Inside Tesla’s factory, a medical clinic designed to ignore injured workers
revealnews.org
revealnews.org
“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.”
Do you have a citation/source/link for statement?
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.
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.
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.
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.
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.
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.
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.
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?
The article describes medical professionals making medical judgment calls, and getting censured or fired for it.
~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.
Your anger seems grossly misplaced and based on a deliberate misreading or uncharitable reading.
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.
It's sad that we're debating whether an ambulance is needed for people with back injuries or mangled/broken fingers.
Sure about that?
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.
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 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.
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.
I know nothing specific to Tesla's environment.
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.
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.
(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.
The gas station right next to my house has EMT vehicles almost every night hanging out and waiting to interveene in the area.
> 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).
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).
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).
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).
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.
What?
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.
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.
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?
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.
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.
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.
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.
Example?
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.
>“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,”
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.
It is illegal for “ride shares” to provide medical transport. The fact that an on-site physician would not call medical transport and put patients with crush hands/severed fingers in a ride share is per se illegal.
Next we will hear the “SV disruption cult” begin making their claim that those regulations only exist because the EMT lobby industry is spending billions for legislation to protect the market incumbent. Well don’t forget your extra $150 Uber cleaning fee for bleeding all over your drivers car.
you need to add professional cleaning cost and lost revenue while cleaning to the bill.
and not just professional cleaning... the injured person could've a serious illness (think HIV), so it will probably cost even more
i'd wager you'll need at least twice that amount
*Truly ideally there wouldn't be ambulance bills stuck on people, but I mean within the framework of what's currently in practice.
A person with a severe impact might not have much external signs or pain, but could be bleeding internally. That would present a problem in the backseat of an uber on the highway.
Without stabilization, a broken bone can cut or puncture any number of blood vessels or organs (for a rib).
There's a reason we use medical transport after injuries -- you don't really know what might follow.
If the cost is the concern, using cheap transport isn't the answer. Either socialize the care or force workplaces to pay the EMT fees for workplace injuries. Sending someone in a cab is just not acceptable if a doctor deems medical transport necessary.
Now, all of this hinges on the particulars and accuracy of the description of the situation, which I can't really judge from the outside. But if otherwise independent medical professionals are being urged to reduce ambulance use in order to save face for the factory, that's a real problem. I'm inclined to believe the ousted clinicians and former employees, though.
If your partner goes into cardiac arrest while you're driving, what are you going to do? Stop to apply CPR and while simultaneously calling 911? Start driving faster, running red lights, and hope you both survive the trip?
If you went to a licensed medical professional with your foot cut off, they're not allowed to call you a cab. They have to call an ambulance. You can tell them, to hell with your fancy EMT's and expensive rides, I'll just have my wife take me over to the ER to get this foot sewn back on, but they have to call an ambulance if you need transport. This is a liability and safety issue. It's also a kickback issue.
TL;dr- No, it shouldn't, and nobody wants to make that illegal.
Or is your partner offering emergency services to the public in exchange for money? If so is your partner properly licensed and registered to provide those services? Is your partner insured to provide those services?
They are medical professionals, and thus held to the standard of only being allowed to call an ambulance. That was the whole point.
Whether that should have been used in the cases described in the attached article is a reasonable debate. I'm more confident in the people on the ground making this choice than the news reporter.
Medical practitioners, however, cannot send someone in a cab. It's a huge liability issue for them. If someone is injured and needs medical transport, they need to use proper medical transport. This is what Tesla is accused of violating. Their on-site nurses are licensed medical professionals. It's worlds different from random person taking a cab to a hospital.
State law regulates drivers, medical transport is a subsection and medical transport is further broken down into emergency transportation and non-emergency transportation. What the law says is you can’t just start offering medical transportation services to the public in exchange for money without complying with the law/regulations.
Further, as you might imagine doctors are regulated, and if you are treating a patient who needs to be transported to an ER for emergency services, the doctor should understand a Lyft/Uber isn’t the appropriate standard of care and is per se illegal under those facts. The doctor may have had his/her heart in the right place be not calling an abmbulance to reserve that for a hypothetical life/death patient, but it’s hard to argue this isn’t an emergency when your a doctor sending your patient to the ER, at which point emergency medical transportation laws/regulations apply.
My wife drive me by nothing stopped me from using a taxi or ride share.
Doctors definitely have a duty of care that must consider emergency transport, but it's be surprised if laws explicitly stated you need to call an ambulance for stable patients that need emergency treatment.
However, the medical practitioner themselves cannot tell you to take an Uber to the hospital. Which is sensible.
I gp is rarely going to be in a situation where they need to call an ambulance for a patient; generally it's going to be the organization (like a nursing home) or management/administrator to avoid potential liability
Tell that to the California Department of Heath Care Services...and the 49 other states who have similar regulations and regulatory agencies in place.
Lyft/Uber giving rides to people in no way means or suggests those rides are legal. And there is a differnce between non-emergency transportation and emergency transportation...but it is all highly regulated. Still doctors and drivers should both know these laws that affect them directly. If a doctor is dumb enough to put an employee with a workplace injury in a rideshare, the onus is on the driver to deny the ride and tell the rider they are licensed/insured to take a patient to the ER and they should call 911...that doesn’t happen because ride share drivers are not professional drivers who actually know the laws that regulate them.
They should not be used for emergency transport, and that is part of the argument. Again, that is worthy of debate, but blanket statements about Lyft not being usable for "medical transport" aren't really useful.
Pretty sure my comment you replied to acknowledges there is a difference between emergency and non-emergency transportation.
If you want to argue how a worker with a crushed hand/severed fingers going to the Emergency Room for emergency medical treatment isn’t an emergency...go nuts, and please feel free to be liberal with the case Law you cite.
>And there is a differnce between non-emergency transportation and emergency transportation...but it is all highly regulated.
Nevertheless, I am right. Even to provide non-emergency medical transportation you must be registered (hold appropriate licenses/insurance), a random ride-share driver can not legally offer non-emergency medical services...unless they are registered with the government to provide those services.
Still none of them can provide emergency transport services to the public for money. So now you can continue debating that a patient with a crushed hand/severed fingers diagnosed by their doctor as needing emergency treatment in an ER is not an emergency requiring emergency transport under the law.
Please can you link to the law that you're talking about?
https://projects.propublica.org/graphics/workers-compensatio...
I think you mean the "private EMS lobby". Individual EMTs are equally opposed to most of the legislation being pushed by big EMS companies (notably Prop 11, being voted on today, which is an attempt by AMR to avoid having to comply with meal break rules)
Usually, when employees in an industry oppose an initiative, they actually file opposition to it; Prop. 11 was unusual in having no opposing argument filed, which usually only happens with non-controversial proposals.
The group behind Prop 11, Californians for Emergency Preparedness and Safety, is an AMR shell corp. AMR provided all of its funding, and it's CEO, Thomas Wagner, is the CEO of AMR's Western Region operation.
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.”
26 PM_ME_UR_Definitions • 1h Maybe you don't believe this guy? Maybe you think he's a genius? It doesn't really matter, leaving out this kind of information from someone you interviewed is the definition of bias. The reporter was filtering out information not because it's inaccurate, but because it didn't fit with the narrative they wanted to tell."
Really? A couple years ago I brought my buddy to the hospital in an Uber and he was pretty close to dying, nobody at the hospital seemed to have any issues with it. I later emailed Uber to praise the driver and they thanked me for the writeup of what happened and said they distributed it on their internal listserv. Definitely did not feel like anything illegal was happening throughout process.
In your role as on-site physician for a corporation?
https://slate.com/technology/2018/02/when-should-you-uber-to-the-hospital-and-when-should-you-call-an-ambulance.html
https://www.webmd.com/health-insurance/news/20170515/uber-lyft-er-trips#1
https://www.rewire.org/living/uber-emergency-room/https://www.usatoday.com/story/tech/news/2018/03/01/doctors-...
With Uber Health, a doctor can send an Uber to pick a patient up to transport them to the doctor's office, and many doctors have offices in hospitals, so this service would then be illegal according to you, but it isn't.
What you probably meant to say is a medical practitioner can't call a non-medical transport for a patient in an emergency, which also doesn't seem true, but I can't find any articles that directly say that (why would someone write such a thing?).
this might be because they had more important things to attend to, like your dying friend.
This is impressive how far the US has normalised the concept that health is primarily a financial decision. Especially in the HN bubble that consists mostly of wealthy individuals.
Human life isn't worth anything if the people can't use legal means to protect themselves.
For these US citizens (SV elite), healthcare is akin to a status symbol or a luxury that only rich people or people bestowed by the rich (think: employment) should be able to attain.
And then look at how much hatred there was when Obama tried to implement the Heritage Foundations plan, which was done by Mitt Romney in Massuchusetts. Republican, btw.
These people really don't care about the "rest of us". That's why Trump was elected. He showed he had the similar hatred and focused it. Don't get me wrong- he's done horrible for the US... But that's why.
EDIT: I would love to hear a description why I'm wrong. I've lived through the creation of Obamacare, my diabetes T2 diagnosis under it, and now the structured destruction of it, along with trying to eliminate 'preexisting conditions' exception. In short, if they get their way, I'll be dead sooner. Like 10 years sooner. Lack of health care + diabetes = death sentence.
But in the end, having us "dead weights" dying isn't a bad thing when you boil us down to $$$.
False. Healthcare is not a human right, but the insane inflation of healthcare costs would be avoided by removing a large portion of the regulation surrounding it. If hospitals actually had to compete to get patients, based on affordability, among other factors, healthcare would be far cheaper, and private charity/need-sharing would take the place of insurance.
I mean, your argument holds true for everything. And yet, look around us and compare to any instance of communism on various extents. Capitalism is always better.
Modern mixed economies are better, but there is a reason capitalism as a system (rather than a component of another system) died sooner than Soviet-style communism, to the extent that we now unironically call mixed economies with large socialized elements “capitalism”.
Among mixed economies, it's not the more strongly capitalist ones that have the most efficient, effective, or publicly popular health care systems, either.
Enjoy bartering and purchasing your way across private property to something distant. (Yeah, fat chance you actually hold to your criticisms.)
Edit: Also, I grew up in a country (India) where healthcare was definitely part of the market economy. And what that meant (and still does) was that people with money get high quality immediate care, and those without get shafted. That's what the market does to healthcare.
Pay up for the nearest facility, IF you have the funds to do so.
Or die.
Back when people thought that healthcare should not be regulated.
Now, there's a lot of fuckery in the healthcare industry. A lot. Both, business side and gov side. Both are to blame. But just saying regulation is flat out bad. That's stupid. There are many issues and each have to be addressed.
Not just a one MAGIC PILL solution.
....So it can only be for the rich.
Insurance is simple - you have a group pool their risk together so that everyone's protected.
Yet, when we try to discuss making an insurance pool the size of the country, for everyone, people like you go all "not a right".
When I see "not a right", I read into it as "Fuck you I got mine".. when there is plenty to go around for everyone.
> If hospitals actually had to compete to get patients, based on affordability, among other factors, healthcare would be far cheaper
Citation needed: prices are NOT linked to how much thing is, but how much the market will bear. Stating falsehoods to cover up your intent is disgusting. We know how c(r)apitalism works. We're rejecting that. Tried it, didn't work. Reiterating for better.
> private charity/need-sharing would take the place of insurance.
Uh huh. So non-christians need not apply? I know how this plays out... This is a citizenry issue, for the whole country. And you end up wanting to make it a fractured "small group" issue. People fall in cracks, and you don't care. Some "mythical" group will fix it.
And yet there is a Constitutional right to a lawyer in most criminal cases if you can’t afford one. I can assure you, while public defenders might not get paid well and maybe many can’t afford their student loans, they are not slaves.
Isn't that all forced "slave labor" by this same argument?
But that case is more defensible: the enforcing of the rule of law is powerful for freedom. So sacrificing some freedom to get a lot of freedom is an easy case.
Health services do not relate to freedom, but to the cost of insurance. If the government can provide a cheaper healthcare then it should provider a cheaper healthcare, and citizens can choose the government's plan and it will eat out the competition.
Why would the government need to ban the competition if its so good at providing insurance?
In no country ever is private healthcare and competition banned. There is a free* hospital across the street from me and I have private healthcare.
It’s about acknowledging that a) it is cheaper for everyone if people with no money go to the doctor early, because a GP is 1k% less expensive to society than a hospital bed runout. This is one of the reasons healthcare in single payer countries is ~50% per capita.
B) people without money don’t deserve to die because they are poor and should have basic treatments, even when it is their own fault they are poor and make bad decisions.
* I pay tax which pays for the hospital
Thats not factually true: there are many places that ban private healthcare, including canada. Then there are other conditions that punish private disproportionately: like funding public healthcare with taxes, but private healthcare with private funds: that means a person would have to pay 2 insurances to get private services. Also single payer really means there is only 1 insurance, so yes, it bans all other insurances.
> It’s about acknowledging that a) it is cheaper for everyone if people with no money go to the doctor early, because a GP is 1k% less expensive to society than a hospital bed runout. This is one of the reasons healthcare in single payer countries is ~50% per capita.
There are multiple issues why healthcare in the US is more expensive than "single payer systems", and preventative medicine is a small part.
> people without money don’t deserve to die because they are poor and should have basic treatments, even when it is their own fault they are poor and make bad decisions.
Is this moral line of yours defined by the country? Because if you want to save people's lives, single payer systems are very expensive. Its a lot better to open immigration and bring poor people from abroad.
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…”[1]
[1] Article 25 UN Declaration of Human Rights
My point is definitely that you have an obligation to provide society funding for healthcare even if they don’t pay. Just like the military will defend them even if they don’t pay, or a firefighter will put out their house.
The right to be provided something is the right to take from someone else. There is no escape to this, its a right that infringes on the right of others.
Theft cannot be a human right, and i would strongly reject anyone that defends such a thing, including the UN.
This thread is going nowhere, you clearly value money more than the health of people less fortunate than you. Systemic poverty and sick people, who cares right.
You mention a trade-off with money and health, but the very idea of taking from some to give another is a violent expression. You might justify to yourself that is fine to rob and murder for the sakes of others. Others will think the same way.
I’m no longer participating in this thread, and won’t read any replies.
This statement is incorrect. Libertarians want competition in the emergency medical transport industry. If someone can offer a better service and at a lower cost, then that service should be an option.
All other things being equal, if it takes an ambulance 20 minutes to arrive on scene versus a ride share that takes 5 minutes, which is preferred? Granted ambulances provide more than simply transporting someone to a hospital, but those services could easily be applied under legal alternatives and done in a safe, effective, and efficient manner.
The libertarian argument is that it should not be illegal to let the market provide alternatives.
https://en.wikipedia.org/wiki/United_States_presidential_ele...
It’s to vote, convince and then copy the model from every other 1st world country... super hard sure but perceptible
Now depending on the issue it is faster to drive/be driven from where I work so an ambulance is often not that useful. For example a while back a coworker ate a tamale off the food truck only to find out that it contained peanuts. After noticing the reaction the owner took him to the ER personally (Coworker used his epipen as soon as it was known he needed it.) It is ~8 mins by car and at best an ambulance would have been 6 here and 6 back for an arrival time of 12 minutes. Now had they not been breathing they probably could have gotten a fire truck here in 2-3 mins to administer some epinephrine but they would still have had to wait the same 12 minutes to make it to the hospital because the fire truck EMT's can only do on site treatment.
So unless it is extremely dire taking a coworker to the hospital can be faster than an ambulance. That said a crushed hand or cut off finger? That is one of those where seconds matter and the fire truck/ambulance combo would be used.
Unless there is uncontrolled bleeding that is definitely not a "seconds matter" situation. Sure, you want to get to a surgeon sooner rather than later, but an extra 5 minutes isn't going to matter.
Where do you even begin to make that sort of claim?
My uncle worked for a place where a vendor CE had a heart attack and died in the early morning in a raised floor space control room. Someone called 911 multiple times and due to bureaucratic fuckery security didn't let the EMS in multiple times. In short, the dead guy was wheeled back and forth by operators for 12 hours, when the plant manager dropped in and lost his shit and took care of it.
Like I said somewhere else, this topic is a corner of the world that sounds insane if you're not in it.
Where I work, 911 has no idea where we are for reasons, and a serious incident where a person isn't vocal requires a floor sweep. The emergency services don't have the time or interest to handle your company's internal stuff, particularly if you have a high call volume.
I just skipped through the comments, and the fact that hardly anybody points out the fact that an employer should care for his employees and follow all applicable regulations is mind boggling.
But it could also point to a general issue regarding SV and SV-style disruption. Build a business around ignoring existing regulations, because of disruption.
HN appears to have a more highly paid engineer out-of-touch with financial reality user base, it's not everyone, and I don't think they're doing it on purpose, but it's certainly noticeable. Even on my barely-enough-to-live wage in Seattle it's tough to not find myself forgetting the struggles of people lower in class than I. Workers rights are not popular here, and I'm guessing it's because engineers and higher paid people are often treated pretty fairly and have workplace freedoms the rest of the workforce could only ever imagine in their dreams.
Also zrue that a person tends to stay in their own social bubble, I do it myself. Lucky me I don't have to worry about money most of the time. But that doesn't mean that you cannot be aware of others that are not in that situation. Not that I care about that often enough. Again something I realized lately.
Bear in mind that europe also has 10%+ unemployment.
Major countries close to 10% are Italy and France with 9.7% and 9.3%. That, obviously, is not good. The country that surprised me was Germany with 3.4%. No idea why this is not celebrated more, I wasn't aware of that number until now and I live in Germany.
What is worrying so is youth unemployment of people between 15 and 24. It is roughly twice as high as the rates mentioned above, in Italy even three times as high. I considee that to be extremely dangerous for a society.
Your post made me want to go deeper in german and came across an interesting bit: german has a very low minimum wage, and also some antics around the lower eschelons. https://www.quora.com/Why-is-the-German-unemployment-rate-co....
That bein said, this is a terrible thing to do to people if you ask me. And maybe not doing it and having higher unemployment would be more humane. But I'm no eypeet, just a guy with an opinion.
Also, out of experience, in Germany you are not officially unemployed if you are in a training program sponsored by your oocal unemployment agency. Also a nice way to optimize your numbers. And the explanation why there is a whole industry built around just these trainings.
When Germany introduced all these thing back in the early 2000s, it was tough. Germany was called the sick man of Europe. Maybe, these initiatives, Agenda 2010 it was called, were not totally wrong. Downside was the creation of whole class of people that aee basically stuck at the lower ranks of the social ladder. So, good for the economy, yes. Good for the country maybe. Good for society, I would say no.
Highest income workers always get the benefits of workers perks first, and this is unavaoidable. Look at google, famous for giving benefits to employees like good, gym, juic etc, but buildings maintained by swathes of contractors that dont have access to these services.
The more of these you pile up, the bigger the divide.
This is in no way a defense of Tesla's on-site medical facility's policy of not calling 911 without authorization, but the location of Tesla (U.S.A) is not somehow responsible for draconian policies, nor is it fair to assume that if Tesla operated in the EU, such policies wouldn't exist.
FYI - from the way the article paints it, Tesla's policies are in clear violation of U.S. law.
My insurance for an ER visit would be roughly $4500 right when I walked in, or they wouldn't cover anything. Every time after that though would be $300 until next year when I'd have to pay $4500 again.
There's unfortunately no consensus on how to solve it.
I’ve dreamt of buying a Tesla but I could not ethically rationalize that to myself if this article is true.
It also shows the problem of measuring companies by specific metrics. It sounds like good old “juking the stats” (the wire).
It gives the impression that things actually end up worse because of how injuries are measured.
Also, this report was done by one of the most respectable investigative news organisations in the world. Its hard to see how the PR wing of a corporation that just settled with the SEC for fraud could be considered more trustworthy.
I'm not sure if this answer is in anything posted, however: 1) is that claim of someone with a "crushed spine denied an ambulance" proven, and 2) is "because it would've shown up on OSHA logs" proven as Tesla's reasoning, or just conjecture and/or speculation?
Likewise, why aren't people addressing that maybe an ambulance being called as the triggering something added to OSHA logs is incomplete or badly designed - and because Tesla has doctors on staff/on-site 24/7 for workers to go to first, maybe a visit to doctors should actually be the trigger adding the event to logs? Maybe the process is broken, but requiring an ambulance be called for a sprained wrist - if they trained doctors on staff to access the situation isn't reasonable, it certainly is an emotional reaction they're triggering in people though.
"Also, this report was done by one of the most respectable investigative news organisations in the world."
I've never heard of them and likewise - is this specific journalist (and perhaps the editor) known and associated with any awards the journal received?
1) The source is named, and to be included in the article would've likely provided medical records backing up his assertions. Not to mention the fact that Tesla (which has previously demonstrated its willingness to go the media to try and discredit former employees) has not denied his claims.
2) There are multiple sources in the article that mention being taught by lawyers how to deny care in a way that avoids legal requirements to log incidents.
> I've never heard of them and likewise
That says more about you than the source, Reveal has broken a number of extremely important stories and won many awards for doing so.
> is this specific journalist (and perhaps the editor) known and associated with any awards the journal received?
You could've just clicked on the author's bio, but yes. "His reporting with a partner and CNN exposed rampant fraud in California's drug rehab system for the poor, winning an Investigative Reporters and Editors Award."
Ubfortunately, people buy products produced by effectively torturing workers all the time.
That doesn't in any way justify what Tesla is doing of course. Just pointing out that this is "peanuts" compared to other products that people do not tend to boycott.
Wish there was a good solution. I try to buy fairtrade-marked goods when I can but the selection is limited as most people seem to not care.
For cars, there is no measurement or guarantee that other brands are better that is easily available to me, especially if you include Asian subcontractors / parts producers.
>A Tesla recruiter called me, high pressure tried to get me to move to California, ending in- "So you don't want to do anything important with your life?"
>Elon's marketing team spam reddit and manip upvotes. This was my first wakeup call that we were being tricked
>That Tesla =/= getting to Mars in 2023.
>The Chevy Bolt was car of the year. Tesla's will be unreliable for ~10 years until they work out design related issues. (This is unavoidable for every new car company)
>The horrid conditions of employees, seems like we are taking a step back in employee conditions in favor of 'progress'.
>Manipulation of news, numbers, etc... make the company seem unethical.
I still have Elon as my wallpaper, with a motivation phrase telling me to "Get to work". But I've sobered up, he was a cult of personality.
I can't really reply to anything else you posted, there's reasonable counter-points to all of it. You shouldn't blindly trust any one source of course, and excitement/emotion for someone or an organization doing something good can prevent use from critical thinking. At the same time, it's important to understand what it means for a company to be the most shorted stock in history - and the amount of effort, and financial gain, that will come to people purposely trying to put down Tesla et al.
Good can come from this process if everyone involved is being reasonable. Is it good that someone who asked for an ambulance to go to the hospital, instead after an assessment by an onsite doctor, were said to take a Lyft? It clearly wasn't life threatening in that doctor's eyes to require the life-stabilizing ability/necessity of an ambulance - I suppose that person sharing their story might not be talking to us then today. Likewise, is the issue that Tesla is purposefully trying to avoid "an ambulance being called" to avoid a log in OSHA records? I doubt it, however this does highlight that the processes and requirements for OSHA likely need to be updated: so that if there are on-site doctors who do an assessment, then that also gets into the log. I imagine it's more likely an incomplete/inadequate process of reporting because how many work places have on-site doctors 24/7? Not very many I'm guessing.
The biggest short in history aligns well with many people not having the critical thinking ability to understand all of the facets to what Elon is doing and has already done - if you look at the whole ecosystem, which I won't write out to argue for here - though I have in the past in comments. Many people invest on short-term trends and don't have the ability to actually understand from founding principles; e.g. it's why they're building a Gigafactory for batteries, to knock the cost of battery production down by 50% - and unless competitors all start trying to do the same, they're going to have higher battery costs - and so can't compete as strongly on price as Tesla can, etc.
The reason these things have happened is due to the insane pressure from upper management.
Sure they can fire the guy who tried recruiting me, but that person was likely under insane pressure to get new bodies to replace the many people who left Tesla.
There is a reason these things are happening.
* They track everything about the vehicles, including GPS. You have no privacy when driving in a Tesla.
* The cars have extensive DRM.
* Automatic remote updates that can, and sometimes do, brick the car.
As they can't transport people to hospital and they don't carry strong painkillers they're basically useless if you've got, say, a broken arm.
Lol what? It's the job of the state to provide adequate resources (for example, the law in Germany requires that emergency personnel be at your location in 10min tops, on average). Telling people to use an Uber/Lyft/cab due to cost concerns or not enough ambulances being available is bad. Demand proper emergency services funding from your politicians!
Obviously: when all you got is a small cut on your finger, fine, take public transport or whatever. But for a back injury?! No way in hell I'd risk my chance in public transport or taxi.
https://en.wikipedia.org/wiki/Emergency_medical_services_in_...
Forget Uber, you better be able to walk to Canada or something.
Now, the NHS may not charge German patients themselves for an ambulance ride in UK but either quietly deal directly with the German insurance to get the cost back, or eat it entirely because the administrative overhead would cost more than the fees paid by German insurance would actually bring in - while the German ambulance operator might have decided to put the administrative burden on your friend.
tl;dr: international health care insurance/refunds are weird, avoid if possible...
The hospital won't send an ambulance with ER stuff for a guy who don't need it.
In France firemen do a very big chunk of that work with their ambulances.
I assume you're a doctor and able to perform a medical analysis on the accident, so you're fine to go with Lyft.
I better call the emergency service and let them decide what would be the best way to go forward depending on my symptoms/injury.
The point here is that it is preferable to sometimes use resources badly in order to avoid sometimes not at all using the resource when it would be necessary. The point is to not discourage people from calling 911 (or the local equivalent).
If there actually are constrained resources† then, sure, that cultural value should probably be set somewhat differently, but I cannot for the life of me imagine why that should be the case in the US. It’s not necessary to set that value differently. (If it were that would be a real shame for US healthcare and you should demand immediate change from your political representatives.)
—
† I am aware that at some point all resources are constrained. What I’m talking about here is that the system should be designed in such a way that there is spare capacity availible at all times when looking at the maximum number of required ambulances at the same time during, say, the past twelve months.
Medical professionals that they "incentivize" to make a specific decision they like.
> “It was bullying and pressuring to do things people didn’t believe were correct,”
Isn't it the same with ER? People are severely discouraged from using ER for any concern that doesn't require an immediate action. ERs, like ambulances, are services whose time and resources need to be highly available for those who really need them.
There's a conflict right now in Germany, as many people turn to the ERs instead of primary care practitioners or specialized doctors (e.g. urologists), as for ordinary people it's next to impossible to get a timely appointment.
This, again, has the reason that specialized practices reserve the "timely" slots for higher paying privately insured patients, and that the distribution of general practitioners as well as their supply is a bit... mismanaged, leading to either the practices not being open at times when people are not working (in contrast to a 24/7 ER) or horribly overcrowded.
I guess in the US the incentive of the hospital is just to bill you as much as possible so it makes things different. In many places the incentives of the hospital are just to keep you in good health and do not overspend their budget ...
There are enough ambulances to cover legitimate needs. Why then waste money by using ambulances to transport people who would be just fine in a Lyft? That money could be better spent on actual patient care. No matter how much money you're willing to spend on healthcare, using it efficiently is always better than wasting it.
> what kind of ambulances should be used should be up to medical professionals, not yourself
Having medical professionals decide whether an ambulance is appropriate, instead of patients, is one of the main things the article is slamming Tesla for doing.
Medical professionals who are under orders to ignore their medical judgement and always treat patients as lightly as possible.
Also, deciding for yourself not to take an ambulance is one thing (even if questionable). Being forbidden by your employer to call 911 is something completely different.
TFA says Tesla managers made a policy to not involve emergency services. They are not entitled to make either a policy or a decision in this regard.
In other countries making such a policy is flat out illegal, telling subordinates to not involve emergency services is illegal and following such directions from superiors is illegal as well.
then again one time I helped an old lady when she biked home drunk, fell over and got a concussion and they sent an ambulance.
However in my experience the incentive of the hospital in the U.S is to bill you as much as possible.
And it's worth nothing that this is very much how non-profits operate too. Without making any claims of efficiency there is a wink wink nudge nudge in the US system that overbilling wealthy and insured patients is how we cover costs for patients who cannot afford it.
Horrible cost on the first glance, but if you actually talk to doctors (my fiancee is one), you realize most of the system is under constant overload. If they have emergency call, it can be (and often is) something trivial, when taking a cab for 5% of the costs would be more appropriate. But you have tons of crazy people (not crazy enough to be in asylum, but enough to wreak havoc on everything and everybody around them) and hypochondriacs. Polytoxicomans that effectively can't be helped.
We're not talking about a drive by a specific vehicle, but locking of 2 highly trained professionals that can't be used for any other emergency, with vehicle full of life-saving equipment. Which can easily mean another ambulance has to come from afar if needed, which can be fatal/debilitating in number of cases.
So its not about US as much, its about making system effective, because resources (people, equipment, ambulances) are scarce and you need to prioritize, or people will die. These things can and should be improved, but until they are, doctors and everybody else need to work with what they have.
This is not true for the entire country. Emergency services are usually organized on a local level.
For example: In the city of Zurich emergency services are run by the city (which also serves 17 additional communities). It's very much a publicly owned and operated enterprise.
In addition there are private services, but on a very limited manner. For example: The orthodox jewish community runs its own ambulance service.
Details, in German, can be found here : https://www.stadt-zuerich.ch/pd/de/index/schutz_u_rettung_zu...
https://www.nremt.org/rwd/public/data/maps
(the circle thing that should be a table)
There are two "halves" to EMS in the US. One half is 911/scene response, the other half is interfacility transports. It's pretty common for interfacility transport companies to staff most of their rigs with EMTs, since those patients tend to be low acuity, and just need to be moved from one hospital to another.
Companies that do 911 response generally staff their ambulances with an EMT and a paramedic. Paramedic training is several thousand hours of classroom and clinical time.
So while it's true that overall EMS is mostly EMTs, in the area we're discussing (ambulances that respond to 911 calls) paramedics are much more common. Granted, that's only a $3-5/hr difference in most places, so it's not a massive difference in cost.
Actually $500 is cheap. It'd be a no brainer if it were that cheap in the US.
I think 'Ambulance no Ambulance' almost has to be kind of a moral decision, not a cost one: if you don't need it, don't use it because it's a scarce resource that will always be scarce.
There’s a lot of downsides to that when a true emergency isn’t happening.
The US has no problem with ambulance quantities, but why take an expensive taxi ride?
Even if it was 'free', its not really free.
I completely agree that the US medical system is corrupt, https://www.opensecrets.org/lobby/top.php?indexType=s
But you have seemingly no understanding of how insurance works or how deductibles work.
No, this is kind of a naive position.
The OP's comment is to a great extent valid.
Ambulances and their staff are extremely expensive.
Do you think in Brazil, France or Japan money just grows on trees and you can just magically buy more stuff?
Medical systems the world over are failing under understaffing and over demand - and a considerable amount of the demand is small stuff.
There are many people in socialized systems who go to the clinic/hospital with great frequency - any old thing: see the doctor. It's hugely, hugely expensive. In some cases it's merited, and I understand it's a moral dilemma because often you don't know if something is serious ...
But Emergency care in particular is bonkers expensive, even by cost not profit ... and there's no getting around it.
If people need to call an Ambulance, then get one.
But if you don't need one, get in a car and go or have someone drive you.
It doesn't matter what 'system' it's in because everything associated with 'Emerg' is very costly to the system, and it will always be a very scarce resource.
I wouldn't let anyone at my company decide for me though - if I needed one I would call.
Tesla might need a union.
No, but even Brazil can buy more ambulances.
Also in Brazil, you have paramedics that can ride motorcycles and can be sent to the site of an injury first, to stabilize the patient, provide immediate care, and prepare for the arrival of a proper ambulance. Since they are bikes, they can better navigate traffic jams and can get to the site more quickly. If it turns out that an ambulance ride is NOT required, then it can be canceled. There are some paramedics in cars for a similar function, except cars can carry more equipment.
These are trained paramedics who have seen their fair share of injuries. I'd trust them much more than a company health clinic doctor.
There ARE alternatives. Ambulances are a limited resource everywhere, but you can work around the issue.
But then we'd have to (melodramatic pause) raise taxes!
(Audience faints en masse)
I remember the “funny” story of the guy who accidentaly stabbed himself in the chest with a nail gun and drove to the hospital thinking “that’s a pretty f*cked up day”
It makes for a nice tale, but those people are real, and for every drama queen going to ER for a papercut there is people in serious condition waiting for a Lyft that decides to drive a better client first or stays stuck in the trafic.
I’m not totally sure why it’s created such a huge disagreement. Obviously there are some injuries which totally don’t need an ambulance, and some which do, and then a big grey space in the middle where it’s harder to tell. Unfortunately, in some places (like here in the UK), there aren’t the resources to err on the side of caution as much as in other places (by the sounds of some commenters). Being able to have an ambulance arrive within 10 minutes for any situation sounds like a wonderful luxury if you have infinite resources to burn. I personally was impressed they dispatched an ambulance when we delivered our baby at home (on the bedroom floor!). But I also felt a bit like it was a resource that might have been wasted.
There is only one claim, ie. "Ambulance when required". The point of contention is who decides what required means.
Tesla has a perverse cost saving incentive to recommend the cheaper option. The person in shock is no position to make a rational decision. It is medical practitioner's responsibility to put his practice before his employer and decide what is a medically appropriate response. The emergency service has an incentive to be deployed regardless of severity.
The comments section in general, agrees that a severed finger and crushed hand are sufficiently severe injuries to warrant an ambulance.
It seems pretty.obvious to me that lay-managers and CEOs should not be the ones deciding emergency policy. That is what trained practitioners are for and the expectation is that they will hold the org to a certain regulatory safety standard.
And the cheaper option for Tesla would be not to hire a team of full-fledged doctors waiting in a room 365 days/year for taking care of any injured worker.
Amazing.
And in the wealthiest country in human history, that staffing cost is also the highest in human history.
Ambulance drivers are customed to drive fast and ignore any red light; they have accidents also. To expose yourself to an increase in the probability of having a car crash because you had a minor injury, or one that is stable and can not really benefit of the specialised services provided by the ambulance, is stupid. Each case is different and must be treated individually.
Actually the Lyft is the stupidest idea here, you combine the disadvantages of ambulances with those of personal transport, with none of the pluses
If you as a patient drive yourself to an outpatient cardiology office to get some diagnostics and feel perfectly found but severe blockage is found, the staff will call an ambulance and have you transported to the nearest ED. Even if you are asymptomatic. Fun fact: this will also happen if the ED is within walking distance. There have been cases where an MA was wheeling a seeminly OK patient from a cardiology office to the ED and the patient collapsed in the hallway. That's why it's against protocol.
Yes ambulances are insanely expensive (that's another problem). But availability issues are handled by the 911 dispatcher.
Reporters say Tesla is shitty. But reporters often lie and even more often exaggerate.
Musk says he cares about safety and all accusations are wrong. But CEOs often lie and even more often are uninformed or delusional.
If anyone has advice about how I can develop some trust in one side or the other, please let me know.
For a site that prides itself on it's intellect and knowledge, it's unsettling how often I'm seeing people jump to "fake news" type of commenting.
By the way, this also explains why prosecutors sometimes lie or exaggerate.
Furthermore, some reporters want to influence public opinion in a certain way because of their personal beliefs or peer pressure.
I do not claim any of this applies to Reveal. I just want to point out why money from views isn't the only mechanism for misleading reporting.
A really good news organization may create pressure against reporters overstepping the bounds in pursuit of a story. But IMO it takes an incredible effort to counteract the human tendency to bend the facts to help make a point.
Of course, CEOs have even more obvious reasons to mislead people: maintainging good corporate and personal image. This is compounded by the fear subordinates have in telling the CEO that they are wrong. Also, the more successful the person, the more likely they are to be a bit delusional by believing everything they do is right, and ignoring any criticism.
And generally speaking, if it's to the point of multiple articles written on a subject, there's almost certainly a fair amount of truth there.
After reading this article, I’m of the opinion that Tesla is intentionally trying lowball their workplace injury numbers. The article mentions 48 were reported, but the fired medical professional says the actual number was probably twice as much. Let’s say that this estimated actual number is indeed true and there were 96 actual injuries. How many factory employees does Tesla have compared to and conventional car factory and what are injury rates there (pick something in the same state to keep workplace injury laws the same). It makes no sense to me to underreport this number and risk serious repercussions as opposed to report accurately, give injures employees sufficient medical care and support, and improve the manufacturing process thereby reducing the rate of injuries. Yes, Tesla is burning a lot of money, and doing the right thing would cost them more. The question is how much more compared to the risk of getting caught underreporting.
This entire situation reeks of “Move fast and break things” applied ad nauseum to where Tesla is becoming its own worst enemy as opposed to its short sellers.
* Intentional underreporting of injuries.
* Disallowing the use of yellow tape at the factory.
* Disallowing audible warnings ("beeps") on forklifts.
"Outside of the statute of limitations" is very different than "proved wasn't true."
Gaining true knowledge about a situation is not possible without establishing a chain of trust. Whose reporting do you trust ? Each person in the chain needs to be evaluated individually and re-evaluated when new information comes to light.
Right now I rather trust what Tesla says when I hear horrendous claims like until proven otherwise. Especially since news media are not independent. They rely almost entirely on advertisement which is a direct relation to "most eyeballs moved away from other 'free' options", which is directly related to the impact of the headline.
Do you have any evidence to back this up? Citations, studies showing reporters lie .. often?
And on the other side you have a guy who is stepping down as Tesla CEO after fraud charges, and who's being sued for losing his temper and calling some random cave-diver a paedophile, twice.
Personally I trust the news organisation more.
The regulators will insure that corrections take place if the company is really misidentifying, mistreating, and underreporting injuries.
https://twitter.com/PlainSite/status/1059875691263483904
According to the tender it used to get the Tesla engagement, one of Access Omnicare's explicit objectives was to reduce OSHA recordability:
https://www.tesla.com/blog/one-year-in-tesla-update
You don't pass a 4 month long safety inspection by California OSHA by making injured workers continue working.
"News organization" writes article about a company in California under reporting and hiding injuries, leading to a 4 month OSHA investigation that completely clears company of the accusation. Do they retract the accusation, write an article on why they made the previous accusations given we now know they were wrong?
No, they write a new article making new accusations about the company.
@danso: Please consider this the follow up to our earlier discussion on the issue. [3]
[1] https://www.revealnews.org/article/tesla-left-injuries-off-t...
> Reveal had documented many other cases of injuries that Tesla had failed to record. But the agency had only about six months from the date of an injury to fine a company. By the time Cal/OSHA concluded its four-month investigation, the statute of limitations had run out.
Of course, it could both be the case that the time limit ran out and Tesla books happen to be fine. But if OSHA doesn’t consider the contrary examples reported on by Reveal, then it’s to be expected they won’t find Tesla at fault.
https://www.businessinsider.com/california-regulators-open-a...
The thing about inspections is that it's quite possible for a company to put on their best face during an inspection, only to resort to their unsafe practices after the inspection concludes. This is, for example, why restaurant inspections are conducted without notice.
The fact that Tesla has survived two inspections doesn't mean anything--companies are expected to pass inspection. However, the fact that they have had 3 inspections in a single year... That is a matter for concern, since CalOSHA generally doesn't inspect a workplace more than once every few years. If they felt that multiple inspections were warranted--especially a new one so soon after finishing a thorough, months-long inspection, that means they have serious concerns about Tesla's safety practices. Given the relative lack of issues pointed out so far by CalOSHA, it's likely that they don't trust management to adhere to safe practices or that they feel that Tesla is changing work practices while inspectors are present.
Or that Tesla's the most shorted stock in history and there's a lot of negative, probable propaganda, being created/distributed to impact the stock price.
Union activists join tons of companies to try and unionize them, because get this, they’re union activists. They think unionizing labor is a moral imperative, and so they act as such. You might not like it, but it’s hardly unique to Tesla or a big dark conspiracy.
https://www.bloomberg.com/news/articles/2018-08-16/musk-call...
The shorts aren't behind a massive conspiracy to destroy Tesla. Hell, this summer, Elon Musk almost destroyed Tesla all on his own and he's Tesla's biggest shareholder.
Tesla's problem is a constant failure to properly execute. It's happened with every model they've made, with every endeavor they've undertaken. They've constantly over-promised and just as constantly under-delivered. (And please, none of this BS about how they're trying to accomplish great things. Other companies are also trying to accomplish great things--and actually succeed in doing so without constantly bragging about what they're trying to do.)
Tesla may have a great vision for cars. But a great vision without proper execution just means having the best seats for watching someone else succeed in their place.
[1] https://www.businessinsider.com/california-regulators-open-a...
It includes the fact that the statute of limitations had expired on many of the reported violations. As a result, state legislators ended up changing the window so that it wouldn't happen again in the future for similar reports.
When I see things voted up which are misleading, false, or ridiculous, my reaction is typically that of distrust and an expectation of manipulation. But my hope for humanity lies in believing that some posts are simply because the poster was mistaken.
But assessing fines is one thing -- it's not clear whether the statute of limitations restricts OSHA from considering these past injuries when scrutinizing Tesla's recordkeeping. Reveal certainly implies it does, and Tesla doesn't mention it. Neither Reveal nor Tesla links to the published investigation results. I think it's OK to assume that Tesla isn't going to be punished by OSHA (in this case; several more investigations are still ongoing. But I see no reason until OSHA says otherwise that its investigation "completely clears [Tesla] of the accusation." Only Tesla itself has asserted that, and well, Tesla has been creative in the past at interpreting results; NHTSA having to publicly clarify an Autopilot statistic that Elon Musk eagerly touted comes to mind [0].
Whatever the case, I don't agree with your interpretation of cause-and-effect -- i.e. "No, they write a new article making new accusations". Tesla's statement about OSHA came on Oct. 26 [1], just a little more than a week ago from the submitted article's publish date. While the article does have several confidential sources, it leads with a former employee making litigious claims. The lawyering for this story alone would've taken at least a week, nevermind the time it takes to find the sources and interview them, and to talk to Tesla and check the related sources and documentation. I wouldn't be surprised if this story was at least a couple months in the making, with the timing of its publication only coincidental with Tesla's recent statement.
[0] https://www.wired.com/story/tesla-autopilot-safety-statistic...
[1] https://www.teslarati.com/tesla-releases-workers-safety-upda...
Although I hope the US adopts a more Nordic/German style union system which is less adversarial. I think the US system has sadly given unions a bad reputation.
You mean big corporations have spent millions of dollars and hours lobbying against unions and crushing any whiff of unionization by immediate termination of employment? All hail to your corporate overlords ...
It's a double-edged sword really, explotation of low cost labor allows you to innovate and be the technologically advanced society you are, but it also hurts those at the bottom who have no other choices/options.
Not saying unions are unjustified in all cases, but to be fair, they visibly _do_ get obtrusive in some instances. It's another problem than our southern neighbors though.
If you're refering to the concept of the German Betriebsrat[1] that has nothing to do with being owned by the company, but with union represenation in the high echelons of big companies.
The entire idea of an union being company owned would pretty much render such an entity useless.
We are talking about the same place that claimed that Tesla factory did not have yellow safety tape because "Elon hates the color yellow". The factory did have the yellow-black safety tape around all dangerous machinery, and still does today. This is an organization that publishes literal fake news.
Tesla obviously sucks at everything when it comes to workers. But recommending stretches can make things worse if it’s not clear what kind of back problem it is. In any case I think it’s all about liability and costs.
Not many people want to pay for badly informed opinions dressed up as journalism with cut & paste from other sites and Reuters.
Take the Economist vs. most other publications. An usual Economist article has 20 facts about the issue (e.g. elections in South Sudan) and at the end sometimes an opinion (notwithstanding the general thinking of the Economist). Opinion pieces are easily spotted ("Charlemagne"). Others take 20 facts and write 20 articles and add 10 opinions to each of them to get out more content.
Print newspapers definitely had more editors proofing your copy. But even with a completely computerized publishing system, if I wanted to make a last minute change, I still had to go through at least 2 editors. At some point, making a fix requires, well, literally "stopping the presses". Having several editors in a well-defined editing workflow was a luxury that news orgs could afford decades ago, but it was also a necessary cost to prevent any reporter from making a costly "stop the presses" last minute fix. Digital-only news orgs don't face that consequence.
Editors cost money. Text without proper editing is worse, but not bad enough to impact readership. Therefore, editors are not needed.
Ultimately, what you get is the worst possible product that can still be sold.
Never heard of it. Strike 1.
Ok.
How different is this from the policies of most auto factories? They are all incentivised to minimize the number of reported injuries.
But since osha found tesla was doing a good enough job after months of investigation, it's hard to trust this report. I searched google news for osha penalties and found issues about nail gun injuries, plumbing, a death of a worker at a winery, metal working, foundry, etc. So I don't see them as just letting tesla get a free ride.
Could it be that tesla meets the legal requirements but some injuries aren't well treated? I like tesla generally but I want to see them treat their workers well. I'd like to see a more mainstream media investigation further, like the ny times maybe.
With tesla there was also an incredible negative fud campaign about them, leading to many sensible financial journalists mystified that they didn't go out of business. So I am struggling to be neutral about this story.