WhiteCoat

Don’t Eyeball Me

OK, I’m thinking we need a STAT consult from Walter Olsen at Overlawyered.com. If his blog isn’t on your list of daily reads, it should be.

A Muslim woman named Rona Mohammedi comes to the Somerset Medical Center emergency department with “severe chest pain.” She refuses to get undressed in front of a strange man so that EKG leads could be applied to her body in order to see whether she was having a heart attack. Already JCAHO is going to have a field day with this case.

Apparently the patient demanded that a woman perform the EKG and no women technicians were available. The patient waited in the emergency department for five hours before leaving against medical advice and going to another hospital. Now she is suing the first hospital for discrimination and for violating the patient’s bill of rights.

In the linked article, the author of a book on Muslim women’s civil rights says that “a number” of such lawsuits have been filed and some settlements and compromises have been reached.

If you undress the patient against her will, you’re sued for assault and for violating her religious rights.
If you don’t undress the patient, you’re sued for discrimination.
If you don’t undress the patient and you miss a medical problem, you’re sued for malpractice.
Kind of like bringing your car to a mechanic and threatening to sue him if he opens the hood, but also threatening to sue him if he doesn’t fix your car.

Yes, the patient’s initial request was only for a female EKG technician. But what if there were no female nurses? Or no female doctors? Or no female radiology technicians? Is the patient going to dress back up after her EKG and refuse further examination?
What if the EKG showed an acute MI? Thrombolytics and cath lab on hold until we can find an all-female staff?

If Jehovah’s Witnesses can refuse blood transfusions and then accept the responsibility for their actions, Muslim women who refuse to disrobe in the emergency department should do the same. This woman and her lawyer should be forced to reimburse the hospital for having to defend this frivolous lawsuit.

This case is another example of why we need to begin using video cameras to capture interactions in emergency department examination rooms.

By the way, does anyone know whether or not Muslim women are allowed to wear hijabs in prision? Or in court?

UPDATE JULY 15, 2010

First, thanks to Jenn and Muhammad for answering my questions in the comments section. Their answers and a comment on the New Jersey newspaper’s web site raise another important issue.
A commenter on the newspaper’s web site stated that “Rona’s husband is a NY Attorney, and the attorney covering the case is a partner in his law firm. This is probably more a case of entitlement and arrogance as opposed to the Hospital not respecting their religious rights.”
I checked for attorneys with the last name of “Mohammedi” on Martindale.com and wasn’t able to find an attorney in NY or in NJ with that last name. However, using Google, I did find an attorney named Omar Mohammedi who works in the NYC Commission on Human Rights who is the president of the New York Area Muslim Bar Association.
If what Jenn and Muhammad are saying is true regarding Muslim religious requirements, then it raises a question in my mind whether this patient may have purposely misstated the requirements of her religion so that she could get preferential treatment or possibly even as a pretense so that she could file a lawsuit.
If the patient really did overstate the requirements of her religion, Somerset Medical Center and any doctors named in the lawsuit should be filing their own lawsuit against the patient for fraud and filing ethics charges against her attorney and her attorney’s law firm for perpetuating the fraud.
Come to think of it, maybe they should file the lawsuit anyway and let a jury decide what really happened. That’s what lawsuits are for, right? Resolving disputes?

34 Responses to “Don’t Eyeball Me”

  1. Matt says:

    I think video cameras are an excellent idea. Police resisted them for years, yet they have made prosecutions, particularly for DWI, much easier to obtain. They’ve cost some rogue cops their jobs, but society is better for that.

    As for Overlawyered, one thing it does do is point out we have waayyy too many statutes and “Bills of Rights” and similar nonsense on the books covering every bitch any person ever complained to their local congressman about. It’s just too much.

    As to hijab related lawsuits, I think you’ll find that when you’re examining the limits of the Constitution with any religion (or for that matter any true Constitutional issue), it’s done in the courts. There are groups dedicated to either expanding or limiting Constitutional rights through test cases based on their views. The NRA, for example.

    • VA Hopeful says:

      I think cameras would be an OK idea so long as we did something about the getting undressed/dressed thing. Otherwise there is no way those tapes wouldn’t be stolen/used outside of official capacity/sent to youtube.

  2. Matt says:

    As to Overlawyered, it’s actually a pretty funny site, although I don’t think it’s intentionally funny all the time. It’s an entertaining read, but I would be hesitant to reach too many firm conclusions based on the blurbs.

  3. [...] This post was mentioned on Twitter by Vijay , rlbates. rlbates said: ER sued for discrimination by Muslim woman … — just read it. >> From WhiteCoat's Call Room: Don’t Eyeball Me http://bit.ly/98sHav [...]

  4. Gene says:

    This is actually a quite common issue and the potential for problems. I’ve known of a family who dropped their doctor after a year of successful chemo after they found out their doc was Jewish. They refused to see her, but wanted to continue at the same hospital with another doc. The group had other docs, so agreed. And it hasn’t happened, but I wonder what they would do it she was on call in the middle of the night and their kid (currently in remission) got sick…

    I had a Muslim father who brought his baby daughter to the ER for Fever Without Source. We happened to have an all female crew, which I think made him both a bit upset (a FEMALE doc? a FEMALE in charge?) and relieved. Until I mentioned a cath urine specimen. He refused because “We’re Muslim” and “She must be a virgin when she marries” (direct quotes). I spend quite a bit of time drawing anatomy and assuring him that the cath would be nowhere near her vagina, etc etc. Still no dice. Tried a bag and she peed all around it. CBC was OK, so he left “semi-AMA” refusing urine, but to be see if worse and the next day regardless. He actually thanked me for being so understanding. Go figure…

    I’ve had plenty of teen boys with urinary or genital complaints get nervous and upset when I walk in, but I’ve never had a refusal (once as a med student, but never as a resident, fellow, or attending). I also have a colleague who refuses to treat Muslim or homosexual patients (seriously). BUT, he is private practice in a referral only specialty and just sends “them” on their way to his colleague who is happy to treat everyone. I don’t send anyone to him.

    I think that there is a risk here on both sides: if my colleague was in the ER and refused to treat based on his prejudice, that would be wrong. But refusing consent in an ER setting because of the doctor/tech/nurse’s gender/religion/sexualpref/etc must fall mostly onto the shoulders of the patient (and/or family). You can try to accommodate to a point (is there a female tech elsewhere in the hospital? a male nurse?). Make sure that language difficulties aren’t as the root of the issue. But if someone refuses care and basic preferences can’t be met (female doc/nurse to do a rape kit if possible, etc), DOCUMENT THE REFUSAL.

    Imagine a community ER with only one male doc (and the female is on vacation). No way to have an all female staff. It would be impossible to have an on-call staff to meet every patient requirement (all female for one group, all female but headed by male for another, all Christian, all Muslim, all Jewish, all straight, all gay). Treating patients and family with respect is one thing, but (as my spouse and many others have said), “The ER ain’t Burger King: you can’t have it your way!”

    • MikeMD says:

      I think it’s even more complicated in the case of a child, especially a young child (infant). Because the parents can refuse something, but there might be a significant chance of something bad going on, and you’re also obligated to advocate for the child. I’ve had to get judicial consent for the case of a Jehovah’s Witness refusing blood for severely anemic 2 year old, and have treatened to do so for an 2 week old with fever when the parents initially refused an lumbar puncture.

      I even had parents refusing phototherapy for hyperbilirubinemia! When I worked in the nursery a parent refused vitamin K, insisting she’d ‘take her chances’ with hemorrhagic disease. I printed out a paper in large, bold letters “I understand my child could die and I take full responsibility.” Changed her mind.

      There’s a fine and difficult line to walk there. If you let them refuse and walk out, and you have a bad outcome, you’re liable and should have got a court order. But doing so can be so traumatic for the patient and the family, and it’s difficult to estimate the real risk to the patient.

  5. Jenn says:

    I’m Muslim, I have had to go to the ER, doctor’s offices, etc, and while I have had no problems with getting undressed for exams, the doctors have been unusually gentle about suggesting that I could keep on as many clothes as possible.
    I’m American, and perhaps that is why I have no issue with it myself, but a lot of the time Muslims from other countries have some undoubtedly wacky cultural ideas that have no formal prohibitions in our religion (They just tell each other that it is ‘forbidden’ with no basis in reality.)

    • Jenn says:

      I wanted to add that most prisons do allow women to wear hijabs (Though really, if you are in prison, you probably haven’t been the most observant muslim anyway) and you are allowed to wear them in court.

    • Muhammad says:

      I agree with Jenn, it is very clear in Islam that what is forbidden will be allowed in case of emergency. unfortunately as Jenn said many issues in Islam has a cultural background and Islam has nothing to do about it.
      i have faced many patient like that, and as long as i explicitly explain to them the risks of refusing such exam and that they understand it. then it is there decision to do so.
      I try my best to accomodate there requests, but not always possible.
      hope that gives some insight to the issue.

    • Molly, NYC says:

      Jenn and Muhammad – Thanks for the input. My impression is that in predominately Islamic countries, everyone is assumed to be Muslim (and a fairly pious one at that) and pretty much everything is set up to accommodate Muslim beliefs. For someone coming out of that milieu, dealing with a culture where they’re expected to accommodate other beliefs must take some getting used to.

  6. [...] read this over at WhiteCoat’s Call [...]

  7. igloodoc says:

    Hospital or physicians are held liable for failing to provide a certified medical translator, with the premise that if you cannot communicate with the patient, it is the hospital/physician’s responsibility to provide the means of communication, no matter how distant the language (or how expensive).

    Thus it follows that the hospital/physician should be held liable for not providing adequate resources for to a patient practicing a religion that has strict requirements on who provides or what services can be preformed to conform with the religion. Religious beliefs are even more important than language.

    In either case, the patient has no responsibility to adapt to the customs and language of the country where he/she lives. I’m sure this happens in most civilized countries right?

    I’m curious. What would happen if a Jehovah’s Witness physician failed to transfuse a patient based on his religious belief? Could the physician file suit against the hospital for providing a working environment that forces the physician to do things contrary to the physician’s religion?

    • Ben S says:

      There’s a pretty big difference between requiring one additional person to assist in communication and requiring that all medical staff caring for a patient fall within their required parameters.

      • igloodoc says:

        Really? Try finding a Mixtec translator for our rather sizable Guatemalan population. Finding one ties up more than just one person. In fact, it usually means several people phoning around to find a translator, and paying someone to come in (with no medical certification for translation… another legal minefield in itself). It does get rather costly.

        As WC asks, at what point do we draw the line? At what point can a hospital or physician say that the patient’s “parameters” cannot be accommodated, without the threat of lawsuits?

        Believe me, in most countries I have travelled the line is drawn well before the issue of translation, let alone religious preferences.

        Patients must take some responsibility.

        One interesting point in the article was that the Muslim patient ended up at the hospital founded by Jewish charities, and her religious requirements were respected. Maybe we all can get along…

      • Matt says:

        Testing the law is how the limits of our Constitutional boundaries are found. Where free speech ends and inciting a riot begins, for example. Or whether smoking peyote is or is not a religious practice. And yeah, it’s usually an obnoxious thing to the general public, because it’s often on the fringes where the Constitution is most relevant.

        That’s how we draw the line in this country on where the free exercise of religion right ends, or where the right to bear arms ends. Our other options are majority rule, which would require us to vote on every issue, or physical force (might makes right). So when you get to the edges, like in this case, there may well be a lawsuit.

    • igloodoc says:

      Yes Matt. Let’s let the courts decide. And after months to years, untold expenses, appeals, appeals to appeals, court delays, trials sent back to lower courts for retrial, and so on, the courts will decide.

      Meanwhile, this hospital continues to “do business” in what the think is good faith, trying to accommodate the patient but unable to do so. And, if the plaintiff is successful, the hospital has a target painted on them for the 10 or 15 subsequent patients/plaintiffs they treated “in good faith” (now determined wrongly after years of litigation).

      You see Matt, this is a major source of frustration for doctors and the public at large with the legal system. It is too damn slow, too inefficient, and too inconsistent. My hospital needs to know NOW if this patient’s rights have been violated, and needs to know NOW that the decision is applied everywhere. Money can be spent to prevent the issue from happening again, instead of policy deductibles to defend the bevy of future suits.

      • Matt says:

        Sorry igloo, but the world doesn’t work as quick as you want it. Hell, no one wants it to work quicker than the litigants. But when we’re talking about questions of Constitutional import, we’re going to take some time to get them right as a society.

        The limits of Constitutional rights aren’t, and have never been, simply decided in the moment.

      • DensityDuck says:

        “Sorry igloo, but the world doesn’t work as quick as you want it.”

        I’m sure that WhiteCoat et al will be glad to use that excuse the next time they have to make a decision that might get them sued. They’ll call legal and wait three days for a response, all the while telling the patient “sorry about that sucking chest wound, but the world doesn’t work as quick as you want it.”

      • Matt says:

        Not an excuse, just a fact.

        If you can’t understand the difference between a Constitutional issue regarding the limits of religious freedom and the life and death issue you describe, then you’re going to struggle in a lot of areas, I’m afraid.

      • DensityDuck says:

        Matt, so your advice as a lawyer is that doctors should just do whatever they think is right and depend on malpractice insurance to handle the inevitable lawsuits? Interesting. Would you consider it appropriate if a doctor suggested that patients should just eat all the french fries they want because most insurance programs cover bypass operations?

  8. Webhill says:

    Kind of reminds me of a local hospital where a racist patient demanded no black people be allowed to care for him. Initially the hospital tried to go along with it, but ultimately told him they refused to (this was after a huge PR nightmare obviously). I think if a patient can’t demand a white person, they also can’t demand a man, or woman, or Greek, or astronaut. You go to the hospital for medical care. When it comes to the individuals delivering emergent medical care, “you get what you get & you don’t get upset,” as any kindergarten teacher can tell you :)

  9. BinkRN says:

    What i wonder is why a female nurse could not have done the EKG? I assume there were female nurses available in that ER…in my ER, the techs do the EKGs, but if they aren’t available, it is our responsibility.
    I have also had other patients, male and female, refuse to undress for EKGs. It can be done, but is a little bit difficult to get the wires to pass through right the first time.
    I think the lawsuit is frivolous, but the ER should have had a female nurse do the EKG- it is only a 5 minute interchange anyhow.

  10. Nurse K says:

    They might be in trouble if there were females working able to do an EKG (nurses, etc). I just Googled this ER, and they see 50,000 patients/year, so….there are chicks there that know EKGs.

    It probably is an EMTALA violation to not do an EKG on her because of this request unfortunately since it is for a religious reason that she was requesting a chick (vs. bigotry or “just cuz”-type reasons).

  11. SeaSpray says:

    But why go there in the first place? Any reasonable thinking person must know there may or may not be females available.

    I can see trying to accommodate if possible ..but if it is not ..then it was the *PATIENT’S* choice to refuse.

    Lawsuit was so wrong. And they settled? Just wrong. Sends the message to continue this behavior and make some money too.

    Still not on board about the cameras in an exam WC ..not a personal exam. Record conversation ..docs do that ..but not on film.

  12. Marilyn says:

    In many countries under sharia women are forbidden from education. How does a sick woman get medical care in that case?

    I don’t like disrobing for strangers, but I like dying from some disease even less. I just take my husband with me and he is good company in the examining room. He also keeps me from rifling through the drawers soiling all the sterile stuff (wink).

  13. The courts have had to weigh the privacy interest of the patient against anti-discrimination employment law.

    The relevant paragraph is toward the bottom of this review of case law.

    http://www.gklaw.com/news.cfm?action=pub_detail&publication_id=544

    “At this point, few courts have authorized the use of a consumer privacy BFOQ. Discrimination in favor of female OB/GYN physicians is not widely accepted by the courts. If a health care provider is willing to take a risk on the argument that a consumer privacy BFOQ does apply, it should have a carefully crafted policy in place. In addition, the health care provider should take measured steps to document the consumer’s preference as well as the basis for the privacy concerns. Like many areas of health care, the consumer privacy BFOQ is constantly growing and may soon apply to more and more instances within the health care field and, potentially, beyond.”

  14. BFOQ: “Title VII of the Civil Rights Act: Statutory BFOQs
    Title VII of the Civil Rights Act of 1964 states: “It shall not be an unlawful discrimination practice for an employer to hire and employ employees…on the basis of his religion, sex, or national origin in those certain instances where religion, sex or national origin is a bona fide occupational qualification reasonably necessary to the normal operation of that particular business or enterprise….” 42 U.S.C. § 2000e-2(e)(1)(emphasis added). The final clause is known as the “business necessity” standard. Arguments in support of a consumer preference bona fide occupational qualification (BFOQ) are rooted in the belief that consumer desires and demands necessitate some consideration in the name of profitable business.”

    From the above reference.

  15. paul says:

    hmm… not sure i’m on board with the cameras in the department. my gallows humor is pretty awful.

  16. [...] Rona Mohammedi is now suing Somerset Medical Center in New Jersey because it told her only male ER technicians would be available to check whether her severe chest pains were the result of a heart attack. [Newark Star-Ledger, White Coat] [...]

  17. DensityDuck says:

    This isn’t just a religious thing. A friend of mine works for a senior-citizen in-home care business, and she says that it’s almost impossible to find work for male caregivers. Old women are terrified that they’ll be raped; old men are terrified that they’ll catch The Gay.

  18. Molly, NYC says:

    If what Jenn and Muhammad are saying is true regarding Muslim religious requirements, then it raises a question in my mind whether this patient may have purposely misstated the requirements of her religion so that she could get preferential treatment or possibly even as a pretense so that she could file a lawsuit.

    What if she didn’t? She’s in the States now. I realize that (a) the idea that you’re responsible for your own religious beliefs might take some adjustment for someone from a one-religion-only culture (as mentioned in an above comment), and (b) medical professionals are expected to cut people a reasonable amount of slack w/r/t their religions.

    But this whole notion that people’s own beliefs are just handed to them and it’s okay for them to declare themselves incapable of thinking them through or adjusting them in any way, and are certainly not responsible for the results of their averred beliefs, and–in particular–non-coreligionists are expected to expend any effort to accommodate said beliefs is the sort of thing that gives religion a bad name.

    Welcome to America, honey. Your religion (or anyone else’s) is not being oppressed just because it’s not being catered to on the public dime.

  19. Molly, NYC says:

    Where’d I put that close-italics?

  20. Banterings says:

    …The court noted that “giving respect to a deep-seated feeling of personal privacy involving one’s own genital area is quite a different matter from catering to the desire of some male airline passenger to have…an attractive stewardess.”….

    Put cameras in after the court said this and watch the lawsuits.

    If the TSA (a government agency) can’t keep the pictures of passenger off the internet.

    More lawsuits!!!!

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