Comment by blub | Hacker News Reader

Comment by blub | Hacker News Reader

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Of course that the owner of the medical services company being accused of not treating patients properly claims that they are doing everything properly. What else could they say?!

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.

> On the other hand we have Anna Watson, a medical professional...

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.

Everything you state about doctors applies to PAs as well. Like most states, California has a PA board [0] and patients can complain to the board. Sure, a doctor has more responsibilities, but a PA is also a medical professional.

[0] https://www.pac.ca.gov

Anna is a physician assistant, she can literally do almost anything a doctor can do(prescribe drugs, diagnosis etc) and has almost as much training as a doctor.

> almost as much training as a doctor.

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.

And those additional 5-9 years are critical for accurately deciding if the amputation of a digit requires hospitalisation....

It’s just a flesh wound! /obligatory

PAs can do a lot of the same things that physicians do, and are of vital importance but are distinct from physicians. For one, physicians in the US complete 4 years of medical school, then a residency, and then possibly a fellowship. On the other hand a PA is generally done in 3 years, total.

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.

I was just pointing out that physician assistant is a legitimate medical profession like nurses and doctors.

Yeah, I’m sure all the workers for whom that job is probably the only income they have will sabotage their future by filing a formal claim with the medical board. That’s going to be great for their continued employability.

Being a medical professional or a doctor does not per se make you an honest person. It also doesn't necessarily prevent you from doing incalculable harm for your own fun and profit.

Example?

https://en.wikipedia.org/wiki/Andrew_Wakefield

Why don't you think physician assistants are medical professionals? They have a medical degree and are board certified.

They are different from physicians, but they're still medical professionals.

Perhaps because they are not held to the same standards as an MD. PAs are typically employees in a clinic, hospital, or practice, and they work with limited autonomy under the supervision of MDs.

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.

Or, believe the org just proven liars after publishing similar accusations by disgruntled ex employees by an OSHA investigation.

I guess we're supposed to be upset because they didn't call an ambulance for workers who were feeling light headed, or had crushed or severed fingers. These are the examples provided, and it isn't stuff you need to call an ambulance for. And I'm a big Tesla critic, I get really excited when there's a Tesla scandal, but this article is a baseless hit piece. The concrete examples they provided were dealt with appropriately and the rest is pretty nebulous.

> I guess we're supposed to be upset because they didn't call an ambulance for workers who were feeling light headed, or had crushed or severed fingers.

(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.

Why? Why do you need the equipment in an ambulance for a crushed or severed hand? Wouldn't you be better served in literally halving the time it took for you to get to the hospital (driving one way vs waiting for the ambulance to come pick you up) so you can be treated there?

Ambulances don't come from the hospital. They are stationed a bit all over and listen for emergencies. They also listen on the police scanners and can get to an emergency before actually being requested.

The gas station right next to my house has EMT vehicles almost every night hanging out and waiting to interveene in the area.

You need to get them to the hospital ASAP - yes, where doctors can start to work on the finger(s). I can't imagine they are going to do anything in the ambulance that the doctors on-site at Tesla aren't capable of stabilizing/prepping for care at a hospital.

> > 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.

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.

It's not life threatening

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.

As someone who suffered a crushed finger accident as a teenager and did not take an ambulance to the ER, I really really wish that I had. Ambulance = immediate admittance, rather than waiting for 8 hours only to be told that you need to see the specialist who has gone home for the day.

> Ambulance = immediate admittance

This is not true. Patients arriving in ambulances are triaged and helped according to need, just like anyone else.

> 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).

That's not what I was told by a doctor working at the hospital.

> If you crush or sever your fingers, you really do need to call an ambulance.

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).

Yeah unless there is a traffic jam on the way, then you're fucked in your Uber.

This is a good point, with the caveat that it's roughly 5 miles to two hospitals north of the Fremont factory. If traffic is terrible, an ambulance should be called; otherwise, a Lyft vs ambulance will make no difference.

An ambulance isn't going to make much difference in gridlocked traffic anyway. They're not going to use the lights and sirens for a stable patient.

Crushing injuries can result in life threatening issues even if someone appears stable. Clot or hemorrhage can go from everything looking ok to serious very quickly.

Ambulances are low risk and cheap somthey really should be used even down to ~0.1% chances of serious issues.

I am a paramedic. If someone with a crushing injury to their hand is otherwise stable, I am not going to be headed to the hospital with the lights and sirens on.

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).

I appreciate you taking the time to provide context and insight here. Even having taken a wilderness EMT course, I still learned something from your comments. Thank you!

I don't disagree with that, but is otherwise stable can change. With an Uber their is no recourse if the person in the back starts having a heart attack for example.

Man, am I happy to live in Europe. Because over here, your employer has an obligation to care for his employees. And that means that, yes, in those cases you have to call an ambulance. Otherwise the professional health insurance will sue the employer to death (obvious exaggeration). At least in Germany.

The stuff Tesla is doing, allegedly, is only done by really shaddy companies.

If germany had the cost of healthcare the US had, such obligation would bankrupt many german businesses.

Imagine that Germany does have universal health care.

If ambulances cost in Germany what they cost in the US under a universal health care program, then they would either ration them or charge exorbitant taxes for them.

Overall 50% taxation sounds about right?

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.

50% is, as very rough ballpark number, your net salary in Germany. Usually it is more than that. Not all of the other 50% is taxes so. It is social security, unemployment insurance, salary taxes and part health care (usually around 15% with your employer paying the same amout directly as well).

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).

You didn't provide a rationale for your position, and I don't think you have one. You just get squeamish thinking about this stuff.

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.

> crushed or severed fingers [...] isn't stuff you need to call an ambulance for.

What?

In the context of there being doctors on-site at Tesla who would be assessing/caring for the injured person, if the person is stable/stabilized and the severity of the injury requires treatment at a hospital (say surgery but they're not bleeding out etc) - just getting them to the hospital in a reasonable manner should be the goal, yes? We can make assumptions about what would take longer to get to the workplace and then to the hospital - a Lyft nearby or an ambulance who perhaps has to travel further.

A severed finger is a pretty serious and catastrophic injury. You think workplace clinic has the ability stabilize that kind of injury, such that there's little difference between a 10 minute and a 30 minute trip to the hospital? Don't you there's a better outcome than the patient not bleeding to death, like getting to a surgeon ASAP to increase the chances of a successful reattachment surgery?

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.

Like I said, we can make assumptions about travel time difference between Lyft and an ambulance - however unless we're in the actual scenario and know the circumstances, and likely times/estimates for each, a private driver can certainly be faster than when an ambulance can arrive (and likewise what is the indirect cost if not using that ambulance means someone else gets an ambulance faster who more reasonably needs it?).

So you continue to make assumptions about a Lyft being faster than an ambulance. Do you also believe that an ambulance lacks trained medical personnel and equipment compared to a Lyft?

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?

> Do you also believe that an ambulance lacks trained medical personnel and equipment compared to a lyft

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.

Maybe an ambulance is slower than a Lyft. What's definitely faster than a Lyft is: a car that's already on-site, driven by a co-worker tasked to take you to the hospital.

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?

I don't think anyone was arguing against what is likely the fastest option (someone already on-site driving), it's however possible that once being assessed but before being ready to go, a vehicle could be ready to transport them immediately - whether that is someone from on-site or a Lyft et al that was ordered.

I think this reaction is justified. The HN reality distortion field is at effect here where otherwise intelligent and rational people make completely unlevel arguments on the basis of weird logic.

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.

>As if a person in that situation is going to deduce the pros and cons of the situation at the time

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, I would call an ambulance.

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.

An EMT friend told me that the best times to call an ambulance are when you need immediate medical attention, if it would take you much longer to get to the hospital yourself, or if there's a reasonable chance you would distract the driver (e.g. screaming pregnant woman, someone heaving and clawing for air during an asthma attack). While having broken/severed fingers sounds awful, I would probably make the same call (take this as hearsay + a non-medical opinion)

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