Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Don’t let vindictiveness creep into medicine like it has in politics

Arthur Lazarus, MD, MBA
Policy
September 20, 2022
22 Shares
Share
Tweet
Share

The callous and inhumane dislocation of migrants recently perpetrated by governors of the states of Florida and Texas reminded me of an equally disdainful and appalling tactic utilized by health care workers since the 1960s: “Greyhound therapy.”

Greyhound therapy refers to attempts by health care workers and administrators to remove undesirable patients from emergency rooms, hospitals, and other types of facilities by providing them one-way tickets on a Greyhound Lines bus to another far-away location, hoping they will never return. Some of the patients are troublemakers and rabble-rousers known to frequent emergency departments, but the majority are destitute, homeless, or mentally ill – or all three – and deserve our compassion.

Greyhound therapy is still in play in certain medical and mental-health circles. Between 2013 and 2018, a state-run psychiatric hospital in Nevada routinely bused patients to places they had never been or had no ties to, providing only a few days of food rations and medication for the trip. A class-action lawsuit was filed against the hospital on behalf of approximately 1500 patients that were cast off, and a Las Vegas jury returned a unanimous verdict in favor of the patients, awarding each person $250,000 for the hospital’s egregious treatment.

A far more common but no less derisive practice is patient “dumping” – discharging uninsured and undesirable patients to the street or transferring them to another facility. Patient dumping was – and still is – such a huge problem that it literally has required an act of Congress to stop it: the federal anti-dumping law passed in 1986 known as the Emergency Medical Treatment and Active Labor Act (EMTALA).

Under EMTALA, patients must be medically screened and stabilized prior to discharge or transfer. If a hospital is unable to stabilize a patient given its resources, or if the patient requests, a transfer may be made with the consent of the receiving hospital.

Greyhound therapy, dumping, and the busing of migrant workers have their roots in the “Freedom Riders.” Freedom Riders were civil rights activists who rode interstate buses into segregated southern states in 1961 to challenge Jim Crow laws that remained in force despite Supreme Court decisions that outlawed segregation in schools and public buses and depots.

To embarrass Northern liberals and humiliate Black people, southern White Citizens Councils and other groups countered the Freedom Riders. “Reverse Freedom Riders” issued Black people one-way tickets to northern cities with false promises of jobs, housing, and better lives. The Kennedy White House received mail from leaders in the targeted states asking the federal government to intervene in the cruel trafficking of people of color.

The past behavior of bigots is remarkably similar to the current behavior of the governors of Florida and Texas. As one columnist observed, the two governors simply followed an old playbook by shipping the migrants North. The governors were not clever. They were racist. At least officials in Arizona coordinated their efforts to relocate migrants.

The recent display of vindictiveness shown by the governors cannot be attributed to implicit bias. Implicit bias originates in prejudices that unknowingly influence how people are treated, especially minorities. However, there is nothing unknowing or unconscious in the minds of those who orchestrate and approve the trafficking of vulnerable populations.

Exploiting people’s misery for political gain is shameful and no more acceptable than sending patients on dead-end journeys. JFK characterized the Reverse Freedom Rides as “a rather cheap shot.” He envisioned government contractors would treat their employees without regard to their race, creed, color, or national origin. Shouldn’t the same hold true for health professionals?

The notion of equal medical treatment dates back to Hippocrates. He stated: “Into whatever homes I go, I will enter them for the benefit of the sick … whether they are free men or slaves.” In many U.S. medical schools, it has become customary for incoming medical students to write and recite their own versions of the Hippocratic Oath. Many of the variants include language that specifically prohibits discrimination or bias in the practice of medicine.

I have often wondered about the state of mind of health care providers who approve of one-way travel as a solution to homelessness, drug addiction, and mental illness. Health officials in Nevada strung together a thin veil of excuses, ranging from denial to arguing that they were sending patients directly to family members and other mental health facilities – possibly true in a few cases but utterly false in a majority of them. Clearly, there was a blatant disregard for human rights fueled by prejudice and stigma against the mentally ill.

Nevada is not alone in its brazen treatment of psychiatric patients – nor do southern states own the exclusive rights to export its citizens. New York City secretly sends the homeless to Hawaii and other states. Only in rare instances does travel therapy aim to be genuinely therapeutic.

For example, Hawaii has attempted to reunite homeless people with relatives on the mainland, so-called airplane therapy. But due to the high cost of running such a program and the fact that approximately one-third of Hawaii’s population is transient or from out of state, the number of needy people who actually benefit is very small.

The American Medical Association is worried about “scope creep” that threatens patient safety, i.e., the infusion of advanced practice providers into medical practice. I’m more concerned about the impact of crass politics. Anyone – politician, provider, or health care administrator – who uses human beings as pawns for leverage or personal gain, or displaces or disrupts their medical treatment for prejudiced reasons, should be guided through serious self-reflection around how racism has entered their lives and, more importantly, affected the lives of innocent people and disadvantaged patients.

Politics, whether inside the Capitol or the hospital C-suite, should never take precedence over people. Leaders and caregivers must never forget the welcoming inscription engraved on the base of the Statue of Liberty – “give me your tired your poor” – and especially the words that follow: “Send these, the homeless, tempest-tost to me.”

Migrants, like many of our patients, are overwhelmed by life’s circumstances. We are, and always have been, a nation that opens its arms to vulnerable people rather than consigns them to a destination far worse than where their journey began.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.

Image credit: Shutterstock.com

Prev

Giving up the knife: Saying goodbye to surgery

September 20, 2022 Kevin 2
…
Next

Is your smartwatch smart about your health?

September 20, 2022 Kevin 0
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Giving up the knife: Saying goodbye to surgery
Next Post >
Is your smartwatch smart about your health?

More by Arthur Lazarus, MD, MBA

  • Crying to be heard: women in emotional pain

    Arthur Lazarus, MD, MBA
  • Man’s search for meaning is spiritual, and relevant to medicine

    Arthur Lazarus, MD, MBA
  • A season of emotions: spring, trauma, and healing

    Arthur Lazarus, MD, MBA

Related Posts

  • Take politics out of science and medicine

    Allison Neitzel, MD
  • Why politics has a place in medicine

    Ariana Witkin, MD
  • Politics is health care on a grand scale

    Kasey Johnson, DO
  • Talking politics in the exam room

    Hayward Zwerling, MD
  • Medicine is failing rural Americans

    Michael McCarthy
  • Melting the iron triangle: Prioritizing health equity in dynamic, innovative health care landscapes

    Nina Cloven, MHA

More in Policy

  • Pediatricians grapple with guns in America, from Band-Aids to bullets

    Tasia Isbell, MD, MPH
  • Health care wins, losses, and lessons

    Robert Pearl, MD
  • Maximizing care amidst provider shortages: the power of measurement-based care

    Tom Zaubler, MD
  • Unveiling excessive medical billing and greed

    Amol Saxena, DPM, MPH
  • Chronic health issues and homelessness

    Michele Luckenbaugh
  • The impact of certificate of need laws on rural health care

    Jaimie Cavanaugh, JD and Daryl James
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Doctors and disability insurance: Protecting your income

      Amarish Dave, DO | Finance
    • Emergency care nightmare: the urgent need for experienced nurses

      Rachel Basham, RN, CCRN | Conditions
    • Physicians have no autonomy. Here’s how to change that.

      Diane W. Shannon, MD, MPH | Physician
    • Understanding intersex health care [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Report: Persistence of Gender Inequalities in Cancer Care, and a Call to Action
  • Cancer Risk in NAFLD Higher With Early Disease Onset
  • FDA Displeased With Companies Purposely Adding Sesame to More Foods
  • COVID Vax Appointment Cancelled? New Shot Rollout Faces Challenges
  • Medical Residents Receive 100+ Job Offer Contacts, Survey Shows

Meeting Coverage

  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
  • Recent Posts

    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • Doctors and disability insurance: Protecting your income

      Amarish Dave, DO | Finance
    • Emergency care nightmare: the urgent need for experienced nurses

      Rachel Basham, RN, CCRN | Conditions
    • Physicians have no autonomy. Here’s how to change that.

      Diane W. Shannon, MD, MPH | Physician
    • Understanding intersex health care [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Don’t let vindictiveness creep into medicine like it has in politics
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...