to take on a bunch of debt to do.
Are you burdened by your debt or able to make payments?
Most of my debt is federal so I’m not paying anything right now because it’s still at 0%. My hospital qualifies for the public service loan forgiveness. So if I make 120 payments it can be forgiven. There's also the fear that, depending on who is president, they can just get rid of that.
Right. I’ve seen some stories where people miss one payment or don’t dot an i or cross a t and they’re fucked.
For a lot of people the emergency room functions as their primary care, correct?
Yes. Most of the patients I see have not seen their primary, if they have one, in the last year I would say. The Emergency Medical Treatment and Labor Act requires us to provide treatment to anyone who walks through the door. It’s the last line of healthcare. If you don’t have a primary you can come into the emergency department and get your meds filled and leave. It’s putting a strain on emergency care and limits the amount of people we’re able to see.
It’s also one of those things where it’s an example of how it’s more expensive to be poor.
If you go in for something that’s not an emergency, and I’m sure a lot of people do that, the bill is going to be so much higher than if you just saw a regular PCP.
There are all these glaring examples of how being un- or underinsured makes the treatment you get cost five or ten times more or whatever it is. Do people come in a lot for things that are kind of bullshit? Not bullshit, but not an emergency I mean.
Every single night. Stuff that I would never dream of coming to the emergency department for, people come in for every night.
I wrote in here the other day about going to the emergency department recently for one of the first times in my life because I thought I was having chest pain. I went in and they looked at me and they gave me an EKG then I sat there for like two hours. I was thinking, and tell me if this is right, if they saw something terrible they would have taken me in more quickly as opposed to letting me languish out there. Or are they just so busy that’s just how it is? There’s obviously a level of triaging going on right?
Yeah. It depends on how the hospital functions, but generally how the triage system works is you’re assigned a number, one through five, depending on what we think the severity of your condition is. And the amount of resources it would take to diagnose that. If it was chest pain, I’m going to pick that patient up before leg pain. So there is some of that going on. However, one of the hospitals I work at now, you’re seen by a physician within a couple minutes of walking in the door to be triaged, and they order labs, but the problem is there are so many people waiting to be seen, people that are boarding in the emergency department, meaning they are picked up by the medicine team if they’ve been admitted, that there’s nowhere to place them. So we have people waiting in the waiting room that we just can’t see right away.
Nothing has changed in terms of abortion in Pennsylvania yet as far as I know, but what do you make of these stories around the country about doctors waiting until the last minute to save a woman’s life when there are complications because they’re unclear if they’ll get in trouble for “performing an abortion”?
It’s definitely a concern here. If Josh Shapiro isn't elected governor we’re going to be in a lot of trouble. Right now I think the legislature here is majority Republican and our governor is a Democrat. He’s basically the last line of defense for us having access to abortion. I think it will be very unfortunate if that comes to fruition. Doctors will be placed in that position where they’re really not sure. I know they’ll push it through the legislature without actually consulting anyone in medicine about, you know, what an ectopic pregnancy is. We’ll be forced to toe the line where it's like is this person dying? I really hope it doesn’t come to that. In the emergency room, ultimately we’re going to decide whether or not this person needs emergency transfer or emergency treatment, but I think that’ll come down to surgery and medicine with whether or not they’re allowed to intervene. We do see ectopic pregnancies all the time.
In the emergency room?
So hypothetically you might find yourself involved in one of these decisions.
My attending physician and I. Yeah… It would probably come down to a conversation like, we have this person here who has an ectopic pregnancy. Either it’s ruptured or not. A ruptured ectopic pregnancy is a life threatening condition. They can die. If that fetus has a heartbeat… I don’t know. You know… I don’t know.
What do you think of the ethics of it? Some people say, well, these doctors should be risking going to jail for their patients. Have you thought about it much?
A lot. I personally think a woman has a right to make choices about her body and especially her healthcare. For the most part, everyone I know who works in healthcare is trying to do the right thing. They got into healthcare because they wanted to help people. Working with patients in the middle of what could be a life-ending condition that we’re not able to intervene in is not something I got into healthcare to do. I would say all of the healthcare workers I work with are of the same opinion. In a large city people are generally on the more liberal spectrum of things. But… It’s horrible. I haven’t seen this yet, but I never thought that people would want healthcare workers to die over this.
This guy Doug Mastriano seems like a real piece of shit.
What do you make of John Fetterman? You think he’s good, or just better than the other fucking guy?
I like him. I voted for him in the primaries. I think we align generally with what we believe in. He does have some things to answer for in his past that he didn’t address very well. The thing about chasing a black man with a gun. Which is unfortunate. But if it’s him or Dr. Oz I don’t think there’s much of a question here. I appreciate that he’s very pro-union and has gone to most small towns in Pennsylvania to meet people.
Have you seen any Monkeypox cases lately?
Yes. It’s a lot more prevalent than we think. I had a guy come in with it the other day and I felt so bad for him. It looked really painful…
I’ve talked to nurses and other emergency department people in here a few times, and they talk about becoming, not indifferent to death and suffering, but how as a survival mechanism you can’t take it home with you. Is that a skill you have yet? Or is losing someone still really hitting you the way it would a normal person as opposed to a medical professional?
I’ve worked in healthcare for like eight years now. Before this I worked with individuals with leukemia. So I think that’s a skill I’ve had for a while. Working in that field you tend to develop that. But I think I’m pretty good at separating my work and home life. Working in an emergency room in this capacity lets me leave everything at the door. My husband doesn’t work in healthcare, so talking to him when something does affect me can help. But also talking to friends who work in other areas of healthcare I’ve made over the years, who do understand that feeling of losing someone or something sticking with you. A lot of times, if there’s a particularly bad death, especially in emergency medicine or critical care, some of the teams will have a mortality debrief, so that it allows everyone to talk through it, and I think that’s really important.
Thanks for reading as always. If you can grab a paid subscription to make sure you get every issue of Hell World plus access to the archives and the Discord server.
The other day the nice folks at Embedded interviewed me about my internet habits (not healthy!) so check that out here if you like.
EMBEDDED:Where do you tend to get your news?
LUKE O’NEIL:I spent about nineteen hours a day either on Twitter following the news of the day or else reading the major national newspapers and magazines for the sole purpose of getting absolutely red-assed and pissed-off out of my mind.
EMBEDDED:What’s one positive trend you see in media right now? What's one negative trend?
LUKE O’NEIL:This could just be my bubble but I’m noticing a lot more people becoming aware of how most of the people at the prominent newspapers and magazines are the dumbest fucks alive and that there is and has never been any such thing as the objectivity that they use as their little frat club oath to shield themselves from criticism while clocking in at the consent factory and advocating every day for policies that will immiserate us all.
The negative trend is that despite more people knowing all of this now the media institutions do not give a shit. What’s the Drill tweet that’s like “keep telling me to shut the fuck up it’s only going to make my opinions worse”?
EMBEDDED:What does “cancel culture” mean to you?
LUKE O’NEIL:Pee pee poo poo.