Healthcare Update 10-26-2009


Another large emergency department is on the verge of closing in Memphis, TN. The Regional Medical Center at Memphis, or “The MED,” as it is called, is in need of $32 million in the next few months or the emergency department and ambulance services will be discontinued. The heart of the issue resonates all over the country. Hospitals can’t provide free care to everyone and remain solvent for very long. Tennessee isn’t paying The MED enough to care for Medicaid patients and neighboring states of Arkansas and Mississippi owe millions of dollars to The MED for providing out-of-state indigent care.
A quote in this article about the potential closure confirms a prediction I had when discussing similar problems in New York City: “Those patients have to be cared for somewhere,” Smith said. “Most of them are uninsured so the new receiving institution would have that financial burden shifted to them.”
A game of hot potato with uninsured patients … coming to a hospital near you?

When a dog gets whooped on in a dogfight, where does it run to? You guessed it. The emergency department. Now if I could just get certified in doggie CPR.

Emergency department tweezer thief gets an all-expense paid trip to the Greybar Motel. Moral of the story: Go buy your own tweezers to pluck your nose hairs … and show up at your court dates so warrants aren’t issued for your arrest.

Taser International issued a press release advising police agencies not to shoot stun guns at a suspect’s chest, since doing so could pose an “extremely low risk of an adverse cardiac event.” Ummm … it’s not like police have a choice where to shoot the electrodes when suspects lunge at them or try to steal their guns. All about CYA for the lawsuits. Best quote in the article: “Critics called it a stunning reversal for the company [that had previously stated]its stun gun was incapable of inducing a cardiac arrest.” No pun intended, of course.
In other news, police agencies have issued a press release on how suspects can avoid Taser-related cardiac events altogether: Do what the frick police officers tell you to do so you don’t get tazed in the first place.

If we want your opinion, we’ll give it to you … The Senate passed a health care bill to the House that contains a “public option” plan. States have until 2014 to opt out of the plan. One  commenter to the cited article raised an interesting factoid – no states have ever opted out of another public option plan called Medicare. If the House passes the plan, insurance companies will have to compete against the government. Then we’ll see what kind of pressure insurance companies put on State governments to “opt out”.

Is the public plan option what you expect? Newsweek columnist Robert Samuelson thinks the plan is a bunch of smoke and mirrors.

But the public option plan is to get rid of the obscene profits made by the health insurers, right? According to the LA Daily News, health care insurers only made 2.2% profit last year. How much more is there to trim? (thanks to Denise for the tip)
According to the American Association for Justice
, there’s a lot to trim. Medical malpractice insurance company profits are in the top 1% of all Fortune 500 companies. The AAJ says that insurance company profits average 31.2%. Whom should we believe?

Get ready for health care spending cuts. A Thomson Reuters report released October 26, 2009 states that inefficiencies, defensive medicine, and fraud amount to between $505 billion and $850 billion in health care costs each year – nearly one third of total health care spending. With that much “waste” in the system, you know a certain Uncle with a blue and white stove pipe hat is going to try to tighten up the purse strings. The report states that “defensive medicine” accounts for up to $300 billion in costs per year. Funny how the largest “unnecessary” cost in health care gets a measly $25 million Band-Aid thrown at it.

Melancholy story about a doctor-patient encounter in the emergency department. Just because you had a job doesn’t mean you won’t end up needing “indigent care”.

Interesting take by a lawyer on the medical malpractice crisis – or lack thereof – in Montana. Raises a very good point – in the past 10 years of dental malpractice cases in Montana, only one dentist was sued. The case went to trial and the dentist won. How much are dentists paying for malpractice insurance and why are they paying it?
Answer: Fear.
Better question: What is the source of the fear and why are medical professionals buying into it?

This happens to me all the time. Ten interruptions per hour in the ED? With me, that number is on the low side. I’m in with a patient and get a phone call. Go back in with patient, critical patient comes in. Back in with patient, another phone call. By the fourth time, I joke with the patient that I’m going to go get a hammer and nails to nail the door shut. The system sucks, but how do we fix it?


  1. “Ummm … it’s not like police have a choice where to shoot the electrodes when suspects lunge at them or try to steal their guns.”

    It seems you don’t know much about taser usage. Cops routinely use them in lieu of even approaching suspects, even little old ladies and people hogtied on the ground.

    “health care insurers only made 2.2% profit last year.”

    Tell me you understand that such needs to be viewed in the context of utterly massive revenue. Like UnitedHealth: 84B revenue, 3.5B profit. Or Aetna: 32B revenue, 1.5B profit. For comparison, Dell’s annual profit is under 2B.

    • Max,

      As a SWAT Team physician, I can tell you that our hyperbole regarding tasers is far worse than WCs. Here is the reality (in rough terms): If a gun is used to subdue a subject, the risk of significant morbidity or mortality approaches 70%. If physical force is used using batons or other weapons, the rate is just under 50%. If just “good old fashioned strong arm” (i.e., no weapons) the chance of significant morbidity or mortality still approaches 30%. A taser? Far less than 0.1%. You do the math. If an officer reasonably believes he will need to use physical force to subdue someone, he or she had best use the taser first. There is simply no excuse not to.

      • @Fyrdoc,

        Thx 4 the rough terms 🙂
        Aus has been a little slow in getting tasers issued to police (we have State/Territory forces here sd well as the Australian Federal Police – not as many jurisdictions etc!). Not all states have them, and we are now going through the same media blitz with regards to ‘tasers are bad, hmmkay, ppl have died’ trotting out all the same misinformation.
        Yep, tasers hurt and there is a risk, albeit a tiny tiny risk, of an adverse outcome. But heck, I’d rather a taser than a gun.
        My hubby, the crotchety old sgt of police, loves his taser, and instant compliance from the threat potential when the offenders see that he is carrying it 🙂

      • Your math is crap: 30% morbidity from no weapons and 0.1% morbidity from taser? I don’t think so. I know you don’t think so either. Quit the hyperbole.

        When you have a hammer, everything looks like a nail. A taser makes sense when used as an alternative to lethal or severe force; it makes little sense as, e.g., a method for “facilitating cuffing” of a blind diabetic with cancer lying on the floor:

        The biggest problem is the lack of policies / training by police forces and by Taser in how the device should be used. Some, like you, take the erroneous, cruel and medically-unsupportable view that, since a Taser is essentially harmless, it should be used in every circumstance. Taser, finally, is starting to warn police departments of the dangers it has known about for years. It’s offensive to see either you or WC criticize that.

      • Really Max? You really want to debate this with me? O.K.

        From: Am J Public Health. 2009 Oct 21
        The Effect of Less-Lethal Weapons on Injuries in Police Use-of-Force Events.

        Results. Odds of injury to civilians and officers were significantly lower when police used CED weapons, after control for differences in case attributes and departmental policies restricting use of these weapons. Monthly incidence of injury in 2 police departments declined significantly, by 25% to 62%, after adoption of CED devices.Conclusions. Injuries sustained during police use-of-force events affect thousands of police officers and civilians in the United States each year. Incidence of these injuries can be reduced dramatically when law enforcement agencies responsibly employ less-lethal weapons in lieu of physical force.

        Yeah, a drop to 25% from 62% means nothing.

        From: Ann Emerg Med. 2009 Apr;53(4):480-9.
        Safety and injury profile of conducted electrical weapons used by law enforcement officers against criminal suspects.

        RESULTS: Conducted electrical weapons were used against 1,201 subjects during 36 months. One thousand one hundred twenty-five subjects (94%) were men; the median age was 30 years (range 13 to 80 years). Mild or no injuries were observed after conducted electrical weapon use in 1,198 subjects (99.75%; 95% confidence interval 99.3% to 99.9%). Of mild injuries, 83% were superficial puncture wounds from conducted electrical weapon probes. Significant injuries occurred in 3 subjects (0.25%; 95% confidence interval 0.07% to 0.7%), including 2 intracranial injuries from falls and 1 case of rhabdomyolysis. Two subjects died in police custody; medical examiners did not find conducted electrical weapon use to be causal or contributory in either case. CONCLUSION: To our knowledge, these findings represent the first large, independent, multicenter study of conducted electrical weapon injury epidemiology and suggest that more than 99% of subjects do not experience significant injuries after conducted electrical weapon use.

        Confirming my statement that they are largely benign to use (and yes, I have been tasered in training)

        From: J Clin Forensic Med. 2006 Jul;13(5):229-41.
        The relative risk of police use-of-force options: evaluating the potential for deployment of electronic weaponry.

        We analysed use-of-force data from Northamptonshire Police Force and M26 field use data from TASER International. We found officer injury rates associated with M26 deployment were lower than those for CS spray and baton use. Subject injury rates were lower in M26 deployment than in deployment of CS spray, batons or police dogs. We suggest that the M26 should be made more widely available to police officers in the UK.

        From: J Trauma. 2008 Jun;64(6):1567-72.
        Conductive electrical devices: a prospective, population-based study of the medical safety of law enforcement use.

        RESULTS: Among 426 consecutive CED activations (November 1, 2004 through January 31, 2006), the suspects’ mean age (years +/- standard deviation) was 30 +/- 10 (range, 13-72) years and 90.4% were male. Suspects’ mean distance from the officer was 5.0 +/- 4.5 feet (range, 0-21). Reasons for use included: evading or resisting arrest (33.3%, n = 142), public intoxication or disorderly conduct (15.8%, n = 76), interrupting a felony in progress (9.3%, n = 45), and interrupting an assault on an officer or public servant (6.0%, n = 29). Mean total duration of exposures was 8.6 +/- 5.9 seconds, and total energy delivered per suspect was 227 +/- 156 joules. Officers followed policy in all cases and, accordingly, all suspects rapidly received medical evaluation or simple first aid. No suspect required further treatment except one who was later found to have severe toxic hyperthermia and who died within 2 hours of activation despite rapid on-scene intervention. In 5.4% of deployments (n = 23), CED use was deemed to have clearly prevented the use of lethal force by police. CONCLUSION: Police were compliant with policy in all cases, and, in addition to avoiding the use of lethal force in a significant number of circumstances, the safety of CED use was demonstrated despite one death subsequently attributed to lethal toxic hyperthermia. Collaborative nationwide research using similar registries is strongly recommended to document compliance and ensure ongoing safety monitoring.

        In 5.4% of cases LETHAL force was prevented. This is bad how again?

        And counselor, read my statement again. I said 30% SIGNIFICANT morbidity or mortality. If a subject needs to literally be beaten into submission, these numbers (drawn from two internal DoJ documents not readily available on the web) are not off at all. Do you really believe that in a fistfight where a group of trained officers uses martial arts to produce “compliance through pain” that bones aren’t broken or heads injured? Sir, go back to the courtroom – your ignorance of injury patterns is almost too little to even join this debate.

        And please, do not throw up an improper use of a taser as a reason to remove this important (and proven lifesaving tool) from use. Honestly, by your logic the story of the off-duty cop pulling his gun on a haunted house character in Baltimore this week should lead to the dis-arming of our police forces.

        If you wish to debate this further, please do so with data not anecdote. We in medicine, unlike your ilk, realize that the plural of anecdote is not fact.

      • “And please, do not throw up an improper use of a taser as a reason to remove this important (and proven lifesaving tool) from use.”

        Try to stay on topic, frydoc. You’ve thoroughly defeated a strawman.

        Nobody said anything about removing them. You and WC threw a hissy-fit about TASER warning police of the danger of aiming an electrical charge at people’s chests.

        How is that warning a problem?

        My whole point — one ignored by you — is that tasers aren’t magical lollipops that cause people to change their minds. They’re serious tools with a risk of serious injury, and cops should be trained accordingly.

        How could you possibly object to that?

        Need some studies? Okay, let me do two minutes of refreshing through a search of nothing more than “taser:”

        Am Surg. 2008 Sep;74(9):862-5.
        Taser and Taser associated injuries: a case series.

        Mangus BE, Shen LY, Helmer SD, Maher J, Smith RS.

        Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA.

        Taser devices were introduced in 1974 and are increasingly used by law enforcement agencies. Taser use theoretically reduces the risk of injury and death by decreasing the use of lethal force. We report a spectrum of injuries sustained by four patients subdued with Taser devices. Injuries identified in our review included: 1) a basilar skull fracture, right subarachnoid hemorrhage, and left-sided epidural hemorrhage necessitating craniotomy; 2) a concussion, facial laceration, comminuted nasal fracture, and orbital floor fracture; 3) penetration of the outer table and cortex of the cranium by a Taser probe with seizure-like activity reported by the officer when the Taser was activated; and 4) a forehead hematoma and laceration. The Taser operator’s manual states that these devices are designed to incapacitate a target from a safe distance without causing death or permanent injury. However, individuals may be exposed to the potential for significant injury. These devices represent a new mechanism for potential injury. Trauma surgeons and law enforcement agencies should be aware of the potential danger of significant head injuries as a result of loss of neuromuscular control.

        Generalized tonic-clonic seizure after a taser shot to the head.
        Bui ET, Sourkes M, Wennberg R. Can Med Assoc J CMAJ 2009; 180(6): 625-6.
        Affiliation: Division of Neurology, Krembil Neuroscience Centre, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ont.
        DOI: 10.1503/cmaj.081364 What is this?
        PMID: 19289806
        (Copyright © 2009, Canadian Medical Association)
        During a police chase on foot, a previously well police officer was hit mistakenly by a taser shot meant for the suspect. The taser gun had been fired once, sending 2 barbed darts into his upper back and occiput. Within seconds, the officer collapsed and experienced a generalized tonic-clonic seizure with loss of consciousness and postictal confusion. Subsequent magnetic resonance imaging scans of the head and electroencephalograms were normal. The patient has experienced no recurrence of seizure over more than a year of follow-up. This report shows that a taser shot to the head may result in a brain-specific complication such as generalized tonic-clonic seizure. It also suggests that seizure should be considered an adverse event related to taser use.

        Pneumothorax as a complication after TASER activation.
        Hinchey PR, Subramaniam G. Prehosp Emerg Care 2009; 13(4): 532-5.
        Affiliation: WakeMed Health and Hospitals, Raleigh, North Carolina 27614, USA.
        DOI: 10.1080/10903120903144890 What is this?
        PMID: 19731168
        (Copyright © 2009, Taylor and Francis Group)
        Use of the TASER electronic control device by law enforcement and civilians is increasing. Advocates for the use of the device believe that it has reduced the number of officer and suspect injuries. However, the use of the device is not without complications. Many of these injuries to superficial body structures or those sustained in the postactivation fall have been described in the literature. Injury to deep structures of the abdomen and chest were previously thought to be unlikely given the length of the TASER barb. This case report of a 16-year-old male patient who suffered a pneumothorax after TASER activation is thought to be the first reported in the literature.

        TASER study results do not reflect real-life restraint situationsemail this articleEmail this article to a colleague. save this article to My ClippingsSave this article to My Clippings. discuss this articleDiscuss or comment on this article.
        We appreciate the work presented in the recent study of Ho et al entitled “Prolonged TASER Use on Exhausted Humans Does Not Worsen Markers of Acidosis.” Their findings add to a growing literature showing that electrical weapons appear reasonably safe under certain conditions and in certain populations.
        Source: The American Journal of Emergency Medicine – June 30, 2009 Category: Emergency Medicine Authors: Jared Strote, H. Range Hutson

        But, hey, maybe you’re right: maybe tasers are like lollipops, and should be given to every citizen whom the police encounter, in every situation.

        After all, if we train police on how do use them, that might… well, I don’t know what’s wrong with that, you tell me.

      • Now who is flailing at a straw man. No where have I said that TASERS are completely safe. What I have said is that they are FAR safer than alternative means of subduing a subject. No case report (which by the way have far less scientific credibility than a systematic study) you posted addresses this fundamental difference. And, BTW the very fact that significant TASER injuries still warrant case reports indicates their safety. (Do you really think I could get a paper entitled “Subdural hematoma resulting from law enforcement use of a baton” published? Not a chance – a medical editor would laugh out loud probably saying “What did expect would happen?”)

        Now YOU started this by saying: “It seems you don’t know much about taser usage. Cops routinely use them in lieu of even approaching suspects, even little old ladies and people hogtied on the ground.” – If that isn’t decrying the improper use of a TASER I don’t know what is. I can tell you, as a person trained to use a TASER, a “little old lady” who is not armed or attacking an officer should not be tased. A hogtied person (leaving aside that a person shouldn’t ever be hogtied) should also not be tased. If you want to find cases where that has happened – fine, we can agree that would likely be misconduct.

        You then opined: “Your math is crap: 30% morbidity from no weapons and 0.1% morbidity from taser? I don’t think so. I know you don’t think so either. Quit the hyperbole.”

        I posted studies that clearly demonstrate, in large, validated fashion that what I am saying is true. TASERS are FAR more safe than alternative means of subduing subjects. You responded with case reports (which by medical definition are discussions of rare events) which sort of even proves my point.

        You also spewed: “The biggest problem is the lack of policies / training by police forces and by Taser in how the device should be used.” Umm, no. All police officers issued the device are required to be trained in its use by the manufacturer. If they ignore that training, that is a separate issue.

        And truly, is a comment such as: “Some, like you, take the erroneous, cruel and medically-unsupportable view that, since a Taser is essentially harmless, it should be used in every circumstance.” You sir do not get to call me cruel until you have been there to inform family members that their loved one is dead as a result of being shot or beaten by the officers trying to subdue them. Unlike lawyers, physicians actually care about their fellow man. There is NO question that the literature overwhelmingly supports the view that TASERS are far preferable to the alternatives. That view is entirely medically supported and not erroneous at all.

        But hey, I love that I offend you. Pissing off a spawn of Satan probably means I’m doing something right.

      • You forget, I argue for a living; it doesn’t piss me off, it invigorates me.

        I think we agree more than we disagree.

        PS – re: Satan, at the moment I represent more doctors (1) than I’m suing (0).

      • No QED – there has been no proof of your premise. The argument started with your asinine comment “It seems you don’t know much about taser usage. Cops routinely use them in lieu of even approaching suspects, even little old ladies and people hogtied on the ground.” A patently untrue statement. Cops do not “routinely” misuse them, all police officers equipped with them are trained in their use and do recognize them as weapons. After I thoroughly schooled you on the realities you now claim “My point is: TASERs aren’t “safe.” They’re “less dangerous” than many other methods.” – no sir. That is my point. Your point was not defensible so you abandoned it. Nice try counselor, but if you do this for a living I really hope you are better at it in person…

    • Max,
      Your opinion reminds me of a JCAHO mandate – wonderful in theory, but lacking real-world experience.
      For example, JCAHO mandates that health care providers use the “least restrictive method” before restraining someone and use more restrictive methods only after other methods have been tried and fail. When a drunk meth-head is throwing punches at me and my staff, he is getting “hogtied” before I ask him if he’d like some apple juice and cookies. JCAHO can kiss off.
      You use the unsubstantiated premise that misuse of TASERs is routine. As if cops are sitting in their cruisers drinking beers and telling their partners “I bet I can nail that old lady in the crosswalk through the rungs of her walker.”
      Until you have been in the situation – face to face with physical harm – you can comment all you want, but you’re blowing smoke.
      As fyrdoc notes, your generalizations based on anectdotes about some people misusing TASERS hold no more water than an allegation that all lawyers are perverts who gratify themselves by “paddling the bare bottoms of prisoners” just because one judge was accused of doing so.

      • Wow Max you have just shown with your ability to google that you don’t have the clue as to what the difference is between retrospective and prospective studies (as shown by Fyrdoc) and CASE REPORTS. Anybody can find a case report for anything in a medicine journal. What you come across as to those of us who have actually practiced medicine for a while is a young punk lawyer looking for a fight. I read lawyer’s blogs like Eric Turkowitz whom I may not always agree with, but respect for his ability to make a well-reasoned argument, then I read about you and your ability to use google. There is no comparison. You have got a lot to learn my young friend.

        PS: re: You and your “thesis” showed no evidence that police officers in general (Please leave out subsequent case reports/news articles thank you) are not appropriately trained in the us of tasers even though that is your main “point” (i think). From what I can tell here is your average police officer is better trained to use taser then Yale trained you to think critically as a lawyer.

      • elmo –

        Eric’s blog is great.

        You’re attacking a straw man as well. My point is: TASERs aren’t “safe.” They’re “less dangerous” than many other methods.

        But they’re still dangerous weapons; that point can be proven by a single case report.


      • Do you even know what a strawman is Max?
        We do not practice medicine based on case reports. Guidelines are not written based on case-reports? If you had given prospective lessor so, retrospective studies (like fryerdoc) showing an inherent increase in injuries by tasers or systemic lack of training by officers leading to increased injuries….different story. But you didn’t. Is any of this making sense max?

    • Oh, and just out of curiosity, how much profit *should* health care insurers be limited to?
      Can we limit plaintiff lawyer profits to that same amount?

      • Let’s pick a number, just like you want us to do for the injured victims of malpractice, and cap everyone, including physicians, at that amount. I mean, if we’re being fair and all.

        Or, since physicians are always wanting other countries’ malpractice systems, let’s adopt their whole healthcare systems, including what they pay their docs.

        Why do you guys only want to do these things piecemeal? Surely not your own financial self interest?

      • I don’t see a reason to “limit” them. My default position is to believe in the free market; of course, health insurance is anything but a free market given antitrust exemptions, regulatory capture, etc.

  2. Re: “Interruptions”…Our license is on the line too, sorry. Do stuff like write 1 mg dilaudid Q 30 mins PRN up to 2 doses and write everyone with narkies for an antiemetic. That will save you at least 50% of my interruptions that I have to do—it’s almost always for more pain meds or nausea meds. Maybe half of the remaining times I interrupt the doc it’s because I’m sick of playing Mystery ER with my patient. Hi, you know the diagnosis and I’m supposed to admit this patient w/o knowing it or the CXR results or the CT results? Keep the nurse apprised of the plan/results when you have a free minute.

    • K,
      Not saying that interruptions aren’t necessary part of the business and not blaming nurses for them (secretaries interrupt me more often than nurses do ;-)). Just that interruptions suck if you’re the patient trying to get care and the doctor is being pulled in 10 different directions.

  3. Well, I work in a state run and funded health care system and it is absolutely broke. How broke? Real broke – non-essential services cut to the bone and the goalpost for the definition of ‘non-essential service’ keeps being moved so that nore and more essential services are targeted.
    It’s bloody ridiculous, especially when you see the spin from the politicians and state bean-counters stating that nothing will affect the commitment to patient focused care. As long as that care is cost-neutral, nothing will affect it!
    I am very frustrated, but I don’t know how it is going to be fixed 🙁

  4. This happens to me all the time…we are written up for not answering our phones…becomes problematic when you’re in the bathroom. It does send a bad signal to the patient when you’re discussing,oh let’s say, a new dx of cancer and the phone starts ringing. I have to get this but I’ll be right back atcha about the six months you’ve got left. Nurses’ phones ring constantly too…families, patients, the lab, xray, transportation and ,yes, the docs. 🙂

  5. I worked at the Med for a few years. Before moving to Memphis, I felt like the welfare system and the medical system of this country could be fixed. Living and working among the poor of the mid-south has led me to believe I had no clue how deep the issues run.

    If the Med does close it’s ED, the other local hospitals will not be able to handle their new patient population that does use the ED as their own personal physician.

  6. Erratum: Medicaid is the program states can opt out of (but none have). That is because it is in part state funded. Medicare is entirely federally funded and administered and states cannot opt out of medicare.

  7. If the states wish to “opt out” of the govt. plan, it’s far from clear that the state will similarly be able to opt out of the taxes, fines, etc. This entire issue may end up in the hands of the Supremes.

  8. Soronel Haetir on


    If tazer use were limited to cases where lethal force were appropriate you would see far less complaint. However many officers seem to view the device as a no-cost compliance tool and that does lead to problems. Witness the “Don’t taze me, bro” incident for an excellent example of such behavior.

    When you add a tool that removes the need for an officer to be able to handle a situation through manner and presence alone you have lost something valuable. You remove the need for an officer to think about their actions and how the public will view them.

    • I agree the device can be misused. But, on the whole, it is a net positive. Even the “don’t taze me, bro” incident isn’t that clear cut. The reality is officers are trained to use the device when a situation has escalated to a point where the officer would (without the device) use physical force against a subject. Use of physical force often ends in significant injury to subjects (and officers). The famous “don’t taze me bro” incident, had TASERS not been there, would have resulted in the officers physically removing the individual from the auditorium. As it sits, he was not injured. Could we say the same if a physical fight ensued to remove him? Remember, when these devices were first deployed they were only used when lethal force was called for. Now they are deployed instead of physical force (a much lower threshold) because even at that lower level, they help prevent serious injury.

  9. As I outlined before in EPM Letters (“The Dr. Ho Doeth Protest”) TASERS have no role in law enforcement for use against the citizens of a democratic society…

  10. As a physician tasked to a SWAT team, I respectfully disagree for the reasons outlined above. That said, I’m certain we would disagree regarding the role of law enforcement in general.

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