[DashRattlesnake]

> Lauren Singer, who worked for six months at the front desk of Colorado’s Highlands Behavioral, said people who were waiting in the lobby for an assessment would ask her what it would entail. “I would frequently get yelled at for overstepping my bounds and telling them too much about the evaluation process,” Singer said. A button behind the receptionist’s desk controlled the lock to the front door of the facility, and, she said, “If someone came in voluntarily, I wasn’t allowed to let them out of the door.”

That's terrifying. Earlier in the article they talked about people coming in for simple depression screening based the hospital's ads, but things like locking the doors behind people who choose to come in are probably keeping a lot of people from getting the help they need.

Medical care, especially medical care with an involuntary component, should never be for profit. The profit motive is just too corrupting.

[StanislavPetrov]

This is kidnapping plain and simple. The fact that it is done under the guise of a corporate/medical structure should not be relevant. Those involved in these crimes should be arrested and prosecuted under RICO laws, from the top to the bottom.

[ethbro]

Sadly, I can see the counter argument. "It's not kidnapping, because someone with mental health issues can't be trusted to make their own decisions." {Cue jury ignoring logic errors and nodding}

Maybe it's currently reading Larsson's books, but mental health issues seem to raise incredibly challenging ethical questions (under economically feasible settings).

[throwaway729]

Mental health issues may raise incredibly challenging ethical questions, but that's beside the point in this case. There is a legal structure set up for this sort of thing. You don't just lock people in a building against their will for days or weeks without a court order. And you certainly don't choose which people to lock up based upon availability of insurance money.

IMO Matthew Salanger should be facing down charges carrying hard jail time right now.

[cmdrfred]

If these allegations are proven and those responsible for these policies don't spend significant time in prison then we can no longer deny that we live in a corrupt society.

[eli_gottlieb]

I mean, this sounds a lot like criminal kidnapping.

[gumby]

And indeed she reached a settlement with the company which presumably means they were worried about losing a lawsuit or worse.

[eli_gottlieb]

Why weren't criminal charges pressed? Why is nobody in jail? Holding people hostage is definitely illegal.

[gumby]

Because in the US (at least) if the victim won't press charges the police can't take action. And in a case like this the defence will attempt to attack the (alleged, at the time of the trial) victim's credibility, which can be devastating. It's the main reason why rapists so often get away with it. Also why gang members are hard to convict.

Some crimes don't have a legal victim, e.g. murder (victim is dead) or so-called "victimless" crimes (prostitution, drug possession, speeding, etc).

[mikeash]

That's not true. The decision about whether to press charges is up to the prosecutor. The prosecutor will often take the victim's wishes into account when deciding what to do, but they aren't required to.

[cmdrfred]

Kidnapping in the the latter category it does not require anyone to press charges. Assault is the same way as well. If LE has evidence they can move on it. The fact of the matter is prosecutors don't want to risk their win loss ratio.

[nommm-nommm]

This is not true. The only person with the choice/authority to prosecute is the prosecutor.

[cmdrfred]

If abducting someone for profit isn't kidnapping then I don't know what is.

[scythe]

http://en.wikipedia.org/wiki/Kids_for_cash_scandal

[Avshalom]

So I mean this is all super fucked up but:

http://app.leg.wa.gov/RCW/default.aspx?cite=9A.40&full=true

I suspect If I kept google-ing danger to self or others gives institutions authority to restrain.

[GrinningFool]

> then we can no longer deny that we live in a corrupt society

I've not heard anyone denying this. The only thing people like to debate is which aspect - as if it were a binary choice.

[bitJericho]

Feel free to think otherwise, but we are living in a corrupt society. This isn't any news to anybody except those with no experience with any part of the government system.

[maxerickson]

There can be pernicious motives whether a facility is nominally for profit or not.

(For instance, say there is a doctor who gets paid in proportion to the time they spend treating patients at a non profit facility)

[omginternets]

>There can be pernicious motives whether a facility is nominally for profit or not.

This is colloquially known as "whataboutism".

The fact that there are other pernicious motives is completely irrelevant. For-profit medicine constitutes a pernicious motive -- that's the point.

[johncolanduoni]

I believe the GP is arguing that the same exact motives can happen in non-profit hospitals (as in the tax designation). This amounts to (at most) no more than a different route for the profits to those setting these policies. IMHO seeing this as a separate issue makes about as much sense as seeing false advertising to be separate problem depending on whether the corporation files as a C-corp or S-corp.

I for one think it is very important that any attempts to prevent this behavior don't leave loopholes for non-profit hospitals, so keeping this in mind here is actually very important.

[maxerickson]

Well, I don't agree with that. I see generous salaries as being exactly the same thing as profit (they are just taxed differently). I also have difficulty with the idea that only de facto agents of the state can deliver healthcare (care only available at fixed prices, etc).

So my point is that you need external controls regardless of the motivations of the actors inside the institution.

[rounce]

> I also have difficulty with the idea that only de facto agents of the state can deliver healthcare (care only available at fixed prices, etc).

It seems that they aren't the only difficulties you have. In a social health-care system, possession of a medical license doesn't entail one's employer. You're more than welcome to set up private practice, though you'll have less chance of the career defining cases, as the majority of patients will not be using your one-man-band practice. Thus many doctors in the UK, split their time between their private practice and public services. The only thing that's "de-facto" is the need to be qualified to treat people.

[maxerickson]

It's implicit in the argument I replied to that the side practice better not deliver excess economic benefits (profits!) compared to working in the public facilities.

[omginternets]

This is completely beside the point. "For-profit healthcare" and "well-paid doctors" are distinct concepts.

Doctors are still very well-paid in France, for instance. It's just that the hospital isn't expected to turn a profit.

[maxerickson]

I'm arguing that compensation and profit are actually the same thing.

They are both economic benefits from providing a valued product or service. Saying that the one is evil while ignoring the other doesn't make any sense at all. It's the opposite of being beside the point.

Take the case of 2 doctors that have the same price list. One is better at doctoring and sees more patients. Because there is only the other doctor, their faster appointments represent a higher income than the other doctor. The second doctor still manages to provide competent care to all the patients they see, but they are capturing less economic benefit than Dr. Speedy. Is Dr. Speedy evil for charging the going rate?

[DashRattlesnake]

That's true, but removing the profit motive of the facility removes one major incentive for coordinated, large scale corruption like this. Other incentives (like production-based compensation being gamed by unscrupulous individuals) will have to be dealt with in other ways.

[sageikosa]

So without profit, the operating metric will be what exactly?

[gurneyHaleck]

I can see it now:

  "This graph depicting
   revenue reveals that
   the maternity ward is
   quite the cost center. It
   should be going up and 
   to the right!

   Smithers, why are there
   so few pregnancies? We
   need more in-patients,
   otherwise our overhead
   starts eating away at 
   our profits."

  "Well, sir, I suppose 
   there aren't as many
   teen pregnancies as 
   there used to be, and
   with the benefit of 
   modern procedures, the
   pregnancies we do see
   are fairly uncomplicated..."

  "Uncomplicated?! Why,
   everyone knows live
   vaginal births are the
   devil's causeway. Those
   infants can't be as 
   healthy as these so-
   called 'doctors' seem
   to believe. See to it
   that more tests are 
   performed. I'm sure we
   can find something wrong 
   with some of these 
   freeloaders."

...enter Dr. Nick.

  "Hi, everybody!"

[sageikosa]

You'll just need to have permission before you can get pregnant; cost problem solved (except for the expanding bureaucracy to manage the rules and operations of maternity).

[bandrami]

In healthcare we have this amazing thing called "outcomes".

[danso]

Er...are you questioning the existential purposes of the non-profit sector in general, or just non-profit healthcare?

[sageikosa]

Just trying to point out that human action without profit requires something else to account for the costs; otherwise there is no way to judge comparatively how limited resources should be applied. So if there isn't going to be profit driven activity, what will be the metric for success? If it is "outcomes", then we should start plowing everything we've got into it. Of course, should that mean we stop plowing resources into other endeavors? Do we make a vote of it? A law case?

[nommm-nommm]

Patient outcomes?

[Spooky23]

People associate everything with the hospital and don't realize that doctors are frequently part of independent practices.

I remember vividly when my grandmother was in an awful hospital in NYC dying, I found the hospitalist to talk about her situation. He claimed to not Treating her and had no idea who was and directed me to another doctor. Yet he was standing at the station, with my grandmother's chart open with marking that he had just added her condition.

He actually told me the truth, but he was sitting there with a stack of files defrauding Medicare. Whatever profit the hospital was or wasn't making, the doctor was ringing his till.

[specialist]

I use the word "incentives".

[scythe]

>should never be for profit.

That may be, but -- as other commenters have noted -- the definition of "for profit" is colloquial and subject to concept creep. A more specific prescription (heh), I think, would be that medical care (or at least involuntary care) should never be subject to fiduciary duty in the sense of Dodge v. Ford.